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: nifedipine attending: chief complaint: nausea/vomiting major surgical or invasive procedure: intubation suboccipital craniectomy and r venticulostomy - ventriculostomy - vp shunt- trach and peg history of present illness: neurology at bedside for evaluation after code stroke activation within: 2 minutes time (and date) the patient was last known well: 12:30 on nih stroke scale score: 10 t-: --- yes time t-pa was given ------:------ (24h clock) -x- no reason t-pa was not given or considered: out of window i was present during the ct scanning and reviewed the images instantly within 20 minutes of their completion. nih stroke scale score was 0: 1a. level of consciousness: 0 1b. loc question: 0 1c. loc commands: 0 2. best gaze: 1 3. visual fields: 0 4. facial palsy: 2 5a. motor arm, left: 0 5b. motor arm, right: 0 6a. motor leg, left: 0 6b. motor leg, right: 2 7. limb ataxia: 0 8. sensory: 2 9. language: 0 10. dysarthria: 2 11. extinction and neglect: 0 hpi: mr. is a 42 yo portuguese-speaking man with h/o dm2, htn, hl who presents with l facial droop, r sided numbness, and slurred speech. history is somewhat limited due to language barrier and acute code stroke setting. the patient developed nausea/vomiting at 12:30 am today. over the next several hours, he worsened, developing difficulty with balance and right sided numbness and weakness. at 4:00pm, wife noticed l facial droop. patient was brought to hospital. nchct was interpreted as normal. neurology was consulted over the phone. nihss 8. received iv labetalol 20 mg total, zofran and asa 325 mg. he was transferred to without any thrombolysis (unclear if on-call stroke line thought he was out of window). in , patient had nihss 9. bp was elevated at 254/125. he was started on nicardipine drip for bp control. according to patient's wife, he has been stable to slightly improving over past few hours. he was quite restless because he is bothered by the absence of sensation on his right side. he has no pain or headache. no nausea. no diplopia in primary gaze, and no vertigo. on limited ros, no fever, cough, sob, chest pain. past medical history: dm2 htn hl social history: married, no tobacco. speaks portuguese. understands very limited english family history: h/o cad physical exam: admission exam physical exam: vitals: t: afeb p:100 r: 16 bp:215/135 sao2:96/ra general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd extremities: no c/c/e bilaterally skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3. attentive and cooperative. language is fluent with intact naming and comprehension. speech was moderately dysarthric. able to follow both midline and appendicular commands. there was no evidence of apraxia or neglect. -cranial nerves: i: olfaction not tested. ii: r pupil 6mm, l pupil 4mm, both briskly reactive both direct and consensual responses. vff to confrontation with blink to threat. iii, iv, vi: in primary gaze, l eye deviated inward. complete l gaze palsy b/l. on r gaze there is horizontal nystagmus. vertical gaze and convergence intact. v: facial sensation intact to light touch. vii: upper and lower facial musculature weakness. viii: hearing intact to voice grossly. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii. xii: tongue protrudes in midline. -motor: normal bulk. decreased tone in right side. r pronator drift present. no adventitious movements, such as tremor, noted. delt bic tri wre ffl fe io ip quad ham ta l 5 5 5 5 5 5 5 5 5 5 5 5 r 5 5 5 5 5 5 5 3 4- 4- 4 4- -sensory: decreased light touch and pinch on right upper and lower extremities (now intact on face though previously right face numb). no extinction to dss. -dtrs: tri pat ach l 2 2 2 2 1 r 2 2 2 2 1 plantar response was flexor on left, extensor on right. -coordination: no intention tremor, no dysdiadochokinesia noted. no dysmetria on fnf bilaterally. -gait: deferred on transfer out of icu: spontaneously awake, follows commands, shows thumbs-up for yes and shakes pointer finger for no. pupils r 2.5->1.5, l 2->1.5. l gaze palsy, r eye abducens weakness (r beating nystagmus when looking r). no blink to threat. no corneals. l upper/lower face weakness. +gag. +cough. lue/lle 4+ to 5/5 strength. rue/rle hemiplegia but r fingers/wrist/elbow extending/flexing now and r quad contracts (almost antigravity). inconsistent with r side depending on exhaustion level. r toe up. discharge exam: spontaneously awake, follows commands, shows thumbs-up for yes and shakes pointer finger for no. pupils r 2.5->1.5, l 2->1.5. l gaze palsy, r eye abducens weakness (r beating nystagmus when looking r). l upper/lower face weakness. lue/lle 5/5 strength. rue/rle hemiplegia but r fingers/wrist/elbow extending/flexing now, can move r quad anti-gravity and dorsi/plantar flex foot with good strength. r toe upgoing. pertinent results: 07:15pm wbc-11.6* rbc-5.87 hgb-17.8 hct-52.3* mcv-89 mch-30.3 mchc-34.1 rdw-13.0 07:15pm plt count-278 07:15pm pt-9.8 ptt-26.9 inr(pt)-0.9 07:15pm urea n-16 07:26pm glucose-353* na+-141 k+-4.1 cl--100 tco2-23 08:30pm urine blood-tr nitrite-neg protein-100 glucose-1000 ketone-40 bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 08:30pm urine rbc-1 wbc-1 bacteria-none yeast-none epi-<1 08:30pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 10:58pm calcium-9.1 phosphate-3.4 magnesium-1.9 10:58pm ck-mb-3 10:58pm ck(cpk)-171 10:58pm glucose-313* urea n-14 creat-0.9 sodium-140 potassium-3.7 chloride-103 total co2-26 anion gap-15 3:41 pm bronchoalveolar lavage left lung. **final report ** gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive cocci. in pairs and singly. respiratory culture (final ): 10,000-100,000 organisms/ml. commensal respiratory flora. staph aureus coag +. 10,000-100,000 organisms/ml.. sensitivities performed on culture # from . fungal culture (final ): no fungus isolated. 7:48 pm sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram negative rod(s). smear reviewed; results confirmed. respiratory culture (final ): sparse growth commensal respiratory flora. gardnerella vaginalis. moderate growth. 10:01 pm mini-bal bronchial lavage. **final report ** gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive rod(s). respiratory culture (final ): >100,000 organisms/ml. commensal respiratory flora. yeast. 10,000-100,000 organisms/ml.. 2:16 pm blood (toxo) source: venipuncture. **final report ** toxoplasma igg antibody (final ): positive for toxoplasma igg antibody by eia. 53 iu/ml. reference range: negative < 4 iu/ml, positive >= 8 iu/ml. toxoplasma igm antibody (final ): negative for toxoplasma igm antibody by eia. interpretation: infection at undetermined time. a positive igg result generally indicates past exposure. infection with toxoplasma once contracted remains latent and may reactivate when immunity is compromised. if current infection is suspected, submit follow-up serum in weeks. ecg normal sinus rhythm. q waves in leads iii and avf consistent with prior inferior myocardial infarction. no previous tracing available for comparison. cta head/neck impression: 1. unremarkable head ct without evidence of infarct or hemorrhage. mri is suggested if clinically warranted. 2. hypoplastic right vertebral and small left vertebral arteries, likely developmental. both vertebral arteries end as pica with reconstitution of the right vertebral artery from the right superior cerebellar. cxr impression: 1. unremarkable head ct without evidence of infarct or hemorrhage. mri is suggested if clinically warranted. 2. hypoplastic right vertebral and small left vertebral arteries, likely developmental. both vertebral arteries end as pica with reconstitution of the right vertebral artery from the right superior cerebellar. cxr as compared to the previous radiograph, there is no relevant change. minimal atelectasis at the right lung base. borderline size of the cardiac silhouette. no pneumonia, no pulmonary edema. the nasogastric tube is in constant position. mri/a brain findings: there is an acute infarct with hemorrhagic conversion identified in the left cerebellum in the region of posterior inferior and anterior inferior cerebellar arteries extending to the left side of the pons. there is mass effect on the fourth ventricle. there has been a craniectomy identified in the region for decompression. there is mild indentation of the lateral ventricles and there is presence of a right frontal approach ventricular drain with the tip in the region of left lateral ventricle. the temporal horns are mildly dilated indicating some degree of obstructive hydrocephalus. there is signal change within the anterior portion of corpus callosum related to the tract of the ventricular drain. the flow void of the distal left vertebral artery is not well visualized. on the mra of the head no abnormalities are seen in the anterior circulation. both vertebral arteries are not visualized beyond posterior arch of c1. subtle flow signal is identified in the distal basilar artery but flow signal is not seen in the proximal basal artery nor the distal vertebral arteries. there are fluid levels within the left maxillary sinus which could be related to intubation. impression: postoperative changes for decompression secondary to hemorrhagic left cerebellar infarct. there remains mass effect on the fourth ventricle and some dilatation of the lateral ventricle. a ventricular drain is in position. both vertebral arteries are not visualized distal to the posterior arch of c1 level. the proximal basal artery is not visualized as well. there abnormalities on the anterior circulation on mra. nchct impression: 1. known left cerebellar infarct with hemorrhage, with mass effect on the 4th ventricle and basal cisterns, stable in appearance since the earlier study of . 2. stable positioning of the ventricular drain, coursing through the frontal of the left lateral ventricle, terminating at its lateral margin. minimal interval increase in the ventricular size since ct study. nchct impression: 1. interval repositioning of the right external ventricular drain with tip now projecting anterior to the frontal of the right lateral ventricle adjacent to the falx, outside the ventricular system. 2. otherwise similar exam with left cerebellar infarct with hemorrhagic conversion, adjacent mass effect, and stable ventricular size. nchct impression: 1. interval repositioning of right frontal external ventricular drain, now terminating in the left putamen or internal capsule. ventricles have decreased in size since the prior exam. 2. left cerebellar infarction with stable posterior fossa mass effect and hypodensity extending into the pons. nchct impression: 1. significant interval decrease in size of left lateral ventricle is likely related to over shunting through the right frontal approach evd, as there is no associated sulcal effacement or new edema. correlate with catheter function and close f/u. assessment of the position of the tip of the catheter is difficult due to the significant decompression of the ventricle- it is either outside the ventricular margin or within. pl. review the images to decide on further management. 2. left cerebellar infarct with stable posterior fossa mass effect and suboccipital craniectomy. nchct impression: 1. right frontal approach evd terminates in the left lateral ventricle. left lateral ventricle has increased in size since the prior exam, with ventricles and sulci now similar in size and configuration to . 2. status post suboccipital craniectomy with unchanged posterior low-density fluid collection. left cerebellar infarction and pontine infarction are stable. slight improvement in effacement of fourth ventricle. r lower ext - doppler us: findings: -scale and doppler son of the right common femoral, superficial femoral, popliteal, posterior tibial and peroneal veins were performed. there is normal compressibility, flow and augmentation. impression: no evidence of deep venous thrombosis in the right lower extremity. nchct impression: 1. repositioning of the evd with the tip in the third ventricle. 2. continued effacement of the fourth ventricle by mass effect in the left cerebellar hemisphere. status post suboccipital craniectomy. renal son: renal son: the right kidney measures 12.8 cm, and the left kidney measures 13.6 cm. there is no hydronephrosis, stones, or mass. bladder is collapsed with a foley in place. impression: normal renal son. tee: conclusions 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. right atrial appendage ejection velocity is good (>20 cm/s). no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast at rest x 4 injections (central line x 2; peripheral line x 2). there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch (clip ) and 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 valve abscess is seen. 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. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no valvular vegetation, intracardiac mass/thrombus seen. no evidence for an atrial septal defect or patent foramen ovale by color flow doppler or saline injection at rest. simple thoracic atheroma. brief hospital course: 42yo m with h/o dm2, htn who presented with l lower face weakness, dysarthria, r sided sensory loss and hemiparesis, nausea/emesis, found to have l vertebral and proximal basilar artery occlusion resulting in l cerebellar / l pontine infarct. . acute ischemic stroke, vertebrobasilar occlusion - the patient was found to have a clinical syndrome consistent with a brainstem stroke and was found on imaging to have stenosis of both vertebral arteries and the proximal basilar artery. he arrived at the hospital outside the window for intravenous tpa or intra-arterial therapies. he has two fetal pcas coming from his anterior circulation which would preclude him from being able to have a mechanical thrombectomy. he was started on a heparin infusion with goal ptt 60-80 to aid the dissolution of the thrombus. after hemorrhagic conversion was found on a repeat mri, this was switched to aspirin 81 mg daily. a tte was performed which was unrevealing for thrombus, wall motion abnormalities, or intracardiac shunt, but the suspicion for venous hypercoagulability causing paradoxical embolism remained high given the history of a brother of similar age with bilateral lower extremity dvts. hypercoagulability labs (except for genetic studies) were obtained and were normal. a tee was obtained that failed to show an intracardiac shunt and showed only aortic arch simple atheroma. the patient will have genetic hypercoagulability studies as an outpatient. . he was transferred to the stroke step-down unit on and remained stable. his exam has continued to improve, as he is more alert and following commands well. he has begun to use a passy-muir valve to speak and is tolerating this well. his right hemiparesis is also improving, and he is currently able to lift his r arm over his head, can extend his leg anti-gravity, and dorsi/plantarflex his foot. . increased intracranial pressure - on , he transiently developed worsening neurologic deficits including losing his corneal, cough and gag reflexes. a repeat nchct showed worsening infarction of the left cerebellum and compression of the fourth ventricle. he was taken to the or by neurosurgery for emergent decompression/occipital craniectomy and placement of a ventriculostomy. the ventriculostomy was revised/replaced twice for improved placement. due to mildly elevated icp and csf drainage, this was converted to a ventriculoperitoneal shunt on . he had no complications and no further signs of increased icp after the procedure. . pulmonary edema/volume overload - in the setting of receiving ivf, he became net positive in his fluid balance, tachypneic, and hypoxic. furosemide did not sufficiently improve his respiratory status. he was also noted to have worsening leukocytosis and extensive secretions concerning for infection. he subsequently was electively intubated to provide further respirator support. he was unable to wean from the ventilator and failed an extubation trial. an endotracheal tube was placed on . he succeeded in tolerating the trach mask for 36-48 hours on and was subsequently transferred to the stroke step-down unit. his secretions have improved with a scopolamine patch. he continues to have intermittent tachypnea of unclear etiology without desaturation or any compromise of his respiratory status. . pneumonia - he had recurrent fevers shortly after admission. cultures were obtained and revealed mssa in the sputum. he was treated with iv antibiotics for 10 days for this. he also had proprionobacterium acnes in the blood. later he again began having fevers and increased sputum production. he underwent bronchoscopy again on and was treated with vap protocol (cefepime, cipro, and vanc) from , during which time his fever curve and sputum improved. he had transient low grade fevers to 99.8 axillary on ; repeat infectious work-up including ua/ucx/blood cultures/cxr as well as leni's was negative. he subsequently remeained afebrile with no signs of infection. . diabetes - his hgba1c was 11.9, and his blood sugars were initially difficult to control. he was placed on an insulin gtt and then transferred to long acting insulin. blood sugars remained well-controlled on this regimen. . hyperlipidemia - initial ldl was 109. he was restarted on statin therapy and this improved to 59. he will continue on atorvastatin 20mg daily for his hyperlipidemia. . nutrition - he was maintained on tube feeds. due to the likelihood of an inability to swallow based on the area of his stroke, a gastrostomy was placed on . our speech/swallow team continue to follow for progress. his phos has been running a little high; please check a chem-10 in the next week to re-evaluate. . . transitional care issues: he will need intensive pt, ot, and speech therapy. please check chem-10 at least once in next week to re-evaluate his bun/creatinine and phos. hypercoagulability - prothrombin and factor v leiden gene mutation tests should be obtained as an outpatient. he has a follow-up appointment scheduled with dr. in our stroke clinic on . he also has an appointment to establish care with a new pcp . on . medications on admission: asa 81 atenolol 50 mg daily chlorthalidone 10 mg daily hctz 25 mg daily lisinopril 40 mg daily amlodipine 10 mg daily pravastatin 40 mg daily metformin 1000 mg daily discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). 4. acetaminophen 650 mg/20.3 ml solution sig: six y (650) mg po q6h (every 6 hours) as needed for pain/fever. 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 6. amlodipine 5 mg tablet sig: four (4) tablet po daily (daily). 7. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 8. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 9. clonidine 0.1 mg tablet sig: three (3) tablet po tid (3 times a day). 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. erythromycin 5 mg/gram (0.5 %) ointment sig: see instructions ophthalmic qid (4 times a day): apply to both eyes qid. 12. labetalol 100 mg tablet sig: five (5) tablet po q6h (every 6 hours). 13. insulin glargine 100 unit/ml solution sig: thirty five (35) unit subcutaneous twice a day: 35u with breakfast and dinner. 14. insulin aspart 100 unit/ml solution sig: as instructed subcutaneous achs: give achs as per insulin sliding scale. 15. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 16. polyethylene glycol 3350 17 gram powder in packet sig: one (1) powder in packet po daily (daily) as needed for constipation. 17. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic qid (4 times a day): left eye. 18. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic qid (4 times a day). 19. scopolamine base 1.5 mg patch 72 hr sig: one (1) patch 72 hr transdermal q 3 days (): for increased secretions. discharge disposition: extended care facility: - discharge diagnosis: left cerebellar/pontine stroke occlusion of the left vertebral and basilar arteries hypertension hyperlipidemia diabetes type ii discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you were admitted to on due to nausea/vomiting, right sided weakness, and a left facial droop. you were found to have a stroke in the left side of your cerebellum as well as part of your brainstem. this stroke likely resulted from a clot in your vertebral artery in your neck. this may be related to your high blood pressure, high cholesterol, and diabetes. you had tests to look at your heart as well as to look for any disorders of blood clotting and these were normal. you had tracheostomy and gastrostomy tubes placed while in the intensive care unit. you will need intensive physical therapy to help regain your strength. you were started on some new medications to better control your blood pressure and cholesterol. we made the following changes to your medications: increased amlodipine to 20mg daily started clonidine 0.3mg 3 times a day and labetalol 500mg 4 times a day to help control your bloood pressure held atenolol 50mg daily and hctz 25mg daily continued lisinopril 40mg daily changed from pravastatin to atorvastatin 20mg daily to help control your cholesterol changed from metformin to lantus 35mg twice a day in addition to insulin sliding scale injections to better control your diabetes if you experience any of the below listed danger signs, please call your doctor or go to the nearest emergency department. it was a pleasure taking care of you during your hospital stay. followup instructions: you have the following appointment scheduled with a new primary care physician at : provider: , md phone: date/time: 2:15 you also have the following appointment scheduled with dr. in stroke clinic: provider: , md, phd: date/time: 3:00 md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain diagnostic ultrasound of heart fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] ventricular shunt to abdominal cavity and organs temporary tracheostomy closed [endoscopic] biopsy of bronchus insertion or replacement of external ventricular drain [evd] diagnoses: obstructive hydrocephalus unspecified essential hypertension acute kidney failure, unspecified occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction intracerebral hemorrhage compression of brain other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonitis due to inhalation of food or vomitus pulmonary congestion and hypostasis staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus ventilator associated pneumonia diabetes with ketoacidosis, type ii or unspecified type, uncontrolled occlusion and stenosis of basilar artery with cerebral infarction other fluid overload dysphagia, unspecified conjunctivitis, unspecified flaccid hemiplegia and hemiparesis affecting unspecified side 

Answer: The patient is high likely exposed to