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: patient recorded as having no known allergies to drugs attending: chief complaint: intracranial bleed. major surgical or invasive procedure: cvl placement arterial line placement intubation mechanical ventilation thoracentesis x 2 history of present illness: ms. is a 87 yo f with h/o afib on coumadin, chf, and asthma, who presents following an unwitnessed fall at home from her chair at 6 a.m. this morning. per her husband's report, he heard her calling for help from the kitchen and found her lying on the floor. he states that she was responsive and communicative at the time and denied any bladder or bowel incontinence. he called ems, and she was transported to hospital. stat ct head revealed smal acute subdural hematoma within the interhemispheric fissure adjacent to an acute corpus callosum hematoma. she received 1 unit ffp, vitamin k 10 mg x1, and 20 meq of kcl at osh. ct c-spine and pelvic x-ray were negative. she was found to have a troponin leak of 0.1 with mbi 6.6 at osh and an ekg with nonspecific st deviations in the precordial leads. ua was negative. on arrival to , t 98.5, hr 66, bp 108/50, spo2 95% on 4l nc. she complained of right hip pain and denied headache or chest pain. she received 2 additional units of ffp, vitamin k 5mg sc, profilnine 4 vials iv, lasix 40 mg iv, and 20 meq kcl. abg was 7.53/50/266. stat head ct was performed which confirmed small sdh. neurosurgery and neurology were consulted. past medical history: * paf * copd/asthma * chf * macular degeneration * s/p tah * s/p appendectomy social history: married to her husband for 68 years. she smoked briefly while a teenager. she denies alcohol use. family history: parents died in their 80's, father of an mi. her sister died of breast cancer. her two daughters are healthy. physical exam: physical examination on admission: vs: t 100.4, bp 116/53, hr 96, spo2 96% on 4l nc gen: thin elderly woman, supine in bed with hob elevated to 30 degrees, in mild distress, pointing to forehead heent: perrl, sclera anicteric, conjunctivae clear, dried blood in oral cavity neck: supple, jvp elevated to level of mandible cv: irregularly, irregular, normal s1, s2. no m/r/g. chest: resp were unlabored, no accessory muscle use. ctab, crackles halfway up bilaterally. abd: soft, nt, nd, no hsm ext: no c/c/e. skin: multiple ecchymoses in various stages of healing neuro: moaning, eyes closed, pupils equal and reactive, no obvious facial droop but unable to perform cranial nerve exam as patient does not follow commands, moving all extremities, does not respond to questions physical examination on transfer: vitals - t: 95.2 (but unable to hold po thermometer) bp: 134/69 hr: 84 rr: 20 02 sat: 96% 2 l nc general: elderly female, lying in bed with eyes closed, restrained heent: could not assess ocular movements as pt blind; op - mm dry, no erythema, no exudate, but some white spots on tongue, no lad, cvl on r in place with c/d/i dressing, carotid pulses bounding cardiac: rrr, nl s1, s2, no m/r/g lung: ctab, no w/r/r on anterior exam, but limited abdomen: ndnt, soft, nabs ext: no c/c/e neuro: tongue midline, 5/5 strength in bilateral upper extremiteis, pt not cooperating with assessment of bilateral lower extremity strength, cn v, vii, xii intact. unable to assess eomi as pt blind. a&o x 1 (name, "doctor's office," wrong year) skin: multiple ecchymoses pertinent results: admission labs: =============== 10.7 7.2 >-------< 228 33.7 mcv 78 neuts 82.6 lymphs 10.7 monos 5.4 eos 0.8 basos 0.5 pt 23.5 ptt 44.7 inr 2.3 142 93 40 -----|-----|-----< 168 3.7 39 1.1 ca 9.5 mg 2.4 phos 2.7 ck 313 mb 8 trop 0.03 pertinent labs during hospitalization: ======================================= ck trend: mb trend:8 - 4 - 3 troponin trend: 0.03 - 0.04 - 0.07 microbiology: ============= 10:46am pleural wbc-200* rbc-* polys-24* lymphs-34* monos-34* myelos-2* plasma-1* other-5* 10:46am pleural totprot-1.8 glucose-162 ld(ldh)-91 ucx: negative bcx x 2: negative ucx: yeast ~1000 ucx: negative 10:46 am pleural fluid pleural fluid. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. anaerobic culture (preliminary): ucx: yeast. 10,000-100,000 organisms/ml. ucx: staphylococcus species. ~/ml. ucx: negative c. diff: negative bcx: negative bcx: negative studies: ========= chest (portable ap) impression: 1. unchanged moderate pulmonary edema with new moderate bilateral pleural effusions. 2. right middle and lower lobe opacities appear more confluent with worsening of retrocardiac consolidation could reflect worsening atelectasis and/or interval aspiration. ct head w/o contrast impression: 1. no interval change in the small-moderate subdural hematoma with adjacent intraparenchymal hemorrhage in the left frontal lobe. 2. hypoattenuation in the right frontal lobe, chronicity of which is unknown, and may reflect an area of encephalomalacia from prior infarct. however, comparisonw ith prior studies is essential for better assessment and to exclude acute etiology. hip (unilat 2 view) w/pelvis (1 view) impression: no evidence of fracture or dislocation. ct head w/o contrast head ct w/o iv contrast: adjacent to the left falx, there is a small subdural hematoma superior to the corpus callosum. there is also an adjacent parenchymal hematoma measuring 3.1 cm (ap) x 2.3 cm (transverse) x 1.8 cm (cc). there is surrounding vasogenic edema with mild effacement of the sulci. there is no midline shift. a several centimeter area of hypoattenuation in the right frontal lobe (2:21) is consistent with encephalomalacia due to prior infarction, although comparison to more remote studies is recommended to exclude an underlying mass. the ventricles and sulci are otherwise normal in size and configuration. there is no fracture. impression: 1. left subdural hematoma and adjacent intraparenchymal hemorrhage related to fall. resulting vasogenic edema and effacement of the sulci with no midline shift. 2. right frontal low density focus consistent with encephalomalacia, but comparison to older (outside) studies is recommended to exclude an underlying mass. ekg atrial fibrillation. ventricular premature beats. left axis deviation which may be left anterior fascicular block and consider also possible prior inferior myocardial infarction. delayed r wave progression with late precordial qrs transition. st-t wave abnormalities. the qtc interval appears prolonged but is difficult to measure. findings are non-specific but clinical correlation is suggested. no previous tracing available for comparison. tracing #1 ct head w/o contrast impression: 1. small subdural hematoma and left frontal intraparenchymal hematoma unchanged with mild sulcal effacement. small focus of hyperattenuation along the right superior frontal convexity may represent a small focus of subarachnoid hemorrhage; this is also unchanged from prior exams. 2. hypoattenuation in the right frontal lobe which is again of uncertain chronicity, is likely to reflect an area of encephalomalacic change from prior infarct. however, comparison with prior study or mri is recommended to exclude an acute process. eeg findings: abnormality #1: throughout the recording the background rhythm remained slow and disorganized, typically reaching a 6 hz maximum in most areas. there were some superimposed faster frequencies. abnormality #2: there were additional bursts of generalized mixed frequency slowing. hyperventilation: could not be performed. intermittent photic stimulation: could not be performed. sleep: no normal waking or sleeping morphologies were seen. cardiac monitor: showed an irregularly irregular rhythm with frequent pvcs. impression: abnormal portable eeg due to the slow and disorganized background rhythm and due to the bursts of generalized slowing. these findings indicate a widespread encephalopathy. medications, metabolic disturbances, and infection are among the most common causes. no prominent focal slowing was evident. there were no epileptiform features. an abnormal cardiac rhythm was noted. tte (complete) done the left atrium is mildly dilated. the right atrium is moderately dilated. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50%). there is no ventricular septal defect. the right ventricular free wall is hypertrophied. the right ventricular cavity is dilated with depressed free wall contractility. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. an eccentric, anteriorly directed jet of mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the supporting structures of the tricuspid valve are thickened/fibrotic. moderate to severe tricuspid regurgitation is seen. there is at least moderate pulmonary artery systolic hypertension. the main pulmonary artery is dilated. the branch pulmonary arteries are dilated. there is no pericardial effusion. impression: at least moderate pulmonary hypertension: moderate-to-severe tricuspid regurgitation; right heart failure chest (portable ap) findings: there are bilateral pleural effusions, right greater than left, with volume loss in both lower lobes. there is pulmonary vascular re-distribution. right ij line tip is in the right atrium. impression: chf, cannot exclude underlying infectious infiltrate. ct head w/o contrast impression: 1. no change in appearance of the brain compared to . left frontal intraparenchymal hemorrhage unchanged in size. the findings are not necessarily post-traumatic in etiology, and the possibility of an underlying mass at this site cannot be excluded. further evaluation with mr gadolinium may be helpful. 2. no change in small parafalcine subdural hematoma. 3. stable hypodensity of the right frontal lobe, which may reflect encephalomalacia from prior infarction. abd (single view only) impression: no evidence of free air or ileus. with this degree of osteopenia subtle fractures in the spine may not be identified without cross- sectional imaging. unilat lower ext veins right impression: no evidence of dvt. incidental right cyst behind the knee. ct abdomen w/contrast; ct pelvis w/contrast impression: 1. no evidence of obstruction or abscess. 2. large gallstone without evidence of cholecystitis. 3. lobular filling defect in the right atrial appendage which may represent adherent thrombus, however, echocardiography would be more specific. 4. bilateral large effusions with adjacent compressive atelectasis. 5. extensive vascular calcifications throughout the intra-abdominal vessels, without any secondary findings to suggest bowel ischemia. portable abdomen impression: no radiographic evidence of ileus or obstruction. chest (portable ap) unchanged radiographic appearance with extensive right-sided pleural effusion, small left pleural effusion and bilateral areas of hypoventilation. unilat lower ext veins left impression: no evidence of deep vein thrombosis in the left leg. chest (pa & lat) since the prior chest x-ray of , the size of the left pleural effusion is essentially unchanged and there is now a small right effusion which was not there following stat thoracentesis. no other significant change has occurred. impression: stable left effusion, small right effusion. chest (portable ap) impression: 1. no pneumothorax and no focal consolidation. 2. unchanged moderate bilateral pleural effusion, bibasilar atelectasis and mild pulmonary edema. chest (portable ap) impression: ap chest compared to and 16: moderate bilateral pleural effusion, right greater than left, has increased since . mild pulmonary edema is probably unchanged. there is no pneumothorax currently. ct chest w/o contrast impression: 1. severe right more than left pleural effusion with adjacent atelectasis. without contrast, it is difficult to exclude any superimposed pneumonia in the atelectatic lung segments. 2. moderate cardiomegaly. 3. minuscule left pneumothorax with no mass effect on the adjacent ipsilateral structures. chest (portable ap) impression: 1. no pneuothorax. 2. unchanged mild pulmonary edema, bibasilar atelectasis, and bilateral pleural effusions. chest (portable ap) impression: ap chest compared to through at 7:56 a.m. moderate bilateral pleural effusion, left greater than right, unchanged since earlier in the day, worsened on the left since , obscuring the cardiac silhouette which is moderately enlarged, but not appreciably changed. lower lungs obscured by effusions, and on the left, by atelectasis. upper lungs show mild vascular congestion but no edema. no pneumothorax. brief hospital course: micu course: ============ ms. is an 87 y.o. with afib on coumadin, chf, and asthma, admitted after unwitnessed fall at home from her chair at 6 am on day of admission, . pt was responsive and communicative at the time and denied bladder or bowel incontinence. she was transferred by ems to hospital. osh head ct showed small acute subdural hematoma within interhemispheric fissure adjacent to an acute corpus callosum hematoma. received 1 unit ffp, vitamin k 10 mg x 1, and 20 meq kcl at osh. ct c-spine and pelvic xr negative. had troponin leak of 0.1 with mbi 6.6 at osh. osh ekg with nonspecific st deviations in precordial lead. on admission to , she received 2 more units of ffp, vitamin k 5 mg sq, profilnine 4 vials iv, lasix 40 mg iv and 20 meq kcl. abg 7.53/50/266. stat head ct showed small sdh. neurosurgery and neurology were consulted and no intervention was pursued. she was intubated on for respiratory distress for airway protection and extubated on . repeat head ct showed stable ich and the hypodensity in the r frontal lobe. per neurology, ddx consists of trauma, coagulopathy, ruptured avm/aneurysm and amyloid angiopathy. per neuro, will need a repeat mri in weeks to evaluate any underlying lesion as well as characterization of older hypodensity. pt's inr actively being corrected in the micu with vitamin k for goal inr<1.4. hypernatremic in micu that is also being corrected with d5w. pt on seizure ppx per neurology. on day of transfer to the medical floor, cxr shows ? chf/effusion; however, as hypernatremic, holding active diuresis. currently, pt being treated with steroids po for possible copd and levofloxacin for retrocardiac opacity. per family, pt mental status is not at baseline. medicine floor course: ======================== # parenchymal bleed & subdural hematoma: a repeat head ct performed during micu course showed stable lesions. neurology and neurosurgery followed the patient during her hospitalization. her aspirin and coumadin were held in the setting of a bleed. aspirin was re-started as per neurology. per neurology, coumadin will not be reinstated until patient is able to have mri to clarify underlying issues (amyloid angiopathy vs avm) that may have preceded acute bleed. additionally, neurology recommended that inr<1.4, sbp<150. she was initially loaded with phenytoin and then continued on phenytoin 100 mg tid for 10 days. this was completed and titrated off. she remained seizure free. hob>30 degrees and neuro checks q2 hours were maintained. she was also on aspiration precautions. # altered mental status/delirium: on the medicine floor, the patient's altered mental status was waxing and . on several occasions, she was not responsive to sternal rub, but then would be responsive to pain. she had a ct of the head during her time on the medicine floor during one of her unresponsive episodes, which showed stable parenchymal bleed and subdural hematoma. she will need to have an mri/mra once she can tolerate the study. most likely, her delirium/altered mental status is due to her intracranial pathology. # respiratory failure: the patient became tachypneic and hypoxic in the micu shortly after the 4th unit of ffp with rigors, low grade temperature, and jvp to mandible. in the micu, she was being treated for copd and aspiration pneumonia. she was continued on a prednisone taper and then finished this course. she also completed a course of levofloxacin x 5 days. neurogenic pulmonary edema was also considered but she could not be diuresed due to her hypernatremia. # tachypnea: the patient continued to be tachypneic during her time on the medicine floor. this was most likely due to large bilateral pleural effusions. she had a r sided thoracentesis with 1300 cc removed. pleural fluid supported transudative fluid, likely chf. she was weaned off oxygen and was sating 95% on ra after this procedure, but remained tachypneic. she then went for a l sided thoracentesis; however, when the small needle was inserted, air was promptly removed. most likely, a bleb had popped overnight prior to this procedure, causing a pneumothorax. thoracentesis was abandoned. her family decided not to pursue a chest tube. the pneumothorax was monitored with serial cxrs without progresion. she needed 4 l nc for o2 sat in mid 90s due to her pulmonary effusions. she continues to remain tachypnic from high 20s up to 40s. lasix 10 mg iv daily was given to help with the bilateraly pleural effusions. # hypernatremia: initially, she was hypernatremic due to being intravascularly dry. this was corrected with d5w. # supratherapeutic inr: on arrival to the floor, the patient's inr was reversed with vitamin k for a goal of inr < 1.4. she remained <1.4 on discharge. # atrial fibrillation: rate controlled with beta-blockade as tolerated by bp. as she is npo, she is getting 2.5 mg metoprolol iv. when she can tolerate po's, please change to 12.5 mg metoprolol daily. anticoagulation was held in the setting of acute bleed. <b> she is not to start anticoagulation until a repeat mri is completed in weeks. </b> she was monitored on telemetry. # chf: initially, the patient was volume overloaded as per bilateral pleural effusions, but she was intravascularly dry as reflected by hypernatremia. she was continued on metoprolol. diuresis was originally held as the patient appeared intravascularly dry. after correction of her hypernatremia, gentle diuresis was started with iv lasix 10 mg prn. # s/p fall: consider syncope in the setting of hypovolemia/over diuresis vs. seizure vs. cardiac event vs. mechanical fall vs. toxic-metabolic process. eeg negative for seizure activity, but reflects encephalopathy. # abdominal pain: the patient moaned and had some guarding with palpation of her abdomen during her hospitalization. a ct of the abdomen/pelvis and multiple abdominal xrs were completed that showed no intraabdominal pathology. she was continued on aggressive bowel regimen as it appeared that she had copious amounts of stool in her bowel. # bilateral leg pain: the patient complained of bilateral leg pain. bilateral lenis were completed and were negative for dvts. cyst was found on her right lower extremity. # hematuria: the patient continued to have hematuria. this was most likely to traumatic foley placement. this was monitored closely. # aspiration: patient was continued on aspiration precautions. she was noted to aspirate her thin liquids/soft pureed foods. for this, she was made npo and all medications were changed to iv. # right forearm ulcers: wound care applied. # fen: no ivfs, replete lytes prn, pureed diet # ppx: bowel regimen, pneumoboots, ppi # code: dnr/dni confirmed with husband and daughter. # dispo: rehabilitation facility. medications on admission: home medications: coumadin (5mg x 3d, 2.5x4d) fosamax 70mg qweekly lasix 80 qday lisinopril 10 qday toprol 50 qday asa 81 qday kcl 1 tab daily caltrate 200 qday mvi qday medications on transfer: acetaminophen 650 mg pr q4 hour prn pain ipratropium bromide 1 neb q4 hours prn albuterol neb 1 ih q4 hours prn cefepime 1 g iv q 24 hours insulin sq ssi ipratropium bromide 1 neb ih q 4 hours prn lansoprazole 30 mg po daily metoprolol tartrate 12.5 mg po bid phenytoin 100 mg po tid prednisone 60 mg po daily vancomycin 1 gm iv q24 hours discharge medications: 1. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q4h (every 4 hours) as needed. 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q4h (every 4 hours) as needed. 3. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 5. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 6. sliding scale insulin please follow attached sliding scale insulin scale. 7. furosemide 10 mg/ml solution sig: ten (10) mg injection daily (daily): hold for sbp<95. 8. acetaminophen 650 mg suppository sig: one (1) suppository rectal q6h (every 6 hours) as needed for pain/fever. 9. clindamycin phosphate 150 mg/ml solution sig: six hundred (600) mg injection q12h (every 12 hours) for 7 days. 10. morphine 10 mg/ml solution sig: 0.5 mg intravenous every four (4) hours as needed for shortness of breath or wheezing. 11. metoprolol tartrate 5 mg/5 ml syringe sig: 2.5 mg intravenous once a day: hold for sbp<95 or hr<60. discharge disposition: extended care facility: - - discharge diagnosis: primary diagnosis 1. subdural hematoma 2. intraparenchymal hematoma 3. aspiration pneumonitis secondary diagnoses 1. atrial fibrillation 2. copd 3. chf 4. macular degeneration discharge condition: stable. discharge instructions: you were admitted for evaluation of a bleed in your head following a fall from a chair. you were given medicine to prevent you from having a seizure because of the bleed, and the bleed was monitored to make sure it was not getting bigger. your coumadin (blood thinner) was discontinued to prevent further bleeding. you were also given supplemental oxygen and medications to make it easier for you to breath. at one point, you were intubated to help you breath. you were found to have elevated sodium levels, and this was corrected with fluid. you also had a procedure called a thoracentesis to help take the fluid out of your lungs. the second time this was done, you were noted to have had a pneumothorax. this was treated with oxygen. please take your medications as prescribed. please keep all your medical appointments. please go to the emergency room or contact your pcp if you develop any of the following: shortness of breath, confusion or decreased alertness or fever> 101.5. followup instructions: please see your primary care physician, . (), on at 10 am. please see your cardiologist, dr. , on at 1 pm. please following up with dr. () from neurology on tuesday at 5pm. please call him to schedule an mri of the brain prior to following up with neurology. . please consult with your neurologist to determine whether you should follow up with the neurosurgeon who saw you while you were in the hospital, dr. (). please obtain the mri prior to seeing him. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis arterial catheterization diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation acute respiratory failure pneumonitis due to inhalation of food or vomitus iatrogenic pneumothorax alkalosis chronic obstructive asthma, unspecified hyperosmolality and/or hypernatremia acute on chronic systolic heart failure subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness legal blindness, as defined in u.s.a. accidental fall from chair chronic ulcer of other specified sites other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness 

Answer: The patient is high likely exposed to