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: penicillins attending: chief complaint: r sided neglect major surgical or invasive procedure: peg tube history of present illness: as per neurology h+p: patient is a 76 yo rhw with unclear pmh other than htn and hx of heavy etoh use per sister-in-law who last saw her 3 years ago. per medical records from from where she was transferred, she lives alone and is looked in on by neighbors. she was last seen at baseline several days priort to admission, gardening in the yard. a neighbor noticed that she has not been seen for a few days went to check in on her and found her down. she was supine but unclear whether in bed or on the floor and was nonverbal. at this time she was taken to . she was found to be in afib with rvr at and was started on diltiazem gtt and had a head ct that showed no hemorrhage or fracture. then, she was transferred here for further evaluation and care. her next of is , her sister-in-law who reports that she does not know anything because she last saw her > 3 years ago and the patient has never shown up for family events despite invitations. she does report that the patient was a heavy drinker and was still drinking heavily 3 years ago. review of systems was not able to be obtained due to the patient's dysphasia. past medical history: 1. htn 2. etoh abuse social history: lives alone - no family or children. next of is who is her sister-in-law () and code status unknown hence presumed full. heavy drinker per sister-in-law and retired employee. family history: father died of mi at age 63 and brother died of kidney failure at age 59. physical exam: as per neurology admit note: bp 120/70 hr 130 rr 18 o2sat 100% ra gen: lying in bed, nad though very disheveled and poor grooming. heent: nc/at, moist oral mucosa cv: irregularly irregular, no murmurs/gallops/rubs abd: +bs, soft, nontender ext: no edema; trace dorsalis pedis palpable bilaterally. pitting edema on rue only. neurologic examination: mental status: awake and alert - oriented to self but only response is "okay" to all questions. no repetition. does not follow commands except for opening and closing eyes - no appendicular commands or sticking tongue out. cranial nerves: pupils reactive and equal. does track across midline but less blinking to threat on r side. r facial droop. no gag but palate elevates evenly. motor: diffusely decreased bulk. spontaneous movements on l - appers full strength although individual muscle group testing not possible. does withdraw to pain on rle and when lifting the rue in front of her eyes, no drift. sensation: appears intact to noxious stimuli and lt in all extremities. reflexes: +2 and symmetric for ues but trace on l patellar vs. 2 for r patellar. toes upgoing bilaterally pertinent results: 11:45am glucose-87 urea n-7 creat-0.4 sodium-137 potassium-3.8 chloride-105 total co2-20* anion gap-16 11:45am calcium-8.5 phosphate-2.9 magnesium-1.7 11:45am wbc-11.6* rbc-3.15* hgb-11.6* hct-34.5* mcv-110* mch-36.8* mchc-33.6 rdw-16.8* 01:00am urine blood-sm nitrite-neg protein-neg glucose-neg ketone-150 bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 01:00am urine rbc-* wbc-* bacteria-few yeast-none epi-0-2 11:45am %hba1c-4.7* 02:34am urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 01:19am lactate-1.7 01:00am ck(cpk)-24* 01:00am ctropnt-<0.01 01:00am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 01:00am pt-13.5* ptt-22.4 inr(pt)-1.2* nchct: appears to have extensive small vessel ischemic changes and possibly subacute/chronic l putamen infarct. g tube placment uncomplicated placement of 12 french wills- percutaneous gastrostomy tube. the tube may be used in 24 hours, if the patient is not experiencing pain. the t-fasteners will fall out on their own in approximately 6 weeks. the patient can return for routine tube exchange in three months, or earlier for removal if no longer needed. mri/mra brain 1. extensive evolving acute infarction, predominantly involving the anterior cerebral, deep middle cerebral, and superior middle cerebral arterial territories. small foci of infarction in the posterior/inferior middle cerebral arterial territory. 2. extensive chronic small vessel ischemic disease. 3. normal head mra. brief hospital course: neurology course: 76y rhf with htn and h/o etoh use w/ a. fib w/ rvr, right neglect, right weakness and global aphasia of unknown duration. pt was admitted to neuro icu team for observation and treatment of a.fib w/ rvr. her neurologic exam remained stable. mri showed left aca and mca stroke. she underwent stroke work up including echo which did not reveal clot,carotid ultrasound, hba1c, tsh, fasting lipids were done. pt found to have uti on ua and treated with bactrim.her hospital course was complicated by rapid a fib/ flutter and was treated with diltiazem and beta blockers per cardiology inputs. neurologically she did not show much improvement and failed speech, swallow test. she underwent peg placement. she was later transfered to cardiology service for control of heart rate. cv-coronary: despite heart rates in the 140's and 150's, she has never desaturated and never appeared to be in pain or respiratory distress. she has never had ekg changes consistent with ischemia, and never made cardiac enzymes. cv-pump: echo showed the left atrium as mildly dilated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast without maneuvers. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. she has never appeared to be in chf or otherwise volume overloaded, and her pressures have tolerated high doses of diltiazem, though 90mg qd is likely the max dose her pressures can handle given occasional dips into the high 80s. cv rhytym: the patient arrived to the cardiology service on 180 sr diltiazem with diltiazem drip. she was converted to 90mg diltiazem q6h. after starting this regimen her hr never exceded 110 bpm, and in fact she remain in aflutter with a rate of 72. given that aflutter is notoriously difficult to rate control, we evaluated her for tee and d/c cardioversion. however the team felt on examining the patient that she would not be able to cooperate in tee exam and that it would be traumatic with high liklihood of faillure. because she never seemed uncomfortable, even with excessively high heart rates we decided to send her to rehab for 4 weeks of anticoagulation and have her return to see dr. to evaluate her for d/c cardioversion at that juncture. we can tolerate hr up to 150 if she has no hemodynamic instability or obvious discomfort with it. - please continue on 120mg diltiazem in the morning and 90mg three times a day (regimen will be 120mg/90mg/90mg/90mg every 6 hours). - pt noted to have episodes of a. fib with rvr into the 140s, after discussion with cardiology would allow pt to continue at this rate as it usually terminates when she recieves her next dose of diltiazem. would refer back to the ed if pt become hemodynamically unstable with systolic pressure less than 90 - pt will need to follow up with new cardiologist to assess for possible cardioversion in 4 weeks (she will need to be anticoagulated for this) - please continue to follow inr every mon, wed, fri to titrate coumadin dose for a goal inr of . uti: pt noted to have a mild leukocytosis prior to discharge, pt showed no evidence of fevers or symptoms. a u/a was obtained which showed positive leukocyte esterase as well as bacteria and wbcs. pt was started on a 3 day course of levofloxacin 500mg daily. urine culture obtained, will call rehab facility if culture is positive for resistance against levofloxacin. nutrition: during hospitalization pt underwent video swallow which showed multiple consistencies of oral barium were administered and passed beyond the oropharynx without evidence of obstruction. however thin liquids were seen to penetrate and were aspirated silently. a cued cough was ineffective. pt underwent peg tube placement and was started on tube feeds. - please continue fibersource hn full strength at 45cc/hr, with residual check q4hrs. please continue on h20 flush w/ 150 ml every 6 hours. medications on admission: none discharge medications: 1. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for t>100.4 or pain. 2. atorvastatin 20 mg tablet : one (1) tablet po daily (daily). 3. folic acid 1 mg tablet : one (1) tablet po daily (daily) as needed for alcohol abuse. 4. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily) as needed for alochol abuse. 5. levalbuterol hcl 0.63 mg/3 ml solution for nebulization : one (1) inhalation q6h () as needed for copd. 6. diltiazem hcl 90 mg tablet : one (1) tablet po qid (4 times a day): please take with the extra 30mg of diltiazem in the morning. you will be taking 120mg in the morning and 90mg the other times. 7. multivitamin tablet : one (1) tablet po once a day. 8. warfarin 5 mg tablet : one (1) tablet po qhs (once a day (at bedtime)). 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. outpatient lab work please have the rehab doctors your pt/inr every monday, wednesday, friday to adjust your coumadin to a goal inr of . 11. diltiazem hcl 30 mg tablet : one (1) tablet po qam: please take with the 90mg dilitazem morning dose. 12. outpatient lab work please have your blood drawn every monday, wednesday, friday to check your inr. the rehab doctors be to titrate your coumadin level for a goal inr of 2 to 3. 13. ciprofloxacin 250 mg tablet : one (1) tablet po q12h (every 12 hours) for 5 doses. discharge disposition: extended care facility: hospital - discharge diagnosis: left anterior cerebra artery stroke , medial coronary artery stroke atrial flutter/ fibrillation hypertension percutaneous enteral gastric tube placement discharge condition: improved discharge instructions: you were admitted to after having a large stroke, that has heavily effected the left side of your brain, and as a result you now have significant weakness on your right side and difficulty speaking. you also developed an irregular and rapid heart beat. you will need to return to the hospital in 4 weeks to have a special procedure done where we shock your heart back into rhythym. you were determined to have a uti on the last day of your hospitalization. you were started on ciprofloxacin 250mg twice per day for 3 days. we were never able to determine your home meds, however you were started on several new medications in the hospital including: atorvastatin 20 mg daily diltiazem 90 mg 4 times per day lansoprazole oral disintegrating tab 30 mg thiamine 100 mg daily warfarin 5 mg qhs ciprofloxacin 250mg twice per day for 5 more doses after discussion with the cardiologist we will tolerate your heart rate in the 140s unless your blood pressure drops below 90 for systolic pressure. if you experience any fevers >101, heart rate >140 with a systolic blood pressure <90 or you have difficulty breathing and are hypoxic. followup instructions: please follow up with dr. , md phone: date/time: 1:00 ****please make a follow up appointment with the cardiology attending that saw you here, dr. to be evaluated for electric cardioversion. ****very important! you will need to see him in 4 weeks time. please make a follow-up appointment to see your pcp @ in , ma within 2 weeks of your discharge. please have your blood drawn three times a week monday, wednesday and friday to check your pt and inr so the rehab doctors adjust your coumadin dose to get a inr goal of . your heart rate is acceptable up to the low 150's as long as you do not have chest pain, dyspnea, oxygen desaturation to less than 90, st-elevations on ekg. and are hemodynamically stable. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] diagnoses: urinary tract infection, site not specified chronic airway obstruction, not elsewhere classified atrial fibrillation atrial flutter cerebral embolism with cerebral infarction other and unspecified alcohol dependence, unspecified aphasia hemiplegia, unspecified, affecting unspecified side unspecified hypertensive heart disease without heart failure 

Answer: The patient is high likely exposed to