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: acute onset left-sided weakness, dysarthria and confusion with concern for stroke. major surgical or invasive procedure: picc placement history of present illness: 80f with a past history of af not on warfarin, cads/p mi, htn, hld presents with acute onset left-sided weakness, dysarthria and confusion with concern for stroke. patient was discharged from yesterday and details of her hospitalisation are currently unknown. history was not possible from the patient due to confusion, drowsiness and inattention. patient was apparently last seen well between 08:15 and at roughly 08:30 at the nursing home found to have left hemiplegia, garbled speech and gaze deviation to the right. at that time, fingerstick was greater than 300. ems was called and patient transferred to . in the ed, her fsbglc was 130 and she was noted to have a dnr/dni form but this was not signed by the patient. patient was per ed gurgling and they were concerned regarding her ability to protect her airway. they asked patent several times regarding whether she would want to be intubated and she nodded yes and was following commands and was subsequently intubated after nihss performed by me. there was some confusion regarding whether she was on warfarin as there was documentation of an inr goal on one sheet but not on her medications. the ed called the nursing home and they said that she was on warfarin and attempted to reach her primary care doctor and health care proxy but eventually the covering doctor was reached and had never seen the patient. she was transiently hypotensive in the ct scanner to sbp 70s briefly and she was started on neosynephrine. she had a severe right mca syndrome and concern was for ischaemic vs hemorrhagic stroke but ct showed signs in keeping with ischaemia. there was unfortunately a delay in giving tpa due to confusion about whether she was on warfarin and once inr returned back as normal 1.1, tpa was administered. she is currently intubated and sedated - propofol was changed to fentanyl/midazolam given hypotension. given mental status, not able to obtain full ros but nodded to being asked about having a headache and did note that she could not see on the left side. she was speaking and able to be easily understood but dysarthric. she was not tachypneic or in respiratory distress. past medical history: - af on coumadin, it was held at the end of given patient's hematoma with her cardiac cath. - htn - hld - macular degeneration - multinodular goiter - cad s/p mi and bms placement in rca at ; also has significant lad lesion but was not treated as it was not the culprit lesion - on po vancomycin ? c difficile social history: the patient presented from a nursing home after discharge from yesterday. per ed staff had relayed that patientis normally a+ox3 at baseline and ambulatory. patient is originally from and reported to have practiced as a lawyer, no family members and never married. she lives alone in an apartment and her health care proxy is her friend, . unclear smoking or alcohol history. family history: unknown physical exam: admission exam: vitals: t:afebrile p:140s-160s r:16 bp:164/123 sao2:100% on high flow o2 general: awake, obeying commands somewhat inconnsistently and latterly intubated. heent: nc/at, no scleral icterus noted, mmm neck: supple, no carotid bruits appreciated. no nuchal rigidity. pulmonary: lungs cta bilaterally without r/r/w cardiac: af, nl. s1s2, no m/r/g noted abdomen: soft, nt, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, absent right radial weak right brachial and present but weak left radial. possible weak right dp pulse easily palpable on the left. calves snt bilaterally. skin: no rashes or lesions noted. neurological examination: nih stroke scale score was 15 1a. level of consciousness: 0 1b. loc question: 1 1c. loc commands: 0 2. best gaze: initially felt to be 2 but latterly agreed 1 3. visual fields: 2 4. facial palsy: 2 5a. motor arm, left: 3 5b. motor arm, right: 0 6a. motor leg, left: 3 6b. motor leg, right: 1 7. limb ataxia: 0 8. sensory: 0 9. language: 0 10. dysarthria: 1 11. extinction and neglect: 1 - mental status: patient initially drowsy and confused eyes open spontaneously and latterly intubated. oriented to her name and age but would not answer further. nodding and shaking her head appropriately to questions prior to intubation. inattentive and inconsistently following comands. no clear aphasia. she followed midline and appendicular commands. unable to comply with task. assessment was brief as once nihss done she was intubated and sedated. she had left neglect and seemed to have visual but not sensory inattention. - cranial nerves: i: olfaction not tested. ii: perrl 3.5 to 2.5mm and brisk. seemed to be left homonymous hemianopia - patient stated that she could not seen on the left side. funduscopic exam reveals no papilledema, exudates, or hemorrhages. iii, iv, vi: initially right gaze deviation but and latterly after intubbation eyes midline and no doll's following significant sedation. no nystagmus. v: intact corneal bilaterally. vii: left facial droop and apperaed to have right partial ptosis. viii: hearing inatct to voice. ix, x: present gag and cough. : unable to assess. xii: unable to assess. - motor: normal bulk. episodes of increased tone in the left arm. no adventitious movements, such as tremor, noted. no asterixis noted. good spontaneous movement in the right arm and leg prior to intubation. no spontaneous movement in the left arm and extensor posturing to noxious. some flexion (non-antigravity) of left hip flexion and strong toe extension/amkle dorsiflexion to babinski in left foot. - sensory: no deficits to light touch, pinprick, cold sensation, vibratory sense, proprioception throughout in ue and le. no extinction to dss. - dtrs: bj sj tj kj aj l 2 2 2 2 2 r 2 2 2 2 2 there was no evidence of clonus. plantar response was initially mute on the right and extensor on the left and latterly extsnor bilaterally. - coordination: no gross ataxia on the right, unable to assess on the left. - gait: unable to assess. ================================== discharge exam: vs: afebrile, vss neuro: mental status: awake and alert this morning, opens eyes spontaneously and able to keep them open. speaks in short sentences, better in spanish than english (though patient reportedly spoke perfect english prior to stroke). waves hello and goodbye spontaneously. able to follow simple commands. patient has fluctuating level of arousal, with question of frontotemporal dementia given history and imaging, but unable to diagnose at this time. cn: had right gaze deviation during the hospitalization, but improved at this time. primary gaze appears midline and crosses over to left though not fully. pupils are equal and reactive. l facial droop. dysarthric speech. motor: rue with most spontaneous and purposeful movements (scratching nose or grabbing examiner's hand when it's applying noxious stimuli). rle with some spontaneous movements, and right side is at least antigravity. increased tone on the left side; lue strength improving, has spontaneous movements, also at least antigravity. with stimulation, can flex lle little bit off the bed. pertinent results: admission labs: 09:15am blood wbc-10.4 rbc-3.42* hgb-11.5* hct-32.3* mcv-94 mch-33.7* mchc-35.7* rdw-18.3* plt ct-249 07:17am blood pt-12.5 ptt-26.4 inr(pt)-1.2* 09:15am blood pt-11.6 ptt-24.4* inr(pt)-1.1 07:17am blood glucose-100 urean-19 creat-0.8 na-139 k-3.6 cl-108 hco3-21* angap-14 09:15am blood glucose-106* urean-35* creat-1.5* na-134 k-4.5 cl-95* hco3-20* angap-24* 07:17am blood alt-16 ast-22 alkphos-77 totbili-0.9 09:15am blood alt-22 ast-57* ck(cpk)-41 alkphos-90 totbili-1.3 discharge labs: 05:57am blood wbc-6.8 rbc-3.30* hgb-10.7* hct-30.6* mcv-93 mch-32.6* mchc-35.2* rdw-18.0* plt ct-411 05:57am blood pt-17.4* inr(pt)-1.6* 05:57am blood glucose-110* urean-16 creat-0.8 na-135 k-4.1 cl-99 hco3-27 angap-13 05:57am blood calcium-9.0 phos-4.1 mg-2.0 relevant labs: 09:15am blood %hba1c-4.9 eag-94 07:17am blood cholest-121 triglyc-143 hdl-28 chol/hd-4.3 ldlcalc-64 05:56am blood tsh-0.43 05:56am blood t4-8.5 t3-110 free t4-1.8* 07:17am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg imaging: head and neck cta: complete occlusion of the distal m1 segment of the right mca. matched elevated mean transit time and decreased cerebral blood volume in the right mca territory, indicating a large infarct without significant ischemic penumbra. no acute hemorrhage. 2. approximately 50% stenosis of the proximal right internal carotid artery. mild, less than 40% stenosis of the proximal left internal carotid artery. mild stenosis at the origin of the dominant left vertebral artery. 3. multifocal intracranial atherosclerosis involving the anterior and posterior circulation, as detailed above. 4. large multinodular thyroid, with massive enlargement of the left lobe which extends into the mediastinum, with associated rightward tracheal deviation. if this was not previously evaluated, then outpatient son is recommended in the first instance, when the patient is stable, though son would not be able to visualize the mediastinal component. echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). the right ventricular cavity is dilated with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. no cardiac source of embolus other than atrial fibrillation found. mri/mra : 1. acute infarction of the right mca territory affecting a wide region of right hemispheric cortical matter, with additional involvement of the caudate, putamen, and possibly globus pallidus. 2. technically limited mra with lack of flow beyond the right m1 branch of the mca and poor filling of the distal branches beyond this location. head ct : 1. loss of -white differentiation at right insular ribbon as well as hypodensity in the right lentiform nucleus, consistent with patient's known right mca stroke. 2. no evidence of hemorrhage, mass effect, or new evolving territorial infarction. 3. periventricular white matter hypodensities, sequelae of small vessel ischemic disease, are unchanged. *** eeg: : findings: abnormality #1: the background activity on the right hemisphere showed near continuous slowing mostly in hz delta intermixed with 5-7 hz theta. but, the background on the left hemisphere was predominantly hz theta often intermixed with 8 hz alpha and hz delta. abnormality #2: there were occasional left temporal sharp waves with negative phase reversal at t3-t5 electrodes. abnormality #3: there were occasional burst of generalized slowing in 1 hz delta frequency lasting 2-4 seconds. abnormality #4: there were occasional generalized blunted sharp waves often with triphasic morphology. background: as above. hyperventilation: could not be performed due to a recent history of stroke. intermittent photic stimulation: photic stimulation was done with no activation of the study. sleep: the patient remained awake during the study. cardiac monitor: a single ekg channel showed an irregularly irregular rhythm with an average rate of 60-90 bpm. impression: this is an abnormal eeg because the background activity was asymmetric with near continuous delta slowing intermixed with some theta on the right hemisphere but the left hemisphere had predominant theta activity admixed with some 8 hz alpha and hz delta activity. there were occasional left temporal sharp waves with negative phase reversal at t3/t5 electrodes, suggestive of potential epileptogenic cortex in the same area. there was occasional generalized burst of delta slowing and generalized blunted often with triphasic morphology. : continuous eeg recording: the recording begins at 7:01 a.m. background demonstrated a hz posterior dominant rhythm. there is an amplitude asymmetry with lower amplitudes seen throughout on the right. fairly frequent generalized blunted sharp and slow triphasic waves were observed. again seen were left temporal discharges with phase reverals noted at t3-t5, occasionally followed by a slow wave and, at times, occurring in brief runs in a periodic or pseudoperiodic manner. intermittently isolated sharp and slow wave discharges were seen more broadly over left hemisphere or in a more generalized pattern. no clinical correlate seen on video with epileptiform activity. there were also less frequent bursts of sharp and slow wave generalized discharges seen throughout the recording with, at times, more broad-based blunted sharp features more characteristic of triphasic waves. spike detection programs: multiple files were recorded for abnormalities described above. several files also contained, muscle, movement, electrode artifact. seizure detection programs: multiple files were recorded. no clear clinical or electrographic seizures were observed in these files. several files did contain movement, electrode artifact and abnormalities noted above. pushbutton activations: there was one pushbutton activation at 18:58. no clear clinical or electrographic seizure activity present at this time. the patient can be seen lying in bed with eyes closed, no adventitious movements noted and no significant changes noted on eeg. sleep: the patient progressed from wakefulness to sleep with no additional findings. no normal sleep cycles observed. cardiac monitor: showed an irregularly irregular rhythm between 50-80 bpm. impression: this telemetry captured one pushbutton activation. no clinical or electrographic seizures were recorded. background ryhthms during wakefulness were slowed and a voltage asymmetry was noted throughout the study with rightsided ampitude lower than left. focal left temporal discharges in isolation and in brief runs, as well as intermittent generalized discharges, were observed on this day's recording. this eeg continues to demonstrate a moderate encephalopathy with diffuse slowing and with superimposed epileptiform activity. the amplitude asymmetry likely reflects a structural lesion on the right. the more pronounced focal discharges on the left are suggestive of an area of potential epileptogenesis. : continuous eeg recording: the recording begins at 11:37. background during the most awake portions of recording demonstrated a 6 hz posterior dominant rhythm on left and 5 hz on right. there is an amplitude asymmetry with lower amplitudes seen throughout on the right. multifocal epileptiform sharp discharges were seen in left temporal, parietal, and right central and temporal regions. these were most frequently seen in left temporal regions with phase reverals noted at t3-t5, occasionally followed by a slow wave, and at times occurring in brief runs. no clinical correlate seen on video. there were also less frequent bursts of sharp and slow wave generalized discharges seen throughout the recording with, at times, more broad-based blunted sharp features more characteristic of triphasic waves. spike detection programs: multiple files were recorded for abnormalities described above. several files also contained, muscle, movement, and electrode artifact. seizure deteecion programs: multiple files were recorded. no clear clinical or electrographic seizures were observed in these files. several files did contain movement, electrode artifact. pushbutton activations: there were no pushbutton activations. sleep: the patient progressed from wakefulness to sleep with no additional findings. cardiac monitor: showed an irregularly irregular rhythm between 50-70 bpm. impression: this telemetry captured no pushbutton activations. no clinical or electrographic seizures were recorded. background rhythms during wakefulness were slowed and a voltage asymmetry was noted throughout the study with rightsided amplitude lower than left. multifocal discharges, most prominent in left temporal regiona as well as intermittent generalized discharges, were observed on this day's recording. this eeg demonstrates a moderate encephalopathy with superimposed epileptiform activity. the amplitude asymmetry likely reflects a structural lesion on the right. the more pronounced focal discharges on the left are suggestive of an area of potential epileptogenesis. *** microbiology: ua: moderate leukesterase, 31 wbc and few bacteria. no nitrites. urine culture (final ): staphylococcus, coagulase negative. 10,000-100,000 organisms/ml. c. difficile dna amplification assay (final ): negative for toxigenic c. difficile by the illumigene dna amplification assay. mrsa screen (final ): no mrsa isolated brief hospital course: transitional issues: ongoing swallow evaluation ?evaluation of the multinodular goiter as outpatient inr monitoring had urinary retention in house, possibly related to new uti. please monitor. patient has fluctuating level of arousal, with question of frontotemporal dementia given history and imaging, but unable to diagnose at this time. ================================== 82f with pmh of af previously on coumadin, cad s/p mi in with bms stent placed, htn and hld who present with acute onset severe right mca syndrome from rehab. patient had been just discharged from where she was hospitalized for an mi requiring cardiac catheterization and bms stent placement to rca. the hospital course at was complicated by groin hematoma from cardiac cath requiring intubation and transfusion. she was taken off coumadin during this hospitalization given her active bleeding. her hospital course was further complicated by decreased level of arousal, prompting neurological evaluation with head ct, mri and eeg. ct and mri did not show acute strokes, and eeg showed some gpeds which were not treated. patient eventually woke up and the episode was attributed to sedating medications (with intubation, and also received some antipsychotics for agitation). here, found to have large r mca infarct, received tpa in the ed and intubated for decreased level of arousal and need for airway protection. she was monitored in the icu and transferred to the floor. the hospital course here was also complicated by decreased level of arousal, and eeg here showed bilateral spikes but no electrographic seizures. she was started on amantadine to help with awakefulness. #neuro: per pcp, may have some paranoia at baseline but has never had formal diagnosis of frontotemporal dementia or other behavioral variant of dementia. however, given the history of fluctuating level of alertness during these hospitalizations and given her imaging with significant brain atrophy, it is possible that she has some underlying dementia that become exacerbated with these stressors. after her prolonged hospitalization at as above (for mi c/b hematoma), she was discharged to . she had been there for 1 day when she developed new left hemiplegia with garbled speech and gaze deviation to the right, and brought into ed. she was found to have a large area of signs of early ischemia on the non contrast head ct. after contrast, the area of hypodensity became more pronounced and involved the entire right mca territory. given the finding on her imaging and as she presented within three hours of last normal, it was decided to give her iv tpa. she was felt to be not protecting her airway by ed and was intubated just after nihss performed. post intubation she had significant hypotension and was rapidly put on pressor support with neosynephrine. she was given tpa, still within 3 hours after last known normal, but about 65 minutes after presenting to the ed, the delay was due to her almost coding in the ct scanner. 24 hours after tpa she became able to move all her limbs. f/u mri mra were positive for right mca territory ischemic infarct. she was evaluated by speech/swallow, physical therapy and occupational therapy. she did pass s/s evaluation in the icu with modified diet of pureed solids and nectar thick liquid, however, her hospital stay was complicated by decreased and fluctuating level of arousal which made feeding difficult. she had an ng tube placed for tube feeding given the poor caloric intake. eeg was done to rule out seizures as a cause of her mental status, and though it showed bilateral spikes, there was no electrographic seizures noted. she was started on amantadine to help with her level of arousal with some improvement. # cv: patient with known atrial fibrillation, monitored on telemetry which showed atrial fibrillation but rate controlled. some of her antihypertensives were held in the setting of acute stroke, but they were restarted with goal normotension. if her blood pressure becomes more elevated, lisinopril can be increased to 20 mg daily (which was her home dose). she was initially anticoagulated with coumadin with aspirin bridge, but coumadin was held and she was started on lovenox bridge as there was thought of peg tube. however, as she is tolerating po intake better, will restart coumadin with lovenox bridge. # pulm: intubated in the ed, extubated successfully in the icu. no respiratory issues afterwards. # id: completed course of ceftriaxone for uti (coag negative staph). no further leukocytosis or fevers. also had history of c diff treated with oral vancomycin, which was completed during this hospitalization. repeat c diff toxin was negative. on , found to have difficulty urinating, and ua showed leukesterase, wbc and bacteria, started on 3 day course of bactrim. # heme: in the icu, she also developed drop in h/h, so coumadin and plavix was held and ct of abd/pelvis was performed to rule out retroperitoneal hematoma. fecal occult blood result came back positive. she received 1 unit of prbcs and her hematocrit remained stable afterwards. # renal: had with cr of 1.5 on admission, but creatinine improved throughout the hospitalization. # fen: passed speech/swallow evaluation on , on pureed solid and nectar thick liquid. po intake improved with improved alertness. # ppx: - systemic anticoagulation for atrial fibrillation, at the time of discharge, patient is on lovenox bridge to coumadin - continue famotidine - bowel regimen with docusate/senna # code status: - dnr/dni per conversation with hcp. - contact: hcp , (cell) medications on admission: aspirin 81mg qd amlodipine 10mg qd atorvastatin 80mg qd hydrochlorothiazide 12.5mg qd famotidine 20mg hs atenolol 50mg qd lisinopril 10mg qd diltiazem cr 240mg qd vancomycin 125mg qid for 7 days to stop on ocuvite 1 tab qd bisacodyl 5mg qd docusate 100mg tid miralax 1 sachet qd senna 2 tabs acetaminophen prn ondansetron 4mg po prn q3h discharge medications: 1. acetaminophen 650 mg po q6h:prn fever or pain 2. aspirin 81 mg po daily 3. docusate sodium 100 mg po tid:prn constipation 4. famotidine 20 mg po qhs 5. senna 2 tab po bid:prn constipation 6. diltiazem extended-release 240 mg po daily hold if sbp <100 or hr <50 7. ocuvite *nf* (vit a,c & e-lutein-minerals;<br>vit c-vit e-lutein-min-om-3) 1,000-60-2 unit-unit-mg oral daily 8. polyethylene glycol 17 g po daily:prn constipation 9. bisacodyl 5 mg po daily:prn constipation 10. atorvastatin 20 mg po daily 11. lisinopril 10 mg po daily hold if sbp <100 12. amantadine syrup 100 mg po daily 13. amantadine syrup 50 mg po q1pm 14. enoxaparin sodium 60 mg sc q12h bridge to coumadin. can stop this when inr is >2.0 15. atenolol 50 mg po bid hold sbp <110, hr <60 16. sulfameth/trimethoprim ds 1 tab po bid duration: 3 days first day 17. warfarin 2 mg po daily16 goal inr discharge disposition: extended care facility: hospital - discharge diagnosis: primary diagnosis: right middle cerebral artery stroke, atrial fibrillation, urinary tract infection secondary diagnosis: hypertension, hyperlipidemia, coronary artery disease s/p myocardial infarction and stent placement discharge condition: mental status: confused - most of the time; difficult to assess as patient is frequently somnolent. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. neurologic status: left facial droop, some left sided weakness, lle > lue. patient has fluctuating level of arousal, with question of frontotemporal dementia given history and imaging, but unable to diagnose at this time. discharge instructions: dear ms. , it was a pleasure to take care of you at . you were admitted to the hospital because you had a stroke. you were given tpa (clot dissolving medication) and was monitored in the icu. you were restarted on coumadin during this hospitalization because the atrial fibrillation is the most likely cause of your stroke. because of your confusion and somnolence, eeg was done and did not show seizures. you were started on medication called amantadine to help make you more awake. you were also started on bactrim for urinary tract infection. followup instructions: please call dr. to make a follow up appointment when you are discharged from rehab. department: neurology when: tuesday at 1 pm with: , m.d. building: campus: east best parking: garage md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation percutaneous transluminal coronary angioplasty status other persistent mental disorders due to conditions classified elsewhere other and unspecified hyperlipidemia intestinal infection due to clostridium difficile nonspecific abnormal findings in stool contents cerebral embolism with cerebral infarction dysarthria do not resuscitate status hemiplegia, unspecified, affecting unspecified side staphylococcus infection in conditions classified elsewhere and of unspecified site, staphylococcus, unspecified nontoxic multinodular goiter acute myocardial infarction of unspecified site, subsequent episode of care other localized visual field defect 

Answer: The patient is high likely exposed to