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: past medical history: 1. rheumatic fever. 2. noninsulin dependent diabetes mellitus. 3. asthma. 4. hypertension. past surgical history: history is significant for a hysterectomy. medications on transfer: 1. cardizem. 2. nitropaste. 3. insulin. 4. paxil. allergies: the patient denied known allergies. family history: noncontributory. social history: the patient smokes one pack per day. she lives with her daughter, , whose phone # is . the patient is spanish-speaking only. physical examination: examination at the time of admission revealed the following: vital signs: heart rate 70 and regular, blood pressure 120/70, respiratory rate 20. general: hispanic woman communicating with the translator in no acute distress. heent: unremarkable. neck: supple with bilateral carotid bruits. there was no lymphadenopathy. lungs: lungs were clear. heart: heart sounds with 3/6 systolic ejection murmur. abdomen: soft, nontender, nondistended, no masses. there was a well healed vertical midline incision. extremities: no clubbing, cyanosis or edema. strong pulses, femoral, dorsalis pedis and posterior tibial, no varicose veins. neurological: the patient was alert and conversant, moves all extremities. cranial nerves ii to xii grossly intact. laboratory data: laboratory data revealed the following: sodium 143, potassium 3.7, bun 6, creatinine 0.8, white count 5, hematocrit 37, platelet count 220,000. cardiac catheterization from center demonstrated no coronary artery disease. echocardiogram at center showed the mean valve gradient to be 65 -mm of mercury and a peak gradient of 115 mmhg with a normal ejection fraction of 70%. the patient was transferred to for evaluation of aortic valve replacement. upon arrival at the patient underwent preoperative workup, which included a dental consultation. the dental consultation recommended extraction of four teeth and on the the patient had those four teeth extracted. preoperative workup also included a cardiology consultation. the department of cardiology reviewed the cardiac catheterization and echocardiogram data provided from center. following this review, the patient underwent an additional cardiac catheterization. repeat cardiac catheterization showed severe aortic stenosis with a bicuspid aortic valve, hypertrophic cardiomyopathy, peak valve gradient of 115, mean of 68, and aortic valve area of 0.8-cm squared. following the repeat cardiac catheterization, the discussion between ct surgery and cardiology centered around the degree of aortic stenosis versus a left ventricular outflow tract obstruction. decision was then reached that the patient indeed need to undergo aortic valve replacement. on , .she was brought to the operating room at which time she underwent an aortic valve replacement. please see or report for full details. in summary, the patient underwent an aortic root and valve replacement with a #19 carbomedics valve. this was a prolonged procedure with a bypass times 2.5 hours and cross clamp time of 2 hours. postoperatively, the tee showed normal biventricular function, prosthetic valve in the aortic position was well seated with normal leaflet function, mild aortic insufficiency, aortic valve area of 1.5 -cm squared with a gradient of 20-mm of mercury with severe tricuspid regurgitation and trace mitral regurgitation with no dynamic outflow tract obstruction. for the operation, the patient was transferred to the cardiothoracic intensive care unit, where in the initial postoperative care, she remained hemodynamically stable on levophed, milrinone, and nitroglycerin. she did, however, have significant amount of drainage from her mediastinal and pleural chest tubes. over the course of the first twenty-four hours she was treated with five units of packed red blood cells, six units of ffp cryoprecipitate and several liters of crystalloid. given her high-volume requirements, the patient was kept sedated and intubated throughout the postoperative day #1. on postoperative day #2, the patient's sedation was discontinued. she was successfully weaned from the ventilator and ultimately extubated. the cardioactive drugs were weaned to off. she was, however, at that point, started on a labetalol drip for blood pressure control. following extubation, the patient failed the swallow study. on postoperative day #3, the patient spiked a temperature to 102.8. she was pancultured at that time. she also had periods of tachypnea requiring re-intubation. chest x-ray,at that time, revealed a presumed aspiration pneumonia. the patient remained intubated on pressor-support ventilation over the next several days. on postoperative #6, the patient self extubated. she did well for the first twenty-four hours, but on postoperative day #7, she required re-intubation. the patient again did well with pressor support wean. over the next several days, attempt was made at extubation again on postoperative day #10. the patient, initially did well. however, after several hours of being extubated, she again became tachypneic with worsening blood gases. attempt was made to use bipap to avoid reintubation, however, this was unsuccessful and the patient was reintubated five hours after extubation. the patient required minimal ventilatory support following reintubation. on postoperative day #14, she underwent a diaphragmatic ultrasound to assess phrenic nerve injury. the ultrasound was positive for phrenic nerve injury of questionable etiology. at that time pulmonary medicine was consulted. their recommendation was to maintain the patient on ventilatory support to give her diaphragms a chance to recover. given this scenario, the patient was then scheduled to undergo a percutaneous tracheostomy and peg placement. at this point, the patient was also noted to have a small amount of drainage from the lower pole of her sternum. at that time the distal portion of the incision was opened. tissue was healthy, viable, and beefy red. dressings were normal saline wet-to-dry t.i.d. cultures at that time revealed no growth. the patient remained stable over the next several days. on , the patient underwent a percutaneous tracheostomy with a #8 tex and a percutaneous peg placement. two days following peg placement, the patient was noted to have increasing abdominal tenderness around the peg site. she was also noted to have a slight elevation of her white blood cell to 10.9 and the temperature to 101.0. she was pancultured at that time. general surgery was consulted regarding the peg-site placement. the patient was also started on an antibiotic regimen of vancomycin, levofloxacin, and flagyl. the following day, , the patient continued to complain of abdominal pain. at that time she underwent an abdominal cat scan. cat scan showed subcutaneous extravasation of contrast; etiology unclear. plans were made to remove the tube at that time. she was returned to the operating room with general surgery, where at that time the patient underwent exploratory laparotomy, removal of her g-tube, closure of her gastrostomy site, insertion of jejunostomy tube and insertion of penrose drain to drain an abdominal wall abscess. since that time, patient's white count has returned to . fever has resolved and the abdominal pain has diminished. the patient's pulmonary status over the past two weeks has improved. at this point, she is maintained on trach collar during the day, with short periods of pressor-support ventilation during the overnight hours. the patient's transfer will be postoperative day #43. the patient remained hemodynamically stable. respiratory status continued to show gradual improvement. infectious disease status: the patient remains on vancomycin, levaquin, and flagyl for a one-month course. she is tolerating tube feeds at goal rate. she is ambulating with minimal assistance around the intensive care unit. at this time, it has been decided that she is stable and ready for transfer to for continuing postoperative care and cardiac respiratory rehabilitation. at the time of transfer, the patient's physical examination was as follows: temperature 99, heart rate 110 to 115 sinus tachycardia, blood pressure 117/60, respiratory rate 24, oxygen saturation 99% on 40% trach collar. in the overnight hours, the patient has periods where she is maintained on cpap 40% with peep and pressure support. tidal volumes of that ventilatory support ranged between 300 and 400 cc. laboratory data: laboratory data revealed the following: white count 13.3, hematocrit 32, platelet count 165, sodium 136, potassium 3.8, chloride 97, co2 30, bun 11, creatinine 0.6, glucose 132, inr 2.7. physical examination: the patient was alert and oriented. heent: pupils equal, round, and reactive to light. neck was supple. trach in place. breath sounds revealed fine rhonchi. heart: heart sounds tachycardiac, s1 and s2, no murmurs. abdomen: abdomen was soft, with staples. the wound was clean and dry. left peg site is granulating. extremities: warm with no edema and good pedal pulses. sternum is stable with a small distal incision. there was some fibrinous material at the base of the incision, otherwise, beefy red. medications on discharge: 1. colace 100 mg b.i.d. 2. zinc sulfate 220 mg q.d. 3. vitamin c 500 mg b.i.d. 4. lopressor 75 mg b.i.d. 5. flagyl 500 mg t.i.d. 6. vancomycin 1 gram q.12h. 7. levaquin 500 mg q.d. 8. prevacid 30 mg q.d. 9. nystatin powder at the peg site t.i.d.. 10. paxil 50 mg q.d. 11. nph insulin 25 units q.a.m. and 20 units q.p.m.; regular insulin sliding scale q.a.c. and q.h.s. 12. coumadin 2.5 to 5 mg q.d. for a goal inr of 3.0. p.r.n. medications: 1. tylenol 650 q.6h.p.r.n. 2. motrin 600 q.6h.p.r.n. 3. ativan 0.5 mg b.i.d.p.r.n. abdominal dressing is normal saline wet-to-dry t.i.d.. chest dressing is santyl ointment covered with dry sterile dressing b.i.d. tube feeds are promote with fiber at 50 cc per hour. discharge diagnosis: 1. aortic stenosis status post aortic valve replacement with a #19 carbomedics mechanical valve. 2. rheumatic fever. 3. noninsulin dependent diabetes mellitus. 4. asthma. 5. hypertension. 6. idiopathic hypertrophic subaortic stenosis. 7. status post percutaneous tracheostomy and peg placement. 8. status post exploratory laparotomy with closure of peg site and jejunostomy tube placement. 9. status post hysterectomy. th was discharged to . she is to have followup with dr. in one month. she is to followup with her cardiologist on discharge from and followup with her primary care physician upon discharge from . , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization insertion of endotracheal tube percutaneous [endoscopic] gastrostomy [peg] open and other replacement of aortic valve temporary tracheostomy aortography resection of vessel with replacement, aorta, abdominal diagnoses: other primary cardiomyopathies other postoperative infection thoracic aneurysm without mention of rupture atrial fibrillation aortic valve disorders pneumonitis due to inhalation of food or vomitus 

Answer: The patient is high likely exposed to