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: lower gi bleed major surgical or invasive procedure: colonoscopy history of present illness: the patient is a 55 year-old man with a history with myxomatous mitral valve and moderate to severe mr syndrome presented with two weeks of high-grade fevers from 103.0 to as high as 105.0. he had these on a daily basis multiple times a day. the patient was able to control his fever during the daytime with multiple doses of acetaminophen (1 g q6h) however otherwise at night he said that when he woke up in the morning he soaked the bed with sweat. otherwise, the patient did not have any localizing symptoms except for mild dyspnea and cough. he also reported a mild neck pain which he stated was from laying in bed for so long. he did not have neck stiffness, photophobia, headache or other neurological symptoms. the patient did not have any chest pain, abdominal pain, diarrhea, or urinary changes. he last had dental work in and took amoxicillin at that time. he had otherwise not taken antibiotics or been hospitalized recently. he had not traveled out of the country in more than ten years or left the area in several months. . in the ed, initial vs were: t 103.8, hr 110, bp 152/76, rr 20, sat 93% ra. before starting fluids, his o2 saturation dropped to the mid 80s on 2l. cxr showed a right middle lobe pneumonia. blood cultres were drawn before starting gentamicin, ceftriaxone, and azithromycin to cover for icu community-acquired pneumonia and also for endocarditis. past medical history: myxomatous mitral valve disease with partial p2 flail, moderate-to-severe mitral regurgitation but normal left ventricular dimensions and systolic function hypertension mild dyslipidemia depression syndrome social history: unemployed. single. no children. lifetime nonsmoker. zero to three drinks per week. family history: noncontributory physical exam: exam on admission: vitals: t: 99.2 bp: 120/73 p: 90 r: 30 o2: 91% on 6l general: alert, oriented, no acute distress, sweating profusely heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp to angle of jaw, no lad cv: regular rate and rhythm, normal s1 + s2, holosystolic murmur at the apex lungs: crakles in b/l bases and mid l lung, otherwise ctab. 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 neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . exam on discharge: vitals: t: 97.8 bp: 91/61 p: 72 r: 18 o2: 95% on ra general: alert, oriented, no acute distress, sweating profusely heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp to angle of jaw, no lad cv: regular rate and rhythm, normal s1 + s2, holosystolic murmur at the apex lungs: ctab. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, gait normal pertinent results: 06:18pm comments-green top 06:18pm lactate-1.0 06:10pm glucose-157* urea n-14 creat-1.1 sodium-127* potassium-4.5 chloride-93* total co2-26 anion gap-13 06:10pm estgfr-using this 06:10pm alt(sgpt)-103* ast(sgot)-81* alk phos-92 tot bili-0.6 06:10pm lipase-26 06:10pm albumin-3.9 calcium-8.6 phosphate-3.1 magnesium-2.1 06:10pm osmolal-272* 06:10pm crp-93.0* 06:10pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 06:10pm wbc-8.4 rbc-3.60* hgb-10.5* hct-33.0* mcv-92# mch-29.2 mchc-31.8# rdw-13.5 06:10pm neuts-91.6* lymphs-6.2* monos-2.1 eos-0 basos-0 06:10pm plt count-334 06:10pm pt-13.4* ptt-28.9 inr(pt)-1.2* 06:10pm sed rate-98* . . cxr : there is a new widespread opacity along the right mid lung with patchy left peri and infrahilar opacification as well, suggesting multifocal pneumonia. elsewhere, the lungs appear clear. there are no pleural effusions or pneumothorax. . tte : parial mitral leaflet flail with eccentric, moderate-to-severe mitral regurgitation. valve is structurally thickened and has probable torn chordae associated with it; cannot definitively exclude a vegetation vs. myxomatous degeneration but appears similar to prior study of . compared with the prior study (images reviewed) of , the estimated pulmonary artery pressures are higher. the severity of regurgitation may be slightly increased. the valve structurally appears similar. . ct torso : 1. multifocal pneumonia involving both lungs. no evidence for abscess. 2. small bilateral pleural effusions. 3. normal examination of the abdomen and pelvis with incidental finding of a left renal cyst as well as a subcentimeter hypodense lesion in the left kidney that is too small to characterize but likely also represents a cyst. . ruq ultrasound : normal right upper quadrant ultrasound. . tee : no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 40 cm from the incisors. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. no aortic regurgitation is seen. there is moderate/severe posterior leaflet mitral valve prolapse. there is partial p2 mitral leaflet flail. severe (4+) mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. . microbiology . blood culture (identical organism in 3 of 3 bottles) sensitivities: mic expressed in mcg/ml _________________________________________________________ viridans streptococci | clindamycin----------- =>2 r erythromycin---------- =>4 r penicillin g---------- 0.06 s vancomycin------------ <=1 s . clostridium difficile: negative . urine legionella antigen: negative . blood culture: no growth . 07:50am blood hbsag-negative hbsab-negative hbcab-negative hav ab-negative 07:50am blood hiv ab-negative 07:50am blood hcv ab-negative . 10:48am blood wbc-7.4 rbc-3.47* hgb-10.1* hct-30.7* mcv-88 mch-29.2 mchc-33.0 rdw-13.5 plt ct-368 10:48am blood glucose-93 urean-17 creat-1.1 na-133 k-4.7 cl-96 hco3-28 angap-14 10:48am blood alt-129* ast-57* brief hospital course: bacterial endocarditis: given the patient's abnormal mitral valve, weeks of high fevers, and blood cultures positive for streptococcus viridans in the setting of a recent dental procedure, he most likely has endocarditis. the organism is sensitive to penicillin and ceftriaxone, and the latter was ultimately chosen for treatment since it would be easier for the patient to adhere to a regimen of daily infusions rather than q4h infusions. the initial tte did not show any vegetations or significant changes in the valve from the prior study. we consulted the infectious disease service, who recommended that the patient be on four weeks of ceftriaxone therapy, which would therefore end on . after five days of treatment, he continued to have night sweats and occasional low grade fevers, although his repeat blood cultures were negative. therefore, a tee was performed that showed no valvular abscess. a picc was placed to facilitate long-term antibiotic therapy. the infectious disease service has arranged for outpatient follow up and monitoring. . mitral regurgitation: the patient sees dr. in cardiology clinic. he has a myxomatous mitral valve and was noted to have moderate to severe mr on his tte and tee during this admission, which is consistent with prior studies. he is mildly symptomatic at baseline and has elected to pursue observation rather than surgical repair for now. . multifocal pneumonia: the patient had evidence of multifocal pneumonia on chest x-ray and chest ct. we suspect that endocarditis was the primary process, and that there may have been seeding of the lungs while he was bacteremic. his hypoxia improved quickly and he was weaned off oxygen. a repeat chest x-ray that was taken to confirm picc placement showed no further evidence of pneumonia. . hyponatremia: the patient was mildly hyponatremic at his initial presentation. this is likely due to increased intake of water and decreased intake of solids while he was ill preceding hospitalization. the urine legionella was negative. the hyponatremia corrected qulickly with iv normal saline and he had no further issues with it throughout his hospital course. . transaminase elevation: the patient's ast and alt were elevated during this admission. the cause was unclear. hepatitis and hiv serologies were negative. there were no cause seen on right upper quadrant ultrasound or abdominal ct. this may have been due to acetaminophen usage in the setting of high fevers, although the degree of elevation seen is not consistent with acetaminophen toxicity. he may have had small abscesses not visible on imaging, given the prolonged time he was likely bactermeic. regardless, the ast and alt levels trended down for several days in a row prior to discharge. . hypertension: once the patient's vital signs were stable and his clinical course was improving, his home enalapril was restarted. medications on admission: amoxicillin as needed for dental work bupropion 300 mg q.a.m. and 150 mg q.p.m. clonazepam 0.5 mg q.a.m. and 1 mg q.p.m. enalapril 10 mg b.i.d. lexapro 20 mg b.i.d. seroquel 100 mg daily ascorbic acid 500 mg daily b complex vitamins calcium plus vitamin d one tablet a day vitamin d2 lysine 500 mg b.i.d. magnesium 250 mg day multivitamin omega-3 fish oil discharge medications: 1. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: two (2) grams intravenous q24h (every 24 hours) for 20 days: last dose on . 2. bupropion hcl 150 mg tablet extended release sig: two (2) tablet extended release po qam (once a day (in the morning)). 3. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po qpm (once a day (in the evening)). 4. seroquel xr 50 mg tablet extended release 24 hr sig: two (2) tablet extended release 24 hr po qpm (once a day (in the evening)). 5. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 6. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po qam (once a day (in the morning)). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po qpm (once a day (in the evening)). 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. escitalopram 10 mg tablet sig: two (2) tablet po bid (2 times a day). 10. omega-3 fatty acids capsule sig: one (1) capsule po bid (2 times a day). 11. clonazepam 0.5 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 12. clonazepam 1 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 13. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 14. magnesium oxide 140 mg capsule sig: two (2) capsule po daily (daily). 15. b complex vitamins capsule sig: one (1) cap po daily (daily). 16. enalapril maleate 10 mg tablet sig: one (1) tablet po bid (2 times a day). 17. acetaminophen 325 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for pain. 18. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. discharge disposition: extended care facility: for the aged - discharge diagnosis: bacterial endocarditis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to for high fevers and found to have endocarditis, an infection of one of your heart valves. you were initially admitted to the medical intensive care unit for monitoring of you breathing and your blood pressure. bacterial cultures of your blood showed that the infection was caused by streptococcus viridans. you received antibiotics for this, and will need to complete a total of four weeks of antibiotics. initially, your sodium level was low, but this returned to . you also had a ct scan of your chest that showed what was likely pneumonia, which probably spread from the infection on the heart valve. your liver function tests were elevated, but an ultrasound of your liver did not show anything problems with the liver and the tests were returning to normal when you were discharged. you had two echocardiograms of your heart, which showed that your mitral valve was abnormal but there did not appear to be any significant change from prior studies. medication changes: start ceftriaxone 2 g iv daily, last dose stop taking lysine until your ast and alt have normalized and you have discussed it with your primary care physician followup instructions: department: infectious disease when: tuesday at 9:30 am with: , md building: lm campus: west best parking: garage department: cardiac services when: tuesday at 11:30 am with: , md building: campus: east best parking: garage department: infectious disease when: tuesday at 9:00 am with: , md building: lm bldg () campus: west best parking: garage department: dermatology and laser when: thursday at 2:30 pm with: , md building: (, ma) campus: off campus best parking: free parking on site name: , specialty: internal medicine address: ,, , phone: **please discuss with the staff at the facility the need for a follow up appointment with your pcp when you are ready for discharge** procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart diagnoses: pneumonia, organism unspecified mitral valve disorders unspecified essential hypertension hyposmolality and/or hyponatremia severe sepsis acute and subacute bacterial endocarditis streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus streptococcal septicemia other specified pervasive developmental disorders, current or active state 

Answer: The patient is high likely exposed to