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 / heparin agents attending: chief complaint: endocarditis major surgical or invasive procedure: cardiac cath tee re-do sternotomy, replacement of asc. aorta (26 mm graft), avreplacement(25mm mechanical), mv repair, lvot repair, debridement of abscess (on ) cardiac cath history of present illness: pt is a 69 male with cad s/p cabg in , in , s/p biv pacer/aicd in , who presented to ed on with c/o sob 1 day, wkness, fever to 104. found to have mssa endocarditis after blood cx's grew mssa. subsequently became septic and developed cardiogenic shock requiring intubation on . started on dopa/neo/vasopressin. tte 0.5 inner vegetation posterior av ring w/o vavular leak. dx prosthetic valve endocarditis and transferred to on . on he had a cardiac cath which revealed patent grafts to lad and om, with occluded graft to pda.; not medicated for the contrast, cr rose to 1.6 on from baseline of 1.1 thought to be contrast related. at that time, abx consisted of oxacillin/gent/rifampin. tee on revealed probable aortic root abcess with suspected small pacer wire vegetation. also had sputum growth positive for serratia proteus on sensitive to levo, thought to be ventilator associated pneumonia. renal us sone on showed no hydronephrosis. gentamycin was d/c'd on , after cr continued to rise. had stool cultures positive for c.diff on and was placed on flagyl. tte on revealed an anterior echo dense space (2.5 x 1.5 cm), with 1+ mitral regurgitation, and a nonruptured, posterior sinus of valsalva aneurysm (3.5 x 1.5 cm) which is being closely monitored. renal was consulted on , at which time the cr had risen to 3.1. patient is now being transferred to apg for medical management. 69 yo m with multiple medical problems including an in w/ mechanical valve, s/p biv pacer/aicd in , cad s/p cabg in , who presented to ed on with c/o sob 1 day, weakness, and fever to 104. blood cxs grew mssa leading to suspicion for mssa endocarditis. the pt subsequently became septic and developed cardiogenic shock requiring intubation on . he was started on dopamine/neosynephrine/vasopressin. tte demonstrated 0.5cm inner vegetation on the posterior av ring w/o vavular leak. the pt was diagnosed with prosthetic valve endocarditis and transferred to on for further management. . on the pt had a cardiac cath which revealed patent grafts to lad and om, with occluded graft to pda. the pt was not medicated for the contrast and his cr rose to 1.6 the following am () from baseline of 1.1. at that time, abx consisted of nafcillin/gent/rifampin. tee on revealed ? aortic root abcess with suspected small pacer wire vegetation. also had sputum growth positive for serratia proteus on sensitive to levo, thought to be ventilator associated pneumonia. renal us done on showed no hydronephrosis. gentamycin was d/c'd on , after cr continued to rise. had stool cultures positive for c.diff on and was started on flagyl. tte on revealed an anterior echo dense space (2.5 x 1.5 cm), with 1+ mitral regurgitation, and a nonruptured, posterior sinus of valsalva aneurysm (3.5 x 1.5 cm) which is being closely monitored. . renal was consulted on , at which time the cr had risen to 3.1. . on the evening of patient developed hypotension and received ivf. on the am of , the patient developed respiratory distress, thought to be to fluid overload. noted to have wheezing (+smoking hx but no dx of copd and no prior tx with nebs) and clinically was very volume overloaded. patient received nebs without relief; cxr and physical exam consistent with chf. he received lasix 40mg iv x2 and 80mg iv x1. patient had a repeat tte to assess for increasing valavular dysfunction which found the mechanical aortic valve leaflets more echogenic, with increased acoustic shadowing, possibly indicating the presence of vegetation or thrombus. correlation with tee was recommended. . upon arrival to ccu, patient denied chest pain, was feling short of breath. no n/v, abd pain, or other localizing complaints. . past medical history: 1. s/p mechanical (#27 -) for severe ai 2. cabg x3 3. s/p aicd/biv ppm 4. dm2 5. htn 6. chf ef 10-15% echo below 7. cri-baseline cr 1.3 8. hypercholesterolemia 9. gout social history: lives at home with wife. retired elementary school principal. smokes cigars/day. enjoys golfing and riding 3 wheeled motorcycles. family history: six relatives with htn, dm, cad physical exam: vs: 98.6 127/65 91 20 9% ra fs 118,60,89 gen: alert, comfortable, sitting up in chair, nad heent: ncat, anicteric, perrl, eomi neck: supple, no lad, no carotid bruits cv: rrr nl s1,s2 blowing systolic murmur with loud click (prosthetic valve) lungs: ctab no r/r/w, abd: s, f, ntnd, nabs back: no cvat ext: rue cubital edema at picc site with ecchymosis. dp 2+. 2+ edema b/l. with erythematous toes, flaky skin. +left big toe 3 mm blue ulcer tip. neuro: alert, oriented x 3, cn ii-xii intact, cerebellar reflexes intact. senation and strength intact. reflexes 3+, toes down. pertinent results: 01:49am blood wbc-6.8 rbc-3.01* hgb-9.0* hct-27.1* mcv-90 mch-29.9 mchc-33.2 rdw-16.1* plt ct-207 01:49am blood pt-21.6* ptt-48.4* inr(pt)-2.1* 01:49am blood glucose-60* urean-56* creat-3.4* na-143 k-4.0 cl-100 hco3-35* angap-12 brief hospital course: transferred to from on with acute endocarditis of his aortic valve (mssa). he had a prolonged pre-operative course on the cardiology medicine service complicated by: removal of infected aicd & leads ventilator associated pneumonia post-cath atn, requiring temporary dialysis c.diff colitis sacral decubitus he was taken to the or on for a 2nd time re-do sternotomy, and mediastinal dissection. since this was quite extensive, he was taken back to the csru overnight. the following day, he was taken back to the or on , where he underwent replacement of asc. aorta (26 gelweave graft), re-do mecahnical (25 st. ), mv repair, lvot repair, repair of proximal om vein graft. post-op, he wsa taken to the cardiac surgery recovery unit on vasopressin, epinephrine, levophed, milrinone, and amiodarone, with an iabp in place. his vasoactive drips were weaned, and his iabp was removed on pod # 3. over the next few days, he was weaned from mechanical ventilation, and extubated on pod # 5. speech therapy evaluated mr. , and felt it was safe to feed him, but due to poor apetite, and low po intake, a feeding tube remained in place and continues to be used for nutrition. anticoagulation was initiated with heparin, but he was found to be hit positive. heparin was discontinued, argatroban and coumadin were started. argatroban was discontinued when the inr was theraeutic. he had a pleural effusion drained on , and remianed hemodynamically stable. his nph insulin was started post-op, but then discontinued due to hypoglycemia. he was continued on glyburide, with sliding scale regular insulin coverage as needed. he was followed closely by the infectious disease service, who recommended that he discontinue the po vancomycin, and continue iv vanco & rifampin until . the ep service followed his as well, and felt that he should be on continuous cardiac monitoring, as he has had some non-sustained v-tach, and will ultimately need an aicd. the renal medicine service followed him for his atn, which has greatly improved, and he did not require any dialysis post-operatively. the wound care nurses followed him for many skin breakdowns, and the recommendations were to leave them open to air. he has remained stable, and his primary problems at this time are mobility, often limited by pain in his feet (due to skin lesions), and poor nutritional status (due to poor apetite and fatigue causing him to tire while eating). his is felt to be ready to be discharged to rehab to progress in these areas. medications on admission: nafcillin 2 gm iv q6h (-) levofloxacin 250 mg po q24h (-) rifampin 300 mg po q12 (-) metronidazole 500 mg tid (-) . albuterol 0.083% neb soln 1 neb ih once pantoprazole 40 mg po q24h aspirin 81 mg po daily carvedilol 6.25 mg po bid glipizide 10 mg po bid rosuvastatin calcium 10 mg po daily acetaminophen 650 mg po q4-6h:prn riss starting at 121 up by 2 every 50 warfarin 5 mg qhs ambien prn discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 2. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 3. acetaminophen 650 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for temperature >38.0. 4. rifampin 600 mg recon soln sig: three hundred (300) mg intravenous q12h (every 12 hours): continue until . disp:*qs mg* refills:*2* 5. mupirocin calcium 2 % cream sig: one (1) appl topical (2 times a day). 6. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 7. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po daily (daily). 8. albuterol sulfate 0.083 % solution sig: two (2) puffs inhalation q6h (every 6 hours) as needed. 9. ipratropium bromide 0.02 % solution sig: two (2) puffs inhalation q6h (every 6 hours) as needed. 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) gm intravenous q48h (every 48 hours): dose for level < 20, continue until . 12. potassium chloride 20 meq packet sig: one (1) packet po bid (2 times a day). 13. calcium acetate 667 mg capsule sig: one (1) capsule po bidwm (2 times a day (with meals)). 14. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). 15. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). 16. glipizide 10 mg tablet sig: one (1) tablet po bid (2 times a day). 17. crestor 10 mg tablet sig: one (1) tablet po once a day. 18. oxycontin 20 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po twice a day. 19. megestrol 40 mg tablet sig: one (1) tablet po qid (4 times a day). 20. metoclopramide 5 mg/ml solution sig: five (5) mg injection q6h (every 6 hours). 21. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 22. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 23. warfarin 5mg daily. titrate for target inr (mechanical aortic valve) discharge disposition: extended care facility: - discharge diagnosis: aortic valve endocarditis c.diff colitis (treated with full course of po vancomycin) post-cath atn hit discharge condition: good discharge instructions: take all medications as prescribed keep all follow-up appts as outlined below call for any fevers no driving for 1 month no lifting > 10 # for 10 weeks no creams, lotions or powders to any incisions may shower, no bathing or swimming for 1 month followup instructions: dr. in clinic ( in weeks dr. in weeks dr in 4 weeks procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization other endoscopy of small intestine diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances hemodialysis thoracentesis open and other replacement of aortic valve (aorto)coronary bypass of one coronary artery implant of pulsation balloon other cystoscopy other operations on heart and pericardium resection of vessel with replacement, aorta, abdominal transfusion of packed cells open heart valvuloplasty of mitral valve without replacement closed biopsy of skin and subcutaneous tissue exploratory thoracotomy operations on other structures adjacent to valves of heart continuous intra-arterial blood gas monitoring diagnoses: other primary cardiomyopathies acidosis anemia, unspecified coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled paroxysmal ventricular tachycardia intestinal infection due to clostridium difficile pressure ulcer, lower back chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction other and unspecified complications of medical care, not elsewhere classified pain in joint, shoulder region infection and inflammatory reaction due to cardiac device, implant, and graft other specified hypersensitivity angiitis other aneurysm of heart 

Answer: The patient is high likely exposed to