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: past medical history: 1. copd. 2. hypertension. 3. end-stage renal disease. 4. congestive heart failure with an ejection fraction of 25% on an echocardiogram done in , inferior lateral wall motion abnormalities, mitral regurgitation, and severe aortic stenosis. 5. bph. 6. cholecystectomy. allergies: the patient is allergic to bactrim and sulfa. admission medications: 1. prednisone. 2. pepcid. 3. rofecoxib. 4. docusate. 5. vitamin e. 6. quinine. 7. glucotrol 5 mg p.o. q.d. 8. nephrocaps. social history: the patient lives with his wife. reportedly has a 300 pack year smoking history. his primary care physician is . , whose telephone number is . physical examination on admission: vital signs: the patient's temperature was 103.8, heart rate 122, blood pressure 120/78, respiratory rate 24, and oxygen saturation 96% on room air. he was somnolent and in no acute distress. his head was normocephalic, atraumatic. perrl, and eomi. heart: there was a systolic ejection murmur, rating ii/vi at the right upper sternal border and iii/vi mitral regurgitation murmur was heard at the apex. pulmonary: there was decreased air movement throughout his lung fields on pulmonary auscultation; there were no crackles or rhonchi. abdomen: soft, nontender, nondistended, and there were decreased bowel sounds. rectal: no stool in the rectal vault. he had no clubbing, cyanosis or edema of his extremities. neurologic: difficult to assess due to the patient's somnolence. laboratory/radiologic data: the patient's white blood cell count was 7.7 (with a differential of 87% neutrophils, 7% lymphocytes and 6% monocytes), hematocrit 46.1, and platelet count of 159,000. his pt was 13.8, ptt 25.5, and inr 1.3. serum chemistries demonstrated a sodium of 133, potassium 5.7, chloride 90, bicarbonate 27, bun 21, creatinine 5.4, glucose 126, calcium 10.3, magnesium 1.9, and phosphate 3.2. his alt was 34, ast 46, amylase 87, alkaline phosphatase 105, total bilirubin 0.6, and albumin 4.0. initial ck was 59 and troponin 1.9. his initial ekg demonstrated sinus tachycardia at 118 beats per minute, normal axis, normal intervals, st segment elevations in leads v1 and v2 and t wave inversions in leads v4 through v6. this ekg was reportedly similar to an ekg that was obtained on . initial chest x-ray demonstrated a right-sided pleural effusion with cephalization of the vasculature consistent with congestive heart failure. an initial abg demonstrated a ph of 7.33, pc02 of 61, and p02 of 96 on 4 liters of oxygen by nasal cannula. initial head ct was negative for an acute process. initial lumbar puncture demonstrated 11,000 white blood cells in tube one and 850 red blood cells in the same tube. in tube two, there were 8,250 white blood cells, 575 red blood cells, glucose 26, and protein 635. hospital course: the patient's initial lumbar puncture was clear consistent with an infectious bacterial meningitis. the blood cultures that were obtained in the emergency department ultimately grew out alpha hemolytic streptococcus. on hospital day number six, the patient obtained a tee that demonstrated a small, mobile, and filamentous vegetation on the atrial surface of the anterior mitral valve leaflet. given this finding, in the context of the patient's bacteremia and meningitis, it was felt that the patient's primary source of infection was his bacteremia and endocarditis, and that he subsequently seated his meninges. it was felt that the patient's hypotension on admission was due to this overwhelming infectious process. as noted above, the patient was admitted to the micu. he was continued on ceftriaxone, and vancomycin and ampicillin were added for empiric antibiotic coverage initially. once his bacteremia was speciated as alpha hemolytic streptococcus, the ampicillin was discontinued. throughout the patient's hospitalization, the patient was managed in conjunction with the infectious disease service as well as the renal service for management of his hemodialysis. despite appropriate antibiotic coverage, and despite a brief period of improvement in the patient's mental status, his mental status remained poor throughout his hospitalization. on hospital day number four, a head ct scan was obtained to evaluate for possible etiology of his altered mental status. the study was limited by motion artifact but demonstrated no evidence of hemorrhage or mass affect, normal cisterns were seen. the paranasal sinuses were unremarkable. no enhancing lesions were seen. overall, this was felt to be a negative head ct scan. also, on hospital day number four, the patient had a repeat chest x-ray that demonstrated no new infectious process. he had a lumbar puncture done on that day; the results were consistent with resolving bacterial meningitis. by hospital day number five, the patient's levophed, which had been started on hospital day number one due to his pervasive hypotension, was discontinued, as the patient remained normotensive without any blood pressure support. a transthoracic echocardiogram was also done on hospital day number five. this study did not demonstrate any evidence of a vegetation but, as noted above, the patient had a tee done the next day that did demonstrate a mitral valve vegetation. also, on hospital day number six, the patient's bacteremia was identified as alpha hemolytic streptococcus, and at this time, his vancomycin was discontinued. on hospital day number six, an mri of the head was obtained to evaluate for possible etiology of the patient's persistently altered mental status. this study was also limited due to motion artifact but demonstrated no definitive evidence of an intracranial mass, mycotic aneurysm, or abnormal enhancement. on hospital day number seven, a repeat chest x-ray was obtained. this study raised the question of a possible new right middle or lower lobe pneumonia, so the patient was started on metronidazole for a coverage of a possible aspiration pneumonitis. on hospital day number eight, the patient had his third lumbar puncture, this time to rule out the possibility of communicating hydrocephalus. his opening pressure of made this possibility unlikely. by hospital day number ten, the patient's vital signs had been stable for several days, although his white blood cell count remained persistently elevated. in addition, his mental status remained poor. the patient was intermittently agitated. he was also persistently somnolent and difficult to arouse. in order to evaluate for possible etiologies of his ongoing altered mental status, an abdominal ct scan was obtained on hospital day number ten. this study demonstrated bilateral pleural effusions on the right greater than on the left associated with compressive atelectasis. also seen were a few small areas of hypodensity peripherally within the spleen, likely related to early mixing, although septic emboli could not be excluded as delayed images were not obtained. in addition, multiple sigmoid diverticula with apparent evidence of diverticulitis were seen. given the patient's history, these diverticuli were thought to be possibly related to ischemia. finally, smooth, colonic, intraluminal wall thickening of the cecum was seen. in addition, an mri scan of the head and spine was obtained on hospital day number ten given the patient's ongoing altered mental status. this study demonstrated small, bilateral, subdural effusions which could be related to the patient's history of meningitis. also seen were mildly prominent ventricles. cervical spinal mri was limited due to motion artifact but demonstrated multiple levels of degenerative changes without spinal stenosis, external cord compression, or extrinsic scarring. in the context of these new findings, as well as given his persistently elevated white blood cell count and altered mental status, the patient's antibiotics were broadened to piperacillin/tazobactam on hospital day number 12. overall, despite exhaustive imaging studies, as noted above, as well as extensive laboratory evaluations, no clear etiology of the patient's persistently altered mental status was obtained at any point. on hospital day number 13, the patient's blood pressure began to drop. his systolic blood pressure ranged from 65-100 throughout the afternoon, but remained at a level of 65 after a total of 750 milliliters of intravenous fluid via bolusing. when the patient's systolic blood pressure remained low following these intravenous fluid boluses, the available treatment options were reviewed at length with the patient's family. the possibility of pursuing full resuscitative efforts, including cpr with pressors versus maintaining the patient's dnr/dni status with pressors, versus continuing the current level of care with intravenous antibiotics, intravenous medications, tube feeds, and intravenous fluids as needed for blood pressure support were all reviewed with the family. after a lengthy consideration, the family elected to withdrawal all medical care except for any measures that might ensure the patient's comfort. the family indicated that they felt that they were acting in accordance with the patient's wishes. as a result, on hospital day number 13, all medications were withdrawn, as noted above. the only medications that were continued were to ensure the patient's comfort. he then died on hospital day number 14. time of death was 22:50. discharge diagnosis: 1. endocarditis due to alpha hemolytic streptococcus. 2. alpha hemolytic streptococcus bacteremia. 3. secondary bacterial meningitis. 4. sepsis. 5. persistently altered mental status. 6. chronic obstructive pulmonary disease. 7. hypertension. 8. end-stage renal disease, on hemodialysis. 9. congestive heart failure with an ejection fraction of 25%. 10. mitral regurgitation. 11. severe aortic stenosis. , m.d. dictated by: medquist36 procedure: spinal tap incision of lung diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances hemodialysis diagnoses: rheumatic heart failure (congestive) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease pneumonitis due to inhalation of food or vomitus bacteremia mitral valve insufficiency and aortic valve stenosis acute and subacute bacterial endocarditis encounter for palliative care diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled streptococcal meningitis 

Answer: The patient is high likely exposed to