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: acute right sided hemiparesis and aphasia major surgical or invasive procedure: ct angiogram with merci retrieval of intracranial clot with successdul revascularization of left mca history of present illness: this 39 y/o woman with history mitral valvular disease, s/p valvuloplasty and new onset atrial fibrillation today and prior right hemiphere stroke presents with aphasia and right hemiplegia. per report, she was in usoh this morning, having gone to work at beauty salon. her husband last saw her well at 0830h. at 1000h, she was found on floor of salon, alert but aphasic and right hemiplegic. ems was activated, she was brought to er. the neurologic deficit was documented, quantified as nihss=24. sbp 110s, hr 80s and irregular, wbc 9, hct 41, plt 189, inr 1.1, ptt 26. head ct said to be unremarkable. the patient's husband consented to iv tpa; however the consulatant neurologist deemed the patient not a candidate for iv tpa due to severe quantified deficit. stroke service contact. the patient was transferred to . at er, the patient was found to be aphasic, right hemiplegic. sbp 130s, hr 80s. sats in 90s with obtundation so patient was intubated electively w/ fentanyl and versed. past medical history: rheumatic heart disease c/b mitral valve stenosis s/p mitral valvuloplasty with perioperative right parietal infarction (no residual functional deficit) social history: lives with husband and children (twin boys). employed at the beauty salon. family history: nc physical exam: temp: 99.2; bp: 104/60; hr: 80s but occ tachy esp. with movements rr: 12; sao2: 95% gen: alert. sclerae anicteric. mmm. no meningismus. no carotid bruits auscultated. lungs clear bilaterally. heart irregularly irregular in rate. abd soft, nontender, nondistended. bowel sounds heard throughout. neuro: >>ms?????? awake and alert but does not follow commands without prompting. appears to have poor comprehension -randomly shakes or nods in response. mute. >>cn??????fundi w/ sharp discs. perrlb. vfic. no ptosis. eomi and tracks across the room. r facial droop. scms intact. tongue protrudes midline. >>motor??????wiggles r hand/wrist and antigravity at wrist on rue. right le w/o spont movement but occasionally lifts the leg antigravity at times. l side appears full strength. >>sensory??????intact to nox stim throughout but given patient mute and poor comprehension, unclear for other modalities. >>dtrs??????l/r: bic , br , tri ; pat , ach . right plantar extensor. pertinent results: 01:05pm pt-17.4* ptt-35.8* inr(pt)-1.6* 01:05pm plt count-190 01:05pm neuts-81.3* lymphs-14.6* monos-3.5 eos-0.2 basos-0.3 01:05pm wbc-10.2 rbc-5.76* hgb-12.3 hct-40.9 mcv-71* mch-21.3* mchc-30.0* rdw-15.9* 01:05pm albumin-4.0 calcium-8.4 01:05pm ck-mb-notdone 01:05pm alt(sgpt)-62* ast(sgot)-26 ck(cpk)-51 alk phos-52 tot bili-0.3 01:05pm estgfr-using this 01:05pm glucose-111* urea n-10 creat-0.7 sodium-137 potassium-5.8* chloride-106 total co2-22 anion gap-15 01:10pm freeca-1.05* 01:10pm glucose-103 lactate-1.5 k+-5.3 cl--106 tco2-20* 01:10pm type-art ph-7.34* 05:58pm plt count-167 05:58pm wbc-12.1* rbc-4.71 hgb-10.9* hct-32.7* mcv-69* mch-23.1* mchc-33.2# rdw-15.8* 05:58pm calcium-7.5* phosphate-3.3 magnesium-1.7 05:58pm ck-mb-notdone ctropnt-<0.01 05:58pm ck(cpk)-78 05:58pm glucose-105 urea n-10 creat-0.5 sodium-139 potassium-4.4 chloride-112* total co2-19* anion gap-12 05:58pm ck(cpk)-78 05:58pm glucose-105 urea n-10 creat-0.5 sodium-139 potassium-4.4 chloride-112* total co2-19* anion gap-12 06:25pm freeca-1.08* 06:25pm glucose-103 lactate-1.5 06:25pm type-art po2-383* pco2-32* ph-7.44 total co2-22 base xs-0 10:43pm hct-31.9* echo - impression: no cardiac source of embolism seen (cannot exclude laa thrombus on a trans-thoracic echo). there is characteristic rheumatic deformity of the mitral valve with moderate mitral stenosis and at least mild mitral regurgitation. normal regional and global biventricular systolic function. mild aortic regurgitation. mild pulmonary artery systolic hypertension. hct pre-ia tpa and merci - right, predominantly white matter hypodensities as detailed above, concerning for areas of stroke. please note that per report, this patient is being transferred emergently to the interventional service in view of further imaging studies to characterize possible infarctions. recommend repeat evaluation with contrast or mr head when clinically able to tolerate repeat imaging. the left mca is dense suggestive of left middle cerebral artery thrombosis. hct post ia tpa and merci - 1. interval hemorrhagic transformation of the left mca infarct, with acute hemorrhage seen within the left basal ganglia and caudate head, with small scattered foci of petechial hemorrhage. 2. interval malacic changes involving the right frontal, temporal and parietal lobes, likely from prior infarct/insult. mri brain - 1. hemorrhagic transformation of a left mca territorial infarct within the left basal ganglia and left caudate head. additional scattered foci of restricted diffusion within the left frontal, parietal, and temporal lobes compatible with areas of acute infarct. 2. stable encephalomalacic changes within the right mca distribution. brief hospital course: pt was admitted after at 1000h, she was found on floor of salon, alert but aphasic and right hemiplegic. ems was activated, she was brought to er. the neurologic deficit was documented, quantified as nihss=24. sbp 110s, hr 80s and irregular, wbc 9, hct 41, plt 189, inr 1.1, ptt 26. head ct said to be unremarkable. the patient's husband consented to iv tpa; however the consulatant neurologist deemed the patient not a candidate for iv tpa due to severe deficits and high nihss. stroke service contact. the patient was transferred to . at er, the patient was found to be aphasic, right hemiplegic. sbp 130s, hr 80s. sats in 90s with obtundation so patient was intubated electively w/ fentanyl and versed. pt went to the angio suite for ia tpa with insertion of merci appartus. her intracerebral thrombosis was successfully retrieved with full revascularization of her left mca. post-angio, she was noted to have faint right femoral pulses. her pulses were monitored post-angio with doppler eval of pulses. post-ia tpa and merci, she was noted to have a basal ganglia hemorrhage. post hct showed an overal stable hemorrhage with edematous changes to the area of stroke with slight midline shift. pt obtained another head ct on which was overall stable. pt obtained a bedside tte. sedation was removed and she was extubated on . pt had a repeat mri brain on for planned anticoagulation on . neuro: patient was started on coumadin 6 days after admission after repeat head ct showed no worsening of hemorrhage given her afib. currently, her inr was supratherapeutic to inr of 4.8 she needs daily inr and restarted on coumadin likely coumadin 2.5mg when inr < 3 with goal inr between 2~3. cardiovascular: patient remains in afib with occasional tachycardia. she was seen per cardiology who recommended digoxin and rate control with metoprolol metoprolol may be titrated up as needed for rate control but needs to ensure that sbp >95~100. patient also had r femoral dissection likely from instrumentation. she was improving clinically, hence no further intervention required. please be sure to check for peripheral pulses (i.e. dorsalis pedis). respiratory: although remained afebrile, had leukocytosis and cxr finding concerning for healthcare acquired pneumonia hence started on vancomycin and zosyn on for total 7 days hence patient needs to be on antibiotics through . gi: patient was initially fed through ngt but as her mental status improved, she was seen per speech and swallow who recommended diet with 1:1 supervision for encouragement and supervision. patient remains mute but is awake and walks with pt although very weak on r side. patient does not follow commands without prompting hence comprehension is poor. she will need acute rehab and intense physical, occupational and speech therapy for her stroke. motor recovery is quite optimistic. patient will be discharging to acute rehab and has a follow up head ct scheduled plus follow-up appointment with dr. as outpatient. medications on admission: none discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever. 2. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation, no bm for >2 days. 6. metoprolol tartrate 25 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for hold for sbp < 90 or hr < 55: titrate up for tachycardia if bp tolerates. 7. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours) for 5 days. disp:*10 bag* refills:*0* 8. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours) for 5 days. 9. coumadin 2.5 mg tablet sig: one (1) tablet po once a day: only restart once inr < 3.0. dosing may be titrated with goal inr 2~3 - needs daily inr checked until dosing stable. 10. outpatient lab work inr 4.8 on - day of transfer. coumadin should be held until inr < 3.0 and restarted at 2.5mg. daily inr until coumadin dosing stable. discharge disposition: extended care facility: - discharge diagnosis: l mca infarct likely embolic etiology s/p ia tpa with hemorrhagic transformation. hx of r mca infarct s/p mitral valvuloplasty for mitral valve stenosis from rheumatic heart disesase discharge condition: stable - remains in atrial fibrillation rhythm with occ. tachycardia especially with exertion. awake and alert but remains mute. does not follow commands without prompting - randomly shakes and nods head but inconsistent. r facial droop. r hemiparesis - minimal movement of r arm except for wiggling of hand/fingers but able to stand and pivot with support. discharge instructions: you were transferred from after presenting with right sided weakness and aphasia. your arrival was not in time for iv tpa but given the left mca clot, you underwent ia tpa and merci procedure but was found to have hemorrhagic transformation. also, you were found to be in atrial fibrillation rhythm which was never documented in the past per medical records and your pcp. you were seen per cardiology who recommended digoxin and metoprolol for rate control. metoprolol can be titrated up as long as blood pressure tolerates it. also, 6 days after admission and after head ct showed no worsening of hemorrhage, you were started with coumadin for afib and aspirin was discontinued once inr therapeutic. your inr is 4.8 on the day of discharge to facility on hence your coumadin is held. please hold coumadin until inr <3.0 then restart at 2.5mg and titrate the dose to goal inr 2~3. you were also found to have right femoral dissection likely due to instrumentation during the merci/ia tpa procedure, vascular surgery was consulted but given clinical improvement, no further intervention was warranted. you have good peripheral circulation including palpable dorsalis pedis on your right foot. on , your wbc started to trend up again with cxr showing likely infection hence you were started on healthcare acuquired pneumonia regimen of vancomycin and zosyn for 7 days. you should be on both through . please follow-up with dr. as scheduled and you have follow-up head ct on . please follow-up with your pcp 2~3 weeks after discharge from . followup instructions: provider: scan phone: date/time: 2:00 you have repeat ct of head ordered for thursday at clinical center - please do not eat anything 3 hrs prior to the appointment and please arrive by 1:45pm provider: , .d. phone: date/time: 5:00 clinical center md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent arteriography of femoral and other lower extremity arteries arteriography of cerebral arteries procedure on single vessel endovascular removal of obstruction from head and neck vessel(s) diagnoses: pneumonia, organism unspecified other primary cardiomyopathies atrial fibrillation other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypotension, unspecified other specified complications of procedures not elsewhere classified cerebral embolism with cerebral infarction aphasia dissection of other artery flaccid hemiplegia and hemiparesis affecting unspecified side other facial nerve disorders 

Answer: The patient is high likely exposed to