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 attending: chief complaint: brain mass major surgical or invasive procedure: r frontal craniotomy for tumor resection history of present illness: pt is a 68 yo rh female w/ pmhx sig for rheumatic fever s/p mvr with mechanical valve, atrial fibrillation/flutter s/p ablation on coumadin who presents as transfer from after ct showed large r frontal brain mass. the patient's family noticed that she has been confused for the last few days. it took her six hours to get home from her sister's house - normally takes 40 minutes. she has been forgetful and not as outgoing. the patient describes having frontal headaches waking her from sleep over the last 2.5 weeks. 2 weeks ago she did endure a bad cold with fever but took a z-pack and it resolved. today the family noted the patient to be confused with a l facial droop. she was brought to where she was found to have a 3.7 x 3.7 cm r frontal brain mass with vasogenic edema. she was given 10 mg of decadron and transferred to . past medical history: rheumatic fever s/p mvr with mechanical valve, atrial fibrillation/flutter s/p ablation currently on coumadin, r knee arthroscopy for meniscus tear, lue surgery for bursitis. social history: lives with husband. smoked for 15 years, quit > 20 years ago. retired electrical technician. 2 glasses of wine/month. family history: father - deceased throat cancer. mother - deceased heart disease. brother - deceased pancreatic cancer physical exam: on admission: vitals: t ; bp 148/64; p 54; rr 18; o2 sat 96% general: lying in bed nad heent: ncat, moist mucous membranes neck: supple pulmonary: bronchial breath sounds an l lower base. cardiac: regular rate and rhythm, with no m/r/g carotids: no blood flow murmur extremities: no c/c/e. neurological exam: mental status: a & o x3, unable to say moyb. fluent speech with no paraphasic or phonemic errors. adequate comprehension. follows simple and multi-step commands. registers , recalls at 30 sec and 5 min. repetition intact (no ifs, ands or buts). able to name low and high frequency objects. no left/right mismatch. no apraxia/neglect. /writing intact. clock drawing shows good planning. cranial nerves: i: not tested ii: perrl, 4-->2mm with light. iii, iv, vi: eomi. no nystagmus. v, vii: facial sensation intact, l umn facial droop viii: hearing intact b/l to finger rubbing. ix, x: palatal elevation symmetric. : scm xii: tongue midline without fasciculations. motor: normal bulk. normal tone. no pronator drift. orbits left hand on spinning. delt tri we wf fe ff ip qd ham df pf edb c5 c7 c6 c8 l2 l3 l4-s1 l4 l5 l5 rt: 5 5 5 5 5 5 5 5 5 5 5 5 5 5 left: 5- 5- 5 5 5 5 5 5 5 5 5 5 5 5 sensation: intact to light touch, cold. decreased to vibration in toes. reflexes: 1+ symmetric. toes downgoing bilaterally. coordination: fnf intact. on discharge: as above. neurologically intact. incision clean, dry and intact pertinent results: mr head w/ contrast 1. large, heterogeneous and multilobulated right frontal lobe mass with central necrosis and extensive peripheral zone of edema, causing 12 mm leftward subfalcine herniation and effacement of the right lateral ventricle, with no sign of transtentorial or tonsillar herniation. 2. anterior aspect of the tumor extends inferiorly to the peripheral margin of the sylvian fissure with focal overlying dural enhancement, raising question of pial involvement and transgression. the overal appearance is most suggestive of high-grade primary glial neoplasm, e.g. glioblastoma multiforme. ct torso: 1. no ct evidence of intrathoracic or intra-abdominal malignant process. no mass or lymphadenopathy. 2. 2-mm right middle lobe pulmonary nodule. recommend followup in one year with ct chest. 3. status post mitral valve replacement with intact sternotomy wires. 4. 12-mm left-upper-pole likely renal cyst. mr head w & w/o contrast status post resection of right frontal lobe mass. expected post-surgical changes are seen with mild residual enhancement on the medial aspect of the surgical cavity. no evidence of acute infarct or hydrocephalus seen. ct head : impression: 1. right frontal lobe post-surgical changes without evidence for hemorrhage. 2. stable edema, mass effect and midline shift. 3. improving pneumocephalus. ct head : 1. stable right frontal encephalomalacia with expected postoperative changes. 2. stable leftward shift of midline structures. 3. hypodensity in right caudate head, which likely represents evolving infarct when correlated with previous imaging. discharge labs: 05:10am blood wbc-5.4 rbc-3.63* hgb-11.1* hct-33.3* mcv-92 mch-30.5 mchc-33.2 rdw-14.3 plt ct-204 05:52am blood neuts-78.2* lymphs-15.2* monos-5.5 eos-1.0 baso-0.1 05:10am blood pt-25.7* ptt-26.5 inr(pt)-2.5* 05:10am blood glucose-93 urean-11 creat-1.2* na-139 k-4.1 cl-103 hco3-26 angap-14 05:10am blood calcium-9.2 phos-3.2 mg-2.3 05:52am blood alt-30 ast-22 totbili-0.5 brief hospital course: 68 y/o f with past medical history significant for rheumatic fever and mvr with a-fib and a-flutter presents s/p few days of confusion noticed by her family. head ct at osh showed large frontal mass. she was transferred to for further neurosurgical workup. mri confirmed the left frontal mass and revealed a ring enhancing lesion. metastatic work up revealed no lesions elsewhere in the body. she was admitted to the neurosurgical service for resection of mass. cardiology was consulted due to her cardiac history and her need for anticoagulation. patient went to the or on for a r frontal craniotomy which was uncomplicated intraoperatively. she remained stable post operatively and was transferred to the floor from the icu on . her decadron was being weaned. on , patient developed bradycardia to the 30s in which she has been asymptomatic. cardiology was reconsulted. their recommendations after speaking with patient's outpatient cardiologist were to decrease amiodarone dose to 300mg/200mg. it is known that the patient has a history of asymptomatic bradycardia. they also recommended that we continue to bridge her over to coumadin from heparin with a gaol ptt of 60. on , her ptt was 23.6 and her heparin gtt was increased to 800u/hr. her ptt did not increase by much in 6hrs, her heparin drip was increased again to 1000u/hr. on , her ptt was 41, noncontrast head ct ordered and coumadin will be started. non contrast head ct stable, coumadin was started at 10mg and we will monitor inr. on , patient complained of severe headache, valium and fiorcet were started. a head ct was repeated, which demonstrated no changes and no acute incracranial process. on , the patient was noted to have very l facial droop, and no other significant findings. neurology was consult to rule out the possibility of seizure, but they did not feel that this was a possiblity. they recommended adjustment of anti-seizure medications, checking lfts to rule out encehpalopathy. on her ppt was 79, and the heparin was decreased on 1000. inr was 2.1. on her ppt was 71, inr 2.6. she was discharged to home with 5mg coumadin daily and instrcutions to have her inr checked at her pcp's office on monday. medications on admission: coumadin, vitamin d, amiodarone 750 mg qod/500 mg qod. discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal q6h (every 6 hours) as needed for hemorrhoids. 3. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 4. menthol-cetylpyridinium 3 mg lozenge sig: lozenges mucous membrane prn (as needed) as needed for sore throat. 5. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po hs (at bedtime) as needed for sleep. 6. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q12h (every 12 hours) as needed for constipation. 7. amiodarone 200 mg tablet sig: one (1) tablet po every other day (every other day). disp:*60 tablet(s)* refills:*0* 8. amiodarone 200 mg tablet sig: 1.5 tablets po every other day (every other day). disp:*60 tablet(s)* refills:*0* 9. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for headache. disp:*30 tablet(s)* refills:*0* 10. diazepam 5 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain/anxiety. 11. warfarin 5 mg tablet sig: one (1) tablet po daily (daily): make sure you have your inr checked on monday. disp:*20 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: r frontal brain mass - gbm bradycardia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ?????? 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 sutures and/or staples have been removed. if your wound closure uses dissolvable sutures, you must keep that area dry for 10 days. ?????? 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 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 . if you haven been discharged on keppra (levetiracetam), you will not require blood work monitoring. ?????? 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 return to the office in days(from your date of surgery) for 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. you will not need an mri of the brain you have an appointment with the brain clinic on at 11:30. this is located on the of the building, located on the . you should follow up with your cardiologist or primary care physician next week, and should have your inr rechecked. procedure: other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain other immobilization, pressure, and attention to wound diagnoses: toxic encephalopathy atrial fibrillation personal history of tobacco use atrial flutter heart valve replaced by other means other specified cardiac dysrhythmias cerebral edema long-term (current) use of anticoagulants malignant neoplasm of frontal lobe 

Answer: The patient is high likely exposed to