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: sulfa (sulfonamide antibiotics) attending: chief complaint: s/p fall down 8 steps major surgical or invasive procedure: picc line placement history of present illness: 83m with cad (mi years ago, cabg #1 30 years ago at , cabg #2 20 years ago at ), icd/pcm who was in his usual state of health until when he fell while carrying a door up some stairs. he was taken to an osh where he was awake but perseverating. he then started vomiting. he was paralyzed and intubated to protect his airway. he wastransferred to where a head ct showed sah (massive sah, bilat sdh. downward transtentorial herniation. effacement of the midbrain bilaterally, uncal herniation cannot be excluded. occ fracture extending to the foramen magnum). . his course is complex and is summarized in the following follows. he was intubated in sicu on admission. on admission, he got 1 unit of platelets given. on , he was febrile with worsening head ct, however, he improved in respiratory status, was able to wean down from vent. due to fever and concern for aspiration pna, sputum cultures were sent, blood culture negative thus far. he was extubated on . on , vanc/cefepime was started. he had a fall from bed. subsequent ct head showed no significant change. he passed speech and swallow. the following day on , he was cleared from c-collar. echo showed ef of 20-25% with lv thrombus calcified. he was restarted on home lasix. renal function improving. abx was dc'd as sputum showed 2+gpcpc/2+gpr/sparse yeast and no fever. he was cleared collar and tolerated pos. . of note, ct torso showed left upper lobe lung mass and subcarinal enlarged node is seen. just below this there is a 3.8 cm mass, difficult to be certain whether this is in the left atrium or just extrinsic to it. there is also a calcified left ventricle aneurysm with thrombus. multiple hypodensities in splenic, left renal and left upper quadrant concerning for metastases. the is a left thyroid nodule, incompletely evaluated. . on transfer: vs at transfer: afebrile, 125/70, hr 90-100, rr 20-30, 90-100% on nc. past medical history: cad, v-paced, s/p cabg based on the scar gout cad chf crf social history: social hx: quit smoking 30 years ago. travels to (pcp in ). travelled to with the military. . family history: family hx: unknown physical exam: physical exam: gen: intubated, sedated. ext: cold to touch . neuro: off propofol: pupils 3-2 mm, no corneals, no cough, no gag, not over breathing the vent. no movement to bue except for some hand twitching to noxious. no movement with the ble except for some twitching of his toes to noxious. . at the time of discharge the patient's neurologic exam was substantially improved. he was intermittently oriented x1-2 and responsive to basic commands. he was moving all extremities. pertinent results: laboratories at admission: 10:18am blood wbc-8.7 rbc-4.20* hgb-12.1* hct-35.0* mcv-83 mch-28.8 mchc-34.5 rdw-13.5 plt ct-170 10:18am blood pt-12.8 ptt-26.3 inr(pt)-1.1 02:06am blood glucose-115* urean-29* creat-1.2 na-138 k-4.1 cl-104 hco3-22 angap-16 02:06am blood albumin-3.7 calcium-8.2* phos-3.8 mg-2.1 02:06am blood albumin-3.7 calcium-8.2* phos-3.8 mg-2.1 02:06am blood phenyto-10.0 10:42am blood type-art rates-/14 tidal v-550 po2-378* pco2-33* ph-7.46* caltco2-24 base xs-1 -assist/con intubat-intubated ct head: extensive sah, r frontal ich, bilateral sdh that appear chronic with some acute component. occipital nondisplaced fracture. there could be some blood at the midbrain with effacement. no hydrocephalus noted. cta head: pre-lim read prior to recons: negative for aneurysm. this was discussed with the neuro-radiology attending. ct head - 1. massive subarachnoid hemorrhage. 2. bilateral subdural hemorrhages. 3. occipital fracture extending to the foramen magnum. ct c-spine - no ct evidence for acute fracture or malalignment. however, severe degenerative changes puts the patient at risk for cord contusion even with minor trauma ct c/a/p - 1. left upper lobe lung mass and subcarinal enlarged node is seen. just below this there is a 3.8 cm mass, difficult to be certain whether this is in the left atrium or just extrinsic to it. there ias also a calcified left ventricle aneurysm with thrombus. cardiac echo suggeted. 2. splenic, left renal and left upper quadrant complex hypodensities, concerning for metastases. this finding was discussed with 3. right mainstem intubation. 4. left thyroid nodule, incompletely evaluated. ultrasound could be performed non-urgently for further evaluation ct-angiogram - 1. head ct has shown diffuse subarachnoid hemorrhage with small bilateral subdural hematomas. the subarachnoid hemorrhage is predominantly seen at the convexity but also seen in the right sylvian fissure greater than left side. no occipital fracture is seen. 2. ct angiography of the head demonstrates no definite aneurysm, vascular occlusion, or high-grade stenosis. 3. ct angiography of the neck demonstrates vascular calcifications, but no evidence of high-grade stenosis or occlusion in the carotid or vertebral arteries. 4. left upper lung mass, left mediastinal lymphadenopathy, and upper lung scarring are noted and correlation with the torso ct is recommended. ct brain findings: in comparison to examination, there has been no substantial change in the extent of the widespread multicompartmental hemorrhages. bilateral subdural collections are again evident. subarachnoid blood, distributed throughout the bilateral frontoparietal and temporal regions, with clot forming in the right sylvian fissure, does not appear substantially increased from the prior examination. there is no shift of normally midline structures. a small amount of layering intraventricular blood is evident, with no significant change in ventricular size or shape to suggest developing hydrocephalus. the imaged osseous structures and soft tissues are unremarkable. the sphenoid sinuses are partially opacified in this intubated patient. impression: extensive multicompartmental, including subarachnoid and subdural hemorrhage, as well as small amount of intraventricular blood, stable when compared to the study from . cxr heterogeneous opacification in the right lung is probably largely pulmonary edema, since perihilar edema was already present in the left lung yesterday and has worsened. moderate cardiomegaly is stable and there has been a slight increase in mediastinal vascular caliber, which could be a reflection of supine positioning rather than an indication of elevated central venous pressure or volume. left lower lobe consolidation has worsened in the interim. whether this is pneumonia or active aspiration, or atelectasis or even asymmetric pulmonary edema is radiographically indeterminate. left upper lobe mass is a known feature. transvenous right atrial and left ventricular pacer leads and right ventricular pacer defibrillator lead are in standard placements. calcified apical ventricular aneurysm is also longstanding. brief hospital course: mr. was transferred to intubated after osh imaging revealed sah after fall down 8 stairs. he was admitted to nicu for further management. a cervical collar was maintained. but cleared on after no reports of neck pain and no fracture. the patient was admitted initially by neurosurgery and subsequently transfered to medicine for further evaluation of multiple medical conditions. . neuro: cta of the brain was obtained but did not demonstrate evidence of aneurym. he thrombocytopenic on arrival and was given platelet transfusion. repeat ct imaging of his brain demonstrated persistent b/l sub dural hematoma's and worsening diffuse sah. his exam improved and he was able to be extubated without incident. per neurosurgery there was no indication for surgical intervention. his mental status continued to worsen over the course of next several days. it was noted he was also having fevers and elevated white count. he was treated for presumed vap. per laboratory evaluation, it was noted that he had pancreatitis and developed ilieus with colonic distension. he was treated symptomatically and continued on antibiotics. he continued to deteriorate. he was made cmo toward the end of his hospitalization and was discharged on home hospice. . pulmonary: plain cxr imaging was suspicous for aspiration, thus sputum was sent which showed gp rods and cocci. he was on vancomycine and cefipime for this. final culture showed yeast and normal respiratory flora and the anitbiotics were discontinued. he required iv lasix on . he underwent ct toros to rule out additional injury. this was significant for lul lung mass concerning for malignancy. per ip, further workup would have required ct guided biopsy. at the time of discharge the wife and hcp as well as the patient's daughter were not inclined towards invasive diagnostic procedures and the mass was not further evaluated. pet ct or further imaging may be indicated pending family wishes. he was treated with vanc/cefepime for presumed vap due to his ms decline. . cardiac: ct torso showed a also a calcified left ventricle with aneurysm and thrombus. echo was done for further work up and ef was noted to be 20-25 % (baseline from osh records). further evaluation of left ventricular thrombus would require tee and based on families desires to avoid invasive procedures was not indicated at this time. anticoagulation was similarly not indicated due to the patient's sah. . left thyroid nodule: incompletely evaluated on ct torso. outpatient work up needed but deferred at this time due to multiple other conditions and family's reluctance to pursue invasive procedures. . ct torso: splenic, left renal and left upper quadrant complex hypodensities, concerning for metastases. the underlying pathology of these hypodensities remains unclear though may be due to abdominal visceral or lung metasteses. at the time of discharge, the wife and daughter were not interested in invasive diagnostic procedures and this was not further evaluated. . hematology: plavix and aspirin was stopped due to head injury. inr was elevated to 1.5 and vitamin k was started on . the elevated inr was thought to be due to poor nutrition; dic was unlikely given the stability of the patient and the normal platelet count. nutrition services were consulted to assist with management of the patient's diet. vitamin k was given again on . . renal: he had acute renal insufficanty and developed hypernatremia over the course of his hospital stay. his renal failure resolved and his creatinine returned to his baseline of 1.3. the etiology of his hypernatremia was initially unclear. the patient's decreased po intake during his admission, it was thought that this was a contributing factor. however, partial diabetes could not be excluded based on his urine osms in the mid400s. he was treated with gentle hydration with d5w with care not to overload his heart given ef of 20-25%. electrolytes were monitored twice daily while the patient was hypernatremic. he was given multiple boluses and free water intravenously. transitional: he was discharged to hospice. medications on admission: allopurinol 100 mg daily alprazolam 0.5mg tid asa 81 mg daily plavix 75 mg daily digoxin 0.125 mg daily lasix 40 mg indomethacin 75 mg daily imdur 60 mg daily nazonex spray daily potassium chloride 20meq daily ramipril 2.5mg daily ranitidine 150 mg daily simvastatin 40mg qhs sprionolactone 25mg daily vitamine b daily carvedilol 6.25mg discharge medications: 1. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: 5-10 mg po q2h (every 2 hours) as needed for pain or respiratory distress. 2. ativan 1 mg tablet sig: 1-2 tablets po four times a day as needed for sizeure. 3. haloperidol 1 mg tablet sig: 1-2 tablets po q4h:prn as needed for agitation. discharge disposition: extended care facility: house discharge diagnosis: subdural hemaoma's bilaterally subarachnoid hemorrhage left upper lobe lung mass pulmonary edema aspiration pneumonia pancreatitis ilieus fever occipital skull fracture non displaced renal insufficiency cardiac aneurysm with thrombus discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: you were admitted to the hospital after you fell down some stairs. you sustained injury to your brain including subdural hematoma, hemorrhage into the brain and subarachnoid hemorrhage. you also sustained a skull fracture. none of these injuries required srgical intervention. you also had a cat scan of your body to assess for other injury. incedentally found was a lung mass in the left upper lobe with masses in spleen and thyroid. you were also noted to have pancreatitis, ilieus, fever from aspiration pneumonia. unfortunately, these combination of events have lead you to a state where your goals of care was targetted towards your comfort in accordance to your living will. you were discharged to hospice near your home where you can spend more time with your family in the last days of your life. discharged home on home hospice. followup instructions: none md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified gout, unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status hypopotassemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pneumonitis due to inhalation of food or vomitus accidental fall on or from other stairs or steps old myocardial infarction unspecified disorder of kidney and ureter chronic systolic heart failure paralytic ileus automatic implantable cardiac defibrillator in situ encounter for palliative care do not resuscitate status pulmonary congestion and hypostasis encephalopathy, unspecified hyperosmolality and/or hypernatremia ventilator associated pneumonia delirium due to conditions classified elsewhere acute pancreatitis splenomegaly unspecified disorder of thyroid swelling, mass, or lump in chest aneurysm of heart (wall) closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness other ill-defined heart diseases other specified disorders of intestine 

Answer: The patient is high likely exposed to