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: patient recorded as having no known allergies to drugs attending: chief complaint: cc: major surgical or invasive procedure: ivc filter placement history of present illness: this is a 60 year old man with lung cancer with brain metastases previously on anticoagulation for transferred to the micu from the sicu in the setting of arrythmias, most prominently tachyarrythmias, who originally presented to medical care on late morning after being found by his family, lying down on the sidewalk outside of his home, minimally responsive. he awoke at the scene complaining of headache and left shoulder pain. he was taken to hospital; and then taken by to after a ct showed extensive acute ich. an ekg there showed sinus rhythm, with an s in i and a q in iii, with prominent upright t waves in precordial leads and no indication of ischemia. he reportedly started the flight being aox3 and following commands and then deteriorated into lethargy and minimal responsiveness. he was intubated for airway protection. of note, his inr was 3.7 on arrival to consistent with coumadin taken regularly at home for known pe in . he received 2 units of ffp and vitamin k. . at he was admitted to the sicu on the neurosurgical service. ultimately, neurosurgery decided to observe the patient, start seizure prophylaxis, normalize inr (with a recommendation to avoid anticoagulation for one month) with no indication for neurosurgical intervention. he was diagnosed with a left humeral fracture for which orthopedics recommended splint. he was extubated on . an ivc filter was placed on . . of note in terms of his functional status prior to the event, he had not had recent falls prior to this. however, prior to his diagnosis with brain mets, he had a persistent cough and had some prior episodes, unwitnessed by family and only uncovered in retrospect, in which he coughed violently and then fell down, perhaps similar to this presentation. he was until this admission able to perform basic adls, ambulating, toileting, eating, etc; though with low energy and slow mobility. past medical history: stage iv lung cancer with brain metastases diagnosed after episode of seizures, s/p r craniectomy for tumor resection, s/p chemo/radiation; oncologist (), rad onc ( ); per daughter, little effect of chemo/rads, oncologist said emphasis should be on quality of life at this point pe diagnosed in (on coumadin), diagnosed by routine ct scan, was evidently asymptomatic at that time hyperlipidemia niddm gerd bipolar disorder diagnosed in after a psych hospitalization for mania, has been on several meds; stopped meds and was rehospitalized; since then has been on seroquel alone seizure disorder secondary to brain mets only . social history: ran an auto detailing and used car sales business until his cancer diagnosis; was on disability thereafter. two adult children who live ~half hour away from his home. lives with wife. portuguese-speaking only. 60 pack year cigarette history. no etoh or drugs by report. family history: non-contributory physical exam: physical exam on admission: o: t:97.0 bp:129/6/ hr:102 rr:16 o2sats 96% gen: wd/wn, comfortable, nad. heent:normocephalic, small superficial abrasion to left head. pupils:perrla eoms: uta due to inattention/lethargy neuro:mental status: lethargic, arousable to loud voice. no commands. face appears to be symmetric. spont mvmt observed in the rue. brisk w/drawl of le(r>l). minimal mvmt of lue observed, though also withdraws to nox. 5/5 strength throughout. + reflexes, equal bl. normal coordination. gait assessment deferred discharge: o: t:97 bp:132/60 hr:84 rr:18 o2sats 97%ra heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or gallops. lungs: high whistle-like wheeze heard throughout bilat lung fields abdomen: nabs. soft, nt, nd. extremities: no edema or calf pain or cords, 2+ dorsalis pedis/posterior tibial pulses. skin: no rashes/lesions, ecchymoses. no ulcers. neuro: awake with eyes open, follows simple commands. a&o to name, hospital, president. responds appropriately to questions (eg "how are you today?" "i'm ok." perrl, eomi, face symmetric. able to squeeze hand with l and r hand, decreased strength on l. unable to assess left arm due to orthopedic injury and l arm in sling. moves rue and rle spontaneously. no spontaneous movement of lle but withdraws from pain. lines: bilateral scds, r piv without erythema, cords, purulence, ttp. pertinent results: left shoulder, three views : there is a fracture involving the proximal shaft of the left femur. there is displacement by approximately one shaft width with apex lateral angulation of the fracture site. ct osh(1227 ): "extensive acute ich identified which all appears to be extra-xial and is most prominent superficial to the anterior left frontal lobe, but there is less extensive acute ich along the right anterolateral aspect of the suprasellar cistern, right side of the anterior cranial fossa, left ambient cistern, along the adjacent left tentorium cerebelli, and along the sulcus posterior right frontal lobe". ct/cta(): left frontal subarachnoid hemorrhage and subdural blood measuring up to 6mm and layering along the falx. no signficant mass effect. no intraventricular hemorrhage. 5 x 9 mm focus of hemorrhage in the right parietal lobe. no e/o aneurysm or vascular abnl. cta: 1. left frontal subarachnoid hemorrhage and subdural hematoma without evidence of significant mass effect. 2. small focus of subarachnoid hemorrhage or intraparenchymal hemorrhage in the right parietal lobe. 3. small amount of intraventricular hemorrhage in the left perimesencephalic cistern. 4. unremarkable cta of the head. repeat cta : impression: 1. previously noted left frontal hypodensity and subarachnoid hemorrhages as well as intraventricular hemorrhage are again seen. 2. mild vasospasm is identified more predominantly in the left middle cerebral artery and the main divisions of middle cerebral artery. no vascular occlusion is seen. echo (): left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef= 40-50 %) secondary to inferior posterior hypokinesis right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. video oropharyngeal swallow (): no gross aspiration or penetration. labs: 05:51pm glucose-176* urea n-10 creat-0.7 sodium-143 potassium-3.9 chloride-103 total co2-29 anion gap-15 05:51pm calcium-9.3 phosphate-3.4 magnesium-1.9 05:51pm wbc-9.7 rbc-3.67* hgb-9.4* hct-30.7* mcv-84 mch-25.7* mchc-30.6* rdw-14.8 05:51pm plt count-252 05:51pm pt-16.5* ptt-20.4* inr(pt)-1.5* brief hospital course: 60 year old portugese speaking gentleman found down and taken to outside hospital where ct scan revealed left frontal tentorial cistern acute subarachnoid and subdural hemorrhage. he was transported by to when his mental status deteriorated in flight. he was intubated for a gcs of 7 at arrival and recieved profiline and ffp in ed. he also sustained a left humeral fracture that was splinted by ortho trauma. on he was found to have a left lower lobe mass. he remained intubated becuase he did not tolerate cpap. on , the patient was extubated and placed on nimodipine for subarachnoid hemorrhage. on physical exam, patient was awake, following commands, giving thumbs up and moving r>l. pupils were equal and reactive. on , cardiology was consulted for arrthymias seen on telemetry and nimoedipine was discontinued, as no vasospasm was seen on cta. on , a repeat head ct scan showed a stable intra-cranial bleed. patient did not sustain any further injuries to the body per trauma. family meeting was conducted to discuss goals of care and patient was made dnr/dni. patient was transferred out of the icu to the medicine floor to coordinate recommendations of consult services and to initiate discharge planning. 1. intracranial hemorrhage: the patient's intracranial bleed was stable on head cts on and . patient's mental status improved over the course of the admission, becoming more interactive, a&ox2, able to state his address and birthday, following commands and moving all four extremities to command. it's still unclear why the patient fell initially--the differential includes seizure, arrythmia, hypoxia secondary to cigarette smoking/lung ca. the patient had cardiac enzymes negative x3. he had an echo with above results. neurosurgery followed the patient while admitted, with recommendations to hold the patient's coumadin for (at least) 1 month as well as to continue seizure prophylaxis with keppra 1000 mg . neurology and neurosurgery both felt the patient's prognosis was somewhat guarded, but may improve in time. as his coumadin had to be discontinued, the patient had an ivc filter placed while admitted. . 2. arrhthymias: the patient had several episodes of atrial tachycardia while on telemetry, as well as one episode of bradycardia. this was likely atrial fibrillation secondary to the stress of acute event. cardiology was consulted and recommended a low-dose beta blocker for rate control (metoprolol 12.5mg three times daily). tsh was normal. the patient remained hemodynamically stable throughout his admission, with normal blood pressure. cardiology was also concerned that additional anti-arrythmic intervention would increase his risk for bradycardia, of which the patient had only one concerning episode but which would ultimately likely be more problem than his well-perfusing tachycardia. if the patient decompensates in the future, a pacemaker could be considered as a palliative measure if life expectancy sufficient. . 3. lung cancer: per report of family, the patient and his oncologist had decided to emphasize on quality of life for the last few months given failure to respond to chemo/rads. the patient had a chest ct, showing 8 cm mass of the left lower lobe growing into the left main stem bronchus and associated with complete collapse of the left lower lobe. this mass may contribute to future respiratory compromise via obstruction or subsequent pneumonia--however, the patient remained stable from a respiratory stand-point throughout his hospitalization, with 02 saturations >95% on room air and without respiratory distress. in the future, if the patient develops respiratory distress, intervention on the bronchial mass could be considered by interventional pulmonology with stenting or phototherapy. these procedures would require intubation with bronchoscopy. the patient with follow up with ip as an out-patient. . 4. fever: the patient became febrile on the floor, spiking fevers of up to 101.3 (po) on multiple occasions. although he had no obvious source, with a negative ua and indeterminate cxr showing extensive left lung collapse and effusion, the patient was begun on coverage for ventilator associated pneumonia with iv cefepime, vanc, and flagyl, given his increased risk from recent intubation. he will continue this regimen at rehab. blood and urine cultures were pending at discharge. the patient had been afebrile for 24 hours at discharge after 3 days of antibiotics. . 5. diabetes: while in the hospital, the patient had elevate cbgs into the 300s. he was started on a pm dose of lantus (14 units) prior to discharge. his blood sugar control can be further titrated at rehab. however, intensive glucose control may create sharp swings in glucose, could precipitate arrythmias so aggressive glucose control should be avoided. . 6. hypertension: the patient's systolic blood pressure should be kept <180 per neurosurgery recommedation. this was achieved with metoprolol 12.5mg tid, with the patient's blood pressure ranging from 114-132/60-80 on day of discharge. . 7. left humerus fracture: the patient is being discharged with his arm in a sling after splinting by ortho. he will need to follow up with ortho as an outpatient. . 8. nutrition: the patient was evaluated by the speech and swallow with the recommendation to feed the patient thin liquids/soft solids with 1:1 supervision. he had a video swallow which showed no aspiration. medications on admission: medications prior to admission: 1. omeprazole 20mg 2. tramadol 50mg q 6h 3. simvastatin 20mg daily 4. seroquel 100mg hs 5. glipizide er 10mg daily 6. coumadin 4mg daily 7. keppra 500mg 8. ibu 800mg discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 2. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed for thrush. disp:*1 bottle* refills:*0* 3. levetiracetam 500 mg tablet : two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*0* 4. metoprolol tartrate 25 mg tablet : 0.5 tablet po tid (3 times a day). disp:*45 tablet(s)* refills:*0* 5. simvastatin 10 mg tablet : two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 6. docusate sodium 50 mg/5 ml liquid : two (2) doses po bid (2 times a day). disp:*120 doses* refills:*0* 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). disp:*30 tablet,rapid dissolve, dr(s)* refills:*0* 8. acetaminophen 160 mg/5 ml solution : ml po q6h (every 6 hours) as needed for pain/fever. disp:*1 bottle* refills:*0* 9. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours) as needed for dyspnea. 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q6h (every 6 hours) as needed for wheezing. 11. insulin regular human 100 unit/ml solution : asdir unit injection four times a day: see attached insulin sliding scale. 12. insulin glargine 100 unit/ml solution : fourteen (14) units subcutaneous qa breakfast: see attached sliding scale. 13. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback : one (1) intravenous q8h (every 8 hours) for 5 days. disp:*qs * refills:*0* 14. cefepime 2 gram recon soln : one (1) dose intravenous twice a day for 5 days. disp:*qs * refills:*0* 15. vancomycin in dextrose 1 gram/250 ml solution : one (1) dose intravenous twice a day for 5 days. disp:*10 dose* refills:*0* discharge disposition: extended care facility: rehab hospital discharge diagnosis: primary: 1. intra-cranial hemorrhage 2. heart arrhythmias 3. left humerus fracture 4. ventilator associated pneumonia secondary: 1. stage 4 lung cancer with brain metastasis 2. pulmonary embolism s/p ivc filter placement 3. diabetes, type 2 4. htn discharge condition: stable. discharge instructions: general instructions ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, or ibuprofen etc. ?????? if you were on a medication such as coumadin (warfarin), or plavix (clopidogrel) prior to your injury, you may safely resume taking this on xxxxxxxxxxx. ?????? if you have been prescribed dilantin (phenytoin) for anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing in one week. this can be drawn at your pcp??????s office, but please have the results faxed to . if you haven been discharged on keppra (levetiracetam), you will not require blood work monitoring. call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion, lethargy or change in mental status. ?????? any numbness, tingling, weakness in your extremities. ?????? pain or headache that is continually increasing, or not relieved by pain medication. ?????? new onset of the loss of function, or decrease of function on one whole side of your body. followup instructions: follow-up appointment instructions ??????please call ( to schedule an appointment with dr. , to be seen in 4 weeks. ??????you will need a ct scan of the brain without contrast prior to your appointment. this can be scheduled when you call to make your office visit appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube interruption of the vena cava enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus angiocardiography of venae cavae diagnoses: esophageal reflux unspecified pleural effusion diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation pulmonary collapse other and unspecified hyperlipidemia secondary malignant neoplasm of brain and spinal cord long-term (current) use of anticoagulants epilepsy, unspecified, without mention of intractable epilepsy personal history of venous thrombosis and embolism ventilator associated pneumonia bipolar disorder, unspecified fall from other slipping, tripping, or stumbling malignant neoplasm of lower lobe, bronchus or lung foreign body accidentally entering other orifice subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness closed fracture of unspecified part of upper end of humerus foreign body in larynx 

Answer: The patient is high likely exposed to