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 / ampicillin / folic acid attending: chief complaint: 60m s/p wittnessed seizure while at homeless shelter and then fell to ground major surgical or invasive procedure: endotracheal intubation history of present illness: the pt is a 60y/o m with a pmh of chf, seizures transferred to for evaluation of left frontal iph and right edh. the patient was found to have a witnessed seizure in bed at homeless shelter. he was taken to where a ct showed bleed and he was sent to for neurosurgical evaluation. in ed initial vitals, t 102.8, bp 124/84, hr 16, o2 sat 97% 2l nc. the patient was intubated for airway protection. ct scan was repeated showing an intraparenchymal bleed l>r and epidural bleed of r occipital region. he was loaded with dilantin and neurosurgery consultation was obtained, recommending medical management. he was given levaquin and flagyl for suspected retrocardiac opacity. past medical history: diastolic chf chronic pleural effusions s/p vats and decortication copd etoh abuse with history of withdrawal seizures pulmonary htn chronic atrial fibrillation adenocarcinoma of the esophagus s/p chemotherapy and radiation depression osa gerd social history: per osh dc summary - pt is homeless and lives in a shelter in . drinks 1pt vodka daily family history: unable to obtain physical exam: vitals: tm:98 tc:95.6 bp: 148/100 p: 97 r: 18 o2: 98% on ra general: unkempt, alert/oriented to time, place, and person, lying on bed, uncooperative heent: sclera anicteric, pupils slightly sluggish but reactive, mmm, oropharynx with some erythema, poor dentition, pink complexion neck: supple, jvp not elevated, patient refusing to wear c-collar so not in place, 3cm round soft tissue mass on right side of neck, not ttp, soft. lungs: decreased bs at bases, no wheezes appreciated cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, no appreciable organomegaly, no rebound or guarding ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: na 129 cl 93 bun 8 glc 94 k 4.5 hc03 24 cr 0.6 phenytoin: 8.7; most recent albumin 3.4; corrected phenytoin is 11.1 wbc 4.5 plts 579 hct 28.1 ct head with reconstruction impression: 1. the appearances of the right posterior fossa extra-axial most likely an epidural hematoma and bilateral frontal and left temporal subarachnoid blood as well as intraparenchymal blood in the left frontal lobe has not changed. chronic infarcts are again visualized. 2. normal ct angiography of the head for stenosis or occlusion. 3. the transverse sinuses are not well visualized. this could be related to the acquisition obtained during the arterial phase. however, given the presence of epidural hematoma and fracture in the right occipital bone evaluation of right transverse sinus may be required but could not be evaluated on the current study. if clinically indicated a ct venography of the head can be obtained. ct c spine 1. multilevel degenerative changes of the spine as described above with no acute spinal fracture. 2. centrilobular emphysema. 3. right occipital fracture, refer to ct head report from same date 4. right sided subcutaneous cystic lesion, perhaps a sebaceous cyst. cxr impression: 1. endotracheal tube tip in satisfactory position. 2. feeding tube side port appears to be in the distal esophagus and should be advanced. the distal tip of the feeding tube is not visualized. 3. dense retrocardiac consolidation could represent atelectasis or perhaps aspiration. probable right pleural effusion. dedicated pa and lateral views of the chest are recommended when the patient is in stable condition. repeat ct head impression: 1. small amount of new hemorrage layering along the tentorium. 2. new sinus disease since recent comparison with air-fluid level suggesting acute sinusitis. 3. right occipital fracture with no interval growth of a presumed venous epidural hematoma. 4. small amount of hemorrhage layering within the occipital horns of the lateral ventricles without appreciable change to the ventricular appearence. attending note: small amount of new posterior falx/tentorium sdh described above could just be due to redistribution and is likely not a new finding. egd: findings: esophagus: contents: two coins were found in the lower third of the esophagus, one nickel and one . there was associated food mixed in as well. the foreign body was successfully removed using net excavated lesions a large nearly circumferential ulcer was found in the lower third of the esophagus at the site of coin impaction. stomach: mucosa: diffuse erythema and petechiae of the mucosa were noted in the whole stomach. duodenum: normal duodenum. impression: two coins in the lower third of the esophagus (foreign body removal) ulcer in the lower third of the esophagus erythema and petechiae in the whole stomach c/w gastritis otherwise normal egd to third part of the duodenum brief hospital course: a/p: pt is a 60yo m with pmh of etoh abuse admitted with fever, multifocal intraparenchymal hemorrhagic contusions, course complicated by aspiration pneumonia and siadh # traumatic head injury with intraparenchymal bleed and subdural bleed - pt found s/p seizure per report, had mechanism significant enough for occipital frx. evaluated by neurosurgery with no indication for surgical intervention. tox screen negative. no evidence of lelevated icp. repeat ct head showed likely stable blood, redistribution, but no new acute bleed. dilantin was started in house; he had apparently been on depakote before, and keppra was considered, however, cost makes dilantin more appropriate. currently on stable dose 250mg with levels, corrected for albumin, in the therapeutic range (target , recent corrected levels on this dose have been ). will followup with neurosurgery/dr on at which time he will also have repeat ct of head (noncontrast) for resolution. # siadh: likely ich, also consider drug effect from ssri, which was stopped. stable on regimen of nacl tabs (3gm tid with meals) and lasix 20mg daily, which has kept serum sodium between 126 and 130 for over a week. should have sodium checked at least twice a week; we expect this to resolve as ich resorbs and brain parenchyma heals. # cervical spine injury: pt w/ negative c-spine ct. mri obtained to eval for ligamentous injury but not useful due to motion artifact. # aspiration pneumonia- retrocardiac opacity on initial cxr was thought most likely aspiration pneumonia, which was treated with a full course of antibiotics. he continues to have silent aspiration secondary to dysphagia; speech and swallow therapist recommended thickened liquids and soft foods, 1:1 assistance with meals, and aspiration precautions (sitting fully upright to eat, chewing carefully, small bites alternating with sips). however, patient has been intermittently noncompliant, drinking tap water in his room despite our recommendations not to. # chronic pleural effusions s/p vats and decortication - unclear if cxr change from baseline. # copd - reported history of chronic pleural effusions, s/p vats and decortication, as well, which may explain poor/rhonchorous breath sounds on exam. continued on spiriva and albuterol. # alcohol withdrawal seizures - unclear seizure history - pt on depakote as outpatient. possible seizure focus related to bleed, although report from osh indicated pt had seizure event prior to fall with head trauma. etoh level negative on presentation, # atrial fibrillation - holding asa as above, will restart per neurosurgery recs on/after . # gerd, esophageal ulcer - increased ppi to , which should be continued until pt sees gi in follow-up in to evaluate for resolution with repeat egd. medications on admission: advair 50/500 albuterol mdi asa 325mg depakote 500mg lasix 40mg toprol xl 25mg daily paxil 40mg daily prilosec 20mg daily simvastatin 40mg daily spiriva 18mg daily discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed. disp:*1 inhaler* refills:*2* 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). disp:*1 disk with device(s)* refills:*2* 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*30 capsule* refills:*2* 6. prilosec otc 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 7. phenytoin 125 mg/5 ml suspension sig: ten (10) cc po q12h (every 12 hours): = 250mg . disp:*600 cc* refills:*11* 8. sodium chloride 1 gram tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). disp:*300 tablet(s)* refills:*2* 9. magnesium oxide 400 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 10. multivitamin tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary: 1. hyponatremia 2. intracranial hemorrhage 3. occipital fracture 4. seizure 5. chronic obstructive pulmonary disease 6. diastolic congestive heart failure 7. pulmonary hypertension 8. chronic pleural effusion 9. adenocarcinoma of esophagus s/p chemo and radiation therapy 10. aspiration 11. foreign body ingestion with associated esophageal ulceration (foreign bodies removed) secondary: 1. depression 2. obstructive sleep apnea 3. gastroeshopageal reflux disease discharge condition: alert and oriented. ambulating at baseline. discharge instructions: you were admitted with witnessed seizure and fall. you were brought to from hospital. you were intubated for your airway protection in emergency department and monitored in medicine intensive care unit for few days before you came to regular floor for further care. . the ct from and showed that you have some bleeding in your brain as well as non-displaced fracture in the base of your skull. neurosurgeon (dr ) evaluated you and thought that you do not need operation. neurology team examined you and recommended the medication (dilantin) for seizure prevention and we titrated the dose and measure your blood level of medication which was improving. the repeated ct of your head showed no additional acute bleed. . you had difficulty swallowing with food going into your airway caused coughs and sputum production. you were treated with antibiotic for possible aspiration pneumonia. series of chest x-ray showed chronic fluid in your lung which has worsened with aspiration. speech and swallow team examined you and you had swallowing test done which showed that you are aspirating some of your food. be sure to sit up straight while eating, and soft/ground consistency foods will be easier to eat than solids. . you experienced low blood pressure and change in mental status in setting of dehydration and low sodium (from , sodium has been stable between 126 and 130). the nephrologists examined you and recommend additional salt in your diet to help with low sodium. do not drink more than 1 liter of water or other fluids in a day. your mental status improved as the sodium level improved. . it is important that you take all the medications as prescribed to prevent further seizure and fall. also, you will need to follow up with your primary care nurse practitioners and neurosurgeon for the blood in your brain and the broken skull bone. you can resume taking aspirin 81mg starting on per neurosurgeon. . finally, while in the hospital, you swallowed 2 coins, which had to be removed endoscopically. an ulcer was seen in the distal esophagus, so you will need to take lansoprazole twice a day for 4 weeks and then have a repeat endoscopy with dr to make sure this is resolving. . if you have shortness of breath, fever, chills, nausea, vomiting, difficulty breathing, severe headache, vision changes or chest pain, please contact your primary care physician or come to emergency room. . contacts: case manager: mr. , clinic: /fax ; np: (pager-) followup instructions: you will get non-contrast head ct at 8:30am on prior to seeing dr. . on . in clinical center , ct scan. the number for radiology is . . you will need see dr. in neurosurgery department on at 9:00 am.(. # 3b. gastroenterology (gi/stomach doctor) followup for ulcers in your esophagus: , : provider: , md phone: date/time: 1:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other endoscopy of small intestine insertion of endotracheal tube removal of intraluminal foreign body from esophagus without incision diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux unspecified pleural effusion congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases depressive disorder, not elsewhere classified pneumonitis due to inhalation of food or vomitus epilepsy, unspecified, without mention of intractable epilepsy accidental fall from bed other disorders of neurohypophysis lack of housing chronic diastolic heart failure ulcer of esophagus without bleeding alcohol withdrawal foreign body in esophagus personal history of malignant neoplasm of esophagus closed fracture of base of skull with other and unspecified intracranial hemorrhage, unspecified state of consciousness 

Answer: The patient is high likely exposed to