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: percocet / prednisone / darvocet a500 attending: chief complaint: class iv heart failure, here for on major surgical or invasive procedure: tavi/ percutaneous aortic valve replacement history of present illness: mr. is an 84-year-old gentleman with a history of cad s/p lad stenting in , who has known diastolic heart failure with a normal lvef (70%). he also has a history of tachy-brady syndrome and underwent a permanent pacemaker placement. in , was admitted to with dyspnea and treated for a presumed chf exacerbation. trop at osh was 0.07 (indeterminate) and had increased o2 requirement. he was transferred to for cardiac catheterization which revealed nonobstructive cad. he was evaluated for aortic valve treatment options. after informed consent including full explanation of risks vs. benefits, he was enrolled into the high risk arm of the /tavi study. he met all inclusion criteria, and did not meet any exclusion criteria, was screened and accepted to be randomized to either /tavi or surgical avr as per study protocol. patient was admitted from - for optimization of cardiac status prior to randomization in study. patient was randomized into arm, which he will receive during this hospitalization. during te last hospitalization, he was started on pradaxa in preparation for procedure. patient given clear instructions to stop taking pradaxa 3 days prior to procedure (on ). he was also diuresed with lasix and achieved euvolemia, maintained on 2l oxygen, which he is on at home. since his last discharge, patient has been feeling well. he had one episode of severe epistaxis requiring packing by an ent at hospital. per the patient, dr. was aware of this and oversaw his care, and his pradaxa dose was decreased. patient stopped taking pradaxa the day prior to admission in anticipation of procedure. patient has not had any more episodes of epistaxis since then. additionally, while receiving 2 units of prbc at on , he developed abdominal pain which he thought was reflux, but was not relieved by tums. he was admitted for cardiac enzyme monitoring, out of concern abd pain could be cardiac in etiology. troponins were trended and were 0.074, then 0.102, then 0.121. ck-mb flat. subsequently, he developed diarrhea, report 10 episodes in one day. patient reports diarrhea has improved and he now has 1-2 episodes of loose stool. he endorses a decreased appetite, but denies nausea/vomiting. c. diff was negative. past medical history: past medical history: 1. cardiac risk factors: + dyslipidemia, + hypertension 2. cardiac history: - percutaneous coronary interventions: : s/p stent to lad and d1 : s/p diagonal stent 3. other past medical history: - aflutter s/p ablation, then tachy-brady s/p ppm - aortic stenosis ( 0.8cm2) - chronic af: previously on coumadin, stopped epistaxis, hematomas, frequent falls (now s/p ivc filter) - dchf(moderate-severe r dchf, moderate l dchf) - hcm - copd on home o2 - osa - hypothyroid - chronic renal insufficiency - mrsa old wound and sputum - s/p ivc filter - s/p fracture of lower sacrum/upper coccyx - spinal stenosis, s/p multiple interventions - prostate cancer - bph - chronic fatigue - right rotator cuff injury - arthritis shoulders and knees (cortisone injections) - s/p multiple back surgeries - sbo s/p resection c/b post-op gi bleed in setting of elevated inr social history: retired; former occupation was research and development of jet engines x45 years. denies tobacco or etoh. lives with wife and disabled adult son. a daughter who is a radiology tech. home oxygen. uses wheelchair. family history: -brother passed from pancreatic cancer at 43 yo -father passed from cerebral hemmorrhage physical exam: physical examination on admission: 98.1/98.1 hr:70 bp:111-123/75-80 rr:20 02 sat: 96 (ra) in/out: last 24h: last 8h: 360/750 weight: kg(88.8 kg) general: nad. oriented x3. mood, affect appropriate. heent: ncat. perrl, eomi. moist mucous membranes, no lymphadenopathy neck: supple with jvp of 10 cm. cardiac: rrr, normal s1, s2. high-pitched murmur at rusb, radiating to carotics. lungs: ctab, no crackles, wheezes or rhonchi. abdomen: normoactive bowel sounds, soft, ntnd. extremities: 1+ pitting edema to knees b/l. right 1st and 2nd toes with blood bruises, bandage over wound. pulses: right: dp 1+ pt 1+ left: dp 1+ pt 1+ pertinent results: labs on admission: 03:53am blood wbc-4.3 rbc-3.93* hgb-10.4* hct-32.7* mcv-83 mch-26.4* mchc-31.7 rdw-16.9* plt ct-102* 03:53am blood pt-12.0 ptt-52.9* inr(pt)-1.1 03:53am blood glucose-87 urean-20 creat-1.0 na-140 k-4.0 cl-108 hco3-21* angap-15 03:53am blood alt-26 ast-35 ck(cpk)-35* alkphos-116 totbili-0.7 03:53am blood albumin-3.7 calcium-8.7 phos-2.9 mg-2.1 labs on discharge 06:10am blood wbc-3.4* rbc-3.19* hgb-8.3* hct-25.5* mcv-80* mch-26.1* mchc-32.7 rdw-16.7* plt ct-103* 06:20am blood pt-15.5* ptt-63.8* inr(pt)-1.5* 06:10am blood glucose-111* urean-15 creat-0.8 na-139 k-4.1 cl-106 hco3-27 angap-10 06:10am blood calcium-8.5 phos-2.6* mg-2.4 reports cxr pa/lat impression: interval enlargement of the right atrium and left ventricle since . persistent central vascular congestion with mild edema. echo pre implant no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is mildly depressed (lvef= 45 %). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild (1+) aortic regurgitation is seen. moderate (2+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is a very small pericardial effusion. dr. was notified in person of the results on at 1500 hours. very poor transgastric views. unable to evaluate wall motion thoroughly. post implant seen in the aortic position. slightly lower implant. mild perivalvular leak present. moderate mitral regurgitation persists. echo the left atrium is moderately dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is dilated with normal free wall contractility. the ascending aorta is mildly dilated. an aortic prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , a prosthesis is present and is functioning normally with no evidence of aortic regurgitation. the other findings are similar. echo the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). a well-seated aortic prosthesis is present. the prosthetic aortic valve leaflets appear normal the transaortic gradient is normal for this prosthesis. very mild (1+) paravalvular aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , very mild paravalvular aortic regurgitation is now seen and the estimated pa systolic pressure is now lower. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. micro urine urine culture-negative staph aureus screen staph aureus screen-final {staph aureus coag +} inpatient stool clostridium difficile toxin a & b test-negative brief hospital course: assessment and plan: #.aortic stenosis ( 0.8cm2): enrolled in /tavi study high risk arm with randomization to tavi. ppm interrogation was unremarkable. the patient did receive his beta blocker the night before the implantation on . the patient was also plavix loaded with 300mg prior to the procedure. the patient tolerated the procedure well and post-procedure echo showed resolution of aortic stenosis with a well-seated valve, with an ef of 55%. he was completely asymptomatic from a cardiovascular standpoint upon discharge. # nyha class iv diastolic chf: patient has hypertrophic cardiomyopathy, with moderate-severe r dchf, moderate l dchf. during his last admission, he was diuresed with lasix 40mg iv bolus once, and achieved euvolemia. home torsemide and metoprolol were continued. patient is on home o2 (2l per nc) at night, and continued this during hospitalization. diuresed as necessary to achieve euvolemia. . # cad: pt is s/p stent to lad and d1 () and s/p diagonal stent (). most recent cath at () revealed no obstructive cad. - continue home metoprolol tartrate 25mg po bid, pravastatin 20mg daily and asa 81mg. asa increased to 325mg for tavi procedure. # atrial flutter: pt has history of aflutter s/p ablation, then tachy-brady s/p ppm. also has history of chronic afib, for which he was just switched to pradaxa from coumadin. we continued home digoxin 0.125 and home metoprolol tartrate 25 . he did have a bit of oozing from his left groin site, this was fixed with local lido/epi and pressure bandages. given his several hospitalizations for epistaxis we discussed the risk benefit of anticoagulation with his hematologist/oncologist dr. , who agreed with us that given his chads2 score of 4 with an annual stroke rate of 8% and no major bleeds, anticoaggulation would still be indicated, and the patient agreed with this plan. he was continued on warfarin. . # diarrhea: patient initially presented with nausea, vomitting and diarrhea. c diff toxin was negative. his symptoms were thought to be due to a viral gastrointestinal syndrome and resolved with supportive measures prior to his procedure. # anemia: patient with a clear iron deficiency anemia on labs from (iron of 31, ferritin of 26, tibc of 463). patient has a recent gi bleed admission in with stable hcts and colonscopy being a poor study but egd showing erosive gastritis. the patient showed no signs of gi bleed during his hospitalization. he received 1 unit of prbcs for a hct of 25.5, and discharge hct was 28. the patient's pcp will be notified of his anemia and that a screening colonoscpy (given the poor study) would be indicated in the future. # htn: continued home metoprolol, as per above. . # hld: continued home pravastatin. . #.osa: pt has been on cpap. pfts actually show more of a restrictive pattern. he is on home o2 at night, which was continued during hospitalization. we continued 2l home o2 and cap nightly. . #.ckd: baseline creatinine 1.2, stable throughout last hospitalization. creatinine remained stable at 0.8 upon discharge. . #.niddm: diet-controlled. check qachs finger sticks, and continued iss. blood sugars remained in the 100s throughout his hospital stay. . #.bph: continued home finasteride and tamsulosin . #.spinal stenosis: pt is s/p multiple interventions. continued gabapentin 100mg po tid and tylenol 650mg po q6 hrs prn pain . #.gerd: continued home pantoprazole . #.mrsa old wound and sputum: contact precautions were in place. muciprocin and chlorhexidine skin prep/shower was initiated. . # anemia of chronic renal disease: received procrit 10,000 units s/c on . transfused 2u prbc at . transfused 1 unit prbcs at . code: full code comm: patient, wife medications on admission: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 4. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 7. gabapentin 100 mg capsule sig: one (1) capsule po q8h (every 8 hours). 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 10. fenofibrate micronized 48 mg tablet sig: one (1) tablet po daily (daily). 11. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 12. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 13. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). 14. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 15. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 16. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 17. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day): apply to groin folds and affected area. 18. mupirocin calcium 2 % ointment sig: one (1) appl nasal (2 times a day) for 5 days. 19. dabigatran etexilate 75 mg capsule sig: one (1) capsule po bid (2 times a day): 8am and 8pm - discontinue after pm dose on saturday . discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 3. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 6. pravastatin 20 mg tablet sig: one (1) tablet po at bedtime. 7. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 8. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 11. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 12. torsemide 5 mg tablet sig: two (2) tablet po daily (daily). 13. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dry nose. 14. bacitracin zinc 500 unit/g ointment sig: one (1) appl topical qid (4 times a day) as needed for lower leg sore. 15. gentamicin 0.1 % cream sig: one (1) appl topical qid (4 times a day). 16. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 17. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 18. warfarin 4 mg tablet sig: one (1) tablet po once daily at 4 pm. 19. flomax 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po at bedtime. discharge disposition: extended care facility: newbridge on the - discharge diagnosis: discharge diagnosis: 1. severe aortic stenosis -s/p transcatheter aortic valve replacement with percutaneous approach. 2. diastolic heart failure 3. atrial fibrillation 4. diabetes 5. mrsa (+)nares 6. renal insufficiency 7. anemia of chronic renal disease discharge condition: alert and oriented. verbalizes good understanding of plan. ambulating with walker and one assist. mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr , it was a pleasure caring for you during your stay at . you were transfered from an outside hospital on with a gastrointestinal illness. your workup and cultures here were negative, you remained fever free, and the symptoms resolved on their own. you then underwent elective transcatheter aortic valve replacement by percutaneous approach to treat your severe symptomatic aortic valve stenosis. your procedure was uneventful. you recovered without incident. your were anemic during the procedure and receive one unit of packed red blood cells. you remained anemic later in your stay without any obvious sign of active bleeding for which you received two units of packed red blood cells and your usual dose of procrit. your medications will remain the same as before you came in except: 1. you torsemide has been decreased to 10mg daily as you have much less fluid than before your procedure. 2. we have added lisinopril 2.5 mg once a day to improve heart function. 3. your coumadin dose may need to be adjusted daily until a therapeutic inr of 2.0 is reached as treatment for your underlying atrial fibrillation. followup instructions: name: ,md specialty: hematology oncology when: friday at 11:30am location: hematology oncology address: , , phone: name: , md specialty: primary care/cardiology location: internal medicine associates address: , , , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. department: cardiac services when: friday at 8:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 8:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage procedure: arteriography of femoral and other lower extremity arteries aortography endovascular replacement of aortic valve diagnoses: anemia in chronic kidney disease obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortic valve disorders hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified cardiac pacemaker in situ spinal stenosis, unspecified region examination of participant in clinical trial chronic diastolic heart failure intestinal infection due to other organism, not elsewhere classified other dependence on machines, supplemental oxygen hypertrophic obstructive cardiomyopathy 

Answer: The patient is high likely exposed to