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: penicillins attending: chief complaint: worsening aphasia, right sided weakness, and left facial droop. major surgical or invasive procedure: left crani with drain placement left sided extended craniotomy for re-evacuation of subdural hematoma central line history of present illness: mr is a 80m who is well known to our service. he is s/p left craniotomy for sdh evacuation on . he had an unremarkable post-op course and was sent home with services. subsequently he has returned to the er multiple times. on , he returned with increased headache, the ct at that time showed a slight increase in his l hygroma, he was admitted to neurology as no surgery was indicated and discharged home. he once again presented to the er on with c/o slurred speech and right hand weakness, he was admitted for overnight observation then discharged home. he returns to the er today with c/o worsening aphasia, right sided weakness, and left facial droop. neurology was consulted as well. past medical history: diabetes, prostate cancer status post radiation, hypertension, gerd, hypercholesterolemia. he has had previous craniotomy on the right side for an intracranial hemorrhage. l sdh (evacuated ) social history: retired, used to work as a cabinetmaker. lives with his wife. tobacco use. occasional etoh. denies illicits family history: not known to the patient physical exam: awake, alert, left facial droop, tongue midline, l pupil 4-2mm, r pupil 3-2mm, eom difficult to assess secondary to cooperation, aphasic, unable to name objects, unable to answer orientation questions, comprehension appears intact, + commands l>r. left side was full motor, rue: delt 0/5, bic , tri , r grasp rle: ip/h , quad . sensation intact appears intact to pain. physical exam upon discharge: avss nad, axox4, nods head and answers questions appropriately although complex answers take significant effort to produce words significant expressive aphasia, comprehension intact cnii-xii intact, no facial asymmetry, tongue midline 5- ue strength on r, 5 on l 5- le strength on r, 4 on l sensation grossly intact bilat. extrems wwp, 2+ cr bilat. pertinent results: : nchct impression: no change since prior study . : ap and lateral views of the chest: there are again low lung volumes causing bibasilar atelectasis and crowding of the pulmonary vasculature. no focal opacities concerning for infectious process are present. no pleural effusion or pneumothorax is noted. aorta is tortous, unchanged. ct head post-surgical changes related to left frontal craniotomy as described above. in comparison to exam, there is no significant change in bilateral subdural collections. persistent 6-mm rightward shift of normally midline structures ct head 1. post-surgical changes related to left craniotomy with interval removal of drain and slight decrease in size of bilateral subdural collections. 2. persistent 6 mm rightward shift of normally midline structures, stable from previous exam eeg this is an abnormal continuous video eeg telemetry due to frequent intermittent left posterior slowing mostly in the delta range admixed with theta activity. the posterior dominant rhythm on the left shows attenuation of voltage compared to the right side. there are two pushbutton activations and neither of them show eeg changes to suggest seizure. automated and routine sampling fails to show any epileptiform activity. ct head 1. study limited by streak artifact from overlying eeg leads. the previously seen left subdural hematoma now has more posterior extension, unclear if thisis due to redistribution. would consider continued followup. 2. persistent 8-mm rightward shift of normally midline structures, approximately stable from previous exam echo the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. mri brain/mra brain and neck 1. no acute infarction. 2. similar appearance of moderate-sized left subdural collection, with hemorrhagic component. extensive left-sided pachymeningeal enhancement with appearance of transudation of contrast to the subjacent csf space. 3. post-surgical changes, including small post-operative pneumocephalus account for the described mr abnormality. prominent left-sided cortical vessels. no definite leptomeningeal or mass-like enhancement. 4. tortuous intracranial vessels, as described, but no aneurysm larger than 3 mm, arteriovenous malformation or flow-limiting stenosis. normal cervical vessels. carotid series findings consistent with less than 40% stenosis bilaterally. cxr again seen is bibasilar atelectasis. a small infectious infiltrate at either base cannot be totally excluded; however, the overall appearance is similar to that from one week prior. the upper lungs are clear. the aorta is tortuous, unchanged. there continues to be mild cardiomegaly. ct head persistent left subdural hematoma measuring up to 25 mm in maximal dimension in the inner table of skull with mass effect on the adjacent sulci, greatest at the left frontal lobe, as well as persistent rightward shift of normally midline structures by 9mm, compared to 8 mm previously. post left frontal craniotomy changes are again noted with pneumocephalus. continued followup is recommended. eeg this continuous eeg recording captured three automated events without electrographic correlate. no epileptiform activity was seen. the presence of an asymmetric background typically correlates with subcortical abnormalities under the slower hemisphere, which, in this case, would be the left. ct head: large left-sided subdural hematoma slightly larger since . mild increase in the mass effect and rightward shift of midline structures. chest xray: pa and lateral images of the chest are essentially unchanged from . there are again seen low lung volumes and bibasilar opacities which are unchanged. there is no evidence of new infiltrate or consolidation. cardiomediastinal silhouette is unchanged. visualized osseous structures are unremarkable. ct head - status post evacuation of left hemispheric subdural hematoma, with minimum residual left subdural fluid. significant improvement in the mass effect on the left hemisphere and rightward shift of midline structures. ct head - no change - slight increase in in residual blood in left hemispheric subdural collection. mild mass effect and 5-mm rightward shift of midline structures are unchanged. nchct no changes since previous scan. no new hemorrhage and stable midline shift brief hospital course: the patient was admitted the icu on for close neurological observation. he was prepped for surgery. on he was taken to the operating room and underwent a left cranectomy with drainage of the hygroma with drain left in. this was performed without complication. post operatively the patient did well and was transferred to the surgical icu for monitoring. repeat head ct was stable with persistent 6-mm rightward shift. on the patient's exam was significantly improved from the day of presentation with return of upper right extremity strength, improved word finding ability and only minimal right nasolabial fold flattening. he was draining minimal amounts of serosanguinous fluid and drain was removed. repeat ct head was done in the afternoon for fluctuating neurologica exam. pneumocephalus and persisten sdh was noted. on he was doing well with only mild right pronator drift. on he began to have episodes of dysarthria and rue weakness that would last about 15 minutes with clear episodes of improvement. neurology was called and eeg was in place. there was no clear seizures on report. he had a repeat ct head on that showed increased posterior expansion of the subdural hematoma but stable midline shift. continued to follow and make recommendations for his diabetes management. on the patient had an mri/mra which showed no infarct and no vascular abnormalities. echocardiogram was also done and was normal and carotid ultrasounds showed less than 40% stenosis bilaterally. that evening the patient was noted to be more confused with increasingly frequency episodes of aphasia and right arm weakness. urinalysis and blood cultures were sent to check for underlying infection and continuous eeg was resumed on . the patient also had a repeat ct with reconstructions that showed a persistent l sdh measuring 2.5cm in maximal thickness with 9mm of mls. on he remained stable and on eeg was stopped as he was not noted to have any seizure activity. his antieplileptic regimen was changed to keppra only as well. on his right arm was noted to be decreased in strength with proximal weakness of and distal weakness of 3. ct head was obtained that showed slight increase in the size of the sdh with slight increase in mass effect and edema. in the evening of the patient's strength improved to however he continued to be dysphasic. family meeting was held to discuss the option of a third surgery to evacuate the hematoma and the family and patient decided to defer surgery for now in the setting of his improved strength. on patient's exam again worsened, he was having difficulty speaking and was unable to move to his right arm. he was taken to the operating room and underwent a extended left frontal/temporal craniotomy for subdural hematoma evacuation. post operatively he was transferred to the icu intubaed. he had a head ct immediately after which showed much improvement in the midline shift. on the patient remained intubated overnight due to concerns that he was slow to awake. he was extubated successfully pod #1. his subdural drain was removed. his exam revealed improved right arm strength and facial droop but continued aphasia. later in the day the patient became tachycardic to the 120s. his cardiac enzymes were negative but he had some st changes concerning for demand ischemia. on he had lower extremity ultrasounds which was negative for dvts. as no clear cause for sinus tachycardia could be found, it was thought that is was most likely due to hydralazine that was being given for blood pressure control. this was discontinued and he was started on metoprolol. he started working with physical and speech therapy. on another repeat ct head was obtained which showed no changes. on , patient remained stable, more conversant and with good strength. he was oob with assistance and pt was consulted. on the patient was tranfered to the floor and continued to improve with regards to his aphasia. the patient was discharged the following day in good condition. medications on admission: levetiracetam 500 , losartan 50 daily, omeprazole 40 daily, pravastatin 40 daily, metformin 1700 qam and 850 qpm, not sure if still taking glipizide 10 daily, finasteride 5mg daily, acetaminophen prn discharge medications: 1. finasteride 5 mg po daily 2. levetiracetam 500 mg po bid 3. losartan potassium 50 mg po daily 4. omeprazole 40 mg po daily 5. oxycodone (immediate release) 2.5 mg po q4h:prn headache 6. pravastatin 40 mg po daily 7. acetaminophen 325-650 mg po q6h:prn pain/ fever 8. bisacodyl 10 mg po/pr daily:prn constipation 9. docusate sodium 100 mg po bid 10. heparin 5000 unit sc tid 11. metoprolol tartrate 25 mg po bid hold sbp <100, hr<60 12. multivitamins 1 tab po daily 13. nystatin oral suspension 5 ml po qid:prn thrush 14. ondansetron 4 mg po q8h:prn nausea 15. senna 1 tab po bid 16. glipizide 10 mg po daily 17. metformin (glucophage) 1700 mg po bid 1700mg in am 850 in pm discharge disposition: extended care facility: - discharge diagnosis: subdural hygroma hyperglycemia transient hemiparesis aphasia discharge condition: mental status: clear and coherent (expressive aphasia, comprehension intact) level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: craniotomy for hemorrhage ?????? have a friend/family member check your incision daily for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? **your wound was closed with sutures. you may wash your hair only after sutures have been removed. ?????? ?????? you may shower before this time using a shower cap to cover your head. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. **you have been discharged on keppra (levetiracetam), you will not require blood work monitoring. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. followup instructions: follow-up appointment instructions ??????please return to the office in days(from your date of surgery) for removal of your sutures. this appointment can be made with the nurse practitioner . please make this appointment by calling . if you live quite a distance from our office, please make arrangements for the same, with your pcp. ??????**you may also have them removed at your rehab facility. ??????please call ( to schedule an appointment with dr. , to be seen in 4 weeks. ??????you will need a ct scan of the brain without contrast. procedure: incision of cerebral meninges incision of cerebral meninges diagnoses: esophageal reflux pure hypercholesterolemia unspecified essential hypertension personal history of malignant neoplasm of prostate cerebral edema other antihypertensive agents causing adverse effects in therapeutic use diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness aphasia tachycardia, unspecified personal history of irradiation, presenting hazards to health other accidental fall from one level to another hemiplegia, unspecified, affecting dominant side personal history of allergy to penicillin other external cause status 

Answer: The patient is high likely exposed to