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: codeine attending: chief complaint: aortic stenosis major surgical or invasive procedure: aortic valve replacement (21mm epic supra porcine valve) history of present illness: this 87 year old female presented to emergency room with complaints of chest discomfort in early . her discomfort resolved prior to presentation to the emergency room and apparently all testing was negative. she was to be transferred to but left against advice. she saw dr. on in cardiology follow up but denied any recurrence of symptoms. stress echocardiography on minute had no ekg changes and echo images revealed severe aortic stenosis with a peak gradient of 74 mmhg, a mean gradient of 48 mmhg and a valve area of 0.8-1.0 cm2. there was no evidence of inducible ischemia, though the workload was low and target heart rate not achieved. her lvef was 70%. she denies palpitations, pedal edema, or orthopnea but she reports she has a hospital bed at home and sleeps with her head up due to back pain. she also reports she is unable to walk any distance due to fatigue. past medical history: aortic stenosis aortic regurgitation hypertension hyperlipidemia paroxysmal atrial fibrillation s/p percutaneous fundoplication chronic renal insufficiency chronic anemia left rotator cuff tear compression fractures of the spine s/p multiple breast cyst removal s/p right rotator cuff repair s/p bilateral total knee replacements s/p subtotal gastrectomy in s/p bilateral hammertoe surgery s/p bilateral carpal tunnel repair s/p cholecystectomy s/p total abdominal hysterectomy s/p appendectomy arthritis s/p tonsillectomy s/p umbilical hernia repair social history: occupation: retired lives alone and spends half her year in ma and the other half in , : remote smoking hx(20yr hx), quit 20 yrs ago etoh: drinks alcohol on rare social occasions family history: brother had cabg at age 86 physical exam: admission: t 97.1 pulse: 62 resp: 16 o2 sat: 99% ra b/p right: 149/64 left: height: 5 feet 2 inches weight:150 lbs general: skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur 3/6 sem abdomen: soft non-distended non-tender bowel sounds + no hsm extremities: warm , well-perfused edema varicosities: none neuro: grossly intact pulses: femoral right: 2+ left:2+ dp right: 2+ left:2+ pt : 1+ left:1+ radial right: 2+ left:2+ carotid bruit right: rad murmur left: rad murmur pertinent results: 12:30pm blood wbc-7.6 rbc-4.07* hgb-11.9* hct-36.2 mcv-89 mch-29.3 mchc-33.0 rdw-14.7 plt ct-392# 03:14am blood pt-13.2 ptt-26.4 inr(pt)-1.1 12:30pm blood glucose-124* urean-35* creat-1.3* na-133 k-4.5 cl-93* hco3-31 angap-14 radiology report chest (pa & lat) study date of 9:20 pm , csurg fa6a 9:20 pm chest (pa & lat) clip # reason: eval for pleural effusions s/p medical condition: 87 year old woman s/p avr reason for this examination: eval for pleural effusions s/p avr provisional findings impression: dmfj wed 11:32 am pfi: unchanged bilateral pleural effusions with associated atelectasis. no new consolidation. preliminary report !! pfi !! pfi: unchanged bilateral pleural effusions with associated atelectasis. no new consolidation. dr. dr. pfi entered: wed 11:32 am , f 87 radiology report mr w &w/o contrast study date of 10:10 am , csurg csru 10:10 am mr w &w/o contrast clip # reason: r/o embolus contrast: magnevist amt: 13 medical condition: 87 year old woman s/p avr reason for this examination: r/o embolus contraindications for iv contrast: none. final report indication: status post aortic valve replacement, now with right arm and leg weakness. evaluate for an embolus. comparison: no previous studies. technique: sagittal t1-weighted, t2-weighted, and stir images of the thoracic spine, with axial t2-weighted images. following intravenous gadolinium administration, sagittal t1-weighted images were repeated. findings: there are mild compression deformities of t12 and l1 vertebral bodies, without evidence of bone marrow edema to suggest acuity. there is no significant associated retropulsion. alignment is preserved. high signal in the t12/l1 disc is likely related to degeneration. the spinal cord is normal in morphology and signal intensity, without evidence of an infarction. theconus terminates at t12/l1. there is no spinal canal stenosis. there are at least moderate bilateral pleural effusions, incompletely evaluated. there is questionable caliceal fullness versus parapelvic cysts in the left kidney, incompletely evaluated. impression: 1. unremarkable appearance of the thoracic spinal cord without evidence of an infarction. 2. mild compression deformities of t12 and l1 vertebral bodies, which appear to be chronic. 3. at least moderate bilateral pleural effusions, incompletely evaluated. 4. caliceal fullness versus parapelvic cysts in the left kidney, incompletely evaluated. renal ultrasound is suggested, if clinically indicated. . proved: sun 3:39 pm , f 87 radiology report mr head w/o contrast study date of 10:10 am , csurg csru 10:10 am mr head w/o contrast; mra brain w/o contrast clip # reason: r/o cva medical condition: 87 year old woman s/p avr reason for this examination: r/o cva contraindications for iv contrast: none. wet read: pxdb sun 1:36 pm bilateral microvascular embolic acute infarcts. no focal vascular occlusion, stenosis or aneurysm, however mra is limited by motion degradation. dw , pa for cardiac surgery, at 1:20 pm. ( ) final report indication: status post aortic valve replacement with right arm and leg weakness. comparison: non-contrast head ct dated technique: sagittal t1-weighted and axial t2-weighted, flair, gradient echo, and diffusion-weighted images of the head were obtained. three-dimensional time-of-flight mra of the head was obtained. findings: there are multiple small (3-4 mm) foci of slow diffusion in the and white matter of the frontal, parietal, posterior temporal, and occipital lobes, as well as two foci in the right cerebellar hemisphere. they demonstrate low signal on the adc map and high signal on flair images, consistent with acute infarctions which are less than 10 days old. there are additional small hyperintensities in the supratentorial white matter and pons on t2-weighted and flair images, likely representing mild to moderate chronic small vessel ischemic disease in a patient of this age. the ventricles and sulci are normal in size and configuration for age. head mra: the study is slightly limited by motion artifact. flow is visualized in the intracranial internal carotid and vertebral arteries, and their major branches. apparent diminished signal in the short horizontal segment of the left vertebral artery is likely artifactual. otherwise, no hemodynamically significant stenoses are seen. there is no evidence of ananeurysm. impression: 1. multiple small acute infarctions (less than 10 days old) involving the anterior and posterior circulation territories bilaterally, highly suggestive of embolic etiology, particularly given the history of aortic valve replacement. 2. unremarkable head mra. the study and the report were reviewed by the staff radiologist. dr. dr. . approved: sun 3:37 pm echocardiography report , (complete) done at 11:14:03 am final referring physician information , , status: inpatient dob: age (years): 87 f hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: avr icd-9 codes: 402.90, 786.05, 786.51, 799.02, 440.0, 424.1, 424.0 test information date/time: at 11:14 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 #: 2009aw1-: machine: aw000 echocardiographic measurements results measurements normal range left ventricle - inferolateral thickness: *1.6 cm 0.6 - 1.1 cm left ventricle - ejection fraction: 55% to 60% >= 55% aorta - descending thoracic: 2.3 cm <= 2.5 cm aortic valve - peak gradient: *66 mm hg < 20 mm hg aortic valve - mean gradient: 36 mm hg aortic valve - lvot diam: 2.0 cm aortic valve - valve area: *0.6 cm2 >= 3.0 cm2 findings left atrium: no spontaneous echo contrast is seen in the laa. right atrium/interatrial septum: normal interatrial septum. left ventricle: overall normal lvef (>55%). right ventricle: mild global rv free wall hypokinesis. aorta: normal ascending aorta diameter. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. severely thickened/deformed aortic valve leaflets. critical as (area <0.8cm2). mild to moderate (+) ar. mitral valve: mildly thickened mitral valve leaflets. mild (1+) mr. tricuspid valve: physiologic tr. pulmonic valve/pulmonary artery: physiologic (normal) 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. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. conclusions pre-cpb: no spontaneous echo contrast is seen in the left atrial appendage. overall left ventricular systolic function is normal (lvef>55%). with mild global free wall hypokinesis. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. post-cpb: the patient is av paced, on low dose phenylephrine. there is a prosthetic aortic valve with no leak and no ai. residual mean gradient is 15. good biventricular systolic fxn. trace mr. aorta intact. other parameters as pre-bypass. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 13:01 brief hospital course: this patient was admitted and underwent aortic valve replacement with a 21mm st. epic porcine valve. the cross clamp time was 77 minutes and the total bypass time was 92 minutes. she was given kefzol for her perioperative antibiotics. she tolerated the procedure well and was transferred to the cvivu on neosynephrine and propofol. she received 3 units of prbc on the post op night and was extubated on pod 1. she remained stable, was neurologically intact. on the morning of pod 1 she was noted to have weakness of the right extremeties. she required phenylephrine for low svr and her extremeties moved, albeit with proximal motor weakness and a noted rt facial droop.. a mri of the head revealed evidence of acute rt cerebral diffuse embolic infacts. her neuro exam waxed and waned. pt worked with her for mobility, strength and rehabilitation. she weaned from pressors and her strength returned. diuresis was begun, beta blockade resumed and ace inhibition resumed for bp control as well as after load reduction for her cardiovascular profile. her wounds were healing well, her cts and pacing wires had been removed according to protocol. she was alert and oriented, but overall weak. she was moving all extremeties, the left side being stronger than the right. she had a urinary tract infection with pseudomonas aeruginosa for which cipro was given. arrangements were made for rehabilitation placement for further recovery prior to eventual discharge home. medications on admission: diltiaem sr 240 daily hctz 25 daily lisinopril 20 daily iron 325 daily oxybutynin 5 daily simvastatin 20 daily aspirin 325 daily calcium carbonate/vit d 600/400 1 tab benadryl/tylenol 500/25 qhs discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po once a day for 2 weeks. 4. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 5. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 6. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for secretions. 8. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 9. tramadol 50 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain for 4 weeks. 10. acetaminophen 500 mg tablet sig: two (2) tablet po every six (6) hours as needed for fever or pain. 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days. 12. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po daily (daily) for 2 weeks. 13. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 14. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 15. lasix 20 mg tablet sig: one (1) tablet po once a day for 2 weeks. discharge disposition: extended care facility: discharge diagnosis: diffuse right cerebral perioperative embolic strokes aortic stenosis regurgitation s/p aortic valve replacement hypertension hyperlipidemia paroxysmal atrial fibrillation gastroesophageal reflux disease s/p fundoplication chronic renal insufficiency chronic anemia left rotator cuff tear compression fractures of the spine s/p multiple breast cyst removal s/p right rotator cuff repair s/p bilateral total knee replacements s/p subtotal gastrectomy in s/p bilateral hammertoe surgery s/p bilateral carpal tunnel repair s/p cholecystectomy s/p total abdominal hysterectomy and salpingo-oophorectomy s/p appendectomy arthritis tonsillectomy s/p umbilical hernia repair urinary tract infection 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 no lifting more than 10 pounds for 10 weeks please call with any questions or concerns take all medications as directed followup instructions: dr in 4 weeks ()- dr after discharge from rehab dr in weeks - please call for appointments md procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve with tissue graft diagnoses: anemia in chronic kidney disease esophageal reflux urinary tract infection, site not specified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortic valve disorders chronic kidney disease, unspecified other and unspecified hyperlipidemia cerebral embolism with cerebral infarction pseudomonas infection in conditions classified elsewhere and of unspecified site iatrogenic cerebrovascular infarction or hemorrhage 

Answer: The patient is high likely exposed to