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: vicodin / oxycodone attending: chief complaint: nausea, fatigue, and malaise major surgical or invasive procedure: cardiac catheterization aortic valve replacement utilizing a 27mm mosaic porcine valve history of present illness: mr. is a 74 male with history of endocarditis, ulcerative colitis s/p total colectomy with end ileostomy, chronic renal insufficiency who presented with nausea and malaise. for three weeks prior to admission, the patient felt food getting "stuck" about midway down his chest. no chest pain. on the day of admission, his wife noticed that he looked grey, very ill, and could not get out of the bed. she brought him to the ed. since , has lost 60 lbs, 10lbs over the past 2 weeks. his ileostomy output has remained unchanged. notes decreased urine output this past week. now admitted with acuter enal failure. past medical history: 1. endocarditis- patient diagnosed with vegitation on aortic leaflet and blood cx + for strep pnuemo currently getting pen g 2. uc- diagnosed age 21, s/p partial colectemy and repair, with ileostomy. 2. - in pt became dehydrated and hypotensive and had arf 3. osteoarthritis 4. ? gout- told he has this in the past, 2 yrs ago left middle finger swelling -> hand swelling then gone within same day social history: runs childcare company, accountant. uses wheelchair and walker. quit smoking in , former 3ppd x 20yrs. no etoh or illicit drug use. family history: father with cancer. mother with chf. states sister and brothers had congenital heart defects. physical exam: admission vs: 96.4 100/50 87 18 100%ra gen: nad, cheerful, alert heent: temporal wasting, perrl, sclera anicteric, dry mm, o/p with dried blood skin: decreased turgor, some bruises anterior shins, no rash, lesions, osler's nodes neck: no lad, no jvd cor: regular rhythm. soft systolic murmur, non radiating, loudest at llsb. distant heart sounds. pulm: ctab abd: soft. llq ileostomy bag full of dark brown liquid. non-tender. non-distended. ext: trace edema at ankles. +dp and pt pulses b/l. neuro: alert, oriented x 3. cn ii-xii intact. no dysarthria. speech fluent, language intact, recall intact. 5/5 strength upper extremities. 5/5 strength r leg. 3/5 strength l leg, painful rotation and flexion. no asterixis, dysmetria, dysdiadochokinesia. t/l/d: foley in discharge vs t bp 125/61 hr 85 sr rr 20 o2sat 96%-ra gen nad neuro a&ox3, nonfocal exam cor:rrr. sternum stable, incision: c/d/i pulm:ctab abd:soft, llq ileostomy bag full of dark liquid. ext:trace edema skin: his left gluteal has impairment of tissue approx 6 x 3 cm, intergluteal impairment 1 x 1 cm and right gluteal approx 5.5 x 1.5 cm. all open stage ii ulcers are red with irregular wound edges. there is a small amt of serosang drainage from the sites with no odor. the periwound tissue is fragile, intact with dark hyperpigmented tissue especially on the right lateral aspect. there is no s/s of erythema, edema, induration, fluctuance or crepitus. b/l ischium: left -intact purple discolored tissue approx 2.5 x 1 cm-no induration, erythema, edema right-epitheliazing stage ii ulcerated area approx 3.5 x 0.5 cm with no s/s of infection right heel: lateral aspect-2 x 1.5 cm intact darkly pigmented tissue suspicious for deep tissue injury post heel: 1 x 1.5 cm intact darkly pigmented tissue suspicious for deep tissue injury pertinent results: 03:20pm blood wbc-11.4* rbc-4.18* hgb-12.1* hct-33.8* mcv-81* mch-28.9 mchc-35.8* rdw-16.0* plt ct-240 03:20pm blood neuts-92.6* lymphs-3.9* monos-3.1 eos-0.2 baso-0.2 03:20pm blood pt-15.2* ptt-22.2 inr(pt)-1.3* 07:20am blood esr-95* 02:07pm blood glucose-165* urean-224* creat-15.1*# na-134 k-4.5 cl-90* hco3-6* angap-43* 07:05am blood alt-3 ast-7 alkphos-55 totbili-0.4 02:07pm blood ctropnt-0.05* 07:05am blood albumin-3.7 calcium-8.0* phos-12.1*# mg-2.0 iron-81 07:05am blood pth-338* 11:00am blood wbc-6.2 rbc-3.02* hgb-8.8* hct-25.0* mcv-83 mch-29.1 mchc-35.2* rdw-15.3 plt ct-375 11:00am blood plt ct-375 11:00am blood pt-13.9* inr(pt)-1.2* 11:00am blood glucose-122* urean-23* creat-1.5* na-139 k-3.1* cl-104 hco3-28 angap-10 06:50am blood alt-10 ast-14 ld(ldh)-174 alkphos-50 amylase-81 totbili-0.2 02:25pm blood %hba1c-6.2* 9:10 am tissue site: aorta aortic valve . 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. renal us: the right kidney measures 10.5 cm and the left kidney measures 10.3 cm. a 3.7 x 2.5 cm upper pole cyst of the right kidney is identified. there are multiple shadowing echogenic foci compatible with renal stones which are unchanged compared to the previous examination. a foley balloon is present within the bladder, which is decompressed and unable to be assessed. echo: the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. there is a 1.0 cm moderate-sized mass on the aortic valve (best seen in clips 52, 55) which may be consistent with a vegetation; however, a prolapsed leaflet cannot be excluded. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to increased stroke volume due to aortic regurgitation. moderate to severe (3+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. contrast barium esophagram: no evidence for stricture or obstructing lesion in the visualized portion of the esophagus. tertialy contractions. tee: no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. the non-coronary cusp is flail. since the leaflets fail to coapt, there is severe (4+) aortic regurgitation. the aortic regurgitation jet is eccentric, directed toward the anterior mitral leaflet. the non-coronary cusp is perforated with a prior abcess at the tip. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. no masses or vegetations are seen on the tricuspid valve, but cannot be fully excluded due to suboptimal image quality. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. mri l spine: 1. no evidence of discitis or osteomyelitis. 2. multilevel degenerative joint disease, most prominent at the level of l4-s1. at these levels, there is mild-to-moderate neural foraminal narrowing bilaterally at the l4-l5 and mild-to-moderate right neural foraminal narrowing at the l5-s1 levels. there is associated mild spinal canal stenosis at the l4-l5 level. upper extremity us: 1. no evidence of deep vein thrombosis in the right arm. 2. thrombus in the right cephalic vein at the level of the antecubital fossa (the cephalic vein and the superficial vein). cxr medical condition: 74 year old man with s/p avr final report indication: 74-year-old man status post avr with decreased hematocrit and left-sided picc line placement. comparison: . frontal chest radiograph: there has been placement of a left sided picc line with tip at the cavoatrial junction. a right internal jugular sheath and dobbhoff tube are unchanged. there are expected postoperative changes following aortic valve replacement including left retrocardiac atelectasis and small bilateral pleural effusions. the study and the report were reviewed by the staff radiologist. dr. dr. echocardiography report , (complete) done at 8:56:23 am final referring physician information , c. , status: inpatient dob: age (years): 74 m hgt (in): 70 bp (mm hg): 114/56 wgt (lb): 200 hr (bpm): 76 bsa (m2): 2.09 m2 indication: severe aortic regurgitation due to endocarditis icd-9 codes: 440.0, 424.1 test information date/time: at 08:56 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 #: 2008aw2-: machine: echocardiographic measurements results measurements normal range left atrium - four chamber length: 4.7 cm <= 5.2 cm left ventricle - ejection fraction: 60% to 65% >= 55% left ventricle - stroke volume: 152 ml/beat left ventricle - cardiac output: 11.56 l/min left ventricle - cardiac index: 5.53 >= 2.0 l/min/m2 aorta - annulus: 2.3 cm <= 3.0 cm aorta - sinus level: 3.4 cm <= 3.6 cm aorta - sinotubular ridge: 2.7 cm <= 3.0 cm aorta - arch: 2.7 cm <= 3.0 cm aorta - descending thoracic: 2.5 cm <= 2.5 cm aortic valve - peak velocity: 1.6 m/sec <= 2.0 m/sec aortic valve - peak gradient: 11 mm hg < 20 mm hg aortic valve - mean gradient: 6 mm hg aortic valve - lvot vti: 40 aortic valve - lvot diam: 2.2 cm aortic valve - pressure half time: 171 ms findings left atrium: mild la enlargement. right atrium/interatrial septum: normal interatrial septum. no asd by 2d or color doppler. left ventricle: normal lv wall thickness and cavity size. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: simple atheroma in aortic arch. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. severely thickened/deformed aortic valve leaflets. aortic root abscess. no as. severe (4+) ar. mitral valve: moderate (2+) mr. tricuspid valve: normal tricuspid valve leaflets. mild to moderate +] tr. pulmonic valve/pulmonary artery: mild 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. no tee related complications. results were conclusions prebypass 1. the left atrium is mildly dilated. no atrial septal defect or pfo is seen by 2d or color doppler. 2. left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is normal (lvef>55%). 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is no aortic valve stenosis. there is a flail non coronary cusp leaflet .severe (4+) aortic regurgitation is seen. 6. moderate (2+) mitral regurgitation is seen. 7. there is no pericardial effusion. 8. dr. was notified in person of the results at the time of surgery. post bypass 1. patient is on phenylephrine infusion. 2. a well seated, well functioning tissue aortic bioprostetic is seen in the aortic position. no perivalvular leak is seen, no ar is noted. a mean gradient of 22mmhg is noted, with a cardiac output of 9. surgeon is aware. 3. left ventricular function remains good, with ef 65%. 4. mitral regurgitation is less than preop, now mild with vena contracta of 0.2cm i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 11:16 brief hospital course: mr. was admitted to the medical service with acute on chronic renal failure. on admission, he displayed mild congestive heart failure and possible septic polyarthritis. he was started on a course of nitrofurantoin for a urinary tract infection. preoperatively, he had already completed 8 weeks of antibiotics for aortic valve abscess, but continued with persistent 4+ aortic insufficiency. given his multiple medical issues, the renal, infectious disease and orthopaedic services were consulted prior to cardiac surgical intervention. he underwent extensive evaluation which included renal ultrasound, echocardiograms, spinal mri and multiple joint x-rays - please see result section for details. his acute renal insufficiency was attributed to pre-renal etiology. intake/output were monitored daily and he was hydrated accordingly. joint aspiration of the left hip found no evidence of infection. pan cultures were negative and he remained afebrile. once his creatinine improved, cardiac catheterization was performed which found no flow limiting coronary artery disease. preoperative course was also notable for superficial thrombophlebitis of right upper extremity and a stage 2 pressure ulcers of his coccyx, right heel and scrotum. prior to cardiac surgery, he was cleared by the dental service. on , dr. performed an aortic valve replacement. given his inpatient stay was greater than 24 hours, vancomycin was given for perioperative antibiotic coverage. for surgical details, please see seperate dictated operative note. following the operation, he was brought to the cvicu for invasive monitoring. within 24 hours, he awoke neurologically intact and was extubated without incident. given poor nutritional status, a dobhoff feeding tube was placed to ensure adequate caloric intake. double lumen picc line was also placed for poor intravenous access on . amiodarone was initiated for frequent premature atrial contractions. he otherwise remained in a normal sinus rhythm, maintained stable hemodynamics and transferred to the sdu on postoperative day two. vancomycin was continued until operative valve cultures remained negative. on pod4 he was transferred to rehabilitation at center medications on admission: otc nsaids (last dose of pcn ) discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 2. amiodarone 200 mg tablet sig: two (2) tablet po once a day: take 400mg daily for 1 week, then decrease to 200mg daily. disp:*60 tablet(s)* refills:*2* 3. ranitidine hcl 15 mg/ml syrup sig: one (1) po daily (daily). disp:*30 * refills:*2* 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 5. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). disp:*90 injection* refills:*2* 7. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. disp:*50 tablet(s)* refills:*0* 8. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po bid (2 times a day) for 7 days: assess need for further doses at end of course. disp:*14 tab sust.rel. particle/crystal(s)* refills:*0* 9. furosemide 10 mg/ml solution sig: one (1) injection injection (2 times a day) for 7 days: assess need for further doses at end of course. disp:*14 injection* refills:*0* 10. epoetin alfa 4,000 unit/ml solution sig: one (1) injection injection qmowefr (monday -wednesday-friday). disp:*qs injection* refills:*2* discharge disposition: extended care facility: for the aged - macu discharge diagnosis: aortic valve endocarditis(streptococcus pneumoniae) - s/p avr acute on chronic renal failure preoperative urinary tract infection superficial right upper extremity thrombophlebitis stage ii ulcers of coccyx, heel and scrotum ulcerative colitis, s/p colectomy with ileostomy history of atrial fibrillation osteoarthritis history of squamous cell carcinoma splenic and renal infarcts(secondary to endocarditis) discharge condition: stable 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 followup instructions: 1)dr. in weeks, call for appt () 2)dr. , clinic () at at 11:30am 3)dr. , pcp, see in weeks if possible, call for appt procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances open and other replacement of aortic valve with tissue graft arthrocentesis diagnoses: acidosis anemia in chronic kidney disease unspecified pleural effusion urinary tract infection, site not specified acute kidney failure, unspecified atrial fibrillation chronic kidney disease, unspecified pulmonary collapse pressure ulcer, other site osteoarthrosis, unspecified whether generalized or localized, site unspecified pressure ulcer, lower back acute and subacute bacterial endocarditis pressure ulcer, heel phlebitis and thrombophlebitis of superficial veins of upper extremities ileostomy status pressure ulcer, stage ii spinal stenosis, lumbar region, without neurogenic claudication acquired absence of intestine (large) (small) olecranon bursitis 

Answer: The patient is high likely exposed to