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: flagyl / ceftazidime attending: chief complaint: sob/cp/af major surgical or invasive procedure: - redo sternotomy, mv repair (30mm band), full maze procedure. - exploratory diagnostic laparoscopy conversion to open. history of present illness: mr. is a 54 y/o gentleman admitted for a redo mitral valve repair and maze procedure. he has undergone several pvi procsdures for af with his last being complicated by tamponade requiring emergent sternotomy. he now has 3+ mr documented by echo. he is admittedprior to surgery after stopping his coumadin for iv heparin in preparation for surgery. past medical history: -atrial fibrillation -atrial flutter -hyperlipidemia, diet and exercise controlled -mildly elevated lfts . cardiac history: mr. was initially diagnosed with atrial fibrillation approximately four years ago. in , he was evaluated at and subsequently underwent a pulmonary vein isolation procedure by dr. . unfortunately, that procedure was complicated by a left ventricular hematoma and perforation resulting in a cardiac tamponade and cardiac arrest. mr. was taken emergently to the operating room for relief of his tamponade. he was in the intensive care unit for approximately 15 days and ultimately discharged one month later. unfortunately, postoperatively, mr. to atrial fibrillation and was discharged on amiodarone. . in , he was found to be in atrial flutter, with heart rate in the 120s. at that time, his -xl dose was increased, he failed dc cardioversion, and he was referred to dr. . in , he underwent successful ablation of reentry around the anterior portion of the cs ostium by dr. , which was complicated by a prolonged vagal response and post-procedure hypotension requiring dopamine infusion, iv fluids, and atropine for resolution. he was admitted to the ccu, and at that time developed chf which was likely to fluids given for hypotension in setting of decreased hr after ablation. . in , he was found at his follow-up visit to be back in aflutter. in , a second atrial flutter ablation procedure was performed. . in , he had a successful atrial flutter ablation, completion of previously done tv-ivc isthmus line of block. . in , his amiodarone was discontinued after pft's revealed a mild restrictive physiology and lft's were found to be elevated. . in , he presented again with symptomatic palpitations and was started on digoxin. he had a repeat pvi on and propafenone was initiated post-procedure. dccv on . social history: social history is significant for the absence of tobacco use. there is no history of alcohol abuse. he was formerly a pediatrician for 18 years in prior to emigrating to the us ten years ago. he is married with three sons. family history: his father died of complications of diabetes. there is no family history of premature coronary artery disease or sudden death. physical exam: 97.5 110/73 66 18 98% ra nad chest cta. well healed sternotomy. cv: rrr, holosystolic murmur abd: benign ext: warm, well perfused pertinent results: 05:58am blood wbc-13.7* rbc-4.04* hgb-12.1* hct-36.3* mcv-90 mch-30.0 mchc-33.4 rdw-15.7* plt ct-563* 05:58am blood pt-16.6* ptt-116.3* inr(pt)-1.5* 04:33am blood glucose-99 urean-20 creat-0.8 na-134 k-4.5 cl-100 hco3-25 angap-14 chest (pa & lat) 4:18 pm chest (pa & lat) reason: evaluation of infiltrate medical condition: 54 year old man with s/p mv repair reason for this examination: evaluation of infiltrate type of examination: chest pa and lateral. indication: status post mitral valve repair. evaluate for infiltrates. : this is the first pa and lateral chest examination since the preoperative study before mitral valve re-do operation obtained on . there is status post sternotomy, including a row of cutaneous surgical clips in the midline. a left subclavian central venous line is in place, seen to terminate overlying the svc at the level of the carina. no pneumothorax is identified. the overall heart size is now only slightly larger than it was on the pre-re-do examination of and the cardiac configuration remains the same. a left-sided lateral pleural sinus obliteration has developed and as it does not continue into the posterior pleural sinus, it most likely represents postoperative scar formations. comparison also reveals additional linear densities and a relatively crowded vasculature in the left lower lobe consistent with partial atelectasis, but no new parenchymal infiltrates are identified. when comparison is made with the most recent single view portable chest examination of , the previously present multifocal parenchymal densities as well as pleural densities have regressed markedly and there is no evidence of new acute infiltrates or increased pulmonary congestion. as already noticeable on previous postoperative examinations, there exists a faintly visible semi-circular thin density consistent with a surgically performed mitral annuloplasty. impression: marked improvement of pulmonary infiltrates encountered postoperatively to mitral valve annuloplasty and maze procedure (). moderate cardiomegaly as before, presently no signs of pulmonary vascular congestion. left-sided basal scar formations and partial atelectasis. echocardiography report , portable tee (complete) done at 7:47:12 am final referring physician information , /department of anesthesia , cc540 , , division of cardiothoracic , status: inpatient dob: age (years): 54 m hgt (in): 69 bp (mm hg): 104/60 wgt (lb): 160 hr (bpm): 64 bsa (m2): 1.88 m2 indication: tee for evaluation of ?shunt left ventricular function. mitral valve disease. icd-9 codes: 424.0, 424.2 test information date/time: at 07:47 interpret md: , md test type: portable tee (complete) son: , md doppler: full doppler and color doppler test location: west sicu/ctic/vicu contrast: none tech quality: adequate tape #: 2008w1-: machine: other echocardiographic measurements results measurements normal range left ventricle - ejection fraction: 60% >= 55% right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. normal interatrial septum. no asd or pfo by 2d, color doppler or saline contrast with maneuvers. left ventricle: overall normal lvef (>55%). no vsd. right ventricle: mildly dilated rv cavity. normal rv systolic function. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: mitral valve annuloplasty ring. well-seated mitral annular ring with normal gradient. trivial mr. tricuspid valve: mildly thickened tricuspid valve leaflets. moderate tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was sedated for the tee. medications and dosages are listed above (see test information section). the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. the patient appears to be in sinus rhythm. results were personally conclusions 1. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. 2. overall left ventricular systolic function is normal (lvef>55%). 3. there is no ventricular septal defect. 4. compared to the previous tee on , the right ventricular cavity is mildly dilated but remains with normal free wall contractility. 5. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. 6. a mitral valve annuloplasty ring is present. the mitral annular ring appears well seated and is not obstructing flow. trivial mitral regurgitation is seen. 7. the tricuspid valve leaflets are mildly thickened. compared to the previous tee, tricuspid regurgitation has increased to moderate tricuspid regurgitation. cta head w&w/o c & recons 8:25 am cta head w&w/o c & recons; cta neck w&w/oc & recons reason: r/o bleed medical condition: 54 year old man with reason for this examination: r/o bleed contraindications for iv contrast: none. history: 54-year-old male with concern for intracranial hemorrhage or infarction. the patient is recently status post mitral valve replacement. comparison: non-contrast head ct . technique: non-contrast head ct followed by ct angiogram of the neck, head and circle of after optiray iv contrast with multiplanar reformats and 3d reconstructions. ct of the head without iv contrast: overall, the appearance of the brain is unchanged compared to . there is no evidence of intracranial hemorrhage, shift of normally midline structures, mass effect, hydrocephalus, or vascular territorial infarction. paranasal sinus mucosal thickening has improved and there is mild residual mucosal thickening of the floor of the right maxillary sinus and of the left sphenoid sinus air cell. there remains a small amount of fluid and a few bilateral mastoid air cells; however, a majority of air cells remain well aerated. ct angiogram of the neck with iv contrast: the carotid and vertebral circulations are patent without evidence of aneurysm, stenosis, dissection or vascular malformation. at a level slightly superior to the carotid bifurcation, the left internal carotid artery measures 10 mm maximal diameter. slightly inferior to the skull base, the left ica measures 5 mm. at similar reference levels, the right internal carotid artery measures 9 and 6 mm respectively. limited visualization of the upper lungs demonstrate airspace consolidation at both apices as well as moderate-sized pleural effusions layering dependently. ct angiogram of the head and circle of : the anterior and posterior circulations as well as circle of are patent without evidence of aneurysm, stenosis, dissection or vascular malformation. ct perfusion: the ct perfusion images are somewhat limited due to technical artifacts; although, no definite asymmetric perfusion defect is seen. impression: 1. no evidence of acute infarction or hemorrhage. 2. unremarkable ct angiogram of the neck, head, and circle of . medical condition: 54 year old man with s/ mv repair reason for this examination: apparent anterior displacement of the lateral masses of c1 relative to the occipital condyles is incompletely evaluated on this head ct. further evaluation with noncontrast ct of the cervical spine is recommended. contraindications for iv contrast: none. history: 54-year-old male found to have apparent anterior dislocation of the lateral masses of c1 relative to the occipital condyles on recent head ct, referred for evaluation of the cervical spine. comparison: non-contrast head ct, . technique: non-contrast ct of the cervical spine with multiplanar reformats. : there is no evidence of fracture or malalignment of the cervical spine. the vertebral body heights are maintained. there is no significant central canal or neural foraminal stenosis. there is normal articular alignment of the bilateral lateral masses of c1 with their respective occipital condyles. there is no evidence of anterior dislocation of the lateral masses of c1 relative to the occipital condyles which was suspected on a limited evaluation by recent head ct. paranasal sinus mucosal thickening and partial opacification of bilateral mastoid air cells are incompletely included in the field of view. ground- glass opacity and interstitial thickening is noted of the visualized right lung apex. the patient is intubated with terminus out of view. impression: 1. normal articulation of the lateral masses of c1 with their respective occipital condyles. 2. no fracture or malalignment of the cervical spine. 3. paranasal sinus mucosal thickening and bilateral mastoid air cells partial opacification not fully evaluated. 4. ground-glass opacity at the visualized right lung apex may relate to infection as suspected on the patient's recent chest radiographs. ct abd w&w/o c 1:06 pm ct chest w/contrast; ct abd w&w/o c reason: pna, bowel ischemia medical condition: 54 year old man with unexplained acidosis, question of pna reason for this examination: pna, bowel ischemia contraindications for iv contrast: none. indication: unexplained acidosis, question of pneumonia and bowel ischemia. technique: axial volumetric images have been obtained through the chest, abdomen and pelvis before and after administration of iv contrast. delayed images in the venous phase through the abdomen and pelvis have also been obtained. coronal and sagittal reformats were performed. ct chest: there are multifocal airspace opacities within the right and left lung, predominantly on the right with evidence of ground-glass opacities and air bronchograms. there is a questionable small right apical pneumothorax with no evidence of mediastinal gas. endotracheal tube is in place. the heart is enlarged with evidence of small amount of pericardial effusion. mediastinal catheters are in place. there are shotty mediastinal lymph nodes which are all less than 1 cm in diameter in short axis. there is no evidence for pleural effusion. there are two hypodense nodules within the right thyroid lobe for which an ultrasound is recommended. ct of the abdomen: the patient is status post recent laparotomy two days ago. there are residual two small pockets of free air superior and anterior to the hepatic dome. the liver, the spleen, the pancreas, and the bilateral adrenal glands are unremarkable. the gallbladder appears slightly thick-walled and this is likely due to the presence of small amount of ascites in the abdomen. there is a short segment of proximal small bowel that is prominent measuring 3.2 cm in diameter. there is no evidence of transition point. the remainder of the bowel appears unremarkable. this is most likely due to postsurgical changes. there is no evidence of pneumatosis or portovenous gas. small amount of free fluid in the abdomen. there are slightly prominent retroperitoneal lymph nodes, all of which are subcentimeter in diameter in short axis. there is no evidence of hydronephrosis. there is a small left upper pole cyst. otherwise, the bilateral kidneys are unremarkable. ct pelvis: the urinary bladder is decompressed with evidence of foley catheter in the bladder. there is a small amount of free fluid in the pelvis. there is a right-sided femoral catheter within the right femoral artery. there is mild subcutaneous edema. musculoskeletal: there are no lucent or sclerotic bony lesions. impression: 1. evidence of multifocal airspace disease concerning for multifocal pneumonia. were communicated to the fellow dr. on at 4:00 p.m. 2. questionable small right apical pneumothorax which may be tracking from catheter placement. additional foci of gas in the anterior abdominal wall as described may also reflect gas tracking from the mediastinal catheters. 3. two hypodense lesions within the right lobe of the thyroid for which an ultrasound is recommended. 4. slightly thick-walled gallbladder which may be related to the small amount of ascites in the abdomen. focal short segment dilatation of jejunum with no evidence of transition point. this is most likely post-surgical in nature. brief hospital course: mr. was admitted to the on for surgical management of his mitral valve disease and his atrial fibrillation. as he had stopped coumadin, heparin was started as a bridge to surgery. on , mr. was taken to the operating room where he underwent a redo sternotomy with a mitral valve repair using a 30mm band and a full maze procedure. postoperatively he was taken to the intensive care unit for monitoring. on postoperative day one, mr. was extubated. throughout the day, he became progressively agitated with an increase lactate causing acidosis. he was subsequently reintubated to protect his sternum and to allow his acidosis to clear. he developed copious secretions and an elevated white blood cell count. vancomycin flagyl, ciprofloxacin and ceftaz were continued for coverage. an echo was performed which ruled out a ventricular septal defect. the infectious disease consult was obtained and a pneumonia was suspected. the general surgery service was consulted given his acidosis and distended bowel. an exploratory laparotomy was performed which was negative. he developed rapid atrial fibrillation and amiodarone was continued. heparin was also started for anticoagulation. the nutrition service was consulted and tube feeds were started for nutritional support. the neurology service was consulted secondary to his continued unresponsiveness and cta imaging was not suggestive of any acute process. an eeg was performed which was also negative. a toxic-metabolic encephalopathy was presumed possibly secondary to sedatives. slowly his confusion and agitation improved. he was gently diuresed towards his preoperative weight. on , mr. had a catatonic state and a head ct scan was performed which was negative. of note, thyroid nodules were seen on his scan which should be followed as an outpatient. he quickly improved to his baseline. later on , mr. was extubated. as ceftaz and flagyl were associated with increased risk of seizure, they were both discontinued as they had completed their course. a bedside swallowing exam was performed which he failed and tube feeds were continued. on , mr. was alert, orientated and following all commands. coumadin was resumed for paroxysmal atrial fibrillation. a repeat swallowing exam was performed on which he proved that he could safely tolerate foods. a regular diet was thus started. later on , he was transferred to the step down unit for further recovery. the physical therapy service was consulted for assistance with his postoperative strength and mobility. he continued to make steady progress and was discharged to home on postoperative day 15. medications on admission: lopressor 50" coumadin 2.5' digoxin 0.125' lasix 20' protonix 40' lisinopril 5' discharge medications: 1. outpatient work pt/inr for coumadin dosing - atrial fibrillation goal inr 2-2.5 first draw with results to dr 2. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily): please take 400mg for 5 days then decrease to 200 mg daily and follow up with dr . disp:*50 tablet(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 4. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 5. warfarin 2.5 mg tablet sig: one (1) tablet po once a day for 2 days: please take 2.5mg daily and have inr drawn for further dosing. disp:*60 tablet(s)* refills:*0* 6. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 7. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. aspirin ec 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: paf/a-flutter mitral regurgitation hyperlipidemia chf gastric ulcer pna mental status changes postoperatively discharge condition: good discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. report any wound issues to your surgeon at ( 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) you may shower daily and wash incision. no lotions, creams or powders to wound until it has healed. 5) no driving for 1 month. 6) no lifting greater then 10 pounds for 10 weeks from date of surgery. followup instructions: please follow-up with dr. in 2 weeks. ( please follow-up with dr. in 2 weeks. please follow-up with dr. 1 weeks. please follow up with dr. (surgery) in 1 week pt/inr for coumadin dosing - atrial fibrillation goal inr 2-2.5 first draw with results to dr . scheduled appointments- provider: , md phone: date/time: 12:30 provider: (st-3) gi rooms date/time: 12:30 provider: , m.d. phone: date/time: 3:20 procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery enteral infusion of concentrated nutritional substances exploratory laparotomy excision or destruction of other lesion or tissue of heart, open approach closed [endoscopic] biopsy of bronchus cardiac mapping open heart valvuloplasty of mitral valve without replacement diagnoses: pneumonia, organism unspecified anemia, unspecified mitral valve disorders other postoperative infection toxic encephalopathy unspecified septicemia atrial fibrillation atrial flutter sepsis laparoscopic surgical procedure converted to open procedure 

Answer: The patient is high likely exposed to