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: latex attending: chief complaint: left sided weakness major surgical or invasive procedure: foley catheter history of present illness: the pt is a 53 y/o man with hx of depression, etoh abuse and htn who presents as a transfer from hospital. per gathered information he has been staying with his ex-wife fore the last couple of days drinking. today he was noted to be on the floor (fell from couch?) all day today by ex-wife who thought he was drunk. in the evening he became agitated and paramedics were called. he was transferred to the osh and there he was being worked up for intoxication. he had a negative etoh level and a ct scan demonstrated a right side stroke and so he was transferred to for further care. here he was seen by himself and we were unable to call the ex-wife (wrong number) he received 100mcg of fentanyl before transfer. he is able to state that he had a stroke, and complains of headache. he does not answer when asked what time did he have a headache or what time he felt weak. he denies seizures but was able to state that his lamictal and depakote were for mood. per report he was without atenolol for the last 5 days as well. he did not answer when asked about weakness or changes to vision. past medical history: mood disorder hypertension hypothyroidism alcohol abuse . psh: - lumbar fusion approx 7 years ago social history: pt reports he has been separated from 2nd wife , but has been in the process of reconciliation and recently has been living with her. pt identifies his sister as next of / surrogate decision maker. pt identifies his 2 adult children, age 27 and age 21 (both live in ). pt reports hx of trauma in his childhood, father was physically abusive to pt and his mother. pt was divorced from 1st wife which he identifies as a significant loss, as it also separated him from his children. pt reports hx of physical abuse by his 2nd wife in the past, and reports being choked by her precipitating his stroke. pt denies ever being physically abusive to wife. pt reports having hx of bipolar disorder with anxiety and depression and adhd. he is the in ( and previously saw therapist there. pt unclear why he is no longer seeing ms ; states his children were also seeing her. he states he needs to see a new therapist. pt reports hx of psychiatric admissions, but says he has been stable for a few years. pt reports feeling some suicidal ideation prior to admission, denies feeling suicidal at this time. pt reports hx of daily etoh use, drinking "a few" vodka drinks per night; pt could not quantify amount. pt reports he drinks to numb physical (back) pain and emotional pain. pt has hx of opiate prescription abuse after period of treatment for chronic pain. he attended a pain clinic and eventually went to cab addictions program in ; reports he has not abused opiates in 2 years. pt denies smoking. sister reports that to her knowledge pt has not used opiates since inpt treatment. sister was aware pt drinks etoh, but did not think excessively. she reports wife had called and told her pt drank a whole bottle of vodka on the day of admission and was found unconscious. sister believes excessive drinking is out of the norm for pt, and fears it may indicate psychiatric decompensation. family history: sister with stroke at age 25 (but was born premature and was felt to have a weak blood vessel). she also had severe scoliosis which required surgery. another sister with a cerebellar stroke at age 50 (?) neck injury. another sister with type i diabetes. thyroid disease. father with carotid artery disease and mi at 40 (drinker and smoker) mother died of pancreatic cancer at 62 yo. mother's side with cancer. physical exam: admission exam: physical exam: vitals: t: 98.1 p: 47 r: 16 bp:159/98 sao2:100 2l nc general: somnolent heent: at, no scleral icterus noted, dry mm. neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally cardiac: rrr, nl. s1s2 abdomen: soft. extremities: no edema. skin: no rashes or lesions noted on legs/ arms neurologic: he is somnolent frequently has his eyes closed will occasionally open them to voice to tactile stimuli. states it is and and that he is at hospital knows that he had a stroke. speech is dysarthric but no paraphasic errors noticed. he neglects his left side with a right side gaze deviation which he was unable to overcome when examining him from his left side. when his arm was held in front of him he said it was the examiners arm. his pupils are 3.5mm and symmetric as well as briskly reactive. eyes are conjugate, there is no nystagmus noted and able to cross midline on dolls. he has weakness over his left facial muscles. the left side was flacid with no movement on pain and mute toes. his right side was at the deltoid, grip, hamstrings, quads and ta with a down going toe on plantar stimulation. . . discharge exam: a+ox3 but at times slightly inappropriate and joking left neglect better - able to completely draw clock and attending much better to left side severe left facial droop with dysarthria dense left hemiparesis 0/5 in ue and 0-1/5 in le decrease sensation to light touch on left side with intact to painful stimuli pertinent results: admission labs: 01:36am blood wbc-9.0 rbc-4.74 hgb-16.1 hct-45.7 mcv-97 mch-34.1* mchc-35.3* rdw-13.8 plt ct-181 01:36am blood neuts-79.6* lymphs-16.4* monos-3.4 eos-0.3 baso-0.3 01:36am blood pt-12.3 ptt-20.1* inr(pt)-1.0 01:36am blood glucose-102* urean-10 creat-0.7 na-142 k-4.0 cl-106 hco3-24 angap-16 04:24am blood calcium-8.9 phos-2.9 mg-1.9 cholest-151 . other pertinent labs: 03:00pm blood aca igg-2.3 aca igm-9.9 03:00pm blood lupus-neg 04:24am blood tsh-0.040* 06:25am blood tsh-4.1 06:25am blood free t4-1.1 05:30pm blood t4-7.7 t3-76* 05:30pm blood -negative 05:30pm blood valproa-25* . cholest-151 triglyc-76 hdl-56 chol/hd-2.7 ldlcalc-80 %hba1c-4.9 eag-94 . tox screens: 01:36am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 01:36am urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg . discharge labs: 06:25am blood wbc-9.2 rbc-4.20* hgb-14.6 hct-41.0 mcv-98 mch-34.9* mchc-35.7* rdw-13.2 plt ct-227 06:25am blood glucose-89 urean-13 creat-0.6 na-137 k-4.1 cl-106 hco3-24 angap-11 06:25am blood calcium-9.0 phos-2.8 mg-2.1 01:33pm blood alt-54* ast-34 alkphos-62 totbili-0.7 . . urine: 01:36am urine color-yellow appear-clear sp -1.015 01:36am urine blood-sm nitrite-neg protein-neg glucose-neg ketone-40 bilirub-neg urobiln-neg ph-5.5 leuks-neg 01:36am urine rbc-2 wbc-1 bacteri-few yeast-none epi-1 01:36am urine mucous-rare . . microbiology: 4:23 am mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. . . imaging: head ct/cta head and neck cta neck: the origin of arch vessels is patent. minor soft plaques are seen in the cervical carotid vessels without evidence of a flow-limiting stenosis. the origin of vertebral arteries is patent. impression: hyperdense right mca sign and a large right mca territory infarct involving the right frontal, temporal and parietal lobes without hemorrhagic transformation. mri brain evolving large right mca territory infarct, with increased vasogenic edema and effacement of the right lateral ventricle and right uncal region. no hemorrhagic transformation is seen. . ct c spine impression: no evidence of fracture or malalignment with normal prevertebral soft tissues. . ct-head essentially unchanged right frontal mca territory infarct with no evidence of hemorrhagic transformation. . cxr impression: no evidence of acute cardiopulmonary process. . . cardiology tte the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. no atrial septal defect or patent foramen ovale identified by color doppler study or agitated saline contrast study (at rest x 2) in suboptimal views (cannot definitively exclude). . tee no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. there is no pericardial effusion. impression: no echocardiographic evidence for cardiac source of embolus identified. no asd or pfo by color, 2d, or saline contrast injection. . cardiology report ecg study date of ????????????1:42:12 am ?????? sinus bradycardia with sinus arrhythmia. no previous tracing available for comparison. ?????? read??????by: , a. ?????? intervals axes rate pr qrs qt/qtc p qrs t 47 156 98 65 . cardiology report ecg study date of ????????????8:51:16 pm ?????? sinus rhythm. tracing is within normal limits. compared to the previous tracing of the rate is increased and no longer bradycardic. there are no other diagnostic differences. ?????? read??????by: , ?????? intervals axes rate pr qrs qt/qtc p qrs t 61 148 86 398/399 55 63 67 brief hospital course: neuro: right mca stroke . 53 yo rhm with history etoh abuse, depression and hypertension presents with l hemiparesis and slurred speech. the patient was initially thought to be intoxicated, but etoh level at osh was 0. head ct then showed r mca stroke. he was out of the window for tpa or intervention based on the time last seen well and the ct findings. he was transferred to and admitted to neuro icu. . neuro: # right mca stroke: the patient was somnolent on presensation and during examination developed bradycardia to 40s and hypertension over 200s. head ct did show increased edema in the r mca territory with mass effect on the frontal of the lateral ventricle but no significant midline shift or downward herniation. a repeat head ct the following morning showed no significant worsening, and his clinical exam had begun to improve. he was alert though drowsy, and oriented x 3, able to follow commands on the left. he had a persistent dense left hemiparesis. tee was . workup for etiology of the stroke was unrevealing. cta showed normal vessels in the head and neck. cardiac telemetry showed intermittent bradycardia but no atrial fibrillation. tte was normal. tee showed minimal plaque in the descending aorta, no intracardiac source of thrombus and no asd/pfo. it was hypothesized that volume depletion in the setting of recent heavy etoh intake could have caused the stroke. an abbreviated hypercoagulable panel was sent (anticardiolipin negative, lupus anticoagulant negative) were negative. further hypercoagulable work-up will be deferred to the o/p. . he complainted of burning pain in his leg and right foot and was started on gabapentin. this was uptitrated on the day of discharge. he was also aspirating and patient was seen by the speech and swallow services who recommended a modified diet. this was upgraded prior to discharge with a discharge diet of soft dysphagia diet and nectar thick liquids. . on the day of discharge, the patient remained awake, alert and fully oriented. mild anisocoria with left 5mm +, right 4.mm + in dim light. repeat ct scan was without evidence of herniation. he continued to have neglect to double simultaneous stimulation in the left leg, a resolving left sided neglect visually. patient was able to draw a full clock on discharge inkeeping with considerable improvement in his neglect. there was a flicker of movement in the proximal left leg (), no movement of the left arm. some intermittent effort and generally full power on the right likely due to deconditioning during his protracted hospital course. patient was transferred to rehab on . patient has follow-up with neurology on . . # headache: patient complainted of headache since admission. headache is generalised, constant and throbbing. he has received frequent acetaminophen and was initially treated with iv hydromorphone. patient was started on ibuprofen prn. he is also treated with oxcarbazepine, valproate and gabapentin. . # leg pain: the patient complained of burning pain in his legs and was started on gabapentin for neuropathic pain. symptoms are possibly due to alcoholic neuropathy (b12 and folate were within normal limits) and possibly related to his stroke. he was started on gabapentin at 200mg tid and this can be uptitrated as needed. . #psych: patient has depression and etoh abuse. he was restarted on his home doses of depakote, trileptal and remeron once taking pos. he did express a persistent ideation that his wife strangled him, causing the stroke, but there was no evidence of trauma. social work was involved. he had no suicidal or homicidal thoughts. during this hospitalization, the patient exhibited signs of ethanol withdrawal including formication hallucinations. these have resolved and the patient is no longer requiring benzodiazepine coverage. ciwa scale was stopped on the day of discharge. he received folate and thiamine. in speaking with his wife prior to discharge, there remains concern that the patient has been confabulating significant information for the last 1.5 years. apparently he tells others he has reunited with his children, but when they were contact by his ex-wife regarding this hospitaliztion, they reported that they have not seen him in 20 years. it is unclear how much confabulation has been going on prior to the patient's stroke, but certainly he will require psychiatric evaluation once the acute phase of his neurologic rehabilation is completed. patient has complaints of chest pain associated with anxiety. there episodes were were without changes on ecg. patient is on a number of mood stabilisers and treatment with oxcarbazepine and valproate were continued. we continued mirtazapine for anti-depressant and patient continued to volunteer symptoms of depression. . cardiac: patient has complaints of chest pain associated with anxiety. there episodes were were without changes on ecg and other cardiac workup including echo were unremarkable with no source of cardiac cause of stroke. . # endo: the patient was continued on his home dose of levothyroxine. his tsh on admission was significantly suppressed (tsh 0.040) however in discussion with endocrine, this was felt to be of limited significance given his acute illness. free t4 was within normal limits. repeat tsh was 4.1. . # tobacco abuse: the patient was placed on a nicotine patch. . # alcohol abuse: patient was a heavy drinker in the community and was treated for alcohol withdrawal on transfer to the neurological floor. patient noted visual hallucinations of insects crawling and was anxious and agitated high on ciwa scale. she was treated with lorazepam prn and had no withdrawal symptoms on discharge. . . transitional issues: patient awaits further hypercoagulable work-up regarding the etiology of his stroke to include factor v leiden, fibrinogen and consideration of ct-chest/abdomen/pelvis. this will happen as a neurology out-patient. medications on admission: ? clonazepam trileptal depakote levothyroxine discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) dose injection tid (3 times a day). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. levothyroxine 175 mcg tablet sig: one (1) tablet po mon, tues, wed, thurs, fri, sat (). 8. levothyroxine 88 mcg tablet sig: one (1) tablet po sun (). 9. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever, ha. 11. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 12. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 15. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 16. oxcarbazepine 600 mg tablet sig: one (1) tablet po bid (2 times a day). 17. mirtazapine 15 mg tablet sig: two (2) tablet po hs (at bedtime). 18. divalproex 500 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po bid (2 times a day). 19. gabapentin 100 mg capsule sig: two (2) capsule po tid (3 times a day). 20. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: acute right middle cerebral artery stroke . secondary diagnoses: alcohol withdrawal left hemi-sensory neuropathic pain post stroke headache likely multifactorial in etiology mood disorder discharge condition: mental status: clear and coherent but occasionally will be mildly disoriented. patient has a long history of psychiatric issues. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: it was a pleasure taking care of you at the . you presented with left sided weakness and slurred speech and were found to have a stroke on the right side of the brain on ct and mri scan which was responsible for this. you had some swelling in the head and you were observed in the icu. your ct scans of the head were stable. you were transferred to the neurology but still had significant left sided weakness. you had swallowing problems due to your stroke and were assessed by speech and swallow and you were started on a thick diet to help prevent choking and inhaling food. you also had alcohol withdrawal and were treated for this. you had episodes of chest pain associated with anxiety and headache which is likely partly due to your stroke but also has likely been aggravated by taking pain-killers during your hospitalization. nerve pain from your stroke was treated with a tablet called gabapentin. you were assessed by physical therapy and as you required acute rehab you were transferred on . you have neurology follow-up as below. . medication changes: we started heparin to prevent blood clots we started folic acid 1mg daily we started multivitamins we started thiamine 100mg daily we started famotidine 20mg twice daily for increased stomach acid we started aspirin 325mg daily to reduce risk of further stroke we started a nicotine patch we started acetaminophen as required for headache although this should be used sparingly we started simvsatatin 20mg daily to help lower cholesterol and hence risk of stroke we started ibuprofen 400mg as required for pain we started gabapentin 200mg three times daily for arm and leg pain from your stroke we continued your trileptal (oxcarbazapine), sodium valproate and mirtazapine followup instructions: we made the following neurology appointment for you: department: neurology when: monday at 3:30 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: diagnostic ultrasound of heart alcohol detoxification diagnoses: tobacco use disorder unspecified essential hypertension mononeuritis of lower limb, unspecified dysthymic disorder cerebral edema headache bipolar disorder, unspecified attention deficit disorder with hyperactivity cerebral artery occlusion, unspecified with cerebral infarction other and unspecified alcohol dependence, unspecified alcohol withdrawal delirium hemiplegia, unspecified, affecting nondominant side neurologic neglect syndrome 

Answer: The patient is high likely exposed to