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: tegretol / vicodin attending: chief complaint: shortness of breath major surgical or invasive procedure: aortic valve replacement (21mm st. mechanical), mitral valve replacement( . mechanical), tricuspid valve repair (32mm contour 3d ring), and patent foreman ovale closure) history of present illness: 31 year old female with history of mssa endocarditis in , seizures, depression, hepatitis c p/w fever. fevr started 2 days ago, highest temp has been 103 at home, and also low back pain. in addition she has felt palpitations at night along with shortness of breath. yesterday symptoms got works with nausea and vomiting, vomited x 5 which was nonbloody and yellow. mostly she has been eating soup and water, as she has had difficulty eating solid foods. she feels that her back pain is worsening as well from her chronic low back pain. . initially pt presented to on . blood cultures were drawn, which are pending. she was started on vancomycin and gentamicin given concern for endocarditis. daptomycin was started in place of vancomycin for concern for vre on as blood cx pwere positive for likely enterococcus also per chart pt had an adverse reaction to vancomycin. cxr was concerning for infiltrate as well thought to be septic emboli. tee was done and concern for vegetations on mitral and aortic valves on , also noted ot have 2+ ai and 2+ mr. mri of spine showed no e/o osteomyelitis. abx changed to gentamicin and ampicillin following blood cx returned with enterococcus faecalis. id team was consulted regarding these recommendations. tte done on showed vegetations on av and on mv, c/w tee results on . cxr was done on which showed rll infiltrate, cefepime was started but discontinued after ct chest showed no pna and bilateral pleural effusions concerning for chf thought to be endocarditis. bnp was 508. pt transferred to for evaluation by cardiac surgery for surgical eval of valvular disease. . currently, pt complaining of mild back pain and abdominal pain, c/w pain that she had at osh resolving with percocet. no shortness of breath, nausea, or other complaints. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. referred for surgical evaluation. past medical history: mssa endocarditis in seizures x 3 years depression hepatitis c anemia ivdu social history: tobacco history: denies etoh: denies illicit drugs: endorses heroin use, last use 3 months ago herbal medications: denies lives alone, no sick contacts family history: adopted, family hx unknown physical exam: admission physical exam: 53 kg 61" vs: 98.5 96/44 111 18 95% ra general: wdwn f in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 15 cm. cardiac: rrr, ii/vi systoilic and diastolic murmurs heard throughout, no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. extremities: no c/c/e. no femoral bruits. picc line in place in l arm skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ pertinent results: labs: 03:52am blood wbc-8.2 rbc-3.33* hgb-9.1* hct-28.4* mcv-85 mch-27.3 mchc-32.1 rdw-16.8* plt ct-276# 04:49am blood wbc-9.9# rbc-3.10* hgb-8.6* hct-26.0* mcv-84 mch-27.8 mchc-33.1 rdw-17.0* plt ct-178 03:56am blood wbc-21.4* rbc-3.60* hgb-9.8* hct-29.5* mcv-82 mch-27.3 mchc-33.3 rdw-16.9* plt ct-238 03:52am blood pt-22.4* ptt-37.0* inr(pt)-2.1* 04:49am blood pt-15.0* inr(pt)-1.4* 03:56am blood pt-14.1* ptt-26.8 inr(pt)-1.3* 01:35am blood pt-13.4* ptt-31.2 inr(pt)-1.2* 03:52am blood glucose-96 urean-18 creat-0.6 na-141 k-4.5 cl-105 hco3-29 angap-12 04:49am blood glucose-103* urean-16 creat-0.6 na-139 k-3.4 cl-99 hco3-33* angap-10 03:56am blood glucose-117* urean-12 creat-0.7 na-135 k-4.9 cl-97 hco3-28 angap-15 01:35am blood glucose-91 urean-10 creat-0.6 na-131* k-5.1 cl-99 hco3-26 angap-11 04:28am blood wbc-8.9 rbc-3.79* hgb-9.5* hct-30.6* mcv-81* mch-25.0* mchc-31.0 rdw-14.5 plt ct-398 04:28am blood pt-11.2 ptt-34.0 inr(pt)-1.0 04:28am blood glucose-90 urean-12 creat-0.7 na-140 k-4.7 cl-103 hco3-29 angap-13 06:11am blood alt-8 ast-13 ld(ldh)-191 alkphos-59 totbili-0.3 04:28am blood calcium-9.0 phos-4.8* mg-2.3 04:28am blood %hba1c-5.3 eag-105 03:41pm blood genta-0.8* 05:43am blood hct-29.1* 05:43am blood pt-33.8* inr(pt)-3.3* 05:43am blood urean-13 creat-0.5 na-135 k-4.4 cl-101 abd ultrasound (): findings: there is a large right and left pleural effusion identified. the hepatic architecture is unremarkable. no focal liver abnormality is identified. no biliary dilatation is seen and the common duct measures 0.6 cm. the portal vein is patent with hepatopetal flow. the gallbladder is normal. the pancreas is unremarkable. the spleen is borderline in size measuring 12.1 cm. no hydronephrosis is seen. the right kidney measures 11.8 cm and the left kidney measures 12.6 cm. the aorta is of normal caliber throughout. the visualized portion of the ivc is unremarkable. no ascites is seen in the abdomen. impression: 1. no findings to suggest a hepatic abscess. 2. bilateral pleural effusions. 3. no ascites. tee :conclusions (prelim) pre-bypass: the left atrium is moderately dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. a patent foramen ovale is present. a right-to-left shunt across the interatrial septum is seen at rest. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is moderately depressed (lvef= xx %). the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to xx cm from the incisors. there is a large vegetation on the aortic valve. no aortic valve abscess is seen. severe (4+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is a moderate-sized vegetation on the mitral valve. severe (4+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is no pericardial effusion. post cpb#1 1. improved left and right ventricular systolci function with background inotropic support (epinephrine) 2. bileaflet maechanical valves seen in mitral aortic position. well seated and stable with good lealflet excursion with mild valvular regurgitation jets (washing jets) 3. minimal gradients across the prosthetic valves in aortic and mitral position. 4. progressive worsening of trisuspid regurgitation (central) after separation from cpb with associated systolic reversal of hepatic venous flow. no lealfelt avulsion/restriction visualized, but necessitated re-institution of cpb. post cpb#2 1, annuloplqasty ring seen in the tricuspid position. good leaflet excursion and mnimal gradient, with trace trisuspid regurgitation. 2. no ther change. echo left atrium: mild la enlargement. right atrium/interatrial septum: normal ra size. left ventricle: normal lv wall thickness and cavity size. mild regional lv systolic dysfunction. no resting lvot gradient. right ventricle: mildly dilated rv cavity. borderline normal rv systolic function. abnormal septal motion/position. aortic valve: bileaflet aortic valve prosthesis (avr). avr well seated, normal leaflet/disc motion and transvalvular gradients. mitral valve: bileaflet mitral valve prosthesis (mvr). tricuspid valve: tricuspid valve annuloplasty ring. moderate tr. pericardium: trivial/physiologic pericardial effusion. conclusions the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with septal hypokinesis. the right ventricular cavity is mildly dilated with borderline normal free wall function. there is abnormal septal motion/position. a bileaflet aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. a bileaflet mitral valve prosthesis is present. a tricuspid valve annuloplasty ring is present. moderate tricuspid regurgitation is seen. there is a trivial/physiologic pericardial effusion. impression: no significant pericardial effusion. normal lv cavity size with hypokinesis of the septum. the movement of the septum appears abnormal - probably due to a combination of hypokinesis and post-pericardiotomy. the right ventricle is borderline dilated and borderline hypodynamic. mitral and aortic mechanical prosthesis are functioning normall. there is moderate tricuspid regurgitation compared with the prior study (images reviewed) of , the patient is post-op with avr, mvr and a tricuspid ring. ventricular function has improved, the amount of pericardial fluid has decreased. brief hospital course: she was admitted with enterococcus endocarditis sensitive to ampicillin and gentamicin. power picc was in place. her antibiotics started and first negative blood cultures were on . she had some dyspnea on exertion, and was requiring 2l-3 o2. ruq u/s demonstrates b/l pleural effusions (no abscesses). echo demonstrated severe 4+ aortic valve regurgitation, aortic veg and 3+ mr. surgery with dr. on and was transferred to the cvicu in stable condition on epinephrine and propofol drips. she was extubated the following morning and epinephrine weaned off. she was transferred to the floor on pod #2 to began to work with physical therapy to increase strength and mobility. coumadin was started for mechanical valves and was bridged with heparin until she was anticoagulated for inr goal 3.0-3.5. the infectious disease team was consulted and recommended 6 weeks of ampicillin and gentamicin from for enterococcus. chest tubes and pacing wires removed per protocol. she continued to progress well. gentamicin peak and trough were checked to assure proper dosing. by pod 6 she was ambulating with assistance, her incisions were healing well and she was tolerating a full oral diet. it was felt that she was safe for transfer to state hospital for continued antibiotics. medications on admission: home medications: depakote 250 mg daily zoloft 50 mg daily lexapro 20 mg daily . medications on transfer: depakote 250 mg daily acetaminophen 325 mg prn percocet q4h prn lactobacillis lovenox 40 mg daily ferrous sulfate 325 mg daily clotrimazole 1% cream gentamicin 70 mg/1.75 ml every 8 hrs ampicillin 2 gm q4h discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po once a day. 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 4. divalproex 250 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 5. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 6. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 7. outpatient lab work labs q cbc with diff, lft, bun, cr, gent peak and gent trough, pt/inr labs qwed pt/inr labs qfriday pt/inr bun, cr gent peak and gent trough lab results to clinic phone ( office fax:( 8. warfarin 1 mg tablet sig: goal inr 3-3.5 tablets po once a day: to check inr in am for further dosing - had received between 2-6 mg see coumadin form . 9. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 10. ampicillin sodium 2 gram recon soln sig: two (2) recon soln injection q4h (every 4 hours): 2 gram q4h for 6 weeks thru follow up in clinic prior to completion . 11. gentamicin 40 mg/ml solution sig: fifty (50) mg injection q8h (every 8 hours): 50 mg q8h next trough and peak on for 6 weeks thru follow up in clinic prior to completion . 12. lexapro 20 mg tablet sig: one (1) tablet po once a day. 13. dilaudid 2 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. discharge disposition: extended care facility: discharge diagnosis: mssa endocarditis complicated by enterococcal endocarditis s/p avr/mvr/tv repair/pfo closure aortic valve regurgitation mitral valve regurgitation seizures hepatitis c ivdu depression anemia discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with dilaudid incisions: sternal - healing well, no erythema or drainage edema none 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 approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **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. at 1:00 pm, bldg, cardiologist:dr. at 11:30 am 1- infectious disease with dr - please call to schedule for appointment in 4 weeks labs weekly - cbc with diff, lft - results to clinic labs biweekly bun, cr, gent peak and trough - results to clinic 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** labs: pt/inr for coumadin ?????? indication mechanical aortic and mitral valves goal inr 3-3.5 first draw friday please check , wednesday, and friday for 2 weeks then twice a week if inr and dosing stable rehab physician to manage coumadin until discharge from rehab **please arrange for coumadin/inr f/u prior to discharge from rehab* procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve open and other replacement of mitral valve other and unspecified repair of atrial septal defect open heart valvuloplasty of tricuspid valve without replacement diagnoses: anemia, unspecified congestive heart failure, unspecified unspecified viral hepatitis c without hepatic coma mitral valve insufficiency and aortic valve insufficiency depressive disorder, not elsewhere classified ostium secundum type atrial septal defect acute and subacute bacterial endocarditis epilepsy, unspecified, without mention of intractable epilepsy streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] acute systolic heart failure diseases of tricuspid valve opioid abuse, unspecified 

Answer: The patient is high likely exposed to