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: patient recorded as having no known allergies to drugs attending: chief complaint: mental status changes major surgical or invasive procedure: cardiac catherization mitral valve replacement with 27-mm st. porcine valve. exploration for bleeding/tamponade.cauterization of bleeding vessel from sternum.debridement of mitral annulus. sternal debridement sternal debridement. bronchscopy dressing change in the operating sternal debridement and omental flap closure and bilateral pectoralis advancement flaps. evacuation of hematoma and ligation of bleeder. cardioversion evacuation of hematoma. picc line placement in ir tracheostomy (#8 portex) history of present illness: 71 year old male admitted to outside hospital for mental status changes. blood and urine culture +. tee revealed 2-3 cm mass on anterior mitral valve leaflet and smaller vegetation on posterior leaflet. also left atrial appendage thrombus. ct head showed acute/subacute r pca infarct without hemorrhage, developed atn from gentamycin. he was started on antibiotics and transferred for surgical work up. past medical history: mitral valve endocarditis stroke atn urosepsis cri hypertension anxiety depression prostate cancer s/p radiation c. diff colitis social history: lives in landing nursing home. never married, no children. denies present or past tobacco, denies etoh, no ivdu. used to work as a security guard and car salesperson. family history: noncontributory; has one sister, poor relationship with her; no children or other siblings, both parents deceased physical exam: admission no acute distress alert oriented moving all extremeties equally perrla no carotid bruits lungs clear to auscultation card rrr abdomen soft, nontender ext no edema palpable distal pulses pertinent results: time taken not noted log-in date/time: 11:44 am tissue site: valve-bicuspid (mitral) mitral valve vegitation. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs. reported by phone to dr 1400 . tissue (final ): enterococcus sp.. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s penicillin------------ 4 s vancomycin------------ <=1 s anaerobic culture (final ): no anaerobes isolated. 06:01am urine color-yellow appear-clear sp -1.020 06:01am urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-0.2 ph-6.5 leuks-tr 06:01am urine rbc-* wbc-0-2 bacteri-occ yeast-rare epi-0 09:16am blood freeca-1.17 07:13pm blood freeca-1.15 09:15am blood o2 sat-98 09:16am blood glucose-88 na-138 k-4.2 07:13pm blood lactate-1.4 k-2.8* 06:48pm blood wbc-21.6* rbc-2.87* hgb-8.8* hct-26.4* mcv-92 mch-30.7 mchc-33.4 rdw-15.9* plt ct-408 03:37am blood wbc-17.9* rbc-3.21* hgb-9.8* hct-28.4* mcv-88 mch-30.4 mchc-34.4 rdw-16.8* plt ct-392 04:48am blood wbc-25.6* rbc-3.45* hgb-10.2* hct-29.9* mcv-87 mch-29.7 mchc-34.3 rdw-16.5* plt ct-196 05:07am blood wbc-6.7 rbc-3.56* hgb-10.0* hct-30.1* mcv-85 mch-28.0 mchc-33.1 rdw-19.4* plt ct-234 02:09am blood neuts-82.8* bands-0 lymphs-8.2* monos-4.3 eos-4.3* baso-0.4 03:59am blood neuts-82.9* lymphs-9.7* monos-5.4 eos-2.0 baso-0 02:09am blood hypochr-1+ anisocy-occasional poiklo-2+ macrocy-occasional microcy-normal polychr-occasional ovalocy-1+ burr-1+ stipple-occasional 06:48pm blood plt ct-408 02:09am blood pt-13.7* ptt-24.7 inr(pt)-1.2* 04:49pm blood pt-12.9 ptt-31.5 inr(pt)-1.1 06:25am blood plt ct-251 01:51pm blood fibrino-126* 01:31am blood ret aut-2.0 04:32am blood glucose-136* urean-58* creat-1.5* na-149* k-4.3 cl-112* hco3-26 angap-15 02:40am blood glucose-34* urean-30* creat-1.2 na-146* k-3.9 cl-111* hco3-26 angap-13 01:45am blood glucose-145* urean-39* creat-1.7* na-138 cl-105 hco3-21* 02:01am blood glucose-129* urean-27* creat-2.3* na-138 k-4.7 cl-103 hco3-19* angap-21* 02:14am blood glucose-108* urean-15 creat-1.6* na-142 k-4.0 cl-114* hco3-22 angap-10 05:07am blood glucose-82 urean-14 creat-1.9* na-137 k-4.0 cl-105 hco3-24 angap-12 06:55pm blood alt-37 ast-35 ld(ldh)-274* alkphos-41 amylase-38 totbili-0.2 09:41pm blood alt-17 ast-27 alkphos-35* amylase-75 totbili-0.5 05:07am blood alt-16 ast-29 ld(ldh)-247 alkphos-32* totbili-0.3 06:55pm blood lipase-33 09:41pm blood lipase-42 12:52pm blood ck-mb-3 ctropnt-1.08* 04:32am blood mg-3.1* 02:13am blood calcium-9.1 phos-1.5* mg-2.0 03:13am blood calcium-8.3* phos-4.7* mg-2.7* 06:25am blood calcium-8.4 phos-4.0 mg-2.3 12:49am blood caltibc-70* ferritn-901* trf-54* 04:49pm blood %hba1c-5.8 -done -done 06:24am blood vanco-14.1 unilat up ext veins us right 5:32 pm unilat up ext veins us right reason: r/o dvt pt has line in and rt arm swelling medical condition: 71 year old man with picc in r and increased swelling. reason for this examination: r/o dvt indication: picc in right arm. increased swelling. rule out dvt. right upper extremity ultrasound: grayscale, spectral, and color doppler analysis of the right internal jugular vein, subclavian vein, axillary vein, brachial veins, cephalic vein, and basilic vein was performed. picc catheter is seen in one of the brachial veins. there is normal flow, compressibility, augmentation, and waveforms in the right jugular vein, axillary vein, and brachial veins. no evidence of thrombus in the basilic or cephalic veins. impression: no evidence of right upper extremity dvt. medical condition: 71 year old man s/p mvr reason for this examination: please place picc indication for exam: this is a 71-year-old man status post mvr, needs iv access. radiologists: the procedure was performed by drs. and , the attending radiologist who was present and supervising throughout the procedure. procedure and findings: since no suitable veins were visible, ultrasound was used to identify the right basilic vein, which was patent and compressible. the right arm of the patient was then prepped and draped in standard sterile fashion. after injection of 5 cc of 1% lidocaine, 21-gauge needle was advanced into the right basilic vein under ultrasonographic guidance. hard copies of the images before and after the venipuncture were obtained. a 0.018 guidewire was then advanced through the needle into the distal part of the svc under fluoroscopic guidance. the needle was then exchanged for a 5 french micropuncture sheath. based on the markers in the guidewire, it was decided that a length of 43 cm would be suitable. the line was then trimmed to this length and advanced over the wire into the distal part of the svc. the wire and the peel-away sheath were then removed. the line was flushed, heplocked and statlocked. a dressing was applied, and final fluoroscopic image of the chest demonstrated tip of the catheter to be located in the distal part of the svc. the patient tolerated the procedure well. impression: successful placement of a 43 cm long double lumen line with the tip in the distal part of the svc. the line is ready for use. technique: ct of the chest, abdomen and pelvis with iv contrast. 130 ml of nonionic contrast were administered. nonionic iv contrast was used due to rapid bolus necessary for this study. ct chest: the patient is status post median sternotomy and near complete removal of the sternum. there is interval placement of an omental flap and closure of the skin. no evidence of new hematoma. a small fluid collection near the left cardiophrenic angle measuring 45 x 22 mm (2:38) appears to be slightly smaller than the previous study from , and also more hypodense. the findings are consistent with a resolving hematoma. the vessels supplying the flap are patent. tiny pericardial effusion unchanged. severe coronary artery calcifications and stents in the coronary arteries. calcifications of the aorta. large bilateral pleural effusions with associated atelectasis, similar to . et tube is located 1-1.5 cm from the carina and could be withdrawn approximately 1 cm. a feeding tube with the tip in the stomach. right ij cordis catheter within the upper right brachiocephalic vein. ct abdomen: small amount of free fluid in the abdomen with simple characteristics. no evidence of hematoma within the abdomen. the liver, spleen, and adrenal glands are within normal limits. the proximal portion of the pancreatic duct is slightly dilated measuring 8 mm, but the distal pancreatic duct is unremarkable. this is of unknown clinical significance. multiple hypodense areas in the kidneys bilaterally, likely representing cysts. some of the hypodense areas are too small to be characterized. no retroperitoneal lymphadenopathy. multiple surgical clips in the regions of the harvesting of the omentum. small periportal nodes do not meet ct criteria for pathology. multiple nodules in the subcutaneous tissues in the anterior abdominal wall, likely from medication injection. ct pelvis: there is malposition with the foley catheter likely with the balloon in the urethra. (2:123.) the rectum, urinary bladder, distal ureters, intrapelvic bowel loops are unremarkable. small amount of simple free fluid in the pelvis. bone windows: there are degenerative changes of the spine, but no suspicious lytic or blastic lesions. healing fracture of the right twelfth rib. impression: 1. no reason to explain dropping hematocrit. 2. resolving left cardiophrenic hematoma. 3. viable flap. 4. large bilateral pleural effusions and associated atelectasis. the pleural effusions have simple characteristics and are unchanged since prior study. 5. hypodense areas in the kidneys likely representing cysts, but some are too small to be characterized. 6. mild dilatation of the central portion of the pancreatic duct measuring up to 8 mm of unclear significance. correlate with history of simple ascites. be sinus bradycardia with left atrial abnormality but consider also ectopic atrial rhythm low qrs voltage prolonged q-tc interval clinical correlation is suggested since previous tracing of , sinus tachycardia absent read by: , w. intervals axes rate pr qrs qt/qtc p qrs t 49 0 94 546/514 0 11 28 mri head impression: 1. right occipital lobe lesion as described above, of uncertain etiology. the intense restricted diffusion may suggest a small involving infarction with surrounding hemorrhage. given the patient's history of sepsis, an abscess is also possible. 2. areas of susceptibility artifact seen scattered throughout both cerebral hemispheres suggestive of amyloid angiopathy. multiple cavernomoas is an alternative diagnosis. 3. subgaleal fluid collection over the left temporal bone- etiology uncertain. 4. mr no stenosis or aneurysm centrally. evaluation for a mycotic aneurysm is unsatisfactory, as there is no clear visualization of the distal intracranial arterial vasculature, which is the usual locale for mycotic aneurysms. tee pre-bypass: the left atrium is normal in size. no thrombus/mass is seen in the body of the left atrium. a patent foramen ovale is present. a left-to-right shunt across the interatrial septum is seen at rest. left ventricular wall thicknesses and cavity size are normal. the remaining left ventricular segments contract normally. the right ventricular cavity is mildly dilated. there is mild global right ventricular free wall hypokinesis. the ascending aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are mildly thickened. mild (1+) aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the motion of the mitral valve prosthetic leaflets appears normal. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is a small pericardial effusion with no evidence of tamponade. brief hospital course: 71 year old male admitted from outside hospital with mitral valve endocarditis, r pca infarcts, and atn for preop evaluation. he underwent preoperative workup including cardiac catherization and infectious disease consult. cardiac catherization mild single vessel coronary artery disease. he received hydration and creatinine was monitored closely. on he was brought to the operating room and underwent mitral valve replacement #27mm porcine valve. please see operative report for further details. he was transferred to the cardiac surgery recovery unit requiring vasopressors and blood products. he returned to the operating room that evening due to bleeding and widened mediastinum. he returned to the csru and postoperative day 1 he was weaned from vasopressors and sedation. he awoke and responded to voice, weaned to pressure support. on postoperative day 2 he was extubated, chest tubes removed, and transferred to the floor. he continued to progress but on postoperative day 4 he was in atrial fibrillation with hypotension and returned to the csru for monitoring and vasopressors. he continued to be in and out of atrial fibrillation and sternal click noted with no drainage. then on postoperative day 8 there was sternal drainage, erythema, and tenderness. he became asystolic, intubated, and returned to the operating room for reexploration . he returned to with open chest on nimbex. plastic surgery was consulted, vac dressing was placed until he was ready for sternal closure. he was weaned off pressors and underwent flap closure . he required returns to the operating room for sternal exploration due to bleeding. he has continued to progress since sedation was weaned and he underwent a tracheostomy due to failure to wean from the ventilator. neuro: required nimbex while chest open, discontinued with closure. weaned off sedation, and has been improving. he is alert, follows commands, and tramadol for pain control pulmonary: he was extubated pod 2 and then reintubated due to cardiac arrest. do to failure to wean he required prolonged ventilation, he had a tracheostomy placed # 8 portex without complications. in addition he has had pigtails placed for pleural effusions which are now removed. he has since been able to tolerate trach collar during the day and rested on the ventilator overnight. he cont cardiac: has been in and out of atrial fibrillation, now in normal sinus rhythm. he has required vasoactive medications during icu stay for blood pressure support with b/p stable off pressors. renal: baseline creatinine was 1.9 with a peak to 2.3, now 1.5. medications adjusted due to renal clearance and has been slowly diuresed. nutrition: has been receiving tube feeds via ng and now dobhoff. he passed his swallow evaluation on for a full diet, but given his poor po intake, he remains with tube feeds. heme: received multiple blood products due to coagulopathies and falling hematocrit. hct was stable at d/c. plastics: on went to operating room due to sternal drainage, he underwent mediastinal exploration with sternal debridement and chest open underwent sternal wound debridement and vac dressing placed . he remained on nimbex while chest open. he returned to the operating room for sternal debridement and omental flap closure and bilateral pectoralis advancement flaps and nimbex discontinued. due to bleeding he returned to the operating room multiple times for reexploration of chest and washout. jp have been removed by plastics and sternum has staples that are to be maintained for four weeks. id: enterococcal mitral valve endocarditis with septic emboli, mitral valve replaced and valve tissue culture + enterococcus received vancomycin, fluconazole,levoquin, ampicillin and ceftriaxone based on increased wbc and culture data. antibiotics dc'd on , as he finished his 6 weeks course.he will follow up with id in 2 weeks. white count at the time of discharge is 18, down from 24, and will need to continue to be followed. medications on admission: ativan 0.5 q6h prn citalopram 20mg daily mvi buspar 10mg twice a day teraozosin 2mg at bedtime vitamin c 500mg twice a day colace senokot 2 tabs twice a day protonix 40mg daily kcl 10 meq twice a day ampicillin 2gm iv q6h heparin 5000units sq three times a day discharge disposition: extended care facility: - discharge diagnosis: mitral valve endocarditis hypertension anxiety depression prostate cancer s/p radiation c. diff colitis discharge condition: fair discharge instructions: shower, 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 no lifting more than 10 pounds for 10 weeks please call with any questions or concerns procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy atrial cardioversion reopening of recent thoracotomy site reopening of recent thoracotomy site temporary tracheostomy control of hemorrhage, not otherwise specified local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] attachment of pedicle or flap graft to other sites open and other replacement of mitral valve with tissue graft other repair of omentum diagnoses: mitral valve disorders other postoperative infection congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia cardiac complications, not elsewhere classified atrial fibrillation disruption of internal operation (surgical) wound hematoma complicating a procedure sepsis hemorrhage complicating a procedure cardiac arrest intestinal infection due to clostridium difficile iatrogenic cerebrovascular infarction or hemorrhage mediastinitis 

Answer: The patient is high likely exposed to