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: penicillins / erythromycin base / motrin / ampicillin / lactose / latex / adaptic / amiodarone attending: chief complaint: confusion major surgical or invasive procedure: none history of present illness: the patient is an 86y/o f with a pmh of cad s/p cabg 86f with cad s/p cabg (svg-om, lima-lad), as s/p valvuloplasty , diastolic chf, af on coumadin, s/p r colectomy admitted with generalized tonic clonic seizure. her recent past medical history inculdes an admission for a history of worsening doe with as with valve area of 0.56cm2. she underwent valvuloplasty with subsequent diameter of 0.98cm2. her course was complicated by lgi bleed and on colonoscopy a precancerous 2cm cecal polyp was found. she was then admitted from 1/11-20/10 for right hemicolectomy. low-grade t2n0m0 well or moderately differentiatedadenocarcinoma. her hospital course (- ) was complicated by hypercarbia requiring intubation and fluid overload requiring diuresis. subsequent to this she developed c. difficile colitis, for which she has been on po vancomycin since; she continued to complain of abdominal pain, with fevers post op and had a ct in , that revealed slight increased fat stranding in the region of the sigmoid colon at sites of diverticula, representing a mild case of uncomplicated diverticulitis. the patient was admitted on to neurology service after tonic clonic seizure activity which resolved spontaneously. her daughter and husband were visiting her and they noticed a self-limitted 5 minutes seizure, described as acute onset of loc, followed by whole body stiffens and later shaking. she was brought to the ed, and during her observation in the ed she another 30 seconds gtc seizure. to stop the cluster she received ativan iv and later she was loaded with 1000mg of iv keppra. no further seizures in the ed. she was admitted to the neuro icu for further management. she was initially treated with broad spectrum abx including vancomycin/cipro/bactrim and acyclovir for concern for meningitis/encephalitis. these were stopped after approx 24 hours. lp was not pursued given elevated inr on coumadin. cta negative for cva. she had no further seizure activity. head demonstrated a focal area with high signal intensity in the right superior parietal lobule. on evening of the patient triggered for altered mental status and lethargy following head . o2 sat found to be 84% and hr 130s, sbps in 80s. lasix 10mg iv given with no improvement. abg 7.32/65/89/35. micu consult was called and an additional 30mg iv lasix given with metoprolol 5mg iv. ams felt most likely secondary to ativan given for head . repeat abg this am 7.35/63/72/36. given continued tachypnea and hypoxia requiring 4-5l nc, the patient was transferred to the ccu for further managment. temp spiked to 101 and cultures sent. past medical history: 1. cad status post cabg 2. severe aortic stenosis, s\p recent valvuloplasty. 3. afib on coumadin 4. htn 5. hyperlipidemia 6. osteoarthritis - hip replacement spinal stenosis 7. squamous cell carcinoma 8. chronic venous stasis with ulceration 9. hypothyroidism 10. peripheral neuropathy 11. raynaud's synd 12. right retinal vein clot with mild loss of vision 13. diastolic heart failure 14. shingles in 15. status post right hemicolectomy in social history: has been staying at rehab since her partial collectomy and c.diff. at baseline is awake, interactive with family but confused about dates, current events and prior conversations. occupation: previously managed a store with her husband etoh: denies drugs: denies tobacco: denies family history: mother - chf father - x ~6, starting in 60's physical exam: admission examination (per admitting neurology resident) vs: genl: obtuned cv: irregular rate afib, chest: cta bilaterally, no wheezes, rhonchi, rales abd: +bs, soft, mild dyscomfort to deep palpation neurologic examination: mental status: eyes closed. not following verbal commands. barely localizing pain. cranial nerves: fundoscopic examination reveals sharp disc margins. pupils equally round and sluggish reactive to light, 4 to 2 mm bilaterally. extraocular movements intact bilaterally without nystagmus. motor: normal tone moving all extremities antigravity. sensation: withdraw with noxious stimulation. reflexes: decreased particularly in the lower extremities. exam on icu admission: vs: t=100.2 bp=123/66 hr= 87 rr= 21 o2 sat=95% on 4lnc general: responds to voice and painful stimuli, unable to follow commands. opc/nc/at/no lad neck: supple with jvp of cm in mid neck) cardiac: iirregularly irregular, late peaking sem heard, hear both s1 and s2 clearly, s2 may be fainter, throughout precordium, radiating to carotids. lungs: diffusely ronchorous, wheezing. abdomen:+bs, soft, nt, obese. extremities: 1+ pitting edema up to mid calf, bandages in place bilaterally in mid shin at site of presumed venous stasis ulcers. r/l dp/pt pulses weak,palpable, extremities wwp, good cap refill, skin turgor. exam at time of discharge: pertinent results: labs on admission: 12:30pm blood wbc-12.1* rbc-4.30# hgb-10.4*# hct-36.4# mcv-85 mch-24.1* mchc-28.4* rdw-18.3* plt ct-602* 12:30pm blood neuts-80.4* lymphs-12.2* monos-5.2 eos-2.2 baso-0.2 12:30pm blood pt-26.7* ptt-31.4 inr(pt)-2.6* 12:30pm blood glucose-121* urean-24* creat-0.8 na-142 k-4.4 cl-103 hco3-32 angap-11 04:27am blood alt-6 ast-18 ld(ldh)-202 ck(cpk)-15* alkphos-62 totbili-0.2 12:30pm blood ctropnt-0.02* 04:27am blood ck-mb-notdone ctropnt-0.02* 04:35am blood albumin-2.8* calcium-8.0* phos-3.5 mg-1.7 04:28am blood %hba1c-5.9 eag-123 04:27am blood triglyc-98 hdl-26 chol/hd-3.1 ldlcalc-34 04:27am blood tsh-6.8* 04:35am blood t3-pnd free t4-pnd imaging: ct head - findings: there is no acute hemorrhage, edema, mass effect, or infarct. the ventricles and sulci are again prominent, consistent with age-related atrophy. note is made of extensive calcifications in the bilateral cavernous carotid, vertebral, and leptomeningeal arteries. the paranasal sinuses and mastoid air cells are clear. there are no fractures. the orbits and soft tissues are unremarkable. impression: no acute intracranial process. cta head and neck () - impression: 1. no acute infarction or hemorrhage. 2. severe atherosclerotic narrowing of the distal right vertebral artery and moderate-to-severe narrowing of both cavernous internal carotid arteries. small focus of calcification in the basilar a. close to ithe tip. given the extent of disease in the dominant right vertebral artery, associated vertebrobasilar insufficiency cannot be excluded. further evlauation with mra neck with gado can be considered for temporal info regarding the direction of flow, if there is no contra-indication to . 3. moderate microangiopathic ischemic white matter disease cxr - impression: mild pulmonary edema. opacity in the left lower lobe may represent atelectasis or infection. echo - the left atrium is dilated. there is symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is a mild resting left ventricular outflow tract obstruction. the aortic valve leaflets are severely thickened/deformed. significant aortic stenosis is present (not quantified). trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. no vegetation seen (cannot definitively exclude). head () - impression: 1. focal area with high signal intensity is demonstrated at the right superior parietal lobule, with no significant mass effect and may represent a chronic hemorrhagic area. 2. subcortical areas with high signal intensity are identified on t2 and flair sequences, likely consistent with chronic microvascular ischemic changes. 3. tortuosity of the basilar artery, consistent with dolichoectasia, previously described by cta on . ct head () - impression: 1. no acute intracranial hemorrhage seen. small ovoid hypodensity in right parietal lobe corresponds to area demonstrating old blood products seen on of . 2. new opacification of left anterior ethmoid air cells and increased opacification of left mastoid air cells. echo () - the left and right atria are moderately dilated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is severe mitral annular calcification. there is no mitral stenosis. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: critical aortic valve stenosis. pulmonary artery hypertension. right ventricular cavity enlargement with free wall hypokinesis. mild symmetric left ventricular hypertrophy with preserved global and regional systolic function. compared with the prior study (images reviewed) of , the across the aortic valve has increased and the right ventricular cavity is now dilated with free wall hypokinesis. the estimated pa systolic pressure and severity of mitral regurgitation are similar. head () - impression: 1. severe tortuosity of the vertebrobasilar system without evidence of pontine infarction. 2. no evidence of large hemorrhage, edema, masses, mass effect, or infarction. 3. unchanged small area of subacute blood products in the right parietal lobe. brief hospital course: 1st neuro icu course: 86 year-old woman with cad s/p cabg, htn, hl, r retinal vein occlusion and recently dx. colon cancer, s/p colectomy c/b c.diff coilitis who now presented from nh with two episodes of gtc seizures. she was loaded with keppra iv and was transferred to . at upon evaluation in the ed, she was found to be "obtunded" s/p keppra load and given multiple hospitalizations, wbc and seizure, she was felt to be at risk for meningitis, thus was treated with vancomycin iv, bactrim iv and acyclovir iv for possible meningitis. lp couldn not be performed due to requirement of remaining on coumadin and inr of 2.6. there was also concern for top of the basilar syndrome, thus she underwent a cta of the neck, showing severe atherosclerotic narrowing of the distal right vertebral artery and moderate-to-severe narrowing of both cavernous internal carotid arteries along w/ a small calcification in the basilar artery. she was transfered out of neuro icu on for further care. on hd#1 patient was noted to be arousable to voice, oriented to hospital and following simple appendicular and axial commands. given sudden improvement and no menigismus the antibiotics were discontinued. she continued to improve in her mental status. the detailed neuro exam after she came back to neuro floor showed subtle weakness on the left side and absent reflexes. to assess the etiology of the seizure (stroke vs. metastatic mass), pt. underwent an of the head w/ and w/o contrast. unfortunately she was agitated and was unable to complete the sequences with contrast. the non contrast showed a lesion in right parietal area, possibly infarct with hemorrhagic conversion, although mass or avm could not be ruled out due to lack of contrast administration. initially there was concern for endocarditis, tte was performed and showed no vegetations. cv. s/p cabg and av valvuloplasty. patient was noted to have episodes of hypotension in setting of her home bb dose, this was decreased to 1/2 dose and her lasix was held x 1 day in this setting. tte revealed ef of > 60%, lvh, mild lvot and aortic valve leaflets are severely thickened/deformed as well as "significant aortic stenosis." she was continued on the remainder of her nh medications. we held lasix after transfer to floor as there was concerns about lowering her blood pressure in setting of possible ischemic stroke. pulm. mild oxygen requirement in setting of b/l pleural effusions and mild volume overload, likely due to diastolic dysfunction. in setting of hypotension, the lasix was temporarily held but shortly resumed after concern for her tenuous fluid balance. gi. c. diff infection. per discussion w/ nh, it appears that the loose stools have been declining and the plan was to d/c flagyl/vanco on day of transfer. she has not had any more loose stools while in the sicu and last c.diff was at nh and was neg. these were discontinued. 1st ccu course: pt was found to be in afib with rvr on admission secondary to missing several doses of metoprolol on the floor. she was also found to be in acute pulmonary edema likely secondary to combination of afib with rvr and missing lasix doses. cxr also showed rll lung collapse. she was febrile to 100.3 and given her worsened lung exam and ms it was thought that she had additional experienced silent aspiration. she was initially kept np her depressed mental status and her afib with rvr was rate controlled with iv metoprolol. as her sensorium cleared she was transitioned to p.o metoprolol with effect. she was treated for hap aspiration pneumonia with vanc/falgyll/cefepime. on icu day 3 she spiked to 102 and was pancultured with urine analysis showing pyuria and positive leuk esterase. she was kept on broad spectrum coverage with culture data pending. she was noted to have some new anisocoria on exam on hospital day three felt likely nebulizer treatment, given that her was still overall improved but should be followed with serial exam. the neurology service had recommended with gadollinium once medically stable to evaluate hyperdensity noted on prior imaging. currently this is believed to be in nature (infarct) although metastatic disease cannot be ruled out given her history of colon cancer. her inr was supratherapeutic on ccu admission, is now 1.4 with neurology recommending restarting low dose coumadin. given her as she was being judiciously diuresed with lasix drip, was running negative and was switched to her home lasix p.o dosing. discussion is underway with dr regarding percutaneous aortic valve replacement once she is medically stable. oral vancomycin suppression for c.diff infection has been discontinued following a negative c.diff and the fact that she has not had any further diarrhea. she was seen by speech and swallow with recommendation made for tube feeding and an ngt was placed. as her mental status was not improving, she was started on continuous eeg monitoring. on the evening of the patient was found to be in ncse with generalized spikes in all leads at 2hz on eeg. she was given ativan 0.5 mg x1, continued on keppra 1g and loaded with dilantin and was no longer in status. she was transferred to the neuro icu for further care. 2nd neuro icu course: neurology; the patient remained on continuous video eeg monitoring. her eeg remained active with generalized sharp waves at a rate of approximately 2 hz, and on was found to be back in subclinical status. her keppra was increased to 1500 mg and her dilantin was adjusted for goal levels 15-20. her eeg remained active on am. she also had worsening renal function. therefore, she was given ativan 1 mg x1, her keppra was decreased to 500 mg q12h, and she was loaded with phenobarbital at 15 mg/kg with maintenance dose of 1 mg/kg. an with and without contrast was unable to be performed due to the patient's instability. her eeg has slowly become less active, currently consistent with encephalopathy and occasional gpeds with less sharp activity. her keppra was discontinued , and phenobarbital was decreased to 60 mg . her phenytoin is continued with goal level of 8 (which corresponds to free dilantin level 1.9 as per draw). trough levels are requested for dilantin and free dilantin levels on . clinically, she does not open eyes to noxious stimuli or follow any commands. respiratory; the patient had worsening respiratory status , requiring intubation. id; the patient completed a seven-day course of vancomycin and cefepime for a presumed pneumonia. she spiked a low grade fever and urinalysis revealed a likely uti, but culture grew yeast. she received a three-day course of ciprofloxacin. cv; the patient continued to have a tenuous fluid balance. she was continued on aspirin, lasix, digoxin, lopressor, and statin. she required pressors to maintain her sbp (phenylephrine). a bedside tte showed an aortic valve area of 0.6 cm2. she is on coumadin for goal inr . renal; the patient has had worsening renal failure with minimal urine output. this was presumed to be due to cardiorenal syndrome. she is being followed by nephrology and is considered to be a poor dialysis candidate. goals of care; multiple family meetings have been held regarding goals of care. the patient's husband and son still wish for all aggressive measures at this time. 2nd ccu course: the patient was transferred back to the ccu service on . at this time, she was intubated and unresponsive. she was also grossly fluid overloaded and in renal failure. attempts at diuresis with iv lasix, diuril, and bumex were all unsuccessful. on transfer to the ccu service, the patient was on pressors; however, these were able to be weaned off. the neurology service continued to follow the patient and provided recommendations for weaning down her phenobarbital and dilantin. per neurology recommendations, the patient underwent of his head, which did not reveal any acute changes from prior mris. the patient was continued on eeg monitoring, which did not reveal any active seizure activity. the prospect of dialysis was brought up; however, it was felt that the patient was not a candidate for dialysis at that time. after multiple family meetings, the patient's family decided that she was unlikely to awaken from her coma. they decided to make the patient dnr/dni with a focus on comfort. they decided not to escalate the patient's care any further but also not to deescalate. the patient remained stable until when she started to desat and look dusky. the family was notified of her clinical deterioration. on the patient expired. medications on admission: home medications: 1. furosemide 60mg daily 2. levothyroxine 75mg daily 3.latanoprost 0.005% drop daily 4. timoptic 0.5% drop daily 5. lipitor 40mg daily 6. gabapentin 300mg 7. coumadin 4mg . medications on transfer: glucagon 1 mg im q15min:prn hypoglycemia protocol insulin sc (per insulin flowsheet) acetaminophen 325-650 mg po/ng q6h:prn pain\fever ipratropium bromide neb 1 neb ih q6h aspirin 81 mg po/ng daily latanoprost 0.005% ophth. soln. 1 drop both eyes hs atorvastatin 40 mg po/ng daily levothyroxine sodium 75 mcg po/ng daily bacitracin-polymyxin ointment 1 appl tp q6h:prn wound levetiracetam 750 mg iv q12h collagenase ointment 1 appl tp daily lidocaine 5% patch 1 ptch td daily dextrose 50% 12.5 gm iv prn hypoglycemia protocol digoxin 0.0625 mg po/ng daily metoprolol tartrate 25 mg po/ng tid famotidine 20 mg iv q24h folic acid 1 mg po/ng daily nystatin oral suspension 5 ml po qid:prn gabapentin 100 mg po/ng timolol maleate 0.5% 1 drop both eyes daily . allergies: penicillin and erythromycin with rash and gi upset from motrin discharge medications: pt expired discharge disposition: expired discharge diagnosis: pt expired discharge condition: pt expired discharge instructions: pt expired followup instructions: pt expired procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy electroencephalogram diagnoses: acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status aortic valve disorders pulmonary collapse acute respiratory failure pneumonitis due to inhalation of food or vomitus anoxic brain damage cellulitis and abscess of leg, except foot long-term (current) use of anticoagulants personal history of malignant neoplasm of large intestine hypoxemia altered mental status accidents occurring in residential institution chronic diastolic heart failure ulcer of other part of lower limb venous (peripheral) insufficiency, unspecified benzodiazepine-based tranquilizers causing adverse effects in therapeutic use generalized convulsive epilepsy, without mention of intractable epilepsy anomalies of cerebrovascular system 

Answer: The patient is high likely exposed to