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: speech disturbance, right sided weakness, transferred from osh for higher level of care major surgical or invasive procedure: intubation tracheostomy and peg picc line history of present illness: 69yom w/hx of htn and hyperlipidemia who presents from osh with ischemic stroke (l-pca infarction involving l-occipital and posterior temporal lobes with conversion to hemorrhagic stroke). pt is from and was brought to center by his son. reports that patient vomitted in his sleep and was unable to speak. on admission to patient was arousable, but 'non verbal,' unable to follow commands and 'flaccid' in r-upper and lower exremities as per ed note. . hosp course at . presented at osh with aphasia, r-sided weakness 8/25 mri showed acute ischemic change of l occipital, parietal and temporal lobes - left thalamus diffusely involved. hemorrhage was noted in area of thalamus. tee showed no obvious source of embolus, with normal ef, no pfo. continued to have confusion/vomitting. ct showed l-pca territory infarction with areas of hemorrhage. mass effect and midline shift present. pt started on aspirin 325mg, vomitting resolved. pt started to improve (per family) prior to increasing somnolence on (see below). pt had fluent speech, required 2 people to help stand, 1 to help sit, weaker on r side, mild r-facial droop, was not oriented to date, but knew he was in hospital. . pt became drowsy. ct of head showed increasing acute intracranial hemorrhage within large l pca territory, increasing mass effect and midline shift compared with . neurosrug consulted, recommended transfer to . family decided to keep pt at and decline neurosurgical intervention. pt transferred to icu. pt became more delirious and agitated. able to speak but as per son and wife, his wording was not making any sense neuro exam remained the same, head ct showed increased hemorrhage and surrounding edema in l hemisphere with slight increase in shift of midline. possibly interventricular hemorrhages as well. pt reaffirmed decision to decline neurosurgical intervention, but agreed to transfer pt to . . of note per osh report bp remained 'in good control' throughout hosp course. . past medical history: 1. l-ischemic stroke conversion into hemorrhagic stroke with increasing icp midline shifts 2. hyponatremia most likely secondary to siadh 3. newly dx'd dm on osh admission 5. hyperlipidemia 6. hypertension 7. left thyroid nodule - found incidentally on head ct. social history: lives with in came to visit son at beginning of . planning to go home . prior to stroke, walking at home, speaking fluently, had a retail business. native language is tamil. denies tobacco, alcohol, illicits. married w/ 3 children. family history: fam hx: mother died of cervical cancer ?age, father died of 'old age'. physical exam: physical exam on admission: vs: 97.2, hr 99, bp 150/68, rr 21, 97%ra gen: elderly male lying in bed intermittently agitated heent: op clear, neck supple cv: rrr, no m/r/g pulm: cta-b laterally abd: soft, nt, nd ext: no peripheral edema . neurological exam: mental status: awakens to voice, answers in "nonsens words" (per his family who were translating) when asked the date, where he was. per family speech not slurred. pt able to repeat short phrases, but not long phrases (longer than 3 words). pt uses "made up words" on confrontation naming, and got more agitated with each question. he was unable to read, unable to write. however, at the very end of the exam he said "don't disturb me i want to sleep" fluently. he can follow midline, appendicular and x-body commands. no evidence of neglect . -cranial nerves: i: olfaction not tested. ii: pupils post-surgical bilaerally, reactive 2->1.5mm, vff to confrontation. pt unable to cooperate with fundoscopic exam iii, iv, vi: eomi without nystagmus. normal saccades. v: facial sensation intact to light touch. vii: r sided facial droop viii: hearing intact to finger-rub bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline, but unable to get past bottom lip. . -motor: normal bulk throughout, increased tone in rle. pt unable to cooperate with pronator testing. no adventitious movements, such as tremor, noted. no asterixis noted. delt bic tri wre ffl fe io ip quad ham ta edb l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 r 1 2 2 1 3 1 2 2 2 2 2 2 3 3 . -sensory: no deficits to light touch, but pt unable to cooperate with rest of sensory exam. . -dtrs: tri pat ach l 3 2 2 2 1 r 3 2 2 3 1 plantar response was upgoing on the r, down on the l. . -coordination: pt unable to cooperate with fnf . -gait: deferred __________________________________________________________ discharge exam heent: at/nc, trach in place - capped cv: rrr, no m/r/g pulm: cta-b laterally abd: soft, nt, nd ext: no peripheral edema neurological: awake, alert, oriented to self only. language is fluent (speaks tamil). follows simple axial and appendicular commands. perrl, eomi, right facial droop. lue and lle has 3-4/5 strength throughout. rue has 2/5 strength throughout; rle toes wiggle. he is able to sit with zero to moderate assistance. he is able to stand with 1-2 person assist. pertinent results: labs on admission: 09:05pm blood wbc-6.0 rbc-5.04 hgb-15.0 hct-43.2 mcv-86 mch-29.8 mchc-34.7 rdw-12.1 plt ct-368 09:05pm blood pt-14.5* ptt-27.7 inr(pt)-1.3* 09:39pm blood esr-52* 09:05pm blood glucose-164* urean-16 creat-0.8 na-136 k-4.1 cl-104 hco3-19* angap-17 09:05pm blood alt-27 ast-68* ld(ldh)-534* ck(cpk)-301 alkphos-46 totbili-0.4 09:05pm blood ck-mb-22* mb indx-7.3* ctropnt-0.49* 09:39pm blood ck-mb-21* mb indx-7.0* ctropnt-0.49* 05:20am blood ck-mb-14* mb indx-6.4* ctropnt-0.55* 09:05pm blood albumin-4.0 calcium-9.4 phos-2.7 mg-2.2 09:39pm blood %hba1c-8.3* eag-192* 05:20am blood triglyc-59 hdl-36 chol/hd-3.1 ldlcalc-64 09:05pm urine blood-tr nitrite-neg protein-neg glucose-neg ketone-10 bilirub-neg urobiln-2* ph-6.5 leuks-tr 09:05pm urine rbc-2 wbc-1 bacteri-few yeast-none epi-0 08:45pm urine casthy-3* 09:05pm urine mucous-rare 01:57pm urine hours-random creat-73 na-178 k-50 cl-201 no labs were done prior to discharge as pt was clinically stable. eeg: this is an abnormal eeg due to the presence of bursts of generalized slowing superimposed upon an asymmetry of background activity. the first finding is suggestive of a mild to moderate encephalopathy of toxic, metabolic, or anoxic etiologies. the second abnormality suggests a widespread area of subcortical dysfunction involving the left hemisphere. no evidence of ongoing or potential seizure activity was seen at the time of this recording. markedly abnormal portable eeg due to the background voltage suppression on the left side, particularly posteriorly, and due to the additional slowing and occasional suppression on the left side. these findings suggest a focal structural abnormality on the left, but the tracing cannot specify its etiology. in addition, the background was slow in all areas, suggesting a concomitant widespread encephalopathy. medications, metabolic disturbances, and infections are among the most common causes of these encephalopathies. there were no epileptiform features or electrographic seizures in the recording. this telemetry captured no pushbutton activations. there were no electrographic seizures. the record showed an encephalopathic pattern throughout. for about an hour on the morning of , the blunted sharp waves were particularly rhythmic at about 1.3 hz in the right frontal region. their resolution later that morning was likely to have followed administration of phenytoin as described by the clinical teams. the encephalopathy persisted. this telemetry captured no pushbutton activations. it showed a slow or suppressed background throughout, particularly in the left posterior quadrant. the focal voltage suppression indicates some cortical dysfunction there. some of the record appeared to suggest ongoing sleep, but most indicated an encephalopathy, with the faster regular alpha frequencies suggesting medication effect. there were no clearly epileptiform features or electrographic seizures. this extended routine eeg over the morning of showed a very suppressed background over the left side, particularly posteriorly. the faster alpha frequencies on the right were widespread and suggested medication effect rather than normal wakefulness. there were no epileptiform features or electrographic seizures. neuroimaging: suboptimal mri study secondary to patient motion. hemorrhagic infarction seen in the left posterior cerebral artery territory with involvement of the splenium of corpus callosum. there is surrounding edema causing partial effacement of left lateral and third ventricles along with a midline shift of 1 cm towards the right side. large left hemispheric acute infarction, also involving the left thalamus and cerebral peduncle, with extensive hemorrhagic transformation. partial effacement of the left lateral and third ventricles. dilated temporal of the right lateral ventricle suggests trapping. evolving left pca territory infarct with hemorrhagic conversion. stable mass effect and rightward shift of midline structures. no significant interval increase in the hemorrhage. no significant change from the prior exam- see details above in the left temporal and callosal lesion and edema . however, there is a small hypodense focus in the right lentiform nucleus that is more conspicuous since the prior study and not seen on more earlier studies and may represent a focus of evolving acute infarct. no appreciable change from prior examination. no new areas of hemorrhage. : expected evolution of blood products within the left pca infart, with slightly decreased mass effect. no evidence of new intracranial abnormalities. ecg : sinus tachycardia. probable prior anteroseptal myocardial infarction. diffuse non-specific st-t wave flattening. compared to the previous tracing of no diagnostic interim change. intervals axes rate pr qrs qt/qtc p qrs t 102 134 82 318/391 58 0 95 tte - echo : the left atrium is mildly dilated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with distal septal and apical hypokinesis (distal lad). the remaining segments contract normally (lvef = 45-50%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mild regional left ventricular systolic dysfunction, c/w cad. no pfo, asd or cardiac source of embolism seen. other radiology: abdomen supine portable: gastrostomy tube appears to be in a satisfactory position. the stomach is not dilated. there is gas throughout the bowel as far as the rectum. no dilated loops of small bowel are present. bowel gas is therefore unremarkable. there is no evidence either obstruction or ileus. cta chest with and without contrast: impression: 1. no evidence of pulmonary embolism to the subsegmental levels bilaterally. 2. minimal bilateral dependent atelectasis. 3. left hepatic lobe hypodensities too small to characterize but not significantly changed compared to prior ct. renal ultrasound: impression: 1. bilateral caliceal diverticula. small renal stone in the left lower pole. simple cyst in the mid portion of the right kidney. no hydronephrosis. video oropharyngeal swallow: impression: 1. weakness at the base of the tongue. 2. no evidence of aspiration or penetration. brief hospital course: mr. was admitted to the neuroicu as a transfer from hospital. his outside hospital course was described above. briefly, his problems began when following dinner one night, he vomitted while in bed and was poorly responsive. at the osh, he was found to have a dense right hemiparesis with global aphasia and left gaze preference and was started on a large aspirin therapy. while his ct scan showed an evolving left pca stroke, he did have some punctate hemorrhagic regions in the thalamaus on the left. he initially did well, participated in rehabilitation and speech therapy, and was showing improvement. his a1c returned elevated (newly diagnosed diabetic) and both a tee/tte were unrevealing for a thrombus. on , he developed an acute worsening in his mental status with delirium and drowsiness. a nchct at that time showed worsening of his edema and hemorrhagic conversion. his asa was held and he was transferred to the icu where over the next two days, his examination remained stable. he remained hemodynamically stable during his course, but for some mild hyponatremia, he was started on hypertonic saline (3%). the family eventually agreed to be transferred to the for a higher level of care. on arrival to us, his examination was such that he had a profound right homonymous hemianopia with right sided neglect, right hemiparesis and facial droop, a largely expressive aphasia (language had to be tested in telugu (tamil) through his son/family). throughout the course of his stay, this was his best examination. over the course of the next several days, his examination deteriorated to the point where he was poorly responsive to sternal rub, he started to display weakness of the left lower and upper extremities. through his deterioration, he was initiated on a variety of therapies to reduce his intracranial pressure, including high dose iv mannitol, hypertonic saline (3% or 23%) and iv steroids. he developed fevers during this period (thought to be of a pulmonary source) and was initiated on cooling blankets and broad spectrum iv antibiotics. at the peak of his diminished consciousness, he had an episode where he frankly aspirated his tube feeds. following this he was sedated and intubated. under the guidance of dr. of the neuro-icu, we undertook an intravascular cooling protocol to reduce icp. he attained a core body temperature of 34c for at least 24 hours and during this period, his shivering was controlled with high doses of fentanyl/propofol. he was slowly warmed, and following regaining normothermia, he remained intubated for a few days. off sedation, his examination was quite poor: intact brainstem reflexes, but with no response to calling his name, no spontaneous eye opening, no movements of his lower extremities. his steroids were slowly tapered. we had at least two formal family meetings where we discussed his grave prognosis. on the final family meeting on , the family wished to pursue a full code and trach/peg. their ultimate goals were to have the patient transported back to for continued care. he was shown to be having electrographic seizure activity on eeg, and was started on pheytoin, which stopped the seizure activity. he received his tracheostomy/gastrostomy tube on setmeber 23, and was tolerating trach collar well the next day. he started to spike fevers to 103 shortly therafter and was found to have mrsa colonization of his trach. he was started on linezolid on , but continued to spike through this antibioic so he was broadened to zosyn also on . he had some transient episodes of hypotension, felt to be from likely sepsis, and he was put on pressors for <24 hours. these were weaned without issue, and he was started on ivf to help with volume status. his ucx then grew out klebseilla, which was sensitive to zosyn, so his abx were not changed. his phenytoin levels were difficult to control and so he was switched to keppra on . ultimately he was transferred out of the icu on when he was afebrile x 24hrs, was more alert, was intermittently responding to commands and was able to be sat up in the chair without issue. his neurologic exam had improved such that he was able to open his eyes to voice and tracked relatively well, primarily to the left. he was able to move his lue spontaneously and purposefully. he continued to have dense weakness of the rue and rle but did show very small movements of the right hand. he was able to speak phrases with the passy-muir valve in place. he remained mildly tachycardic to the 90s-120s and was maintained on lopressor 25 mg po q6h and continuous normal saline iv fluids which attenuated this. an echocardiogram was performed which showed mild regional left ventricular systolic dysfunction consistent with cad with an ef of 45-50%. a cta was also performed due to concern for pe which was negative. he completed a 10 day course of linezolid and piperacillin-tazobactam for his mrsa tracheobronchitis and uti. he had another fever on which was likely secondary to continued infection from klebsiella which grew in a urine culture from that day; we replaced his foley catheter (which was required for urine output monitoring, avoid exacerbating pressure ulcers, and transitioning of care to another facility/travel). mr. remained medically stable over the next 4 weeks. he was re-evaluated by the swallow therapists and found to be safe for all consistencies po after a video swallow exam on . he continues to receive nighttime tube feeds until he is able to take in a full diet. his trach has been capped intermittently and he is able to tolerate it capped for 48 hours without difficulty. he continues to make strides with physical therapy and is now able to stand with 1-2 person assitance. on day of dispo, at the request of the transporting doctor, we changed his dvt prophylaxis from heprain sq to lovenox. pt was sent with 6 doses of dosed lovenox as well as a week supply of heparin in case his transport took longer than expected. he was also sent with 2 doses of dextrose in case his blood sugar dipped too low. pending labs: viral cx final read transitional care issues: patient's transportation to has been arranged and plan is to have patient go to a rehab facility once in . medications on admission: atorvastatin 10mg po incorandil 5mg metoprolol 25mg flavedon mr aspirin ec 150mg ramipril 2.5mg discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day). 2. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 3. senna 8.8 mg/5 ml syrup sig: five (5) ml po bid (2 times a day). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*7 tablet(s)* refills:*0* 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*14 tablet(s)* refills:*0* 6. levetiracetam 100 mg/ml solution sig: 1000 (1000) mg po bid (2 times a day). disp:*14 doses* refills:*0* 7. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 8. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for dry skin. 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*28 tablet(s)* refills:*0* 10. benzoyl peroxide 10 % gel sig: one (1) appl topical daily (daily): for neck folliculitis. 11. nph insulin human recomb 100 unit/ml suspension sig: ten (10) units subcutaneous q breakfast. disp:*7 doses* refills:*0* 12. nph insulin human recomb 100 unit/ml suspension sig: twenty two (22) units subcutaneous q dinner. disp:*7 doses* refills:*0* 13. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous qahs: titrate to sliding scale with qahs finger sticks. 14. insulin syringe 1 ml 30 x syringe sig: one (1) syringes miscellaneous twice a day. disp:*20 syringes* refills:*0* 15. enoxaparin 30 mg/0.3 ml syringe sig: one (1) syringe subcutaneous q12h (every 12 hours) for 6 doses. disp:*6 syringes* refills:*0* 16. dextrose 50% in water (d50w) syringe sig: two (2) syringes intravenous once a day for 2 doses. disp:*2 doses* refills:*0* discharge disposition: extended care facility: nursing facility discharge diagnosis: primary: acute ischemic stroke, intracerebral hemorrhage secondary: urinary tract infection (bacterial, klebsiella), seizure (electrographic), mrsa tracheobronchitis discharge condition: mental status: awake and alert, able to speak in native language. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. neuro: awake, alert, and able to communicate with his family with spontaneous speech in his native language and follow basic commands. he has a tracheostomy as well as a peg tube, but recently passed a swallow evaluation and is tolerating food by mouth. his pupils are reactive, extraocular movements are intact, and has a right facial droop. he is able to lift his left arm and leg antigravity (approximately 4/5 strength, but formal assessment is difficult due to cooperation). his right arm and leg are 1-2/5. he is able to stand with two-person assist. discharge instructions: dear mr. , you were seen in the hospital for a large acute ischemic stroke which was complicated by hemorrhagic conversion (bleeding). while here you needed to be on a ventilator (breathing machine) for a very long time. because of this, we had to place a tracheostomy and a peg tube to help you breath and get nutrition. your hospital course was complicated by a urinary tract infection and tracheobronchitis, both of which were treated and have resolved. we made the following changes to your medications: increased metoprolol from 25mg po bid to 25mg po every 6 hours stopped atorvastatin 10mg po stopped incorandil 5mg stopped flavedon mr increased aspirin ec 150mg to aspirin 325mg daily stopped ramipril 2.5mg started famotidine 20mg po bid started keppra (levetiracetam) 1000mg po bid started insulin nph 5 units subcut qam and 22 units subcut qpm started lovenox 30mg subcutaneously every 12 hours if you experience any of the below listed danger signs, please contact your doctor or go to the nearest emergency room. it was a pleasure taking care of you on this hospitalization. followup instructions: it is hoped that mr. will soon be traveling back to to follow up with the accepting physician: . md, dm (aiims) assistant professor national institute of mental health and neurosciences (nimhans) - office- home- fax- +91- email- .in md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus diagnoses: abdominal pain, unspecified site coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other convulsions intracerebral hemorrhage constipation, unspecified other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure other specified cardiac dysrhythmias cerebral edema methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site acute bronchitis hypovolemia ventilator associated pneumonia cerebral artery occlusion, unspecified with cerebral infarction aphasia other alteration of consciousness visual field defect, unspecified nonspecific low blood pressure reading pressure ulcer, stage ii other specified diseases of hair and hair follicles nontoxic uninodular goiter acute venous embolism and thrombosis of deep veins of upper extremity flaccid hemiplegia and hemiparesis affecting unspecified side other facial nerve disorders pressure ulcer, unspecified site 

Answer: The patient is high likely exposed to