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: fall major surgical or invasive procedure: none history of present illness: this is an 89 year old male with past medical history of diverticulosis and melanoma who presented with with altered mental status after a fall. the exact details of what happened are a bit unclear as patient is not able to give a full history but on the patient was shoveling snow when he sustained a fall and struck his head. he managed to get inside and call his daughter who came to check on him and found him very confused but able to speak with blood visible outside and inside the house. she brought the patient to the ed where he had head ct revealing intraparenchymal and subdural hemorrhages and neurosurgery was consulted. they recommended no acute neurosurgical management at the time. patient was extremely confused and becoming less responsive at that time so he was emergently intubated for airway protection and admitted to the neurosurgery icu. of night, he had a ct of his chest, abdomen, and pelvis that night, which was remarkable for signs of aspiration as well as some free air in his abdomen. his abdominal exam was benign and surgery evaluated him feeling there were no signs of an acute surgical abdomen or need for intervention. past medical history: -diverticulosis -melanoma r. chest -cataract -pseudoexfoliation syndrome -htn -basal cell ca social history: very independant, care taker for his wife who has dementia family history: nc physical exam: physical exam: in nicu o: t: af bp: 157/ 62 hr: 60 r :18 o2sats99 gen: wd/wn, trying to sit up on the stretcher at times. heent: pupils: bilaterally eomis / no hemotympanum noted / no csf rhinorrhea / no battles / no raccoons sign's neck: in cervical collar. neuro: gcs e= 3 / m=6 / v=4 = 13 mental status: lies with eyes closed. opens them easily to voice. attentive to the examiner/ slightly lethargic. he is cooperative with exam, normal affect. orientation: oriented to person only. does not know location / date / season recall: 0/3 objects at 5 minutes. language: speech fluent with good comprehension and poor repetition. naming is not intact. + dysarthria and paraphasic errors intermittently. cranial nerves: i: not tested ii: pupils equally round and reactive to light,2 to1 mm bilaterally. visual fields are full to confrontation. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: normal bulk and tone bilaterally. no abnormal movements, tremors. strength full power throughout. no pronator drift sensation: intact to light touch pertinent results: head ct : impression: 1. multi-compartment intracranial hemorrhage, including extensive left parafalcine and left convexity mixed density subdural hematoma, left inferior frontal hemorrhagic contusion, and scattered bifrontal subarachnoid blood. there is mass effect upon the left cerebral hemisphere, with 1-cm rightward shift of midline structures, and some evidence of encroachment upon the left suprasellar cistern. 2. left frontal subgaleal hematoma, with underlying nondisplaced skull fracture. ct cspine : impression: no apparent fracture or traumatic malalignment involving the cervical spine. degenerative changes are noted, worse from c5 through t1. note that motion artifact somewhat limits evaluation of the lower cervical spine, and if there is high clinical suspicion for injury, repeat ct or mr could be considered for further evaluation. ct chest/abd/pelvis : impression: 1. bilateral dependent pulmonary opacities, most compatible with aspiration. 2. low positioning of the endotracheal tube, which is positioned 2 cm above the carina, and could be withdrawn for optimal positioning. 3. free intraperitoneal air, located anterior to the liver, in the splenic hilum, and tracking through the hiatal hernia defect into the hiatal hernia sac. while highly worrisome for bowel perforation, the source is unclear. if further evaluation is desired, ct with enteric contrast could be considered. 4. indeterminate 2.1 cm right adrenal mass. if clinically indicated, when patient is stable, dedicated adrenal mri or ct could be performed. 5. small amount of free fluid tracking into the right inguinal hernia. 6. extensive aortic atherosclerosis. 7. degenerative changes throughout the spine, with no evidence of fracture. head ct : impression: 1. minimally changed multi-compartment intracranial hemorrhage, as detailed above. blood is now seen layering in the right lateral ventricle. mass effect upon the left cerebral hemisphere is stable, with persistent sulcal effacement, 1 cm rightward shift of midline structures, and minimal encroachment upon the left suprasellar cistern without herniation. this is unchanged from prior study. 2. nondisplaced skull fracture, as previously demonstrated. head ct : impression: 1. compared to the study from 1820h and, in particular, the study from 1355h (both ), there has been mild interval increase in the subdural hematoma layering along the left cerebral convexity and that leaflet of the tentorium cerebelli, as well as the intraventricular and left more than right subarachnoid hemorrhage. 2. evolving large left frontal hemorrhagic contusion. 3. unchanged mass effect with stable 10mm rightward shift of midline structures. 4. no evidence of herniation or acute infarction. head ct : impression: 1. interval decrease in density of left subdural hemorrhage. interval mild prominence of the right extra-axial space concerning for post-traumatic hygroma. 2. subdural hematoma layering along the tentorium cerebelli, similar to prior. similar intraventricular hemorrhage layering in the occipital of bilateral lateral ventricles. 3. similar bilateral foci of subarachnoid hemorrhage. 4. evolving large left frontal hemorrhagic contusion. 5. evolving areas of hypodensities in bilateral frontal lobes; evolving contusions. 6. similar mass effect with a similar approximately 7 mm rightward shift of midline structures. 7. no evidence of hydrocephalus. cxr : findings: in comparison with the study of , there is diffusely increased prominence of pulmonary vessels consistent with vascular congestion. in the appropriate clinical setting, the possibility of superimposed pneumonia, especially on the left, must be considered. large hiatal hernia is again seen. cxr : findings: ap single view of the chest has been obtained with patient in sitting semi-upright position. analysis is performed in direct comparison with the next preceding similar study of . again there is perivascular haze indicative of pulmonary vascular congestion. basal densities exist more marked on the left than on the right. again as mentioned on preceding study, consideration for superimposed pneumonic infiltrates in this patient with chf must be considered. there is no significant interval change during the latest 24 hours examination interval. echo : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is small. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). there is a severe resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. 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. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: small, hyperdynamic left ventricle with severe outflow tract obstruction. ct chest/abd : impression: 1. resolution of free intraperitoneal air. 2. very large hiatal hernia containing stomach and transverse bowel loop. 3. new bilateral pleural effusions. nearly resolved bibasillar opacities most likely represented aspiration. 4. extensive aortic atherosclerosis. 5. indeterminate 2.1 cm right adrenal mass. again, if no comparison available and clinically indicated, when patient is stable, dedicated renal mr could be performed. cxr: findings: there is a new et tube with tip 4 cm above the carina. the ng tube tip is in the stomach and is coiled in the lower thorax in the hiatal hernia. the heart is mildly enlarged. there continues to be vascular plethora. there are small bilateral effusions but these are less apparent than on the study from one hour prior. overall the aeration is slightly improved. ct head: 1. little change in bilateral chronic subdural, left subarachnoid and left occipital hemorrhage. slight increase in subdural hemorrhage along the falx. ct head: impression: 1. in comparison to an exam obtained the day prior, there are new hypodensities involving bilateral anterior cerebral artery and left middle cerebral artery territories, with significant cerebral edema and mass effect as demonstrated by increased rightward shift of normally midline structures. these findings are concerning for acute ischemia possibly secondary to vasospasm. 2. evolving right frontal hematoma. stable appearance of ventricular hemorrhage as demonstrated by layering of blood products in the occipital of the right lateral ventricle. 3. small bilateral chronic subdural hematomas. pertinent labs: 01:30pm blood wbc-12.5* rbc-4.29* hgb-11.3* hct-33.8* mcv-79* mch-26.3* mchc-33.4 rdw-14.1 plt ct-305 02:57am blood wbc-13.9*# rbc-3.22* hgb-8.4* hct-25.9* mcv-81* mch-26.2* mchc-32.5 rdw-14.4 plt ct-175 03:15am blood wbc-12.6* rbc-2.90* hgb-7.5* hct-23.3* mcv-80* mch-25.8* mchc-32.1 rdw-14.7 plt ct-390 01:30pm blood pt-12.5 ptt-22.5 inr(pt)-1.1 01:30pm blood glucose-197* urean-39* creat-1.2 na-137 k-4.9 cl-103 hco3-22 angap-17 03:15am blood glucose-156* urean-32* creat-1.7* na-141 k-3.9 cl-114* hco3-19* angap-12 01:05pm blood alt-48* ast-56* ld(ldh)-372* ck(cpk)-295 alkphos-97 amylase-90 totbili-0.6 03:15am blood alt-39 ast-59* ld(ldh)-386* alkphos-82 totbili-0.4 05:59am blood ck-mb-10 mb indx-3.5 ctropnt-0.03* 03:15am blood albumin-2.3* calcium-7.5* phos-2.5* mg-2.2 brief hospital course: this is an 89 year old male with past medical history of melanoma, htn, and diverticulosis, who presented from home on s/p fall. per review of omr, the patient was shoveling snow on when he fell and hit his head. he managed to get inside and call his daughter who came to check on him and found him very confused but able to speak with blood visible outside and inside the house. she brought the patient to the ed where he had head ct revealing intraparenchymal and subdural hemorrhages and neurosurgery was consulted. they recommended no acute neurosurgical management at the time. patient was extremely confused and becoming less responsive at that time so he was emergently intubated for airway protection and admitted to the neurosurgery icu. of note, he had a ct of his chest, abdomen, and pelvis that night, which was remarkable for signs of aspiration as well as some free air in his abdomen. his abdominal exam was benign and surgery evaluated him feeling there were no signs of an acute surgical abdomen or need for intervention. . in the sicu, he was intubated for one night and was extubated and sent to the neuro step-down unit. he had sputum cultures sent while intubated, which grew klebsiella. therefore, when he had fevers on and increased respiratory distress he was started on cefepime/vancomycin for concern of pneumonia. on the day prior to transfer he developed tachypnea and increased o2 requirments. therefore he was given iv furosemide for a total diuresis of about 1l negative. a medicine c/s was called and he was transferred to medicine for further evaluation. . on the floor, the patient was somnolent but arousable to sternal rub. he was started on flagyl empirically for aspiration pneumonia, and the respiratory therapist noted that he was having difficulty handling his secretions. he was given one dose of hydralazine iv for sbp > 160. at approximately 4 am, routine vs demonstrated hypoxia to 60% on ra. he was placed on a nrb, to which his sats increased to 100%, and abg and cxr were ordered. the micu was called regarding likely transfer, and as the patient developed increasing respiratory distress, a code blue was called for emergent intubation. he transiently dropped his sbp to the 60s after intubation, which increased to the 100s with ivfs. he was then transferred to the micu. . in the micu, we he was taken off sedation, but did not have any purposeful movements. a head ct right after the event showed no major changed from initial scan. neuro was consulted and a second ct was obtained 24 hrs after intubation. this ct showed severe bilateral ischemic strokes, likely related to vasospasm from the initial bleed. given his poor prognosis, the family decide to pursue only comfort care and he was terminally extubated on . his time of death was 13:40 approximately 1-2 hrs after extubation. his family was informed and declined autopsy. medications on admission: unknown discharge medications: n/a, expired discharge disposition: expired discharge diagnosis: left subdural hematoma left frontal contusion pna left and right ischemic strokes discharge condition: n/a, expired discharge instructions: you came to the hospital after a fall. it showed you had bleeding inside of your brain. while recovering this bleeding led to some spasms in your brain arteries, leading to a stroke. this caused permanent neurological damage that was terminal. followup instructions: n/a, expired procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances closure of skin and subcutaneous tissue of other sites diagnoses: acidosis unspecified essential hypertension acute kidney failure, unspecified unspecified fall open wound of scalp, without mention of complication diaphragmatic hernia without mention of obstruction or gangrene acute respiratory failure other specified cardiac dysrhythmias anoxic brain damage accidents occurring in other specified places encounter for palliative care hyperosmolality and/or hypernatremia cerebral artery occlusion, unspecified with cerebral infarction diverticulosis of colon (without mention of hemorrhage) pneumonia due to klebsiella pneumoniae other conditions of brain dysphagia, unspecified other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness 

Answer: The patient is high likely exposed to