Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: propofol / fentanyl attending: chief complaint: facial droop, dysarthria major surgical or invasive procedure: intravenous tpa history of present illness: ms. is a 77 y/o right handed woman with pmh significant for htn and hypothyroidism, who presents with acute onset of left facial droop and slurred speech. she was in her usual state of health until about 6pm this evening, when she noted onset of vertex headache, which is unusual for her as she does not usually get headaches. shortly thereafter, while the paper, she noticed that she was drooling from the left side of her mouth. she was then speaking on the phone with her friend, who told her that her speechg sounded slurred and that she should go downstairs to her daughter to be looked at. she was able to walk down the stairs without difficulty. around 6:30 pm, she went downstairs and her daughter noticed that the left side of her face was drooping. ems was immediately called and she arrived to , at which time a code stroke was called. of note, she had no other symptoms at this time, including no visual, strength, or sensory changes. she notes no difficulties with swallowing. she says that her headache has since resolved and she is currently not in any pain. past medical history: -htn -? mitral valve prolapse -osa -hypothyroidism -l knee surgery -s/p l hip replacement in social history: she lives above her daughter and son-in-law. she is retired but used to work in banking and as an elementary school teacher. she does not smoke. she drinks alcohol occasionally. no illicit drug use. family history: mother deceased from stomach cancer, but she has history of stroke right after carotid endarterectomy. father deceased from alzheimer's. brother with heart problems. physical exam: at admission: general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple pulmonary: lcta b/l cardiac: rrr, s1s2, no murmurs appreciated abdomen: soft, nt/nd, +bs extremities: warm, well perfused skin: no rashes or lesions noted. neurologic: nih stroke scale score was: 5 1a. level of consciousness: 0 1b. loc question: 0 1c. loc commands: 0 2. best gaze: 0 3. visual fields: 0 4. facial palsy: 2 5a. motor arm, left: 0 5b. motor arm, right: 0 6a. motor leg, left: 0 6b. motor leg, right: 0 7. limb ataxia: 0 8. sensory: 0 9. language: 0 10. dysarthria: 1 11. extinction and neglect: 2 (extinction in 2 modalities- vision and sensory) mental status: awake, alert, oriented to person, place and date. able to relate history without difficulty. attentive, able to spell "world" backwards. able to follow both midline and appendicular commands. no right-left confusion. no evidence of apraxia. she had no neglect when describing the stroke care picture, but seemed to preference of speaking with people who were on her right side. language: speech is slightly dysarthric, but otherwise fluent with intact naming, repetition and comprehension. normal prosody. there were no paraphasic errors. able to read without difficulty. cranial nerves: i: olfaction not tested. ii: perrl 3 to 2mm and brisk. visual fields full to confrontation, but she extinguishes left visual field with simultaneous testing. iii, iv, vi: eomi without nystagmus v: facial sensation intact to light touch. vii: left facial droop, mostly lower face though i had easier time opening her left eye when she tries to close tightly compared to her right eye. viii: hearing intact to finger-rub bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline. motor: normal bulk, tone throughout. no pronator drift bilaterally. no adventitious movements, such as tremor, noted. no asterixis noted. delt bic tri wre ffl fe ip quad ham ta l 5 5 5 5 5 5 5 5 5 5 5 5 r 5 5 5 5 5 5 5 5 5 5 5 5 sensory: no deficits to light touch, pinprick, proprioception throughout. she did extinguish left side to dss. dtrs: tri pat ach l 1 1 1 1 0 r 1 1 1 1 0 plantar response was flexor bilaterally coordination: no intention tremor or dysmetria on finger-nose, fnf or hks bilaterally. gait: deferred as she had gotten tpa _ ________________________________________________________________ at discharge: pertinent results: labs on admission: 07:00pm blood wbc-7.6 rbc-3.96* hgb-12.0 hct-36.1 mcv-91 mch-30.3 mchc-33.3 rdw-13.6 plt ct-237 07:00pm blood pt-11.6 ptt-22.5 inr(pt)-1.0 07:00pm blood glucose-105* urean-20 creat-0.7 na-141 k-4.2 cl-107 hco3-28 angap-10 02:14am blood alt-17 ast-19 alkphos-59 totbili-0.4 02:14am blood calcium-8.9 phos-3.2 mg-2.1 cholest-167 02:14am blood %hba1c-6.0* eag-126* 02:14am blood triglyc-84 hdl-40 chol/hd-4.2 ldlcalc-110 04:45pm blood tsh-0.28 04:45pm blood free t4-1.2 08:00pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg 08:00pm urine rbc-2 wbc-0 bacteri-none yeast-none epi-0 : wound culture staphylococcus, coagulase negative : urine culture ngtd cta head/neck/ctp impression: 1. ct head demonstrates loss of -white matter differentiation in the right temporal region and no hemorrhage is seen. 2. ct perfusion does not show abnormality in the right temporal lobe but a small area of perfusion abnormality is seen in the right frontal region. at the time of interpretation of this study an mri has already demonstrated infarct in the right temporal region. 3. ct angiography of the neck demonstrates no vascular occlusion or stenosis. 4. ct angiography of the head demonstrates no vascular occlusion or stenosis. mri brain impression: acute right partial middle cerebral artery infarct with small subcortical infarcts and a small area of petechial hemorrhage as described above. no midline shift or hydrocephalus. nchct impression: 1. no acute intracranial hemorrhage status post thrombolysis. 2. hypoattenuation in the right posterior frontal, parietal and temporal lobes, findings consistent with recent infarction, though better characterized on prior mri. tte the left atrium and right atrium are normal in cavity size. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending aorta and aortic arch are mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. mild mitral regurgitation. no definite structural cardiac source of embolism identified. tee no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage.evidence of patent foramen ovale is present with right to left flow at rest seen during rest injection of saline contrast (although no shuntidentified by color doppler). there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is a small moblie structure(s) attached the the mitral valve posterior leafelt (see clip , last cycle) consistent with possible small vegetation versus lambl's excrescence or other mass. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. brief hospital course: ms. received iv tpa in the ed for left sided facial droop, extinction to dss on the left and dysarthria on , . prior to her infusion, her nchct had shown no hemorrhage and she had been evaluated by various members of the code stroke team. following thrombolysis, she was transferred to the icu where her neurological deficits improved over time and she remained afebrile and hemodynamically stable. her blood pressures remained well controlled. given her overall clinical stability and a follow up ct scan that showed no new hemorrhages, she was transferred to the floor where a work up for her first stroke was continued. - her a1c was found to be within normal limits. an ldl level returned elevated at 110, for which she was initiated on simvastatin at a low dose. she reported to us that her cholesterol had been checked in the past and had been as high as in the low 120s, and treatment had been deferred at that time. - her daily baby aspirin was switched to a plavix 75mg daily for better antiplatelet control - during her stay, she received extensive teaching and counseling about her condition and about the various risk factors for stroke. all of her and her daughter's questions were answered. - one day prior to discharge, the patient developed some mild swelling at the site of her iv stick on the left antecubital fossa. her iv site was switched, and she was started on five day course of keflex for a superficial wound infection. she did not develop fevers, and redness at the site did not spread. - she had a tte which showed no evidence of an atrial septal defect/pfo or valvular vegetation. to more definitely rule out an embolic source/right to left shunt, we requested a tee which she received on the day of her discharge. - following her procedure, we received a preliminary read from the echocardiography team about a negative study. at this point, we discharged the patient to home. later that night, we noted that the final read on the tee reported a possible mitral valve mass as well as a patent foramen ovale. -the mitral valve lesion was most probably a lambl's excrescence. this is a elongated fibrin strand that is a minor risk factor for stroke. it should be adequately treated by anti-platelet therapy. mrs. had no evidence of systemic infection, no fever, and no leukocytosis to suggest the possibility of endocarditis. she did not have physical stigmata to suggest endocarditis. -the tee showed simple atheroma of the aortic arch. this is a minor risk factor for stroke. -after the tee results were known, the patient was requested to have lenis/lower extremity ultrasound for . the above findings and plan were conveyed to the patient directly. she verbalized understanding of these facts. at this time, the plan would be to pursue anticoagulation if the patient has evidence of a lower extremity dvt. if not, she can undergo mrv of pelvis as an outpatient. -she has not been using her cpap mask at home because she had difficulty tolerating it. she was encouraged to follow up with her sleep medicine specialist to evaluate if a different type of cpap mask would work better for her. she will follow up with her pcp as well as her primary neurologist, dr. in clinic. prior to discharge, she did not have any dysarthria, language or other cortical deficits or weakness in her extremities. her only residual deficit was a slight ptosis on the left eye. her gait was steady and she was judged to be safe for home from our skilled physical and occupational therapists. "bad" cholesterol was elevated above our typical goals, and so we started you on a new medication to reduce cholesterol. we also started you on a new medicine called plavix that will replace your daily baby aspirin (81mg). it is possible that you developed a soft tissue infection at the site of one of your iv sticks. we started you on oral antibiotics which you should complete over the course of 5 days total. these are your discharge medications: -plavix 75mg daily -simvastatin 20mg daily -atenolol 25 mg daily -pantoprozole 40mg daily -levothyroxine 50 mcg daily except mon/fri 100 mcg -thryoid extract daily -keflex 500mg four times daily for infection - five days total -biotin supplementation -vitamin d -vitamin b12 -calcium+d -fish oil medications on admission: -asa 81 mg daily -atenolol 25 mg daily -omeprazole 20 mg daily -levoxyl 50 mcg daily (100 mcg on mon and fri) -biotin -thryoid extract 8 mg daily -vitamin d -vitamin b12 -calcium+d -fish oil discharge medications: 1. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*1* 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*1* 4. levothyroxine 50 mcg tablet sig: two (2) tablet po monday and friday (). 5. thyroid (pork) oral 6. levothyroxine 50 mcg tablet sig: one (1) tablet po every tuesday, wednesday, thursday, saturday, sunday (). 7. simvastatin 20 mg tablet sig: one (1) tablet po at bedtime. disp:*60 tablet(s)* refills:*1* 8. cephalexin 500 mg capsule sig: one (1) capsule po four times a day for 5 days. disp:*20 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: ischemic stroke hypertension hypercholesterolemia hypothyroidism soft tissue infection of the left arm discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were evaluated at the neurology wards of the for new symptoms of left sided facial weakness and slurred speech, which we determined were secondary to a stroke which occured in the right side of your brain. you received a special medication called tpa (an iv clot busting ) which helped dissolve the offending blood clot, and this ultimately improved your symptoms. common risk factors for strokes include elevated cholesterol, high blood pressure, tobacco abuse and uncontrolled diabetes mellitus. we did discover that your "bad" cholesterol was elevated above our typical goals, and so we started you on a new medication to reduce cholesterol. we also started you on a new medicine called plavix that will replace your daily baby aspirin (81mg). it is possible that you developed a soft tissue infection at the site of one of your iv sticks. we started you on oral antibiotics which you should complete over the course of 5 days total. these are your discharge medications: -plavix 75mg daily -simvastatin 20mg daily -atenolol 25 mg daily -pantoprozole 40mg daily -levothyroxine 50 mcg daily except mon/fri 100 mcg -thryoid extract daily -keflex 500mg four times daily for infection - five days total -biotin supplementation -vitamin d -vitamin b12 -calcium+d -fish oil followup instructions: pcp follow up . , md phone: date/time: 10:20 neurology follow up drs. & phone: date/time: 4:30 procedure: diagnostic ultrasound of heart injection or infusion of thrombolytic agent diagnoses: obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia unspecified essential hypertension unspecified acquired hypothyroidism other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure dysarthria accidents occurring in residential institution cerebral artery occlusion, unspecified with cerebral infarction hip joint replacement infection following other infusion, injection, transfusion, or vaccination facial weakness 

Answer: The patient is high likely exposed to