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: speech difficulty, right sided weakness major surgical or invasive procedure: none history of present illness: time code stroke called: 2043 time neurology at bedside for evaluation: 2048 time (and date) the patient was last known well:1830 pm. nih stroke scale score: t-:no reason t-pa was not given or considered: hemmorhage on ct. "i was present during the ct scanning and reviewed the images instantly within 20 minutes of their completion". reason for consult: called by emergency department to evaluate for right sided weakness and facial droop. hpi: the pt is a 86 year-old right-handed female, with no significant past medical history, who presents with right sided weakness and slurred speach. the patient was in her usual state of health until 630 pm at the night of presentation. at that time she was at a grocery store in a motorized chair, when the family initially noted some slurring of her speach. they also observed a right facial droop. she was helped into the car and they drove home. the patient had to be carried into the house. while in the house the symptoms continued. she was however conscious throughout. the family called 911. upon arrival to , the patient was follwoing commands, but not answering questions. she was able to lift the left arm but not the right. she also had leftward eye deviation. the ct scan that was performed showed a left frontal hemmorhage. at that point the patient was intubated. the blood pressure on arrival was 180/80. she was started on a labetolol drip. past medical history: none. no hypertension, or hyperlipidemia. social history: the patient lives at home with her son and grandchildren. she interacts with the family at baseline. she was watching basketball with her grandchildren one day prior. she uses a walker to get around. family history: not known physical exam: admission exam physical exam: general: intubated, heent: nc/at, no scleral icterus noted, neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp pulses bilaterally. skin: no rashes or lesions noted. neurologic: -mental status: intubated receiving propofol. does not open eyes to voice or sternal rub. -cranial nerves: i: olfaction not tested. ii: perrl 1.5 to 1 mm. iii, iv, vi: eyes are midline v and v11: corneals intact. vii: no facial droop. -motor: decreased tone throughout. no spontaneous movement. non-purposeful movement to noxious stimulation. -dtrs: tri pat ach l 1 1 1 1 0 r 1 1 1 1 0 toes are upgoing bilaterally. nih stroke scale score was 20: 1a. level of consciousness: 1 1b. loc question: 2 1c. loc commands: 2 2. best gaze: 2 3. visual fields: 0 4. facial palsy: 2 5a. motor arm, left: 0 5b. motor arm, right: 3 6a. motor leg, left: 0 6b. motor leg, right: 3 7. limb ataxia: 0 8. sensory: 1 9. language: 2 10. dysarthria: 2 11. extinction and neglect: 0 ---- discharge exam arouses to voice and opens eyes, inattentive, occasional whispered verbalization or command following, perrl, r facial droop and hemiplegia, increased muscle tone in lue with cogwheeling rigidity. minimally wiggles/flexes toes to noxious in bilateral le's, and no movement to noxious in rue. pertinent results: admission labs: 09:10pm blood wbc-5.8 rbc-4.59 hgb-13.0 hct-40.9 mcv-89 mch-28.4 mchc-31.9 rdw-13.3 plt ct-273 09:10pm blood pt-11.6 ptt-28.1 inr(pt)-1.1 09:10pm blood plt ct-273 09:10pm blood fibrino-338 02:43am blood glucose-117* urean-12 creat-0.8 na-137 k-3.4 cl-103 hco3-23 angap-14 02:43am blood calcium-8.9 phos-3.8 mg-2.0 02:43am blood osmolal-284 05:28am blood vanco-8.3* 06:48am blood vanco-15.1 discharge labs: no labs were done the day of discharge as patient was stable nchct ct head: in the left frontal region, there is a 6.8 x 3.0 cm intraparenchymal hemorrhage with adjacent edema, sulcal effacement and 2 mm rightward shift of normally midline structures. there is minimal effacement of the left lateral ventricle. mildly prominent ventricles and sulci are compatible with global age-related volume loss. the basal cisterns are patent. hypoattenuation in the subcortical and periventricular white matter is likely sequelae of chronic microvascular ischemic disease. -white matter differentiation elsewhere is preserved. no acute osseous abnormality is identified. the visualized paranasal sinuses and mastoid air cells are clear. impression: large left frontal intraparenchymal hemorrhage with 2-mm rightward shift of normally midline structures and surrounding edema. cta head/neck impression: suboptimal study due to inadequate bolus/ timing. 1. large intraparenchymal hematoma in the left frontal lobe with surrounding edema. no large feeding arteries in the vicinity to suggest a av communicating lesion. mildly displaced normal caliber venous tributaries. however, small vascular/neoplastic lesions obscured by hematoma are difficult to assess. correlate clinically to decide on further workup. 2. patent major intracranial arteries as described above, with a diminutive left vertebral artery not seen in the v3 and v4 segments. no obvious aneurysm within the resolution of the study. eeg impression: this is an abnormal continuous icu monitoring study because of a severely disturbed eeg. there is marked suppression of electrical activity broadly across the left hemisphere suggesting a significant left hemispheric dysfunction. superimposed upon this is a periodic and, at times, active paroxysmal epileptiform disturbance compatible with pleds. this activity was present over the right hemisphere maximally centrally. mri brain with and without contrast impression: large acute left frontal intraparenchymal hemorrhage with surrounding edema and mass effect on the left lateral ventricle without significant midline shift. no abnormal vascular structures are seen or abnormal underlying enhancement identified. signal changes along the right superior frontal sulcus and left side of the tentorium indicate previous hemorrhage and could suggest underlying amyloid angiopathy, although no microhemorrhages are seen within the brain parenchyma. followup study in six-eight weeks is suggested as clinically indicated. eeg impression: this is an abnormal continuous icu monitoring study because of the severe abnormality broadly across the left hemisphere suggestive of a structural pathology and the pseudo-periodic epileptiform transients seen intermittently across the entire right hemisphere not associated with any evidence clinical behavior. this alternates, in the right hemisphere, with a moderately severe diffuse encephalopathic eeg. eeg impression: this is an abnormal continuous icu monitoring study because of the presence of severe suppression of electrical activity broadly across the left hemisphere. during the course of the record, some rhythms were present in the central and posterior head region suggesting perhaps some return of function. there is also extremely active and almost continuous paroxysmal epileptiform activity broadly across the right hemisphere maximum centrally which, during the course of this tracing, seemed to improve. as the tracing continued, this epileptiform activity was replaced by a slow wave abnormality with some paroxysmal sharp features. eeg impression: this is an abnormal continuous icu monitoring study because of the presence of a continuous severe encephalopathy. there continues to be severe suppression of electrical activity broadly over the left hemisphere however activity in the poles appears to be improving. there continue to be periods of periodic lateralized epileptiform discharging activity as noted on the previous several days recordings. the occurrence of this activity appears to be less frequent and the discharges themselves appear to be less physiologically evident over longer periods of time than on previous days. abdominal us findings: portable supine abdominal radiographs are limited due to motion artifact. the bowel gas pattern is nonspecific. the splenic flexure of the colon appears to be located below the left hemidiaphragm. ng tube is coiled in the stomach. there is no evidence of pneumoperitoneum. impression: splenic flexure of colon is below the left hemidiaphragm. eeg impression: this is an abnormal continuous icu monitoring study because of the continued presence of intermittent periodic lateralized epileptiform discharges that were without clinical accompaniment. it also continues to show and demonstrate rather significant pathology in the left hemisphere greater in the middle territory with some improving function at the frontal and occipital poles and over the more lateral temporal region. multifocal independent discharges are noted in addition to the above noted pleds. no sustained seizures were seen. eeg impression: this is an abnormal continuous icu monitoring study because of continued asymmetric activity that is suggestive of widespread left hemisphere pathology but more prominently noted in the more central regions. this is interrupted by periods of periodic lateralized epileptiform activity (pleds) that are present over the right hemisphere and maximum in the central derivatives. multifocal independent epileptic activity is also seen principally within the right hemisphere. compared to the prior day's recording, there were no significant changes. eeg impression: this is an abnormal continuous icu monitoring study because of the continued presence of suppression of electrical activity in the left central region and occasional widespread -hemispheric suppression. there also continued pled discharges that appear to be without clinical accompaniment. there were several short runs of rhythmic fast activity in the right central region and were associated with movements of the left arm, query seizure. in comparison to previous today's recording this days study shows perhaps slight increase in the frequency and duration of the pled activity. eeg impression: this is an abnormal continuous icu monitoring study because of the continued slowing with appearance of epileptiform discharges in the left frontotemporal region. in addition, the background is slow indicative of a mild diffuse encephalopathy. there continued to be brief paroxysmal lateralized waveforms in the right hemisphere. compared to the prior day's recording, there is improvement in encephalopathy and appearance of more focal dysfunction with epileptiform discharges in the left frontotemporal region. abdominal us findings: an ng tube terminates within the stomach. there is a nonspecific bowel gas pattern without evidence of obstruction. osseous structures are unremarkable. impression: nonspecific bowel gas pattern. no evidence of obstruction. ct abdomen/chest/pelvis impression: 1. no evidence of pneumonia. 2. appropriate window for percutaneous gastrostomy tube as described above. 3. right main-stem intubation with tip of ett just below the bifurcation. et tube should be retracted as clinically appropriate. 4. anterior vertebral scalloping of t3 through t7 along with anterior paraspinal ligament hyperostosis. this is non-specific, but in a patient of this age is unlikely to be clinical significance at this time. mri can be obtained to further evaluate only if appropriate. 5. chronic appearing compression fracture of t12. nchct impression: stable left intraparenchymal hemorrhage within the frontal lobe causing unchanged mass effect including rightward shift of midline structures and the brainstem, as well as a protrusion of the left uncus into the ambient cistern. eeg impression: this is an abnormal continuous icu monitoring study because of the continued slowing and frequent epileptiform discharges in the left hemisphere, particularly in the frontotemporal and frontocentral regions. the background is slightly slow indicative of a mild diffuse encephalopathy. there were fewer paroxysmal lateralized waveforms in the right hemisphere. compared to the prior day's recording, there is improvement in background activity over the left hemisphere with increased epileptiform discharges. there were no electrographic seizures. nchct impression: 1. no change in the left frontal intraparenchymal hemorrhage, nor the mass effect that exerts on surrounding structures. 2. no new hemorrhage or evidence of infarct. cxr : tracheostomy is seen. there is an overlying mask which limits evaluation of the mid chest. the cardiac silhouette is grossly within normal limits. there is tortuosity of the thoracic aorta. there is atelectasis at the left lung base. no definite consolidation is seen to indicate a focal pneumonia. : eeg: impression: this is an abnormal awake and sleep eeg because of diffuse polymorphic background slowing with attenuation of faster frequencies indicative of diffuse left hemispheric cortical and subcortical dysfunction. background activity is also mildly slow over the right hemisphere indicative of a mild diffuse cerebral dysfunction of non- specific etiology. in addition, there are further runs of generalized or bifrontal semi-rhythmical or rhythmic delta activity suggestive of deep midline frontal or cerebral dysfunction. alternatively, firda is seen in the setting of hydrocephalus. no epileptiform discharges or electrographic seizures are present. brief hospital course: is an 86 year-old right-handed female with no significant past medical history, who presented with right sided weakness and slurred speech. given her level of sedation, size of bleed and risk for mass effect and herniation and concern for airway protection, she was intubated and transfered to the icu. the ct on admission was significant for a left frontal hemmorhage. the etiology at that time was unclear. amyloid angiopathy was thought most likely given the lobar distribution. although the blood pressure was 180/80 on admission, neuroanatomical localization of the bleed was thought to be inconsistent with hypertensive hemorrhage. # neurology: she was admitted to the neuroicu with q1h neuro checks. given the extent of the bleed, she was started on mannitol with bolus and maintenance q6h na/osm checks. repeat nchct the next day showed possible slight worsening and more shift, and was given another bolus of mannitol 120g and continued on higher dose maintenance 75mg qid. this was eventually weaned off. on , repeat nchct demonstrated possible worsening edema and despite a lack of clinical change, she was restarted on the mannitol therapy. she remained in the icu from . sedation was weaned off on hospital day (hd) 2, but patient was not arousable and demonstrated right shoulder twitching. continuous eeg monitoring demonstrated frequent r-sided pleds. keppra was started to suppress these discharges but there was no clinical change. ativan was added to further suppress pleds but again there was no change. the ativan was eventually weaned off. keppra was continued at 750mg tid. on transfer to the step-down unit on , she remained unarousable and unable to open her eyes even to noxious stimuli as well as demonstrating posturing in the rue and withdrawal in all other extremities. there was some spontaneous movement noted on the left but not on the right. the patient was transferred out of the neuro icu on hyperosmolar therapy with mannitol. a repeat nchct revealed no change in mass effect or shift. her clinical status remained the same: she would open her eyes to noxious stimuli, have intact brainstem reflexes, and withdraw with all four limbs with less withdrawal of the right arm. mannitol was weaned slowly. her blood pressure was maintained with an sbp goal < 160. she had a repeat eeg on that showed no seizures, so keppra was stopped. this medication change and the introduction of amantadine made the patient more alert and awake and she even would occasionally whisper a 1-word answer to a question asked or follow some commands like open your eyes, move your arm etc. # nutrition: given her protracted course, an ngt was placed and tube feeds were started. peg was placed on without complications. she has continued on tube feeds throughour her stay. # cv: she was continued on cardiorespiratory monitor with sbp goals < 160. tachycardia over the first several days prompted ns boluses given likely hypovolemia. however lack of response to fluids led to starting low dose beta-blocker which was continued on transfer. # id: patient remained afebrile until and broad-spectrum abx were started for empiric coverage of vap pna and uti. these were continued on transfer to floor. however, she then began to spike fevers. her investigation for fever revealed a pan-sensitive coagulase negative staphylococcus uti. her sputum sample revealed rare growth of gnrs not considered to represent a clinically significant infection. her antibiotics were switched on to doxycycline 100 x 5 more days for treatment of complicated uti. (until ). then on she spiked another fever and her cxr showed pna. her sputum cx and bcx both grew mrsa so she was put n a 14 day course of vancomycin which she finished on . pending results: none transitional care issues: patient will need to be monitored for alertness and have her amantadine uptitrated as needed. . 1. dysphagia screening before any po intake? (x) yes - () no 2. dvt prophylaxis administered? (x) yes - () no 3. smoking cessation counseling given? () yes - (x) no (reason (x) non-smoker - () unable to participate) 4. stroke education given? (x) yes - () no 5. assessment for rehabilitation? (x) yes - () no medications on admission: multivitamin discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 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: teaspoons po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 6. amantadine 50 mg/5 ml syrup sig: two (2) teaspoons po bid (2 times a day). 7. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 8. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 9. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain or fever. 11. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: highgate manor discharge diagnosis: primary diagnosis: intracerebral hemorrhage (intraparenchymal hemorrhage), amyloid angiopathy secondary diagnosis: urinary tract infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. neurologic: arouses to noxious stimuli and opens eyes, inattentive, no verbalization or command following, perrl, +vor bilaterally, r facial droop and right arm decreased withdrawal to noxious stimuli, increased muscle tone discharge instructions: mrs. , you were hospitalized due to speech difficulty and weakness resulting from an intracerebral hemorrhage (intraparenchymal hemorrhage). this bleed is thought to be due to amyloid angiopathy, a condition where the blood vessels become more susceptible to damage with age. we are changing your medications as follows: 1) please take metoprolol tartrate 50 mg twice daily to control your heart rate and blood pressure. 2) please take amantadine 100mg twice a day to improve your wakefulness. 3) please take lisinopril 5mg once a day to improve your blood pressure. please take your other medications as prescribed by the rehab doctors according to your home needs. please followup with neurology as listed below as well as your pcp. if you experience any of the symptoms below, please seek medical attention. it was a pleasure providing you with medical care during this hospitalization. followup instructions: neurology provider: , md, phd: date/time: 2:00pm, (, building ), , , ma primary care provider: , location: community health center address: , , phone: fax: time: at 1:00pm md procedure: enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy diagnoses: unspecified essential hypertension unspecified protein-calorie malnutrition other convulsions intracerebral hemorrhage acute and chronic respiratory failure other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus persistent vegetative state bacteremia methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure ventilator associated pneumonia legal circumstances infection and inflammatory reaction due to indwelling urinary catheter other amyloidosis other specified hemiplegia and hemiparesis affecting dominant side unspecified cerebrovascular disease 

Answer: The patient is high likely exposed to