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: chest pain major surgical or invasive procedure: egd/panc. biopsy redo avr ( 21mm st. porcine valve) history of present illness: 60 year old male who presented to by ambulance with complaints of chest pain on . he noted substernal chest pressure lasting 3-10 min for the past 2 weeks. the pain does not radiate. he had doe. it is made worse by exertion and he has difficulty climbing the stairs in his home. the pain was worse during night and awoke him from sleep. when he has the pain he has also noticed sob. he was transferred to for further evaluation. past medical history: pmh: 1. alcohol detox 2 wks ago 2. abdominal malignancy - 2.7cm iliac ln/abdominal lad currently being worked up by dr. 3. bicuspid aorta s/p aortic valve replacement with porcine valve in 4.presence of venous angioma vs av malformation seen on prior mras. 5. status post traumatic splenectomy 6. depression 7. essential tremor 8. status post bilateral herniorrhaphy 9. status post right thumb surgery . status post acl repair. social history: divorced but pending re-marriage. 2 children. smokes cigars per day. etoh abuse (8 beers/day x 30 years) s/p detox 2 weeks ago. 1 beer in last 2 weeks per patient. family history: gm with open heart surgery (unclear indication) physical exam: admission vitals: t: 98.0 bp: 104/79 p: 84 r: 20 sao2:93%ra general: awake, alert, nad. heent: nc/at, eomi without nystagmus, no scleral icterus noted, mmm, no lesions noted in op neck: supple, no jvd or carotid bruits appreciated pulmonary: decrease bs b/l with dullness to percussion cardiac: rrr, nl. s1s2, systolic murmur heard best at rusb abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: trace edema skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. -cranial nerves: ii-xii intact -motor: normal bulk, strength and tone throughout. bilateral resting tremor. -sensory: no deficits to light touch throughout. pertinent results: 07:10am blood wbc-14.3* rbc-2.96* hgb-10.2* hct-29.4* mcv-99* mch-34.4* mchc-34.7 rdw-15.5 plt ct-208 07:10am blood plt ct-208 07:25am blood ret aut-2.2 07:10am blood glucose-106* urean-7 creat-0.7 na-134 k-4.1 cl-96 hco3-33* angap-9 07:10am blood estgfr-using this 07:10am blood alt-31 ast-43* ld(ldh)-337* alkphos-130* amylase-51 totbili-0.8 07:10am blood lipase-38 07:10am blood albumin-3.3* 07:25am blood hbsag-negative hbsab-negative hbcab-negative echocardiography report , (complete) done at 9:52:21 am final referring physician information , w. , status: inpatient dob: age (years): 60 m hgt (in): 76 bp (mm hg): 95/52 wgt (lb): 200 hr (bpm): 64 bsa (m2): 2.22 m2 indication: aortic valve disease. intra-op tee for re-do avr icd-9 codes: 440.0, v42.2, 424.1 test information date/time: at 09:52 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2006aw05-: machine: echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.6 cm <= 4.0 cm left atrium - four chamber length: 5.0 cm <= 5.2 cm right atrium - four chamber length: 5.0 cm <= 5.0 cm left ventricle - septal wall thickness: *1.4 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.4 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *6.1 cm <= 5.6 cm left ventricle - systolic dimension: 5.1 cm left ventricle - fractional shortening: *0.16 >= 0.29 left ventricle - ejection fraction: 35% >= 55% aorta - valve level: 2.3 cm <= 3.6 cm aorta - ascending: 3.2 cm <= 3.4 cm aorta - arch: 3.0 cm <= 3.0 cm aorta - descending thoracic: 2.5 cm <= 2.5 cm aortic valve - peak velocity: *5.4 m/sec <= 2.0 m/sec aortic valve - peak gradient: *114 mm hg < 20 mm hg aortic valve - mean gradient: 72 mm hg aortic valve - lvot diam: 2.3 cm aortic valve - valve area: *0.5 cm2 >= 3.0 cm2 mitral valve - peak velocity: 1.0 m/sec mitral valve - mean gradient: 1 mm hg mitral valve - pressure half time: 68 ms mitral valve - mva (p t): 3.2 cm2 findings left atrium: moderate la enlargement. good (>20 cm/s) laa ejection velocity. all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: normal ra size. a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. left ventricle: mild symmetric lvh. moderately dilated lv cavity. moderately depressed lvef. right ventricle: mildly dilated rv cavity. mild global rv free wall hypokinesis. aorta: normal aortic root diameter. focal calcifications in aortic root. normal ascending aorta diameter. focal calcifications in ascending aorta. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: severely thickened/deformed aortic valve leaflets. bioprosthetic aortic valve prosthesis (avr). thickened avr leaflets. increased avr gradient. abnormal avr. no masses or vegetations on aortic valve. severe as (aova <0.8cm2). mild (1+) ar. mitral valve: moderately thickened mitral valve leaflets. moderate mitral annular calcification. calcified tips of papillary muscles. no ms. mild to moderate (+) mr. tricuspid valve: moderate tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. physiologic (normal) pr. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient received antibiotic prophylaxis. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. the patient was under general anesthesia throughout the procedure. the patient appears to be in sinus rhythm. results were personally post-bypass data regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions pre-bypass: 1. the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. 2. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is globally moderately depressed. 3. the right ventricular cavity is mildly dilated. there is mild global right ventricular free wall hypokinesis. 4. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 5. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). mild (1+) aortic regurgitation is seen. 6. the mitral valve leaflets are moderately thickened. mild to moderate (+) mitral regurgitation is seen. 7. moderate tricuspid regurgitation is seen. post-bypass: pt is being a paced and is on an infusion of epinephrine and phenylephrine 1. a 21 mm bioprosthesis well seated in the aortic position, leaflets appear to move well. no significant ai is seen. 2. lv systolic function is slightly improved. 3. episode of moderate to severe rv hypokinesis during sternal closure with moderate lv hypokinesis, improved with inotropes, mild to moderate rv hypokinesis persisting with inotropic and pressor support. 4. mr 5. aorta is intact post decannulation i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician ,: radiology detail - ccc record # preliminary report history: confusion after aortic valve replacement. comparison: mris on and , , . technique: non-contrast head ct. findings: there is no intracranial hemorrhage, shift of normally midline structures, alteration in the -white matter differentiation, or new hydrocephalus. there is no evidence of a major vascular territorial infarct. the sinuses are well aerated. the osseous structures and soft tissues are normal. the known vascular anomaly in the left temporal region is not appreciated on this study. impression: no acute intracranial pathology. dr. dr. ?????? caregroup is. all rights reserved. brief hospital course: admitted on from hosp.to the cardiology service with c/o angina for the past 2 weeks ( as noted above). troponin positive with ekg changes and signs of chf. weight loss recently concerning for possibility of malignancy given lymphadenopathy/alcoholism. echo done as part of w/u which revealed severe prosthetic aortic valve stenosis with 0.4 cm2, peak gradient 131/mean 83, ef 20%, , 1+ ai, 1+ mr, 2+ tr, moderate mac, ascending aorta 3.9 cm, and severe pa systolic hypertension. right lung mass/opacity also seen on cxr. diuresis/asa/ace/beta blockade/digoxin commenced. social work consult done. ct torso also revealed mesenteric /mediastinal lymphadenopathy. neuro consult done for history of venous avms of the brain and they recommended avoiding long-term anti-coagulation which would be required for a mechanical valve. cath done showed a 50% diagonal lesion. ct surgery consulted for redo avr. /oncology consult also done with recs for abdominal node biopsy to r/o malignancy. carotid us did not show any significant stenoses. dental consult done and cleared for surgery. liver service consulted for evaluation. hit panel sent for decreasing platelet count to 91k and all heparin stopped but was ultimately negative. node biopsy specimen was nondiagnostic, and general surgery was consulted for possible laparascopic node biopsy. treated for epistaxis on . nutrition consult done on . cleared for surgery and underwent redo avr with porcine valve on with dr. . transferred to the csru in stable condition on epinephrine and propofol drips. extubated that evening and weaned from drips the next day.transferred to the floor on pod #2 to begin increasing his activity level.developed some sternal drainage on pod #4 and vancomycin started.he remained afebrile.ace restarted, but no beta blockade per cardiology also, and treated for uti that developed on pod #6. will f/u with heme/onc as an outpt. ct brain done for confusion which did not show any intracranial pathology. he has had some diarrhea, without abdominal pain. c diff. was sent & is pending. he was started on flagyl empirically. he had a brief episode (less than 1 hour) of a fib today, with a ventricular rate of 80/minute, which converted spontaneously to nsr. he has remained stable & is ready for discharge to rehab today, . medications on admission: medications at home: lexapro 20 asa 81 advair prn . meds on transfer: asa 325 coreg 6.25mg captopril 6.25mg tid digoxin 0.125mg qd atorvastatin 40mg qd lasix 20mg iv qd lexapro 20mg qd ambien 5mg qhs prn valium 10mg po q2h prn ciwa discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for temperature >38.0. 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day) for 1 months. 4. atorvastatin 40 mg tablet sig: one (1) tablet po hs (at bedtime). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 7. escitalopram 10 mg tablet sig: two (2) tablet po daily (daily). 8. captopril 12.5 mg tablet sig: 0.5 tablet po bid (2 times a day). 9. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days: last dose 12/21 for uti. 10. lasix 40 mg tablet sig: one (1) tablet po once a day for 10 days. disp:*10 tablet(s)* refills:*0* 11. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po once a day for 10 days. disp:*20 tab sust.rel. particle/crystal(s)* refills:*0* 12. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 13. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 14. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 15. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 10 days. discharge disposition: extended care facility: - discharge diagnosis: redo avr (21mm st. porcine valve) prosthetic aortic stenosis with avr current etoh abuse ( detox 2 weeks ago) egd/pancreatic biopsy s/p traumatic splenectomy depression essential tremor s/p bil. herniorrhaphies s/p right thumb . s/p acl repair uti discharge condition: good discharge instructions: no driving for one month no lotions, creams or powders on any incision no lifting greater than greater than 10 pounds for 10 weeks call for fever greater than 100, redness, or drainage may shower over incisions and pat dry followup instructions: follow up with dr. 1-2 weeks follow up with dr. in weeks follow up with dr. in 4 weeks should have ct scan in weeks to evaluate ?malignancy workup provider: , md /oncology phone: cc-7 date/time:......... provider: , /oncology-cc9 date/time:........... procedure: extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters other endoscopy of small intestine diagnostic ultrasound of heart open and other replacement of aortic valve with tissue graft biopsy of lymphatic structure transfusion of other serum transfusion of platelets infusion of vasopressor agent diagnoses: other iatrogenic hypotension thrombocytopenia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified acquired coagulation factor deficiency atrial fibrillation aortic valve disorders mechanical complication due to heart valve prosthesis loss of weight enlargement of lymph nodes epistaxis acute alcoholic intoxication in alcoholism, unspecified hemangioma of intracranial structures essential and other specified forms of tremor alcoholic fatty liver 

Answer: The patient is high likely exposed to