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: all allergies / adverse drug reactions previously recorded have been deleted attending: chief complaint: code stroke major surgical or invasive procedure: : left decompressive craniectomy : percutaneous endoscopic gastrotomy tube placement history of present illness: ms. is a 53 year-old right-handed haitian woman with a history of hypertension and hyperlipidemia who presented to about three hours after last known well with a global aphasia, left gaze deviation, right facial, and right hemiparesis, and was transferred to the when imaging demonstrated a left mca stroke in the setting of an occluded left ica. . according to a friend with whom the patient is staying, ms. was in her usual state of health upon awakening this morning. he called and spoke with her at 1:30 pm and 3:30 pm, at which times she was apparently healthy. he returned home at about 6:45 pm to find a pot burning on the stove. he ultimately found the patient lying on the ground. she did not seem to understand what he said to her and speech was non-sensical. she was dysarthric and weak throughout the right hemibody. he called 911. . the patient was first evaluated at . initial vital signs included bp 185/88, hr 80, o2 sat 100% on 3l. due to concern for stroke, she underwent ct/a head and neck. the study, performed around 7:30 pm, demonstrated a large calcification in the left ica just above the common carotid bifurcation. however, there was evidence of perfusion of the left mca through collateral flow. the patient subsequently underwent an mri head which confirmed a left mca stroke. perfusion studies reportedly showed penumbra. she was transferred to the for consideration of intervention. . at the time of arrival at the about six hours after symptom onset, a code stroke was called. examination translated into an nihss score of 19 (loc questions 2; loc commands 2; partial gaze palsy 1; partial hemianopia 1; facial palsy 2; right hemiparesis 8; aphasia 2; dysarthia 1). the patient was taken to the interventional radiology suite where angiography demonstraed a newly occluded left mca and persistently stenosed left ica. a thrombus was removed from the supraclinoid portion of the left ica following balloon angioplasty. attempts to open the left mca were unsuccessful. past medical history: htn hld social history: - from - visiting one of children who is here - living with friend family history: - positive for stroke (father) physical exam: on admission: physical examination: vitals: p: 81 r: 19 bp: 187/100 sao2: 100% 3l nc general: awake, moaning cardiac: regular rate, normal s1 and s2. pulmonary: lungs clear to auscultation bilaterally anteriorly. abdomen: round. normoactive bowel sounds. soft. non-tender, non-distended. extremities: warm, well-perfused. skin: no rashes or concerning lesions noted. neurologic examination: mental status: * degree of alertness: alert. * language: speech is reportedly non-sensical; the patient does not reliably follow midline or appendicular commands. cranial nerves: * i: olfaction not evaluated. * ii: perrl 3 to 2 mm and brisk. does not reliably blink to threat from right * iii, iv, vi: conjugate left gaze deviation; cannot be completely overcome with doll's maneuver * vii: right facial droop. strength: * left upper extremity: lifts and holds for at least 10 seconds vs gravity * right upper extremity: falls to bed from a height without any resistance; however, able to withdraw meaningfully in plane of bed * left lower extremity: spontaneously moving, can hold vs gravity for at least 5 seconds * right lower extremity: falls to bed from a height without any resistance; however, able to withdraw meaningfully in plane of bed --> starts moving spontaneously in plane of bed reflexes: * babinski: flexor left, extensor right sensation: * nailbed pressure: intact bilaterally in lower extremities, upper extremities with meaningful withdrawal * pinprick: intact bilaterally in lower extremities, upper extremities pertinent results: imaging: echo : the left atrium and right atrium are normal in cavity size. there is moderate symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>70%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is no systolic anterior motion of the mitral valve leaflets. there is borderline pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: moderate symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. trace aortic regurgitation. mildly dilated ascending aorta. these findings are c/w hypertensive heart. no definite cardiac source of embolism identified. head ct : findings: the left hemisphere is diffusely hypodense, with effacement of the overlying sulci and loss of the -white differentiation, compatible with an evolving left mca territory infarct. no acute hemorrhage is detected. there is no shift of normally midline structures. there is no ventriculomegaly. the quadrigeminal and suprasellar cisterns remain preserved. there is no acute fracture. the middle ear cavities, mastoid air cells, and included views of the paranasal sinuses are clear. impression: evolving left mca territory infarct, with no evidence of acute hemorrhagic conversion or concerning mass effect. head ct : further evolution of the extensive left mca territorial infarct with more marked cytotoxic edema and new 8-mm rightward shift of the normally midline structures, but no definite evidence of central herniation. cxr : an endotracheal tube ends appropriately, 4.5 cm above the carina. a right internal jugular central venous line ends in the superior vena cava. a nasogastric feeding tube has been removed and note is made of a rounded opacity in the left epigastric area, possibly gastrostomy tube. lung volumes are low. cardiac, mediastinal and hilar contours are unchanged when accounting for this difference. note is made of left basilar subsegmental atelectasis. there is no pleural effusion or pneumothorax. nchct: evolving left mca territory infarct, with no evidence of hemorrhagic conversion. increased herniation of the left cerebral hemisphere through the craniectomy defect. ct head w/o contrast: prelim - unchanged left subgaleal collection with thick hyperdense rim and slightly decreased adjacent subdural fluid. whether or not either of these fluid collections are infected cannot be determined on this study. cortical laminar necrosis involving the left frontal, temporal, and parietal lobes is again noted. organizing encephalomalacia in the left mca distribution is not significantly changed. no new intracranial hemorrhage or new acute large vascular territorial infarction. no evidence of central hernation. ct head w/ contrast: 1. left frontoparietal small subdural and possibly epidural fluid collections could be infected given the presence of restricted diffusion on recent mr. 2. cortical gyriform enhancement along the fronto-temporo-parietal region could be due to cortical hyperemia or cortical laminar necrosis. 3. unchanged small left parafalcine fluid collection did not appear infected on recent mr. 4. possible hematoma at the site of surgery, anteriorly, is difficult to assess given the administration of intravenous contrast. 5. persistent opacification of multiple left mastoid air cells. mr head w & w/o contrast: 1. extensive acute/subacute left mca territory infarct as described above, with diffuse gyriform enhancement of the cortex in the left mca territory as well as parts of the left basal ganglia likely related to the subacute stage. diffuse enhancement, may relate to suggest subacute stage, however, consider close followup to assess for any inflammatory/infectious component given the lack of prior post-contrast sequences for comparison. mild rightward shift of the midline structures and mild indentation on the left lateral ventricle from the mass effect. attention on close followup. 2. left parafalcine subdural fluid collection extending along the left side of the tentorium as well as in the left middle cranial fossa. part of this may relate to subacute blood products. 3. fluid collections in the left frontal/parietal and temporal soft tissues along with blood products. assessment for superimposed inflammation/infection is limited on the present study. consider close followup to assess stability. 4. diffuse increased signal in the left mastoid air cells from fluid/mucosal thickening. ct head w/o contrast: 1. slight increased size of extradural subcutaneous collection now containing hyperdense material concerning for hemorrhage. infection within this collection is not excluded. 2. substantially less intracranial swelling and edema. no midline shift. 3. extensive hypodensity within the left hemisphere in the mca distribution. chest (portable ap): left lower lobe collapse and/or consolidation, essentially unchanged compared with . the differential diagnosis includes pneumonic infiltrate but the appearance is similar to the film from three days earlier. ct abd: no evidence of hepatobiliary abnormalities. chest (portable ap): the patient was extubated in the meantime interval. cardiomegaly is unchanged. minimal left retrocardiac opacity appears to be unchanged most likely representing atelectasis and likely represent infectious process. there is no appreciable pleural effusion or pneumothorax. liver or gallbladder us: 1. normal son appearance of liver and gallbladder. no biliary ductal dilatation. 2. hepatic vasculature patent with antegrade flow. chest (portable ap): an endotracheal tube ends appropriately, 4.5 cm above the carina. a right internal jugular central venous line ends in the superior vena cava. a nasogastric feeding tube has been removed and note is made of a rounded opacity in the left epigastric area, possibly gastrostomy tube. lung volumes are low. cardiac, mediastinal and hilar contours are unchanged when accounting for this difference. note is made of left basilar subsegmental atelectasis. there is no pleural effusion or pneumothorax. . labs on admission: 09:40pm blood wbc-10.5 rbc-4.38 hgb-11.2* hct-35.6* mcv-81* mch-25.4* mchc-31.3 rdw-21.7* plt ct-339 09:40pm blood pt-12.6 ptt-25.5 inr(pt)-1.1 09:40pm blood glucose-110* urean-15 creat-0.8 na-139 k-3.8 cl-98 hco3-28 angap-17 01:43am blood alt-34 ast-29 alkphos-69 totbili-0.7 09:40pm blood ctropnt-<0.01 09:40pm blood calcium-9.3 phos-3.1 mg-2.0 01:43am blood %hba1c-5.7 eag-117 01:43am blood triglyc-133 hdl-49 chol/hd-3.0 ldlcalc-72 06:03pm blood osmolal-283 01:43am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 01:48am blood type-art po2-256* pco2-32* ph-7.53* caltco2-28 base xs-5 01:48am blood glucose-114* lactate-2.8* na-135 k-3.2* cl-97* calhco3-28 01:48am blood hgb-9.9* calchct-30 01:48am blood freeca-1.11* 12:59pm blood homocys-11.1 12:59pm blood factor v leiden-neg 10:50 alpha-1-antitrypsin elevated above reference ceruloplasmin negative hepatitis delta negative antibody hepatitis e antibody (igm) negative hepatitis c antibody negative testing prothrombin mutation analysis negative brief hospital course: ms. is a 53 year-old right-handed haitian woman with a history of hypertension and hyperlipidemia who presented to about three hours after last known well with a global aphasia, left gaze deviation, right facial, and right hemiparesis, and was transferred to the for consideration of mechanical thrombectomy when imaging demonstrated a left mca stroke in the setting of an occluded left ica; of note, initial studies showed preserved perfusion of the left mca and evidence of penumbra. at the time of arrival at the about six hours after symptom onset, a code stroke was called. examination translated into an nihss score of 19. . as she was not a tpa candidate given timing of presentation, the patient was taken to the interventional radiology suite. angiography demonstraed a newly occluded left mca and persistently stenosed left ica. a thrombus was removed from the supraclinoid portion of the left ica following balloon angioplasty. attempts to open the left mca were unsuccessful. the etiology of the syndrome is thought to be occlusion of the left ica with subsequent propogation of thrombus into the left mca. the infarct evolved and the patient was taken to the or emergently for a left decompressive craniectomy with dr. . course by system: #neurologic: the etiology of her stroke was initially believed to be due to l ica occlusion, though an episode of parxoysmal a. fib during her hospitaliztion raised the possibility of a cardiomembolic nature of the stroke due to paroxysmal a. fib. for this reason, she was started on anticoagulation with coumadin. she is currently on an aspirin bridge with coumadin- the aspirin can be stopped when the inr is therapeutic (goal inr ). stroke risk factors were checked. ldl cholesterol was 72. echocardiogram demonstrated no cardioembolic source. hba1c was 5.7. she remained inpatient long enough to have her flap replacement/craniotomy on . this was performed without complication. she was admitted to the icu for the night after the procedure while there was a drain in place, but this was able to be discontinued the following morning and she was transferred back to the floor. her staples were removed on . she has since been restarted on her coumadin with the aspirin bridge as described above. she should f/u with dr. in 4 weeks with repeat head ct. # cardiovascular: - initial goal sbp 100-160, she was started on amlodipine 10', lisinopril 10', and simvastatin 20'. on a cardiac echo was done which demonstrated moderate symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. trace aortic regurgitation. mildly dilated ascending aorta. these findings are c/w hypertensive heart. episode of paroxysmal a. fib as noted above. started on anticoagulation with coumadin. #dermatology she developed a rash relation to beginning on keppra and appeared to be most consistent with a drug reaction. the rash scabbed over with the cessation of the drug. a wound consult was called with dressing changes and the wound healed with no recurrance of the rash. wound care signed off on . #gastrointestinal / abdomen: - peg placed . lfts had multiple episodes of trending upward. hepatology was consulted. they believe the most likely diagnosis is steatohepatitis. abd us negative for evidence of obstruction, ct abdomen with contrast to look for intra abdominal process: no focal liver lesions or bil dil. hepatitis panel (+) for hep a igg. simvastatin was stopped. she was initially positive for anti smooth muscle ab, but this was repeated at the request of the hepatology service and was negative. remainder of autoimmune testing negative as well however alpha 1-antitrypsin was slightly elevated. lft can be monitored as an outpatient. #nutrition: peg placed on . on ms. has been tolerating her current diet and is being monitored by nutrition for adjustments of tube feeds as appropriate. she is currently off peg feeds and tolerating po intake. prior to d/c peg, nutrition wanted calorie counts wich were performed over her last three days of hospitalization. the patient was able to meet all nutritional requirements vial oral intake. her peg can be removed and she has an appointment scheduled in the next 2 weeks for this procedure. #infectious disease: - she was spiking temps earlier in admission. she was initially started on zosyn and vanco, but this was narrowed to zosyn for uti. urine culture demonstrated >100,000 alpha hemolytic colonies consistent with alpha streptococcus or lactobacillus sp. no recent fever spikes in weeks prior to discharge. #vascular: she seemed to be noting left lower extremity pain during period after surgery when she was off of coumadin. le dopplers were checked and were negative for dvt. this pain has since resolved. #psych: there was concern that the patient's affect reflected depression. she was initially started on prozac but had mild elevations in her lfts so she was transitioned to celexa. medications on admission: unknown discharge medications: 1. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation. 4. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 5. simethicone 80 mg tablet, chewable sig: 0.5 tablet, chewable po tid (3 times a day) as needed. 6. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, temp>101. 8. metoprolol succinate 25 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po once a day. 9. gabapentin 100 mg capsule sig: one (1) capsule po tid (3 times a day). 10. coumadin 7.5 mg tablet sig: one (1) tablet po once a day. 11. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 12. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: radius discharge diagnosis: left hemispheric stroke left ica stenosis cerebral edema discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. neuro defecits: able to say some words (in haitian creole) and some speech is understandable, though still with gibberish speech. does not follow commands, but is able to follow verbal prompts such as when eating. mild right facial droop. dense right hemiparesis, but moves left side spontaneously antigravity. discharge instructions: you were admitted for a left middle cerebral artery stroke. you were initially started on aspirin for stroke protection, but after your heart went into an abnormal rhythm briefly, you were switched to a medication called coumadin for stroke prevention. your stroke risk factors were checked. your ldl cholesterol was 72. you had a cardiac echocardiogram which demonstrated no cardioembolic source. you were checked for blood glucose control with a hgb a1c. the level was 5.7, which is normal. continued risk factor modification is encoruaged.you should continue to eat a low fat healthy diet, and follow up with your primary care physician and stroke neurology. also, please be sure to follow-up with dr. in neurosurgery as noted below. a recent calorie count reflected that mrs is able to eat enough on her own and doesn't need to keep her peg tube in. it should be removed as soon as possible. followup instructions: provider: care clinic phone: date/time: 3:45 (this is for peg removal) . provider: scan phone: date/time: 11:30 provider: , md phone: date/time: 12:30 . provider: , .d. phone: date/time: 2:00 . md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] arteriography of cerebral arteries other cranial osteoplasty other craniectomy percutaneous angioplasty of extracranial vessel(s) procedure on single vessel central venous catheter placement with guidance diagnoses: urinary tract infection, site not specified unspecified essential hypertension unspecified protein-calorie malnutrition atrial fibrillation other and unspecified hyperlipidemia cerebral edema dermatitis due to drugs and medicines taken internally aphasia hemiplegia, unspecified, affecting unspecified side other chronic nonalcoholic liver disease occlusion and stenosis of carotid artery with cerebral infarction other and unspecified anticonvulsants causing adverse effects in therapeutic use streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group a 

Answer: The patient is high likely exposed to