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: history of present illness: the patient is a 59-year-old woman with a history of hypertension, diabetes, hypercholesterolemia, and obesity, who presented with the sudden onset of difficulty speaking. she had been known to be speaking normally at approximately 6:05 p.m. on the day of admission. at 6:30 p.m., she was seen by her family and was noted to have difficulty speaking. the sounds that were coming out did not sound like actual words. it was unclear if she understood what was being said to her. there may have been some right-sided facial weakness. she was brought to the emergency department. in the emergency department, she was noted by the neurology resident and stroke fellow to have wernicke's type aphasia. head ct was negative for bleed. blood sugar on arrival was 468, and this improved to 288 after insulin. blood pressure was as high as the 200s, and this improved with labetalol. given the fact that she had multiple vascular risk factors and presented within the thrombolytic window, she was given intravenous tpa. she was then admitted to the intensive care unit for monitoring, status post tpa. past medical history: 1. hypertension. 2. diabetes. 3. obesity. 4. asthma. 5. hidradenitis suppurativa. 6. osteoarthritis. medications on admission: according to ccc, the family was not aware of her medications: albuterol q.i.d., combivent 2 puffs q.i.d., diovan 320 mg q.d., doxycycline 100 mg b.i.d., duricef 500 mg b.i.d., flovent 110 mcg 2 puffs b.i.d., glyburide 10 mg q.a.m., 5 mg q.p.m., lipitor 10 mg q.d., metformin 850 mg q.a.m., 1700 mg q.p.m., zantac 150 mg b.i.d., rhinocort nasal spray, aspirin 325 q.d., naproxen 500 mg b.i.d. p.r.n. pain. allergies: avandia causes shortness of breath, ace inhibitor unknown reaction. social history: the patient is divorced. she has three children. she is a retired librarian. she has a 15 pack-year history; she quit ten years ago. she rarely drinks alcohol. there is no other drug use. physical examination: vital signs: on admission temperature was 97.8??????, blood pressure 165/66, pulse 88, respirations 18, oxygen saturation 99%. general: this was an obese african-american woman in no acute distress. neck: supple. no carotid bruits. lungs: normal. cardiovascular: normal. abdomen: normal. there was a superficial nodule in the right groin area oozing some pus and blood. mental status exam: exam showed her to be awake and alert. she was oriented to person but not to place or date. she attended to the examiner but was difficult to formally assess attention due to her language deficit. she was intermittently fluent with her best phrase length greater than five words, but she spoke in word phrases. she was unable to repeat. she was able open and close her eyes, but no other commands. on cranial nerve testing, she had decreased blink to threat on the right. her pupils were equal, round and reactive to light. her extraocular movements were intact. her face was symmetric. her tongue was midline. on motor testing, there was at least 4+ strength throughout. sensation was intact to pain in all four extremities. reflexes were symmetric. toes were downgoing. laboratory data: on admission white blood cell count was 11.6, hospital course 39.1, platelet count 197; sodium 134, potassium 4.1, chloride 96, bicarb 28, bun 19, creatinine 1, glucose 425; calcium 9.2, magnesium 1.4, phosphorus 4.2; pt 13.2, ptt 21.7; urinalysis showed white blood cells. head ct was negative. electrocardiogram showed normal sinus rhythm. in summary this was a 59-year-old woman with multiple vascular risk factors who presented with a wernicke type aphasia. although the differential diagnosis included stroke versus seizure versus metabolic derangement, given her vascular risk factors, stroke was felt to be most likely. she was therefore given intravenous tpa. hospital course: the patient was monitored in the neurology intensive care unit with close neurologic checks. she was unable to go to mri due to her size. repeat head ct showed no signs of stroke. cta showed an area of stenosis at the origin of the superior division of the left middle cerebral artery. carotid ultrasound showed no evidence of carotid stenosis bilaterally. a transthoracic echocardiogram was suboptimal due to poor echo windows. she therefore went for transesophageal echocardiogram which showed a patent foramen ovale with an interatrial septum which was aneurysmal. there was a bidirectional shunt across the interatrial septum at rest. there was mild symmetric left ventricular hypertrophy. left ventricular ejection fraction was greater than 55%. there was mild tricuspid regurgitation and mild mitral regurgitation. electroencephalogram was normal. given this data, it was felt that the most likely diagnosis was still transient ischemic attack or stroke possibly due to her paradoxical embolism across the pfo. she was therefore started on heparin with a goal ptt between 45 and 65. she was very refractory to heparin and required very large doses in order to maintain this goal. she was transitioned to coumadin, and again was very refractory, requiring doses as high as 15 mg. her goal inr is between 2 and 3. inr at the time of this dictation is 1.7. prior to starting coumadin, a full hypercoagulation panel was sent. this was notable for an elevated factor 8 level of 342. lupus anticoagulant was negative. antithrombin iii was normal. protein c was normal. homocystine was normal. prothrombin gene mutation is pending. factor is pending. protein s was normal. anticardiolipin antibodies were negative. hemoglobin a1c was elevated at 10.6. over the course of the first several days, the patient showed significant improvement. she essentially regained small speech and language function and had a normal exam at the time of this dictation. cardiovascular: echocardiogram revealed a pfo with an interatrial septal aneurysm as above. fluids, electrolytes, and nutrition: the patient's sugars were followed closely. the service assisted with the management. sugars came under much better control using a single daily dose of glargine, as well as oral agents. heme: as above in infectious disease, the patient had a urinary tract infection on admission with klebsiella pneumonia which was treated with levofloxacin. she had one blood culture positive for coagulase-negative staph, which was likely contaminant. she grew yeast from urine culture, but this cleared after removal of the foley. in summary, the patient is a 59-year-old woman with hypertension, hypercholesterolemia, and diabetes, who presented with the sudden onset of language disturbance thought most likely to be a transient ischemic attack. she has improved significantly. she has been found to have a pfo and will have anticoagulation. condition on discharge: stable. discharge status: home. discharge diagnosis: 1. left mca territory transient ischemic attack status post intravenous tpa. 2. hypertension. 3. hypercholesterolemia. 4. diabetes mellitus. discharge medications: coumadin dose to be determined, glargine 20 u q.h.s., glyburide 10 mg p.o. q.a.m., 5 mg p.o. q.p.m., metformin 500 mg p.o. b.i.d., pantoprazole 40 mg p.o. q.d., albuterol 1 nebulizer q.6 hours p.r.n. wheezing, atorvastatin 10 mg p.o. q.d., colace 100 mg p.o. b.i.d. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart injection or infusion of thrombolytic agent diagnoses: urinary tract infection, site not specified unspecified essential hypertension ostium secundum type atrial septal defect aphasia other specified transient cerebral ischemias aneurysm of heart (wall) other musculoskeletal symptoms referable to limbs congenital factor viii disorder carbuncle and furuncle of trunk 

Answer: The patient is high likely exposed to