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: latex / methotrexate / zofran attending: chief complaint: dyspnea major surgical or invasive procedure: mitral valve repair with mitral valve annuloplasty with a 30-mm physio ii annuloplasty ring and a mitral valve commissuroplasty. . extraction of tooth #19 history of present illness: mr. is a 45 year old male with pmhx significant for lupus, esrd on hemodialysis (tues/thurs/saturday) awaiting renal transplant, and congestive heart failure secondary to severe mitral regurgitation, who was recently admitted for shortness of breath and chest pain with flat cardiac enzymes. during his last admission his shortness of breath was attributed to his mitral regurgitation and chronic renal failure. he was evaluated by cardio-thoracic surgery and was found to be a surgical candidate; however he left before complete evaluation given his mother's death. he subsequently presented to the ed with worsening dyspnea and shortness of breath at rest. has had multiple admissions for same complaints. patient stated that he had severe orthopnea. his chest pain was unchanged for the past several months. he was subsequently admitted for management of dyspnea and workup for mitral valve surgery. past medical history: - chronic diastolic congestive heart failure - mitral regurgitation - pulmonary hypertension - esrd secondary to sle vs fsgs, currently on the transplant list - sle diagnosed in - hypertension - reflex sympathetic dystrophy - osteonecrosis of the foot - right ankle avascular necrosis - gerd - panic attacks - s/p multiple av fistula surgeries - s/p laparoscopic cholecystectomy - t&a as child - right foot bunionectomy - peritoneal catheter placement and subsequent removal social history: lives with 6 year old son in . has good relationship with ex-wife. retired. smoker with 30pk-yr smoking history. denies etoh, illicits. mother recently died of bone cancer. family history: several family members with autoimmune disorders. denies history of premature coronary artery disease. physical exam: on admission: vs: t 98 bp 112/91 p 76 100% ra general: nad, comfortable heent: perrl, eomi, op clear neck: supple, jvd not evaluated cardiac: rrr, iii/vi holosystolic murmur, loudest at apex, w loss of s2 and radiation to axilla, also heard at left carotid, no carotid bruits lungs: resp unlabored, decreased breath sounds throughout, crackles at bases abdomen: soft, nt/nd. extremities: no c/c/e. skin: dry skin pulses: dp 2+ pt 2+ bilaterally pertinent results: chest ct scan : moderate nonhemorrhagic layering left and small nonhemorrhagic layering right pleural effusions. associated left greater than right bibasilar opacification, likely atelectasis. moderate cardiomegaly. tee :conclusions prebypass no atrial septal defect is seen by 2d or color doppler. the left ventricular cavity is moderately dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with borderline normal free wall function. the descending thoracic aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. the mitral valve leaflets do not fully coapt. severe (4+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. postbypass the patient is receiving epinephrine infusion at 0.3 ucg/kg/min lv systolic function is borderline in the setting of inotropes. rv systolic function now appears normal. there is a ring prosthesis in the mitral position. residual mr is now mild to moderate. (1+-2+). the ai and tr are unchanged from prebypass. the remaining study is unchanged from prebypass. i certify that i was present for this procedure in compliance with hcfa regulations.interpretation assigned to , md, interpreting physician cardiac cath : 1. coronary angiography in this right dominant system demonstrated no angiographically-apparent flow-limiting stenosis. the lmca was patent. the lad had a mid 30% stenosis and a 40% d1. the lcx was patent. the rca had a proximal 30% stenosis. 2. resting hemodynamics revealed elevated right and left sided filling pressures with rvedp 13 mmhg and lvedp of 22 mmhg. thre was moderate pulmonary arterial systolic hypertension with pasp of 58 mmhg. the cardiac index was preserved at 2.9 l/min/m2. there was normal arterial systolic and dyastolic pressures at the aortic level 98/64 mmhg. 3. left ventriculography was deferred. . admit labs: wbc-7.6 rbc-3.28* hgb-9.3* hct-29.3* rdw-18.5* plt ct-270 pt-23.7* ptt-31.1 inr(pt)-2.3* glucose-85 urean-31* creat-10.9* na-138 k-7.7* cl-99 hco3-24 ck(cpk)-102 ck-mb-1 ctropnt-0.03* probnp-* albumin-3.5 calcium-8.6 phos-5.6* mg-1.9 %hba1c-4.6* eag-85* brief hospital course: mr was transferred to on for evaluation of mitral valve replacement. his preoperative workup included tooth extraction by omfs. cardiac cath revealed no obstructing coronary lesions. renal was consulted as mr. has end stage renal disease, is hemodialysis dependent and is awaiting transplant. on he was taken to the operating room and underwent mitral valve repair with mitral valve annuloplasty with a 30-mm physio ii annuloplasty ring and a mitral valve commissuroplasty with dr. . cardiopulmonary bypass time= 79 minutes. cross clamp time=46 minutes. please refer to operative report for further surgical details. of note, his tunnel line catheter was noted to be displaced while prepping. it was sutured down for protection. he tolerated the procedure well and was transferred to the cvicu intubated and sedated. he awoke neurologically intact and weaned to extubation. he was weaned off inotropic and pressor support and ultimately started diuresis.postoperative heart block was noted and beta-blocker held. pod#1 he was started on cvvhd secondary to hyperkalemia and volume removal. with improving hemodynamic stability cvvhd was converted to hemodialysis. steroids were resumed for his sle. anticoagulation was resumed for atrial fibrillation. all lines and drains were removed per protocol. pod#3 he was transferred to the step down unit for further monitoring. multiple attempts to gain access via ir/transplant team were attempted and thwarted by the patient. a temporary groin catheter was placed and hd was resumed. during this time, anticoagulation was held for placing indwelling catheter. mr. was placed empirically on antibiotics for temperature spikes and was fully cultured. a positive urine culture grew proteus while all other cultures are no growth to date. he was taken to the or for ir tunnel line placement in his right groin. post procedure anticoagulation was resumed for sle as well as atrial flutter/line patency. physical therapy was consulted for evaluation of strength and mobility. on , a portion of his sternal wound was opened at bedside for developing drainage. he was placed on iv vanco and cefepime x 2 weeks per the recommendation of infectious disease. on the day of discharge his abx regimenwas simplified to vanco and ceftaz with hd to comeplete a 2 week course. wound cultures had no growth at the time of discharge. he was cleared for discharge to home with services on pod #17. all follow up appointments were advised. social work was following and the patient states he is to contact his parole officer regarding his discharge plans (see social work note for details). his picc line was removed at time of discharge as his abx will be given during hd and labs will also be drawn at that time. medications on admission: - chloroquine 250mg daily - albuterol / ipratropium inhaler - asa 81mg daily - b complex / folic acid - atenolol 50mg daily - nexium 40mg - fluticasone inh 2 spray - coumadin 1mg daily (for sle) - oxycodone 15mg q4hrs prn pain - ativan 2mg prn anxiety - trazodone 50mg qhs prn insomnia - prednisone 5mg daily discharge medications: 1. ceftazidime 1 gram recon soln sig: one (1) gm intravenous with hd for 12 days: 2 week course from . 2. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) intravenous hd protocol (hd protochol) for 12 days: 2 week course from . 3. 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:*2* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 6. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 7. chloroquine phosphate 250 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. nicotine 7 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*2* 9. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. guaifenesin 600 mg tablet extended release sig: one (1) tablet extended release po bid (). disp:*60 tablet extended release(s)* refills:*2* 11. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). disp:*1 mdi* refills:*2* 12. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day). disp:*1 vial* refills:*2* 13. lorazepam 1 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for anxiety. disp:*30 tablet(s)* refills:*0* 14. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). disp:*600 ml(s)* refills:*2* 15. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every 4-6 hours as needed for wheezing. disp:*1 mdi* refills:*0* 16. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation twice a day. disp:*1 mdi* refills:*2* 17. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*80 tablet(s)* refills:*0* 18. coumadin 2.5 mg tablet sig: as directed based on inr tablet po once a day: indication sle goal 2.0-3.0. disp:*60 tablet(s)* refills:*2* 19. lidocaine hcl 2 % solution sig: ten (10) ml mucous membrane tid (3 times a day) as needed for tongue pain. disp:*120 ml(s)* refills:*0* 20. outpatient lab work goal inr 2.0-3.0 first draw at hd results to dr. at south suburban phone ; fax 21. hd tunnel line care and flushes of hd tunnel line per protocol discharge disposition: home with service facility: vna discharge diagnosis: - mitral regurgitation, s/p mv repair - chronic diastolic congestive heart failure - end stage renal disease(secondary to sle versus fsgs) - sle diagnosed in - hypertension - s/p multiple av fistula surgeries - atrial flutter discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesia incisions: sternal - surgically opened 4cm long by 1cm wide at mid section-clean beefy red bed. no erythema or drainage leg right/left - healing well, no erythema or drainage. no edema. right hd line in groin- clean at insertion site discharge instructions: please wash incisions daily gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage 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 and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication sle goal inr 2.0-3.0 first draw at hd results to dr. at south suburban phone ;fax followup instructions: you are scheduled for the following appointments surgeon: dr on at 1:15pm in the medical office building suite2a wound check at 10:00am in the medical office building suite2a cardiology: dr (cards at in ) on at 3:40pm dr. , md phone: date/time: 10:40 provider , md phone: date/time: 10:40 please call to schedule appointments with your primary care dr. in weeks . **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication sle goal inr 2.0-3.0 first draw at hd results to dr. at south suburban phone ; fax procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters hemodialysis venous catheterization for renal dialysis incision with removal of foreign body or device from skin and subcutaneous tissue open heart valvuloplasty of mitral valve without replacement other surgical extraction of tooth diagnoses: systemic lupus erythematosus hyperpotassemia other iatrogenic hypotension end stage renal disease renal dialysis status mitral valve disorders other postoperative infection urinary tract infection, site not specified congestive heart failure, unspecified atrial fibrillation acute on chronic diastolic heart failure hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease primary pulmonary hypertension dental caries, unspecified acute respiratory failure following trauma and surgery 

Answer: The patient is high likely exposed to