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: dyspnea/fatigue major surgical or invasive procedure: 1. aortic valve replacement with a 27-mm mosaic ultra aortic valve bioprosthesis. 2. replacement of ascending aorta and hemi arch using a 30-mm dacron tube graft and deep hypothermic circulatory arrest. the graft is a gelweave gelatin impregnated woven vascular dacron prosthesis made vascutek. : open tracheostomy tube and percutaneous endoscopic gastrotomy tube. : picc left basilic 45 cm double lumen history of present illness: this 79 year old caucasian male with known aortic stenosis reports worsening shortness of breath and a 50 pound weight loss. he is on home oxygwen and baseline is limited in his exercise tolerance. he is short of breath after crossing the room. he is unable to tolerate a flight of stairs. he describes feeling of fullness and no appetite. he was seen at as a potential tavi candidate and did not meet criteria. he is referred here for evaluation and aortic stenosis treatment options. past medical history: chronic atrial fibrillation aortic stenosis dilated ascending aorta chronic restrictive lung disease asbestosis chronic home oxygen dependence chronic obstructive lung disease mild dementia prior stroke/cva remote gastrointestinal bleed s/p left hip replacement s/p right hip replacement s/p laminectomy s/p carotid endartectomy macular degeneration and cataracts social history: lives with wife. supportive daughters. dental exam: (has already obtained dental clearance in per patient and daughters). own teeth in upper and lower jaw with one partial of his 2 upper teeth lives with: wife and has 2 very supportive daughters occupation: retired 25yrs ago - shipyard worker w/asbestos exposure tobacco: never etoh: rare family history: there is a family history of heart disease and strokes. there is no history of hypertension or diabetes. his mother died at age 78 and father died at 91. physical exam: pulse: 75 b/p: 115/71 resp: 18 o2 sat: 97 temp: 98.4 general: frail appearing elderly gentleman in wheelchair. skin: color pale, skin warm and dry. heent: normocephalic, anicteric. oropharynx moist. conjunctiva pale. has own teeth in upper and lower jaw with one partial of his 2 upper teeth neck: supple, trachea midline, bilat bruits vs referred murmur. right cea scar chest: no obvious deformities. ls decreased bases. heart: murmer throughout precordium loudest at left sternal border abdomen: soft,round, nontender, nodistended. (+)bowel sounds. extremities: varicosities bilaterally, 2+ pedal edema neuro: alert and oriented, slow wordfinding, pulses: doppler pedal and popliteal pulses pertinent results: admission labs: 06:45pm pt-12.5 ptt-34.5 inr(pt)-1.2* 06:45pm plt count-242 06:45pm wbc-5.3 rbc-4.74 hgb-10.7* hct-37.1* mcv-78* mch-22.6* mchc-28.9* rdw-15.9* 06:45pm %hba1c-5.7 eag-117 06:45pm calcium-9.3 phosphate-3.4 magnesium-2.0 06:45pm lipase-56 06:45pm alt(sgpt)-11 ast(sgot)-26 ld(ldh)-188 alk phos-85 amylase-60 tot bili-0.5 06:45pm glucose-92 urea n-19 creat-1.1 sodium-142 potassium-4.2 chloride-97 total co2-40* anion gap-9 discharge labs: 03:19am blood wbc-13.7* rbc-3.28* hgb-8.7* hct-28.7* mcv-87 mch-26.6* mchc-30.5* rdw-17.0* plt ct-270 03:19am blood plt ct-270 03:19am blood pt-20.5* ptt-34.5 inr(pt)-1.9* 03:19am blood glucose-118* urean-33* creat-0.6 na-149* k-4.7 cl-106 hco3-41* angap-7* 03:19am blood calcium-8.4 phos-3.1 mg-2.3 echo pre-bypass: moderate to severe spontaneous echo contrast is seen in the body of the left atrium. moderate to severe spontaneous echo contrast is present in the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. there are complex (>4mm) atheroma in the aortic arch. the descending thoracic aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results at time of surgery. post-bypass: the patient is av paced. the patient is on no inotropes. there is a well-seated, well-functioning bioprosthetic valve in the aortic position. there is no aortic regurgitation or paravalvular leak. there is mean gradient of 7 mmhg across the aortic valve at a cardiac output of 3.9 l/min. biventricular function is unchanged. mitral regurgitation is unchanged. the aorta is intact post-decannulation. echocardiogram difficulties with esophageal intubation, requiring assistance from anesthesia with laryngoscope. no esophageal complications noted. propofol 50mg was given prior to procedure. right atrium/interatrial septum: normal interatrial septum. left ventricle: overall normal lvef (>55%). right ventricle: normal rv systolic function. aorta: normal ascending, transverse and descending thoracic aorta with no atherosclerotic plaque. normal ascending aorta tube graft. normal aortic arch diameter. mildly dilated descending aorta. aortic valve: bioprosthetic aortic valve prosthesis (avr). no masses or vegetations on aortic valve. no aortic valve abscess. mitral valve: normal mitral valve leaflets with trivial mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was monitored by a nurse throughout the procedure. the patient was monitored by a nurse in throughout the procedure. the patient was sedated for the tee. medications and dosages are listed above (see test information section). no tee related complications. the patient appears to be in sinus rhythm. conclusions overall left ventricular systolic function is normal (lvef>55%). with normal free wall contractility. the appearance of the ascending aorta is consistent with a normal tube graft. the descending thoracic aorta is mildly dilated. a bioprosthetic aortic valve prosthesis is present and well seated. the paravalvular space appearance is consistent with recent surgery. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. there is no perivalvular leak. the mitral valve appears structurally normal with trivial mitral regurgitation. impression: no evidence of endocarditis seen. well-seated aortic valve bioprosthesis. micro: mrsa screen source: nasal swab. mrsa screen (final ): positive for methicillin resistant staph aureus. bronchoalveolar lavage gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): commensal respiratory flora absent. klebsiella pneumoniae. ~6ooo/ml. klebsiella pneumoniae | ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (preliminary): blood culture , routine (final ): 1 bottle enterococcus faecalis. final sensitivities. _________________________________________________________ enterococcus faecalis | ampicillin------------ <=2 s daptomycin------------ s penicillin g---------- 1 s vancomycin------------ 2 s aerobic bottle gram stain (final ): repeat bc x 8: no growth urine cx : no growth radiology report chest (portable ap) study date of 3:20 pm final report reason for examination: evaluation of the patient after aortic valve replacement and hemiarch replacement. portable ap radiograph of the chest was reviewed in comparison to . the tracheostomy is in place. the left picc line tip cannot be clearly seen, most likely at the level of the left brachiocephalic vein. widespread parenchymal consolidations and bilateral pleural effusions appear unchanged since the prior study. no definitive evidence of pneumothorax is seen. dr. there is no report history available for viewing. brief hospital course: mr. was admitted to the on for surgical management of his aortic valve disease. he was worked-up in the usual preoperative manner. as he had been off coumadin for 4 days, heparin was started. on , mr. was taken to the operating room where he underwent aortic valve replacement using a tissue prosthesis and replacement of his ascending aorta and hemiarch. please see operative note for details. postoperatively he was taken to the intensive care unit for monitoring on `neo-synephrine. he was slowly weaned off of his pressors. gentle diuresis was initiated. on postoperative day two, he was extubated. he developed respiratory failure (pco2 106) and was re intubated. he underwent a bronchoscopy for clearance of secretions. dr. of the pulmonary service continued to follow him as he was following him preoperatively. he developed positive blood and sputum cultures for which the infectious disease service was consulted. he was placed on vancomycin, zosyn and ciprofloxacin for ventilator associated pneumonia. once sensitivities returned, he was placed on ampicillin. repeat sputum was sent which grew gpc pairs and chains. seven day course of sulfameth/trimethoprim suspension was started. he was extubated again on pod #12 but required reintubation for hypercapnia of 89. a tracheostomy #8.0 adjustable flange and g-tube were placed on . he tolerated long periods with a trach collar during the day and vent overnight cpap + ps 20 cmh20, 40% peep 5cmh20. speech and swallow was consulted and followed him for passy muir valve which he tolerated for short periods of time. on pod 27 he developed a fever with elevated wbc, a sputum culture at that time revealed coag positive staph and he was begun on a two week course of vancomycin. nutrition followed him and recommended pulmocare goal rate of 60 ml/hr and multivitamin. strict npo. seroquel 25 mg at bedtime was given for delirium with fairly good results and him sleeping through the night. he was found to be oriented to person only. heme: atrial fibrillation coumadin was restarted with inr goal of 1.8. inr on discharge xxxx picc line was placed left basilic 45 cm double lumen. he requires a pulmonary rehab unit to wean from the ventilator and was transferred to on pod29. medications on admission: alphagan .10% right eye citalopram - (prescribed by other provider) - 10 mg tablet - one tablet(s) by mouth at bedtime digoxin - (prescribed by other provider) - 125 mcg tablet - one tablet(s) by mouth daily furosemide - (prescribed by other provider) - 40 mg tablet - one tablet(s) by mouth daily metoprolol succinate - (prescribed by other provider) - 100 mg tablet extended release 24 hr - one tablet(s) by mouth daily pantoprazole - (prescribed by other provider) - 40 mg tablet, delayed release (e.c.) - one tablet(s) daily potassium chloride - (prescribed by other provider) - 20 meq daily simvastatin - (prescribed by other provider) - 40 mg tablet - one tablet(s) by mouth daily sucralfate - (prescribed by other provider) - 1 gram tablet - one tablet(s) by mouth daily warfarin - (prescribed by other provider) - 2.5 mg tablet - one tablet(s) by mouth daily **** stopped on ******* medications - otc docusate sodium - (prescribed by other provider) - 100 mg capsule - one capsule(s) by mouth three times daily discharge medications: 1. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po daily (daily) as needed for constipation. 2. simvastatin 40 mg tablet : one (1) tablet po daily (daily). 3. brimonidine 0.15 % drops : one (1) ophthalmic (2 times a day). 4. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 5. digoxin 125 mcg tablet : one (1) tablet po daily (daily). 6. citalopram 40 mg tablet : one (1) tablet po once a day. 7. quetiapine 25 mg tablet : one (1) tablet po hs (at bedtime). 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. heparin, porcine (pf) 10 unit/ml syringe : two (2) ml intravenous prn (as needed) as needed for line flush: flush with 10 ml ns followed by heparin. 10. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 11. polyethylene glycol 3350 17 gram/dose powder : one (1) scoop po daily (daily). 12. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q6h (every 6 hours). 13. tramadol 50 mg tablet : one (1) tablet po every 4-6 hours as needed for pain. 14. metoprolol tartrate 25 mg tablet : 0.5 tablet po bid (2 times a day). 15. chlorhexidine gluconate 0.12 % mouthwash : fifteen (15) ml mucous membrane (2 times a day). 16. warfarin 2 mg tablet : to maintain target inr 2-2.5 tablets po once a day: to maintain target inr 2-2.5 1/5 dose 3mg. 17. vancomycin in d5w 1 gram/200 ml piggyback : one (1) gm intravenous q 12h (every 12 hours) for 2 weeks: please check trough with 4th dose. 18. sodium chloride 0.9 % 0.9 % solution : ten (10) ml injection prn (as needed) as needed for line flush: sodium chloride 0.9% flush 10 ml iv prn line flush picc: flush with 10ml normal saline daily and prn. 19. lactulose 10 gram/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed for constipation . 20. bisacodyl 10 mg suppository : one (1) suppository rectal hs (at bedtime) as needed for constipation . discharge disposition: extended care facility: hospital for continuing medical care - ( center) discharge diagnosis: chronic atrial fibrillation aortic stenosis dilated ascending aorta s/p aortic valve replacement,ascending and hemiarch replacement postoperative respiratory failure chronic restrictive lung disease asbestosis chronic home oxygen dependence chronic obstructive lung disease mild dementia s/p tracheostomy s/p gastrostomy tube placement prior stroke/cva remote gastrointestinal bleed s/p left hip replacement s/p right hip replacement s/p laminectomy s/p carotid endartectomy macular degeneration and cataracts discharge condition: alert and oriented to person only lift used to transfer patient to chair from bed and back, cannot stand tolerates trach collar for 14 hours daily, tolerates passymuir valve incisional pain managed with ultram incisions: sternal - healing well, no erythema or drainage discharge instructions: 1) 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. 2) please no lotions, cream, powder, or ointments to incisions. 3) each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart provided. 4) no lifting more than 10 pounds for 10 weeks **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. () on at 1:15 pm in the building please call to schedule appointments with your primary care dr. in weeks and home cardiologist 1-2 weeks after discharge from rehab **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] open and other replacement of aortic valve temporary tracheostomy resection of vessel with replacement, thoracic vessels closed [endoscopic] biopsy of bronchus diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified acute posthemorrhagic anemia thoracic aneurysm without mention of rupture chronic airway obstruction, not elsewhere classified atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure loss of weight bacteremia macular degeneration (senile), unspecified long-term (current) use of anticoagulants gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus ventilator associated pneumonia asbestosis examination of participant in clinical trial kyphosis (acquired) (postural) unspecified cataract hip joint replacement orthostatic hypotension other dependence on machines, supplemental oxygen physical restraints status dementia, unspecified, without behavioral disturbance acute and chronic respiratory failure following trauma and surgery 

Answer: The patient is high likely exposed to