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: transferred from osh, intubated, for higher level of care major surgical or invasive procedure: endotracheal intubation x 3 tracheostomy percutaneous gastrostomy central line - right subclavian placement history of present illness: the pt is a 56 y/o with multiple medical problems presented from hospital with ich on coumadin. he was in his normal state of health which per his nephew who he lives with is normal language, normal ambulation, can perform own adl's, when at noon he yelled out to his nephew for help and was found with slurred speech and holding his head in distress. ems was called and he was taken to hospital. there he had a sbp 140. he was reportedly moving all extremities and following all commands. at ct scan demonstrated a bleed at the medulla on the left, he was given 10mg iv vit k for inr of 1.6, and there was some concern for aspiration and was also intubated for airway protection. he also recived a load of dilantin. here he was seen by our ed resident off propofol and intubated. past medical history: - history of ischemic strokes (location? mechanism?) - mi with cabg - pvd - poststreptococcal gn s/p renal transplant - dm c/b diabetic nephropathy (requiring second transplant), diabetic retinopathy, complicated diabetic neuropathy - bilateral nephrectomies social history: patient is divorced and lives alone. he used to work as a general practice attorney. patient is currently on disability. he is independent for adls family history: family history notable for father who died at age 63 from an mi, mother died at age 77 and had diabetes, chf and leukemia. he has five sisters and one brother, two of whom are deceased secondary to cad. patient does not have any children. physical exam: on admission: vitals: t: p:94 r: 18 bp:128/90 sao2:100 general: sedated and intubated heent: right temple excision neck: supple. pulmonary: lungrales b.l frontal fields cardiac: rrr. abdomen: soft, nt/nd. extremities: no edema or deformities. cool to touch feet, faint dp's neurologic: sedated, intubated. opens eyes spontaneous, is able to follow commands correctly. pupils are surgical b/l, brisk reactive, left pupil larger by 0.5mm. was able to look laterally. has a skew with left eye lower. no nystagmus noted but was on initial evaluation where he was unable to fully look to the right. his hand grip was strong b/l. able to raise the right arm against gravity and fast. the left was slower and looked clumsy with some wrist drop. the legs were antigravity. toe was upgoing on the left and mute on the right. reflexes were grade 2 throughout, and none at the ankles. on dicharge: neuro: mental status is intact. aaox3. mouths words fluently, comprehension, naming, , writing intact. cranial nerves: perrl (occasionally had <1mm asymmetry during stay); eomi, intermittently left eye movements are hypotropic (limited); left ptosis and left facial droop with weakness. motor: full strength through out coordination: action tremor, l> r on fnf. pertinent results: on admission: 04:33pm blood wbc-18.0* rbc-4.89 hgb-13.1* hct-39.5* mcv-81* mch-26.8* mchc-33.1 rdw-14.2 plt ct-401 10:59pm blood neuts-89.4* lymphs-6.0* monos-3.7 eos-0.7 baso-0.2 04:33pm blood pt-15.7* ptt-36.2 inr(pt)-1.5* 04:33pm blood fibrino-405* 04:33pm blood glucose-276* urean-11 creat-1.1 na-139 k-4.4 cl-107 hco3-19* angap-17 01:00am blood ck(cpk)-224 06:00am blood ck(cpk)-185 11:35am blood ck(cpk)-147 01:46am blood alt-13 ast-18 alkphos-64 totbili-0.4 04:33pm blood ctropnt-0.50* 01:00am blood ck-mb-13* mb indx-5.8 ctropnt-0.59* 06:00am blood ck-mb-9 ctropnt-0.37* 11:35am blood ck-mb-7 ctropnt-0.27* 10:59pm blood ck-mb-5 ctropnt-0.07* 04:54am blood ck-mb-6 ctropnt-0.07* 01:00am blood calcium-8.5 phos-2.8 mg-2.0 05:28am blood rapmycn-4.2* 05:09am blood rapmycn-6.4 05:59am blood tacrofk-<2.0 05:50am blood rapmycn-6.2 06:20am blood rapmycn-7.2 05:18pm urine blood-neg nitrite-neg protein-100 glucose-300 ketone-tr bilirub-neg urobiln-neg ph-5.5 leuks-neg 05:18pm urine color-yellow appear-clear sp -1.023 05:18pm urine rbc-2 wbc-2 bacteri-none yeast-none epi-0 05:18pm urine castgr-2* casthy-2* microbiology bronchoalveolar lavage gram stain-final; respiratory culture-final {yeast, yeast} bronchoalveolar lavage gram stain-final; respiratory culture-final {yeast, yeast} bronchoalveolar lavage gram stain-final; sputum gram stain-final; respiratory culture-final {yeast} sputum gram stain-final; respiratory culture-final {yeast} blood culture blood culture, routine-final reports: ekg: normal sinus rhythm. intra-atrial conduction abnormality. anterolateral myocardial infarction of indeterminate age. slight anterolateral st segment elevation, non-specific. marked right axis deviation. no previous tracing available for comparison. abnormal tracing. rate pr qrs qt/qtc p qrs t 88 174 98 398/447 58 -139 80 cxr: widespread airspace disease with considerable asymmetry, much more severe on the right than left. asymmetry and confluent focal right infrahilar opacity suggests pneumonia as the likely etiology. short-term followup radiographs are suggested. endotracheal tube terminates at the thoracic inlet. mri/mra brain: evidence for left medullary hemorrhage without definite underlying lesion seen. however, recommend repeat examination after resolution of blood products. no evidence for acute ischemia or hydrocephalus. apparent slow flow in the left transverse sigmoid sinus and proximal jugular vein. this can be further assessed with an mrv if clinically indicated. no evidence for aneurysm or avm. cta/ctv: head ct shows hemorrhage in the left medulla. mrv shows no evidence of venous sinus thrombosis. no apparent arterial abnormalities are seen. cxr: endotracheal tube ends approximately 5 cm above the carina and is adequately positioned. orogastric tube is seen to course below the diaphragm into the stomach; however, the distal end is off the radiographic view. severe right lower lung consolidation is similar. left lower lung atelectasis and small left pleural effusion is unchanged. cardiomediastinal silhouette is stable. patient is status post cabg and sternal sutures are intact. the study and the report were reviewed by the staff radiologist. echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate regional left ventricular systolic dysfunction with hypo to akinesis of the mid-distal segments of the left ventricle and preserved contractility of the lv base (lvef = 35-40 %). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. the non-coronary cusp appears to be less mobile. the exact number of aortic cusps could not be determined. there is no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is no systolic anterior motion of the mitral valve leaflets. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: moderate focal left ventricular dysfunction involving the mid-distal segments consistent with takotsubo versus ischemic cardiomyopathy. mild mitral regurgitation. moderate pulmonary systolic hypertension. cxr: there is a new tracheostomy tube in good location. ng tube tip is in the stomach. right ij line tip is in the distal svc. small bilateral pleural effusions are again visualized. there continues to be increased alveolar infiltrate, right greater than left, compatible with chf with infiltrate is more dense in the right lower lung and an underlying infectious infiltrate cannot be excluded. there is no pneumothorax. cxr: tracheostomy tube in standard placement. nasogastric tube ends in the upper stomach. pulmonary edema is clearing from the upper lungs. residual abnormality at the base of the lungs is probably pneumonia on the right, probably atelectasis on the left. both of these have improved to a lesser degree. heart size is normal. small bilateral pleural effusions are unchanged. no pneumothorax. right subclavian line ends low in the svc. no pneumothorax. : ct of the abdomen without iv contrast indication: 56-year-old man with left medullary hemorrhage, dysphasia, requiring g-tube placement, evaluate for ir placement of g-tube. ct of the abdomen without iv contrast technique: multidetector scanning is performed from the diaphragm through the iliac crests without intravenous contrast. ct of the abdomen without iv contrast: there are small bilateral pleural effusions, right greater than left, with atelectasis in the lower lobes and a rounded atelectasis in the left lower lobe. the liver is without focal lesions. the gallbladder is unremarkable. the spleen is normal in size. there is a 2.8 x 2.5 cm mass off the body of the pancreas that measures 17 hounsfield units. there is no retroperitoneal lymphadenopathy. there is a transplant kidney in the right lower quadrant which contains a 1.5 cm simple cyst. this is not fully depicted on this scan. multiple surgical clips are seen in the retroperitoneum. the stomach is identified in the midline and is seen right underneath the abdominal wall. there is an ng tube in place. on bone windows, there are no concerning osteolytic or osteosclerotic lesions. impression: 1. body of the stomach identified immediately underneath the abdominal wall. 2. 2.8-cm indeterminate mass originating from the body of the pancreas. this is not fully evaluated on this examination, and further evaluation with a multiphasic ct of the pancreas or alternatively mri is recommended. 3. transplant kidney in the right lower quadrant with small cyst. 4. small bilateral pleural effusions and atelectasis in the lower lobes of the lung. mr abdomen with and without contrast (mrcp): prelim read is that mass in the pancreas is a serous cyst. brief hospital course: mr. is a 56 yo man who was transferred to the from an osh following the discovery of a left medulla intraparenchymal hemorrhage in the setting of anticoagulation with warfarin for atrial fibrillation. he had been given 10mg of iv vitamin k for an elevated inr to 1.6. on our initial examination off of propofol, he was able to follow commands, he had reactive pupils with left pupil larger by 0.5mm, but did have a left hypotropia. he displayed some mild left umn weakness/clumsiness with an upgoing toe on the left. he was admitted to our neuro icu where he remained for 12 days. his hospital course is summarized by system: # neuro: his examination never significantly worsened, and there was never any concern for expanding hematoma. he did not require any surgical decompression or hyperosmolar therapy. his examination, particularly cranial nerve examination would fluctuate. at one point, he had a very prominent hypotropia on the left with diplopia complaints. he also displayed prominent left beating nystagmus worse on leftward gaze, left ptosis with a lmn left vii palsy. he had very mild left umn weakness. he had an mri/mra and ctv to try to identify the cause for this hemorrhage. ultimately, our presumption was that this would be related to a capillary telangiectasia or avm. he will need a follow up mri in 6 weeks and will follow up with dr. from the division of vascular neurology. following the placement of tracheostomy (see below), he had a formal speech evaluation which was able to demonstrate significant pharyngeal dysphagia (presumably secondary to dysfunction of cn ix and x) with very inactive pharyngeal movement of foods. a peg was recommended for nutrition. mr. did complain of severe leg pain, and given his known diagnosis of neuropathy, we confirmed his outpatient medications with his primary care physician and the pain service was consulted who assisted us with the management of his pain. we added gabapentin which we increased slowly given his significant neuropathic pain. he was evaluated and treated by pt. # cardiovascular: on admission, mr. had an elevation of his troponins (as high as 0.59) which reduced down to 0.2 on cycled checks. ekg showed nonspecific changes. cardiology consulted, who, in the setting of his cns bleed, recommended no aspirin or iv heparin but just beta blockade and control of myocardial oxygen demand. he remained intermittently tachycardic during his stay, and would intermittently revert to an atrial fibrillation rhythm which always largely rate controlled. his blood pressures were ultimately controlled in the icu using a regimen of lisinopril, clonidine, metoprolol and prn hydralazine. a new systolic murmur was discovered during his admission, but his echocardiogram showed only very mild mr. we will restart warfarin at discharge. we plan as aspirin bridge to warfarin given his previous brain hemorrhage. # pulmonary: mr. completed a 10 day course of zosyn for a possible aspiration pneumonia that he likely sustained following his first intubation. he also received intermittent doses of prn lasix for pulmonary edema noted on cxr. unfortunately, cultures never grew out a culprit organism. the patient's first extubation attempt was complicated by the development of respiratory distress, tachypnea and hypoxia. he was subsequently reintubated several hours later. he was extubated once again several days later and was doing well for at least one day, following which he had to be emergently reintubated for the development of acute hypoxia. a bronchoscopic evaluation of his lungs at the time showed copious secretions which were removed. the cultures from this grew only yeast. we discussed with our id colleauges who recommended holding off on treatment given his fever and white curve have improved. if in the future he were to spike fevers or develop thicker secretions, consider starting micafungin. he underwent tracheostomy. cxrs also improved correspondingly. following tracheostomy, he has been able to tolerate trach mask without difficulties. he continues to have clear thin secretions that have been decreasing. # renal: his kidney function remained stable throughout his icu stay. nephrology was consulted for their thoughts on whether the patient could safely receive iv contrast for a ct venogram. he received a bicarbonate prep prior to this study, and his renal function was not negatively affected. he made excellent urine output throughout his icu stay. his lisinopril was briefly held (in the setting of contrast load and infection), but we restarted in the setting of more difficult to control bps. # gi: interventional radiology was consulted to assist with the placement of a percutaneous gastrostomy. this was performed , and he tolerated this procedure without complications. of note, there was an incidental finding of a pancreatic mass on abdominal ct without contrast. further imaging was done, a mri of the abdomen. the preliminary read for this is a serous cyst. we ask that mr. follow up with his pcp this. # derm: mr. had a skin cancer removed on his left shoulder prior to admission. his stitches are in place and need to be removed in 1 week (). ultimately, the patient was transferred to the floor. he was discharged to with instructions to follow up with dr. in clinic with repeat mri brain with and without contrast prior to appointment. medications on admission: coumadin opioids discharge medications: 1. simvastatin 40 mg tablet : one (1) tablet po daily (daily). 2. fentanyl 50 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 3. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily): stop once inr is . . 4. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 5. sirolimus 1 mg/ml solution : two (2) mg po daily (daily). 6. diltiazem hcl 60 mg tablet : one (1) tablet po four times a day. 7. mycophenolate mofetil 200 mg/ml suspension for reconstitution : two y (250) mg po twice a day. 8. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 9. lisinopril 20 mg tablet : one (1) tablet po daily (daily). 10. scopolamine base 1.5 mg patch 72 hr : one (1) patch 72 hr transdermal every seventy-two (72) hours. 11. clonidine 0.2 mg tablet : 0.3 mg po tid (3 times a day). 12. metoprolol tartrate 100 mg tablet : one (1) tablet po twice a day. 13. gabapentin 250 mg/5 ml solution : five (5) ml po tid (3 times a day). 14. clonazepam 1 mg tablet : two (2) tablet po qhs (once a day (at bedtime)) as needed for insomnia. 15. nicotine 21 mg/24 hr patch 24 hr : one (1) patch 24 hr transdermal daily (daily). 16. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 17. bacitracin zinc 500 unit/g ointment : one (1) appl topical daily (daily). 18. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 19. hydromorphone 1 mg/ml liquid : 4-8 mg po q2 hrs as needed for pain: hold for excess sedation or rr < 12. 20. insulin glargine 100 unit/ml solution : twelve (12) units subcutaneous at bedtime. 21. insulin lispro 100 unit/ml solution : as directed units subcutaneous four times a day: sliding scale. 22. warfarin 5 mg tablet : one (1) tablet po once a day: start . discharge disposition: extended care facility: hospital for continuing medical care - ( center) discharge diagnosis: left lateral medulla hemmorhage aspiration pneumonia dysphagia diabetes mellitus pancreatic cyst discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). neuro: mental status is intact. aaox3. mouths words fluently, comprehension, naming, , writing intact. cranial nerves: perrl (occasionally had <1mm asymmetry during stay); eomi, intermittently left eye movements are hypotropic (limited); left ptosis and left facial droop with weakness. motor: full strength through out coordination: action tremor, l> r on fnf. discharge instructions: dear mr. , it was a pleasure caring for you during your stay. you were admitted to the hospital for left sided weakness. this was found to be due to a small bleed your brain stem, the left lateral medulla. most likely this was due to a small vessel telangectasia. unfortunately due to this bleed, you are currently unable to swallow. for this you now have a feeding tube in your stomach. during your hospital course, your required a prolonged icu stay due to trouble protecting your airway and required multiple intubations. this has been changed to a trach, which you have tolerated well. you completed a course of broad spectrum antibiotics for a suspected pneumonia early in your course. please continue to work with the physical, occupational, and speech/swallow therapists at rehab. due to an incidental finding on a cat scan of your abdomen required prior to peg placement, further imaging of your pancreas was done with a mri for a 3cm mass. the preliminary read of the mr suggests this mass is a benign serous cyst. please follow up with your pcp regarding this. please call and schedule repeat brain imaging as an outpatient prior to seeing dr. on in neurology clinic to follow up on the bleed in your brain. (please see below). followup instructions: please call ( to schedule the brain mri with and without contrast prior to . this will be important to have done to further evaluate for the source of the brain bleed. the neurology clinic is located on the , bldg, . provider: , md phone: date/time: 1:30pm please also follow up with your pcp to make him aware of this stay as well as the pancreas findings. md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus diagnoses: subendocardial infarction, initial episode of care tobacco use disorder adrenal cortical steroids causing adverse effects in therapeutic use atrial fibrillation aortocoronary bypass status polyneuropathy in diabetes peripheral vascular disease, unspecified intracerebral hemorrhage pulmonary collapse acute and chronic respiratory failure personal history of other malignant neoplasm of skin pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin old myocardial infarction long-term (current) use of anticoagulants acquired absence of kidney cyst and pseudocyst of pancreas hemiplegia, unspecified, affecting unspecified side background diabetic retinopathy kidney replaced by transplant facial nerve disorder, unspecified other disorders of glossopharyngeal [9th] nerve secondary diabetes mellitus with neurological manifestations, not stated as uncontrolled, or unspecified disorders of pneumogastric [10th] nerve secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified 

Answer: The patient is high likely exposed to