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: no known allergies / adverse drug reactions attending: chief complaint: palpitations, cough major surgical or invasive procedure: mvr ( 33mm st. porcine)/ maze/ligation laa history of present illness: this 54 year old white male is status post instrumentation of a urethral stricture in when he underwent cystoscopy and urethral dilatation for hematuria. since that time he has had some increased lethargy and generalized weakness, weight loss, night sweats. he is also complaining of more recent onset of a cough productive of clear, brown sputum and chills for the last 1 week. these symptoms have also been associated with chest congestion. he denies sick contacts, recent travel, sore throat, myalgias, or rhinorrhea. as part of the workup, he had elevated esr and crp, and blood cultures drawn, which today resulted in positive results in both aerobic bottle and anaerobic bottle for enterococcus, no sensitivities yet available. he was referred to the ed for admission and further workup of suspected endocarditis. he denies any history of heart disease including valvular abnormalities. . in the ed a central line was placed and levophed was started due to systolic bp's around 90. he was noted to be febrile to 101.1 which came down to 98.8 without intervention. bedside echo did not show pericardial effusion and valves were not well visualized. past medical history: sleep apnea urethral stricture benign prostatic hyperplasia impingement syndrome - shoulder, rt atrial fibrillation arthralgia - knee, rt seizure disorder mitral regurgitation social history: lives with:wife contact: (wife) phone # occupation: cigarettes: smoked no yes other tobacco use:denies etoh: < 1 drink/week drinks/week >8 drinks/week illicit drug use:denies family history: hypertension: mgm. nb father died of esophageal cancer, mother of leukemia premature coronary artery disease- non contributory physical exam: vitals: t:99.1 bp: 100/85 p: 100 r: 18 o2: 100%, nonrebreather 100% patient wt is 174lbs and height is 6ft 2in general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl , no cervical adenopathy neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, 4th intercostal murmur ,nonradiating ,no rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, insp. rales at the bases and mid lung fields b/l,no ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. rubbery subcentimeter lymph node in the left groin area, movable, nontender neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact skin- no rashes or nail lesions pertinent results: urine culture: enterococcus faecalis >100,000 cfu/ml antibiotic atrius blood cx grew enterococcus echo : mild prolapse of the posterior leaflet with valvular vegetation and moderate-severe mitral regurgitation. no abscess visualized. hyperdynamic left ventricular systolic function. . ekg: af/flutter 104 (old), upsloping sub-mm tee : pre-bypass: no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no spontaneous echo contrast is seen in the body of the right atrium. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is mildly depressed (lvef= 45 %). the diameters of aorta at the sinus, ascending, arch, and descending levels are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. there is an echodensity on the noncoronary cusp seen in both short & long axes is most consistent with the appearance of a fibroelastoma although an endocarditic related mass can not be ruled out. the mitral valve leaflets are myxomatous. there is bileaflet flail versus destruction from endocarditis. the anterior leaflet may be torn. torn mitral chordae/masses are present at both leaflet tips. an eccentric, jet of severe (4+) mitral regurgitation is seen (coanda effect). there is a left pleural effusion there is no pericardial effusion. postbypass: the patient is inituially av paced and then atrially paced and is on a norepinephrine infusion. there is a well seated bioprosthetic valve in the mitral position. the leaflets appear to be moving normally. there is trace valvular mr and can not completely rule out a jet of trace perivalvular mr. the maximum gradient through the valve is 12mmhg with a mean of 4 mmhg at a cardiac output in the 7.5 liter/minute range. the remaining valves are unchanged. the rv function is unchanged. the lv function is improved with an estimated ef of 55%. the septum is dyssynchronous consistent with bundle branch block seen on ecg. the aorta remains intact after decannulation. electronically signed by , md, interpreting physician 14:43 10:00 am tissue posterior leaflet. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. tissue (final ): enterococcus sp.. rare growth. reported to and read back by dr.,p at 1300. sensitivities performed on culture # 338-2732l . enterococcus sp.. isolated from broth media only, indicating very low numbers of organisms. second morphology. sensitivities performed on culture # , . anaerobic culture (final ): no anaerobes isolate 05:56am blood wbc-8.9 rbc-3.24* hgb-9.9* hct-29.8* mcv-92 mch-30.5 mchc-33.3 rdw-13.9 plt ct-422 02:45pm blood wbc-16.4* rbc-3.57* hgb-11.0* hct-32.9* mcv-92 mch-30.7 mchc-33.3 rdw-13.5 plt ct-366 05:17am blood pt-15.1* inr(pt)-1.4* 05:56am blood pt-13.3* inr(pt)-1.2* 08:10pm blood pt-12.3 inr(pt)-1.1 05:51am blood pt-12.4 inr(pt)-1.1 03:23am blood pt-11.8 ptt-26.3 inr(pt)-1.1 05:56am blood urean-13 creat-0.9 na-136 k-4.5 cl-99 02:45pm blood glucose-98 urean-14 creat-1.1 na-134 k-4.6 cl-99 hco3-24 angap-16 brief hospital course: he was referred to cardiac surgery and on . he weaned from bypass on levophed and propofol and was transferred to the cvicu in stable condition. he was extubated later that day, but remained pressor dependent for several days. he was transferred to the floor on pod# 4 after weaning from pressor support. his activity level was increased and he was gently diuresed toward his preop weight. or tissue cultures grew enterococcus as preop and infectious disease recommended a 6 week course of iv gentamicin and ampicillin. beta blockade and coumadin wre begun. a picc line was placed. chest tubes and pacing wires removed per protocol. he continued to make good progress and was cleared for discharge to rehab in on . arrangements were made for id followup after discharge as welll as with surgery and his cardiologist. medications on admission: atenolol 25 mg oral tablet tab daily lamotrigine (lamictal) 100 mg oral tablet take 1 tablet twice a day aspirin 81 mg oral tablet 1 tab daily discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day) for 2 weeks. 5. lamotrigine 100 mg tablet sig: one (1) tablet po bid (2 times a day). 6. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain/fever. 7. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 8. ampicillin sodium 2 gram recon soln sig: two (2) gms intravenous every four (4) hours for 6 weeks: 6 week course through . 9. gentamicin sulfate (pf) 100 mg/10 ml solution sig: one y (120) mg intravenous every twelve (12) hours for 6 weeks: 6 week course through ; . 10. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 11. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 12. warfarin 2.5 mg tablet sig: as directed tablet po once a day: goal inr 2-2.5. 13. outpatient lab work (beginning ) cbc,cmp,gentamicin peak/trough levels. fax results to id at discharge disposition: extended care facility: tbd discharge diagnosis: mitral endocarditis mitral regurgitation s/p mitral valve replacement,maze and ligation of left atrial appendage sleep apnea urethral stricture benign prostatic hyperplasia impingement syndrome - right shoulder atrial fibrillation seizure disorder discharge condition: alert and oriented x3, nonfocal ambulating with steady gait incisional pain managed with oral analgesics incisions: sternal - healing well, no erythema or drainage edema: none discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. () on at 1:15pm , 2a cardiologist: dr. (her office will call you with appt) id followup: opat attending visit: ,, 10:00a fellow visit: 11:00a id,, gentamicin peak and trough levels, cmp,cbc,and fax results to please call to schedule appointments with your: primary care: dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication atrial fibrillation goal inr 2-2.5 first draw day after discharge to rehab *** please arrange for coumadin f/u prior to discharge from rehab procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization diagnostic ultrasound of heart excision or destruction of other lesion or tissue of heart, open approach open and other replacement of mitral valve with tissue graft cardiac mapping excision, destruction, or exclusion of left atrial appendage (laa) diagnoses: other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) mitral valve disorders other postoperative infection urinary tract infection, site not specified congestive heart failure, unspecified severe sepsis atrial fibrillation atrial flutter hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) loss of weight septic shock other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation acute and subacute bacterial endocarditis epilepsy, unspecified, without mention of intractable epilepsy streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] acute diastolic heart failure streptococcal septicemia acute edema of lung, unspecified other specified causes of urethral stricture other affections of shoulder region, not elsewhere classified osteoarthrosis, unspecified whether generalized or localized, shoulder region 

Answer: The patient is high likely exposed to