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: caffeine attending: chief complaint: status post fall, dizziness major surgical or invasive procedure: tee mr cervical spine w/o c ct chest w/contrast cta head & neck w&w/o c & reco c-spine, trauma mr head w & w/o contras tte ct head w/o contrast history of present illness: 83 yo female with h/o breast ca s/p mastectomy and chemo and h/o syncope vs seizure event in who is transferred with a left cerebellar ich. she was feeling fine the morning of presentation and got into a shower. she then felt lh and increased the hot water. she still felt lh, leaned forward to grab something and her "head swam" and she felt strange. she then went down to her knees and realized she was going to faint. she reports hitting her shoulder, but she does not think she hit her head(she is not sure though). she was apparently in the tub for some time unable to get up(possibly hours) before her son found her and called ems. she went to and had a head ct which showed a left cerebellar hemisphere hemorrhage with some edema, but no obstruction of the 4th ventricle. she was given mannitol 25g and transferred here. she has been mildly confused; per her son, this started about 3 weeks prior to presentation, fairly acutely. for example, she has been calling the cat the wrong name, went out on the balcony not fully dressed, and thought it was the fourth of last week. she is usually fully functional at home, living just with her cat, so this was a significant change from her baseline. she also has a positive troponin, but had no cp or ecg changes and no asa was given due to the hemorrhage. ros: patient denies any fever, chills, nausea, vomiting, headache, dysarthria, dysphagia, neck pain, weakness, numbness, tingling, visual changes, diplopia, hearing changes, chest pain, shortness of breath, or bowel/bladder problems. past medical history: -breast ca s/p mastectomy and chemo. right mastectomy 6 yrs ago, followed by chemo and tamoxifen. she had recurrence in lns and was treated with 16 months chemo ~1 yr ago. she was off for several months, then got new lns, so started xrt and got 37 treatments which finished 6 weeks ago. she also gets frequent prbcs. onc is dr at n-w (part of farber) -h/o possible seizure in (mri at that time with age related change only by report) -gerd -anemia social history: lives alone with cat. son involved in care. no smoking. etoh socially. family history: no strokes. sister and mother with htn. physical exam: on admission: vitals:98.1, 96, 160/124->142/94, 16, 98% on ra gen:nad. heent:mmm. sclera clear. op clear neck: no carotid bruits cv: rrr, no murmurs/gallops/rubs lung: clear to auscultation bilaterally ext:no cyanosis/edema neurologic examination: mental status: awake and alert, cooperative with exam orientation: oriented to person, , and attention: able to do dowf not b language: fluent with good comprehension and repetition. naming intact. no dysarthria or paraphasic errors no apraxia, no neglect. ? ext to dss on right intact calculation poor. $1.50=8 cranial nerves: i: not tested ii: pupils equally round and reactive to light, 3 to 2mm bilaterally. visual fields are full to finger movement. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to finger rub bilaterally. ix, x: palatal elevation symmetrical : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations, intact movements motor: normal bulk and tone bilaterally postural tremor in l>r ue. no resting tremor d t b we fif ip q h df pf te() right * 5 5 5 5 5 5 5 5 5 5 5 left 5 5 5 5 5 5 5 5 5 5 5 5 no pronator drift sensation: intact to light touch, pinprick, temperature (cold), vibration throughout all extremities. reflexes: b t br pa ankle right 2 t t 1 0 left 2 t t 1 0 toes were downgoing bilaterally coordination: normal on finger-nose-finger, rapid alternating movements normal, ffm normal. gait: not tested pertinent results: labs at osh: chem:138/3.2/100/25/27/1/88 ca=9.7, alb=4.2, alt=37, ast=54 ck=552, mb=12, trop=0.128 cbc:12.6/34.7\106 92% polys inr=1, ptt=33.3 on admission: cbc: wbc-11.6* rbc-3.31* hgb-11.5* hct-31.8* mcv-96 mch-34.9* mchc-36.3* rdw-17.5* plt ct-100* coags: pt-13.8* ptt-32.3 inr(pt)-1.2* chem10: glucose-109* urean-26* creat-1.0 na-139 k-3.3 cl-105 hco3-22 calcium-9.5 phos-4.0 mg-2.2 flp: cholest-163 triglyc-90 hdl-46 chol/hd-3.5 ldlcalc-99 ces: ck(cpk)-690* ck-mb-16* mb indx-2.3 ctropnt-0.16* ck(cpk)-624* ck-mb-13* mb indx-2.1 ctropnt-0.18* ck-mb-9 ctropnt-0.20* %hba1c-pnd imaging: hct : 1. small hyperdense focus in the left cerebellum likely represents subarachnoid hemorrhage. mild surrounding edema, but no significant mass effect on the fourth ventricle. 2. chronic small vessel ischemic disease, with additional area of hypodensity in the right parietal lobe that may represent an area of subacute infarction. if there is clinical concern, mri would be more sensitive for evaluation of acute brain ischemia. mri : multiple infarcts involving several vascular territories, the largest area involving the right temporal and parietal regions, which appear acute and subacute. the areas of enhancement could certainly represent some of the more acute foci of infarction. blood products in both the right parietal region as well as the left cerebellum. these multiple findings can be unified with the diagnosis of emboli. please consider a cardiac echo to evaluate for thrombus and defects such as a pfo or asd. follow up examination in a few days may help to differentiate multiple emboli from the possibility of metastatic disease given the patient's history of breast cancer. c-spine x-ray: 1. limited study as described above. the cervical spine cannot be fully evaluated on these views; however, there are no signs for acute injury. if there is high clinical concern, cross-sectional imaging with ct scan can be performed. 2. extensive degenerative change of the cervical spine. there is also retrolisthesis of c3 over c4 and anterolisthesis of c4 over c5. cta head & neck w/contrast: 1. 3mm left supraclinoid internal carotid artery aneurysm. 2. fusiform aneurysm or pseudoaneurysm in the v3 segment of the right vertebral artery. 3. right upper lobe peripheral consolidation could represent areas of infection/neoplasm or pulmonary infarct from emboli. chest ct w/contrast: 1. air bronchogram containing right upper lobe opacity is likely infectious with malignant etiologies including a slow growing bronchoalveolar carcinoma felt less likely. slightly prominent peripheral interstitial markings more inferiorly is also likely infectious however underlying lymphangitic spread of tumor cannot be excluded. recommend appropriate treatment and repeat ct examination in three months to assess for change. 2. small pericardial effusion. small right renal hypoattenuating lesion, likley benign but too small to characterize. 3. moderate hiatal hernia. 4. moderate atherosclerotic vascular disease. tee : the left atrium is mildly dilated. 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 at rest x 2 (unable to cooperate with maneuvers). there are simple atheroma in the aortic arch and descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. impression: simple atheroma in the aortic arch and descending thoracic aorta. mild-moderate mitral regurgitation. brief hospital course: patient is an 83 yo female with h/o breast ca s/p mastectomy and chemo and history of syncope vs seizure event in , confusion x 3 weeks, who is transferred with a left cerebellar ich. on mri, found to have multiple infarcts, likely embolic as there is a large right temporoparietal infarct and multiple other small infarcts in anterior and posterior circulations bilaterally. . 1. neurology: initial and repeat head ct stable. mri showed right temporoparietal infarct, several other small right and left infarcts, c/w embolic source or prothrombotic state. it was felt that she was prothrombotic and hypercoaguable due to her malignancy. we did not start anticoagulation because of the presence of a large hemorrhagic transformation in the cerebellum. started asa 325. lipid panel was total 163/hdl 46/triglycerides 99/ldl 90, increased pravastatin to 40. hemoglobin a1c was 4.7. plan to repeat mri with contrast in one month and follow-up in clinic at that time to readdress starting anti-coagulation such as lovenox. plan discussed with patient and son who understand the risks of bleeding on anti-coagulation soon after the stroke and of subsequent strokes from prothrombotic state due to her underlying metastatic breast cancer. 2. she had a right upper lobe peripheral consolidation seen on cxr, which could represent areas of infection/neoplasm or pulmonary infarct from emboli. she will need follow up cxr or ct scan, as an outpatient to further assess the nature of this finding. her pcp was notified. 3. status post fall: ct c-spine done at hospital, report no fracture but positive for retrolisthesis. mri c-spine without ligamentous injury. . 4. cards: monitored on telemetry without events. patient had elevated tropt (peak 0.20) with normal mb index. tte with normal ef, agitated saline contrast study revealed late bubbles which may reflect pulmonary a-v shunting but cannot exclude intracardiac shunt. tee negative for valvular vegetations, clot, large atheromas or asd/pfo. tsh and lfts normal . 5. id: ct chest performed showed air bronchogram containing right upper lobe opacity, likely infectious with malignant etiologies including a slow growing bronchoalveolar carcinoma felt less likely. slightly prominent peripheral interstitial markings more inferiorly is also likely infectious however underlying lymphangitic spread of tumor cannot be excluded. recommend appropriate treatment and repeat ct examination in three months to assess for change. started on cipro for treatment of community acquired pneumonia for 7 day course. . 6. gu: continued her home detrol. . 7. heme: iron studies consistent with anemia of chronic disease. per her son, she has been intermittently anemia since start chemotherapy and has required blood transfusions in the past. she drifted down to a nadir of 22.5 and was transfused two units of packed red cells on with an appropriate bump in her hct to 30.9. she will need intermittent checks of her hct and should be tranfused for hct<25. her stools were guaiac'd and were negative. . 8. ppx: ppi, riss, tylenol . 9. other: pt/ot evaluated patient and recommended discharge to rehab. medications on admission: medications: 1. ketoprofen 50 daily 2. detrol la 4 mg 3. pravachol 20 4. tramadol 50 prn 5. omeprazole discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 3. insulin regular human 100 unit/ml solution sig: per sliding scale units injection asdir (as directed). 4. tolterodine 2 mg tablet sig: one (1) tablet po bid (2 times a day). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 10. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours): until . 12. heparin lock flush (porcine) 10 unit/ml solution sig: five (5) ml intravenous daily (daily) as needed: 10 ml ns followed by 5 ml of 10 units/ml heparin (50 units heparin) each lumen daily and prn. inspect site every shift. . 13. metaxalone 800 mg tablet sig: one (1) tablet po at bedtime as needed for muscle spasm. discharge disposition: extended care facility: healthcare - discharge diagnosis: primary diagnosis: - left cerebellar abd right parietal infarcts with hemorrhagic conversion secondary diagnosis: - metastatic breast ca - gastroesophageal reflux - anemia discharge condition: good. alert and oriented x2, not to date. cranial nerves intact. right postural tremor. left finger curl. left upper motor neuron pattern arm weakness (dist>prox). discharge instructions: you have embolic strokes to your brain. you will need to follow-up with the stroke neurologist and get a repeat mri brain with contrast (see below). you will need your red blood cell count checked by your primary care physician one week after discharge. please take medications as prescribed and keep your follow-up appointments. if you have any weakness, numbness/tingling, difficulty speaking, sudden vision or hearing changes or any other worrying symptoms, please call your primary care physician or return to the emergency department. followup instructions: pcp: , md phone: date/time: 11:30 stroke neurologist: , md, phd: date/time: 3:00 repeat mri brain with contrast in one month. please call (#1) repeat chest ct with contrast in 3 months. please call (#1) md, procedure: diagnostic ultrasound of heart transfusion of packed cells diagnoses: esophageal reflux personal history of malignant neoplasm of breast secondary hypercoagulable state anemia in neoplastic disease secondary and unspecified malignant neoplasm of lymph nodes, site unspecified cerebral thrombosis with cerebral infarction 

Answer: The patient is high likely exposed to