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: vancomycin / penicillins / protamine / quinidine sulfate attending: chief complaint: paravalvular leak major surgical or invasive procedure: redo sternotomy/mitral valve replacement (25/33 on-x valve)/repair of svc history of present illness: mrs. is a 51 year old female with presumed rheumatic heart disease who has undergone multiple mechanical mitral valve replacments in the past x 3. in , she was hospitalized with pasteurella bacteremia/sepsis which was further complicated congestive heart failure. a transesophogeal echocardiogram at that time revealed a new paravalvular leak with 3+ mitral regurgitation. past medical history: prosthetic mitral valve regurgitation with paravalvular leak, history of rheumatic heart disease - s/p mitral valve replacements , , (bjork shiley valve), history of complete heart block - s/p permanent pacemaker implantation() and , diaslotic congestive heart failure, paroxsymal atrial fibrillation, history of pasteurella bacteremia secondary to cat scratch, chronic obstructive pulmonary disease, history of gi bleed and secondary to gastric ulcer/gastritis social history: denies tobacco for many years. admits to 10 pack year history. drinks etoh socially, denies excessive intake. admits to cocaine and marijuana in the past, last use over 7 years ago. married and currently lives with husband. family history: no premature coronary artery disease physical exam: physical exam: vitals: t 98.7, bp 120/50, hr 96, rr 18, sat 100 on room air general: thin, frail female in no acute distress heent: oropharynx benign, eomi, perrl skin: well healed sternotomy and left groin incisions neck: supple, no jvd, no carotid bruits heart: irregular rate, normal s1s2, 4/6 systolic murmur radiates throughout precordium lungs: clear bilaterally abdomen: soft, nontender, normoactive bowel sounds ext: cool, 1+ edema bilaterally, bilateral varicosities noted pulses: 1+ distally neuro: nonfocal pertinent results: 05:55am blood wbc-4.1 rbc-2.48* hgb-8.3* hct-24.6* mcv-99* mch-33.4* mchc-33.7 rdw-18.5* plt ct-197 05:55am blood glucose-93 urean-24* creat-1.3* na-132* k-3.2* cl-108 hco3-22 angap-5* 06:00am blood pt-26.1* ptt-94.5* inr(pt)-2.7* cardiology report echo study date of patient/test information: indication: tamponade. s/p mitral valve replacement. height: (in) 63 weight (lb): 127 bsa (m2): 1.60 m2 bp (mm hg): 90/46 hr (bpm): 86 status: inpatient date/time: at 11:15 test: portable tte (complete) doppler: full doppler and color doppler contrast: none tape number: 2007w000-0:00 test location: west technical quality: adequate referring doctor: dr. measurements: left atrium - long axis dimension: *5.6 cm (nl <= 4.0 cm) left atrium - four chamber length: 4.2 cm (nl <= 5.2 cm) right atrium - four chamber length: 4.4 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: *1.2 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 0.9 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 3.9 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 2.0 cm left ventricle - fractional shortening: 0.49 (nl >= 0.29) left ventricle - ejection fraction: >= 60% (nl >=55%) aorta - valve level: 2.6 cm (nl <= 3.6 cm) aorta - ascending: 2.7 cm (nl <= 3.4 cm) aortic valve - peak velocity: 1.6 m/sec (nl <= 2.0 m/sec) mitral valve - peak velocity: 1.8 m/sec mitral valve - mean gradient: 6 mm hg mitral valve - pressure half time: 42 ms mitral valve - e wave: 1.7 m/sec mitral valve - e wave deceleration time: 140 msec tr gradient (+ ra = pasp): *50 mm hg (nl <= 25 mm hg) pulmonic valve - peak velocity: 1.0 m/sec (nl <= 1.0 m/s) interpretation: findings: this study was compared to the prior study of . left atrium: moderate la enlargement. left ventricle: normal lv wall thickness, cavity size, and systolic function (lvef>55%). suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. right ventricle: normal rv chamber size and free wall motion. paradoxic septal motion consistent with prior cardiac surgery. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. aortic valve: normal aortic valve leaflets. no ar. mitral valve: bileaflet mitral valve prosthesis (mvr). mvr well seated, with normal leaflet/disc motion and transvalvular gradients. no mr. tricuspid valve: normal tricuspid valve leaflets. mild to moderate +] tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: small pericardial effusion. effusion echo dense, c/w blood, inflammation or other cellular elements. no echocardiographic signs of tamponade. general comments: the rhythm appears to be atrial fibrillation. conclusions: the left atrium is moderately dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. a bileaflet mitral valve prosthesis is present. the mitral prosthesis appears well seated, with normal disc motion and transvalvular gradients. no mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a small (~ 1cm) circumferential partially echofilled pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study of , the pericardial effusion is new and the mitral valve has been replaced with a normal functioning bileaflet mitral valve. 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. electronically signed by , md on 13:15. physician: , j. radiology final report chest (pa & lat) 2:59 pm chest (pa & lat) reason: evaluate effusion medical condition: 51 year old woman with redo mvr reason for this examination: evaluate effusion reason for examination: followup of a patient after mitral valve replacement. pa and lateral upright chest radiograph compared to serial chest radiographs from to . the patient is after median sternotomy, mitral valve replacement redo and presence of a previously obtained triscuspid valvulopathy. the heart size appears to be gradually increasing since with predominantly increase of the right heart although the left border of the heart is also more pronounced. the lungs are otherwise clear except for chronic bibasilar opacities. the pleural calcifications are again noted involving both sides being more pronounced on the left. the marked distention of the azygos vein which was not present before, also favors right heart failure. the other explanation might be the temponade etiology if there is a presence of large pericardial effusion. the right pacemaker is again demonstrated with its two leads terminating in right atrium and right ventricle. these findings were discussed with dr. . recommendation to proceed with cardiac echo was obtained. the study and the report were reviewed by the staff radiologist. dr. dr. brief hospital course: mrs. was admitted to the on for surgical management of her mitral valve disease. coumadin was held and heparin was started for anticoagulation for her mechanical mitral valve. a dental consult was obtained for oral clearance for surgery. after obtaining a panorex film and performing a bedside exam, mrs. was cleared for surgery from an oral standpoint. gentamycin and dicloxacillin were started per the infectious disease service. this was empiric coverage of bartonella, pasteurella and coxiella given her recent treated bacteremia. the electrophysiology service was consulted given her permanent pacemaker. her pacemaker was interoggated and found to be functioning well and rarely needing to pace. vitamin k was used to reverse her inr. on , when her inr reached a safe range, mrs. was taken to the operation room where she underwent a fourth time redo sternotomy with replacement of her mitral valve with a 25/33 on-x valve. please see operative note for details. postoperatively she was taken to the intensive care unit for monitoring. she was transfused for postoperative anemia. on postoperative day one, mrs. awoke neurologically intact and was extubated. the electrophysiology again interoggated her pacemaker and found it to be functioning within normal limits. she was then transferred to the step down unit for further recovery. coumadin was resumed for anticoagulation for her mechanical valve and chronic atrial fibrillation. dicloxacillin and gentamycin were continued per the infectious disease service. she was gently diuresed towards her preoperative weight. the physical therapy service was consulted for assistance with her postoperative strength and mobility. argatroban was started for anticoagulation as a bridge to coumadin. she was found to be hit negative, argatroban was stopped and she was started on heparin until inr therapuetic. digoxin was resumed for rate control of her chronic atrial fibrillation. she continued to progress and was ready for discharge home with services on postoperative day #8 in stable condition. an echo on the day of discharge revealed a sm. pericardial effusion without evidence of tamponade. medications on admission: 1. atenolol 100 mg 2. disopyramide 100 mg 3. spironolactone 50 mg 4. folic acid 1 mg 5. hexavitamin 6. furosemide 40 mg 7. potassium chloride 20 meq 8. digoxin 125 mcg 1 tab half tab(0.0625 mg) qmon and fri. 9. coumadin 5 mg tablet discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 2. 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:*0* 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 5. hexavitamin tablet sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*0* 6. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 7. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. doxycycline hyclate 100 mg capsule sig: one (1) capsule po twice a day: until follow up with dr. . disp:*60 capsule(s)* refills:*0* 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 10. ferrous gluconate 300 mg tablet sig: one (1) tablet po daily (daily) for 1 months. disp:*30 tablet(s)* refills:*0* 11. furosemide 40 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 10 days. disp:*20 tablet(s)* refills:*0* 12. potassium chloride 10 meq capsule, sustained release sig: four (4) capsule, sustained release po q12h (every 12 hours) for 10 days. disp:*80 capsule, sustained release(s)* refills:*0* 13. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 14. coumadin 5 mg tablet sig: one (1) tablet po at bedtime for 2 days: take as directed by dr. for an inr goal of .5. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: paravalvular leak paf, copd, gib & , mvr , 82, 85(bjork shiley), ppm 94 and 96, pasteurella bacteremia cat scratch discharge condition: good. discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: please call to schedule all appointments dr. 1-2 weeks dr. 2-3 weeks dr. 4 weeks wound check appointment - staple removal schedule with rn , md phone: date/time: 12:00 procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery open and other replacement of mitral valve pulmonary artery wedge monitoring suture of vein transfusion of packed cells diagnoses: unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases atrial flutter accidental puncture or laceration during a procedure, not elsewhere classified hypopotassemia mechanical complication due to heart valve prosthesis cardiac pacemaker in situ accidents occurring in other specified places surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation accidents occurring in residential institution infection and inflammatory reaction due to cardiac device, implant, and graft accidental cut, puncture, perforation or hemorrhage during surgical operation cocaine abuse, in remission mitral stenosis with insufficiency cannabis abuse, in remission 

Answer: The patient is high likely exposed to