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: past medical history: 1. aortic stenosis. 2. coronary artery disease with circumflex stent in and percutaneous transluminal coronary angioplasty to the left anterior descending coronary artery and ramus in . 3. cryptogenic cirrhosis, child's type a. 4. gout. 5. hemorrhoids. 6. gastritis/duodenitis. 7. hypertension. 8. anemia. 9. pancreatitis question post cholecystectomy. 10. paroxysmal atrial fibrillation. 11. psoriasis. 12. thrombocytopenia. 13. arthritis. 14. recurrent urinary tract infections. 15. gastroesophageal reflux disease. 16. chronic sinusitis. 17. peripheral vascular disease. 18. ureteral stones. 19. asthma. 20. epididymitis. allergies: he had no known allergies. past surgical history: 1. cholecystectomy. 2. right shoulder surgery. 3. tonsillectomy. 4. bilateral cataract surgery. 5. sinus surgery. 6. bilateral knee effusion. social history: lives with his wife. is retired. he has no use of tobacco or alcohol or drugs at this time. medications on admission: atenolol 100 p.o. once daily, quinidine 324 mg p.o. 3 times a day, triamterene/hydrochlorothiazide 37.5 mg p.o. once daily, relafen 750 mg p.o. once daily, nexium 40 mg p.o. once daily, allopurinol 300 mg p.o. once daily, flovent and albuterol inhalers, fluocinonide 0.05 percent and dovonex 0.005 percent medications for psoriasis. cardiac catheterization in of 204 showed 70 percent lesion of the left anterior descending coronary artery and 50 percent lesion of the ramus, 70 percent lesion of the circumflex, 50 percent lesion of the obtuse marginal, 80 percent lesion of the right coronary artery. aortic valve area is 0.8 cm sq with a mean gradient of 49 and a 5.5 cm ascending aorta. echocardiogram in showed ejection fraction of 60 percent, aortic valve area of 0.7 cm sq, a peak gradient of 72 mm and a mean gradient of 50 as well as mild mitral regurgitation. abdominal ct scan obtained at the outside hospital showed a normal liver and spleen without any focal abnormalities. gallbladder was absent with no ductal dilatation. abdominal aorta had mild calcifications. please refer to the follow up report. physical examination: temperature 97.8, heart rate 58, blood pressure 142/88, respiratory rate 18, saturation 98 percent on room air. he is sitting in bed in apparent distress. his pupils equal, round and reactive to light. extraocular movements were intact. he was anicteric, noninjected. his neck was supple. he had no obvious skin lesions, no lymphadenopathy or thyromegaly. no bruits or jugular venous distension. his lungs were clear bilaterally. his heart was regular rate and rhythm with s1 s2 tones and a grade iii/vi blowing systolic murmur. his abdomen was obese, soft, nontender with positive bowel sounds. his extremities were warm with no edema. he had 2 plus bilateral carotid pulses, 1 plus bilateral radial pulses, 1 plus bilateral femoral pulses and no palpable dorsalis pedis and posterior tibial pulses. he was admitted preoperatively for bentall procedure and coronary artery bypass grafting and the idea was to have a hepatology consult first prior to surgery given his history of cirrhosis and thrombocytopenia. he was seen by the hepatology fellow on the day of admission. with attempts to try to correct on his prior notes from his hospitalization where the diagnosis was made, preliminary carotid ultrasound also showed no significant hemodynamic lesions in either the right or left carotid bifurcation. on in-house day two his laboratories were as follows: sodium 144, potassium 4.1, chloride 105, bicarb 28, bun 20, creatinine 1.4 with a blood sugar of 146. alt 18, ast 12, alkaline phosphatase 112, total bilirubin 0.5, albumin 4.1, amylase 113, lipase 124, hdl 47, cholesterol 191, white count 7.6, hematocrit 39.2, platelet count 165,000. pt 12.8 with an inr of 1.0. he was alert and oriented. his exam was unremarkable with a chest x- ray that showed multiple calcified granulomas throughout his lungs, no pneumonia or congestive heart failure but he had a 5 mm nodule in the right lower lobe. repeat echocardiogram showed ejection fraction to be 60 percent with a 5.4 cm ascending aorta normal root diameter, severe aortic stenosis, mild mitral regurgitation. hepatology attending stated he would not perform a liver biopsy at this time prior to his surgery. on he underwent coronary artery bypass grafting times four with a left internal mammary artery to the left anterior descending coronary artery, a vein graft to the obtuse marginal, vein graft to the posterior descending coronary artery and a vein graft to the ramus. 2) aortic valve replacement, 25 mm - pericardial valve. 3) ascending aorta and hemiarch replacement with 30 mm gel-weave graft. he was transferred to the cardiothoracic intensive care unit in stable condition on a dobutamine drip at 2.5 mcg per kilo per minute, propofol drip titrated and a nitroglycerine drip at 1.2 mcg per kilogram per minute. on postoperative day one his postoperative laboratories were as follows: potassium 5.0, white count 12.4, hematocrit 29.3, platelet count 103,000. bun 17, creatinine 1.4. his inr was 1.4. he was on dobutamine drip at 2.5, insulin drip at 1 and propofol drip at 10. the plan was to wean his ventilator, he started on lasix diuresis and to try to wean his dobutamine. his lungs were clear bilaterally. his heart was regular rate and rhythm. his incisions were clean, dry and intact. he remained on the ventilator that morning. he was moving all four extremities at the time. he was evaluated initially by case management and followed daily by the hepatology service. that evening the patient developed atrial fibrillation which was initially tolerated and rate controlled with lopressor. eventually his heart rate increased. again he was started on diltiazem drip. he was also given intravenous lasix with minimal response as well as albuterol nebulizer. the decision was made to attempt cardioversion. he was attempted at 200, 300 and 350 joules without any evidence of sinus rhythm. he was then intubated for worsening hypoxia. he had stable blood pressure throughout. on postoperative day two he was extubated. his dobutamine was decreased. he was given a unit of packed red blood cells and he was now on a nipride drip at 0.25 mcg per kilogram per minute. his creatinine was stable with 1.3 with a potassium of 4.1. his inr dropped slightly to 1.2 with a white count of 12.2 and a hematocrit of 32.0. his heart was regular rate and rhythm. he had decreased breath sounds at both bases. his chest tubes remained in place. he had 1 plus peripheral edema. he was started on low dose beta blocker with hydralazine prn with plan to try to wean his nipride. he also continued on lasix diuresis and the plan was to try and get him out of bed and get started with physical therapy. he was also seen by the electrophysiology service fellow that afternoon. however, he remained on diltiazem drip and electrophysiology service recommendations were followed. again the patient had some labile wound dynamics with another episode of atrial fibrillation. an attempt was made to put a swan-ganz catheter back in. on postoperative day three the patient remained intubated on neo-synephrine drip at 0.7. he had a blood pressure of 110/56 with a heart rate of 105 and atrial fibrillation. he remained intubated at that time. his creatinine was stable at 1.3 and he remained sedated. attempts were made again at dc cardioversion which were unsuccessful by the electrophysiology service fellow. he was loaded with amiodarone as well as his diltiazem drip. he was started on norinone on postoperative day 4 and also on his insulin drip and amiodarone drips. he remained intubated and sedated. his heart was irregular, in atrial fibrillation of 106 with blood pressure of 129/71. laboratories for additional liver function tests were sent off and he was started on heparin drip as well as his diltiazem drip. on postoperative day five he was converted, had 10 beats of sinus rhythm again and went back into atrial fibrillation. he was also started on natrecor drip as well as his heparin. in addition he continued with beta blockade and diamox. he remained sedated with bilateral coarse breath sounds. the plan was to attempt to wean him from the ventilator. on postoperative day he was cardioverted to normal sinus rhythm. diltiazem drip was off. he remained on amiodarone drip and heparin drips as well as insulin, norinone and natrecor at 0.01. he remained intubated and sedated. additional attempts were give with intravenous lasix and natrecor to help with diuresis and to try and wean him from the ventilator. he was also seen by case management and followed daily by electrophysiology service. he was started on tube feeds on postoperative day seven and levofloxacin for his pulmonary status. on postoperative day eight he was started back on beta blockade with lopressor. his diltiazem drip was decreased and later that day his tube feeds were held for residuals. his lasix was increased and he remained on amiodarone, heparin, insulin, norinone, natrecor, neo- synephrine, predanex and propofol. his creatinine rose slightly to 1.6. his hematocrit was stable at 36.1. he was also seen by physical therapy and rehabilitation services. a left subclavian line was also placed on the 28th. on the 28th he had a rash also that was evaluated across his chest and groin area which was evaluated by the dermatology team who determined it was some folliculitis and recommended cleocin gel or erythromycin gel b.i.d please refer to the dermatology attending note on the 28th. lso seen by the clinical nutrition team on the 29th for evaluation of his tube feeds. on postoperative day nine he did culture out citrobacter in his sputum. his antibiotics were changed to zosyn. his tube feeds were held for high residuals. he had some transient hematuria. he had a left subclavian swan in place. his lasix was discontinued. he remained intubated and sedated and his natrecor was weaned. he also received one unit of packed red blood cells for volume. on postoperative day 10 he was extubated successfully. he had another run of atrial fibrillation and was bolused with amiodarone and remained on amiodarone and heparin as well as insulin, norinone, natrecor and zosyn. he had a swallow evaluation also. he was alert and oriented times three with decreased breath sounds in his bases as he remained in atrial fibrillation. on postoperative day 11 the norinone wean began and aggressive pulmonary toilet began. patient seemed to be improving at that point. he remained on zosyn and an amiodarone drip with the plan to switch him over to p.o. amiodarone. he had a bedside swallowing evaluation on the and with considered risk for aspiration their recommendations were followed. dr. the stroke attending to evaluate the patient for an acute stroke at 3 p.m. on as he complained of right arm weakness. the stroke attending though the etiology was probably not stroke but asked that a head ct be ordered to rule out a small infarction for which there was low suspicious and to treat his right forearm cellulitis. on postoperative day 13 patient remained on zosyn and amiodarone and heparin drip with no events overnight with a good blood pressure of 130 to 140 systolic over 50s diastolic, heart rate in the 60s in sinus rhythm. his right hand was noticeably more swollen than the left due to his probable cellulitis. the incisions were otherwise clean, dry and intact. his lungs were clear bilaterally. his abdomen was soft. overall he seemed to be improved and the plan was to try and get him up and get him going with some mild physical therapy and ambulation as well as aggressive pulmonary toilet. his central venous line was discontinued on postoperative day 15 and he remained on zosyn and amiodarone. repeat swallowing evaluation was done on and his rash seemed much improved. he was seen by the orl service to assist with evaluation of his swallow study and functional endoscopic evaluation of his swallowing. there was some concern by ear, nose and throat this his supraglottis was suspicious for thrush and they recommended a short treatment of diflucan intravenous and to follow up on re-evaluation of his larynx after the course of diflucan. his vocal cords were moving normally and there was no evidence of nerve damage or epiglottis or laryngeal edema causing any airway compromise. he was cleared for p.o. status post his video swallow evaluation and was re-evaluated by the nutrition team. his ct scan of his head also showed no intracranial hemorrhage or major vascular or territorial infarcts. patient continued to improve. hepatology saw the patient also on the 5th and recommended that he follow up with them as an outpatient. on postoperative day 17 the zosyn was discontinued. patient was continued on diflucan for his oral thrush. the amiodarone was changed to p.o. and his coumadin was restarted on . on postoperative day 18 he had no events overnight. bun 17, creatinine 0.9, white count 4.8, hematocrit 27, platelet count 191,000, potassium 4.0. he remained on a heparin drip also until his coumadin became therapeutic as well as amiodarone and fluconazole. he continued on a pureed diet and on he was transferred out to the floor with stable vital signs. on the 7th his inr was 1.3 and not quite therapeutic. he continued to receive his nightly dose of coumadin. the patient was also on aspiration precautions. bladder training was restarted with the patient with intermittent clamping of his foley catheter. patient went back into atrial fibrillation on postoperative day 19, , but was in the 80s and tolerating it well from a blood pressure point of view with a blood pressure of 120/66. his creatinine was stable at 1.0. he was fine on focal examination but was a little bit agitated and upset. his lungs were clear bilaterally. his heart was irregularly irregular. he had a sternal click which was noted. he was rebolused with intravenous amiodarone with a plan to contact electrophysiology service for cardioversion if the patient had continued atrial fibrillation with a goal of keeping him rate controlled. his foley was discontinued and he received another dose of coumadin. in attempt to get him therapeutic he was a little bit forgetful but otherwise alert and oriented. incisions appeared to be healing . he was seen again by case management on and had a bedside swallow follow up also performed by orl. they recommended soft solid diet with regular liquids and did some retraining with the patient. the patient continued to work with physical therapy who re-evaluated after he got to the floor. on postoperative 20 the patient converted to sinus rhythm overnight but to void with the foley out. his voice continued to be hoarse but he did not have evidence of thrush in his mouth. still he had a grade i to ii/vi systolic ejection murmur with a positive sternal click. he did not complain of any nausea. he had a small area of dark eschar along his incision. he said subjectively that he felt much better and was now back in sinus rhythm. electrocardiogram with gc was checked which was 0.45 on telemetry. he was ordered for 5 mg of coumadin on the night of postoperative day 20 and started his vitamin c, multivitamins and iron. discharge planning was restarted and rehabilitation screens were done. discharge medications: to be dictated tomorrow. discharge diagnoses: 1. status post aortic valve replacement. 2. coronary artery bypass grafting times four and ascending aorta and hemiarch replacement. 2. status post stent of the circumflex and percutaneous transluminal coronary angioplasty of the left anterior descending coronary artery ramus in . 3. cryptogenic cirrhosis, child's type a, doubt. 4. hemorrhoids. 5. gastritis/duodenitis. 6. hypertension. 7. anemia. 8. post cholecystectomy pancreatitis. 9. paroxysmal atrial fibrillation. 10. psoriasis. 11. thrombocytopenia. 12. arthritis. 13. recurrent urinary tract infections. 14. gastroesophageal reflux disease. 15. chronic sinusitis. 16. peripheral vascular disease. 17. ureteral stones. 18. asthma. 19. epididymitis. again discharge medications to be dictated tomorrow, the 10th, the day of his discharge. , m.d. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation arterial catheterization open and other replacement of aortic valve with tissue graft resection of vessel with replacement, thoracic vessels systemic arterial pressure monitoring pulmonary artery wedge monitoring pulmonary artery wedge monitoring transfusion of packed cells transfusion of other serum transfusion of platelets injection or infusion of nesiritide diagnoses: thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension cirrhosis of liver without mention of alcohol thoracic aneurysm without mention of rupture gout, unspecified atrial fibrillation aortic valve disorders peripheral vascular disease, unspecified cellulitis and abscess of upper arm and forearm congenital insufficiency of aortic valve other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms other specified diseases of hair and hair follicles psoriatic arthropathy abnormal sputum 

Answer: The patient is high likely exposed to