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: penicillins attending: chief complaint: diastolic murmur, vegetation on aortic valve major surgical or invasive procedure: aortic valve replacement with a st. tissue valve, size 23 mm. reference #. serial #. dental extractions (teeth number 23, 24, 25, 26). history of present illness: 60m with a past medical history of hypertension, hyperlipidemia, tobacco use, who presents with three weeks of dyspnea on exertion. found to have a new diastolic murmur, an echo demonstrated a vegetation on his aortic valve and 4+ aortic regurgitation. he was referred to cardiac surgery. past medical history: aortic regurgitation -copd (chronic airway obstruction) -fatty liver disease -overweight -hemangioma, hepatic -erectile dysfunction -benign prostatic hypertrophy, with obstruction -hypertension -hyperlipidemia -gerd -hx of tobacco use social history: he quit smoking three years ago and reports a forty pack year history. drinks alcohol socially. he lives alone and works as a manager of airport. family history: his brother died from complication of an aortic valve replacement secondary to endocarditis. his uncle had an abdominal aortic aneurysm. physical exam: admission: vs: 98 138/65 70 18 97% ra general: nad, axox3. heent: jvp unappreciable. sclera anicteric. perrl, eomi. mmm cardiac: rrr, normal s1, s2. diasolic rumbling murmur consistent with ai. no s3 or s4. lungs: poor aeration throughout, no basilar crackles abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. extremities: no le edema 2+ pulses skin: no osler nodes, splinter hemmhorages, lesions, rash discharge: vs: 98.2 86 126/80 18 94% ra wt 88.4kg gen: nad neuro: a&o x3, mae. nonfocal exam pulm: cta-bilat cv: rrr, no murmur. sternum stable, incision-cdi abdm: soft, nt/nd/+bs ext: warm, well perfused. 1+ bilat pedal edema pertinent results: echocardiography report echocardiographic measurements results measurements normal range left ventricle - inferolateral thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.2 cm <= 5.6 cm left ventricle - ejection fraction: 50% to 55% >= 55% aorta - annulus: 2.3 cm <= 3.0 cm aorta - sinus level: *4.3 cm <= 3.6 cm aorta - sinotubular ridge: 2.9 cm <= 3.0 cm aorta - ascending: *3.7 cm <= 3.4 cm aortic valve - mean gradient: 7 mm hg aortic valve - valve area: *2.5 cm2 >= 3.0 cm2 findings left atrium: normal la size. right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. normal interatrial septum. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv wall thickness. normal lv cavity size. low normal lvef. right ventricle: normal rv chamber size and free wall motion. aorta: mildly dilated ascending aorta. normal descending aorta diameter. complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: abnormal aortic valve. severe (4+) ar. eccentric ar jet. mitral valve: normal mitral valve leaflets with trivial 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: written informed consent was obtained from the patient. the patient was under general anesthesia throughout the procedure. the patient appears to be in sinus rhythm. results conclusions prebypass: the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve is abnormal with a coaptation defect between the right and left cusps seen best in long axis view, there is question of leaftlet perforation. severe (4+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. dr. was notified in person of the results on at 0930. postbypass: there is a well seated bioprosthetic valve in the aortic position with no perivalvular leak. there is no evidence of aortic dissection. estimated left ventricular function is unchanged from prebypass. radiology report chest (portable ap) study date of 10:21 am final report: in comparison with the study of earlier in this date, the right chest tube has been removed. no evidence of pneumothorax. bibasilar opacification persists and intact midline sternal wires are present. admission labs: 04:25pm pt-11.8 ptt-31.6 inr(pt)-1.1 04:25pm plt count-158 04:25pm wbc-8.3 rbc-4.80 hgb-15.3 hct-43.7 mcv-91 mch-31.9 mchc-35.0 rdw-12.9 04:25pm ctropnt-<0.01 04:25pm glucose-100 urea n-16 creat-0.8 sodium-140 potassium-3.9 chloride-103 total co2-26 anion gap-15 04:30pm lactate-1.8 11:05pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg discharge labs: 06:15am blood wbc-9.0 rbc-3.78* hgb-12.1* hct-35.5* mcv-94 mch-31.9 mchc-33.9 rdw-13.1 plt ct-159# 06:15am blood plt ct-159# 06:15am blood glucose-122* urean-12 creat-0.9 na-138 k-3.9 cl-98 hco3-31 angap-13 06:05am blood calcium-8.9 phos-3.1 mg-2.0 10:05 am tissue aortic valve leaflet. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. tissue (final ): no growth. anaerobic culture (preliminary): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (preliminary): fungal culture (preliminary): no fungus isolated. potassium hydroxide preparation (final ): no fungal elements seen. brief hospital course: mr. was admitted and placed on iv vancomycin and gentamicin for aortic valve endocarditis per the direction of the infectious disease service. he was evaluated by cardiac surgery for an aortic valve replacement and underwent a pre-operative work-up including teeth extractions. the patient was brought to the operating room on where the patient underwent tissue aortic valve replacement (#23mm tissue). the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. the patient remained stable in the immediate post-op period. anesthesia was reversed, the patient was neurologically intact and he weaned from the ventilator and extubated. over the next several hours he weaned from vasopressor support. on pod1 beta blockers were initiated and he was started on diuretics and gently diuresed toward his preoperative weight. on pod1 the patient was transferred to the telemetry floor for further recovery. chest tubes and pacing wires were discontinued per cardiac surgery protocol without complication. the patient was evaluated by the physical therapy service for assistance with strength and mobility. per infectious disease service it was recommended that he be discharged to home on a 2 week course of ceftriaxone pending the results of his culture data. he declined the recommendation from the infectious diseae service for ivab however, did agree to a 7 day course of po levoflox. the infectious disease service will contact mr. he final results of his culture data. at teh time of discharge there was no growth from the cultures taken and he was afebrile with wbc 9. the remainder of his hospital course was uneventful, by the time of discharge on pod 4 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. the patient was discharged home with vna in good condition with appropriate follow up instructions. medications on admission: preadmission medications listed are correct and complete. information was obtained from patientwebomr. 1. lisinopril 20 mg po daily 2. hydrochlorothiazide 12.5 mg po daily 3. simvastatin 20 mg po daily 4. gemfibrozil 600 mg po bid 5. amlodipine 5 mg po daily 6. omeprazole 20 mg po daily 7. aspirin 81 mg po daily 8. albuterol inhaler 1 puff ih q6h:prn shortness of breath 9. fluticasone propionate 110mcg 2 puff ih 10. vitamin e 400 unit po daily 11. multivitamins 1 tab po daily 12. fish oil (omega 3) 1000 mg po daily discharge medications: 1. aspirin ec 81 mg po daily 2. gemfibrozil 600 mg po bid 3. simvastatin 20 mg po daily 4. acetaminophen 325-650 mg po q4h:prn pain/temp 5. docusate sodium 100 mg po bid 6. furosemide 20 mg po daily duration: 1 weeks rx *furosemide 20 mg 1 tablet(s) by mouth once a day disp #*7 tablet refills:*0 rx *furosemide 20 mg 1 tablet(s) by mouth once a day disp #*7 tablet refills:*0 7. metoprolol tartrate 25 mg po bid hold for hr < 55 or sbp < 90 and call medical provider. *metoprolol tartrate 25 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*1 8. oxycodone-acetaminophen (5mg-325mg) tab po q4h:prn pain rx *oxycodone-acetaminophen 5 mg-325 mg tablet(s) by mouth every four (4) hours disp #*75 tablet refills:*0 9. potassium chloride 20 meq po daily duration: 1 weeks hold for k+ > 4.5 rx *potassium chloride 20 meq 20 meq by mouth once a day disp #*7 tablet refills:*0 10. fish oil (omega 3) 1000 mg po daily 11. fluticasone propionate 110mcg 2 puff ih 12. lisinopril 5 mg po daily rx *lisinopril 5 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*1 13. multivitamins 1 tab po daily 14. omeprazole 20 mg po daily 15. vitamin e 400 unit po daily 16. albuterol inhaler 2 puff ih q4h:prn wheezing 17. levofloxacin 500 mg po q24h duration: 7 days rx *levofloxacin 500 mg 1 tablet(s) by mouth once a day disp #*7 tablet refills:*0 discharge disposition: home with service facility: vna discharge diagnosis: aortic regurgitation,copd (chronic airway obstruction),fatty liver disease,overweight hemangiom hepatic,erectile dysfunction,benign prostatic hypertrophy, with obstruction,hypertension, hyperlipidemia,gerd, hx of tobacco use past surgical history:right shoulder surgery, hernia repair and tonsillectomy discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with percocet incisions: sternal - healing well, no erythema or drainage edema- 1+ bilat 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 one month or while taking narcotics. driving will be discussed at follow up appointment with surgeon. 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. , md phone: date/time: 1:45, in the medical office building, , wound check: phone: date/time: 10:15 in the medical office building, , infectious disease:the infectious disease doctors regarding your final data cardiologist: , m.d. phone: date/time: 1:00 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** procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve with tissue graft extraction of other tooth diagnoses: esophageal reflux unspecified essential hypertension chronic airway obstruction, not elsewhere classified aortic valve disorders personal history of tobacco use other and unspecified hyperlipidemia acute and subacute bacterial endocarditis undiagnosed cardiac murmurs unspecified gingival and periodontal disease 

Answer: The patient is high likely exposed to