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 / codeine / percocet attending: chief complaint: fever major surgical or invasive procedure: ampicillin desensitization history of present illness: this is a pleasant year old woman who presents with a 2 day history of fever to 100.8, chills, increased urinary frequency, and 1 week history of decreased appetite, generalized fatigue. states that she feels like she did last time she had a urinary tract infection. denies dysuria, flank pain, hesitancy, incontinence. reports occasional shortness of breath, back pain and nausea as well as chronic cough for years. she denies chest pain, diaphoresis. denies change in bowel movements. past medical history: subarachnoid hemorrhage and orbital fracture after fall cad, h/oangina-mi in sick sinus syndrome, pacemaker--scheduled to see dr. next week, h/o svt h/o syncope/falls macular degeneration l eye blindness spinal stenosis carpal tunnel syndrome degenerative joint disease gerd social history: patient lives alone in an facility where her meals are made for her. only close family in the area is a daughter in law. has many friends. smoking, alcohol family history: nc physical exam: pe: vs:bp: 122/52 hr: 77 rr 16 t99.9 97%rm air heent: mucuous membranes dry, -lymphadenopathy, -jvd, l eye blindness, anicteric, conjuctival pallor, no hemmorhages lungs: cta b/l heart: normal rate. rr with 3/6 systolic ejection murmur abdomen: +b/s, soft, non-tender -suprapubic tenderness, mild r suprapubic tenderness extr: +1 pedal edema skin: -jaundice, no rashes neuro: alert and oriented x3. cn11-12 intact no focal deficits, no pass-pointing pertinent results: admit labs: 10:15pm urine color-yellow appear-clear sp -1.014 10:15pm urine blood-sm nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.0 leuk-mod 10:15pm urine rbc-0-2 wbc-* bacteria-few yeast-none epi-0-2 renal epi-0-2 08:50pm glucose-180* urea n-21* creat-0.9 sodium-126* potassium-4.5 chloride-92* total co2-21* anion gap-18 08:50pm wbc-10.2# rbc-3.66* hgb-11.4* hct-33.9* mcv-93 mch-31.1 mchc-33.5 rdw-12.6 08:50pm neuts-84* bands-12* lymphs-3* monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 08:50pm hypochrom-2+ anisocyt-1+ poikilocy-1+ macrocyt-1+ microcyt-1+ polychrom-normal ovalocyt-1+ teardrop-1+ 08:50pm plt smr-low plt count-146 blood culture: enterococcus faecalis 4/4 bottles --2/4 bottles --o/4 bottles 0/2 bottles urine culture: e coli cxr: no evidence of acute process ekg: sinus rhythm atrial premature complex rsr'(v1) - probable normal variant since previous tracing of , paced rhythm not evident : ekg: atrial sensed ventricular paced with pattern of ventricular fusion complexes since previous tracing of , ventricular pacing evident discharge labs: 03:57am blood wbc-4.3 rbc-3.30* hgb-10.5* hct-31.0* mcv-94 mch-31.7 mchc-33.7 rdw-13.1 plt ct-263 03:57am blood glucose-91 urean-11 creat-0.8 na-139 k-3.7 cl-103 hco3-27 angap-13 ruq u/s: : mildly dilated common bile duct, which is probably within normal limits for this patient. ct abdomen with contrast: the trace pleural effusions have resolved. minimal atelectasis persists. pacemaker wires are again noted. intrahepatic biliary ductal dilatation and common duct dilatation are present. the intrahepatic dilatation is generalized and does not localize to any particular hepatic segment. no stone is identified. due to the limitations of this exam associated with patient motion, the assessment of the abdomen and particularly the pancreas is limited. the spleen, adrenals, kidneys and intestines are grossly unremarkable. there is no free air or ascites. atherosclerotic calcifications are noted. no discrete fluid collection or abscess is identified. ct pelvis with contrast: no pelvic mass or free fluid is revealed. the pelvic viscera are unremarkable. no lytic or blastic osseous lesions are identified. impression: 1. limited examination due to patient motion. no abscess identified. 2. intrahepatic biliary ductal dilatation and common duct dilatation of unknown etiology and significance. given the limitations of this examination, the pancreas was better assessed by ultrasound on the prior day. tee:the left atrium is mildly dilated. an atrial septal defect cannot be excluded. left ventricular wall thickness, cavity size, and systolic function are normal (lvef 70%). right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. no definite valvular vegetations identified. however, the absence of a vegetation by 2d echocardiography does not exclude endocarditis if clinically suggested. if clinically indicated, a transesophageal echocardiographic examination is recommended. brief hospital course: this is a lovely year old woman with multiple medical issues including h/o cad, svt, sss with pacer, subarachnoid hemorrhage and orbital fracture s/p fall, syncope admitted for febrile illness, found to have high grade enterococcus bacteremia, endocarditis by duke's criteria and e. coli urinary tract infection. enterococcus bacteremia/endocarditis by duke's: patient was admitted with vague complaints of increased fatigue, fever to 100.8 and some mild irritative urinary symptoms. cbc was notable for wbc to 8.2(baseline in this year-old), bandemia, left shift (84n, 12bands). blood cultures obtained in er on admission became gram +cocci culture positive within 18 hours in bottles and patient was started on vancomycin to cover staph. ultimately identified as enterococcus faecalis sensitive to vancomycin and ampicillin. repeat culture on were also enterococcus positive. vancomycin was kept with sensitivity due to questionable pen allergy. patient was subsequently desensitized and was started on ampicillin 1 d prior to discharge to . initial vancomycin dosing was done in light of decreased creatinine clearance (creatine wnl) but 90 pound, year-old lady. her kidney function seems better than other ladies her age and therefore vancomycin was increased after initial levels were inadequate. this may have contributed to the repeat cultures being positive. she has improved clinically throughout her course, remaining afebrile (tylenol started a few days into admission), without significant complaints and no new complaints. her wbc count has trended down with treatment of the bacteremia, with resolved left shift and bandemia. she is surveillance culture negative since with repeat on . investigation of a source of her bacteremia has been largely unrevealing. the following were considered: endocarditis--by duke's patient has 1 major criteria (blood cultures) and minor-fever, predisposing heart lesion and possible vascular phenomena (petechiae). a tte obtained did not show vegetations (sensitivity 60-70%). a tee would be ideal, but given the patient's age and question of effect on ultimate management tee was postponed. treatment without tee would have been the same (6 weeks amp/4weeksgent) without definitive tee evidence of endocarditis, but possible removal of pacer could potentially be based on tee results. ultimately ms. felt the procedure would be too much for her and would not consent. in addition, she wishes not to have a potential invasive procedure to remove her pacer, therefore further intervention/diagnosis is unwarranted. given that she meets duke's clinically(albeit tenuously) and that treatment for this high grade bacteremia entails a similar regimen she will be treated as above with 6 weeks of amp and 4 weeks of gent. considered pneumonia: history inconsistent, no findings consistent on exam and normal chest x-ray ruled out pneumonia. considered possible occult abcess: no evidence by ct with contrast and no clinical reason to suspect. considered osteomyletis-patient has acute complaints of back or joint pain. exam shows no evidence. esr not elevated. considered biliary process: ruq u/s and ct abdomen both showed mildly dilated ducts, consistent with age and no obvious evidence infection. she has no abdominal complaints. urinary tract: please see urinary tract infection below. ultimately her bacteremia is most consistent with an endocarditis. she is currently much improved and can be treated with continued iv antibiotics. urinary tract infection: urine culture on revealed e. coli uti. patient was treated with 5 day course of levoquin with elimination of irritative symptoms. she has no urinary complaints at this time. sick sinus syndrome, h/o svt: there were no acute issues concerning this history. ms. admission ekg revealed that her pacer was not pacing. subsequent ekg on showed pacing. she was seen by her outpatient cardiologist dr. and he recommended interrogation and follow up as an outpatient. her pacer became relevant in the assessment of her endocarditis, since it would likely need to be removed, especially if tee had shown right-sided endocarditis where the pacer sits. because of ms. of tee and wishes not to have invasive procedure to remove pacer, the only further workup warranted is interrogation as an outpatient. hyponatremia-on admission resolved with adequate hydration. possible gi bleeding: patient had one ambiguous guiac positive stool on this admission after she noticed dark stools s/p ct with contrast and initiation of iron. all other stools are definitively guiac negative and her hematocrit has been stable (although anemia of chronic disease--likely secondary to old age is noted.) anemia: hematocrit has been stable, but patient is anemic with crits around 30-32. workup consistent with anemai of chronic disease-likely secondary to old age. given very low iron levels, started on po iron. history of cad--no acute issues on this admission, considered in light of endocarditis, continued toprol xl 12.5, asa 81 mg history of gerd-no acute issues, continued ranitidine. history of falls-fall precautions. prophylaxis of dvt/pe and gi involved heparin and ranitidine respectively. nutrition-po heart diet, calcium, vitamin d code status: full code-sister is health care proxy- . medications on admission: asprin 81 po mg every day toprol xl 12. mg po every day ranitidine tylenol tums discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po qd (once a day). 2. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. multivitamin capsule sig: one (1) cap po qd (once a day). 6. zolpidem tartrate 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 7. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 8. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po bid (2 times a day). 9. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po qd (once a day). 10. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po qd (once a day). 11. ampicillin sodium 2 g recon soln sig: one (1) recon soln injection q4h (every 4 hours). 12. gentamicin sulfate 40 mg/ml solution sig: one (1) 30 mg injection q12h (every 12 hours). discharge disposition: extended care facility: for the aged - acute rehab discharge diagnosis: enterococcal bacteremia, endocarditis, urinary tract infection discharge condition: stable with high grade infection now being adequately treated. discharge instructions: patient to be discharged to facility. she will be under their care. she will need 6 more weeks of treatment with ampicillin 2g iv every four hours and 4 more weeks of treatment with gentamicin 30 mg iv every 12 hours. she will need her bun and creatinine checked twice per week to monitor her kidney function for toxicity secondary to gentamicin. in addition, she needs outpatient follow-up with her cardiologist, dr. for interrogation of her pacemaker, which is not currently pacing based on admit ekg. continue all other meds.patient to follow up wiht infectious diseases at . followup instructions: patient to be discharged to facility. she will be under their care. she will need 6 more weeks of treatment with ampicillin 2g iv every four hours and 4 more weeks of treatment with gentamicin 30 mg iv every 12 hours. she will need her bun and creatinine checked twice per week to monitor her kidney function for toxicity secondary to gentamicin. in addition, she needs outpatient follow-up with her cardiologist, dr. for interrogation of her pacemaker, which is not currently pacing based on admit ekg. continue all other meds. to follow up with infectious diseases at after cessation of antibioitic treatment. md procedure: venous catheterization, not elsewhere classified diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension bacteremia cardiac pacemaker in situ acute and subacute bacterial endocarditis streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] 

Answer: The patient is high likely exposed to