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: penicillin g attending: chief complaint: 49 m healthy male at , found to have blood cultures with staphylococcus bacteremia. on tte mitral valve vegetations were seen along withs severe mr leaflet. patient being transferred to for ct surgery evaluation and further management. major surgical or invasive procedure: mitral valve replacement(29mm st. mechanical valve) with debridement of aortic valve history of present illness: 49 m heavy smoker presented to er with fever, fatigue and malaise on of 3 days duration. he was febrile to 101.5 in er with hr 140s, bp 104/44, rr 22, 90% ra. on labs wbc 16 with 35% bandemia, plt 79, hct 51. he was admitted on friday night and developed a fever to 101.6 and visual changes which prompted a ct head which showed small infarct in the anterior and posterior circulation suspicious for septic emboli. during this time his blood cultures from the er came back with 4/4 bottles positive for staph aureus. he underwent a tte which showed large vegetation on the mitral valve and leaflet with severe mr. has been on vancomycin, ctx, and levofloxacin. the patient was transferred to the icu on saturday for hypotension, tachycardia and had a sc triple lumen catheter placed under sterile conditions and is on levophed for support. he was ruled out for influenza. on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. echocardiogram showed severe mr posterior leaflet. some hazy densities seen on the mitral valve, while not entirely clear that they are vegetations,in the setting of his clinical picture, most likely he has endocarditis. cardiac surgery consulted for mitral valve replacement/aortic valve debridement. past medical history: diabetes dyslipidemia hypertension *note: patient had not seen a physician for many years prior to current admission social history: lives with wife - history: 1.5-2 ppd for last 30 years -etoh: 3-4 beers daily -illicit drugs: none family history: brother had myocardial infarct in 50s. physical exam: general appearance: anxious eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic lymphatic: cervical wnl, supraclavicular wnl, cervical adenopathy cardiovascular: (pmi hyperdynamic), (s1: normal), (s2: normal), (murmur: systolic), holosystolic murmur iv/vi heard best at apex 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 : r>l) abdominal: soft, non-tender, bowel sounds present extremities: right lower extremity edema: absent, left lower extremity edema: absent, petechiae and lesions musculoskeletal: lesion on upper ext skin: warm, rash: upper and lower ext, occ petechiae neurologic: attentive, follows simple commands, responds to: verbal stimuli, oriented (to): x3, movement: purposeful, tone: decreased pertinent results: admission labs : 04:22pm wbc-19.4* hgb-15.3 hct-46.4 plt ct-122 04:22pm neuts-77* bands-10* lymphs-5* monos-2 eos-1 basos-0 atyps-4* metas-0 myelos-0 plasma-1* 04:22pm glucose-130* urea n-8 creat-0.4* sodium-131* potassium-3.6 chloride-98 total co2-24 anion gap-13 04:22pm alt(sgpt)-46* ast(sgot)-49* ld(ldh)-593* ck(cpk)-142 alk phos-64 tot bili-0.5 04:22pm ck-mb-7 ctropnt-0.28* 04:51pm lactate-1.6 u/a: 09:23pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-1 ph-6.0 leuk-neg 09:23pm urine rbc-21-50* wbc-* bacteria-mod yeast-none epi-0\ other pertinent labs: lipid panel: total chol-92 tg-120 hdl-18 ldl-50 hba1c 5.6 fibrinogen 861 -> 650 haptoglobin 217 d-dimer 1765 tsh 1.3 microbiology: : 1 of 4 bottle: staph aureus coag +.sensitivities: clindamycin <=0.25 s; erythromycin <=0.25 s; gentamicin <=0.5 s; levofloxacin <=0.12 s; oxacillin 0.5 s; trimethoprim/sulfa <=0.5 s - : blood cx negative : r elbow bursa cx negative , , : urine cx negative , , : feces negative for c.difficile toxin a & b by eia. imaging: cxr: severe emphysema, bilateral pleural effusions, and adjacent atelectasis. ct head w/o contrast: suboptimal study due to motion. multiple bilateral and supra- and infratentorial hypodense foci, of varying size and degree of definition. in this setting, these very likely represent embolic infarcts from a central source, of varying ages. there is no evidence of hemorrhagic conversion echo: the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. there is a probable (very small) vegetation on the aortic valve. no aortic regurgitation is seen. there is moderate/severe mitral valve prolapse (predominantly posterior leaflet). there is probably partial mitral leaflet of the posterior leaflet. there is a probable vegetation on the mitral valve. an eccentric, anteriorly directed jet of moderate to severe (3+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion ct abdoman: bilateral wedge-shaped defects of the renal parenchyma concerning for septic emboli in the setting of endocarditis. 3.o cm lesion in the mid right kidney is likely a phlegmonous area. renal vessel patency cannot be assessed due to suboptimal bolus timing and patient motion. 2. unchanged bilateral pleural effusions and adjacent atelectasis. 3. ascites and anasarca. 4. tiny foci of air in the urinary bladder, which may be due to instrumentation. r elbow xray: elbow joint effusion, no radiographic evidence of osteomyelitis : cta head/neck: 1. multifocal evolving infarcts, with the most significant interval change representing a progressive large left posterior cerebral artery infarct. 2. slightly attenuated left posterior cerebral artery without focal abnormality or intracranial aneurysm or vascular malformation. 3. it should be noted that cta is not an ideal method for evaluation of mycotic aneurysms. minor vascular abnormalities of vessels distal to the circle of can be better evaulated with conventional angiography. ct head: no acute hemorrhage. evolving multifocal infarcts. no new areas of hypodensity to suggest a new infarct ct abd/pelvis: 1. limited study due to lack of intravenous contrast. the known renal parenchymal defects concerning for infarcts are not well evaluated on this study. 2. no evidence of intra-abdominal or pelvic abscess. 3. increased bilateral effusion with underlying atelectasis. ascites and anasarca. 4. nonobstructing 2-mm right lower pole renal calculus. 5. air in the urinary bladder, which may be due to instrumentation. 6. distended, fluid filled rectum could this explain the patient's symptoms : tee: 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. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. there is a small mobile mass (< 0.5 cm) on the lv side of the aortic valve. trace aortic regurgitation is seen. there is a large mobile vegetation on the anterior leaflet at the base of the mv (a1 scallop), junction . this area is opposite the aortic root. no mitral valve abscess is seen. an eccentric, anterior directed jet of severe (4+) mitral regurgitation is seen. cardiac cath: comments: 1. selective coronary angiography of this right-dominant system revealed single-vessel and branch vessel coronary artery disease. the lmca, lcx, and lad had no significant stenoses. the rca had a 50% mid-vessel stenosis. the first diagonal branch of the lad had a 70% mid-vessel stenosis. 2. limited resting hemodynamics demosntrated normal central aortic pressures. final diagnosis: 1. single-vessel and branch vessel coronary artery disease. mri spine: cta head: brief hospital course: 49 m found to have staphlyococcus aureus bacterial endocarditis with severe mitral regurgitation secondary to mitral valve vegetations and leaflet. hospital course complicated by sepsis, multiple cerebral and renal infarcts. # mitral valve staphylococcus aureus endocarditis/ sepsis staphylococcus aureus bacteremia: bcx grew out mssa, c/x neg since . echo (tte and tee) showed large vegetation on mitral valve and small vegetation on aortic valve. the patient has been treated primarily with nafcillin 2g q4h. abx were broadened briefly to vanc/cefepime/flagyl, but discontinued as there was no evidence of superimposed hospital acquired infection. the patient had multiple emoblic events, with neurologic deficits including left sided facial droop, right sided neglect, right sided hemiparesis, expressive aphasia, some of which have improved during hospitalization. the patient had several teeth extracted by oral surgery. mr spine showed no evidence of epidural abscess. cta head showed no evidence of mycotic aneurysms. risk of hemorrhagic conversion is thought to be significantly reduced after the first three days. pt already has multiple reasons for urgent valve repair and has been preopoeratively optimized. he was taken to surgery on and underwent mitral valve replacement (# 29mm st. mechanical valve)/debridement of aortic valve with dr.. cross clamp time= 95 minutes. cardiopulmonary bypass time= 112 minutes. pt was transferred to the cvicu intubated, sedated, in critical but stable condition requiring neo and milrinone to optimize cardiac output and index. drips were weaned off and aspirin, beta-blocker started. postoperative paroxysmal atrial fibrillation was treated with amiodarone and anticoagulation. he was transfused packed red blood cells for moderate anemia with a hematocrit of 24. chest ct scan done postoperatively to rule out bleed. acute renal failure preop persisted postop. lasix drip initiated for oliguria, with good response and gradual resolution. pod# 3 mr. was weaned to extubation without difficulty. lines and drains were discontinued when criteria met. picc line inserted for long term antibiotics per id. postoperatively surveillance cultures were monitored, id,neuro and opthalmology continued to follow. nafcillin 2gram iv every 4 hours to continue until follow up with clinic. physical therapy/occupational therapy was consulted for evaluation of strength and mobility. anticoagulation with heparin and coumadin was initiated for inr goal 2.5-3.5 for mechanical mitral valve. #preoperative loose stools: pt had loose stools since admission. cdiff negative x3. the patient was treated empirically with iv flagyl and po vanc. flagyl was discontinued, but pt was continued on po vanc. course completed at the time of discharge. he was afebrile and wbc was within normal limits. diarrhea was improving at the time of discharge with the addition of tincture of opium titratated to effect. #preoperative neurological deficits ?????? neurological deficits continue to improve. pt regained ability to move all four extremities. postoperative head ct scan showed no intracranial hemmorrhage. neurology signed off. - future mri head, optic nerves recommended per neuro. #preoperative delirium ?????? pt agitated,requiring standing dose of haldol. psychiatry consulted preop-followed postop. avoid narcotics once extubated- avoid benzodiazapenes. - f/u psych recs - cont standing po haldol with prn haldol #preoperative respiratory distress ?????? intubated preop for pulm edema seen on cxr.diuresis initiated preop and continued postop. #preoperative acute renal failure - creatinine bumped >2.0 (baseline 0.4). multifactorial etiology for arf in setting of multiple renal infarcts, gentamycin use, contrast load and low co from mr. postoperatively his creatnine came down and is currently 1.9. #preoperative olecranon bursistis s/p washout ?????? no evidence of infection as per or report and initial gram stain. wound vac in place, changed . well-healing wound as per ortho. # preoperative hypotension ?????? secondary to sepsis/ low cardiac output. pt weaned off levophed , but restarted on . pt also given ivf and milrinone to improve uop. #preoperative hypoalbuminemia ?????? poor nutrition. dobhoff placed , tube feeds started. postoperatively mr. was npo. after extubation, pod# 4 speech and swallow evaluated for oral and pharyngeal dysphagia.he was receiving assisted feeds until his mental status prevented appropriate po intake and concern for aspiration. pod #7 he failed a video swallow. discussion with wife and team to determine need for peg placement. tpn started until peg placed. on pod # 10 he had a peg placed for nutrition. he was tolerating tube feeds at goal at the time of discharge. #on pod 17 he was ready for transfer to rehabilitation for further increase in strength and mobility. all follow up appointments were advised. medications on admission: none none discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for temperature >38.0. 2. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for itching. 5. warfarin 1 mg tablet sig: one (1) tablet po daily (daily). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. haloperidol 1 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 8. therapeutic multivitamin liquid sig: five (5) ml po daily (daily). 9. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 10. haloperidol 1 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 11. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 12. opium tincture 10 mg/ml tincture sig: ten (10) drop po q4h (every 4 hours) as needed for diarrhea. 13. ranitidine hcl 15 mg/ml syrup sig: one (1) po daily (daily). 14. albuterol sulfate 0.63 mg/3 ml solution for nebulization sig: one (1) inhalation q6h prn as needed for dyspnea/wheezing. 15. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q6h prn as needed for wheezing. 16. nafcillin in d2.4w 2 gram/100 ml piggyback sig: one (1) intravenous q4h (every 4 hours): continue until clinic follow up-appointment . 17. hydralazine 20 mg/ml solution sig: one (1) injection q6h (every 6 hours) as needed for sbp > 140. 18. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed for nausea. 19. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution sig: one (1) intravenous asdir (as directed): ptt goal 50-70 or until inr therapeutic >2.5. 20. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 21. haloperidol lactate 5 mg/ml solution sig: one (1) injection tid (3 times a day) as needed for agitation/delirium. 22. furosemide 10 mg/ml solution sig: one (1) injection (2 times a day). 23. potassium chloride 20 meq/50 ml piggyback sig: one (1) intravenous prn (as needed). 24. magnesium sulfate 4 % solution sig: one (1) injection prn (as needed) as needed for mg <2.0. discharge disposition: extended care facility: discharge diagnosis: mssa septicemia mitral valve endocarditis/mitral valve regurgitation septic emboli acute renal insufficiency olecranon bursitis clostridium difficile colitis discharge condition: ambulating, gait steady sternal pain managed with percocet prn discharge instructions: 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 **vac change to right upper extremity every 3-4 days at rehab, vac suction to 125mmhg **weekly cbc with diff/bun/creatnine/lfts-fax results to clinic followup instructions: please call to schedule appointments -surgeon dr in 4 weeks -primary care dr in weeks -cardiologist dr : in weeks:# -dr., opthalmology: in 2 weeks: # - ,np-orthopedics: in 2 weeks # -dr. : clinic # **vac change to right upper extremity every 3-4 days at rehab, vac suction to 125mmhg **weekly cbc with diff/bun/creatnine/lfts-fax results to clinic md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters parenteral infusion of concentrated nutritional substances left heart cardiac catheterization diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] open and other replacement of mitral valve open heart valvuloplasty of aortic valve without replacement other surgical extraction of tooth repair of blepharoptosis by tarsal technique bursectomy diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified anemia, unspecified coronary atherosclerosis of native coronary artery tobacco use disorder mitral valve disorders acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia severe sepsis cardiac complications, not elsewhere classified atrial fibrillation aortic valve disorders methicillin susceptible staphylococcus aureus septicemia other and unspecified hyperlipidemia acute respiratory failure cellulitis and abscess of upper arm and forearm intestinal infection due to clostridium difficile other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation acute and subacute bacterial endocarditis other encephalopathy cerebral embolism with cerebral infarction other disorders of plasma protein metabolism urinary complications, not elsewhere classified delirium due to conditions classified elsewhere other and unspecified alcohol dependence, continuous vascular disorders of kidney oliguria and anuria alcohol withdrawal acute edema of lung, unspecified dysphagia, oropharyngeal phase septic arterial embolism acute apical periodontitis of pulpal origin olecranon bursitis 

Answer: The patient is high likely exposed to