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: multifocal pontine and cerebrellar infarcts major surgical or invasive procedure: * pt arrived intubated * trach/peg * multiple bals history of present illness: per admitting resident: information for the note was taken from the medical records from as well as the patient's daughter. hpi: 50 year old male with significant medical problems, including afib noncompliant on coumadin, cad s/p stent placement x6, chf with diastolic dysfunction, htn, morbid obesity, alcoholism, and dm was transferred from for possible intervention following cva. briefly, he presented to ed by ambulance on the morning of complaining of 2 days of general malaise and abdominal pain and one bout of emesis. he was prompted to call the ambulance after an episode of near syncope during micturition as well as tinnitus. he was noted to be hypotensive upon arrival to the ed, which resolved following fluid boluses. work-up in the ed with a head ct showed likely old parietal infarct and possible area of low attenuation in the central pons (?infarct). ct of the abdomen and chest showed no evidence of aortic dissection. on presentation his inr was 1.0, pt 10.5s and ptt 26.1s. at 11:35am on he was noted to have transient slurring of his speech, with normal upper and lower extremity strength, tone, and sensation bilaterally. he also had labile blood pressures, becoming hypertensive to 220/135. at 18:00 his speech was still slurred with decreased lue and lle strength ( -> ). tone and sensation were normal and intact at that time. at 20:00 he began to have an expressive language difficulty along with his slurred speech. his tongue was noticed to deviate to the right, with right facial drooping as well as drooping of the right side of his mouth. he also had a poor cough and difficulty clearing his secretions. lue and lle strength were decreased to . tone in lue and lle was flaccid. sensation was intact. at 06:00 on his gag reflex was absent and his lue strength was , still with flaccid tone. at 08:00 he was unable to keep his right eye closed against resistance and his lue and lle sensation was decreased. mri and mra of the head and neck on the morning of showed possible basilar artery thrombosis with multiple infarcts in the brainstem and cerebellar hemispheres. he was note to have abssent gag later in morning and he was intubated prior to arrival in icu for airway protection. past medical history: -atrial fibrillation -cad s/p stent placement x6 -htn -chf with diastolic dysfunction -morbid obesity -alcoholism with ?enlarged liver -dm (borderline - not on medications) -sleep apnea -r eye blindness since childhood . psh: -s/p stent placement (at ) -r cea (at ) social history: social security disability. . habits: long-standing alcoholic and smoker. daughter unable to quantify family history: htn physical exam: on admission: t-afebrile bp-140/90 hr-85, irregular o2sat-97% on ventilator gen: lying in bed, intubated, drowsy heent: nc/at,anicteric neck: no tenderness to palpation, normal rom, supple, no carotid or vertebral bruit cv: afib with heart rate 80s no murmurs/gallops/rubs lung: decreased air entry on left abd: +bs soft, nontender ext: no edema / cyanosis neurologic examination: mental status: intubated , drowsy however follows commands such as opening eyes , moving limbs. other exam diificult owing to intubated status. . cranial nerves: pupils equally round and reactive to light, 2 to 1 mm bilaterally..extraocular movements intact bilaterally, no nystagmus. trapezius normal bilaterally. slight facial droop on right but difficcult to characterise given intubated status motor: limited owing to intubated and sedated status. he was actively moving his right arm and leg , was not actively moving his left ul. however partially cooperated with power testing. he was noted to have full power in all major muscle groups on right and was antigravity on lul in deltoids and triceps but not against resistance, same was noted in lll in ip and hamstrings. sensation: withdraws to pain bl reflexes: hyper-reflexic throughout, l more than r with left toe downgoing and right toe mute coordination: unable to test gait: deferred neurological exam at time of discharge: awake, alert. peg and tracheostomy in place. brief general exam: obese, l subclavian line. cta b/ /, no m/g/r. obese, soft abdomen, nttp. edematous in yues and les, non-pitting. pt. nods and shakes head but irreproducibly to questions and requests. does not follow commands reproducibly. titubation after nodding his head persists for seconds. eomi, 3->2mm b/l, brisk, symmetric face, tongue to midline (responds to mimicking). spontaneous fingermovement in l hand. noxious stim. to rue leads to withdrawal flexor of the lue. to noxious bilaterally. l foot wiggles toes spontaneously, r to noxious only responds with grimace. toes extensor bilaterally. pertinent results: admission labs: . wbc-12.2* rbc-4.18* hgb-13.5* hct-38.2* mcv-92 mch-32.2* mchc-35.2* rdw-14.1 glucose-182* urea n-12 creat-0.9 sodium-144 potassium-3.4 chloride-108 total co2-26 anion gap-13 calcium-8.3* phosphate-4.7* magnesium-1.8 pt-13.8* ptt-45.4* inr(pt)-1.2* . hypercoagulability evaluation prothrombin mutation: negative factor v leiden: negative . crp 56.4 (), 70.7 () . mini-bal gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive cocci. in pairs. . respiratory culture (final ): ~4000/ml commensal respiratory flora. . sputum (): gram stain (final ): this is a corrected report (). >25 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. previously reported as (). >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). 4+ (>10 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): gram positive cocci in pairs. respiratory culture (final ): sparse growth commensal respiratory flora. . catheter tips (): no significant growth. (): no significant growth. (): pending . blood cultures: (): bottle 1 - staphylococcus, coagulase negative.isolated from one set only. - gram stain: gram positive cocci in clusters. bottle 2: no growth. . (): bottle 1: no growth. . (): bottle 1: no growth, bottle 2: no growth. . (): bottle 1: no growth. . (): bottle 1: pending, bottle 2: pending . urine cultures: , , , , : no growth. . mrsa screens: , : no mrsa isolated. . discharge labs: . imaging: . mri/a head and neck (): impression: 1. extensive confluent and multifocal infarcts involving the inferomedial aspect of both cerebellar hemispheres, with signal characteristics suggesting that these are "late-acute" or "early-subacute" and correspond to the infarcts demonstrated on the study, performed one day earlier. 2. no associated hemorrhage, herniation or evidence of obstructive hydrocephalus. 3. abnormalities involving the vertebral arteries, bilaterally, with possible origin stenosis on the right and distal occlusion/thrombosis on the left; given the clinical context, the latter, in particular, could reflect impacted embolic material from a more proximal source. 4. the 2d-tof and the cranial portion of the enhanced cervical mra both suggest very poor flow in the distal left vertebral artery, as well as throughout the basilar artery and its branches, including the superior cerebellar vessels, bilaterally, which may relate to the embolic event, above. there is no finding on these sequences to specifically suggest vertebral arterial dissection, which, in general, would not account for the bilaterality of the cerebellar hemispheric findings. 5. relatively mild atherosclerotic disease involving, particularly, the left common and internal carotid arteries, with no flow-limiting stenosis. there is no flow-limiting stenosis in the intracranial anterior circulation. 6. focal cystic encephalomalacia and surrounding gliosis involving the left frontovertex, likely related to previous embolic infarct. . chest x-ray (): impression: ap chest reviewed in the absence of prior chest radiographs: et tube is in standard placement. left pic line tip projects over the anticipated location of the mid svc. mediastinum and left hemithorax are very abnormal suggesting extensive mediastinal adenopathy and pleural abnormality perhaps lingular collapse. overall the findings are strongly suggestive of extensive malignancy. alternatively there could be widespread hemorrhage in both mediastinum and left pleural space. right lung clear. no pneumothorax. . ct torso (): impression: 1. et tube approximately 7 cm above the carina. 2. left thyroid lobe nodule. clinical correlation is recommended. 3. small bilateral pleural effusions and lower lobe consolidation versus atelectasis. aspiration can have a similar appearance. 4. mediastinal and hilar lymph nodes measuring up to 1 cm in short-axis diameter. these may be reactive but are nonspecific. 5. coronary artery calcifications and vascular calcifications. 6. trace pericardial effusion. . chest x-ray (): severe cardiomegaly is stable. widened mediastinum mainly due to increase in the mediastinal fat as seen in prior ct from is unchanged. et tube remains at the level of the thoracic inlet. right ij catheter tip is in the upper svc. left retrocardiac opacities have improved consistent with improving previously large areas of atelectasis. there is no pneumothorax or large pleural effusions. . chest x-ray (): indication: lymphadenopathy. findings: endotracheal tube terminates above the thoracic inlet level and could be advanced several centimeters for standard positioning. cardiomediastinal contours remain widened. based upon review of recent ct torso, this appears to be due to extensive mediastinal lipomatosis. mild volume overload is present. dense left retrocardiac opacity has developed, likely a combination of atelectasis and effusion. . transthoracic echo (): the left atrium is dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. lv systolic function appears depressed. the right ventricular cavity is dilated with depressed free wall contractility. the aortic valve leaflets are mildly thickened (?#). the aortic valve is not well seen. there is no aortic valve stenosis. significant aortic regurgitation is present, but cannot be quantified. the mitral valve leaflets are mildly thickened. mitral regurgitation is present but cannot be quantified. there is a trivial/physiologic pericardial effusion. . impression: poor technical quality due to patient's body habitus. both ventricles are dilated and hypokinetic however exact function and size cannot be determined. mitral and aortic regurgitation, unable to quantify. pulmonary artery systolic pressure could not be determined. unable to assess if lv thrombus. . eeg (): impression: this is a mildly abnormal extended routine eeg in the waking state. there is occasional theta and delta frequency slowing in the right temporal regions and, to a lesser degree, there was also mild left temporal slowing consisting of theta frequencies. the cardiac rhythm was irregularly irregular with frequent pvcs. there were no epileptiform features on this study. . ct head : findings: there is no intracranial hemorrhage. multifocal hypodensities within the pons and the cerebellum are consistent with the prior infarcts, and are better assessed on previous mri. left frontal area of cystic encephalomalacia is unchanged. otherwise, current -white matter differentiation of the hemispheres is maintained. the ventricles are unchanged in size and configuration. there is no uncal or transtentorial herniation. there are no fractures. there is opacification of scattered ethmoid air cells and mucosal thickening of the sphenoid sinus and maxillary sinuses. the mastoid air cells are under pneumatized and opacified. impression: 1. no intracranial hemorrhage. 2. evolving pontine and cerebellar infarcts. 3. mastoid air cell opacification and paranasal sinus disease. labs at time of discharge: : 136 98 16 113 ------------ 03:56a pt: 25.8 ptt: 40.6 inr: 2.5 brief hospital course: mr. is a 50 year-old gentleman with a past medical history including atrial fibrillation (non-compliant on coumadin - inr 1.0), diastolic dysfunction, hypertension, diet-controlled dm, and cad s/p stenting who initially presented to with tinnitus and presyncope and was transferred to the when he was discovered to have multifocal infarcts involving the pons and both cerebellar hemispheres in the setting of poor posterior circulation. he was admitted to the stroke service in the icu from to . . neuro following his arrival to the , an mri and angiography of the head and neck was performed to better characterize the lesions. the studies demonstrated extensive confluent and multifocal infarcts involving the pons and inferomedial aspect of both cerebellar hemispheres. the strokes appreared in the context of abnormalities in the vertebral arteries (possible origin stenosis on the right and distal occlusion/thrombosis on the left) with poor flow in the basilar artery and its branches, including the superior cerebellar vessels. there was no associated hemorrhage, herniation or evidence of obstructive hydrocephalus. the heparin drip initiated at was continued with an initial ptt goal of 60-80 and subsequent goal of 50-70. following the placement of a peg, coumadin was started with a target inr of two to three. . the patient's neurological examination remained relatively constant. he appeared alert and interactive. he could follow basic midline and appendicular requests (eg "stick out your tongue" and "lift your right arm). there was evidence of gaze-evoked nystagmus. he could voluntarily shake is head "yes" and "no" in addition to moving the distal aspect of his left upper extremity and left toes. occasionally clonus was noted in the left upper extremity. a bilateral extensor response was observed. . cvs the patient was monitored by telemetry, which demonstrated chronic atrial fibrillation. metoprolol was given for rate control and cardioprotection. however, minimal doses of the beta-blocker were used in an attempt to allow a target systolic blood pressure of 120 to 140. a statin was continued. per the patient's cardiologist (and pcp), aspirin and plavix were not necessary for prophylaxis for his cardiac stents, and thus, these meds were not started. . as the appearance of the vessel occlusions and infarcts were suggestive of embolic phenomena from a proximal source, a transthoracic echocardiogram was performed. due to the technical challenges of the study, the presence of an lv thrombus could not be explored. there is no comment regarding the presence of asd, pfo and vegetations. note was made of the irregularly irregular rhythm. as noted above, following the placement of the peg, coumadin was started for the atrial fibrillation, inr goal of . ptt goal while bridging is 50-70. . resp upon arrival mr. had an endotracheal tube placed. to protect the airway, the ett was transitioned to trach () in the course of the hospitalization. he required mmv respiratory support due to having been noted to have episodes of apnea while on trach-mask. these occured o/n only and were of 30s - 2 min duration . repeat hct on was performed to evaluate for pontine hemorrhage possibly affecting the respiratory centers. this was negative. it was felt that etiology was most likely due to pontine infarction. will need further monitoring and weaning as tolerated if apneic episodes do not recur. id in the course of the hospitalization, the patient developed persistent fevers. the peak wbc count was 21.8 (). the bronchealveolar lavage revealed commensal respiratory flora. urine cultures were repeatedly negative. one of six blood cultures () grew coagulase negative staph, and the result was thought to reflect contamination. two mrsa screens were negative. two sputum cultures were negative, and gram stains were considered contaminated by upper respiratory secretions. two of three catheter tip cultures were negative. iv tip catheter culture grew vre. no blood cultures were positive. vancomycin was discontinued and he was started on linezolid for a seven day course, day 1 = with last day of . . although daily chest x-rays failed to reveal clear evidence of the condition, treatment with ciprofloxacin, cefuroxime, and vancomycin was initiated to treat presumed ventilator-associated pneumonia. he completed 7 day course of ciprofloxacin and cerfuroxime and vancomycin on . . heme/onc there was some concern that the patient could be hypercoaguable. analyses for factor v leiden and the prothrombin gene mutation were negative. it might be worth conducting a more thorough study (eg protein c, protein s, anticardiolipin ab, etc)for potential coagulopathy in the non-acute setting. . because the initial chest x-ray was thought to show findings concerning for malignancy, a ct torso was done. the study showed non-specific, possibly reactive, mediastinal and hilar lymph nodes measuring up to 1 cm in short-axis diameter. there were also small bilateral pleural effusions and lower lobe consolidation versus atelectasis. no further investigatory studies were pursued. . abd/gi ultimately, on , a peg was placed by the interventional radiology service to provide nutrition. tube feeds were administered. . endo: insulin was administered by sliding scale with a goal of maintaining normoglycemia. . renal: prior to discharge, the lasix was restarted for diastolic dysfunction intermittently, however, was eventually discontinued due to no oxygen requirement. . rehabilitation: the physical and occupational therapy teams participated in the patient's care . code full . hcp medications on admission: medications on admission: coumadin 10mg qd simvastatin 80mg qd plavix 75mg qd lasix 40mg qd doxazosin 1mg qd nitroglycerin prn chest pain . allergies: nkda discharge medications: 1. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). 2. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 3. white petrolatum-mineral oil 42.5-56.8 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 7. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 8. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 9. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 11. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours): last day . 12. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 13. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 14. 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. 15. outpatient lab work patient will need inr monitoring to goal inr of , cbc monitoring should be peroformed on weekly basis until inr is stable. 16. coumadin 7.5 mg tablet sig: one (1) tablet po once a day. 17. insulin nph & regular human 100 unit/ml (70-30) suspension sig: thirty (30) u nph subcutaneous twice a day: am and hs for nph and as per sliding scale regular. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: embolic strokes secondary: atrial fibrillation, cad, htn, chf discharge condition: hemodynamically stable, on ventilator support for tracheostomy. neurological exam at time of discharge remarkable for: awake, alert, eyes open. tracks past midline. mimicks as permitted by motor status, but does not reproducibly follow verbal commands. brainstem reflexes intact. eomi, nystagmus on b/l gaze. perrl, 3->2mm, face symmetric but weak, able to stick out tongue. scm b/l is 4-/5. motor/reflexes: r paraplegia. frimaces to noxious, trace l finger and l toe movement. dtrs increased on l, mute on r. toes extensor bilaterally. discharge instructions: you were admitted to after having suffered severe strokes to your cerebellum and your pons (parts of your brain). you were left with significant neurological deficits at time of discharge. you were treated with medicatoins to treat your strokes. in addition, you had a course complicated by a lung infection and blood infection. you were treated with antibiotics. because you could not breathe on your own or eat on your own, you underwent placement of a breathing tube (tracheostomy) and feeding tube (peg). you were started on multiple medications. please take them as prescribed. you were discharged to a rehabiliation facility for further treatment of your breathing and stroke. should you develop any symptoms of concern to you, please call your doctor or go to emergency room. followup instructions: neurology: provider: , md phone: at 1pm. please call the office of dr. ,danka to set up a follow up appointment after your discharge from rehabilitation. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus aortography percutaneous (endoscopic) jejunostomy [pej] diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation acute on chronic diastolic heart failure percutaneous transluminal coronary angioplasty status candidiasis of mouth morbid obesity long-term (current) use of anticoagulants ventilator associated pneumonia other and unspecified alcohol dependence, continuous occlusion and stenosis of basilar artery with cerebral infarction foreign body in main bronchus inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation 

Answer: The patient is high likely exposed to