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: iodine attending: chief complaint: hemothorax, hypotension major surgical or invasive procedure: right chest tube placement right vats decortication lumbar puncture history of present illness: 76 year old admitted with h/o parkingon's and paf on coumadin w/ large right hemothorax s/p fall on with rib fractures in setting of supratherapeutic transferred to micu for w/u of fever, ams. he was initially managed conservatively with pain management and sent to rehab. at rehab, on , the patient was noted to be more lethargic and hypotensive. he was transferred back to osh where ct scan was performed that showed large r sided hemothorax with mediastinal shift. he was hypotensive with sbp into the low 90s. hct was 29 and inr 3.8 due to patient's coumadin for afib. due to the high inr, a chest tube was not immediately placed and reversal of anticoagulation was started. he was transferred to the on for further management. on admission, his wbc was 13.7 (now ). the patient had a right sided chest tube placed and removed . . he underwent vats evacuation of right hemothorax and decortication of the lung . on , he began to have fevers. vancomycin, ciprofloxacin, and cefepime were started on . id was consulted, who recommended mri brain to eval for cns pathology in the setting of concommitant altered mental status (+/- lp if that is unremarkable). antibiotics were switched to vanc/cefepime/flagyl with cipro d/c'ed. ucx, blood cx, and cxr have all been unremarkable. antibiotics have since been d/c'ed (since this am). neurology is also following for his parkinson's, and have noted that his rigidity has increased from mild to moderate. also during his course, he has been started on seroquel, which the primary team had felt was responsible for his altered mental status. therefore, mri and lp have not been obtained. patient has been febrile today. . currently, patient is minimally responsive to voice, will follow intermittent commands. will not open his eyes and mumbles nonsensically when sternal rubbed. he has been afebrile today. past medical history: 1. parkinson's disease with first symptoms described 12 years ago. 2. low-grade cml. 3. paroxysmal atrial fibrillation for which he is on coumadin. 4. osteoarthritis, status post knee replacement on the right. 5. history of depression, which is now well controlled with an antidepressant. 6. poliomyelitis at age 12. the patient is not able to indicate what his symptoms or deficits were at that point in time. 7. left hip surgery performed per patient about a year ago, although he is not sure about this. 8. no history of strokes. 9. gerd 10 hiatal hernia 11. r knee replacement social history: the patient lives with fiance, health care proxy is his daughter . pt was at rehab on prior to admission. fiance would like pt to be sent there again if he needs to go to rehab. family history: non-contributory physical exam: vitals: t: bp: p: r: 18 o2: general: refuses to open eyes, intermittent commands only. minimal response to sternal rub. heent: l ij in place lungs: clear to auscultation bilaterally, decr bs at bases cv: tachycardic rate abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused neuro: moderate degree of rigidity with cogwheeling in all extremities. pertinent results: admission labs: 09:10pm blood wbc-13.7* rbc-3.25* hgb-9.5* hct-29.2* mcv-90 mch-29.1 mchc-32.4 rdw-17.3* plt ct-300 09:10pm blood hypochr-2+ anisocy-1+ poiklo-1+ macrocy-1+ microcy-1+ polychr-occasional ovalocy-1+ schisto-occasional acantho-1+ 09:10pm blood pt-28.4* ptt-41.6* inr(pt)-2.8* 09:10pm blood glucose-139* urean-43* creat-2.5* na-140 k-4.6 cl-105 hco3-25 angap-15 blood culture , , , negative urine cultures 12/23, , negative notable labs 02:36am blood tsh-2.9 01:00pm blood heparin dependent antibodies- positive 03:00pm blood serotonin release assay- negative csf, lp 11:27am cerebrospinal fluid (csf) wbc-1 rbc-2* polys-4 lymphs-34 monos-62 11:27am cerebrospinal fluid (csf) totprot-32 glucose-72 11:27am cerebrospinal fluid (csf) cytomegalovirus - pcr-pnd 11:27am cerebrospinal fluid (csf) toxoplasma igg/igm-pnd 11:27am cerebrospinal fluid (csf) herpes simplex virus pcr-negative 11:27am cerebrospinal fluid (csf) negative gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. fungal culture (preliminary): viral culture (preliminary): no virus isolated. 7:39 pm tissue right hemothorax. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. tissue (final ): no growth. anaerobic culture (final ): no growth. acid fast culture (preliminary): no mycobacteria isolated. potassium hydroxide preparation (final ): no fungal elements seen. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. ekg atrial fibrillation. leftward axis. diffuse non-specific st-t wave changes. no previous tracing available for comparison cxr : near complete opacification of the right hemithorax secondary to known large right hemothorax and near complete collapse of the right lung. shift of midline structures to the left. ct chest, review of osh scan : 1. large right hemothorax with near complete collapse of the right lung, and leftward shift of the mediastinal structures. 2. posterior third through tenth right rib fractures. 3. lateral third through seventh right rib fractures. 4. splenomegaly. 5. 3 cm stone within a normal-appearing gallbladder. cxr : after insertion of the right chest tube, there is significant decrease in the right hemothorax. there is also some amount of air seen within the pleural cavity, mostly located at the lateral apical aspect. there is no definitive mediastinal shift at the current examination seen. the left lung is essentially clear except for bibasilar atelectasis with no evidence of left pneumothorax. the fractures on the right are better delineated on the chest ct from . ct chest wo contrast : 1. overall decrease in amount of pleural fluid with unchanged amount of clotted blood consistent with hemothorax. the chest tube lies superior to the majority of the pleural fluid. 2. small pneumothorax. 3. right lower lobe basal segmental bronchi collapse with surrounding right lower lobe atelectasis. 3. 4.5-cm ascending aneurysmal dilation of the thoracic aorta. this should be reassessed in one year with a chest ct. 5. unchanged right rib fractures. 6. splenomegaly, unchanged. ct head : impression: no acute intracranial pathological process; mr is more sensitive in detecting acute infarcts. note at attending review: seen on image 21, series 2a is a 6mm low density zone in the body of the left caudate nucleus that was likely present on the prior study, though less clearly, perhaps due to slight differences in scan levels, and is probably a chronic small vessel infarct. i concur that mri is more sensitive than ct in detecting acute brain ischemia. cxr : as compared to the previous radiograph, the right chest tube has been removed. there is no pneumothorax. unchanged small retrocardiac atelectasis and right basal atelectasis. unchanged course of the nasogastric tube, no complications. bilateral le ultrasound no evidence of deep venous thrombosis in bilateral lower extremities. suboptimal evaluation of veins in the right calf due to positioning. rue doppler us : no evidence of deep venous thrombosis in the right upper extremity. ct torso : 1. no evidence for abscess in the chest, abdomen or pelvis. 2. interval removal of the right chest tube with decrease in the size of the right pleural effusion and increased aeration of the right lung. 3. splenomegaly measuring up to 22 cm. 4. cardiomegaly. 5. cholelithiasis. eeg : this is an abnormal eeg due to the presence of a slow background. this represents a mild encephalopathy such as can be seen with diffuse ischemia, toxic-metabolic, medications, or other generalized pathology. there were no clear epileptiform discharges or electrographic seizures noted. echocardiogram : the left atrium is dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size is top normal with normal free wall contractility. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened and there is mild tricuspid regurgitation. there is no pericardial effusion. there is borderline pulmonary artery systolic hypertension. abdomen plain film : right-sided decubitus radiograph demonstrates no free air. the bowel gas pattern is nonspecific with air seen throughout non-dilated loops of colon. air is also seen in some prominent loops of small bowel. this is a nonspecific bowel gas pattern without definite obstruction. there are some degenerative changes of the lumbar spine and of the right hip. the tip of the feeding tube is in the body of the stomach and could be advanced several centimeters for more optimal placement. brief hospital course: mr. is a 76 year old gentleman admitted with h/o parkinson's and paf on coumadin w/ large right hemothorax s/p fall on with rib fractures in setting of supratherapeutic inr of 5.0, who subsequently developed fever and ams of unclear etiology that eventually dissipated by the time of discharge. 1 hemothorax: pt had a fall on and was admitted to osh and found to have r rib fractures . he was managed conservatively with pain medication and sent to rehab. at rehab, on , patient was noted to be more lethargic and hypotensive. he was transferred back to osh where ct scan was performed that showed large r sided hemothorax with mediastinal shift. patient was hypotensive with sbp into the low 90s. hct was 29 and inr 3.8 due to patient's coumadin for afib. due to high inr, chest tube was not immediately placed and reversal of anticoagulation was started. vitamin k, ffp x2, and 2 units prbcs were given. patient's family requested transfer to for thoracic surgery support. a right chest tube was placed and patient had right vats decortication peformed on . a ct torso on showed resolving effusion. he remained hd stable and maintained his saturations throughout the rest of his hospitalization. repeat cxr likewise showed no reaccumulation. his ct incisions were sutured on (two of the three incision sites were sutured; given posterior location of the third incision it was left open), and he will follow up with thoracics as an outpatient. 2. altered mental status: the patient was transferred to the micu on for fever and altered mental status. per neurology, the patient had been having progressive worsening rigidity from parkinsons over his hospital course and had been less talkative/interactive. on transfer to the micu he would only mumble and would not open his eyes or follow commands. he spiked fevers to 103 almost daily. on a ct torso and head was performed that did not show an infectious process or stroke. leni's and rue for swelling of r arm showed no dvt. on the patients mental status improved somewhat and he was alert, able to follow commands and answer questions appropriately, however he was not oriented to time or place. he was transferred to the floor given improving mental status. there, an lp was performed which ruled out meningitis and yielded negative ebv/cmv/hsv/toxo titers. his mental status incrementally improved while on the floor as his fevers subsided, and so a provisional diagnosis of hospital/icu delirium versus febrile encephalopathy was made. on discharge, he was alert, conversing well, following commands, oriented to person and usually place (not time). in general, likely due to his ongoing parkinson's and deconditioning, he remains slow to answer questions and move physically but is appropriate and not confused/neurologically impaired. 3. fever: the patient had been febrile to 103 with daily fevers in the icu. no sources were found as c.diff, urine and blood cx and ct torso on were all negative for infection and his wbc was never elevated. his l ij was pulled and cultured, which was likewise negative. in the micu, for antibiotic coverage, the patient was intially placed on vanc/cefepime/ampicillin/acyclovir/flagyl for broad coverage including for meningitis, however the micu team felt meningitis was unlikely and d/c'd the ampicillin and acyclovir. he was still on vanc/cefep/flagyl at time of transfer to the floor. an lp ruled out meningitis. without a source of infection, drug fever was suspected, and he was taken off of cefepime after obtaining a negative lp, and replaced with cipro for possible abdominal pathogens given his persistent belly pain. he eventually defervesced on . vanco was stopped . he completed a two week course of cipro/flagyl on . 4. parkinson's: progressively worsening rigidity was noted by neurology. it was thought that his tube feeds were interfering with sinemet absorption and he was switched to a low protein tf diet. his rigidity was slightly improved at the time of transfer from the micu to the floor on . we continued sinemet with good control of his parkinson's and his tubefeeds were ultimately discontinued. 5. afib w/ rvr: the patient has known afib and had been having a rapid ventricular rate while in the hospital. the patients home med of digoxin was continued and he was started on diltiazam. in terms of anti-coagulation, the patients coumadin had been held in setting of supratherapeutic inr and recent hemothorax. his chads2 score was (unclear if he had htn). after discussion with his pcp, was felt that his risk was low enough to forgo further coumadin given his recent hemothorax, and he was placed on aspirin 325mg daily in its . 6. thrombocytopenia: his platelets dropped from over 300 to around 100 over the first week of hospitalization. given a recent heparin exposure in the osh, a diagnosis of hit was entertained and pf4 ab were positive. the optic density was low, conferring low risk of hit, so he was not anticoagulated and a serotonin release assay was sent to confirm this diagnosis before anticoagulation was started in a man with recent serious hemothorax. this test was negative. he may receive heparin products. 7. malnutrition: albumin was quite low at 2.4 and he required tube feeds for much of his hospitalization due to poor swallowing mechanics and aspiration risk. he passed a swallow eval on and began a thin liquid and pureed solid diet, though he had to be continually prompted to eat, taking only a few bites of each meal. he was placed on supplementation tid with ensure plus. he needs 1:1 supervision while eating and coaching to be sure he takes adequate calories. he has good appetite but is mechanically slower when eating. he has temporal wasting and a low albumin of 2.6. he will need close nutritional follow up and support, and may require replacement of dobhoff tube and temporary resumption of tube feeds should his po intake not improve. 8. urinary retention: he failed a voiding trial on and we had considerable difficulty straight-cathing and replacing the foley, requiring a kudet catheter. he was started on flomax thereafter for likely bph, and will need another voiding trial on after about 2 weeks of alpha inhibition. he has outpatient urologic follow up arranged. 9. anemia: he had persistent anemia into the 23-24 range throughout the hospitalization. he required only one blood transfusion around the time of chest tube placement. he was not further transfused as his hct was stable, though he should have this followed every 48-72 hours at rehab, to transfuse if hct<21. 10. loose stools: he has had several loose bowel movements a day for the past week. c dif was negative x 2. it is felt to be secondary to reintroduction of solid foods and tube feeds. pending labs at time of discharge: none transitional care issues 1. voiding trial around with urologic follow up for bph (appt made) 2. will need 1:1 supervision and encouragement with meals to be sure he is eating 3. nutrition followup and support (patient likes chocolate flavored products) 4. right chest tube sutures x2 will need to be removed on . medications on admission: aricept 10 mg po daily digoxin 0.25 mg po daily coumadin 5 mg po daily lexapro 20mg po daily colace as needed potassium chloride 20meq po every other day sinemet 25-100 mg tablet sig: 1.5 tablets po qid discharge medications: 1. donepezil 10 mg tablet sig: one (1) tablet po once a day. 2. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 3. escitalopram 20 mg tablet sig: one (1) tablet po once a day. 4. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po every other day. 5. carbidopa-levodopa 25-100 mg tablet sig: 1.5 tablets po qid (4 times a day). 6. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po daily (daily). 7. aspirin 325 mg tablet sig: one (1) tablet po once a day. 8. multivitamin tablet sig: one (1) tablet po once a day. 9. diltiazem hcl 120 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day: please hold for sbp<100 or hr<60. tablet sustained release 24 hr(s) 10. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. discharge disposition: extended care facility: discharge diagnosis: 1. r rib fractures c/b right hemothorax 2. altered mental status/ delirium 3. atrial fibrilllation 4. parkinson's disease 5. respiratory distress secondary to mucus plugging discharge condition: level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. mental status: confused - sometimes. discharge instructions: dear mr. , you were admitted to the hospital because you bled into your lung (hemothorax) which required surgical drainage and an icu stay. you also developed high fevers after this procedure, requiring intravenous antibiotics. you also developed worsening confusion which was likely driven by infection or just being in the hospital, and it slowly improved throughout your hospitalization. your fevers slowly subsided and you finished your antibiotics before leaving. it is very important that you continue to eat as much as you can tolerate, because you are quite malnourished. the following changes have been made to your medications: 1. start flomax 4mg daily for difficulty urinating 2. start ensure plus, one bottle 3 times a day with meals it was a pleasure working with you, mr. followup instructions: you have the following appointments available: department: hematology/oncology when: thursday at 4:00 pm with: , md building: sc clinical ctr campus: east best parking: garage ** thoracic surgery appts seen in the hemotology / oncology dept. ** please call your pcp . at when you leave your rehab facility to follow up. you have the following appointment to see a urologist: department: surgical specialties when: at 9:00 am with: urology unit building: sc clinical ctr campus: east best parking: garage you have follow up with your neurologist as well: department: neurology when: monday at 11:00 am with: drs. & building: sc clinical ctr campus: east best parking: garage procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified spinal tap incision of lung enteral infusion of concentrated nutritional substances other incision of pleura thoracoscopic decortication of lung diagnoses: thrombocytopenia, unspecified anemia, unspecified esophageal reflux toxic encephalopathy unspecified protein-calorie malnutrition atrial fibrillation unspecified fall depressive disorder, not elsewhere classified diaphragmatic hernia without mention of obstruction or gangrene paralysis agitans long-term (current) use of anticoagulants retention of urine, unspecified knee joint replacement traumatic hemothorax without mention of open wound into thorax closed fracture of multiple ribs, unspecified 

Answer: The patient is high likely exposed to