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: found down by family, stuporous. major surgical or invasive procedure: intubation (outside) placement of oraogastric tube (outside) history of present illness: mr. , "", is a 64-year-old man transferred from after being found down and description of intracerebral hemorrhage on nchct, on a background of chronic hypertension. he was last seen at baseline by his son, , ., on monday evening. on tuesday morning he was seen by his neighbor who described him as lethargic and as having slurred speech. the neighbor came back to mr. door about ten minutes later and mr. did not respond or open his door as he normally would. on wednesday his family tried to call and when they could get no response, decided to visit. his daughter arrived and knocked, then called to him when the door didn't open. she asked how he was and he said "okay" and clearly recognized that it was his daughter. then started to mumble, then did not respond. this was at about 6 p.m., and given their concerns they forced their way in before 7 p.m. mr. was on the floor of his living room. it looked as if he had fallen, was lying on his back and likely hit the sofa with his head on the upper left side, deflecting it to the right. he opened his eyes to voice and was mumbling, sometimes saying things. he could not move when asked, but lifted up his shirt and said he had chest pain. there were no other apparent injuries, but he had been incontinent of urine. ems took him to . upon arrival his family say that he was no longer coherent or opening his eyes. he was intubated given his mental status and concern for aspiration (his family tell us). non-contrast head ct scan revealed left sided intraparenchymal hemorrhage dissecting into the left thalamus and ventricles (see imaging below). he was transferred on propofol to for further management. at he was given 1.5 l ns, fentanyl/versed, etomidate, ativan. ct head, c-spine and chest x-ray were performed (see below). ck was 5374 (with normal ck-mb index). he had a leukocytosis with predominant neutrophils, some bands (22.5, 85 %, 5%). note: patient denied pain, said "it was light out", unable to get up. they noted that he was difficult to understand. patient reported high cholesterol. in the ed he was continued on propofol and nicardipine was started to control blood pressure. review of systems negative except as above. past medical history: - hypertension, 20 years, on hctz monotherapy, per family - hiatus hernia - cardiomegaly per family, likely concentric hypertrophy in context of hypertension - nasal polyps, s/p surgery - recent extraction of all teeth in last couple of months - anxiety (takes klonopin) - dyslipidemia, per patient at (as stated in their note) - family deny diabetes social history: lives alone. retired barber. 40-50 pack years, current smoker of 1 ppd. some alcohol, but not for 8 years. family history: hypertension in many family members, both . mother had 'small stroke'. father with coronary disease. physical exam: exam on discharge: mr is drowsy at times, but will wake to full alertness. he is oriented to self, year and hospital. he mumbles (worse after hemorrhage), but language itself is normal. he does not easily follow midline commands (poke out tongue, smile), but will follow appendicular commands. he has a mild right facial droop with generally decreased facial expression. he has significant ataxia, with a mild right upper motor neuron pattern of weakness, worse in the arm than the leg. weakness seems, prima facie, much worse in the context of ataxia. sensation is intact. coordinated appendicular movements are slow but accurate. exam on admission: appearance: appears stated age, well kept and likely bmi ~ 26. intubated and sedated. son, daughter and wife present at bedside. vitals: afebrile, 174/82 mmhg, 48 bpm and regular, 16 breaths, 99%, intubated, cmv: fio2 0.5, 550 cc, rate 16, peep 5 cmh2o respiratory pattern/ventilator settings: will overbreathe vent. when sedation off. on cmv. primary survey/evidence of trauma: contusion at junction of parietal and occipital bones on left, no skin breakage, no other trauma noted. evidence of chronic or systemic illness: darker pigmentation on face, ? acanthosis nigricans. trophic changes at feet. no surgical incisions. evidence of drug ingestion/use: none. nuchal rigidity neck tone normal. heent: otherwise nc, intubated, with og. neck: supple. no bruits. some secretions audible in upper airway. lungs: cta bilaterally/vent. sounds. cardiac: rrr. enlarged pmi. normal s1/s2. no m/r/g. abdominal: soft, nt, bs+ extremities: warm and well-perfused. peripheral pulses 1+. neurologic: eye response: when propofol off will open eyes to command, but not spontaneously. motor response: will move feet, but not lift from bed. will squeeze both hands, stronger on left, but can make thumbs up on right. will nod when touched on either side. verbal response: mouthed hello on command and daughter thought he mouthed 'hey baby' to his daughter during exam. optic fundi: miotic pupils. not examined. pupillary responses: pupils miotic at 1.5 mm with small symmetric reaction. spontaneous eye movements: made eye contact briefly before closing eyes. will look to right and left. gaze conjugate. corneal responses: present bilaterally. remaining cranial: face symmetric. hearing grossly intact - follows verbal commands. gag intact when sedation light. respiratory pattern overbreathing vent. when sedation lowered. skeletal muscle tone: tone normal throughout. motor responses: as above. can move both feet, squeeze left hand and seems weaker on right. no whole limb antigravity movements noted. myotatic reflexes: b t br pa ac left 2 1 2 2 0 right 0 0 0 1 0 cutaneous reflexes: toes go down bilaterally. sensory responses: can move hand or foot that is touched to command for both feet and hands. pertinent results: on admssion: 12:47am blood wbc-17.2* rbc-5.07 hgb-14.9 hct-43.1 mcv-85 mch-29.3 mchc-34.5 rdw-15.9* plt ct-202 04:15am blood neuts-73.1* lymphs-19.2 monos-6.1 eos-1.2 baso-0.4 12:47am blood pt-13.1 ptt-24.6 inr(pt)-1.1 04:15am blood glucose-75 urean-11 creat-0.5 na-143 k-2.4* cl-117* hco3-18* angap-10 04:15am blood alt-19 ast-75* ld(ldh)-243 ck(cpk)-3625* alkphos-39* totbili-0.4 12:47am blood lipase-22 12:47am blood ctropnt-<0.01 04:15am blood ck-mb-27* mb indx-0.7 08:52am blood ck-mb-37* mb indx-0.6 ctropnt-<0.01 03:53am blood ck-mb-6 04:15am blood albumin-2.5* calcium-5.2* phos-1.6* mg-1.4* cholest-147 04:15am blood %hba1c-6.2* eag-131* 04:15am blood triglyc-79 hdl-28 chol/hd-5.3 ldlcalc-103 06:10am blood tsh-0.86 12:47am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 04:24am blood type-art rates-20/16 tidal v-550 peep-5 fio2-50 o2 flow-9.3 po2-99 pco2-37 ph-7.43 caltco2-25 base xs-0 -assist/con intubat-intubated 12:50am blood glucose-107* lactate-2.1* na-143 k-3.8 cl-99* calhco3-26 12:50am blood hgb-14.9 calchct-45 o2 sat-55 cohgb-2 methgb-0 04:24am blood freeca-1.12 12:47am urine color-yellow appear-clear sp -1.017 12:47am urine blood-lg nitrite-neg protein-100 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-6.0 leuks-neg 12:47am urine rbc-35* wbc-4 bacteri-none yeast-none epi-0-2 12:47am urine casthy-0-2 12:47am urine bnzodzp-pos barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg on discharge: 06:05am blood wbc-17.9* rbc-5.24 hgb-15.0 hct-43.8 mcv-84 mch-28.7 mchc-34.3 rdw-15.4 plt ct-327 06:05am blood neuts-63.6 lymphs-23.1 monos-7.9 eos-2.8 baso-2.5* 06:05am blood glucose-108* urean-17 creat-0.7 na-132* k-3.6 cl-92* hco3-28 angap-16 07:20am blood ck(cpk)-569* 06:05am blood calcium-9.4 phos-3.9 mg-2.0 ekg sinus rhythm with increase in rate as compared with previous tracing of . the ischemic appearing st-t wave abnormalities have improved but may represent pseduonormalization in the context of increase in rate. the initial forces in lead v2 are consistent with prior anteroseptal infarction. followup and clinical correlation are suggested. rate pr qrs qt/qtc p qrs t 84 162 90 386/428 59 -2 87 non-contrast head ct findings: there is a similar moderate-sized left thalamic hemorrhage with surrounding edema which extends into the occipital horns of the bilateral lateral ventricles and the body of the left lateral ventricle. possible small foci of subarachnoid/cortical hemorrhage are noted in the right frontal lobe and unchanged. no increase in the size or new focus of hemorrhage is appreciated. there is a minimal amount of rightward shift of midline structures, though the basal cisterns are preserved. periventricular white matter hypodensity is likely related to chronic small vessel ischemia. the ventricles and sulci are normal in size. elsewhere in the brain, matter/white matter differentiation is preserved. there is a small air-fluid level within the right maxillary sinus. the mastoid air cells are clear. impression: similar appearance of left thalamic hemorrhage with extension into the bilateral occipital horns and body of left lateral ventricle and possible small foci of subarachnoid/cortical hemorrhage in the right frontal lobe. there is minimal rightward shift of midline structures also unchanged. though the hemorrhage may relate to hypertension or fall, underlying vascular/neoplastic etiology cannot be excluded and further workup as clinically indicated. ct c-spine impression: 1. no acute cervical fracture or malalignment. 2. multilevel degenerative changes, with likely chronic uniform vertebral height loss at c5 and c6. 3. partially-imaged brain demonstrates bilateral intraventricular hemorrhage, compatible with the known left thalamic hemorrhage. duplex renal ultrasound impression: 1. normal sized kidneys, without evidence of renal artery stenosis. 2. mildly elevated renal arterial resistive indices could relate to underlying chronic kidney disease. ct head impression: 1. similar appearance of left thalamic hematoma and surrounding edema with extension to the body of the left lateral ventricle and 3rd ventricle and bilateral occipital horns of the lateral ventricles. f/u as clinically indicated. 2. no new interval hemorrhage. 3. stable mild rightward shift of midline structures. chest x-ray impression: marked improvement of previously identified congestive pattern. no new parenchymal infiltrates and only a plate atelectasis remaining on the left base. brief hospital course: mr. was intubated prior to arrival given vomiting, concern for aspiration and stupor. he was admitted to the neurology icu service for monitoring and blood pressure control, given intraparenchymal hemorrhage with intraventricular extension. intraventricular extension was limited to the posterior horns of the lateral ventricles, the ventricular system remaining patent, so ventricular drain placement was not necessary. he was transferred to the floor service when stabilized and extubated where the primary issues became blood pressure control, monitoring for pneumonia given persisting leukocytosis, physical therapy and his dysphagia. intraparenchymal cerebral hemorrhage typical location and historical features for hypertensive etiology. given location and appearance, underlying mass, amyloid and traumatic seem much less likely. blood pressure was controlled and the hemorrhage remained stable. treatment of hypertension will be important for reducing the risk of subsequent hemorrhage. a statin was started given his lipid profile. aspirin is safe to continue as prophylaxis. hypertension mr. antihypertensive regimen was broadened and increased during the admission. amlodipine was started. hctz was increased to 50 mg daily, then decreased again to 25 mg owing to hypokalemia, with carvedilol initiated to help control blood pressure further. valsartan is at maximum dose and hydralazine was also added at 10 mg every six hours. the latter is less ideal for home use given potential rebound and likely non-compliance given four times daily dosing. we would recommend caution in uptitrating carvedilol given heart rate and concomitant use of amlodipine (concern for heart block). clonidine patch and long-acting nitrates might also be considered. mr. blood pressure was improved after diuresis with lasix 20 mg iv also, after receiving fluid in excess of urine output (not hypotonic given cerebral edema) earlier in the admission. doppler ultrasound of the renal arteries was performed. aldosterone level was not checked given that hypokalemia was explained by hctz use. hypokalemia increased and decreased with hydrochlorothiazide dosing, to which this was attributed. serum potassium has been around 3.5 on the present 25 mg of hctz. this should be monitored in rehabilitation to determine whether supplement is necessary. leukocytosis initially attributed to stress-related demargination of neutrophils, but then persisted. this, is conjunction with prior aspiration, along with a hazy left base on portable film raised concern for pneumonia. he remained afebrile, but was treated with ceftriaxone for possible aspiration-related pneumonia. he remained afebrile and further evidence of clinical or radiographic pneumonia did not develop. wbc increased on the day of discharge, but this was attributed to an increase in eosinophils that were not present at admission, suggesting mild allergic reaction to ceftriaxone. nonetheless, given no other evidence of allergy and this short course due to finish after four more doses, we recommend continuing this medication to complete the course, with the last dose of . question of pneumonia see leukocytosis. relative eosinophilia there is no absolute eosinophilia, but has been a relative increased in this cell line since admission. this may represent a mild allergic response to ceftriaxone. please check cbc with differential to see that this does not climb further. drowsiness given peri-thalamic hemorrhage, some decreased level of arousal is not uncommon and this will often improve over several days. klonopin was a home medication that was used at uncertain dose in the home setting, so this was titrated during the admission. he presently is taking 0.5 mg tid, which can likely be tapered to 0.25 mg tid then off over the next few days. hyponatremia mild hyponatremia on discharge that is attributable to mild siadh in the context of intracerebral hemorrhage. this is just under the normal range, 132 versus 133, and has been stable, so no specific intervention seems warranted at this time. elevated ck attributed to rhabdomyolisis given immobility at home - it is likely that he was in the same position for about 36 hours. this trended down and we stopped checking this when in the normal range for african-american males (< ~ 800). prediabetic state a1c was mildly elevated. continued monitoring for diabetes is indicated. we did not initiate treatment during the admission. myocardial ischemia suggested by ekg (see above), but may be prior. enzymes were negative. medications on admission: - hctz, dose unknown - klonopin - total of , maybe more medications per family. pharmacy, in dispensed klonopin, zoloft, trazodone. family will bring list in a.m. discharge disposition: extended care facility: hospital - discharge diagnosis: primary intracerebral hemorrhage hypertension discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you came to the hospital after being found confused at home by your family. you went to an outside hospital where you were noted to have vomiting and were very drowsy and you were therefore intubated. ct scan of your head revealed that there was bleeding in your brain. you were transferred to and initially monitored in the intensive care unit until it was clear that bleeding had stopped. we attribute this intracerebral hemorrhage to high blood pressure. we got your blood pressure under better control. this process of progressively controlling your blood pressure will need to continue at rehabilitation. please stay in regular touch with your primary care physician so that this can be watched closely. you will also need to see dr. in clinic, before which you will need an mri (ordered at ) and laboratory test (prescription attatched). followup instructions: please follow up in clinic with dr. : , m.d. phone: date/time: 7:30 please see your primary care doctor immediately after dishcarge from rehabilitation. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: tobacco use disorder unspecified essential hypertension intracerebral hemorrhage hypopotassemia anxiety state, unspecified pneumonitis due to inhalation of food or vomitus cerebral edema dysarthria other disorders of neurohypophysis rhabdomyolysis hemiplegia, unspecified, affecting unspecified side 

Answer: The patient is high likely exposed to