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: coconut attending: chief complaint: shortness of breath major surgical or invasive procedure: diagnostic laparoscopy, tracheostomy and attempted percutaneous endoscopic gastrostomy redo sternotomy, aortic valve replacement (23mm st. tissue) history of present illness: this 85 year old male underwent coronary bypass grafting in at with dr. . he now has progressive aortic stenosis and mitral regurgitation. he was seen last in . at that time surgery was deferred as he was deemed extremely high risk. he was seen in clinic asking about not only surgical but also percutaneous options. he has had dyspnea on exertion and now has had several episodes of dyspnea that awoke him from sleep. he has found it hard to go back to sleep. he was admitted to mwmc a week prior to this visit for increased shortness of breath and found to be in failure. he was discharged home on increased lasix. his dyspnea occurs at night and at rest, and has resolved with sitting up or using his wife's oxygen. on he underwent cardiac catheterization which revealed three vessel coronary artery disease with patent bypasses, severe aortic stenosis, moderate left diastolic ventricular dysfunction, and moderate pulmonary hypertension. an echo was performed which revealed an ejection fraction of 55%, critical aortic stenosis with an aortic valve area of 0.8cm, moderate aortic insufficiency, moderate mitral regurgitation, and moderate pulmonary artery hypertension. he was not a corevalve candidate due to his mixed valve disease. -a chest ct revealed distal ascending, arch, and descending aortic calcifications. -pulmonary function tests showed an fev1 on 69% predicted pre-drug and 77% post-drug. fev1/fvc pre-drug was 88% predicted and 95% post-drug. dsb was 21, vasb 5, dsbhb 21, and d/vasbhb was 3.6. he returns to the after obtaining dental clearance for heparin bridge in preparation for an avr in the morning. three days ago he was placed on keflex for a possible right medial shin cellulitis which appears today much improved. he has also been treated for the past week for a right eye infection, also much improved per patient report. past medical history: aortic stenosis coronary artery disease chronic atrial fibrillation hypertension hyperlipidemia cardiomyopathy peripheral vascular disease asthma chronic renal insufficiency (baseline 1.7) community acquired pneumonia gout psoriasis kyphosis coronary artery bypass graft surgery (lima>lad, svg>d1, svg>d2, svg>om, svg>pda and are lv by a y graft) right hernia repair left inguinal herniorrhaphy anemia social history: lives with: spouse occupation: retired - artist tobacco: denies etoh: cans of beer a day - last beer family history: mother deceased 62 heart failure physical exam: pulse: 75 b/p 144/76 resp: 18 o2 sat: 95% ra general: nad-kyphotic posture skin: dry intact healed mid line sternotomy, healed right leg incision and lower left leg. right medial shin with slight erythema. heent: perrla eomi r eye with slight redness neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur harsh systolic abdomen: soft non-distended non-tender +bs extremities: warm , well-perfused edema: none varicosities: multiple varicosities bilateral neuro: grossly intact, non focal exam pulses: femoral right: +2 left: +2 dp right: +2 left: +2 pt : +1 left: +1 radial right: +1 left: +1 carotid bruit: radiated murmur bilaterally pertinent results: conclusions the left atrium is dilated. the right atrium is moderately dilated. there is symmetric left ventricular hypertrophy. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). there is considerable beat-to-beat variability of the left ventricular ejection fraction due to an irregular rhythm/premature beats. left ventricular dysnchrony is present. there is a mild resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. a bioprosthetic aortic valve prosthesis is present. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is a probable vegetation on the mitral valve. 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. impression: mild symmetric left ventricular hypertrophy. function is difficult to assess due to likely dyssynchrony (wide qrs). the apex may be hypokinetic. the right ventricle is not well seen but again, is probably normal. there is a small echodensity on the posterior leaflet of the mitral valve -- see images #81-84. this could be a vegetation, a chordal remnant or fibrin attached to mitral annular calcification. avr with normal gradients, cannot exclude a vegetation. mild mitral regurgitation. moderate tricuspid regurgitation. compared with the prior study (images reviewed) of , the echodensity on the posterior leaflet may have been present on the prior study also. electronically signed by , md, interpreting physician 15:47 intra-op tee conclusions pre-cpb: the left atrium is markedly dilated. mild spontaneous echo contrast is seen in the body of the left atrium. mild spontaneous echo contrast is present in the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). a left atrial appendage thrombus cannot be excluded. no atrial septal defect is seen by 2d or color doppler. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. there are grade 4 atheroma in the descending thoracic aorta. no thoracic aortic dissection is seen. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is severe mitral annular calcification. there is moderate central mr. : there is a bioprosthetic valve in the aortic postion. there is a significant paravalvular leak in the area of the right coronary cusp next to the commisure between the right and left cusps, causing moderate ai. the peak gradient across the aortic valve is 12mmhg, the mean gradient is 7mmhg. the mr is now mild to moderate. biventricular function remain normal. brief hospital course: the patient was admitted on for heparin bridge and brought to the operating room on where he underwent a redo sternotomy and aortic valve replacement (23mm rst. tissue valve). please see the operative note for details. overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu on propofol and neo synephrine drips in stable condition for recovery. on pod 1 the patient was extubated and weaned from vasopressor support. on pod 2 he was re-intubated following an episode of unresponsiveness/respiratory distress. he developed thrombocytopenia and a hit panel later returned negative. on post-operative day six he began to present with a septic picture and was seen by the infectious disease service. he was treated for ventilator associated pneumonia with ciprofloxacin, zosyn and vancomycin. likely due to sepsis he developed multi-system organ failure. he developed acute tubular nephrosis and started cvvhd on post-operative day eight. he developed liver failure with an elevated bilirubin requiring a glucose infusion. on post-operative day seven he had melena so he was started on a protonix infusion and the gastrointestinal service was consulted. a ct of the abdomen and pelvis showed no bowel ischemia. on he underwent an exploratory laporatomy and trach placement. the abdominal exploration revealed no abnormal abdominal processes. a peg tube was unable to be placed secondary to anatomy. his platelets continued to drift downward and a seratonin assay was sent. he received a platelet transfusion after bleeding was noted at his trach and right forearm skin tears. a wound care consult was requested secondary to bleeding at the right forearm and aquacel dressings were recommended. a family meeting was held on and a decision was made to continue care. a dobhoff tube was placed in interventional radiology and tube feeds started. he developed an ileus and tpn was subsequently begun as he was intolerant of tube feeding. heparin was continued for his chronic atrial fibrillation. he continued to do poorly. a tunnelled dialysis catheter was eventually placed in the left internal jugular vein after a new right subclavian line was placed. cvvh was resumed. he developed herpetic stomatitis and was treated with iv acyclovir. he continued on cvvh and was diuresed well taking off 200cc/hr for several days. he eventually was converted to hemodialysis. several family meetings were held to discuss his progress and critically ill condition. it was decided that the family does not want compressions if the patient arrests. chemically coding and shocking the patient is permissible. he did not tolerated tube feeds as he had melena whenever tube feeds were increased. he was on tpn for a period of time and then transitioned backl to tube feeds successfully.subsequently, a repeat echo revealed a mv vegetation. abx therapy adjusted per id consultation. the patient continue to fail all attempts to wean his pressor requirement and to wean from mechanical ventilation. on the family decided to make him comfort measures only. his pressors were stopped and he passed away about 90 minutes later medications on admission: lisinopril 2.5 mg daily cartia xt 180 mg daily warfarin 5 mg ecasa 81 mg daily advair 250/50 1 puff daily magnesium oxide 400 mg daily lasix 60 mg daily potassium 10 meq daily simvastatin 20 mg daily zantac 300 mg daily folbee daily (folic acid/vit b6/vit b12) purelax 3350 twice a month allopurinol 100 mg daily colchicine 0.6 mg daily ferrous gluconate 5 grains daily vitamin c daily calcium and vitamin d 600 daily vigamox 0.5% eye drops r eye six times daily starting for 4 days and then four times daily for ten days. erythromycin 0.5% r eye two times per day for ten days. discharge medications: expired discharge disposition: expired discharge diagnosis: aortic stenosis s/p redo sternotomy, aortic valve replacement s/p exploratory laparotomy, tracheostomy s/p tunneled dialysis catheter coronary artery disease chronic atrial fibrillation hypertension hyperlipidemia cardiomyopathy peripheral vascular disease asthma acute renal failure hepatic failure respiratory failure mitral valve endocarditis deep vein thrombosis sepsis chronic renal insufficiency (baseline 1.7) community acquired pneumonia gout psoriasis kyphosis s/p coronary artery bypass graft surgery (lima>lad, svg>d1, svg>d2, svg>om, svg>pda and are lv by a y graft) right hernia repair left inguinal herniorrhaphy discharge condition: expired discharge instructions: expired followup instructions: expired procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis laparoscopy temporary tracheostomy open and other replacement of aortic valve with tissue graft closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus diagnoses: acidosis coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis other postoperative infection congestive heart failure, unspecified toxic encephalopathy acute and subacute necrosis of liver unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation acute on chronic diastolic heart failure aortocoronary bypass status peripheral vascular disease, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia defibrination syndrome septic shock mitral valve insufficiency and aortic valve stenosis paralytic ileus pressure ulcer, lower back acute and subacute bacterial endocarditis chronic obstructive asthma, unspecified hemorrhage of gastrointestinal tract, unspecified other and unspecified infection due to central venous catheter ventilator associated pneumonia other psoriasis examination of participant in clinical trial kyphosis (acquired) (postural) herpes simplex without mention of complication pressure ulcer, stage i other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms jaundice, unspecified, not of newborn acute venous embolism and thrombosis of deep vessels of distal lower extremity pressure ulcer, upper back other allied disorders of spine 

Answer: The patient is high likely exposed to