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: recurrent endocarditis major surgical or invasive procedure: redo sternotomy, aortic valve replacement(27 millimeter onyx mechanical valve), replacement of ascending aorta (24 millimeter gelweave dacron graft) history of present illness: mr. is a 25 year old male with recurrent endocarditis. back in , he underwent bentall procedure utilizing homograft along with vsd closure and debridement of aortic root abscess. unfortunately due to recurrent ivda, he developed recurrent endocarditis. blood cultures were positive for mssa. following a prolonged course of intravenous antibiotics and period of being drug free/drug rehab, he presented to for cardiac surgical intervention. his last heroin abuse was back in . past medical history: recurrent endocarditis, aortic root abscess, severe aortic insufficiency, congestive heart failue, intravenous drug abuser, prior homograft root replacement and vsd closure in , history of septic emboli to spleen, kidney and cerebrum in , history of hepatic pseudoaneurysm embolization in , history of bicuspid aortic valve - s/p aortic valvuloplasty at age 15 social history: quit tobacco 2 weeks prior to admission. admits to 8 pack year history of tobacco. denies etoh over the last year. he currently lives with his parents. family history: denies premature coronary artery disease physical exam: admission: vitals: t 98.2, bp 124/75, hr 80, rr 18, sat 97% on room air general: well developed male in no acute distress heent: oropharynx benign, neck: supple, no jvd, heart: regular rate, normal s1s2, holosystolic murmur lungs: clear bilaterally abdomen: soft, nontender, normoactive bowel sounds ext: warm, 1+ edema bilaterally, no varicosities pulses: 2+ distally(bounding) neuro: nonfocal discharge: vs t 97.5 hr 82 sr bp 115/80 rr 18 o2sat 97% on room air gen nad neuro a&ox3, non focal exam pulm cta- bilat cv rrr, sternum stable, incision with steri strips-cdi abdm soft, nt/nd/nabs rt groin incision with steri strips-cdi ext warm, trace edema pertinent results: admit chest x-ray: diffuse enlargement of the cardiac silhouette consistent with cardiomegaly and/or pericardial effusion. this appears to have increased since the prior examination. the lungs remain clear with no evidence of acute infiltrate, pleural effusion, or pneumothorax. brain mra: no enhancing lesions. encephalomalacia of the right parietal lobe from a prior infarct. minimal chronic microvascular ischemic changes. no acute infarct or evidence of mycotic aneurysm. cardiac catheterization: selective coronary angiography of this right dominant system demonstrated no significant epicardial cad. the lmca, lad, lcx, rca and their branches had no angiographically apparent disease. resting hemodynamics revealed systemic arterial central normotension. supraaortic aortography revealed severe ai. chest (pa & lat) reason: evaluate pleural effusions medical condition: 25 year old man s/p avr, asc ao replacement reason for this examination: evaluate pleural effusions study: pa and lateral chest, . history: 25-year-old man status post aortic valve replacement. evaluate pleural effusions. findings: comparison is made to the previous study from , and . the cardiac silhouette is markedly enlarged but stable since the previous studies. median sternotomy wires are identified. there is some streaky density seen at the left mid lung field consistent with subsegmental atelectasis. there is blunting of the left costophrenic angle consistent with a small pleural effusion. embolization coils are seen within the right upper quadrant. impression: cardiomegaly with likely a small left-sided pleural effusion. cardiology report echo study date of patient/test information: indication: intraoperative tee for re-do bental procedure status: inpatient date/time: at 13:55 test: tee (complete) doppler: full doppler and color doppler contrast: none tape number: 2007aw1-: test location: anesthesia west or cardiac technical quality: adequate referring doctor: dr. measurements: left ventricle - inferolateral thickness: 1.0 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: *9.2 cm (nl <= 5.6 cm) left ventricle - ejection fraction: 20% (nl >=55%) aorta - ascending: 2.8 cm (nl <= 3.4 cm) aorta - descending thoracic: 2.3 cm (nl <= 2.5 cm) interpretation: findings: left atrium: all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. pfo is present. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. severely dilated lv cavity. severe global lv hypokinesis. severely depressed lvef. lv wall motion: regional lv wall motion abnormalities include: basal anterior - hypo; mid anterior - hypo; basal anteroseptal - hypo; mid anteroseptal - hypo; basal inferoseptal - hypo; mid inferoseptal - hypo; basal inferior - hypo; mid inferior - hypo; basal inferolateral - hypo; mid inferolateral - hypo; basal anterolateral - hypo; mid anterolateral - hypo; anterior apex - hypo; septal apex - hypo; inferior apex - hypo; lateral apex - hypo; apex - hypo; right ventricle: dilated rv cavity. severe global rv free wall hypokinesis. aorta: focal calcifications in aortic root. focal calcifications in ascending aorta. normal descending aorta diameter. aortic valve: ?# aortic valve leaflets. mildly thickened aortic valve leaflets. aortic valve homograft (avr). abnormal motion of avr leaflets/discs. aortic valve vegetation/mass cannot be excluded. aortic root abscess. no as. severe (4+) ar. eccentric ar jet directed toward the anterior mitral leaflet. mitral valve: normal mitral valve leaflets. mild mitral annular calcification. trivial mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. 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 was under general anesthesia throughout the procedure. the patient appears to be in sinus rhythm. results conclusions: pre cpb a patent foramen ovale is present. the left ventricular cavity is severely dilated. there is severe global left ventricular hypokinesis. overall left ventricular systolic function is severely depressed. the right ventricular cavity is dilated. there is severe global right ventricular free wall hypokinesis. the number of aortic valve leaflets cannot be determined. patient is s/p aortic homograft placement in past. the aortic valve leaflets are mildly thickened. . motion of the aortic leaflets is abnormal. an aortic valve vegetation/mass cannot be excluded. an aortic annular abscess is seen. the largest abscess cavity is located along the non-coronary cusp. flow is seen into this cavity. there are other echolucencies consistent with perivalvular abscess seen nera both coronary artery takeoffs. there is no aortic valve stenosis. severe (4+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric, directed toward the anterior mitral leaflet. the mitral valve leaflets are structurally normal. trivial mitral regurgitation is seen. post cpb the patient is receiving infusions of milrinone, dobutamine, and norepinephrine. lv systolic function remains severely globally depressed. however, the inferior wall appears to be worse. the ef is perhaps 20%. rv systolic function is somewhat improved from the pre-cpb study. there is still at least moderate if not moderate to severe global hypokinesis. there is a bileaflet prosthesis in the aortic position. it is not well seen but it appears that both leaflets are opening. it appears well seated. there are fibrinous strands near the valve ring - ? signficance. there is trace to mild valvular ai, normal for this prosthesis. can not rule out a small perivalvular leak. there is no as. the abscess cavity near the native non-coronary cusp is still visible. there appears to still be flow into it. the pfo/asd remains. no other changes from pre-cpb. electronically signed by , md on 17:43 brief hospital course: in preperation for cardiac surgical intervention, mr. was admitted several days prior to undergo additional evaluation. brain mri/mra imaging was obtained which showed no acute infarct or evidence of mycotic aneurysm. it was however notable for encephalomalacia of the right parietal lobe from a prior infarct, and minimal chronic microvascular ischemic changes. blood cultures were also taken which remained negative. transthoracic echocardiogram was also obtained which confirmed severe aortic insufficiency. the left ventricle was severely dilated with mildly depressed left ventricular function. right ventriclular systolic function was likely depressed but hard to evaluate given the severity of tricuspid regurgitation which was +. there was 1+ mitral regurgitation and only trivial pulmonic insufficiency. on , he was taken to the operating room. prior to surgery, tee was performed which revealed severely dilated right and left ventricles with severely depressed right and left ventricular function. given these new findings, surgery was postponed and additional evaluation was performed, including potential cardiac transplantation. cardiac catheterization was obtained to exclude a possibility of a coronary embolus. angiography showed normal coronary arteries. he returned to the operating room on with contingency plan for rvad. in the operating room, dr. performed redo sternotomy along with aortic valve replacement and replacement of ascending aorta. surgery was successful and rvad was not required. following the operation, he was brought to the csru in critical condition, on multiple inotropes. for surgical details, please see seperate dictated operative note. within 24 hours, he awoke neurologically intact and was extubated. he maintained stable hemodynamics and weaned from inotropic support without difficulty. he was transfused with packed red blood cells to maintain hematocrit near 30%. his csru course was otherwise unremarkable and he transferred to the sdu on postoperative day two. the pain service was consulted to assist in the postoperative management of his incisional discomfort. he remained in a normal sinus rhythm. his heart failure regimen was optimized. wafarin was dosed for a goal inr between 2.0 - 2.5 given his mechanical aortic valve. he temporarily required heparin for a subtherapeutic prothrombin time. he spiked a fever on postoperative day four for which pan cultures were obtained and empiric antibiotics were given. he continued to make clinical improvements and was eventually cleared for discharge on postoperative day 12. medications on admission: atenolol 25 qd aspirin 81 qd lasix 40 qd kcl 40 qd suboxone - discontinued 1 day prior to admission discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): while taking narcotics. disp:*30 capsule(s)* refills:*0* 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:*0* 3. buprenorphine-naloxone 8-2 mg tablet, sublingual sig: one (1) tablet sublingual breakfast (breakfast). sig: 0.5 tablet qbreakfast. 4. buprenorphine-naloxone 8-2 mg tablet, sublingual sig: 0.5 tablet sublingual lunch (lunch). 5. buprenorphine-naloxone 8-2 mg tablet, sublingual sig: one (1) tablet sublingual qhs (once a day (at bedtime)). 6. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 7. hydromorphone 2 mg tablet sig: 1-2 tablets po q 2-3 hrs as needed: script for 15 tabs given to father . 8. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 9. carvedilol 25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* 10. warfarin 5 mg tablet sig: 2.5 tablets po once a day: please take 12.5 mg and and have inr checked for further dosing. disp:*90 tablet(s)* refills:*0* 11. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 12. furosemide 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 13. outpatient work pt/inr as needed results to dr. fax (. goal inr 2.5-3.0 for avr discharge disposition: home discharge diagnosis: recurrent endocarditis, aortic root abscess, severe aortic insufficiency, congestive heart failue, intravenous drug abuser, prior homograft root replacement and vsd closure in , history of septic emboli to spleen, kidney and cerebrum, history of bicuspid aortic valve - s/p aortic valvuloplasty at age 15 discharge condition: good discharge instructions: patient may shower, no baths. no creams, lotions or ointments to incisions. no driving for at least one month. no lifting more than 10 lbs for at least 10 weeks from the date of surgery. monitor wounds for signs of infection. please call with any concerns or questions. followup instructions: cardiac surgeon, dr. in weeks. dr. in weeks. dr. in weeks. please call for appt with local pcp and cardiologist procedure: extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization diagnostic ultrasound of heart diagnostic ultrasound of heart open and other replacement of aortic valve resection of vessel with replacement, thoracic vessels aortography transfusion of packed cells transfusion of other serum transfusion of platelets diagnoses: tobacco use disorder congestive heart failure, unspecified aortic valve disorders other specified cardiac dysrhythmias long-term (current) use of anticoagulants opioid abuse, unspecified cerebral embolism without mention of cerebral infarction complications of other specified transplanted organ 

Answer: The patient is high likely exposed to