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: levaquin / ativan / adhesive tape attending: chief complaint: respiratory failure major surgical or invasive procedure: placement of a 20-french percutaneous endoscopic gastrostomy tube rigid bronchoscopy black dumon tracheoscope percutaneous tracheostomy with 8-0 portex perfit tracheostomy history of present illness: mr. is a 73 y/o m hx prosthetic hip joint complicated by hemorrhage into joint, recently admitted on to osh for septic shock and s/p joint removal. he subsequently developed enterococcus bacteremia and possible aortic valve endocarditis and has been on ampicillin (day 1= ) and gent (day 1=). he was intubated this admission and remained difficult to wean (was extubated for 2 days last week, but required re-intubation), and he is now transferred for trach and peg. it was felt that he was hard to wean from vent due to volume overload despite trying lasix/albumin. also, some question of edematous vocal cords when seen by ent. his hospital course has also been complicated by elevated lfts and recent ruq u/s with dilated common bile duct. . per family, he has had a prolongued course since of hemorrage/hematoma into his replaced r hip which was surgically drained x 2. . on the floor, he is intubated and sedated. most history obtained from osh records and family past medical history: dm type 2 polyneuropathy paroxsysmal atrial fibrillation on coumadin cad s/p bypass htn gout s/p laminectomies r hip replacement hiatal hernia social history: drugs: none tobacco: 40 pack years, quit 20 years ago alcohol: quit 2 years ago, but heavy drinking in past family history: nc physical exam: tm 97.9 bp 120/70 hr 80 rr 18 with sat 100 on vac 600x18/12 5 0.3 general appearance: overweight / obese eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic, endotracheal tube, og tube cardiovascular: (pmi normal), (s1: normal), (s2: normal), (murmur: systolic) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: crackles : at bases, no(t) bronchial: , rhonchorous: ) abdominal: soft, non-tender, bowel sounds present, obese extremities: right: 3+ edema, left: 3+ edema, pulses intact skin: warm neurologic: follows simple commands pertinent results: 03:11pm type-art po2-203* pco2-46* ph-7.40 total co2-30 base xs-3 02:39pm glucose-102 urea n-42* creat-1.2 sodium-148* potassium-3.5 chloride-111* total co2-30 anion gap-11 02:39pm estgfr-using this 02:39pm alt(sgpt)-58* ast(sgot)-50* ld(ldh)-396* alk phos-244* tot bili-1.2 02:39pm lipase-37 02:39pm albumin-2.9* calcium-8.1* phosphate-3.3 magnesium-1.8 02:39pm wbc-8.1 rbc-3.29* hgb-10.4* hct-30.4* mcv-93 mch-31.6 mchc-34.1 rdw-19.2* 02:39pm neuts-93.3* lymphs-3.7* monos-2.3 eos-0.8 basos-0 02:39pm plt count-263 02:39pm pt-14.9* ptt-27.1 inr(pt)-1.3* portable ap chest impression: intubated, status post bypass surgery with cardiac enlargement, pulmonary congestive pattern indicating severe chf with bilateral pleural effusion. no pneumothorax. no previous films available for comparison. abdominal u/s impression: 1. equivocal, mild dilation of the common duct. no calculi identified in the common duct. 2. multiple small stones in the gallbladder neck, but no evidence of acute cholecystitis. 3. trace ascites. incidentally noted right pleural effusion. ekg atrial fibrillation with controlled ventricular response. right bundle-branch block. diffuse non-specific st segment abnormalities. no previous tracing available for comparison. echo the left atrium is markedly dilated. the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is moderate to severe global left ventricular hypokinesis (lvef = 30 %). there is no ventricular septal defect. the right ventricular cavity is dilated with severe global free wall hypokinesis. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. mild (1+) mitral regurgitation is seen. no masses or vegetations are seen on the tricuspid valve, but cannot be fully excluded due to suboptimal image quality. there is severe pulmonary artery systolic hypertension. no masses or vegetations are seen on the pulmonic valve, but cannot be fully excluded due to suboptimal image quality. there is no pericardial effusion. impression: no obvious vegetations; the right ventricle is severely hypocontractile and dilated if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. cta chest impression: 1. no central pulmonary embolus. 2. no bowing of the intraventricular septum to suggest increased right heart pressures. 3. large bilateral pleural effusions with associated relaxation atelectasis. 4. pronounced vascular calcifications including ubiquitous coronary artery calcifications. 5. pneumoperitoneum likely secondary to peg tube placement; correlate clinically. 6. moderate ascites hand xray two radiographs of the right hand demonstrate severe osteoarthritis of the first cmc joint. there is a comminuted fracture involving the middle phalanx of the fifth finger. there is soft tissue swelling overlying the fracture site. assessment is somewhat limited by radiopaque pulse oximeter and patient positioning. atherosclerotic calcifications are noted. overall mineralization is normal. no previous studies are available for comparison. brief hospital course: this is a 72 y/o m hx paf, cad s/p cabg, r hip replacement c/b joint enterococcus infection, sepsis, prolonged intubation transferred to for trach and peg. # respiratory failure: most likely multifactorial with volume overload, systolic failure, and deconditioning, body habitus. low suspicion for pulmonary infection at this point given lack of fever, leukocytosis, infiltrate on cxr. pt had tracheostomy and peg on . pt was diuresed approximately 5l over the hospital course. on sedation was lightened. pt was transitioned to psv with brief periods of mmv for apnea. on pt tolerated a trach mask for the majority of the day at 30-50% fio2. pt will need to continue with gentle daily diuresis on lasix 60mg iv bid prn, goal of returning to dry weight over next 2-3 weeks. . # septic joint/bacteremia: pt had antibiotic spacer placed in hip joint from osh. daily blood cultures revealed corynebacterium on that was felt to be a contaminant given that all other blood cultures were negative or pending at time of discharge. orthopedics was consulted regarding the hip joint and they felt that a joint replacement would be necessary at a later date. the pt was to follow-up as an outpatient. pt started ampicillin on and gentamicin on . pt completed 10-day course of gentamicin and will need to complete a 6-week course of ampicillin, last day of ampicillin will be . pt will be seen in follow up at clinic on at 1pm. . # possible endocarditis: pt underwent tee at the osh that revealed mobile vegetations on his aortic valve. he was started on ampicillin on and gentamicin on for enterrococcal bacteremia. pt completed a 10-day course of gentamicin and will need to complete a 6-week course of ampicillin. echo at did not reveal any obvious vegetations although it was a tte that was performed. given the vegetations seen on prior tee performed at the osh, pt will need to continue with a prolonged course of antibiotics. last day of ampicillin with be and pt will be seen in clinic on . . # elevated lfts/alk phos: per osh, had dilated cbd and possible stones. on exam, he did not appear to have fever, abdominal tenderness or signs of cholangitis. pt likely has intrahepatic cholestasis from severe illness. ruq at revealed mildy dilated cbd without evidence of choledocolithiasis or cholecystitis. lfts trended down throughout the hospital stay. . # paf: rate-controlled on metoprolol and anticoagulated with coumadin. inr at discharge was 1.8. pt had been dosed for 5 days with coumadin 5mg and was increased to 7.5mg on . inr on day of discharge was 2.5 and will need to monitored every mon, wed, friday while at rehab. . # htn: well controlled on metoprolol. . # cad: pt continued on asa, bb, statin. ace inhibitor was not started due to arf and unclear baseline. pt was not on an ace prior to admission but may benefit from one in the future. . # dm: pt on metformin at home but was held during hospital stay. pt should be continued on insulin sliding scale for coverage. . # gout: due to concern for gouty flare on left mcp, wrist and elbow, pt was started on prednisone 5mg daily and should complete the course on . he was continued on colchicine and allopurinol. . # cri: pt with slight increase in creatinine likely diuresis. creatinine was 1.4 on the day of discharge. . # fen: pt underwent peg placement on and was started on tube feeds without incident. pt should be continued on replete with fiber at 60ml/hr and 150cc of water every 8hrs for free water needs. . # dvt ppx: anticoagulated on coumadin with inr of 2.5 medications on admission: albuterol ipratropium allopurinol 200 mg daily colchicine 0.6 mg erythromycin insulin lactulose lansoprazole lidocaine patch metoprolol 50 mg qid nystatin powder senokot ampicillin 2 gm q6h day 1= gentamycin 90mg q12h day 1= tylenol diltiazem10 mg q3h fentanyl 25-50mcg propofol zofran discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. allopurinol 100 mg tablet sig: two (2) tablet po daily (daily). 6. insulin regular human 100 unit/ml solution sig: 1-8 units injection four times a day: please adjust per sliding scale. 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po q6h (every 6 hours). 8. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical qd (): please place for 12hrs then remove for 12hrs each day. 9. methadone 10 mg tablet sig: one (1) tablet po tid (3 times a day). 10. prednisone 20 mg tablet sig: one (1) tablet po daily (daily) for 2 days: last day . 11. warfarin 2.5 mg tablet sig: three (3) tablet po once daily at 4 pm. 12. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 13. ampicillin sodium 2 gram recon soln sig: one (1) recon soln injection q6h (every 6 hours). 14. lasix sig: sixty (60) mg intravenous twice a day as needed for diuresis goal neg 1-2l per day until back to dry weight, pls check creatinine daily. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: right hip infection s/p washout possible endocarditis respiratory failure secondary to volume overload/sepsis . secondary: right hand fracture cad s/p cabg paroxysmal atrial fibrillaition discharge condition: pt has tolerated short periods on trach mask at 50% fio2 and otherwise requiring mmv/pressure support on the ventilator. he intermittently responds to verbal commands, opens eyes spontaneously. discharge instructions: you were transferred from an outside hospital after admission with septic shock due to joint infection and prolonged intubation. on arrival to , you had a trach and g-tube placed. you have been diuresed with lasix and will need to continue with diuresis at rehab. you should continue the ventilatory wean and physical rehabilitation. . please make sure to continue the ampicillin until and keep all of your follow up appointments with orthopedics and infectious disease. . if you develop any new chest pain, worsening shortness of breath, mental status changes or any other general worsening of condition, please go to directly to the er. followup instructions: please call ( to schedule a follow-up appointment with the hand clinic on tuesday. . you have a follow up appointment with dr. in the clinic on at 1pm. . you have a follow up appointment with infectious disease clinic on friday 27th at 10:30am. please call with questions. . please call your pcp to schedule repeat echo in 1 month. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy diagnoses: other primary cardiomyopathies congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified gout, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status systolic heart failure, unspecified bacteremia long-term (current) use of anticoagulants unspecified accident streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] hyperosmolality and/or hypernatremia unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure leukocytosis, unspecified chronic respiratory failure hip joint replacement endocarditis, valve unspecified, unspecified cause dependence on respirator, status infection and inflammatory reaction due to other internal orthopedic device, implant, and graft edema closed fracture of middle or proximal phalanx or phalanges of hand closed fracture of distal phalanx or phalanges of hand 

Answer: The patient is high likely exposed to