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: patient recorded as having no known allergies to drugs attending: chief complaint: slurred speech and left sided weakness major surgical or invasive procedure: intraarterial tpa administration intubation and mechanical ventilation bronchoscopy history of present illness: the pt is a 58 year-old right-handed woman with a history of esophageal cancer who presented with acute onset slurred speech and left sided weakness. the pt was unable to offer a detailed history at the time of my encounter. therefore, the following history is per ems and the pt's daughter. per the pt's daughter, she was just discharged from hospital at about 4pm on the day of admission. she had been admitted there since past thursday for a "rectal infection" and dehydration. her daughter brought her home and she was initially doing well. at about 1820, per the daughter, she started "mumbling" but seemed to be aware of her surroundings and the fact that she was mumbling. she was seen to have a left facial droop and was not moving her left side. 911 was immediately called and she was brought to ed. code stroke was called at and neurology was immediately at bedside. nihss as follows: 1a. loc: alert, responsive (0) 1b. loc questions: knew age and name of month (0) 1c. loc commands: closed eyes and gripped with right hand (0) 2. best gaze: right gaze preference (1) 3. visual: complete left hemianopia (did not blink to threat) (2) 4. facial palsy: total paralysis of left lower face (2) 5a. left arm: no movement (4) 5b. right arm: no drift (0) 6a. left leg: will only move toes, will not lift leg off of bed (?) 6b. right leg: will only move toes, will not lift leg off of bed (?) 7. limb ataxia: absent (on right, unable to test left) (0) 8. sensory: no sensory loss bilaterally (0) 9. language: no aphasia (0) 10. dysarthria: severe (2) 11. extinction/inattention: neglects left side of space (2) total nihss: 13, but pt did not move either leg, so may in fact be higher the pt was unable to offer a review of systems. past medical history: -diabetes mellitus -esophageal cancer, status post radiation and chemotherapy. also had feeding tube until about three weeks ago. -asthma -depression -history of dvt, had been on warfarin until last week per daughter social history: pt lives alone in and very much wants to go home. she is willing to go to rehab prior to return home. as pt and i were discussing this, screener from walked into the room and spoke with pt about rehab. pt being screened by various facilities. pt feeling that doctors 't understand her strong wish to get home. she is becoming frustrated with long length of stay. pt has a son and a daughter who live relatively close by but were not in to visit at the time of this conversation. pt is coping well but her patience is wearing thin. rehab screens may help things move along for d/c. will meet with family when they are in to visit with pt. family history: nc physical exam: on admission: nihss as follows: 1a. loc: alert, responsive (0) 1b. loc questions: knew age and name of month (0) 1c. loc commands: closed eyes and gripped with right hand (0) 2. best gaze: right gaze preference (1) 3. visual: complete left hemianopia (did not blink to threat) (2) 4. facial palsy: total paralysis of left lower face (2) 5a. left arm: no movement (4) 5b. right arm: no drift (0) 6a. left leg: will only move toes, will not lift leg off of bed (?) 6b. right leg: will only move toes, will not lift leg off of bed (?) 7. limb ataxia: absent (on right, unable to test left) (0) 8. sensory: no sensory loss bilaterally (0) 9. language: no aphasia (0) 10. dysarthria: severe (2) 11. extinction/inattention: neglects left side of space (2) vitals: t: 99f p: 112 r: 16 bp: 135/80 sao2: 92%ra (up to 97% on fm) general: lying in bed with eyes open heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: no carotid bruits appreciated. pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: weeping edema of the lower extremities bilaterally skin: no rashes noted. neurologic: -mental status: alert. mildly inattentive to examiner's questions. language is very difficult to understand due to significant dysarthria. she neglects the left half of space. -cranial nerves: olfaction not tested. perrl 3 to 2mm and brisk. vff to confrontation. right gaze preference. facial sensation intact to pinprick. left facial droop in an umn pattern. tongue protrudes in midline. -motor: normal bulk throughout. flaccid hemiplegia on the left. no adventitious movements noted. -sensory: no deficits noxious stimuli throughout. no extinction to dss. -coordination: no dysmetria to fnf on r, cannot test l due to weakness. -dtrs: tri pat ach l 0 0 0 0 0 r 1 1 1 1 0 plantar response was flexor bilaterally. -gait: deferred. pertinent results: 16> 10.6 <89 31.1 pt: 16.7 ptt: 25.8 inr: 1.5 fibrinogen: 354 na:140 k:3.7 cl:124 tco2:18 glu:143 bun 25 creat 1.1 serum and urine tox negative radiologic data: ct head: there is no evidence hemorrhage. there appears to be slight loss of insular ribbon on the right, but no obscuration of the basal ganglia on that side. i cannot appreciate a dense artery sign. the ventricles, cisterns, and sulci appear normal. ct angio of the cow & neck: possible tapering of the r mca just prior to the bifurcation. heterogeneous area in the right lobe of the thyroid, 7 mm. recommend further evaluation of the thyroid via ultrasound. ekg : sinus rhythm. old inferior myocardial infarction. low voltage in the precordial leads. possible previous anteroseptal myocardial infarction. no previous tracing available for comparison. intervals axes rate pr qrs qt/qtc p qrs t 95 124 86 2 -4 head ct : the exam is somewhat limited by motion. again seen is a rounded focus of hyperdensity in the right basal ganglia consistent with hemorrhage. there is increasing surrounding hypodensity and impression on the right lateral ventricle. there is no hydrocephalus or shift of normally midline structures. fluid is again noted in the sphenoid sinuses. osseous structures are unremarkable. impression: stable rounded focus of right basal ganglia hemorrhage. increasing surrounding hypodensity and mass effect on the right lateral ventricle may represent edema related to the hemorrhage or evolving right mca infarct. note added at attending review: although there is considerable motion artifact, there is evolution of the large right mca infarction since the earlier study of . there is no evidence of new hemorrhage, but the infarction is largely obscured by artifact, small to moderate amounts of bleeding cannot be excluded echo: 1. the left atrium is mildly dilated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. 2. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). 3. the aortic valve leaflets (3) are mildly thickened. mild (1+) aortic regurgitation is seen. 4. the mitral valve leaflets are mildly thickened. abd ct: 1. no evidence of retroperitoneal hematoma. 2. bilateral pleural effusions and atelectasis. 3. ascites. 4. probable small nonobstructive right renal calculi. mri/mra brain: 1. large right middle cerebral artery infarction with sharp cut-off of the right mca at its bifurcation. smaller infarcts in the left parietooccipital watershed region and the left cerebellar hemisphere. the infarctions are of acute/early subacute nature and are likely secondary to a thromboembolic phenomenon. 2. small hemorrhagic component of the right mca infarct. 3. very slow flow in the left vertebral artery. lue us: 1) no dvt visualized. 2) flattening of the left proximal subclavian venous waveform is a nonspecific finding; if there remains high suspicion for venous thrombosis, a ct venogram could be considered to exclude central thrombus. rue us: small linear nonocclusive clot in the left axillary vein. head ct: in the interval, there has been an evolution of large mca infarct, including increasing swelling and edema and compression of the right lateral ventricle. site of hemorrhagic component of the infarct described on the previous mr has not changed in appearance since the prior study. there are no new sites of hemorrhage identified. there is no hydrocephalus or shift of normally midline structures. again noted is a fluid in the sphenoid sinus. osseous structures are unremarkable. impression: evolution of the large right mca infarction since , including increase in edema and compression of the right lateral ventricle. no evidence of new hemorrhage. pcxr: atelectasis is progressed from the left lower lobe and lingula and there to entire left lung, producing severe leftward mediastinal shift, obscuring the entire cardiac contour, accompanied with a complete opacification of the left bronchial tree distal to the main bronchus due to retained secretions. a new focal opacity at the periphery of the right mid lung could be a small amount of pleural fluid in the fissure but should be followed to exclude a new lesion in the one, which would suggest infection or infarction. there is no layering right pleural effusion or any pneumothorax. pcxr: the left lung has re-expanded with minimal left lower lobe atelectasis persisting. there is blunting of bilateral costophrenic angles consistent with pleural effusions. hazy opacity is noted anteriorly in the right upper lobe and involving the right lower lobe as well. there is mild volume overload. the aorta is tortuous. the cardiac silhouette is at the upper limits of normal, accounting for patient and technical factors. there is an indwelling right upper extremity picc line with the distal tip approximately 5 cm proximal to the cavoatrial junction. impression: interval expansion of the left lung post-bronchial washout. there is remnant left lower lobe atelectasis. there is also hazy opacity in the right perihilar and lower lungs as described above which may be confluent edema, aspiration, or multifocal pneumonia. indwelling picc line as above. head ct: unchanged per wet read by radiology. also, reviewed with stroke attending, showing resolving right basal ganglia hemorrhage. brief hospital course: the pt is a 58 year-old woman with a history of deep vein thromboses and esophageal cancer who presented with acute onset dysarthria, left hemianopia, left facial droop, flaccid hemiplegia on the left (at least in the arm), and left hemineglect. these abnormalities pointed to a lesion of the right frontal, parietal and possibly temporal lobes. given acute onset, this was thought to most likely represent a stroke in the distribution of the right mca. her risk factors for stroke included malignancy, diabetes mellitus, and possible radiation to the neck area which may cause acceleration of arterial atherosclerosis of large arteries. the presence of thrombocytopenia was a contraindication to iv tpa. after lengthy discussion with the pt's son, the decision was made to take the pt to angio for ia tpa which showed after this procedure, she was admitted to the neuroicu for further care. neuro: repeat ct scan 24 hours after event showed an area of bleed in the right basal ganglia. aspirin and anti-coagulation was held. mri and mra brain showed right middle cerebral, but also left parietooccipital region and left cerebellar infarcts. carotid ultrasound not necessary as she had a neck cta showed a kink in the right cervical ica without evidence of stenosis or occlusion. bilateral vertebral arteries were also normal in caliber and patent including the origins. patient was resumed on aggrenox on without complication and then on was swtiched to lovenox. at time of discharge, head ct was stable without new bleed and showing resolving right basal ganglia hemorrhage. given stable head ct, patient may start lovenox as above. cv: surface cardiac echo on showed an ef>65% and no pfo, asd, thrombus. blood pressure control with iv labatelol prn sbp > 180mmhg (goal sbp 140-180mmhg). chol 130 and ldl 71. lfts were within normal limits and patient was started on atorvastatin 10mg qd. heme: patient had a history of fv leiden heterozygote, history of esophageal cancer, history of dvt bilateral upper extremities and labile inrs while on coumadin secondary to nutritional status and poor compliance. hematology/oncology were consulted regarding appropriate anticoagulation in this setting and recommended lovenox given malignancy. given initial basal ganglia bleed, aspirin and warfarin were held. aggrenox was started on given stable serial head cts. hit antibody was sent and was negative. of note, patient was transiently thrombocytopenic which was thought to be idiopathic thrombocytopenic purpura and started on prednisone 20mg qd. she will require a slow taper off steroids. patient should continue on aggrenox until . she should then start lovenox as long term form of anti-coagulation. pulm: patient was reintubated for respiratory distress on extubated . cxr showed collapsed left lung. pulmonology was consulted and she was started on standing albuterol/atrovent nebs q6h, chest pt tid and cpap @8mm hg overnight keeping sats>92%. a bronchoscopy was performed on showing complete collapse of left lung/pna. a cleanout was performed and bal fluid was gram stain neg and culture showed oropharyngeal fluid. empiric antibiotics were discontinued after 72 hours of negative culture growth. serial chest x-ray were performed which showed reinflation of the left lung. id: patient had a history of coagulase negative staph "sepsis" @osh on ciprofloxacin since prior to the admission to . ciprofloxacin was discontinued on since picc line was pulled and surveillance cultures from and had only one bottle positive for coag neg staph which was likely contamination. curbsided id who concurred with this decision. patient was started on vanco for possible left-sided pneumonia however it was discontinued after negative growth on bronchial fluid culture. onc: spoke with dr. ( outpatient oncologist who reported that esophageal cancer status post chemotherapy and radiation therapy, no surgery. last chest ct was in which showed no lymphadenopathy and visit notes noted patient to be in remission. gu: creatinine ranged from 1.1 to 1.4. good urine output. end: will need f/u imaging of thyroid glands given nodule seen on cta of neck. hba1c 7.2. fs qid and regular insulin sliding scale. fen: speech and swallow recommended ground solids, thin liquids, crush meds in purees, asp precaut, 1:1 assist, alternate sips/bites. patient refused ngt/peg. ppx: wound care, ppi, bm meds, pneumoboots code: dnr/dni communication: hcp work or ; daughter , /oncologist at : , but he is moving and will be unreachable resident at lmh: ( pcp: medications on admission: -ritalin 5mg po qam -prednisone 10mg po daily -bactrim ds 1tab po bid (?) -magnesium oxide 1tab po tid -remeron 15mg po qhs -tums 500mg 1 tab po qacs discharge medications: 1. acetaminophen 650 mg suppository : one (1) suppository rectal q4-6h (every 4 to 6 hours) as needed for fever or pain. 2. insulin regular human 100 unit/ml solution : per sliding scale units injection asdir (as directed). 3. atorvastatin 10 mg tablet : one (1) tablet po daily (daily). 4. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day). 5. prednisone 20 mg tablet : one (1) tablet po daily (daily). 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 7. docusate sodium 60 mg/15 ml syrup : one hundred (100) mg po bid (2 times a day). 8. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily) as needed for constipation. 9. fentanyl 25 mcg/hr patch 72hr : one (1) patch 72hr transdermal q72h (every 72 hours). 10. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours). 11. albuterol sulfate 0.083 % solution : one (1) neb inhalation q6h (every 6 hours). 12. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical qd (): please apply 1 patch to area for 12 hours then remove. apply a patch every 24 hours. do not apply to open skin lesion. 13. heparin lock flush (porcine) 100 unit/ml syringe : two (2) ml intravenous daily (daily) as needed: 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. . 14. aspirin 81 mg tablet : one (1) tablet po once a day. 15. dipyridamole 50 mg tablet : four (4) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: right middle cerebral artery stroke with small hemorrhage reinflated collapsed left lung status post bronchoscopy secondary diagnosis: h/o deep vein thrombosis on warfarin (h/o noncompliance) esophageal cancer, status post radiation and chemotherapy diabetes mellitus h/o feeding tube (approx three weeks ago) asthma depression discharge condition: neurologically stable. left-sided weakness leg>arm. slight left neglect. oriented x3 person, place and year. discharge instructions: please take medications as prescribed. you have been started on aggrenox (asa81/dipyridamole) which should be discontinued on . lovenox 100mg sc q12h should be started on and continued as anti-coagulation. please check head ct if neurologic exam or mental status changes. please keep your follow-up appointments. if you have any worsening weakness, fevers/chills, severe headache, change in mental status or any other worrying symptoms, please call your primary care physician or return to the emergency room. followup instructions: provider: , md phone: date/time: 1:00pm provider: , md phone: date/time: 1:30pm md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent arterial catheterization insertion of other (naso-)gastric tube closed [endoscopic] biopsy of bronchus transfusion of packed cells diagnoses: acidosis thrombocytopenia, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other pulmonary insufficiency, not elsewhere classified asthma, unspecified type, unspecified depressive disorder, not elsewhere classified pulmonary collapse pressure ulcer, lower back personal history of venous thrombosis and embolism primary hypercoagulable state cerebral artery occlusion, unspecified with cerebral infarction personal history of malignant neoplasm of esophagus homonymous bilateral field defects degeneration of lumbar or lumbosacral intervertebral disc flaccid hemiplegia and hemiparesis affecting unspecified side 

Answer: The patient is high likely exposed to