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: no known allergies / adverse drug reactions attending: chief complaint: chest pain and shortness of breath major surgical or invasive procedure: redo sternotomy, aortic valve replacement(21mm st. epic porcine), two vessel coronary artery bypass grafting utilizing saphenous vein grafts to obtuse marginal and plv. cardiac catheterization history of present illness: mr. is a 77 year old male s/p porcine avr , known coronary artery disease s/p right coronary bare metal stent in , and history of pulmonary embolus(on coumadin) who presents with persistent and worsening symptoms of shortness of breath/angina over the past month. he notes increasing frequency and longer durations of his anginal episodes. when exerting himself, he has substernal chest pain radiating to his right arm. he also has been feeling lousy for the past month. he notes dry cough, hoarseness, chills, and myalgias. he notes rigors with tmax 99 at home. he has been having upper abdominal pain. he saw his cardiologist where he had blood cultures and troponins were drawn. he was found to have a positive troponins and blood cultures were positive for staphylococcus. given the above findings, he was sent to the ed at for further evaluation and treatment. in the ed, initial vitals were 98.4 121/69 55 18 100% on ra. patient given 1 dose of vancomycin and tylenol for fever. he was rigoring when the ed resident saw him. he was chest pain free prior to transfer. past medical history: coronary artery disease, s/p rca bare metal stent s/p aortic valve replacement - porcine dyslipidemia hypertension benign prostatic hypertrophy history of tia history of pulmonary embolism in and arthritis s/p appendectomy gerd barrett's esophagus gout sleep apnea peripheral neuropathy social history: lives in with his wife. exercises with light weight lifting but has not in the past month. he has a trip planned to go to on . -tobacco history: 80 pack year history, quit -etoh: 6-7 beers/week -illicit drugs: none family history: mother with mi. brother with early cabg physical exam: upon admission: vs: 98.7 111/65 59 16 98% on ra 90.7kg general: wdwn male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple without jvd. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. 3/6 sem at rusb. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: +bs, soft, nondistended, left upper quadrant tenderness. no hsm. abd aorta not enlarged by palpation. no abdominial bruits. extremities: wwp, no c/c/e, no evidence of embolic phenomenon, bruise on left nail does not appear to be embolic in origin skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ neuro: a&ox3, cn 2-12 intact pertinent results: labs upon admission: blood wbc-9.6 rbc-4.50* hgb-14.1 hct-40.4 plt ct-159 pt-15.0* ptt-23.9 inr(pt)-1.3* esr-15 glucose-85 urean-23* creat-1.3* na-137 k-4.4 cl-102 hco3-26 alt-15 ast-22 ck(cpk)-76 alkphos-70 totbili-0.6 lipase-81* ctropnt-0.03* calcium-8.5 phos-3.3 mg-2.0 crp-69.1* . imaging: tee: no atrial septal defect is seen by 2d or color doppler. there are simple atheroma in the descending thoracic aorta. a bioprosthetic aortic valve prosthesis is present which appears to be well-seated with normal leaflet motion. the leaflets are thickened. there is a large vegetation on the anterior aspect of the aortic valve bioprosthesis, measuring up to 1.2 x 2.0 cm. the vegetation appears highly mobile and prolapses into the lvot during diastole. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. impression: large, mobile bioprosthetic aortic valve vegetation. mild aortic regurgitation. mild mitral regurgitation. . ct torso: no sequela of septic emboli noted. slight interval enlargement of mediastinal lymph nodes. prostamegaly. vasculopathy. . carotid doppler: right ica 40-59% stenosis. left ica 40-59% stenosis. there is antegrade right vertebral artery flow. there is antegrade left vertebral artery flow. intraop tee: pre-cpb: there is mild symmetric left ventricular hypertrophy. overall left ventricular systolic function is mildly depressed (lvef= 45 %). there is hypokinesis of the basal and mid inferolateral segments. there is akinesis of the basal inferior wall segment. a bioprosthetic aortic valve is present. the prosthetic aortic valve leaflets are thickened. there is a moderate-sized, mobile vegetation on the aortic valve which appears to prolapse into the lvot in diastole. mild (1+) eccentric aortic regurgitation is seen. the mitral valve leaflets are mildly thickened and appears somewhat tethered. moderate (2+) central mitral regurgitation is seen. post-cpb: there is a bioprosthetic valve seen in the aortic position. the valve is well-seated with normal leaflet mobility. there is a small paravalvular leak seen the area between what would have been the left and non-coronary cusps. this leak persisted after protamine administration. the lv systolic function similar to preop, estimated ef is 45%. there is no evidence of aortic dissection. . labs at discharge: wbc-5.7 rbc-2.90* hgb-9.0* hct-25.6* plt ct-246 wbc-6.2 rbc-2.83* hgb-9.0* hct-25.3* plt ct-222 wbc-8.6 rbc-3.10* hgb-9.7* hct-27.6* plt ct-203 pt-23.7* inr(pt)-2.2* pt-20.9* inr(pt)-1.9* pt-17.7* inr(pt)-1.6* pt-15.2* ptt-26.9 inr(pt)-1.3* glucose-101* urean-29* creat-1.7* na-139 k-4.0 cl-104 hco3-28 glucose-95 urean-27* creat-1.6* na-137 k-3.9 cl-101 hco3-30 glucose-101* urean-26* creat-1.5* na-139 k-4.1 cl-102 hco3-26 glucose-103* urean-24* creat-1.5* na-136 k-4.2 cl-101 alt-25 ast-29 ld(ldh)-378* alkphos-53 totbili-0.5 alt-24 ast-32 ld(ldh)-348* alkphos-51 amylase-58 totbili-0.3 . discharge chest x-ray: moderate postoperative cardiac enlargement persists. sternotomy wires in unchanged position. the previously existing blunting of the lateral pleural sinuses has regressed and is almost eliminated on the right side. the left lateral pleural sinus demonstrates some residual pleural density extending into the posterior pleural sinus. no new parenchymal pulmonary abnormalities are identified. comparison also shows that there is some moderate degree of atelectasis in the lower lobes posterior segments remaining but again no new acute infiltrates are seen. no pneumothorax is identified. brief hospital course: mr. was admitted under cardiology with subacute endocarditis and worsening angina. he ruled out for myocardial infarction and remained pain free on medical therapy. tee was notable for a large mobile vegetation on his bovine aortic valve. he had one positive blood culture growing staph capitis from an outside lab and two blood cultures here growing gram negative rods, making propionibacterium the likely culprit. there were no signs of septic emboli, perivalvular abscess, or heart failure. id was consulted and he was placed on vancomycin initially with coverage broadened to include gentamicin, rifampin, and ciprofloxacin. diagnostic catheterization revealed instent restenosis of this bare metal stent in his rca. given anticipation of cardiac surgical intervention, plavix and warfarin were held, and he was transitioned to lovenox. prior to cariac surgery, he required a tooth extraction of the #2 tooth. he will also need outpatient dental follow up regarding his #15 tooth. preoperative course was otherwise uneventful and he was cleared for surgery. . on , dr. performed redo sternotomy, redo aortic valve replacement, and coronary artery bypass grafting surgery. for surgical details, please see operative note. following surgery, he was brought to the cvicu for invasive monitoring. within 24 hours, he awoke neurologically intact and was extubated without incident. short runs of paroxysmal atrial fibrillation were noted but he remained mostly in a normal sinus rhythm. id service continued to monitor antibiotic therapy and titrate accordingly. his cvicu course was otherwise uneventful and he transferred to the sdu on postoperative day two. warfarin anticoagulation was resumed for history of pulmonary embolus with paroxsymal af and dosed for a goal inr between 2.0 - 3.0. he continued to experience intermittent episodes of atrial fibrillation for which beta blockade was advanced as tolerated. amiodarone was not given based on a right bundle branch block. given his mildly depressed lv function, ace inhibitor would have been ideal but ace inhibitor was not given secondary to his mild renal insufficiency. over several days, he continued to make clinical improvements and was cleared for discharge to rehab( house nursing and rehab) on postoperative day six. at discharge, he was in a normal sinus rhythm. . following discharge, he will remain on antibiotic therapy per id recommmendations. all antibiotics are scheduled to end on . while at rehab, bun and creatinine should be monitored twice weekly. cbc with diff, electolytes, lft's, vancomycin trough, and gentamicin peak/trough should also be monitored once weekly. all results should be sent/faxed to clinic @ . medications on admission: 1. metoprolol succinate 25mg po daily 2. nitroglycerin 0.4 mg tablet sl q5 mins as needed for angina. 3. omeprazole 20 mg capsule po daily 4. pravastatin 80 mg po daily 5. warfarin 4 mg tablet daily 6. acetaminophen 500 mg prn pain 7. ascorbic acid 500 mg tablet po bid 8. aspirin 325 mg tablet po daily 9. allopurinol 150 mg tablet po daily 10. clopidogrel 75 mg tablet po daily 11. calcium carbonate-vitamin d3 daily 12. multivitamin tablet po daily 13. lisinopril 2.5 mg tablet po once a day 14. tamulosin 0.4mg po daily discharge medications: 1. warfarin 1 mg tablet sig: three (3) tablet po daily (daily): inr goal is between 2.0 - 3.0. 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. allopurinol 100 mg tablet sig: 1.5 tablets po daily (daily). 5. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 6. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 7. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 8. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 10. rifampin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours): last dose - date may vary according to id service. 11. multivitamin tablet sig: one (1) tablet po daily (daily). 12. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours): last dose 5/27 - date may vary according to id service. 13. vancomycin 500 mg recon soln sig: 1.5 recon solns intravenous q12h (every 12 hours): 750mg iv q12 hours. last dose - date may vary according to id service. 14. metoprolol succinate 50 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po daily (daily). 15. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 16. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 17. potassium chloride 10 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day: hold if k > 4.5. 18. tylenol 325 mg tablet sig: 1-2 tablets po every 6-8 hours as needed for fever or pain. discharge disposition: extended care facility: house rehabilitation & nursing center - discharge diagnosis: primary diagnosis: subacute culture negative endocarditis secondary diagnosis: coronary artery disease chronic systolic congestive heart failure s/p redo aortic valve replacement and coronary artery bypass grafting prior aortic valve replacement in pulmonary embolism dyslipidemia hypertension sleep apnea history of tia postoperative paroxysmal atrial fibrillation acute renal insufficiency discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with tylenol incisions: sternal - healing well, no erythema or drainage leg - healing well, no erythema or drainage. 1+ edema discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **labs: pt/inr for coumadin ?????? indication pulmonary embolus goal inr: 2.0 to 3.0** ** please arrange coumadin followup with dr. prior to discharge from rehab** **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** ** while on antibiotics, please check bun and creatinine twice weekly. also monitor cbc with diff, chem 7, lft's, vancomycin trough, and gentamicin peak/trough once weekly. results should be sent/faxed to clinic @ ** followup instructions: you are scheduled for the following appointments: 1. surgeon: dr. on @ 1pm 2. cardiologist: , / cardiology address: . , , 11:45am 3. infectious disease: md appt on thursday at 1:30. 4. infectious disease: appt: wednesday at 11:30 am. please call to schedule appointments with your primary care dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication pulmonary embolus goal inr: 2.0 to 3.0 ** please arrange coumadin followup with dr. prior to discharge from rehab** ** while on antibiotics, please check bun and creatinine twice weekly. also monitor cbc with diff, chem 7, lft's, vancomycin trough, and gentamicin peak/trough once weekly. results should be sent/faxed to clinic @ ** procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries left heart cardiac catheterization open and other replacement of aortic valve with tissue graft other surgical extraction of tooth partial excision of pituitary gland, transsphenoidal approach local excision or destruction of lesion of facial bone diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension cardiac complications, not elsewhere classified gout, unspecified atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia long-term (current) use of anticoagulants other complications due to other cardiac device, implant, and graft acute and subacute bacterial endocarditis personal history of venous thrombosis and embolism unspecified hereditary and idiopathic peripheral neuropathy acute on chronic systolic heart failure barrett's esophagus dental caries, unspecified developmental odontogenic cysts 

Answer: The patient is high likely exposed to