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: consulted by ed for "ich" major surgical or invasive procedure: none history of present illness: this is an 87 year-old woman with a history of htn, af with pacer, who was found by her niece this am on the floor of her bathroom. she was last known well sunday evening, when her son (who calls every night) spoke to her by phone. he was unable to reach her monday evening and after failing to reach her this am, called his cousin to check in on her. this cousin gained entry into her appartment with the help of the local constabulary and found ms. lying on her r. side, wedged between the toilet and bathtub. she was awake but non-verbal. she moved her l. arm with apparent full strength, l. leg with perhaps moderately decreased strength, and did not move her r. side. in her niece's estimation she had been lying immobile for quite a while - perhaps > 24h. ms. was transported via ems to hospital. there her ct head demonstrated a 1x3cm l. basal ganglia hemorrhage without intraventricular or subarachnoid extension. at she was protecting her airway and maintaining consciousness. however, because of a hospital protocol mandating intuabation for particular gcs scores, she was intubated, sedated, and mediflight trasported to . ros: no known recent symptoms per family. past medical history: - afib with pacer, on coumadin - htn - breast ca, years ago, thought to be in remission social history: the patient lives alone, and is retired. she is functionally independent and manages her own medical care and finances. she just returned from a solo trip to west palm beach. family history: nc physical exam: <<on admission:>> - intubated and sedated, off propofol x 20m: vs: hr 82 rr 14 os 100% riding vent, no spontaneous breaths during ~10m eval. bp upon arrival 121/85, progressively rising with time off propofol, 161/84 at high. general: appearance: intubated and sedated, no spontaneous activity skin: bruising in the r. axilla, r. calvarium, r. flank heent: intubated. ncat, mmm neck: supple, no thyromegaly, no lad, no bruits chest: ctab with good flow. cvs: rrr, nl s1/s2. no m/g/r. no jvd. ext: no cce. dp 2+. ms: gen: non-responsive to voice. responds to sternal rub only with prolonged stim. withdraws to modest nailbed pressure in bilateral toes, no asymmetry. withdraws to strong l. nailbed pressure, no response in r. hand. with sternal rub she localizes with l. arm, no response on the r cn: i: not tested. ii: unable to test visual fields. perrl 2.5mm to 1.5mm, brisk. no rapd. iii,iv,vi no spontaneous eye movements, no aversive movements, in c-collar so can only do limited occulocephalic but that does produce equal, slight lateral eye movement. v: unable to assess. vii: r. facial weakness, upper and lower - limited strength to eye closure, limited grimace with nasal stim. viii: no response to shout or clap. ix,x: unable to assess : scm and trapezii full. xii: unable to assess. motor: normal bulk. increased tone in the r. hand. does not support limbs against gravity. spontaneously grasps hand with l. hand, no response in r. withdraws bilateral limbs at least against gravity reflex: tri bra pat toes c6 c7 c6 l4 s1 r 1+ 1 1+ - - up l 2 1+ 1+ - - up : responds to nailbed pressure in the bilateral toes, l. hand, but not r. hand. responds to vigorous sternal rub. pertinent results: 02:52pm blood wbc-17.2* rbc-4.76 hgb-15.3 hct-45.8 mcv-96 mch-32.3* mchc-33.5 rdw-13.8 plt ct-247 06:40am blood wbc-8.9 rbc-3.70* hgb-12.0 hct-35.7* mcv-97 mch-32.5* mchc-33.6 rdw-14.4 plt ct-210 02:52pm blood neuts-91.4* lymphs-4.0* monos-3.7 eos-0.3 baso-0.5 02:52pm blood pt-26.4* ptt-25.8 inr(pt)-2.6* 06:40am blood pt-14.6* ptt-25.1 inr(pt)-1.3* 02:52pm blood glucose-130* urean-26* creat-1.2* na-143 k-4.4 cl-106 hco3-23 angap-18 06:40am blood glucose-86 urean-29* creat-0.9 na-140 k-3.9 cl-105 hco3-27 angap-12 02:52pm blood ck(cpk)-5055* 07:44pm blood ck(cpk)-3749* 07:44pm blood ck(cpk)-3613* 03:02am blood ck(cpk)-2535* 01:24pm blood ck(cpk)-* 02:26am blood ck(cpk)-1361* 08:45am blood ck(cpk)-91 02:52pm blood ctropnt-<0.01 07:44pm blood ck-mb-33* mb indx-0.9 ctropnt-<0.01 07:44pm blood ck-mb-33* mb indx-0.9 ctropnt-<0.01 07:44pm blood calcium-7.9* phos-2.9 mg-2.0 06:40am blood calcium-8.5 phos-3.6 mg-2.1 04:43pm blood %hba1c-6.4* eag-137* 02:26am blood triglyc-133 hdl-42 chol/hd-3.4 ldlcalc-75 osh ct c-spine: impression: no acute fracture or malalignment. nchct on admission: (read as hemorrhagic infarct, but more likely was hemorrhagic transformation of ischemic infacrt) findings: there is a 3.2 x 1.1 cm focus of parenchymal hemorrhage within the left basal ganglia, with surrounding edema. there is mild mass effect on the adjacent lateral ventricle. a second focus of parenchymal hemorrhage is seen in the left occipital lobe which approximately measures 2.2 x 1.6 cm (2:15) with associated edema in a pattern suggesting cytotoxic edema. there are additional areas of hypodensity in the left occipital lobe, series 2 image 18, suggestive of acute infarct. overall, the findings as described are stable from the outside hospital ct. there is a large right lateral scalp subgaleal hematoma. no acute fracture is identified. the mastoid air cells, the imaged paranasal sinuses are clear. secretions are seen in the nasopharynx. an endotracheal and nasogastric tube are in place. there is coiling of the nasogastric tube in the oropharynx. impression: 1. stable findings of left basal ganglia, and left occipital parenchymal hemorrhage with surrounding edema likely related to htn and hemorrhagic infarction. 2. right lateral scalp subgaleal hematoma. 3. coiling of ogt in oropharynx. please correlate clinically cta of the head and neck, : impression: 1. slightly increased size of the hyperdense hemorrhagic focus, located laterally within the left mca infarct, without evidence of new hemorrhagic focus or active contrast extravasation ("spot sign") to suggest impending expansion. 2. stable appearing left pca infarct with internal hemorrhagic conversion. 3. left fetal pca, which appears patent with increased distal flow compared to the right, possibly secondary to recruitment of flow to this previously ischemic territory. 4. patent left mca with m1 segment uniformly slightly reduced in caliber compared to the right but patent-appearing distal branches. comment: the overall appearance suggests embolism to the left mca and (fetal) pca from a more central, perhaps cardiac source. n.b. the cervical vessels were not included in this study. if evaluation of the more proximal carotid and vertebral arteries is clinically warranted, dedicated neck cta is recommended. ecg on admission: cardiology report ecg study date of 2:50:46 pm atrial fibrillation. st-t wave abnormalities are non-specific. no previous tracing available for comparison. read by: , w. intervals axes rate pr qrs qt/qtc p qrs t 77 0 92 414/443 0 13 -29 echo in icu: conclusions the left atrium is elongated. the right atrium is moderately dilated. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). there is considerable beat-to-beat variability of the left ventricular ejection fraction due to an irregular rhythm/premature beats. the right ventricular cavity is mildly dilated with borderline normal free wall function. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. the mitral valve shows characteristic rheumatic deformity. there is moderate thickening of the mitral valve chordae. there is mild valvular mitral stenosis (area 1.5-2.0cm2). moderate (2+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: preserved left ventricular systolic function. mildly dilated right ventricle with borderline normal function. at least moderate pulmonary hypertension. moderate to severe tricuspid regurgitation. mild mitral stenosis which may be due to rheumatic heart disease. moderate mitral regurgitation. video swallow study : findings: oral phase: poor bolus control was demonstrated with delayed swallowing. liquid barium material remained within the valleculae throughout the oral phase. pharyngeal phase: intermittent aspiration was noted with liquid administration. moderate amount of penetration was also seen. impression: 1. intermittent aspiration with liquids and penetration. 2. moderate impairment during the oral phase, as demonstrated by poor bolus control and delayed swallowing. brief hospital course: 76 yr rh wf with hx of a-fib on coumadin, htn was found down on the floor with decreased mentation and right hemiplegia. she was awake and arousable and followed simple commands. she had bruises on her head, right shoulder/arm region and right hip/lateral right upper leg. brought to osh. hct showed hypodensity and hyperdensity in left basal ganglia region. it was first thought that she had a primrary hemorrhage. 10 mg of vit k was given and she was transferred to . here she received 2 units of ffps. repeat imaging done. no further increase in hemorrhage. however, evaluation of hct by the attending revealed that she has an ischemic stroke involving the striatocpasular branches and some patchy lesions in the inferior division of the mca as well as the pca. there was also a hyperdense sign in the left mca stem. her examination in the unit showed impairment in right gaze and dense right hemiparesis with withdrawal to noxious stimuli in right arm and right foot. she does have a right facial palsy too. pupils are equal and reactive. all brainstem reflexes present. she followed some simple commands with her left hand. multiple bruised areas on her forehead, right shoulder/right arm, right hip. ct is most consistent wiht an ischemic stroke with hemorrhagic transformation. she probably has a fetal pca which might explain why she has a stroke in mca and pca at the same time. multiple emboli are possible as well. hyperdense mca stem suggests clot in mca stem. her echocardiogram showed no evidence of thrombosis. her ldl was 75, total cholesterol was 144. over the next few days she became alert and would follow few simple commands, still with global aphasia amd a dense right hemiparesis. she was transferred to the floor. she was re-started on coumadin on . she started to take a puree diet on . neuro: ischemic stroke involving the striatocpasular branches and some patchy lesions in the inferior division of the mca as well as the pca with hemorrhagic transformation. re-started on coumadin on . therapeutic inr goal . no bridge is necessary. continue aspirin. her ldl was 75, total cholesterol was 144. card: atrial fibrillation; plan to anti-coagulate as above. htn; currently on lisinopril 10mg and atenolol 100mg; may titrate bp medications. sbp should not be higher than 180; prn hydralizine; pulm: no issues renal: no active issues id: no active issues gi: currently on ground-solids/nectar-thick liq diet. caloric intake improved after d/c concurrent ngt feeds as anticipated. speech and swallow consult service cleared the patient for d/c on po intake. proph: heparin sc until warfarin/inr therapeutic > 2.0 medications on admission: synthroid 50mg qday coumadin 5/7.5 alternanting qday digoxin 175 mcg qday lisinopril 5mg qday atenolol 100mg qday kcl 20mg qday hctz/cbrr 37.5/25 qday calcium/vit d multivitamin discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation. 4. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 5. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 7. warfarin 5 mg tablet sig: alternate 1.5 and 1.0 pills qod (7.5/5.0 mg) tablet po daily (daily). 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day): for dvt-ppx. please discontinue this medication once inr is >2.0. 9. atenolol 50 mg tablet sig: two (2) tablet po daily (daily). 10. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: - large left-sided mca+pca-territory infarction (stroke) with hemorrhagic conversion secondary diagnoses: - afib with pacer, on coumadin - htn - chf - breast ca, years ago, thought to be in remission discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted after you were found on the floor. you had a stroke in two different areas of the left hemisphere of your brain. you were in the icu and then transferred to the floor. after receiving food through -gastric tube, you have been able to eat a diet by mouth; this diet is specially formulated to help you swallow without getting food into your lungs (aspiration), which would cause an infection. you will need to have close nutrition monitoring. you are being anti-coagulated (taking a blood thinner called warfarin, aka coumadin) because you have atrial fibrillation and warfarin reduces your risk of a stroke. the a/c was held initially because you had a little bleeding into the stroke, but this was re-started to reduce the chances of additional strokes in the future. followup instructions: 1. with pcp 2. with clinic: , md phone: date/time: 2:00 md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation personal history of malignant neoplasm of breast cerebral edema long-term (current) use of anticoagulants cardiac pacemaker in situ do not resuscitate status cerebral artery occlusion, unspecified with cerebral infarction aphasia rhabdomyolysis hemiplegia, unspecified, affecting dominant side 

Answer: The patient is high likely exposed to