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: addendum: mr was initially scheduled to be discharged on but developed a fever with elevated lft's and was worked up appropriately. major surgical or invasive procedure: - aortic valve replacement utilizing a 23mm mosaic porcine valve - ercp - picc line placement - ercp - exploratory laparotomy; attempted laparoscopic cholecystectomy conversion to open cholecystectomy. past medical history: aortic valve stenosis hypertension hypercholesterolemia diabetes mellitus type ii history of prostate cancer social history: lives with his wife. quit tobacco 60 yrs ago, drinks one glass wine/day. no other drug use. family history: non-contributory physical exam: see previous report pertinent results: cxr: there is no definite evidence of an effusion on the current study, though a lateral view would be more sensitive for a small amount of posterior pleural fluid. sternotomy wires, cardiomegaly, and a heavily calcified aorta are unchanged. the prominent right superior mediastinal contour is related to fat and tortuous vessels as seen on ct. abd u/s: sludge and gallstones again seen in the gallbladder, however, no evidence of cholecystitis. incidentally noted is a right pleural effusion. echo: pre-cpb:1. the left atrium is markedly dilated. mild spontaneous echo contrast is seen in the body of the left atrium. no thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. 2. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. there is mild global left ventricular hypokinesis. overall left ventricular systolic function is mildly depressed. lvef=45-50%. 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the aortic root. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. no masses or vegetations are seen on the aortic valve. there is moderate to severe aortic valve stenosis (area 0.8-1.0cm2). mild (1+) aortic regurgitation is seen. the aortic annulus measures 2.5 cm. 6. the mitral valve leaflets are moderately thickened. no mass or vegetation is seen on the mitral valve. there is severe mitral annular calcification. mild to moderate (+) mitral regurgitation is seen. post-cpb: on infusions of epinephrine, phenylephrine. well-seated bioprosthetic valve in the aortic position. trivial ai, no paravalvular leak. mild as. mr is improved post bypass, now mild. aortic contour is normal post decannulation. lvef is 50%. surgical staples overlie the right upper quadrant soft tissues. 05:30am blood wbc-6.1 rbc-3.20* hgb-9.8* hct-29.2* mcv-91 mch-30.5 mchc-33.4 rdw-14.2 plt ct-172 09:35am blood wbc-7.3 rbc-2.80* hgb-8.6* hct-25.6* mcv-91 mch-30.6 mchc-33.6 rdw-14.1 plt ct-261 08:31pm blood hct-21.9* 05:02pm blood wbc-7.3 rbc-3.57* hgb-10.5* hct-31.0* mcv-87 mch-29.5 mchc-34.0 rdw-15.7* plt ct-239 11:13am blood wbc-18.4*# rbc-4.20* hgb-12.4* hct-37.6* mcv-90 mch-29.5 mchc-32.9 rdw-15.4 plt ct-362 12:20pm blood pt-15.6* ptt-33.8 inr(pt)-1.4* 05:39am blood pt-12.8 ptt-27.0 inr(pt)-1.1 06:30am blood glucose-130* urean-11 creat-0.9 na-144 k-4.2 cl-102 hco3-36* angap-10 11:13am blood glucose-209* urean-8 creat-0.9 na-139 k-3.6 cl-100 hco3-29 angap-14 10:40pm blood alt-258* ast-607* alkphos-479* amylase-59 totbili-3.1* 12:35pm blood alt-408* ast-708* ld(ldh)-534* alkphos-501* amylase-35 totbili-3.1* 11:13am blood alt-52* ast-29 ld(ldh)-322* alkphos-265* amylase-24 totbili-1.0 06:45am blood wbc-8.4 rbc-3.57* hgb-10.5* hct-32.0* mcv-90 mch-29.5 mchc-32.9 rdw-15.1 plt ct-589* 08:57am blood pt-13.8* ptt-29.8 inr(pt)-1.2* 05:57am blood glucose-145* urean-9 creat-0.8 na-141 k-3.8 cl-104 hco3-28 angap-13 06:40am blood wbc-7.6 rbc-3.71* hgb-10.8* hct-32.3* mcv-87 mch-29.1 mchc-33.4 rdw-15.0 plt ct-553* 06:40am blood glucose-109* urean-5* creat-0.7 na-141 k-3.9 cl-105 hco3-27 angap-13 05:57am blood alt-19 ast-22 alkphos-147* totbili-0.7 brief hospital course: as mentioned in the addendum, mr was initially scheduled to be discharged on but developed a fever and he was eventually worked-up for this. it was noted that he had an elevated lft's and total bilirubin. then underwent an ultrasound which revealed sludge and gallstones again seen in the gallbladder, however, no evidence of cholecystitis. he was started on antibiotics and surgery was consulted. on post-op day seven he underwent an ercp. please see ercp report for details. following procedure he was transferred back to the cardiac surgery telemetry floor. id was consulted d/t blood cultures came back positive for klebsiella pneumoniae. on post-op day eight patient developed a gi bleed with a significant drop in hct. general surgery was immediately contact d/t recent ercp procedure. pt was transferred to the csru and had multiple blood transfusions. he also had an urgent endoscopy at bedside which revealed no active bleeding from yesterdays procedure. patient remained stable in the csru for several days with a rise in her hct. once stable, a picc line was placed (on post-op day ten) for long-term antibiotic therapy. later on this day pt appeared clinically stable and was transferred back to the telemetry floor. he remained stable over the next several days while receiving antibiotics and awaiting another ercp for removal of pancreatic duct stent. on post-op day fourteen he had another ercp where the pancreatic duct stent was removed. on post-op day thirteen his wbc became quite elevated and blood cultures were taken. additional antibiotics were started. increased wbc was felt related to his cholecystitis. on post-op day fourteen his pancreatic duct stent was removed. on post-op day sixteen he was brought to the operating room where he underwent a cholecystectomy by dr. . please see operative report for surgical details. of note, lap cholecystectomy was converted to open. following surgery he was transferred to the csru. on post-op day seventeen (one from the cholecystectomy) he required a blood transfusion and was later transferred to the telemetry floor for further care. over the next several days he continued to improve and transplant/general surgery followed him for his gallbladder surgery. electrolytes were repleted and beta blockers/ace-inhibitors were titrated for maximum hemodynamics. finally on post-op day twenty-three he appeared to be doing well and was discharged home with vna services and the appropriate follow-up appointments. during this time he will receive to weeks of antibiotics. medications on admission: lupron aspirin 81 qd univasc 15 qd nifedical xl 30 qd atenolol 50 qd zocor 40 qd glyburide/metformin 5/500 discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*30 capsule(s)* refills:*1* 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*1* 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*1* 4. lasix 20 mg tablet sig: one (1) tablet po twice a day for 7 days: titrate accordingly, preoperative weight 165 lbs. 5. potassium chloride 20 meq packet sig: one (1) po twice a day for 7 days: please take with lasix. 6. simvastatin 40 mg tablet sig: one (1) tablet po once a day: take every evening. disp:*30 tablet(s)* refills:*1* 7. tylenol 325 mg tablet sig: 1-2 tablets po tid as needed as needed for pain. disp:*30 tablet(s)* refills:*0* 8. glyburide-metformin 5-500 mg tablet sig: two (2) tablet po daily (daily). 9. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 10. ceftriaxone-dextrose (iso-osm) 2 g/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours) for 2 weeks. disp:*14 * refills:*0* 11. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*1* 12. glyburide-metformin 5-500 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 13. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*1* 14. amlodipine 5 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*1* 15. heparin flush 100 unit/ml kit sig: two (2) intravenous once a day for 2 weeks: 2ml via picc daily and prn. 10ml ns followed by 2ml of 100u/ml heparin (200units heparin) each lumen daily and prn. disp:*28 * refills:*0* 16. normal saline flush 0.9 % syringe sig: ten (10) ml injection once a day for 2 weeks: 10ml ns followed by 2ml of 100u/ml heparin (200units heparin) via picc line daily and prn. disp:*14 * refills:*0* discharge disposition: home with service facility: - discharge diagnosis: aortic valve stenosis - s/p aortic valve replacement cholecystitis s/p cholecystectomy (s/p ercp x 2) gi bleed bacteremia pmh: hypertension, hypercholesterolemia, diabetes mellitus type ii, history of prostate cancer discharge condition: good discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. in the event that you have drainage from your sternal wound, please contact the 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) no lotions, creams or powders to incision until it has healed. you may shower and wash incision. please shower daily. no bathing or swimming for 1 month. use sunscreen on incision if exposed to sun. 5) no lifting greater then 10 pounds for 10 weeks. 6) no driving for 1 month. 7) call with any questions or concerns. followup instructions: dr. in weeks ( dr. (pcp) in weeks. dr. appt on @ 8:00 please call dr (transplant) and schedule an appointment for 2 weeks after discharge. he can be reached at (. 2 wound clinic in 2 weeks. provider: , md phone: date/time: 10:30 provider: , m.d. phone: date/time: 10:00 provider: phone: date/time: 9:00 md procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery other endoscopy of small intestine endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy cholecystectomy open and other replacement of aortic valve with tissue graft endoscopic insertion of stent (tube) into bile duct transfusion of packed cells endoscopic retrograde cholangiopancreatography [ercp] removal of pancreatic tube or drain continuous intra-arterial blood gas monitoring diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of malignant neoplasm of prostate aortic valve disorders other and unspecified hyperlipidemia hemorrhage complicating a procedure bacteremia cholangitis knee joint replacement delirium due to conditions classified elsewhere laparoscopic surgical procedure converted to open procedure calculus of gallbladder with acute cholecystitis, with obstruction 

Answer: The patient is high likely exposed to