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: ativan attending: chief complaint: confusion, ataxia, neck pain, headache, fever major surgical or invasive procedure: mechanical intubation ij, femoral line picc, right arm history of present illness: 74 y/o diabetic man with avr, cad, chf (? 30% ef) who was in usual state of health until 1 wk pta developed uri symptoms of cough, rhinorrhea, mild neck pain. was improving but 3 days pta he developed increasing confusion, more severe neck pain, headache and fever. wife brought him into ed where he was found to be febrile t101, hypotensive 87/55 responsive to fluids -> 106-130/70-90's, ill but a&o x3. blood cx, head ct w/o contrast, lp. head ct neg for acute cva, lp unsuccessful (s/p spine surgery). received ctx 2g q12h, vanc 1g q12h, acyclovir 1g q8 (small erythematous crust on lips noted). admitted to neeham icu, then transferred to floor for further managment. past medical history: dm-2 avr (, ) cad htn hypercholesterolemia hypothyroidism chronic back pain - spinal stenosis (s/p back surgery ) copd, osa on cpap and home o2 restless leg syndrome social history: married lives at home, has 2 daughters. retired salesman and marine. + smoking history family history: noncontributory physical exam: (according to emergency dept record) vs: t101 bp 87/55 p100 rr20 spo2 92% ga: slightly ill heent: neck supple. op wnl chest: bibasilar rales heart: tachycardic, s2 mechanical click, ii/vi sem abd: soft, nt, nd gu: no cvat ms: no c/c/e skin: no rash, no petechiae neuro: a&ox3, cn ii-xii intact. motor . gait not tested pertinent results: 05:00pm blood wbc-16.6*# rbc-5.12# hgb-15.3# hct-45.0# mcv-88 mch-29.9 mchc-34.0 rdw-14.6 plt ct-311# 02:00am blood wbc-8.5 rbc-3.81*# hgb-10.9*# hct-32.9*# mcv-86 mch-28.6 mchc-33.1 rdw-14.5 plt ct-206 01:54am blood wbc-11.5* rbc-3.83* hgb-10.8* hct-34.2* mcv-89 mch-28.2 mchc-31.6 rdw-14.5 plt ct-282 03:36am blood wbc-8.8 rbc-3.75* hgb-10.6* hct-32.6* mcv-87 mch-28.3 mchc-32.5 rdw-14.6 plt ct-288 05:40am blood wbc-5.3 rbc-3.67* hgb-10.3* hct-32.4* mcv-88 mch-28.1 mchc-31.8 rdw-15.0 plt ct-217 05:00pm blood neuts-81* bands-3 lymphs-5* monos-10 eos-0 baso-0 atyps-0 metas-1* myelos-0 02:00am blood neuts-83.5* lymphs-11.0* monos-5.0 eos-0.3 baso-0.2 04:05am blood neuts-82.5* lymphs-9.7* monos-4.8 eos-2.5 baso-0.5 05:00pm blood pt-30.7* ptt-31.3 inr(pt)-6.2 05:00pm blood plt smr-normal plt ct-311# 05:40am blood plt ct-217 05:40am blood pt-21.6* inr(pt)-3.1 05:00pm blood fibrino-800* 01:54am blood esr-53* 05:00pm blood glucose-173* urean-32* creat-1.1 na-143 k-5.0 cl-104 hco3-24 angap-20 02:00am blood glucose-129* urean-31* creat-0.9 na-145 k-4.1 cl-109* hco3-29 angap-11 05:40am blood glucose-109* urean-15 creat-0.9 na-138 k-3.7 cl-99 hco3-32* angap-11 05:00pm blood alt-45* ast-46* alkphos-123* totbili-1.8* 01:54am blood alt-7 ast-22 alkphos-23* totbili-0.2 05:00pm blood calcium-8.7 phos-4.2 mg-2.1 04:15am blood tsh-1.7 11:44pm blood cortsol-25.4* 02:00am blood cortsol-47.2* 04:42pm blood type-art po2-86 pco2-57* ph-7.28* calhco3-28 base xs-0 07:01pm blood type-art po2-263* pco2-58* ph-7.30* calhco3-30 base xs-1 09:15pm blood type-art temp-37.6 rates-14/ tidal v-700 peep-5 o2-70 po2-221* pco2-59* ph-7.31* calhco3-31* base xs-1 -assist/con intubat-intubated 08:19am blood type-art po2-63* pco2-49* ph-7.47* calhco3-37* base xs-10 04:42pm blood lactate-2.3* k-5.1 09:15pm blood lactate-1.7 brief hospital course: 1. strep viridans prosthetic valve endocarditis: at , became more confused, hypoxic, with ph=7.23. transferred to micu where he was intubated for increasing respiratory distress. became hypotensive --> pressors. neck ct () decmonstrated 8mm oval l cerebellar lesion. repeat head ct on and then on demonstrated same nonenhancing lesion unchanged from involving the cerebellar peduncle with some extension into the pons. bl cx positive x2 sets for strep viridans pcn, mic <0.1. the patient's antibiotic regimen included ctx and gentamycin. bl cx in from remained negative. tee was performed twice with no demonstration of any vegetations. the patient remained mildly febrile with a normal wbc until he was switched from ctx to pcn g 4mu q4h after which his fever dissipated. pt improved, was hemodynamically stable and was extubated after a 5 day icu stay, then transferred to floor. he completed a 2 week treatment course of a beta-lactam and gentamycin. gentamycin was dosed for synergy. pcn g was add midway through the 2 wk treatment course. 2. delerium: on the floor remained delerious but with slow improvement. the etiology of his delerium was felt to be secondary to toxic-metabolic enchephalopathy (sepsis, cns toxic drugs), and icu psychosis. cns toxic agents were held, low dose risperidone 0.5 mg qhs was started to help reinstate an appropriate sleep-wake cycle, and ropinirole was given to minimize periodic leg movements (restless leg syndrome). evaluation of his delerium was complicated by the patient's unwillingness to cooperate with the neurologic and mental status exam secondary to frustration with the hospital staff and depression. the patient slowly improved until he was anwering questions appropriately and able to function without a sitter or need restraints. 3. prosthetic aortic valve, anticoagulation: pt was appropriately anticoagulated for avr without any complications. he remained with good cardiac function without any evidence of heart failure albeit on minimal activity. no significant changes in mumur characteristics or conduction were noted. 4. copd, osa on bipap: it was felt that the patient's respiratory distress was compounded by the patient's underlying chronic lung disease. oxygenation steadily improved until the patient was weaned off o2 during the day. required o2 with bipap machine while sleeping. 5. cerebellar infarct, septic embolus: mr. remained ataxic on his left side with a wide step gait and headaches at the base of his skull/neck. serial cts of the head with contrast demonstrated normal evolution of the infarct without evidence of a cerebellar abscess. pt and ot consultation and treatment was obtained and provided, however the patient will need extensive and long rehabilition for adequate recovery of motor function. 6. acute renal failure at the end of his hospital stay, mr. developed acute renal failure secondary to dehydration (based on calculated fena = 0.8%, physical exam findings consistent with dehydration and reversal of rising cr with rehydration). he was treated with increased po fluid intake and ivf. his baseline creatinine is 0.9. he is being discharged with a cr=1.6. mr will continue to require more fluids (intravenous fluids if possible, in addition to drinking at least 1 liter of fluid each day). his lisinopril, lasix, and metformin were held pending normalization of his renal function. the metformin can be restarted after the creatinine < 1.5 medications on admission: vanc ceftriaxone 2g q12h combivent iss zocor lasix captopril coumadin metformin synthroid asa discharge medications: 1. atorvastatin calcium 10 mg tablet sig: one (1) tablet po qd (once a day). 2. levothyroxine sodium 125 mcg tablet sig: one (1) tablet po qd (once a day). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. disp:*60 tablet(s)* refills:*0* 5. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed. 6. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 8. warfarin sodium 2 mg tablet sig: one (1) tablet po qod (every other day). disp:*15 tablet(s)* refills:*2* 9. warfarin sodium 1 mg tablet sig: three (3) tablet po qod (every other day). disp:*45 tablet(s)* refills:*2* 10. risperidone 1 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 11. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation qid (4 times a day). 13. pantoprazole sodium 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* 14. citalopram hydrobromide 20 mg tablet sig: one (1) tablet po qd (once a day). disp:*30 tablet(s)* refills:*2* 15. ropinirole hydrochloride 2 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 16. ropinirole hydrochloride 1 mg tablet sig: one (1) tablet po daily in am and afternoon (). 17. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours). 18. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). *****note!!!!: lasix 80mg po qd, lisinopril 5 mg po qd, and metformin 500mg po bid were held while patient was in acute renal failure due to dehydrattion. please contact his primary care physcian and see "hospital course section - acute renal failure" before restarting these medications. discharge disposition: extended care facility: rehab unit at - discharge diagnosis: prosthetic valve endocarditis, streptococcus viridans with cerebellar septic embolus septic shock cerebellar infarct restless leg syndrome diabetes mellitus - 2 hypertension hypothyroidism discharge condition: stable discharge instructions: drink at least 1 liter of fluids per day in order to rehydrate your body. do not restart your lasix, lisinopril or metformin until your physician instructs you to or until your serum creatinine is <1.0 (see hospital course section on "acute renal failure" for details. if possible give intravenous fluids in rehab hospital for better and quicker rehydration. avoid medications that contain anticholinergic agents (many cold and sleep medications) until mr. mental status is more stable. contact your physician if temperature >100, becomes very short of breath, becomes more confused. please check inr weekly for appropriate anticoagulation (inr=2.5-3.5) please ask your physician when it is appropriate to restart your lasix. some symptoms include shortness of breath, leg swelling (in both legs), water retention - manifested by weight gain. however, check with your primary care physician before restarting the medication. followup instructions: please contact the pulmonary function testing lab located in , . phone: ( to obtain an appointment for pulmonary function testing if you have not had this recently in the past. continue physical therapy, occupational therapy contact your primary care physician , ., md, phone: to make a follow up appointment once patient is transferred from hospital. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung diagnostic ultrasound of heart insertion of endotracheal tube fiber-optic bronchoscopy thoracentesis arterial catheterization diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified severe sepsis chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease septic shock acute and subacute bacterial endocarditis cerebral embolism with cerebral infarction streptococcal septicemia 

Answer: The patient is high likely exposed to