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: expressive aphasia major surgical or invasive procedure: transesophageal echocardiogram cardiac catheterization surgical extraction of infected teeth number 13 and 32. mitral valve repair(30mm cefuture ring) pfo closure, laa ligation history of present illness: 39 yo male with a history of mitral valve vegetations who presented with aphasia likely from mca embolic stroke. transferred to after presenting to hospital. one week prior to his initial presentation he felt fatigued and stayed in bed for 3 days. for the two days prior to presenting he spent most hours of the day sleeping, did not eat or drink or get out of bed. 1 day prior to inital presentation he found that he could not speak, although he knew what he wanted to say and could understand what others said to him. pt reports he had less energy for the past 1 yrs and feels this may be related to his endocarditis. he describes having night sweats for the past year and a half, and a l parieto-temporal headache for the past year. he had no documented fevers. he had no focal weakness, numbness, or paresthesia. no blurry vision or diplopia. no lightheadeness or dizziness. he initially presented to cape code hospital were he had a ct of the head that showed a low attenuation zone in the posterior corona radiata extending along the left external capsule of uncertain etiology. mri scan showed multiple acute/subacute infarcts with paramagnetic effect in the left temporal lobe and right parietal hemisphere suggestive of hemosiderin from hemorrhage. he was transferred to this hospital for further management. past medical history: 1. endocarditis - strep viridans bacteremia with mitral valve endocarditis in , endocarditis with strep intermedius , and endocarditis with strep oralis . 2. mitral valve prolapse 3. kidney stones 4. hepatitis b 5. hepatitis c 6. mild mi in setting of cocaine use 7. pulmonary fibrosis? (in osh records) social history: smokes pack per day for the past 25 years. he has used every illicit drug in the past but none in the past 5 years. he denies current alcohol use and has not drank for many years, although admits to abuse in past. lives with his girlfriend and 2 cats in . has a teenage daughter. in hvac heating industry, but was laid off 2 months ago. does not have health insurance. was in jail for two years for robbing a bank, released in . family history: father had a stroke at age 35. mother is alive and healthy, but a heavy smoker. physical exam: exam upon arrival to micu: vitals: t: 99.2 bp: 99/59 p: 88 r: 13 o2: 97% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mm dry, poor dentition neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, ii/vi hsm at apex, no rubs or gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neurologic: cn ii-xii tested and intact, strength 5/5 in upper and lower extremities bilterally, sensation intact to light touch and cold bilaterally, is able to name simple objects, is able to repeat, finger to nose intact, gait intact. toes downgoing. skin: no splinter hemorrhages, no rashes pertinent results: osh labs and cultures: troponin of 0.01, bnp of 12.5, tbili of 0.6, na 133, k 4.0, cl 97, co2 27, bun 10, cr 0.98, glu 100, inr 1.1, wbc 12.1, hct 25, plts 406. blood culture : positive for strept mitis preop 11:10pm sed rate-67* 11:10pm plt count-406 11:10pm neuts-74.5* lymphs-17.7* monos-5.3 eos-2.1 basos-0.5 11:10pm wbc-9.8 rbc-3.67* hgb-11.7* hct-32.7* mcv-89 mch-31.8 mchc-35.7* rdw-13.9 11:17pm glucose-115* lactate-1.3 na+-135 k+-3.8 cl--97* tco2-25 11:29pm pt-13.1 ptt-27.9 inr(pt)-1.1 11:29pm hcv ab-positive* 11:29pm crp-62.3* 11:29pm hbsag-negative hbs ab-positive hbc ab-positive 11:29pm caltibc-241* ferritin-264 trf-185* 11:29pm iron-117 11:29pm ck-mb-1 ctropnt-<0.01 11:42pm lactate-1.3 02:38am urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-1 ph-6.5 leuk-neg discharge 05:25am blood wbc-4.2 rbc-2.36* hgb-7.6* hct-22.6* mcv-96 mch-32.1* mchc-33.6 rdw-16.6* plt ct-210 05:25am blood plt ct-210 11:54am blood pt-12.7 ptt-33.6 inr(pt)-1.1 05:02am blood glucose-88 urean-14 creat-1.1 k-4.3 02:16pm blood alt-21 ast-23 alkphos-51 totbili-0.2 id testing: 06:24am blood hiv ab-negative toxicology: blood: asa-neg ethanol-neg acetmnp-6.0 bnzodzp-neg barbitr-neg tricycl-neg urine bnzodzp-neg barbitr-pos opiates-neg cocaine-pos amphetm-neg mthdone-neg micro: blood cultures : positive for strept viridans blood cultures : no growth to date at time of discharge urine culture : negative images: mri/mra head w/o contrast (done at osh): multiple acute/subacute infracts with paramagnetic effect left temporal lobe and right parietal hemisphere suggestive of hemosiderin from hemorrhage. suggestion of petecheal hemorrhage was also noted on recent head ct. the multiplicity of infarcts is suggestive of embolic source. there is gradual narrowing of the m2 segment of the left middle cerebral artery with paucity of signal involving cistal branch vessels. findings are consistent with hemodynamically significant stenosis and probable distal occlusion there is no evidence of aneurysm or high flow avm. mra brain w/o contrast : occlusion of an m2 branch of the left middle cerebral artery with attenuation of distal mca branches and acute ischemia in the left posterior mca territory consistent with acute infarction. additional foci of restricted diffusion as described above along with several punctate foci of enhancement and susceptibility artifact are suggestive of an embolic process. enhancement may be secondary to septic emboli or subacute infarction. bas/ugi air/sbft : normal upper gi esophagram and normal hypopharynx without evidence of zenker's diverticulum, dysmotility, ulcers, or strictures. additional studies: tte : compared to the findings of the prior study of , left ventricular cavity size has increased and systolic function has deteriorated. the previously seen large posterior mitral leaflet vegetation has probably decreased in size while the anterior vegetation has probably increased in size. however, direct comparison of vegetation size can be inaccurated with tte. moderate to severe mitral regurgitation persists. egd : negative for any obstruction or ring/web of esophagus log-in date/time: 11:46 am tissue site: valve-bicuspid (mitral) leaflets. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. tissue (final ): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): acid fast smear (final ): no acid fast bacilli seen on direct smear. log-in date/time: 9:44 am tissue mitral valve vegetation tissue. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. tissue (final ): no growth. anaerobic culture (preliminary): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. fungal culture (preliminary): acid fast culture (preliminary): echocardiography report-intraop date/time: at 11:48 interpret md: , md, md echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.8 cm <= 4.0 cm left ventricle - diastolic dimension: *6.4 cm <= 5.6 cm left ventricle - systolic dimension: 5.4 cm left ventricle - fractional shortening: *0.16 >= 0.29 left ventricle - ejection fraction: 50% >= 55% findings left atrium: moderate la enlargement. right atrium/interatrial septum: pfo is present. left-to-right shunt across the interatrial septum at rest. left ventricle: normal lv wall thickness. moderately dilated lv cavity. normal regional lv systolic function. low normal lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. normal descending aorta diameter. aortic valve: three aortic valve leaflets. no as. no ar. mitral valve: mildly thickened mitral valve leaflets. mild mvp. severe (4+) mr. tricuspid valve: no tr. pulmonic valve/pulmonary artery: no pr. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. see conclusions for post-bypass data the post-bypass study was performed while the patient was receiving vasoactive infusions (see conclusions for listing of medications). conclusions pre-bypass: the left atrium is moderately dilated. a patent foramen ovale is present. a left-to-right shunt across the interatrial septum is seen at rest. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50%). right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is mild mitral valve prolapse of the p3 scallop. annulus is enlarged to 4.5 cm. an echo dense mass ( vegetation vs. torn chordae) seen attached to the p3 scallop. severe (4+) mitral regurgitation is seen. post-bypass: for the post-bypass study, the patient was receiving vasoactive infusions including phenylephrine and is in sinus rhythm. 1. an annuloplasty is seen well seated in the mitral position. leaflets open well. no mr is seen. mean gradient of 3 mm of hg across the valve. 2. ventricular function is unchanged. 3. no flow is detected across the ias by color flow doppler. 4. aortic contours appear intact post decannulation dr. was notified in person of the results. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, md, interpreting physician 12:03 radiology report chest (portable ap) study date of 11:40 am medical condition: 39 year old man cad/post pull final report history: chest tube removal, to evaluate for pneumothorax. findings: in comparison with the earlier study of this date, there is little overall change. no evidence of pneumothorax. left picc line remains in place and the paramediastinal drain has been removed. bilateral small pleural effusions and basilar atelectasis is again seen. dr. brief hospital course: mr. is a 39 year old male with a history of mitral valve endocarditis and iv drug use presenting with word finding difficulties and new infarctions on brain mri. the patient presented with expressive aphasia and was found to have multiple t2 hyperintense lesions in the l temporal and r parietal lobes on mri suggestive of an embolic process. he has a history of infectious endocarditis, for which has has been treated on three occassions in the past, and had a holosystolic mitral murmur at apex on exam. blood culture from came back positive for streptococcus viridans. tee and tte showed evidence of mitral valve vegetations and moderate to severe mitral regurgitation. he was started on vancomycin and gentamicin, later changed to penicillin g (1st day was ) and gentamicin once blood cultures came back positive for strep viridans. the patient tested positive for hepatitis c, so serum hepatitis a antibody and hepatitis b surface antibody were both assessed and found to be positive. he was counseled about getting long-term treatment for hepatitis c as an outpatient. additionally, because of difficulty passing the tee probe during his work-up, mr. had a ugi/sbft and egd, both of which were unremarkable. dental saw mr. during his hospital stay and recommended that dental prophylaxis, completion of a previously started root canal at the left anterior maxilla, and extraction of #32. oral surgery performed extraction of #13 & #32 on without complication. repeat tte showed increased lv size and deterioration of systolic function compared to tte done , and ct recommended mitral valve replacment. ct abdomen/pelvis demonstrating a non-specific splenic edge hypodensity which was non-specific, and a clean cardiac catheterization on . he completed his antibiotic regimen as an inpatient and was sent to surgery on . please see operative report for details, in summary the patient had a mitral valve repair with a p3 posterior leaflet triangular resection and 30-mm profile 3-d ring annuloplasty. resection of left atrial appendage, and closure of patent foramen ovale. his bypass time was 86 minutes with a crossclamp of 67 minutes. he tolerated the operation well and was transferred to the cardiac surgery icu in stable condition. in the immediate post operative period he was hemodynamically stable, his anesthesia was reversed he was weaned from the ventilator and extubated. the following day he was transferred from the icu to the stepdown floor for continued care and recovery. all tubes lines and drains were removed per cardiac surgery protocols. he was started on bblockers and diuretics and activity was gradually advanced. the patient remained on penicillin coverage until the cultures from the operating room were finalized as negative. on pod 4 he was cleared for discharge home with visiting nurses. medications on admission: none discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 2. 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* 3. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. multivitamins tablet, chewable sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*45 tablet(s)* refills:*0* 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*30 capsule(s)* refills:*2* discharge disposition: home with service discharge diagnosis: 1. endocarditis 2. bacteremia 3. mitral regurgitation s/p mitral valve repair(30mm cefuture ring) pfo closure, laa ligation 4. stroke of l mca discharge condition: activity status:ambulatory - independent mental status:clear and coherent level of consciousness:alert and interactive hemodynamically: stable wound: healing well, no erythema or drainage discharge instructions: you were admitted to the hospital because you had an infected heart valve, bacteria in your blood, and septic emboli to your brain. an mri showed that you had a stroke and several small areas of bleeding in your brain. these findings explain your difficulty speaking upon presentation to the hospital. a blood culture grew a bacteria called streptococcus viridans. you had an echocardiogram that showed bacteria growing on your mitral valve, and dysfunction of the mitral valve called mitral regurgitation. cardiothoracic surgery repaired your mitral valve. it is also important that you follow-up with your dentist regarding dental procedures as you will require antibiotics each time you need dental work. please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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 until follow up with surgeon no lifting more than 10 pounds for 10 weeks please call with any questions or concerns danger signs: when to call 911 you should call 911 or your local emergency number to be taken to the nearest emergency room for any emergency situation, such as: * chest pain not related to your incision or angina pain, similar to the pain you had prior to surgery * extreme shortness or breath or difficulty breathing * severe bleeding, especially if you are on warfarin (coumadin) * fainting, severe lightheadedness or changes in mental status when to call your surgeon call your surgeon ( (24 hours a day, seven days a week) if any of the following occur: * your incision is warm, red or swollen or there is increased tenderness or pain * any of your incisions have any fluid or drainage coming out * you have a fever of 100.5 degrees fahrenheit or higher * your weight has gone up more than two pounds in one day or five pounds in a week * you have severe pain or increased swelling in either leg * you have palpitations * you feel dizzy or weak (if severe, call 911) followup instructions: clinic in 2 weeks. appointment to be scheduled before discharge dr on (tues)@1pm dr , r in 2 weeks. please call for appointment procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization other and unspecified repair of atrial septal defect extraction of other tooth open heart valvuloplasty of mitral valve without replacement excision, destruction, or exclusion of left atrial appendage (laa) diagnoses: anemia of other chronic disease tobacco use disorder mitral valve disorders unspecified viral hepatitis c without hepatic coma cocaine abuse, unspecified anxiety state, unspecified bacteremia ostium secundum type atrial septal defect old myocardial infarction acute and subacute bacterial endocarditis personal history of urinary calculi cerebral embolism with cerebral infarction streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus aphasia opioid abuse, unspecified other specified hypotension cardiomegaly septic arterial embolism acute apical periodontitis of pulpal origin other ill-defined heart diseases disease of spleen, unspecified 

Answer: The patient is high likely exposed to