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: no known allergies / adverse drug reactions attending: chief complaint: headache. major surgical or invasive procedure: right craniectomy. history of present illness: this is a 34 year old right handed man with ahistory of htn who was transferred from an outside hospital with l mca stroke. he initially presented to with right sided weakness and a headache. initial head ct was normal and lp was performed which showed elevated protein of >200 he was then admitted to the floor. he had mri which was reportedly negative for stroke and his r sided weakness appeared to have resolved. he later was found to have a left hemiplegia with right eye deviation and dysarthria. repeat head ct showed dense r mca infarfct with subsequent mri showing acute infarct of r mca territory. telephone discussion with a stroke fellow (dr. to the decision to give the patient ivtpa around 6:15pm. he was then then med-flighted to for further evaluation/treatment. per patient, he awoke this morning with ha and visual field defect with r side weakness. he reports that the vision deficit and weakness has lessened but he still has pressure like headache over the r temple. he denies any recent chest pain, racing heart, fever/chills, cough, n/v/d, abdominal pain and/or injury/falls. past medical history: 1. htn 2. fibromyalgia 3. pseudoseizures 4. dyslipidemia - htn - hld - asthma - h/o seizures during benzo withdrawal - idiopathic gastroparesis - anxiety/depression - fibromyalgia social history: lives alone and was working as a auto-mechanic but currently unemployed. smokes 1 ppd. family history: multiple members with stroke including aunt and uncle. physical exam: on admission:o: t: bp: 158/112 hr: 62 r: 14 o2sats: 99% nc gen: mildly sleepy appearing but nad. heent: pupils: 3->2mm neck: no carotid bruits noted. lungs: clear. cardiac: rrr. s1/s2. abd: soft, nt, bs+ and no abdominal bruit noted. extrem: warm and well-perfused. neuro: mental status: mildly sleepy but eyes open spontaneously. orientation: oriented to person, hospital but thinks its . knows is the president. language: speech fluent with intact repetition. mildly slow with latency and mild/moderate dysarthria. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 3 to 2 mm bilaterally. ? l field cut/neglect. iii, iv, vi: extraocular movements intact bilaterally. v, vii: l facial droop although does not cooperate when asked to show me his teeth or smile. motor: normal bulk and tone bilaterally. no abnormal movements, tremors. appears to have near full strength of rue but r ip . lue is plegic with some extensor posturing to noxious stim and triple flexion of lle with noxious stim. sensation: appears intact on r but neglects the l. when touching both sides, he reports only r and when touching the l side, he still reports r side. reflexes: b t br pa ac right 2 2 2 2 2 left 0 0 0 1 1 toes downgoing on r but up on l. on discharge: on the day of discharge he was alert and attentive to events in the room. he was non-verbal but said his last name once to the nurse on the morning of discharge. he will show finger on the right, or a thumb to command. he did not exhibit gaze preference. pupils were symmetrically reactive. his eye movements were conjugate, full. face shows asymmetry with left facial droop. tone in flaccid on the left and there is no movement. he spontaneous and puposively moves the right, which is antigravity and likely full strength (poor effort on strength exam and not always following commands). relexes were coming up on the left prior to discharge. his left great toe goes up. pertinent results: brain perfusion - 1. large right mca territory infarct with no evidence of hemorrhage. 2. the mid right m1 segment is occluded with extension to m2 branches. 3. irregularity along the posteromedial wall of the proximal right internal carotid artery with surrounding increased attenuation may represent a focal dissection or, less likely, an ulcerated plaque. this may have been a source of embolus. 4. symmetric abnormality on the mtt, cbv and cbf maps. ct head/neck - 1. large right mca territory infarct with no evidence of hemorrhage. 2. the mid right m1 segment is occluded with extension to m2 branches. 3. irregularity along the posteromedial wall of the proximal right internal carotid artery with surrounding increased attenuation may represent a focal dissection or, less likely, an ulcerated plaque. this may have been a source of embolus. 4. symmetric abnormality on the mtt, cbv and cbf maps. ct head - 1. the previously hypodense right lentiform nucleus has interval increase in attenuation to now hyperdense, with the affected area measuring 3.4 x 1.4 cm. similar increase of attenuation is also noted in the right periventricular white matter. while this could represent retained contrast from the cta/ctp study five hours ago, interval hemorrhagic conversion cannot be excluded. 2. persistent mass effect with near complete effacement of the right frontal , but no gross midline shift. no developing hydrocephalus. 3. no evidence of subarachnoid hemorrhage or intraventricular hemorrhagic extension. brain mri - continued maturation of large right mca territory infarction with hemorrhagic transformation within the right putamen. while this examination did not include an mr angiogram, there is suggestion of interval recanalization of the right m1 segment which has a probable flow void. ct head - interval increase in the hemorrhage within the known large right mca territory infarct, with increased mass effect and leftward shift of midline structures and mild uncal henriation. no evidence of transtentorial herniation. cxr - cardiomediastinal contours are normal. et tube is in standard position. the tip is 2.9 cm above the carina. ng tube tip is in the stomach, the side port is just distal to the ge junction. right ij catheter tip is in the lower svc. there is no pneumothorax or pleural effusion. there is mild vascular congestion. right lower lobe atelectasis has improved. left perihilar and left lower lobe atelectases are increasing. ct head - 1. interval right hemicraniectomy. mildly decreased leftward shift, from 13 mm to now 10 mm. unchanged right frontal effacement and mass effect. 3. similar large ill-defined hemorrhagic focus centered at the right basal ganglia, with extensive hypodensity along the right mca distribution, may relate to edema, ischemia or post-surgical changes. 4. unchanged small intraventricular hemorrhage in the right occipital . cardiomediastinal contours are normal. et tube is in standard position. the tip is 2.9 cm above the carina. ng tube tip is in the stomach, the side port is just distal to the ge junction. right ij catheter tip is in the lower svc. there is no pneumothorax or pleural effusion. there is mild vascular congestion. right lower lobe atelectasis has improved. left perihilar and left lower lobe atelectases are increasing ct head findings: overall, there is no significant interval change. there is a large parenchymal hemorrhage in the right frontal lobe, with surrounding vasogenic edema and mass effect on the right lateral ventricle. there is a stable 8-mm leftward shift of midline structures, and similar right transgaleal brain herniation. there is a stable small amount of intraventricular hemorrhage seen layering in bilateral posterior horns. there is persistent air and blood superficial to the dural flap and similar appearance of the subcutaneous hematoma. there is no evidence of uncal herniation. the ventricles are stable in size and configuration. there is air-fluid level in the sphenoid sinus. impression: overall, no significant interval change. 1. stable large right frontal hemorrhage with vasogenic edema. stable mass efect. 2. stable intraventricular hemorrhage in bilateral occipital horns. 3. stable subcutaneous hematoma at the craniectomy site. cxr findings: as compared to the previous radiograph, there is no relevant change. no endotracheal tube is seen on today's image. normal course of the nasogastric tube. the tip of the tube is not seen on the image. right internal jugular vein catheter with projection of the tip over the mid-to-low svc. borderline size of the cardiac silhouette. no pulmonary edema. no pleural effusion. no pneumonia. brief hospital course: stroke was admitted as a osh transfer after an mri demonstrated an acute right mca infarct. he was given tpa and transferred here for further care. he was admitted to the icu and was started on mannitol for icp control. he developed hypoxia from aspiration and from a failure to protect his airways and was intubated on a non-emergent basis. numerous hypercoagulable labs pending. homocysteine was elevated and dyslipidemia and hypertension are present. we will need to follow pending results. we have continued his statin and aspirin. he should follow-up in clinic with dr. in two months. given hemorrhagic conversion, aspirin and heparin were briefly held until the bleed was stable. he was also started on keppra for seizure rpophylaxis. craniectomy on patient developed increasing lethargy and a head ct obtained demonstrated interval increase of rigth cerebral edema with midline shift and right uncas was trending downwards. he was intubated for airway protection. neurosurgery called and patient was taken to the or for emergent decompressive right craniectomy on the evening of . he tolerated the procedure well without intraoperative complications. please review dictated operative report for details. he remained intubated and was transferred to sicu for further management. he will need cranioplasty in one to two months - he will follow-up with neurosurgery. mutism there is no neurologic reason for this, although it is possible that edema of the supplementary motor area might contribute. we think that this is possibly reactive and psychologic in this setting, particularly given that he was able to utter some words to his nurse. pneumonia ceftriaxone was chosen given likely community origin. his chest x-ray reveals questionable infiltrate without frank pneumonia. his respiratory status has been excellent without significant coughing. if his respiratory status worsens, nosocomial coverage would be indicated. ceftriaxone should continue until . intubation he was extubated on . fever he was persistently febrile with fever typically lower than 101. this was attributed as central given surgery, stroke and persistence despite few other data supporting infection. we would not recommend broadening antibiotic coverage on the basis of fever less than 101 alone, but only if there is other evidence of infection. medications on admission: - klonpin 2mg bis - metoprolol 100mg qd - simvastatin 80mg qd - lisinopril 20mg qd - reglan 10mg qd discharge medications: 1. ceftriaxone 1 gm iv q24h 2. simvastatin 80 mg tablet sig: one (1) tablet po once a day. 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. levetiracetam 1000 mg iv bid 5. hydralazine 10 mg iv q6h:prn sbp > 140 6. ondansetron 4 mg iv q8h:prn nausea 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever/pain. 8. fluoxetine 20 mg/5 ml solution sig: one (1) po daily (daily). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 10. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 11. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 12. oxycodone 5 mg/5 ml solution sig: one (1) po q4h (every 4 hours) as needed for pain. 13. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for to bm. discharge disposition: extended care facility: rehabillatation discharge diagnosis: right mca stroke itraparenchymal hemorrhage exacerbation of seizure disorder pneumonia discharge condition: level of consciousness: alert and interactive. not speaking at present. please see discharge summary for full description. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you came to transferred from another hospital, after having a stroke. you have elevated cholesterol and high blood pressure, along with elevated homocysteine. some further laboratory results are pending. you are now medically safe to go to rehabilitation. general instructions (post operatively) ?????? have a friend/family member check your incision daily for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? you may wash your hair only after staples have been removed. ?????? you may shower before this time using a shower cap to cover your head. ?????? 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, and ibuprofen etc. ?????? if you were on a medication such as coumadin (warfarin), or plavix (clopidogrel), or aspirin, prior to your injury, you may safely resume taking this on as you already have ?????? 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 . ?????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion 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. ?????? any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: follow-up appointment instructions please call registration on ( before your appointment to update your address and insurance details. , m.d. phone: date/time: 2:30 this will be at , , building, level 8. ??????please return to the office in days(from your date of surgery) for removal of your staples/sutures and/or a wound check. this appointment can be made with the nurse practitioner. please make this appointment by calling . if you live quite a distance from our office, please make arrangements for the same, with your pcp. ??????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. md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization other craniectomy diagnoses: tobacco use disorder unspecified essential hypertension other pulmonary insufficiency, not elsewhere classified hematoma complicating a procedure asthma, unspecified type, unspecified other convulsions intracerebral hemorrhage pulmonary collapse constipation, unspecified dysthymic disorder other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus other late effects of cerebrovascular disease other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cerebral edema cerebral embolism with cerebral infarction aphasia myalgia and myositis, unspecified hemiplegia, unspecified, affecting unspecified side gastroparesis dysphagia, oropharyngeal phase facial weakness family history of stroke (cerebrovascular) disturbances of sulphur-bearing amino-acid metabolism other speech disturbance status post administration of tpa (rtpa) in a different facility within the last 24 hours prior to admission to current facility 

Answer: The patient is high likely exposed to