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 / amoxicillin attending: chief complaint: icu to icu transfer for cva major surgical or invasive procedure: extubation history of present illness: the pt is a 47f yo ? hw with poorly controlled dm htn, obesity and cardiomyopathy (ef 20% on recent hospitalization at hospital, ? ishcemic), who initially presented to hospital with c/o of headache and was found to have word-finding difficulty on . at time of evaluation, she was noted to have a hypodensity oh head ct concerning for a subacute right occipital stroke. given this she was admitted for further stroke w/up, although it was understood that symptoms did not match the findings. she subsequently developed rue weakness and a repeat hct showed a large, left hemisphere hypodensity concerning for an mca infarct. she was started on heparin gtt at this time. mri/a of the head and neck was performed and revealed an acute l temporoparietal infarct, subacute right occipital infarct and an occlusion of l ica. after the mri and neurology consultation, heparing gtt was stopped given the size of the infarct in evolution. because of difficulties controlling bps and evidence of dysrhythmia (? svt, wide complex tachycardia) she was transferred to icu. on late evening patient was apparently restarted on heparin gtt for hours on heparin gtt (duration unclear), pt decompensated: became aphasic with right sided hemiparesis. she was thus intubated for "airway protection" since intubation she has been "stable...she has remained sedated and intubated, responds to verbal stimuli and moves her left side, with right side flaccid." tpn has been started for nutritional support. initial exam on was notable for normal mental status including language, r hemianopsia, vii mild paresis and right spastic hemiparesis. pt. was unable to stand on her own, needed an assisting device. pp decreased over r side of body. she was started on aggrenox per neurology recommendation and was recommended to have cta to look for "residual lumen." work up so far included telemetry (wide complext tachycardia), tte on revealed ef 20-25% (severe global hypokinesis) with dyskinetic septum, decreaed rvf and pressures in 30-40mmhg range, no source of embolus, mild mr tr w/ biatrial enlargement. tee was recommended and showed lvef as above, but no source of embolus. there was ? of sarcoidosis given adenopathy. eeg on showed background slowing and lateralization of slowing to left hemisphere w/ focality and sharp wave development, no seizure discharge. of note, she has been found to have a positive lyme titer, thus was treated with iv abx (md reporting was unsure of igg vs igm?). also of note, her blood pressures were fluctuating including max of sbp of 190. past medical history: - cardiomyopathy (ef 30%) per c/s at osh stress w/ evid of ant/inf infarcts, echo w/ ef of 30% diffuse syst. dysf. but also hx of cm in mother and grandmother. - htn - hl - dm (type ii per records) - obesity - ? sleep distubance though negative sleep study in - mediastinal adenopathy by ct scan - hx of restrictive pattern pfts - onychocryptosis social history: per osh records. single, but has 4 children (age 18-28), all healthy. was employed as a nursing assisstant, but is currently unemployed. family history: htn hl dm cva/tia cad/pvd cancer physical exam: vitals: t:99f p:60-80s r: 20 bp:145/77 sao2:98% on psv 50% fio2 w/ psv/peep of general: awake, obese cooperative, nad, intubated off sedation. heent: nc/at, no scleral icterus noted, mmm, supple. pulmonary: rhonchi and rales b/l cardiac: rr, nl. s1s2, no m/r appreciated abdomen: obese, soft, nt/nd, no masses or organomegaly noted. extremities: warm, dry, trace pedal b/l edema skin: no rashes or lesions noted. neurologic: -mental status: alert, unable to respond to orientation questions. follows axial commands but not appendicular commands reproducibly. mimics. oriented x 3. unable to asess attention. she is unable to utter any words. tracks examiner past midline, but is unable to clap (l hand does not cross midline) suggestive of right sided neglect. did not recognize her own limb. -cranial nerves: i: olfaction not tested. ii: perrl 4 to 2mm and brisk. vff impaired to threat on the right vf. spont. eye movements and room exploration is l predominant. iii, iv, vi: eomi without nystagmus, normal saccades. v: unable to assess vii: r facial droop. viii: unable to assess. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline. -motor: normal bulk, decreased tone in rue. unable to assess for drift on r, no drift on l. delt bic tri wre ffl fe io l 5 5 5 5 5 5 5 r 0 0 0 0 0 0 0 ip quad ham ta edb l 5 5 5 5 5 5 5 r 4- 5 4 5- 5 5 5 -sensory: light touch - intact in lue and lle and rle. not in rue. /not tested cold sensation - intact rue, left side vibr/proprioception - unable to assess. extinction to dss on right. -dtrs: tri pat ach l tr tr 0 1 1 r 2 2 2 2 1 plantar response: right - extensor left - flexor -coordination: can not assess. -gait: unable to assess exam at time of discharge notable for: pertinent results: labs on admission: 10:56pm blood wbc-8.4 rbc-4.86 hgb-13.1 hct-41.5 mcv-86 mch-26.9* mchc-31.4 rdw-17.9* plt ct-336 10:56pm blood pt-13.2 ptt-24.1 inr(pt)-1.1 02:54am blood pt-14.4* ptt-59.0* inr(pt)-1.3* 10:56pm blood glucose-132* urean-10 creat-0.6 na-140 k-3.7 cl-101 hco3-31 angap-12 10:56pm blood alt-12 ast-24 ld(ldh)-372* alkphos-261* totbili-0.7 04:58am blood alt-13 ast-24 alkphos-264* totbili-0.6 07:59pm blood ck-mb-1 ctropnt-<0.01 02:54am blood ck-mb-1 ctropnt-<0.01 09:14am blood ck-mb-notdone ctropnt-<0.01 10:56pm blood albumin-2.6* calcium-8.5 phos-4.1 mg-1.9 02:54am blood %hba1c-9.8* eag-235* 02:54am blood triglyc-102 hdl-47 chol/hd-3.3 ldlcalc-86 04:58am blood digoxin-0.5* imaging: cxr: findings: the patient has been intubated. the tip of the tube projects 3 to 4 cm above the carina. the tip of the newly inserted right picc line projects over the low svc. the course of the line is unremarkable. there is no evidence of complications, notably no pneumothorax. the course of the nasogastric tube is also unremarkable, the tip of the tube is not visualized on this film. there is marked cardiomegaly with perihilar blunting and dependent opacities. in combination with a slightly distended azygos vein, the image suggests pulmonary edema. the presence of a small left-sided pleural effusion cannot be excluded; on the right, no pleural effusion is seen. no focal parenchymal opacity suggesting pneumonia. osh imaging: mri osh : large wedge shape of restricted dwi in left pareital lobe. dwi of bright signal intensity in right occipital lobe w/ ehnacement after contrast administration. few small foci on flair in b/l hemispheres. mra osh: left cca patent, ica occluded at origin. and rcca are patent. patent vertebrals. supplied by aca/acom. carotid doppler - no stenosis. not complete obstruction, 99% stenosis range. anterograde flow in vertebrals. cta - limited study. evolving right occipital and high left f/p infarct with a thin rim of faint hyperdensity relating to occipital infarct keeping with a small amount of acute hemorrhage. ct head : preliminary report: 1. tiny high density foci along the right pca infarct may represent tiny areas of parenchymal bleeding, without mass effect. 2. no bleeding at left mca infarct or elsewhere. 3. evolution of previously noted infarcts without findings of new infarct. 4. stable opacification of scattered left mastoid air cells. brief hospital course: mrs. is a 47 woman with poorly controlled diabetes, hypertension, obesity and cardiomyopathy (ef 20% on recent hospitalization at hospital) who initially presented to hospital with complaints of headache and was found to have word-finding difficulty on and incidental finding of a r-occipital subacute "stroke," followed by a left temporal parietal stroke on mri, both likely of embolic origin (proximal), though tee was unrevealing. she was initially treated with a heparin gtt, then changed to asa/plavix. she was subsequently intabated for ams and rue plegia. eeg showed spikes but no epileptiform activity in the l hemisphere in addition to encephalopathy. mra revealed l ica occlusion with 99% stenosis range on doppler us. there was also concern for a hemorrhagic conversion in r occipital lobe lesion on cta. she was taken off heparin, placed on asa/plavix and transferred to for further care. neuro: exam on admission was notable for global aphasia, r neglect and vf deficit w/ rue plegia and rle paresis consistent with above described infarctions. she was admitted to neuro icu. she likely suffered a cardioembolic infarction given both ant. and post. distribution strokes in setting of severe cm and occlusion, which was felt to be also due to embolic source. there was initially a question of a hemorrhagic transformation in right occipital lobe, but this was later felt to be due to contrast leak during cta imaging in setting of impaired blood brain barrier during stroke. given likely embolic stroke and > 99% occlusion she was started on heparin gtt with ptt goal of 50-70 to prevent stump emboli. she was started on coumadin. at the time of discharge, she was transitioned on a lovenox bridge with an inr of 1.5. on the night prior to transfer , the patient attempted to stand and fell forward. neurological exam remained unchanged from the exam noted below. ct head was repeated with preliminary read of tiny high density foci along the right pca infarct that may represent a tiny area of parenchymal bleeding without mass effect. there was no bleeding at left mca infarct or elsewhere. there were no new areas of infart. neurologic exam at the time of discharge was notable for a non-fluent aphasia. she was able to follow commands. there was a slight right facial droop, right arm with a dense paresis without any movement of the fingers. the right leg was proximally. nutrition: the patient was cleared by speech and swallow evaluation for a pureed (dysphagia) diet with nectar prethickened liquids. she should continue to be assessed and avanced as she improves. cardio: the patient had severe cardiomyopathy as per hpi with biventricular failure, etiology of which was unclear. cardiology consultation at osh felt that likely cause was ischemic given stress showing "anterior and inferior infarction." patient was volume overloaded on admission and require iv lasix diuresis. her weight on arrival was 124.6kg. ldl was 86, continued on simvastatin of 80 started at the hospital. cardiology consultation was obtained to assess the need for icd and cardiac regimen. she was noted to have runs of nsvt on telemetry bt in duration. it was felt that she was a candidate for icd placement however that medical management needs to be optimized prior to placement (1mo post hospitalization and final decision was deferred to patient's cardiologist dr. . magnesium and potassium where kept at >2 and >4 respectively. initally, lisinopril was discontinued, diovan was restarted, and digoxin increased to 0.1875mg. aspirin was recommended for cad prevention, 81mg daily. carvediolol was increased for optimal blood pressure control to 34.375mg . this can continue to be uptitrated as her heart rate tolerates up to a maximum chf dose of 50mg . she is scheduled for follow up with dr. on . pulm: the patient was volume overloaded on admission (see above). she has a history of a possible sleep distubance though negative sleep study in , restrictive pattern pfts and mediastinal adenopathy by ct scan at hospital, though no definitive diagnosis has been made. she is on home oxygen of 4 l/min. she was extubated on hospital day 1 and treated with additional lasix and albuterol as needed to maintain good oxygen saturation. she was sating well (99%) on 3l at the time of discharge, though she remained somewhat tachypneic (rr ~20 with accessory muscle use). id: the patient was afebrile. she underwent a lyme ab test at osh on initial presentation for unclear reasons which had returned positive and was started there on ceftriaxone iv. this was discontinued at and w. blot analysis returned negative. endocrine: the patient had poorly controlled glucose with a hemoglobin a1c of 9.8. she was initially maintained on iss and home regimen of insulin nph. center diabetes consultation was obtained and her glargine and iss scale was adjustments were made. glargine was at 28qam at the time of discharge. sliding scale is as follows: glucose humalog 71-139 0 140-179 5 180-219 9 220-259 11 260-299 16 300-339 18 340-400 20 medications on admission: digoxin 125 mcg daily diovan 160mg daily coreg 6.25mg lasix 80mg daily metformin 500mg daily lexapro 10mg daily humalog 75/25 80u discharge medications: 1. escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). 2. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. digoxin 125 mcg tablet sig: 1-2 tablets po daily (daily). 5. valsartan 160 mg tablet sig: one (1) tablet po twice a day. 6. furosemide 40 mg tablet sig: two (2) tablet po daily (daily). 7. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 8. insulin glargine 100 unit/ml solution sig: twenty eight (28) units subcutaneous once a day: qam. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for shortness of breath. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 12. carvedilol 6.25 mg tablet sig: five (5) tablet po bid (2 times a day). 13. enoxaparin 150 mg/ml syringe sig: one (1) subcutaneous q12h (every 12 hours): until inr >2. 14. insulin aspart 100 unit/ml solution sig: per sliding scale units subcutaneous three times a day: see sliding scale. discharge disposition: extended care facility: hospital at discharge diagnosis: bilateral thromboembolic strokes with residual non-fluent aphasia and right upper extremity paralysis left ica occlusion congestive heart failure, ef 25% hypertension hyperlipidemia diabetes (insulin dependent) discharge condition: neurologic exam at the time of discharge was notable for a non-fluent aphasia. she was able to follow commands. there was a slight right facial droop, right arm with a dense paresis without any movement of the fingers. the right leg was proximally. she was hemodynamically stable. o2 sat was 99% on 3l. discharge instructions: you where admitted for evaluation of right sided weakness and difficulty speaking. you were found to have multiple strokes which were likely caused by blood clots. you were started on a medication called coumadin to thin your blood and prevent future strokes. you are being discharged to rehabilitation for further treatment. you have been scheduled for follow up in the neurology clinic as well as with your outpatient cardiologist. followup instructions: neurology provider: , md phone: date/time: 8:30 cardiology: dr. 2:15om pcp , md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances insertion of indwelling urinary catheter diagnoses: other primary cardiomyopathies congestive heart failure, unspecified unspecified essential hypertension other and unspecified hyperlipidemia long-term (current) use of insulin morbid obesity diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled cerebral embolism with cerebral infarction other specified hemiplegia and hemiparesis affecting unspecified side acute on chronic systolic heart failure aphasia facial weakness personal history of allergy to penicillin late effects of other and unspecified infectious and parasitic diseases paroxysmal tachycardia, unspecified ingrowing nail 

Answer: The patient is high likely exposed to