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 / tetracycline / codeine attending: chief complaint: dyspnea/chest pain major surgical or invasive procedure: - re-do sternotomy, avr (21mm st. mechanical) history of present illness: this 62 year old patient with previous coronary artery bypass grafting in presented at this time with symptoms of chest pain and dyspnea on exertion. he was investigated and was found to have residual disease in the obtuse marginal graft and also severe aortic stenosis and mild to moderate mitral regurgitation. he had no viable leg veins to be used as conduits and hence preoperatively, the obtuse marginal vein graft was stented successfully and he was electively admitted for aortic valve replacement with or without mitral valve repair or replacement. past medical history: coronary artery disease s/p cabgx4 cri with acute creatinine rise post cardiac catheterization mi pvd af dvt diabetes htn neuropathy/retinopathy iron deficiency anemia depression/anxiety s/p subdural hematoma with evacuation multiple pci's atrial flutter ablation multiple toe amputations green field filter placement s/p right lower extremity bypass left saphenous vein harvest aortic stenosis social history: lives with wife in , ma. prior alcohol and drug abuse (pills/cocaine). he is disabled. smoked ppd stopping in . family history: 2 uncles died of at age 57 and 60. physical exam: 52 sb bp (r) 132/70 (l) 140/74 98% ra weight 230 73" gen: wdwn in nad. multiple bruises noted on arms from scratching skin: warm, dry. chronic venous stasis changes of bilateral le heent: ncat, od blindness, os prl/eomi, op benign. teeth in fair repair. neck: supple, no jvd, delayed carotid upstrokes w/ transmittyed murmur vs. bruit. lungs: clear. well healed sternotomy heart: rrr, nl s1-s2, +s3, iv/vi systolic murmur. abd: obese, benign ext: 2+ le edema, no left toes, 3 remaining right toes. + stasis dermatitis. pulses faint to 1+ of bilateral le's varicosities: right incision from groin to mid calf. left incision from mid thigh to groin. no varicosities. neuro: a+ox3. gait slightly unsteady. strength 5/5, od blindness. pertinent results: 05:50am blood wbc-9.5 rbc-2.73* hgb-8.3* hct-25.2* mcv-92 mch-30.3 mchc-32.9 rdw-16.9* plt ct-333 05:50am blood plt ct-333 05:50am blood glucose-100 urean-24* creat-1.6* na-135 k-4.2 cl-98 hco3-24 angap-17 ekg probable sinus but possibly ectopic atrial tachycardia. since the previous tracing of the rate has increased and pacing is no longer seen. the rapid is accompanied by inferolateral ischemic st-t wave abnormalities. cxr the patient is status post median sternotomy and aortic valve replacement as well as coronary artery bypass surgery. the cardiac silhouette is enlarged but stable compared to the previous postoperative radiographs. there has been interval resolution of bibasilar atelectasis. the right hemidiaphragm has an unusual tenting at its mid portion, likely due to mild right upper lobe volume loss as the minor fissure is also slightly elevated. a small amount of pleural fluid in the subpulmonic space could also produce this appearance of the diaphragm. healed rib fractures on the left are incidentally noted as well as coronary artery stents. echo pre-bypass: 1.the left atrium is markedly dilated. the left atrial appendage emptying velocity is depressed (<0.2m/s). no thrombus is seen in the left atrial appendage. 2.the right atrium is markedly dilated. a patent foramen ovale is present. a left-to-right shunt across the interatrial septum is seen at rest. 3.left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is moderate regional left ventricular systolic dysfunction. overall left ventricular systolic function is moderately depressed. resting regional wall motion abnormalities include inferior and septal basal and mid moderate hypokinesis. . 4.there is moderate global right ventricular free wall hypokinesis. 5. there are simple atheroma in the aortic arch. the descending thoracic aorta is mildly dilated. there are complex (>4mm) atheroma in the descending thoracic aorta. 6. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis. mild to moderate (+) aortic regurgitation is seen. 7. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. 8. there is no pericardial effusion. post cpb: moderately depressed lv systolic function. moderate rv free wall hypokinesis which improved gradually with inotropic support. mechanical valve in aortic position/wellseated with good leaflet excursion, trace ai. mitral regurgitation is of mild intensity now. brief hospital course: mr. was admitted to the on for elective surgical management of his aortic valve disease. he was taken directly to the operating room where he underwent a redosternotomy with an aortic valve replacement using a 21mm st. mechanical regeant valve. postoperatively he was taken to the cardiac surgical intensive care unit for monitoring. on postoperative day one, mr. neurologically intact and was extubated. aspirn, plavix, beta blockade and a statin were resumed. coumadin was started for anticoagulation for his mechanical aortic valve. he developed atrial fibrillation for which amiodarone was started with conversion to normal sinus rhythm. on postoperative day two, he was transferred to the cardiac surgical nursing floor for further recovery. mr. was gently diuresed towards his preoperative weight. the physical therapy service was consulted for assistance with his postoperative strength and mobility. a psychiatry consult was obtained for some postoperative confusion and crying episodes. fluoxetine was continued and frequent family/staf reorientation was encouraged. one month follow-up was recommended. mr. developed sternal drainage and vancomycin and levaquin was started. vancomycin was discontinued on , he has remained afebrile with a normal wbc. his sternal drainage has subsided, and he is ready to be discharged today. he will follow-up here next week for a wound check. medications on admission: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. fluoxetine 40 mg capsule sig: one (1) capsule po once a day. 4. furosemide 20 mg tablet sig: one (1) tablet po qod (). 5. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 6. avandia 4 mg tablet sig: one (1) tablet po once a day. 7. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily (). 8. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. crestor 40 mg tablet sig: one (1) tablet po once a day. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 12. niaspan 1,000 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. 13. lantus 100 unit/ml solution sig: 10 units 10 units subcutaneous qpm. discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. tramadol 50 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 5. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day). disp:*1 vial* refills:*2* 6. prednisolone acetate 1 % drops, suspension sig: one (1) drop ophthalmic daily (daily). disp:*1 vial* refills:*2* 7. ferrous gluconate 300 mg tablet sig: one (1) tablet po daily (daily): take for 1 month. disp:*30 tablet(s)* refills:*0* 8. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day): take for 1 month. disp:*60 tablet(s)* refills:*0* 9. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 10. plavix 75 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 11. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. disp:*7 tablet(s)* refills:*0* 12. warfarin 1 mg tablet sig: four (4) tablet po daily (daily) for 2 days: take 4mg saturday and sunday then vna to draw inr, and call results to dr. for continued dosing. disp:*120 tablet(s)* refills:*2* 13. prozac 40 mg capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*2* 14. crestor 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 15. niaspan 1,000 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. disp:*60 tablet sustained release(s)* refills:*1* 16. carvedilol 25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 17. rosiglitazone 4 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: as mr cad ^ chol pvd af dm-2 htn anemia depression sternal drainage discharge condition: good discharge instructions: may shower, no bathing or swimming for 1 month no creams, lotions or powders to any incisions no lifting > 10# for 10 weeks p instructions: with dr. in weeks with dr. in weeks with dr. in 4 weeks procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart open and other replacement of aortic valve diagnoses: unspecified essential hypertension cardiac complications, not elsewhere classified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes mitral valve insufficiency and aortic valve stenosis 

Answer: The patient is high likely exposed to