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: right sided weakness major surgical or invasive procedure: received iv tpa history of present illness: 88 year old right handed man hx of atrial fibrillation (on coumadin) and hypercholesterolemia, who had acute onset of expressive aphasia and right sided hemiparesis at 7pm on . patient was gardening at home and was last seen normal at 6:30pm. his family found him at 7pm on the ground with right sided weakness. he was unable to get. patient was unable to produce any speech. he was taken to and arrived at ed at 7:55pm. stroke code was called at 7:55pm. stroke fellow was at bedside at 8:08pm. his vitals were bp 136/81, pulse 120, rr 20, and o2 94%. his nihss was 22 (-2 questions, -2 expressive aphasia, -2 dysarthria, -2 right homonymous hemianopsia, -2 gaze deviation to the left, -2 visual and sensory neglect, -2 right lower facial droop, -4 right arm weakness, -2 right leg weakness, -2 right hemisensory loss, unable to test coordination on the right side due to weakness. patient was agitated during the ct non-contrast. he required ativan 1mg for completion of the imaging. ct brain showed no signs of acute infarct. no bleed or mass. initial read of cta brain showed no evidence of stenosis or occlusion of intracranial vessels. no aneurysm seen. cta neck showed no significant atherosclerosis of carotids or vertebrals. patient was given iv tpa bolus of 6.1mg at 8:58pm. he got an infusion of 55.3mg iv tpa over one hour. he was transferred to the trauma icu. past medical history: angina nstemi hypercholesterolemia atrial fibrillation psh: cardiac cath and pci left knee surgery social history: lives with his son. does not smoke or use illegal drugs family history: non-contributory. no hx of strokes or mi for either parent physical exam: vs: bp 136/81 p 120 r 20 02 94% ra gen: thin heent: supple neck, no carotid bruits, no lymphadenopathy chest: lungs clear to auscultation bilaterally, no wheezes, rales, or rhonchi heart: irregularly irregular, no murmurs, abd: soft, non-distended, non-tender, no mass, positive bowel sounds ext: no cyanosis, clubbing, or edema skin: no erythema neuro: ms: alert, follows commands to lift left arm and leg, sticks out tongue to command, unable to produce speech, patient is able to moan, cn: right homonymous hemianopsia, no papilledema in the right fundus, unable to see the left fundus, pupils equal, round, and reactive, eyes are deviated to the left and do not cross midline to the right, right lower facial droop motor: flaccid right arm, decreased bulk of all 4 ext., no tremor right arm is 0/5 strength, right leg is anti-gravity for four seconds and then drifts down to the bed left arm and leg are anti-gravity sensory: does not withdraw right arm or leg to noxious does withdraw left arm and leg to noxious reflex: t br b k a toes left 2 2 2 1 1 down right 1 1 1 1 1 up coord: unable to assess gait: unable to assess pertinent results: 09:30pm urine color-yellow appear-clear sp ->=1.035 09:30pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 09:30pm urine rbc->50 wbc-0-2 bacteria-few yeast-none epi-0 08:10pm glucose-119* urea n-36* creat-1.3* sodium-142 potassium-4.3 chloride-108 total co2-24 anion gap-14 08:10pm wbc-5.5 rbc-5.11 hgb-15.0 hct-46.0 mcv-90 mch-29.4 mchc-32.6 rdw-14.0 08:10pm neuts-59.2 lymphs-31.3 monos-6.1 eos-2.7 basos-0.7 08:10pm plt count-235 08:10pm pt-17.3* ptt-27.8 inr(pt)-1.6* 03:06am blood ck-mb-notdone ctropnt-<0.01 05:30pm blood ck-mb-notdone ctropnt-<0.01 11:00pm blood ck-mb-3 ctropnt-<0.01 05:40am blood pt-17.2* ptt-28.3 inr(pt)-1.6* 05:40am blood glucose-98 urean-11 creat-0.7 na-141 k-4.1 cl-108 hco3-26 angap-11 03:06am blood %hba1c-5.5 03:06am blood triglyc-70 hdl-35 chol/hd-4.6 ldlcalc-113 blood and urine cultures from - nothing to date, pending ct head/cta head and neck/ct-perfusion : impression: 1. ct perfusion shows an acute infarction in the distribution of the distal inferior division of the left mca vascular territory. no evidence of acute intracranial hemorrhage on non-contrast ct. no definite stenosis or occlusion seen in the left mca on cta. 2. atherosclerotic plaques which are partially calcified at the bifurcation of the ica causes minimal narrowing without evidence of stenosis or occlusion. 3. hypodensity along right lateral temporal lobe may represent old infarct or old insult. repeat ct head : impression: increased conspicuity to infarct involving the left frontal lobe in the distribution of the left mca. no evidence of hemorrhagic transformation and no new significant mass effect. transthoracic echo : the left atrium is markedly dilated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). the right atrium is markedly dilated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. impression: no pfo, asd, or cardiac source of embolism seen. normal global and regional biventricular systolic function. mild aortic regurgitation. mild-moderate mitral regurgitation. moderate tricuspid regurgitation. marked biatrial enlargement. cxr : mild cardiomegaly, peripheral and central pulmonary vascular engorgement and mild edema all point toward cardiac decompensation. pleural effusion, if any, is minimal. there are no focal findings to suggest pneumonia. ekg : atrial fibrillation with rapid ventricular response. non-specific st-t wave changes. rsr' pattern in lead v2. brief hospital course: after receiving iv tpa, the patient was admitted to the icu for further monitoring per protocol post tpa. ct perfusion eventually showed an acute infarction in the distribution of the distal inferior division of the left mca vascular territory. the patient was monitored on telemetry his his atrial fibrillation with rapid ventricular response carefully controlled so as not to drop blood pressure in the acute period. his evaluation included fasting lipids that revealed an ldl 113; his lipitor was increased to 40 mg daily. a1c was within normal limits. transthoracic echo showed atrial septal defect, patent foramen ovale, or source of cardioembolism. nevertheless, given the presentation in atrial fibrillation with rapid ventricular response, it was thought that the most likely mechanism for the infarct was cardioembolic. given the tpa load, the decision was made to resume the patient on warfarin with aspirin bridging to a therapeutic inr (range 2-3). therefore, the aspirin should be stopped once the inr is greater than 2. the patient passed speech and swallow and was started on a diet. he was stable for transfer to the floor on . physical and occupational therapy saw the patient and rehabilitation was recommended. on , the patient developed a transient fever on the floor, but urinalysis and urine/blood cultures were negative and a chest x-ray was unchanged. he defervesced and remained clinically stable. his heart rate was generally well-controlled on a low dose beta-blocker, but was transiently tachycardic with periods of exertion; the resolved spontaneously. over the course of the hospitalization, the patient remained aphasic with a dense right upper extremity flaccid paralysis. there was trace weakness in the leg with hip flexion that seemed to improve. the patient was dnr/dni during the hospitalization. medications on admission: atenolol 25mg daily aspirin 81mg daily coumadin 2.5mg daily lipitor 10mg qod discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po three times a day as needed for fever or pain. 2. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 3. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily): please discontinue aspirin when the patient's inr on warfarin is greater than 2. tablet, delayed release (e.c.)(s) 4. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm. 5. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 6. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 7. colace 100 mg capsule sig: one (1) capsule po twice a day. 8. senna 8.6 mg tablet sig: 1-2 tablets po once a day as needed for constipation. discharge disposition: extended care facility: - discharge diagnosis: cerebral embolism with infarct atrial fibrillation discharge condition: stable, has aphasia and flaccid right arm paralysis/plegia and a perhaps trace weakness on right hip flexion. discharge instructions: the patient should take medications as prescribed and follow up with appointments as scheduled. should the patient experience any new, worsening or concerning symptoms, including vision change, confusion, or new weakness, please contact the patient's neurologist (dr. at ) or immediately take him to the nearest emergency department. the patient is currently on both warfarin and aspirin. his inr was 1.6 this morning, and should be checked daily. the aspirin should be stopped when the inr is greater than 2. his warfarin should be re-dosed to a target inr of . followup instructions: neurologic follow-up: provider: , md phone: date/time: 2:00 provider: , orthopedic private practice phone: date/time: 11:15 md procedure: injection or infusion of thrombolytic agent diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation percutaneous transluminal coronary angioplasty status old myocardial infarction cerebral embolism with cerebral infarction aphasia hemiplegia, unspecified, affecting unspecified side 

Answer: The patient is high likely exposed to