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: patient recorded as having no known allergies to drugs attending: chief complaint: fevers/malaise major surgical or invasive procedure: mechanical ventilation left parietal embolectomy history of present illness: 43 year old male, with history of iv drug abuse (cocaine/oxycontin) and hepatitis c, presents from osh after experiencing fevers, abdominal pain, shortness of breath, and malaise. hx is somewhat limited secondary to patient's lethargy. per patient and girldriend, he has been having fevers at night for a little less than a week, with night sweats. his girlfriend took his temperature 2 nights prior to admission and was found to be 103.2. over the last few days he has felt "tired" but continued to use iv drugs and drink etoh. patient drinks 1-2 liters of rum daily and shoots cocaine and oxycontin. last drank alcohol 3 days prior to admission. last used cocaine 3 days prior to admission and last used oxycontin 1 day ago. patient was trying to self detox and describes becoming very ill last time he attempted detox. he also complains of abdominal pain, with one episode of non-bloody emesis today. patient also endorses feeling shortness of breath, worse in the evenings when at rest over the past three days. he denies any chest pain. there was some concern of assymetric swelling of right calf but this has since improved per girlfriend. otherwise he denies changes in vision, weakness. he went to osh and vs were tm 103.3, hr 143, bp 126/86, 93% on ra. his ecg showed sinus tachycardia, an echocardiogram showed mitral valve vegetation and mr (no report), and ct chest/abd/pelvis showed splenic, renal and hepatic infarction. an rle us was done, no official report, but reportedly negative for dvt. patient was started on vancomycin and zosyn, and also got toradol, zofran and 2mg ativan. he was transferred to for further work up. at , patient arrived in ed with vs: 98.4 108/72 104 20s 80s on ra. he improved on a nrb to the mid 90s. exam notable for a murmur. labs notable for wbc 40s, 89% polys, neg serum alcohol/benzos, lactate 1.6, abg: 7.45/38/128/27. he received one dose of gentamicin. a head ct was done and prelim showed: with 8mm hypodense area in right frontal periventricular region. while on the floor, patient complained of shortness of breath, restlessness, and abdominal pain. he denied chest pain, fevers since the am. past medical history: cardiac history: questioned distant history of mi associated with drug use per girlfriend abuse/ivda/alcoholism --ivdu x 22 yrs (cocaine, oxycodone)- last use 40mg oxycodone injected a few hours prior to presentation at osh () hepatitis c dx 6 years ago -->hcv ab + but vl ndetectable social history: -owns tree clipping business -tobacco history: 2-3ppd for unclear number of years -etoh: 1-2 liters of rum daily -illicit drugs: iv admin of cocaine and oxycontin, ivda since years old physical exam: admission exam: vs: t=36.4 hr=112 rr=33 o2 sat=97% on 15l with nrb general: arousable, closing eyes in middle of question. oriented x3. cooperative. using respiratory accessory muscles heent: sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with no elevation in jvp cardiac: rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4;however, difficult to accurately assess with lung sounds lungs: appeared in respiratory distress using accessory muscles. late expiratory wheeze throughout, poor air movement throughout, decreased breath sounds at bases with occsional crackles. no chest wall deformities, scoliosis or kyphosis. abdomen: mildly distended, diffusely tender with voluntary guarding, worse in ruq, hepatomegaly to 4cm below lateral costal border. abd aorta not enlarged by palpation. no evidence of caput medusa. extremities: no peripheral edema. right calf measured 1/2inch greater than left, no edema or erythema. skin: no evidence of lesions, osler nodes, or splinter hemorrhages. lesion on right index finger patient states is an old cut. no stasis dermatitis, ulcers, scars, or xanthomas. no evident spider angiomas. neuro: cnii-xii intact, strenght bilaterally, sensation grossly intact, no evidence of tremor or asterixis. . discharge exam: tmax: 98.4 t current: 97.1 bp: 116-131/73-83 hr 120-128 97% ra last 24 hours: i= 960 o= 1775 and incontinent last 8 hours: i= 680 o= 400 + incontinent . general: alert. oriented x2. cooperative, calm. heent: sclera anicteric. neck: supple with no elevation in jvp, no lad cardiac: tachy, rrr, normal s1, s2. 3/6 systolic murmur at apex, now non radiating to right and carotids. lungs: clear to auscultation anteriorly and posteriorly abdomen: soft, nt, nd, +bs extremities: no peripheral edema. left arm picc line c/d/i skin: no evidence of lesions, osler nodes, or splinter hemorrhages. neuro: cn2-12 intact. left sided extremities 5/5 strength. weakness on right upper and lower extremeties (starting to lift right arm to gravity for 1-3 seconds), can move fingers, hip and toes. follows all commands. markedly improved since . pertinent results: labs on discharge: xxxx 10:05am blood wbc-46.8*# rbc-4.16* hgb-11.9*# hct-35.8* mcv-86 mch-28.6 mchc-33.3 rdw-13.8 plt ct-251 05:00am blood wbc-28.0* rbc-3.88* hgb-11.1* hct-33.3* mcv-86 mch-28.6 mchc-33.3 rdw-13.8 plt ct-268 04:30am blood wbc-23.5* rbc-3.61* hgb-10.5* hct-30.6* mcv-85 mch-29.1 mchc-34.4 rdw-13.8 plt ct-294 05:16am blood wbc-20.1* rbc-3.75* hgb-10.9* hct-31.1* mcv-83 mch-29.1 mchc-35.2* rdw-13.6 plt ct-510* 05:04am blood wbc-21.9* rbc-4.03* hgb-11.3* hct-32.9* mcv-82 mch-28.1 mchc-34.5 rdw-13.7 plt ct-591* 06:00am blood wbc-23.0* rbc-4.04* hgb-11.6* hct-33.9* mcv-84 mch-28.7 mchc-34.2 rdw-13.7 plt ct-667* 07:30am blood wbc-17.7* rbc-4.30* hgb-12.1* hct-34.8* mcv-81* mch-28.1 mchc-34.6 rdw-14.4 plt ct-720* 04:58am blood wbc-18.2* rbc-4.57* hgb-12.6* hct-38.1* mcv-83 mch-27.6 mchc-33.1 rdw-14.7 plt ct-768* 06:00am blood neuts-80* bands-0 lymphs-13* monos-5 eos-2 baso-0 atyps-0 metas-0 myelos-0 07:30am blood neuts-79.6* lymphs-12.8* monos-5.7 eos-1.2 baso-0.7 10:05am blood pt-12.8 ptt-29.9 inr(pt)-1.1 10:05am blood plt smr-normal plt ct-251 05:00am blood pt-14.3* ptt-28.7 inr(pt)-1.2* 05:00am blood plt ct-268 03:38am blood pt-13.6* ptt-26.6 inr(pt)-1.2* 03:38am blood plt ct-519* 03:13am blood plt ct-584* 05:16am blood pt-13.7* ptt-27.1 inr(pt)-1.2* 05:16am blood plt ct-510* 02:31am blood plt ct-650* 02:22am blood plt ct-627* 07:30am blood plt ct-720* 10:05am blood glucose-116* urean-12 creat-0.6 na-133 k-4.7 cl-97 hco3-27 angap-14 10:25pm blood glucose-105* urean-13 creat-0.4* na-132* k-4.4 cl-100 hco3-27 angap-9 05:00am blood glucose-118* urean-15 creat-0.4* na-134 k-4.6 cl-99 hco3-27 angap-13 04:50pm blood urean-14 creat-0.4* na-134 k-4.3 cl-96 03:38am blood glucose-126* urean-15 creat-0.4* na-129* k-4.1 cl-93* hco3-30 angap-10 03:13am blood glucose-123* urean-20 creat-0.5 na-135 k-4.6 cl-98 hco3-31 angap-11 05:04am blood glucose-95 urean-15 creat-0.4* na-139 k-3.8 cl-101 hco3-29 angap-13 06:00am blood glucose-79 urean-12 creat-0.3* na-134 k-4.1 cl-96 hco3-28 angap-14 02:31am blood glucose-99 urean-11 creat-0.4* na-134 k-4.0 cl-100 hco3-25 angap-13 02:22am blood glucose-105* urean-12 creat-0.5 na-134 k-4.1 cl-98 hco3-28 angap-12 04:58am blood glucose-103* urean-13 creat-0.6 na-134 k-4.2 cl-97 hco3-26 angap-15 05:39am blood alt-14 ast-18 ld(ldh)-213 alkphos-71 totbili-0.3 07:30am blood alt-20 ast-20 ld(ldh)-230 alkphos-65 totbili-0.3 04:58am blood alt-21 ast-20 ld(ldh)-235 alkphos-72 totbili-0.3 02:33pm blood ck-mb-23* mb indx-16.0* ctropnt-0.19* 05:00am blood ck-mb-17* mb indx-21.5* ctropnt-0.22* 11:06am blood ck-mb-14* mb indx-11.3* ctropnt-0.18* 10:05am blood lipase-9 04:30am blood lipase-11 10:05am blood albumin-2.9* calcium-8.1* phos-4.2 mg-2.2 10:25pm blood calcium-7.7* phos-5.0* mg-2.1 05:00am blood calcium-8.0* phos-4.5 mg-2.1 05:16am blood calcium-8.6 phos-4.2 mg-2.3 05:04am blood calcium-8.3* phos-3.5 mg-2.1 06:25am blood calcium-9.0 phos-5.0* mg-2.3 02:22am blood calcium-8.7 phos-3.9 mg-2.2 04:58am blood calcium-9.7 phos-4.8* mg-2.3 04:30am blood triglyc-147 05:39am blood triglyc-144 03:38am blood triglyc-93 02:49pm blood osmolal-283 07:44pm blood osmolal-282 03:41am blood osmolal-281 05:39am blood rheufac-11 crp-70.4* 04:30am blood genta-1.0* vanco-5.2* 05:39am blood genta-0.4* 10:05am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 10:18am blood po2-128* pco2-38 ph-7.45 caltco2-27 base xs-3 comment-no clinica 01:30pm blood type- po2-104 pco2-39 ph-7.45 caltco2-28 base xs-2 06:43pm blood type-art po2-44* pco2-40 ph-7.46* caltco2-29 base xs-4 06:22am blood type-art temp-37.7 po2-120* pco2-49* ph-7.45 caltco2-35* base xs-9 08:36am blood type-art rates-/33 tidal v-464 peep-5 fio2-50 po2-80* pco2-43 ph-7.48* caltco2-33* base xs-7 intubat-intubated vent-spontaneou 05:01pm blood type-art peep-5 po2-86 pco2-43 ph-7.50* caltco2-35* base xs-8 intubat-intubated 03:26am blood type-art temp-37.9 rates-/23 tidal v-570 peep-5 fio2-50 po2-83* pco2-44 ph-7.49* caltco2-34* base xs-9 intubat-intubated vent-spontaneou 05:26am blood type-art temp-37.8 peep-5 fio2-50 po2-77* pco2-47* ph-7.46* caltco2-34* base xs-8 intubat-intubated vent-spontaneou 12:40pm blood type-art po2-109* pco2-37 ph-7.47* caltco2-28 base xs-3 11:29pm blood lactate-1.0 k-4.2 03:26am blood lactate-0.9 11:29pm blood o2 sat-98 03:26am blood o2 sat-95 11:35am urine color-yellow appear-clear sp -1.010 10:30am urine color-yellow appear-clear sp -1.037* 03:51pm urine color-straw appear-clear sp -1.007 03:51pm urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg . blood culture, routine (final ): staphylococcus, coagulase negative. isolated from one set only. sensitivities performed on request.. aerobic bottle gram stain (final ): reported by phone to @ on - fa6b. gram positive cocci. in pairs and clusters. . ecg study date of 10:21:58 am sinus tachycardia. cannot exclude prior septal myocardial infarction. no previous tracing available for comparison. intervals axes rate pr qrs qt/qtc p qrs t 105 138 80 322/400 68 44 48 . tte (complete) done conclusions the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-15mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size is normal. with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no vegetations seen on the aortic valve. no aortic regurgitation is seen. the mitral anterior valve leaflet is moderately thickened and does not coapt well with the posterior leaflet. no vegetations seen on the mitral valve. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is severe pulmonary artery systolic hypertension. there is a very small pericardial effusion. impression: very abnormally thickened anterior mitral leaflet with moderate to severe mitral regurgitation. no clear vegetations. if clinically indicated, a transesophageal echocardiographic examination is recommended to further evaluate mitral leaflets and mitral regurgitation. . ct head w/o contrast study date of impression: 8 mm right frontal white matter hypodensity, nonspecific, and without mass effect. finding may represent a small focus of chronic small vessel ischemic change, however given patient age, lack of additional evidence of small vessel ischemic change and his history of endocarditis with evidence of emboli elsewhere in the body, septic embolus can not be excluded. recommend mri for further evaluation. no acute intracranial hemorrhage. . tee (complete) done conclusions no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. a patent foramen ovale is present. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. there is a 12 x 5-mm broad-based, sheet-like vegetation on the anterior leaflet of the mitral valve. a highly-eccentric, posteriorly-directed jet of severe (4+) mitral regurgitation is seen. impression: mitral valve vegetation with severe regurgitation. no annular abscess or infectious involvement of other valves seen at this time. patent foramen ovale. . mr head w & w/o contrast study date of impression: 1. new area of left parietal hemorrhage measuring approximately 4 cm with surrounding edema without midline shift. no enhancement seen in this region. 2. acute infarcts in the right temporal lobe and right parietal lobe in the region of posterior cerebral artery. 3. small areas of blood product near the left sylvian fissure, which given patient's clinical history of septic emboli needs further evaluation with ct angiography to exclude a mycotic aneurysm. other findings as described above. 4. at the present time, infarcts do not demonstrate any enhancement but underlying septic emboli cannot be excluded. 5. the findings were discussed with dr. at the time of interpretation of this study on at 11:00 a.m. . ct head w/o contrast study date of impression: 1. no significant change in size of left parietal intraparenchymal hemorrhage compared to mri , with extension into the subarachnoid space, with diffuse subarachnoid hemorrhage within the left cerebral hemisphere. 2. evolving infarct within the right pca territory. 3. mild mass effect on the left lateral ventricle, with mild rightward shift of midline, and slight increase in dilation of the left temporal . . ct head w/o contrast study date of impression: 1. stable left parietal intraparenchymal hemorrhage with persistent stable mass effect and rightward shift of normally midline structures. 2. evolving right temporal lobe infarction. 3. stable left subarachnoid hemorrhage. 4. orogastric tube remains coiled in the nasopharynx. . foot ap,lat & obl left study date of impression: no radiographic evidence of osteomyelitis. if there is continued concern for a bone infection, recommend further evaluation with mri. . ct head w/o contrast study date of impression: 1. stable appearance of left parietal intraparenchymal hemorrhage with mild mass effect. 2. evolving right pca infarct. . ct pelvis w/contrast study date of impression: 1. expected evolution of the infarcts in the left kidney and spleen. small new infarct in the right kidney. 2. no new intra-abdominal fluid collections or abscesses are detected. 3. small pericardial effusion. 4. trace pleural effusions with subsegmental left lower lobe atelectasis. . carotid/cervical bilat study date of impression: diagnostic cerebral angiogram demonstrates a sidewall, likely infective microbial (mycotic) aneurysm arising from the posterior parietal branch of the left m3 mca segment. the aneurysm and the supplying posterior parietal branch was successfully embolized by onyx. no immediate post-procedure complications. . ecg study date of 6:17:34 pm sinus tachycardia. there is variation in precordial lead placement as compared with previous tracing of . the rate has increased. otherwise, no diagnostic interim change. intervals axes rate pr qrs qt/qtc p qrs t 112 130 78 316/407 60 10 40 . brief hospital course: mr. is a 43 year old male with hx of hcv and abuse who presented with fevers, malaise x 5 days, transferred from osh and found to have mitral valve vegetation and evidence of septic emboli concerning for infective endocarditis. # endocarditis: the patient was admitted with complaints of fatigue, malaise, abd pain, sob, and fever for past week. he had been actively using iv drugs (shooting crushed oxycontin and cocaine) prior to admission and drinking 2 liters of etoh daily. ct abd showed septic embolic and tte; subsequent tee showed mitral valve vegetation and leukocytosis. he was started on vancomycin and zosyn at osh; here, he was started on vancomycin and ceftriaxone with gentamicin for synergy. on presentation, ct did show evidence of septic emboli to the abdomen and brain. blood cultures at osh were positive for strep salivarius; blood cultures here on were positive for staph epi, thought to be a contaminant. his course was complicated by finding of large intraparenchymal brain hemorrhage on mri attributed to his endocarditis. he was started on levetiracetam 1000 mg po/ng for seizure prophylaxis. picc line was placed for long term iv antibiotic administration. gentamicin was administered for total of 14 days. vancomycin (day #1 ) should continue for a total of 6 weeks, last dose on . patient has followup set up with infectious disease team after discharge. patient will require outpatient evaluation by cardiothoracic surgery to evaluate for mitral valve repair after finishing his course of antibiotics. he should follow up in cardiology clinic after the ct surgery evaluation. # cerebral hemorrhage: on presentation, neurological exam was normal, though head ct showed 8 mm right frontal white matter hypodensity, nonspecific, and without mass effect. follow up study using head mri showed large brain hemorrhage in region of r pca territory with a l parietal intraparenchymal hemorrhage. neurosurgery and neurology were consulted and pt was started on keppra for seizure prophylaxis. follow up studies suggested midline shift in the evolving r pca lesion and he was started on mannitol briefly. patient was followed with serial neuro exams on the ventilator however after extubation he continued to be unable to move right side of body. has been informed of this, but patient unable to remember or process this information completely at this time. he was kept on fall precautions and low boy bed. cerebral angiogram on monday showed mycotic aneurysm in the left middle cerebral artery; the aneurysm was embolized with some sacrifice of a small distal branch of the left mca. patient had some mild cerebral edema post procedure and was monitored for two nights in the neuro icu, then transferred to the floor. on the floor, he showed some mild improvement in being able to just slightly move his right hand and foot. of note, patient does appear to show some signs of frontal lobe dysfunction, including impulsivity. patient was seen by physical and occupational therapy. he will require extensive post-stroke physical therapy to attempt to regain as much function as possible of his right upper and lower extremities. patient will need ct-a of head and follow up with neurosurgery team in 1 month as outpatient, already scheduled. # respiratory status: he was intubated for respiratory distress likely to alcohol withdrawal. he was extubated w/o complication and kept on oxygen via nc. oxygen was weaned as tolerated. # alcohol withdrawal: patient describes very difficult prior detox attempts. he admitted to drinking >2 liters of alcohol during his recent substance abuse binges. intubated in ccu for respiratory distress. valium per ciwa scale was unable to alleviate his diaphoresis, anxiety, and tachypnea. he was started on thiamine and mvi and midazolam sedation while intubated. post-extubation he was continued on lorazepam 2-4 mg iv q2h:prn ciwa>10 for a few days. ciwa scale was discontinued upon transfer to floor, as patient no longer showed any signs of withdrawal. # abdominal pain: pt complained of abdominal pain early during hospitalization, likely secondary to septic emboli to kidney, liver, and spleen. abdominal pain self-resolved. patient was treated for endocarditis to prevent further septic emboli. # abuse: patient has recent history of iv drug abuse with injection of cocaine and oxycontin. social work was consulted to follow along with patient. withdrawal symptoms managed as stated above. patient was kept on nicotine patch. # hepatitis c: patient was diagnosed with hcv 6 years ago, unclear if he had started any treatment. alt, ast, and total bili were not elevated with normal inr. no stigmata of chronic liver disease were noted on exam. recommend follow up with hepatologist as outpatient. . # agitation: pt had several episodes of agitation and delerium at night time. pt was otherwise calm during the day. agitation was felt to likely be a sundowning effect or possible residual withdrawal symptoms. on several occasions pt attempted to stand up and walk which resulted in him falling out of bed given his limited mobility. pt did not injure himself or hit his head but there was concern regarding his agitation leading to possible injury. veil bed and low bed were tried; veil bed made the pt more agitated and angry while the low bed did not fully keep pt within the bed but prevented falls from any height. zyprexa was tried as an alternative but there was some concern about whether this contributed to further agitation on one occasion. pt was given low dose of ativan in the evenings with good effect, allowing him to sleep through all or most of the night without incident. #discharge: pt was discharged to in stable condition for further rehabilitation care during his recover and completion of iv antibiotics. medications on admission: tylenol - up to 4 tabs mvi ibuprofen ? amount discharge medications: 1. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: one (1) bag intravenous q24h (every 24 hours) for 4 weeks: last day on . 2. outpatient lab work please send weekly lft's, cbc with differential and chem -7 while pt on iv antibiotics to fax ( id outpt safety lab) , md 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily) for 3 weeks. 6. nicotine 7 mg/24 hr patch 24 hr sig: one (1) patch transdermal once a day for 2 weeks: then d/c. 7. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch transdermal once a day for 2 weeks. 8. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever or pain. 9. cortisone 1 % cream sig: one (1) appl topical qid (4 times a day) as needed for itching: on arm and wrist. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 12. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 13. lorazepam 1 mg tablet sig: 1-2 tablets po 12:00am. 14. heparin (porcine) 5,000 unit/ml solution sig: one (1) syringe injection tid (3 times a day). 15. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 16. lorazepam 0.5 mg tablet sig: 1-2 tablets po q8h (every 8 hours) as needed for anxiety. 17. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for arm rash. discharge disposition: extended care facility: - discharge diagnosis: endocarditis hemorrhagic stroke alcohol withdrawal substance abuse discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking care of you at . you were admitted to the hospital with symptoms of fever, abdominal pain, shortness of breath and low energy. you were found to have an infection in your heart on your mitral valve called endocarditis likely secondary to your iv drug use. you were started on iv antibiotics to treat this infection. while you were hospitalized, your breathing became more labored and you had difficulty protecting your airway in the setting of withdrawal from the recent drugs and alcohol you had been using. you were intubated and kept on a ventilator to help you breath. you were extubated after a few days on the ventilator without complication. you also had a stroke that was attributed to your heart infection. it was a bleed detected which is the reason for your right sided arm and leg weakness. you were transferred to the general floor after being stabilized in the icu. you were continued on iv antibiotics for the infection. neurology followed your case in the hospital to make recommendations regarding your stroke. you were also seen by the neurosurgery team who embolized the aneurysm they found in the left side of your brain so that it would not bleed again. the following changes have been made to your medications: 1. started ceftriaxone to treat the infection in your heart valve 2. take folic acid, thaimine and a multivitamin to treat nutritional deficiencies. 3. take nicotine patch to treat your nicotine addiction. 4. take levetiracetam to prevent a seizure after your stroke. 5. take cortisone or sarna lotion as needed for your rash 6. take colace and senna if you get constipated 7. take tylenol for pain 8. take ativan 1-2mg at midnight to help you sleep or for anxiety 9. take heparin injections to prevent more blood clots 10. stop taking ibuprofen please follow up with your doctors at the below. it is important that you follow up with the neurosurgery team and get a repeat ct-angiogram of your head in 1 month. you will also follow up with the infectious disease doctors. after finishing all of your antibiotics, you will need to see the cardiothoracic surgeons in clinic so that they can decide whether or not you would benefit from surgery to fix your heart valve that has been damaged from your infection. followup instructions: department: infectious disease when: friday at 11:00 am with: , md building: lm bldg () campus: west best parking: garage . department: radiology when: thursday at 1:30 pm with: cat scan building: cc clinical center campus: west best parking: garage department: neurosurgery when: thursday at 2:15 pm with: , md building: lm campus: west best parking: garage department: cardiac surgery when: thursday at 2:00 pm with: , md building: lm campus: west best parking: garage department: cardiac services when: thursday at 2:40 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances arteriography of cerebral arteries arterial catheterization endovascular (total) embolization or occlusion of head and neck vessels diagnoses: mitral valve disorders chronic hepatitis c without mention of hepatic coma intracerebral hemorrhage opioid type dependence, continuous acute respiratory failure acute and subacute bacterial endocarditis cerebral embolism with cerebral infarction embolism and thrombosis of other specified artery streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus delirium due to conditions classified elsewhere cocaine dependence, continuous other and unspecified alcohol dependence, continuous vascular disorders of kidney hemiplegia, unspecified, affecting unspecified side alcohol withdrawal septic arterial embolism frontal lobe syndrome 

Answer: The patient is high likely exposed to