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: benadryl / morphine / ativan / compazine / dilaudid attending: chief complaint: fever and mental status changes major surgical or invasive procedure: hemodialysis history of present illness: 65 year old man with a past medical history significant for cad, chf, esrd on dialysis, copd, and hypothyroidism who presents with fever and mental status changes. patient is a poor historian and was unable to relay much of story and patient's wife was not available, so history gleaned from ed records. on the day of admission, patient was noted by family to have altered mental status and was unable to answer questions appropriately. on review, patient states that he has had a productive cough over the past several days and that " didn't feel right". after driving down the sidewalk today, patient was brought to the ed by family. in the ed, patient was febrile to 104, hr 80, bp 130/60, rr 20, and oxygen saturation was 96% on room air. white count was 16.1. venous blood gas revealed 7.37/53/66. he received levofloxacin, vancomycin, and flagyl. ct head was negative for intracranial hemorrhage. ct abdomen and pelvis pending. lumbar puncture negative for infection. past medical history: 1. coronary artery disease: myocardial infarction in , mqwmi in . most recent cath, : lcx stenting; previous rca stent patent at that time. 2. nonischemic dilated cardiomyopathy; ef 33%. ef to 25% 3. diabetes greater than 20 years; with triopathy. 4. hypertension. 5. end stage renal disease on hemodialysis, q. monday, wednesday and friday via right arteriovenous fistula. 6. hypothyroidism. 7. chronic obstructive pulmonary disease. 8. hepatitis c. 9. chronic pancreatitis. 10. peptic ulcer disease. 11. right perinephric hematoma; status post embolization. 12. obstructive sleep apnea on cpap. 13. ruptured right groin abscess; recurrent right groin abscess in . 14. peripheral disease. 15. status post r pfa to bk bypasss graft with vein 16. status post 2nd and 3rd toe amps 17. status post left cfa to ak with ptfe 18. status post l inguinal hernia repair 19. status post umbilical hernia repair 20. ischemic left foot 21. a - fib- not well documented. followed by of cardiology who notes he was previously on coumadin. social history: lives in with wife, has older children tobacco: 1 ppd x 60 yrs. quit 3 months ago, no etoh. +hx of narcotic abuse. family history: non contributory physical exam: 98.2, 101/50, 60, 20, 97 gen: middle-aged man in wheelchair in nad heent: mild conjunctival pallor. no icterus. moist mucous membranes neck: supple. no cervical or supraclavicular lymphadenopathy could be appreciated. cv: regular rate and rhythm. normal s1 and s2. no murmurs, rubs or appreciated. lungs: decreased breath sounds in lower lung fields, bilaterally. no wheezes, crackles, or rhonci appreciated. abd: soft. nontender, +bs. left inguinal hernia : warm and well perfused upper extremities. right av fistula in place. lower extremities with hyperpigmentation on anterior aspects of legs. all ten toes amputated. no lower extremity edema, bilaterally. neuro: cao3. answered questions appropriately. flexion and extension in upper extremities and hip flexors pertinent results: blood cultures: beta streptococcus group b clindamycin-----------<=0.25 s erythromycin---------- 2 r penicillin------------<=0.12 s vancomycin------------ <=1 s 04:01am blood wbc-6.0 rbc-3.74* hgb-11.6* hct-35.3* mcv-94 mch-31.1 mchc-32.9 rdw-17.1* plt ct-215 04:01am blood pt-15.1* ptt-37.1* inr(pt)-1.4* 04:01am blood glucose-102 urean-48* creat-7.2*# na-136 k-4.9 cl-96 hco3-26 angap-19 04:01am blood alt-16 ast-24 alkphos-228* totbili-0.3 02:28am blood lipase-17 ggt-236* 01:52pm blood ck-mb-4 ctropnt-0.13* 04:01am blood calcium-8.6 phos-5.7* mg-2.6 02:28am blood ammonia-65* 02:28am blood tsh-5.9* 05:23am blood free t4-1.1 06:45am blood vanco-20.5* tte the left and right atrium are moderately dilated. the estimated right atrial pressure is >20 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated with severe global hypokinesis. no masses or thrombi are seen in the left ventricle. the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. the aortic valve leaflets are moderately thickened. no discrete vegetation is seen (cannot exclude). moderate or greater aortic stenosis is not suggested (minimal aortic stenosis may be present). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the tricuspid valve leaflets fail to fully coapt. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the left ventricular cavity is slightly larger and the estimated pulmonary artery systolic pressure is higher. valvular morphology and the severity of regurgitation are similar. tee: conclusions: the left atrium is dilated. mild spontaneous echo contrast is seen in the body of the left atrium. no mass/thrombus is seen in the left atrium or left atrial appendage. the right atrium is dilated. no atrial septal defect is seen by 2d or color doppler. lv systolic function appears depressed. right ventricular systolic function appears depressed. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no echo evidence of endocarditis. limited ultrasound examination of the right forearm in the region of the av fistula: arteriovenous fistula is identified with appropriate aliasing on color flow images and appropriate doppler flow. no fluid collections were identified abutting or in the region around the fistula. there is no soft tissue edema. impression: appropriate flow within the av fistula with no evidence of fluid collection or abscess. ct abd and pelvis 1. left inguinal hernia containing normal-appearing loops of small bowel. the exam is somewhat limited without the administration of oral contrast. 2. multiple bilateral renal cysts appear unchanged, with single exophytic left renal lower pole lesion, possibly representing a prior rf ablation site. 3. stable cardiomegaly and diffuse atherosclerotic involvement of the abdominal aorta and its branches. 4. cholelithiasis with gallbladder wall thickening, unchanged. 5. anasarca with mild increase in intra-abdominal free fluid. . ct head no intracranial hemorrhage or edema. . brief hospital course: patient is a 65 year old man with coronary artery disease, congestive heart failure with ef 20%, diabetes, and end stage renal disease on hemodialysis who presents with mental status changes and fever, found with streptococcal septicemia due to strep viridans. . . 1) septicemia - streptococcal - id consultation - pv consultation - tee/tte negative for endocarditis - penicillin-g x 2 weeks iv at home 2) peripheral disease - surgical consultation - initial concern for infected grafts, ruled out by ultrasound - le: distal occlusion of bilateral popliteal to tibial bypass grafts - no immediate intervention - continue aspirin/ 3) paroxysmal atrial fibrillation: - continue on amiodarone 200 mg qd - metoprolol 4) systolic chf and coronary artery disease: - continue aspirin, atorvastatin 10mg, clopidogrel 75mg, lisinopril 5mg, and metoprolol 25. . 5) depression: - citalopram 30mg. 6) end stage renal failure: - continue dialysis sessions (m,w,f) via right av fistula - continue cinacalcet 30 mg qd - renal consultation - continue sevelamer 800mg tid - continue zinc supplementation. 7) type 2 diabetes controlled with complications - insulin sliding scale - metoclopramide 10 mg qidachs, and lorazepam 0.5 mg po tid prn for nausea. 8) hypothyroid: - continue levothyroxine 50mcg daily 9) obstructive sleep apnea - cpap mrsa and vre precautions. medications on admission: -amiodarone 200 mg qd -aspirin 81 mg qd -atorvastatin 10 mg qd -cinacalcet 30 mg qd -citalopram 30 mg qd -clopidogrel 75 mg qd -ipratropium bromide 0.02% inh q6hr -lactulose tid prn -levothyroxine 50 mcg qd -lisinopril 5 mg qd -metoclopramide 10 mg qidachs -oxycodone 5 mg po q6hr prn -pantoprazole 40 mg qd -zinc sulfate 220/50 mg qd -metoprolol 25 qd -lorazepam 0.5 mg po tid prn nausea -sevelamer 800 mg tid -papain-urea 830,000-10 unit td qd -zolpidem 5 mg po qhs prn -insulin regular human discharge medications: 1. penicillin g potassium 20,000,000 unit recon soln sig: one (1) million units injection q4h (every 4 hours) for 14 days. :*qs recon soln* refills:*0* 2. picc care picc care per neht protocol 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 8. sevelamer 400 mg tablet sig: two (2) tablet po tid (3 times a day). 9. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 10. zinc sulfate 220 (50) mg capsule sig: one (1) capsule po daily (daily). 11. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 12. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 13. ranitidine hcl 150 mg tablet sig: one (1) tablet po once (once). 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. albuterol 90 mcg/actuation aerosol sig: one (1) puff inhalation every 4-6 hours as needed for shortness of breath or wheezing. 16. ipratropium bromide 17 mcg/actuation aerosol sig: one (1) puff inhalation every six (6) hours. discharge disposition: home with service facility: homecare discharge diagnosis: streptococcal septicemia peripheral disease paroxsysmal atrial fibrillation depression type 2 dm controlled with complications obstructive sleep apnea cad esrd chf - systolic discharge condition: good discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet return to the hospital if you have fevers, chills, redness at your picc site, cough, difficulty breathing you will be on antibiotics 6 times a day for 2 weeks with vna. it is important that you receive all abtibiotics during this course. followup instructions: provider: , dpm phone: date/time: 8:50 provider: . phone: date/time: 1:45 procedure: venous catheterization, not elsewhere classified spinal tap incision of lung diagnostic ultrasound of heart hemodialysis diagnoses: other primary cardiomyopathies end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes sepsis systolic heart failure, unspecified streptococcal septicemia chronic pancreatitis diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy 

Answer: The patient is high likely exposed to