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: ams major surgical or invasive procedure: left craniectomy, evacuation of left ich, partial temporal lobectomy dobhoff placement peg placement, dr. . history of present illness: ms. is a 60 year old female with history significant for hypertension, cocaine and alcohol abuse who presented to after she began to develop altered mental status including speech disturbance and right sided hemiparesis. her son reports she was involved in an altercation earlier in the day where she most likely struck her head. upon presentation to her left pupil was dilated and right was small and reactive, she was not moving her right side to noxious. her respiratory status was tenuous and she was emergently intubated. ct scan of the brain showed a large left iph with midline shift and mass effect. she was not on any anticoagulation and her bp upon arrival was 200's systolic. past medical history: past medical history: #hypertension #glaucoma nos #alcohol abuse #cocaine abuse #tobacco dependency #peptic ulcer disease #hx breast lump #hepatitis c #myocardial infarction, subendocardial assoc. w/ cocaine social history: the patient is widowed and lives with her son. she has a long history of cocaine use; last known use was a week prior to presentation. she has a long history of alcohol use, and finishes gallon of hard liquor every 2 days. she was in a rehab for one month in , but has continued to drink alcohol since then. she also has a long history of 1 pack per day cigarette smoking. family history: (per son, : father with stroke at age 78 and seizures in the context of alcohol use. physical exam: admission physical exam: gen: intubated and sedated heent: pupils: left 4mm nr right pinpoint neck: supple.lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: sedated, intubated, no commands orientation: unable to obtain language: intubated cranial nerves: i: not tested ii: left pupil 4mm nr, right pupil pinpoint iii-xii: unable to assess given clinical status motor: rue and rle flaccid, lue and lle weak withdrawal sensation: unable to assess toes mute coordination: unable to asses at discharge: she is awake and alert. she intermittently follows commands. she was oriented to self. pertinent results: admission labs: 01:56am blood wbc-8.2# rbc-3.92* hgb-13.2 hct-40.2 mcv-103* mch-33.6* mchc-32.8 rdw-12.1 plt ct-298 01:56am blood neuts-87.7* lymphs-10.4* monos-1.3* eos-0.2 baso-0.4 01:56am blood pt-10.1 ptt-25.4 inr(pt)-0.9 01:56am blood glucose-135* urean-10 creat-0.5 na-139 k-3.3 cl-98 hco3-22 angap-22* 01:56am blood calcium-9.3 phos-3.8 mg-1.6 02:28am blood type-art rates-16/0 tidal v-450 peep-5 fio2-100 po2-455* pco2-39 ph-7.38 caltco2-24 base xs--1 aado2-219 req o2-45 -assist/con intubat-intubated 02:28am blood lactate-3.6* 04:57am blood hgb-10.8* calchct-32 o2 sat-98 cohgb-1 methgb-0.3 04:57am blood freeca-0.99* reports: nchct : impression: 1. large left temporoparietal intraparenchymal hemorrhage with extension in the left lateral ventricle and surrounding edema resulting in sulcal effacement and 7 mm of rightward shift of midline structures. basal and suprasellar cisterns appear patent with a small amount of effacement. 2. underlying lesion is not excluded on this study. cxr : impression: mild vascular congestion with satisfactory position of endotracheal tube. cta : impression: 1. stable large left temporal and parietal intraparenchymal hemorrhage, causign aterior displacement of the left middle cerebral artery as described in detail above, with no frank evidence of aneurysms larger than 2 mm in size. slightly prominent venous structures surrounding the left middle cerebral artery, possibly representing crowded vessels due to mass effect, however, underlying conditions including vascular malformations cannot be completely ruled out. followup is recommended after complete resolution of the hematoma. 2. the posterior circulation, right middle and anterior cerebral arteries are grossly unremarkable. ct c-spine : impression: 1. no fracture with mild en bloc retrolisthesis of c5 and c6 on c7 which is likely degenerative. multilevel degenerative disease results in moderate canal narrowing, most pronounced at c5-c6. 2. a large amount of secretions and fluid are seen in the nasal and oropharynx. postop nchct : impression: marked reduction in the left temporoparietal intraparenchymal hemorrhage after craniectomy and evacuation, with expected post-operative appearance and decreased mass effect as above. mri brain - findings related to the left temporoparietal intraparenchymal hemorrhage and left craniectomy are similar in appearance to the most recent head ct. subdural blood is likely a sequela of the craniectomy. no new hemorrhage identified. 2. given the limitations on the prior cta, repeat vascular imaging to rule out avm as the underlying cause of the hemorrhage is recommended once there has been sufficient clearing of intraparenchymal blood. cxr - dobhoff placed in stomach left upper extremity u/s - significantly limited study due to patient's condition. normal flow is seen in portions of the brachial and basilic veins, but the entire veins could not be assessed and a focal thrombus could be missed. the remainder of the left upper extremity veins could not be evaluated. portable abdomen- ng tube in the stomach. nonspecific bowel gas pattern. ct abdomen- impression: 1. no evidence of surgical change within the abdomen; colon is interposed between the gastric body and abdominal wall as above. 2. 7-mm right lower lobe pulmonary nodule for which followup in months is required if the patient is low risk for primary lung neoplasm, or 3-6 months if patient is high risk according to society guidelines. 3. mild left basal bronchial wall thickening, correlate with infectious or inflammatory symptoms. lenis: impression: 1. no right lower extremity deep venous thrombosis. augmentation could not be performed on the right. 2. unable to perform the left lower extremity due to patient's inability to cooperate. brief hospital course: is a 60 year old woman who presented with ams with respiratory decompensation and hypertension found to have a large left iph. she was given mannitol and keppra in the er and a cta was obtained which showed no gross evidence of aneurysm. the patients exam was consistent with flaccid right side. the patients left side withdrew minimally to noxious stimulus. the right pupil was pinpoint and the left pupil was 3mm and non reactive. the patient had both cough and corneal reflexes. after discussion with the family she was taken to the or emergently for left hemicraniectomy, left temporal lobectomy, and partial clot evacuation. after surgery, she did well and was able to be extubated. after extubation, it became clear that she had both receptive and expressive aphasia. post operatively, the patient was unable to follow commands the patient tracked with her eyes and smiled. the patient was verbal but non sensical and difficult to understand. the patient was purposeful/antigravity with the bilateral upper extremities. the patient exhibited spontaneous/antigravity movement in the left lower extremity. the patient a small amount of movement in the right lower extremity. a non contrast head ct was performed and consistent with expected post operative changes. a ciwa scale was initiated for etoh withdrawal. on , a urine toxicology screen was positive for cocaine. decadron continued. the patient was found to be hypertensive with a systolic blood pressure of 160 and a clonidine patch was initiated. subcutaneous heparin was initiated for deep vein thrombosis prophylaxis. on , a helmet was ordered for the patient to be worn at all times when the patient is out of bed given her craniectomy. the decadron wean was initiated and the blood pressure goal was libralized to 100-160. a mri was performed which was consistent with previous known left temporoparietal intraparenchymal hemorrhage and left craniectomy. there was no new hemorrhage identified or vascular anomaly. on , she continued to be confused and agitated requiring haldol and zyprexa. she was noted to have a lue swelling at iv site. this was removed and a lue u/s was obtained which showed no dvt although study was incomplete. a dobbhoff was placed in routine fashion and a cxr confirmed placement. on tfs were initiated and nutrition was consulted. acs was also consulted for peg placement. physical and occupational therapy consults were placed. a speech and swallow consult was also consulted but was deferred due to patient's mental status as of . acs was called to evaluate her for peg. she had a kub to evaluate her abdomen as she has a surgical scar from an unknown procedure. tube feeds were started. she was put on bactrim for a positive u/a. on , a ct abdomen was ordered for further evaluation for peg placement. this confirmed no surgical changes. exam remains unchanged. family meeting was held updating them of the current plan of care. on she was on the add on list for peg placement. she remained neurologically stable and was cleared for transfer to the floor from stepdown. she underwent peg placement on and was restarted on tube feeds on . she continued to be agitated and she was switched from standing zyprexa with prn valium to standing and prn seroquel. she remained stable through while awaiting rehab placement. she pulled out her foley and was incontinent of urine post-pull. bladder scan was done and she was not retaining urine. she was offered a rehab bed at however the family initially declined the bed and subsequently rescinded the bed offer. on , the patient continued to follow commands, her eyes were open spontaneously, she was verbalizing and moving all four extremities with equal strength. the patient was asking to eat. speech and swallow was re-consulted giving improved exam. she continued to require restraints as she was impulsive and attempting to get out of bed. on , the patients exam was stable. intervenous fluid was discontinued. on , the patient passed her swallow exam and was initiated on a diet of thin liquids/soft solids. the patient continued to be screened for rehabilitation. she continued to require restraints as she was impulsive attempting to get out of bed. on she was following commands and doing well with her meals. tf were stopped. she had a uit and antibiotics were started on for a 7 day course. she was discharged to on , tolerating a regular diet, ambulating with assistance, afebrile with stable vital signs. medications on admission: discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever/pain: max 4g/day. 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 3. levetiracetam 100 mg/ml solution sig: one (1) gram po bid (2 times a day). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 6. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 7. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 8. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day). 9. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day). 10. multivitamin tablet sig: one (1) tablet po daily (daily). 11. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 12. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmon (every monday). 13. hydralazine 25 mg tablet sig: one (1) tablet po q6h prn () as needed for sbp >160. 14. metoprolol tartrate 25 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for sbp>160mmhg or hr >120: hold hr < 55 . 15. quetiapine 25 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for agitation. 16. quetiapine 25 mg tablet sig: one (1) tablet po bid (2 times a day). 17. insulin regular human 100 unit/ml solution sig: two (2) units injection asdir (as directed): see sliding scale. 18. nitrofurantoin monohyd/m-cryst 100 mg capsule sig: one (1) capsule po q12h (every 12 hours) for 7 days. discharge disposition: extended care facility: - discharge diagnosis: cocaine use htn left intracerebral hemorrhage cerebral edema with herniation seizures acute mental status change respiratory failure malnutrition agitation confusion discharge condition: level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. mental status: confused - always. discharge instructions: general instructions - helmet at all times when oob ?????? 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. ?????? your wound closure are dissolvable sutures, you may now get this area wet. ?????? 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 when cleared by your neurosurgeon. ?????? you have been prescribed keppra (levetiracetam), you will not require blood work monitoring. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. if diet advancement goes well, please call dr. office for removal of your peg. the number is 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 ( to schedule an appointment with dr. , to be seen in __4__weeks. ??????you will need a ct scan of the brain without contrast. you should follow up with your pcp. was noted that you have pulmonary nodules on your ct scan and its recommended that these are followed every 6-12 months. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] other incision of brain other repair of cerebral meninges diagnoses: tobacco use disorder urinary tract infection, site not specified unspecified essential hypertension unspecified protein-calorie malnutrition unspecified viral hepatitis c without hepatic coma unspecified glaucoma cocaine abuse, unspecified compression of brain cerebral edema old myocardial infarction epilepsy, unspecified, without mention of intractable epilepsy dysarthria unarmed fight or brawl drug withdrawal alcohol abuse, continuous aphasia other and unspecified alcohol dependence, continuous alcohol withdrawal other urinary incontinence personal history of peptic ulcer disease other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness acute respiratory failure following trauma and surgery physical restraints status flaccid hemiplegia and hemiparesis affecting unspecified side 

Answer: The patient is high likely exposed to