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: addendum: ***please note, due to a computing error, this discharge summary was filed prior to its completion. please refer to this addendum for a more accurate hospital course and for the remainder of the studies performed during this hospitalization.** pertinent results: b. henselae igg titer >=1:1024 a <1:64 titer igg titer >=1:1024 a <1:64 titer b. henselae igm titer tnp-screening test <1:16 titer negative. igm titer see below <1:16 titer endoscopy: ulcer in the cardia; erosion in the stomach body; erythema and congestion in the stomach body and antrum compatible with gastritis; there was no blood or active bleeding noted. there was no blood to second portion of duodenum; there were no esophagitis or varices; otherwise normal egd to second part of the duodenum. ct left shoulder: limited examination due to lack of iv contrast. moderate joint effusion in the left shoulder and lymph nodes, as described above. if peripheral iv axis is obtained, the patient can receive repeat examination as clinically indicated. rue u/s: focused grayscale and color ultrasound of the right antecubital fossa was performed. within the antecubital fossa is a long hypoechoic, poorly defined that is difficult to measure but likely measures 7 cm in length, and 2.5-1.7 cm in transverse diameter. the echogenicity suggests a large necrotic lymph node. . this collection appears to be distinct from the joint capsule. ct rue: 7.4 x 2.3 x 2.2 cm multilobulated peripherally enhancing mass in the antecubital fossa, most consistent with necrotic lymph nodes given patient's history of cat scratch disease. although this peripherally enhancing mass is likely extracapsular in location, given the lack of posterior fat-pad displacement, an ultrasound examination is recommended to better exclude an infectious arthropathy. tee: 1. the left atrium is dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. the atrial septum appears thickened with echodense material consistent with a patch. no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). 3.the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. 4. a single tilting disk mitral valve prosthesis is present. the gradients are higher than expected for this type of prosthesis. a posteriorly directed moderate-to-severe eccentric paravalvular mitral prosthesis leak is present. no mass or vegetation is seen on the mitral valve. no mitral valve abscess is seen. 5. a tricuspid valve annuloplasty ring is present. 6.there is no pericardial effusion. lshoulder xr: there is no evidence of fracture or dislocation. no evidence of osteomyelitis is identified. the small effusion cannot be evaluated by the plain radiograph. bone scan: no focal abnormal tracer activity in the hands and upper extremities to suggest the presence of osteomyelitis. nonspecific increased tracer activity in multiple joints of both upper extremities is suggestive of degenerative change. brief hospital course: ms. is a 50 yo woman with history of mitral valve repair (x3) on coumadin, tricuspid valave annuloplasty ring, atrial fibrillation, and recent cat scratch who presented with 4 days of melena and a hematocrit of 10.8, as well as inr of >88. gi bleed: in the er the patient received ffp x 2 as well as prbcs x 2. she was initially admitted to the icu, where she was given vitamin k, ffp, and 7 units of prbcs in total. her inr was reversed with vitamin k, and her hematocrit remained stable. she had one day of low o2 saturations (high 80s) and required brief intubation, during which time she had an endoscopy, which found gastritis, an ulcer in the cardia, and an erosion in the stomach body, neither of which were actively bleeding and both of which were felt to be likely causes of her gi bleed and anemia. her hematocrit stabilized and she continued to pass guaiac positive, although not melanotic, stool. on her last two days of hospitalization she passed guaiac negative stool. the patient was instructed to follow up with our gi department for a repeat endoscopy as an outpatient in weeks. colonoscopy was not performed as an inpatient but this could be considered for more complete outpatient work up. supratherapeutic inr: the patient arrived with a very elevated inr of >88 (the limit of our laboratory). she denied taking poor pos and denied low vitamin k diet. she last had her inr checked 2months ago by her pcp and states that this has never happened to her before. she was seen by our pharmacist while in house for a very extensive discussion of her coumadin use, other medication use, and diet, which were unrevealing with respect to her sudden inr elevation. the patient's coumadin was initially held, she was given ffp as above, and after reversal of her inr with vitamin k, she was restarted on coumadin after her inr fell below 2.5. she was given heparin iv to bridge her when she fell below 2.5 given her high risk of thrombus to her mechanical valve. before discharge the patient was on coumadin 3mg po qhs and remained stable at inr of about 2.7 for several days. she was dishcarged on this dose and instructed to have her inr checked 2d after discharge (on monday) and twice per week subsequently. pasteurella bacteremia: the patient suffered cat scratches approximately 7-10 days prior to admission. she received a tetanus vaccine as an inpatient. she was found to grow blood cultures bottles of pasteurella and was treated with ceftriaxone. she was followed extensively by hte infectious disease team while in-house. as the patient also appeared to have mental status changes in the micu, she was started on meningitis doses. we did not perform lp, as the patient has a mechanical valve and we could not let her inr drop low enough for this to be safe, and instead treated her empirically, after being transferred from the icu to the floor, the patient's mental status returned to baseline. it is believed unlikely that she had pasteurella meningitis at this time. tte and tee were performed and no vegetation was visualized, however a paravalvular leak was noted around her mechanical mitral valve. she was also noted to have persistent edema in her bilateral arms/wrists/hands. plain films, ct scan, and bone scan were all negative for osteomyelitis. upper extremity ultrasounds showed no dvt, but did show some left antecubital necrotic lymph nodes. she worked with physical therapy to mobilize her arms and the edema appeared to respond somewhat to this. the patient also had persistent pain in her left shoulder with markedly reduced range of motion. ct of her left shoulder showed no sign of osteomyelitis or effusion. given hte absence of meningitis (presumed), endocarditis, and osteomyolitis, the patient was switched to po levofloxacin on the last day of hospitalization, to finish a total of three weeks of treatment, which is scheduled to end on . on the day prior to discharge the patinet's bartonella results came back positive igg but negative igm. it is unclear how these should be interpreted, as with the patient's extensive cat ownership she may have been infected with bartonella in the past, versus a concurrent infection with the pasteurella 10 days prior to admission so we may have missed the igm peak. repeat bartonella studies were sent prior to discharge and will be followed up by infectious disease. the patient will be followed by dr. in infectious disease clinic and already has an appointment scheduled for . she will have an outpatient ct of her r shoulder and l arm one week prior to this appointment. she will have labwork drawn weekly and faxed to the clinic after discharge as well. atrial fibrillation: the patient has a history of afib, and remained in afib throughout her stay. as an outpatient she was rate controlled on digoxin, norpace, and atenolol. her digoxin was discontinued during this admission, as it is a relatively poor rate-controlling , and she was maintained on norpace and beta blocker as tolerated by her blood pressure. she is on coumadin, as stated above, for anticoagulation and stroke risk reduction. she has an appointment to follow up with her usual cardiologist at his next available appointment in . hyperemia of hands: the patients hands remained erythematous adn in some places pale throughout her stay. although she has no stated history of raynaud's disease, and denied exacerbation in the cold, the patient stated that her hands did not appear abnormal to her and they "look purple all winter and red all summer." she likely has raynaud's disease. this should be followed up as an outpatient by her pcp. mechanical mitral valve: as stated above the patient is anticoagulated on coumadin with goal 2.5-3.5 for her valve. a tee performed during her hospitalization showed paravalvular leak. per cardiology recommendations here, this should be followed up by the patient's outpatient cardiologist and she will likely require another tee in the near future to monitor progression. she has a follow up appointment with her usual cardiologist (who the patient believed was no longer practicing, so i do not know when she was last seen there) in his next available slot in . access: during her stay the patient had a l subclavian central catheter and a l antecubital picc. both of these were removed prior to discharge from the hospitalization without event. general: it remains unclear to us whether ms. has an underlying diagnosis of liver disease or some other systemic illness. she comes in on chronic diuretic therapy for lower extremity edema, yet does not have heart failure by echo. when her diuretics were held during this hospitalization she indeed did develop pitting edema bilaterally. spot urine had an elevated protein/cr ratio, however 24 hour urine collection showed protein in the normal range. she is at baseline somewhat ill-appearing and also presented with a very low albumin. she did eat well after recuperating somewhat during her stay here. this issue is better served by the patient's pcp, it appears to be chronic in nature, and remains to be followed up as an outpatient. the patient was discharged to home with follow up appointments scheduled for her cardiologist and our infectious disease clinic, as stated above. she was instructed to call her pcp for follow up appointment in the next 1-2 weeks and to call our gastroenterology department for a follow up endoscopy in the next 6-8 weeks. she was also instructed ot have her bloodwork drawn for inr check two days after d/c and twice per week after that, and faxed to her usual pcp, well as to have labwork faxed to our infectious disease clinic once per week. discharge disposition: home with service facility: vna md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine diagnostic ultrasound of heart insertion of endotracheal tube transfusion of packed cells transfusion of other serum diagnoses: hyperpotassemia thrombocytopenia, unspecified acute gastric ulcer with hemorrhage, without mention of obstruction acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation acute respiratory failure mechanical complication due to heart valve prosthesis bacteremia long-term (current) use of anticoagulants cardiac pacemaker in situ other and unspecified coagulation defects rheumatic heart disease, unspecified acute pancreatitis pain in joint, shoulder region acute gastritis, with hemorrhage swelling of limb pasteurellosis unspecified chronic liver disease without mention of alcohol 

Answer: The patient is high likely exposed to