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: patient recorded as having no known allergies to drugs attending: chief complaint: fatigue major surgical or invasive procedure: aortic valve replacement history of present illness: the patient is a 56 year old white male who presented to his primary care with fatigue in . workup revealed blood cultures positive for streptococcus sanguinis. echo revealed mod-severe aortic insufficiency with a vegetation on the left coronary cusp of the aortic valve. he was treated with 4 weeks of antibiotics and sent for cardiac surgery evaluation. past medical history: aortic insufficiency endocarditis (streptococcus sanguinis) mild acute diastolic heart failure s/p cervical fusion at 19 yrs. old s/p mva social history: lives with tobacco: denies etoh: none for months, however previously 2-4 per month works as senior vice president for a software firm family history: mom- hypertension- died in her 70s dad- died in his 70s from complications of a cva physical exam: on admission: vs: afebrile, hr: 85, bp: gen: nad, wg, wn, white male heent: unremarkable lungs: ctab cv: rrr, no murmur or rub abd: +bs, soft, non-tender, non-distended ext: warm, well-perfused, no edema small lesion noted on the palmar surface of right hand neuro: grossly intact pertinent results: 08:10am blood wbc-7.5 rbc-2.95* hgb-8.8* hct-25.0* mcv-85 mch-29.9 mchc-35.3* rdw-15.0 plt ct-232 08:10am blood glucose-88 urean-13 creat-0.9 na-133 k-4.4 cl-97 hco3-27 angap-13 08:10am blood mg-1.9 echocardiography report , (complete) done at 11:58:54 am final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 56 m hgt (in): 71 bp (mm hg): 120/40 wgt (lb): 93 hr (bpm): 65 bsa (m2): 1.52 m2 indication: aortiv valve vegetation icd-9 codes: 424.1, 424.0 test information date/time: at 11:58 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2009aw03-: machine: echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - ejection fraction: 55% >= 55% aorta - ascending: *3.6 cm <= 3.4 cm findings left atrium: no spontaneous echo contrast or thrombus in the la/laa or the ra/raa. right atrium/interatrial septum: normal ra size. pfo is present. left-to-right shunt across the interatrial septum at rest. left ventricle: normal lv wall thickness, cavity size and regional/global systolic function (lvef >55%). right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. focal calcifications in ascending aorta. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: moderate-sized vegetation on aortic valve. no as. moderate to severe (3+) ar. mitral valve: no mvp. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. conclusions pre-bypass: no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage a patent foramen ovale is present. a left-to-right shunt across the interatrial septum is seen at rest. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. there is a moderate-sized vegetation of 0.6 to 1.5 cm on the aortic valve (left and extending onto the non-coronary cusp. there is no aortic valve stenosis. moderate to severe (3+) aortic regurgitation is seen. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results on at 10am before incision. post-bypass: normal biventricular systolic function. intact interatrial septum post repair with no flows across with color doppler. thre is a bioprosthetic valve at the native aortic position with normal function and stability, with a residual peak and mean of 20 and 10mm of hg. thoracic aortic contour is intact. mild mr. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 12:54 ?????? caregroup is. all rights reserved. , m 56 radiology report ct chest w/contrast study date of 7:04 pm , r. csurg fa6a sched ct chest w/contrast; ct abdomen w/contrast; ct pelvis w/contrast clip # reason: septic emboli **w/o contrast field of view: 39 contrast: optiray medical condition: 56 year old man s/p endocarditis,avr reason for this examination: septic emboli **w/o contrast contraindications for iv contrast: none. provisional findings impression: cxwc 10:20 pm focal splenic defect consistent with infarct, although acuity unknown, this could be due to septic embolus. no acute vascular abnormalities identified on this exam. no other end organ damage. post-surgical changes into mediastinum, without fluid collection or pericardial effusion. atelectasis at the lung bases. final report indication: 56-year-old man status post endocarditis and aortic valve replacement. evaluate for septic emboli. comparison: coronary cta. technique: mdct-acquired axial images were obtained through the chest, abdomen and pelvis following administration of intravenous contrast material. multiplanar reformatted images were generated. ct chest with iv contrast: the patient is status post aortic valve replacement, and post-surgical changes are seen throughout the mediastinum, consisting of a small amount of pneumomediastinum, soft tissue stranding and edema, although without focal fluid collection. transcutaneous pacing wires are present. median sternotomy closure wires are intact. the heart remains slightly enlarged, but there is no pericardial effusion. there is no hilar or mediastinal lymphadenopathy. great vessels are within normal limits. lungs demonstrate a small amount of dependent atelectasis, greater at the lung bases. there is a small right pleural effusion. there is no consolidation or pneumothorax. the tracheobronchial tree is patent to subsegmental levels. there are no masses or nodules in the lungs. ct abdomen with iv contrast: within the posterior superior aspect of the spleen, there is a wedge-shaped hypoattenuating defect consistent with infarct. however, its acuity is unknown. other intra-abdominal organs are within normal limits, without evidence of infarct. the liver, gallbladder, pancreas, stomach and duodenum, and adrenal glands are normal. the kidneys enhance and excrete contrast symmetrically without hydronephrosis. the aorta and its major branches are patent, without filling defect. there is no free air or free fluid in the abdomen. ct pelvis with iv contrast: multiple loops of large and small bowel are within normal limits. the urinary bladder and distal ureters are unremarkable. there is no free fluid in the pelvis. while the scrotum is incompletely imaged, there is evidence of a small right hydrocele. there is no mesenteric, retroperitoneal or pelvic lymphadenopathy. osseous structures: mild degenerative changes are present in the thoracic and lumbar spine. median sternotomy wires are in place. there is no fracture, or worrisome lytic or sclerotic bony lesion. soft tissues are unremarkable. impressions: 1. wedge-shaped defect in the posterior aspect of the spleen consistent with infarct, although the acuity is unknown. no gross vascular abnormalities are detected. 2. post-surgical changes in the mediastinum following aortic valve replacement. no large fluid collection or pericardial effusion. 3. no other solid organ infarct or other evidence of embolic phenomena in the chest, abdomen or pelvis. 4. mild dependent atelectasis at the lung bases. 5. right scrotal hydrocele. the study and the report were reviewed by the staff radiologist. dr. dr. approved: sat 10:16 am imaging lab , m 56 radiology report ct head w/o contrast study date of 7:01 pm , r. csurg fa6a sched ct head w/o contrast clip # reason: s/p endocarditis medical condition: 56 year old man s/p endocarditis,avr reason for this examination: septic emboli contraindications for iv contrast: none. provisional findings impression: cxwc 9:56 pm multiple small hypodense foci in the subcortical white matter and deep matter on the left, without associated hemorrhage, edema or mass effect. these could represent septic emboli. final report indication: 56-year-old man with endocarditis and avr. evaluate for septic emboli. comparison: none. technique: contiguous axial images were obtained through the brain. no contrast was administered. findings: there are subcentimeter hypodense foci at the /white matter junction in the superior left frontal lobe (2:28), left parietal lobe (2:21), and left posterior temporal lobe (2:12). there is a small hypodensity in the left lentiform nucleus (2:16). there is no associated hemorrhage or mass effect. there is no evidence of a major vascular territorial infarction. ventricles and sulci are normal in size and configuration. the bones are unremarkable. there is a small mucus retention cyst in the right maxillary sinus. impression: few hypodense foci in the left cerebral hemisphere, mostly at the /white matter junction, which are nonspecific but compatible with septic emboli. they may also be related to chronic small vessel ischemic disease. given the clinical concern for septic emboli, mri is recommended for further evaluation. the study and the report were reviewed by the staff radiologist. dr. dr. . approved: sat 11:48 am imaging lab brief hospital course: mr. was admitted for surgical management of his endocarditis. on admisson, he underwent preoperative testing, as well as an echocardiogram and ct chest with coronary reconstruction to evaluate the coronary anatomy. no hemodynamically significant stenoses were found on ct evaluation. pre-op echo did reveal a secundum type atrial septal defect (asd). the patient was brought to the operating room on where he underwent aortic valve replacement with a 27mm porcine bioprosthetic as well as primary closure of the asd. overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu for further recovery and invasive monitoring. the patient was started on beta blocker and diuresed toward his preoperative weight. chest tubes and pacing wires were discontinued without complication. the patient was found suitable for transfer to telemetry on pod 1. he continued to receive ceftriaxone 2g daily throughout the hospital course. additionally, he received vancomycin for perioperative prophylaxis. pathology of the excised, native valve revealed gram positive cocci with acute and chronic inflammation. however, final culture of the tissue revealed no growth. additionally, ct of the head, torso and pelvis revealed no abscess or collection. recommendation from infectious disease is to complete the 4 week course of ceftriaxone on and send the patient home off of antibiotics. the patient was discharged on pod 4 with appropriate follow up instructions. medications on admission: lisinopril 5' lasix 40' multivitamin' advil prn ceftriaxone 1g iv daily through discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. disp:*60 capsule(s)* refills:*0* 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day) for 1 months. disp:*60 tablet(s)* refills:*0* 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 4. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 5. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 8. furosemide 20 mg tablet sig: two (2) tablet po once a day for 1 weeks. disp:*14 tablet(s)* refills:*0* 9. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day for 1 weeks. disp:*7 tab sust.rel. particle/crystal(s)* refills:*0* discharge disposition: home with service facility: vna, discharge diagnosis: endocarditis, s/p aortic valve replacement pmh: aortic insufficiency acute diastolic heart failure normochromic anemia s/p cervical fusion s/p tonsillectomy and adenoidectomy discharge condition: good discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month, and while taking narcotics no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: dr. in 3 weeks at for wound check and post-op follow-up : dr. ,bundit y in 3 weeks dr. in 2 weeks procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart open and other replacement of aortic valve with tissue graft other and unspecified repair of atrial septal defect diagnoses: anemia, unspecified unspecified pleural effusion congestive heart failure, unspecified aortic valve disorders acute and subacute bacterial endocarditis acute diastolic heart failure benign essential hypertension acquired cardiac septal defect 

Answer: The patient is high likely exposed to