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: heart murmur major surgical or invasive procedure: - aortic valve replacement (23mm ce magna pericardial), ascending aorta and hemiarch replacement (24mm gelweave graft). - sternal rewiring and dedridement gj tube placement history of present illness: 53 y/o male who was noted to have a heart murmur on routine physical exam in . underwent an echo which revealed severe as with dilated aorta and ef 65-70%. subsequently had cardiac cath which showed no coronary disease. also underwent chest ct which showed a dilated ascending aorta measured at 5.1 x 4.9cm. now referred for cardiac surgery. past medical history: gout, arthritis, h/o hepatitis a, s/p vasectomy social history: denies tobacco use. admits to rare etoh use. family history: nc physical exam: vs: 93 134/97 75" 235# gen: wdwn male in nad skin: w/d intact heent: eomi, perrl ncat neck: supple, from, -jvd, -carotid bruit chest: ctab -w/r/r heart: rrr w/ holosystolic murmur abd: soft, nt/nd +bs ext: warm, well-perfused, -edema, -varicosities neuro: a&o x 3, mae, non-focal pertinent results: 05:25am blood wbc-2.6*# rbc-3.25* hgb-9.5* hct-28.0* mcv-86 mch-29.1 mchc-33.7 rdw-14.1 plt ct-237 05:08am blood wbc-5.3 rbc-3.58* hgb-10.1* hct-31.0* mcv-87 mch-28.3 mchc-32.7 rdw-14.4 plt ct-291 12:30am blood wbc-19.2* rbc-3.02* hgb-9.5* hct-26.3* mcv-87 mch-31.6 mchc-36.3* rdw-12.3 plt ct-208 05:55am blood wbc-14.8* rbc-3.29* hgb-10.2* hct-29.0* mcv-88 mch-31.0 mchc-35.3* rdw-12.9 plt ct-144* 05:25am blood glucose-104 urean-36* creat-2.6* na-138 k-3.6 cl-105 hco3-22 angap-15 05:08am blood glucose-119* urean-29* creat-2.5* na-139 k-4.2 cl-103 hco3-22 angap-18 radiology final report chest (pa & lat) 3:14 pm chest (pa & lat) reason: pna medical condition: 53 year old man with with fevrs to 105 / r/o pna reason for this examination: pna pa and lateral chest, history: high fever, rule out pneumonia. impression: pa and lateral chest compared to : small bilateral pleural effusion unchanged since . no consolidation or other evidence of pneumonia. heart size normal. upper lungs clear. dr. approved: sun 9:27 pm radiology final report ct chest w/o contrast 2:31 pm ct chest w/o contrast; ct abdomen w/o contrast reason: r/o infectiond no contrast medical condition: 53 year old man with wit fevers to 105 / now 103 / post avr (tissue) with asc ao hemiarch repair. also has acute renal failure creat 1.0 to 2.5 no contrast reason for this examination: r/o infectiond no contrast contraindications for iv contrast: arf with creat of 2.5 ct torso on clinical history: fevers, question source of infection. technique: helical acquisition of ct images performed from the thoracic inlet through the ischial tuberosities following administration of oral contrast only, via gj tube. iv contrast unable to be administered due to poor renal function. comparison made to recent ct of . findings: left-sided picc line extends to the cavoatrial junction. prior aortic valve replacement is again seen, with high density surrounding the ascending aorta, and multiple surgical clips, all stable and post-operative. previously described gas- and fluid-containing collections at the sternotomy site are again seen, decreased in size when compared to prior. there is mild persistent stranding in the subcutaneous fat of the anterior mediastinum. bilateral small pleural effusions are seen. there is no focal airspace consolidation. respiratory motion limits evaluation of the underlying parenchyma. below the abdomen, non-contrast evaluation of the liver, spleen, pancreas, and adrenal glands reveals no abnormalities. there are two small subcentimeter hypodensities within the liver, likely benign cysts and unchanged. there is biliary sludge within a non-distended gallbladder. there is a new 4mm round high density focus within the proximal left ureter, compatible with ureteral calculus, with mild associated fullness of the more central collecting system. a caliceal diverticulum versus dilated calix is also seen with layering milk of calcium at the left lower pole. right collecting system is decompressed. no additional stones are seen. colon is decompressed. no pelvic mass or lymphadenopathy. bladder, seminal vesicles, and prostate are unremarkable with periurethral prostatic calcifications. no abscess or drainable fluid collection. there is stranding in the left groin with surgical clips likely from recent procedure. impression: 1. slightly increased pleural effusions with improved left base airspace consolidation when compared to prior study. 2. improved postoperative gas/fluid collections in the anterior mediastinum. 3. new 4 mm left proximal ureteral calculus with only minimal associated left hydroureteronephrosis. 4. no abscess or drainable fluid collection within the abdomen or pelvis. no discrete source for the patient's fevers. the study and the report were reviewed by the staff radiologist. dr. dr. radiology final report video oropharyngeal swallow 2:28 pm video oropharyngeal swallow reason: eval swallowing function medical condition: 53 year old man s/p avr reason for this examination: eval swallowing function oropharyngeal video fluoroscopy indication: 53-year-old man post cardiac surgery. findings: oral and pharyngeal swallowing video fluoroscopy was performed today in collaboration with speech and language pathology. various consistencies of the barium were administered. oral phase: there is moderate impairment of bolus formation with prolonged mastication of the solids. there is mild reduction in bolus control with premature spillover before the swallow with liquids. mild reduction of ap tongue movement and oral transit times for ground solids was seen. mild coating of residue remains in the oral cavity after the swallow. pharyngeal phase: there is a delay in initiation in the swallow, intermittently severe. when started, palatal elevation was mildly reduced, laryngeal elevation and laryngeal valve closure are moderately reduced. mild coating of residue remained in the valleculae after the swallow. no residue was seen in the piriform sinuses. aspiration/penetration: patient had penetration before the swallow with thin and nectar-thick liquids secondary to swallow delay and aspiration due to not being able to consistently clear the penetration with thin liquids. the aspiration was silent. impression: mild-to-moderate oral and moderate-to-severe pharyngeal dysphagia with intermittent aspiration with liquids secondary to delayed and premature spillover. for further details and treatment recommendations, please see speech pathology note dated . the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 12:00 pm echocardiography report , tte (complete) done at 3:37:11 pm final referring physician information , , status: inpatient dob: age (years): 53 m hgt (in): 75 bp (mm hg): 130/90 wgt (lb): 225 hr (bpm): 75 bsa (m2): 2.31 m2 indication: endocarditis icd-9 codes: 424.1, 424.0 test information date/time: at 15:37 interpret md: , md test type: tte (complete) son: doppler: full doppler and color doppler test location: west echo lab contrast: none tech quality: adequate tape #: 2008w033-0:30 machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.2 cm <= 4.0 cm left atrium - four chamber length: 4.7 cm <= 5.2 cm right atrium - four chamber length: 4.9 cm <= 5.0 cm left ventricle - septal wall thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.8 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.7 cm <= 5.6 cm left ventricle - ejection fraction: 60% to 70% >= 55% left ventricle - lateral peak e': 0.11 m/s > 0.08 m/s left ventricle - septal peak e': 0.11 m/s > 0.08 m/s left ventricle - ratio e/e': 8 < 15 aorta - sinus level: 3.2 cm <= 3.6 cm aorta - ascending: 2.6 cm <= 3.4 cm aortic valve - peak velocity: 1.8 m/sec <= 2.0 m/sec mitral valve - e wave: 0.9 m/sec mitral valve - a wave: 0.9 m/sec mitral valve - e/a ratio: 1.00 mitral valve - e wave deceleration time: 248 ms 140-250 ms findings left atrium: moderate la enlargement. right atrium/interatrial septum: normal ra size. left ventricle: normal lv wall thickness, cavity size and regional/global systolic function (lvef >55%). no resting lvot gradient. no vsd. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. aortic valve: bioprosthetic aortic valve prosthesis (avr). avr well seated, normal leaflet/disc motion and transvalvular gradients. no masses or vegetations on aortic valve. mitral valve: normal mitral valve leaflets with trivial mr. no mvp. no mass or vegetation on mitral valve. normal mitral valve supporting structures. no ms. normal lv inflow pattern for age. tricuspid valve: normal tricuspid valve leaflets with trivial tr. no mass or vegetation on tricuspid valve. normal tricuspid valve supporting structures. no ts. indeterminate pa systolic pressure. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. no vegetation/mass on pulmonic valve. normal main pa. no doppler evidence for pda pericardium: no pericardial effusion. conclusions the left atrium is moderately dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 60-70%) there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the pulmonary artery systolic pressure could not be determined. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , a pericardial effusion is no longer present. impression: no obvious vegetations seen if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. electronically signed by , md, interpreting physician 16:04 g tube placment, all incl. 9:37 am reason: for feeding contiues to fail swallow contrast: optiray medical condition: 53 year old man with s/p asc aorta replacement reason for this examination: for feeding contiues to fail swallow indication: 53-year-old man status post ascending aortic replacement. failed swallow test. need for feeding tube. radiologists: the procedure was performed with dr. as well as dr. and dr. (both attending radiologists, present and supervising throughout). procedure: the risks and benefits of the procedure were explained to the patient and written informed consent was obtained. the patient was placed supine on the angiographic table and the abdomen was prepped and draped in standard sterile fashion. a preprocedure timeout was performed using two patient identifiers. after insufflation of the stomach via a ng tube, under fluoroscopic guidance and injection of local anesthesia, two t-fasteners were deployed in the stomach. a 19-gauge needle was then advanced into the stomach with the angle pointing towards the pylorus. a 0.035 bentson guidewire was subsequently advanced through the needle and coiled within the stomach. exchange was made for a 5 fr cobra catheter and then a 5 fr sos omni catheter to maneuver across the pylorus and into the duodenum. t a stiff amplatz wire was then passed to the jejunum. the stomach tract was dilated with a 14 french dilator. a 20 french peel- away sheath was then advanced over the wire into the stomach and the inner dilator was removed and a 16 french gj tube () was placed in the jejunum. injection through the tube confirmed the proper location with the tip in the jejunum. the gastrostomy was secured to the skin with a flexi track. the patient tolerated the procedure well and there were no immediate complications. conscious sedation was provided using divided doses of a 100 mcg of fentanyl and a single dose of 1 mg of versed, during a total intraservice time of 30 minutes. the patient's vital parameters were continuously monitored throughout the procedure. impression: successful placement of a 16 french percutaneous gastrojejunostomy tube with tip in the jejunum. the tube is ready for use. the t-fastener sutures should be removed in days as detailed in the provider or entry system. the study and the report were reviewed by the staff radiologist. dr. dr. dr. approved: fri 7:55 am brief hospital course: mr. was a same day admit after undergoing all pre-operative work-up as an outpatient. on he was brought directly to the operating where he underwent a aortic valve replacement and ascending aorta with hemiarch replacement. please see operative report for surgical details. following surgery he was transferred to the cvicu for invasive monitoring in stable condition. within 24 hours he was weaned from sedation, awoke neurologically intact but somewhat confused and was extubated. he was then transferred to the step down unit for further recovery. later on postoperative day one, mr. developed acute onset of short term memory loss and had a seizure. he was returned to the intensive care unit for further care. the neurology service was consulted. a ct scan of his head was normal without any acute changes. dilantin was loaded and keppra was started for his seizure. given his mild respiratory distress and fever, it was presumed that he aspirated during his seizure, vancomycin, levofloxacin and flagyl were started. an eeg showed no epileptiform features and no electrographic seizure activity however was suggestive of a mild encephalopathy suggesting dysfunction of bilateral, subcortical, or deep midline structures. he was sedated and reintubated for aggitation. thiamine and folate were started as acute alcohol withdrawal was suspected. tube feeds were started for nutritional support. his white count continued to decrease however his fevers persisted. a ct of his abdomen was obtained to rule out an abdominal pathology. this revealed a large pericardial effusion and moderate-to-large mediastinal fluid collection with probable dehiscence of the sternotomy. in the setting of continued fevers, infection cannot be excluded and clinical correlation is recommended. there were also large bilateral pleural effusions, left greater than right, and lower lobe atelectasis. tiny hypodense liver lesion too small to characterize and unchanged were also noted. mr. wife admitted that he consumes roughly 30 beers daily thus strengthening the diagnosis of alcohol withdrawal. he was again extubated on however needed to be reintubated shortly after due to large amounts of secretions. given his mediastinal and pericardial fluid collection in the presence of a partially dehissed sternum, mr. was returned to the operating room for debridement. his sternum was washed out and rewired on . his effusions were also drained. he returned to the intensive care unit for monitoring. he underwent a bronchoscopy for a left lower lobe collapse and thick oral secretions. minimal secretions were suctioned however serratia was found on culture. he was seen by id and zosyn was started. the neurology service continued to follow him for memory loss. keppra was continued for his seizure activity. he was evantually and successfully weaned from ventilation. speech and swallow was consulted and followed him. recommendation was to continue tube feeds at this time until his confusion clears. a ng tube was placed for feeding. mr. was transferred to the step down unit for continued recovery. his white blood cell count climbed and vancomycin was restarted for preseumed mediatinitis. he remained confused despite a normal brain mri. a video swallow was performed which showed aspiration with thin and thick liquids, with significant impairment in initiation of pharyngeal swallow. a dobhoff tube was placed under fluorsoscpy as he had manually removed his ng tube. aggressive physical therapy continued. he was seen by neuropthomology for his supranuclear gaze palsy and will follow up with them in months. picc line was placed on . video swallow performed on showed improvement and he was cleared for nectar thick liquids and pureed solids, he continued on 16 hours of tube feeds. he was again seen by speech and swallow on and found to be aspirating more and he was again made npo. he was seen by gi for peg placement evalution. on peg placed and within the next 24 hours tube feeding was started along with supervised feedings. picc line placed on . mr a temperature 103 then to 105. he was again pan cultured. his creatinine also increased from 1.0 to 2.0 then to 2.5. his nsaids were dc'd and free water increased. caspofungin was started per id to treat in blood from . picc was dc'd. he was seen by opthamology and there were no signs of fungal endopthalmitis. rash was noted, and urine eos were increased, therefore zosyn was discontinued. speech and swallow evalution on showed improvement and his diet was advanced to thin liquids and ground solids. picc line was replaced on and he was ready for discharge to rehab. medications on admission: none discharge medications: 1. colace 100 mg capsule : one (1) capsule po twice a day. 2. picc line heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 3. sarna anti-itch 0.5-0.5 % lotion : one (1) topical three times a day as needed for itching. 4. vancomycin 1,000 mg recon soln : one (1) intravenous once a day: continue until . 5. caspofungin 50 mg recon soln : one (1) intravenous once a day: continue until . 6. levetiracetam 500 mg tablet : one (1) tablet po twice a day. 7. metoprolol tartrate 25 mg tablet : 1.5 tablets po three times a day: 37.5mg three times daily . 8. atorvastatin 10 mg tablet : one (1) tablet po once a day. 9. heparin (porcine) 5,000 unit/ml solution : one (1) injection three times a day. 10. aspirin 325 mg tablet : one (1) tablet po once a day. 11. prevacid solutab 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr twice a day. 12. albuterol 90 mcg/actuation aerosol : four (4) inhalation four times a day as needed for shortness of breath or wheezing. 13. outpatient lab work weekly (tuesday) cbc w/ diff, lft, chem 7, vanco trough fax to clinic 14. insulin sliding scale with humalog insulin sc sliding scale breakfast lunch dinner bedtime humalog humalog humalog humalog glucose insulin dose insulin dose insulin dose insulin dose 0-60 mg/dl 4 oz. juice and 15 gm crackers 4 oz. juice and 15 gm crackers 4 oz. juice and 15 gm crackers 4 oz. juice and 15 gm crackers 61-109 mg/dl 0 units 0 units 0 units 0 units 110-130 mg/dl 3 units 3 units 3 units 3 units 131-150 mg/dl 5 units 5 units 5 units 5 units 151-180 mg/dl 7 units 7 units 7 units 7 units 181-210 mg/dl 9 units 9 units 9 units 9 units 211-240 mg/dl 11 units 11 units 11 units 11 units 241-280 mg/dl 13 units 13 units 13 units 13 units 15. lantus 100 unit/ml solution : thirty five (35) units subcutaneous once a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: aortic stenosis/aortic aneurysm s/p aortic valve replacement, ascending aorta and hemiarch replacement pmh: gout, arthritis, h/o hepatitis a psh: vasectomy discharge condition: fair discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. in the event that you have drainage from your sternal wound, please contact the at (. 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) no lotions, creams or powders to incision until it has healed. you may shower and wash incision. gently pat the wound dry. please shower daily. no bathing or swimming for 1 month. use sunscreen on incision if exposed to sun. 5) no lifting greater then 10 pounds for 10 weeks. 6) no driving for 1 month. 7) call with any questions or concerns. followup instructions: dr. in 2 weeks dr. when discharged from rehab dr. when dsicharged from rehab dr. (neuro-opthamology) 1-2 months provider: , md phone: date/time: 9:00 will need outpatient work-up for cpap at night when mental status clears. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy arterial catheterization other repair of chest wall open and other replacement of aortic valve with tissue graft resection of vessel with replacement, thoracic vessels other gastroenterostomy without gastrectomy alcohol detoxification replacement of indwelling urinary catheter electroencephalogram diagnoses: anemia, unspecified thoracic aneurysm without mention of rupture disruption of internal operation (surgical) wound other convulsions pulmonary collapse paroxysmal ventricular tachycardia unspecified disease of pericardium pneumonitis due to inhalation of food or vomitus other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation hypoxemia viral hepatitis a without mention of hepatic coma urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure accidents occurring in residential institution congenital insufficiency of aortic valve other and unspecified alcohol dependence, continuous alcohol withdrawal other complications due to genitourinary device, implant, and graft 

Answer: The patient is high likely exposed to