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: respiratory distress major surgical or invasive procedure: avr ( 27 mm ce magna-ease pericardial) history of present illness: (per records, girlfriend) this patient is a 59 year old male with a pmh of chronic pain, htn, hld, ivda who initially presented to his pcp several days ago with cough/ congestion seen by pcp and started on a z-pack for concern of bronchitis but he has not been taking the antibiotics. his girlfriend states that he has been slowly decling over the past few weeks. he takes large amounts of oxycontin and dilaudid at baseline and she has noticed that her pain medications have gone missing too. he has also been using heroine, last use . has been noted to have minimal po intake, occasionally drooling, noted to have increased lethargy. lethargy and cough have been worsening over the last 5 days. on , he developed shortness of breath and diffuse rhonchi which worsened over afternoon. pt became somnolent, minimally responsive and tachpneic in his pcp . ems was called by pcp and found him altered with o2 saturation 85%. . on arrival to bd , his vs were t 97.3 hr: 89 bp: 117/50 resp: 20 o(2)sat: 82% ra 100% nrb. cxr showed question of chf vs. pna. he was given vanc/zosyn/flagyl for presumed pneumonia. he became more somnolent and was intubated at bidn. sedation was fent/versed gtt. labs were significant for hct 22, trop t 0.152, bnp elevated 63k. ekg showed twi in v2-v4. stools guaiac negative and he was transfused one unit prbcs. there was no report of bleeding. he was given aspirin pr. transferred by . on arrival to , his hct was 25. ekg showed t wave inversions in v2-v4. his most recent vs prior to transfer to the micu were: t 99.3 p 78, bp 99/31 cvp 20, vent settings fio2 100, peep 5, tidal volume 550. . on the floor, patient was intubated, minimally sedated. . review of sytems: per hpi, unable to fully obtain. cardiac surgery was consulted for av vegetation and ai after echo obtained. past medical history: - hypertension. - anxiety. - chronic back pain/ leg pain - questionable history of prior mi. - ivda- heroin- last injection (benzodiazepine and opiate +) - hepatitis c social history: uses heroine, last used . lives in with his girlfriend. smokes 2 ppd. denies any alcohol. veteran. family history: (per omr) father died at age 81 from an aneurysm in his leg. mother is living and had a lower extremity blood clot. two brothers and sisters with no history of cad or diabetes. physical exam: admission: 105 kg 73" vitals: af bp: 135/37 p: 59 r: 29 o2: 100% general: intubated, sedated heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: rhonchorous breath sounds throughout, decreased breath sounds over right lung field cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: surgical scar in ruq, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: raised, erythematous papular rash over back, bilateral knees, elbows, shoulders, le with chronic venous statis changes and diffuse skin defects neuro: intubated, sedated, moving all extremities pertinent results: conclusions prebypass: the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. there are large vegetations on the aortic valve. there is no aortic valve stenosis. severe (4+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. severe (4+) mitral regurgitation is seen due to restricted mitral valve leaflets. no masses or vegetations are seen on the tricuspid valve, but cannot be fully excluded due to suboptimal image quality. severe tricuspid regurgitation is seen. there is no pericardial effusion. no clot in laa. slightly dilated coronary sinus. these finding were discussed with the surgical team. postbypass: normal lv function with lvef > 55% and not segmental wall motion abnormalities. normally functioning aortic valve prosthesis. moderate to severe mr vena contracta > 7.0 mm but pa pressures were much less ( mean pa pressrures systemic) and the tr was much less (mild to moderate). no dissection seen after aortic cannula removed. these findings were discussed with surgical team. electronically signed by , md, interpreting physician 15:59 07:50am blood wbc-5.3 rbc-3.56* hgb-8.6* hct-28.1* mcv-79* mch-24.3* mchc-30.7* rdw-21.8* plt ct-252 11:30pm blood wbc-16.8* rbc-3.55* hgb-7.0* hct-25.6* mcv-72* mch-19.7* mchc-27.3* rdw-20.4* plt ct-284 01:46am blood pt-13.3* ptt-31.1 inr(pt)-1.2* 05:03am blood pt-18.9* ptt-27.9 inr(pt)-1.8* 03:48am blood glucose-100 urean-73* creat-3.3* na-133 k-4.3 cl-99 hco3-27 angap-11 11:30pm blood glucose-133* urean-92* creat-2.4* na-140 k-5.5* cl-111* hco3-18* angap-17 03:48am blood alt-14 ast-22 ld(ldh)-421* alkphos-52 totbili-0.5 brief hospital course: mr. is a 59 year old male with a past medical history of chronic pain, hypertension, hld, iv drug abuse who initially presented with bacteremia, endocarditis, and renal failure. his blood cultures grew pansensitive enterococcus in the blood from an outside hospital, which were the likely cause for septic emboli and vegetations. an mri of his head showed multiple emboli. he was intially given vancomycin and zosyn but then was switched to ampicillin and gentamicin. patient with large pneumonia seen on cxr. ct showed 5-cm right upper lobe consolidation consistent with pneumonia secondary to septic embolus. he required mechanical ventilation with pressure support on the ardsnet protocol. his renal status worsened and he was started on cvvh. he developed a rash which was biopsied and was thought to likely be septic vasculitis. he was referred to cardiac surgery after a cardiac catheterization and underwent an aortic valve replacement with an 27-mm pericardial tissue valve ,debridement of left aortic annular abscess with dr. on .cross-clamp time:70minutes.pump time:88 minutes. aortic valve or culture= (+)enterococcus. he was transferred to the cvicu in fair condition on titrated milrinone, levophed, vasopressin and propofol drips. he underwent cvvhd to help remove fluid. by post-operative day three enough fluid was removed that he was able to be extubated. his chest tubes and epicardial wires were removed per protocol. a picc was placed and he was transferred to the surgical step down floor. the infectious disease service recommended that he complete 6 weeks of ampicillin and ceftriaxone from the day of surgery-last day . the remainder of his postoperative course was essentially uneventful. he continued to progress and was cleared by dr. for discharge to rehabilitation on pod#9.all follow up appointments were advised. medications on admission: oxycontin 60 mg po bid dilaudid 8 mg po 6 times a day xanax clonidine folic acid discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). tablet, delayed release (e.c.)(s) 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 4. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain/fever. 5. methadone 10 mg tablet sig: one (1) tablet po bid (2 times a day). 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 8. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day). 9. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 10. ampicillin sodium 2 gram recon soln sig: one (1) recon soln injection q8h (every 8 hours): last dose on . 11. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours): last dose on , . 12. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 13. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. discharge disposition: extended care facility: discharge diagnosis: aortic insufficiency s/p avr enterococcal endocarditis acute renal failure hepatitis c hypertension acute diastolic heart failure nstemi anxiety chronic back pain/leg pain, ? h/o prior mi ivda (heroin - last injection ) pneumonia septic brain emboli discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesics incisions: sternal - healing well, no erythema or drainage 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 females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. , phone: date/time: at 1:00 , md phone: date/time: 10:00 infectious disease: , md phone: date/time: at 10:00 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** laboratory monitoring required: cbc c diff, chem-7, lfts frequency: weekly infectious disease attending visit: all laboratory results should be faxed to infectious disease r.ns. at ( all questions regarding outpatient antibiotics should be directed to the infectious disease r.ns. at ( procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis thoracentesis open and other replacement of aortic valve with tissue graft closed biopsy of skin and subcutaneous tissue diagnoses: pneumonia, organism unspecified hypocalcemia other chronic pain subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery tobacco use disorder acute kidney failure with lesion of tubular necrosis unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension chronic hepatitis c without mention of hepatic coma hyposmolality and/or hyponatremia severe sepsis mitral valve insufficiency and aortic valve insufficiency opioid type dependence, unspecified other and unspecified hyperlipidemia anxiety state, unspecified acute respiratory failure cardiogenic shock septic shock old myocardial infarction iron deficiency anemia, unspecified acute and subacute bacterial endocarditis streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] cerebral embolism with cerebral infarction acute diastolic heart failure streptococcal septicemia backache, unspecified diseases of tricuspid valve other pulmonary embolism and infarction arteritis, unspecified septic arterial embolism pain in limb 

Answer: The patient is high likely exposed to