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: vitamin e / hydrocortisone / penicillins / bacitracin attending: chief complaint: mental status changes and fever major surgical or invasive procedure: 1. left thoracotomy, placement of epicardial left atrial and left ventricular bipolar pacing leads and insertion of abdominal pocket dual-chamber pacemaker. 2. multilevel left-sided intercostal nerve block. removal of previously implanted transvenous ddd pacing system. delayed primary closure of old pacemaker pocket. history of present illness: 78 year old male with history of mssa endocarditis mitral valve and suspected pacer lead infection discharged from hospital for 3 days to nursing home. presented back to hospital mental status changes, confusion and agitation - diagnosed with metabolic encephalopathy. additionally he has been complaining of right knee pain but worsening just prior to admission at hospital. he is now being transferred for surgical evaluation. prior admission to hospital with dc to rehab for staphyloccus bacteremia treated with oxacillin completed 6 week course on - antibiotics were resumed this admission at hospital with oxacillin and vancomycin and ceftriaxone until sensitives were available due to + culture and sepsis. also noted for tick bite and was tested at hospital which the lyme, anaplasma and babesia were negative he was discharged to rehab on oxacillin and rifampin for 6 week course. past medical history: mitral valve endocarditis septic emboli av block atrial fibrillation degenerative joint disease peripheral vascular disease anemia s/p aortic valve replacement(23 mosaic porcine) s/p permanent pacemaker abdominal surgery after stabbing incident social history: retired lives alone tobacco:10 pack year history off and on - quit in etoh occasional 1 shot brandy in coffee 2-3 days/week beer with dinner family history: non-contributory physical exam: pulse: 72 resp: 20 o2 sat: 100 on ra temp 98.0 b/p 151/68 general: no acute distress, cachetic skin: dry intact stage 1 decub on coccyx, non healing stage 2 ulcer front of left calf, multiple areas of eccyhmosis in particular right flank, bilateral forearms midline sternal incision healing no erythema/drainage midline abdominal surgical scar heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur systolic abdomen: soft non-distended non-tender bowel sounds + extremities: cool, edema no edema, bilateral knees with tenderness with rom - picc line left arm no erythema at site neuro: grossly intact pulses: femoral right: +2 left: +2 dp right: +1 left: +1 pt : +1 left: +1 radial right: +2 left: +2 carotid bruit right and left: murmur vs bruit pertinent results: echocardiography report , portable tte (complete) done at 4:29:11 pm final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 78 m hgt (in): 71 bp (mm hg): 151/68 wgt (lb): 155 hr (bpm): 72 bsa (m2): 1.89 m2 indication: h/o cardiac surgery. endocarditis. icd-9 codes: 424.90, v43.3, 424.0, 424.2 test information date/time: at 16:29 interpret md: , md test type: portable tte (complete) son: doppler: full doppler and color doppler test location: / 6 contrast: none tech quality: adequate tape #: 2009w053-: machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.9 cm <= 4.0 cm left atrium - four chamber length: *6.6 cm <= 5.2 cm right atrium - four chamber length: *5.8 cm <= 5.0 cm left ventricle - septal wall thickness: *1.5 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.5 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.3 cm <= 5.6 cm left ventricle - ejection fraction: >= 60% >= 55% right ventricle - diastolic diameter: *2.7 cm <= 2.1 cm aorta - sinus level: 3.0 cm <= 3.6 cm aorta - ascending: *3.7 cm <= 3.4 cm aortic valve - peak velocity: *2.8 m/sec <= 2.0 m/sec aortic valve - peak gradient: *30 mm hg < 20 mm hg aortic valve - mean gradient: 20 mm hg mitral valve - pressure half time: 95 ms mitral valve - mva (p t): 2.3 cm2 mitral valve - e wave: 1.3 m/sec mitral valve - a wave: 1.7 m/sec mitral valve - e/a ratio: 0.76 mitral valve - e wave deceleration time: *315 ms 140-250 ms tr gradient (+ ra = pasp): *42 mm hg <= 25 mm hg pulmonic valve - peak velocity: 0.9 m/sec <= 1.5 m/sec findings left atrium: moderate la enlargement. right atrium/interatrial septum: mildly dilated ra. a catheter or pacing wire is seen in the ra and extending into the rv. normal ivc diameter (<2.1cm) with >55% decrease during respiration (estimated ra pressure (0-5mmhg). left ventricle: moderate symmetric lvh. normal lv cavity size. normal regional lv systolic function. no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. paradoxic septal motion consistent with conduction abnormality/ventricular pacing. aorta: normal aortic diameter at the sinus level. mildly dilated ascending aorta. aortic valve: bioprosthetic aortic valve prosthesis (avr). avr well seated, normal leaflet/disc motion and transvalvular gradients. no masses or vegetations on aortic valve. no ar. mitral valve: severely thickened/deformed mitral valve leaflets. moderate mitral annular calcification. calcified tips of papillary muscles. minimally increased gradient consistent with trivial ms. mild to moderate (+) mr. tricuspid valve: normal tricuspid valve leaflets. moderate tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets. significant pr. pericardial effusion. conclusions the left atrium is moderately dilated. the estimated right atrial pressure is 0-5 mmhg. there is moderate symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal disc motion and transvalvular gradients. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are severely thickened/deformed but without rheumatic deformity. an underlying vegetation cannot be excluded, but is not seen. there is a minimally increased gradient consistent with trivial mitral stenosis. mild to moderate (+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. impression: normal functioning aortic bioprosthesis. markedly thickened/deformed mitral leaflets and annulus with minimal mitral stenosis and at least mild-moderate mitral regurgitation. pulmonary artery systolic hypertension. if clinically indicated, a tee would be better able to define the mitral valve morphology and severity of mitral regurgitation. 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, interpreting physician 17:36 brief hospital course: mr. is a 78 year-old male who completed his course of antibiotics for mssa mitral valve endocarditis and possible pacer lead infection . he was admitted for lead removal. once cleared by infectious disease, he was taken to the operating room for pacer insertion and removal of old pacer system. see operative report for further details. this was complicated by a hematoma at old pacer site pocket which was opened and packed. on he underwent delayed closure of the old pacer pocket which he tolerated. id: he was seen by infectious disease who recommended continuing nafcillin and rifampin until culture date final. he developed a reaction to nafcillin and was changed to gentamycin for 5 days and cefazolin. picc line was removed and the tip was cultured with no growth. his cultures remained negative since admission. he was placed on cefazolin for treatement with completion plan for . cardiology: he was followed by ep throughout his hospital course. the ddr was interrogated with normal function. respiratory: with aggressive pulmonary toilet and nebs he weaned to room air with oxygen saturations in the high 90's. renal; he was gently diuresed. his renal function remained normal. his lytes were repleted appropriately. gi: his bowel function remained normal. wound: upon admission he was found to have coccygeal stage i pressure ulcer, and lle old traumatic ulcer. see wound care notes. nutrition: he was followed by nutrition throughout his hospital course. his diet improved with po supplementals. picc: placed in interventional radiology. successful placement of a 5-french double-lumen, 41 cm, a left picc with tip in the distal svc. disposition: he was followed by physical therapy throughout his stay. he continued to make steady progress and was discharged to rehab. medications on admission: apirin 81' coumadin dulcolax 1' flomax 0.4' kcl 20' lopressor 25" magnesium oxide 400' oxycontin ir 5/prn oxycontin cr 30" prednisone 5' prilosec 20' oxacillin 2 q4hr rifampin 300''' senekot 2 tabs' mvi miralax-prn discharge medications: 1. cefazolin 1 gram recon soln sig: two (2) gm injection every eight (8) hours: through . 2. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 3. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 4. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 5. senna 8.6 mg tablet sig: two (2) tablet po at bedtime. 6. miralax 17 gram (100 %) powder in packet sig: one (1) packet po once a day as needed for constipation. 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for yeast: groin . 11. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 13. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 14. oxycodone 15 mg tablet sustained release 12 hr sig: two (2) tablet sustained release 12 hr po twice a day. 15. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 16. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 17. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po daily (daily). discharge disposition: extended care facility: pleasant bay nursing & rehabilitation center - discharge diagnosis: lead infection s/p removal of implanted pacemaker s/p pacemaker placement mitral valve endocarditis discharge condition: good discharge instructions: keep wounds clean and dry. please shower daily, no bathing or swimming. take all medications as prescribed. call for any fever 100.5, redness or drainage from wounds. please call with any questions or concerns suture removal from pacer site at follow up with dr - followup instructions: dr (id) clinic appt on , at 9:30am. dr plase call for appointment dr clinic in 2 weeks dr . eten in weeks procedure: venous catheterization, not elsewhere classified other incision with drainage of skin and subcutaneous tissue removal of lead(s) [electrode] without replacement revision or removal of pacemaker device division of sympathetic nerve or ganglion implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system [crt-p] revision or relocation of cardiac device pocket diagnoses: anemia, unspecified unspecified protein-calorie malnutrition atrial fibrillation hematoma complicating a procedure peripheral vascular disease, unspecified osteoarthrosis, unspecified whether generalized or localized, site unspecified pressure ulcer, lower back acute and subacute bacterial endocarditis surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation heart valve replaced by transplant pressure ulcer, stage ii infection and inflammatory reaction due to cardiac device, implant, and graft ulcer of calf 

Answer: The patient is high likely exposed to