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: vancomycin attending: chief complaint: fevers major surgical or invasive procedure: redo-sternotomy and bentall procedure with a 29-mm st. mechanical composite valve graft and coronary button reimplantation. history of present illness: mr. is a 25 yo m w/hx vsd s/p patch and aortic coarctation s/p repair (repaired 10 years ago) who presents with fevers to 103 at home, chills, nausea and nbnb emesis, abdominal cramping and shortness of breath over the past 10 days. he took tylenol at home without much effect and over the course of the last four days, developed difficulty walking as well cramping leg pain bilaterally, from ankles to knees, worse in the calf. he denies back pain, and presented today to an osh ed. he notes travel to in , and had a dental procedure at the time. he took prophylactic antibiotics (amoxicillin) at the time. since then, he has noted tooth pain as well as oozing of black pus from around his tooth several weeks ago, none recently. he denies any history of recent injection drug use, last injected heroin 3 years prior. cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. he does note sob at rest and with exertion. at baseline, he is unable to run, but is able to walk "forever" without development of dyspnea. he denies headache, vision changes, neck stiffness, cough, hemoptysis, chest pain, abdominal pain, dysuria, numbness, weakness. past medical history: history of vsd/aortic coarctation - s/p repair as a teenager hepatitis c history of ivda/heroin abuse social history: he works as an english teacher. denies alcohol use. has a remote history of heroin injection and heavy alcohol use three years prior. he denies any recent travel, last traveled to in 10/. denies pets at home. lives at home with his wife. family history: mother with alcoholism. no hx heart defects in other siblings. physical exam: preop exam vs: t 103.1, bp 101/55, hr 113, rr 19, o2 94% on 4l nc gen: diaphoretic, anxious appearing male in nad. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. +gingivitis and tooth pain at molar on right side. no cervical lad. neck: supple with jvp of 8 cm. cv: tachycardic. no thrill. ii/iv diastolic descrescendo murmur at rusb. hyperdynamic pmi at 5th ics. no rubs or gallops. chest: no chest wall deformities, scoliosis or kyphosis. respirations labored. inspiratory crackles at bases. no wheezes or rhonchi. abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. + . + splinter hemorrhages. -osler nodes. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: wbc-10.9 rbc-3.77* hgb-10.9* hct-31.9* plt count-340 pt-14.5* ptt-26.4 inr(pt)-1.3* glucose-105 urea n-6 creat-0.7 sodium-138 potassium-3.4 chloride-102 total co2-29 anion gap-10 calcium-8.1* phosphate-2.8 magnesium-1.8 lactate-1.9 ck(cpk)-47 ctropnt-0.20* ck-mb-notdone ck(cpk)-51 ck-mb-notdone ctropnt-<0.01 ethanol-neg tricyclic-neg urine barbitrt-neg cocaine-neg amphetmn-neg mthdone-neg urine color-yellow appear-clear sp -1.021 blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-1 ph-5.0 leuk-neg chest/abd ct scan: 1. bilateral lower lobe opacities may represent atelectasis, aspiration, or pneumonia. bilateral small pleural effusions. 2. cardiac enlargement and dilation of the aortic root with narrowing of the aortic arch, consistent with the patient's history of coarctation status post repair. 3. small wedge-shaped region of relative hypoperfusion in the right kidney in otherwise normal-appearing kidneys, most consistent with small focal infarct; differential includes focal pyelonephritis. 4. small amount of ascites distributed throughout the abdomen and pelvis, nonspecific. 5. mediastinal lymph nodes measuring up to 9.5 mm, nonspecific. transthoracic echocardiogram: moderately dilated left ventricle with overall preserved systolic function. there is a vegetation on the non-coronary cusp of the aortic valve. this appears echo-bright suggesting some degree of chronicity. severe aortic regurgitation. dilated aortic sinus. no vegetation seen on mitral valve. normal lv systolic function. mild pulmonary hypertension, borderline rv systolic function. mri spine: no spondylodiscitis or abscess of the cervical, thoracic, or lumbar spine. renal ultrasound: the right kidney measures 12.7 cm and the left kidney measures 12.7 cm. both kidneys demonstrate diffusely increased cortical echogenicity, without cortical thinning, hydronephrosis, focal cortical abnormality or calculi. blood flow is seen throughout both kidneys. the urinary bladder appears unremarkable. there is a small amount of free pelvic fluid. impression: findings compatible with medical renal disease. coronary cta: the ascending aorta at the level of the main pulmonary artery is 46 x 48 mm in diameter and mildly dilated. the aortic root shows a tricuspid valve; however, the valve is considerably thickened with what would appear to be vegetations along the entire leaflets. in addition, there is one vegetation that measures 7.3 x 9.4 mm in diameter that appears to arise from the left anterior cusp and extends over to the right cusp below the origin of the right coronary artery. in addition there is a smaller area of vegetation on the left anterior valve leaflet near the orifice of the left main coronary artery. the coronary arteries arise from their expected locations. the circulation is left dominant with a prominent left anterior descending that extends to the apex with the d1. in addition there is a prominent left circumflex which gives off an om1 or ramus branch. the left circumflex supplies the pda and pdl. intraop tee: pre-bypass: 1. the left atrium and right atrium are normal in cavity size. 2. the right upper pulmonary vein may be entering at the svc/ra junction. 3. a left-to-right shunt across the interatrial septum is seen at rest. a small secundum atrial septal defect is present. 4. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is low l (lvef40%). 5. right ventricular chamber size and free wall motion are normal. 6. the ascending aorta is moderately dilated. there are simple atheroma in the aortic arch. the descending thoracic aorta is moderately dilated. there are simple atheroma in the descending thoracic aorta. 7. the aortic valve is bicuspid. a mass is present on the aortic valve. severe (4+) aortic regurgitation is seen. there is an area degeneration along the length of the aortic valve from the annulus extending to the sinus that appears to be consistent with a former perivalvular abscess, measuring 1cm x 2cm; there is flow demonstrated in this area. 8.the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. 9. moderate tricuspid regurgitation is seen. 10. there is a trivial/physiologic pericardial effusion. 11. there is a small left pleural effusion. post-bypass: 1. there is a mechanical valve in the aortic position, with normal leaflet motion and no aortic regurgitation. mean gradient across the valve is 14mmhg with a cardiac output of 7.56l/min. the area previous mentioned at the level of the aortic valve extending from the annulus to the sinus has been surgically repaired and there is no evidence of flow. 2. degree of mitral regurgitation remains unchanged and is mild (1+) mitral regurgitation. 3. degree of tricuspid is unchanged. 4. the replaced ascending aorta measures 3.7cm. 5. aortic contours are intact post decannulation. brief hospital course: preoperative course: mr. is a 26 year old male who presented with culture negative aortic valve endocarditis, with hospital course complicated by acute renal failure secondary to acute tubular necrosis, likely medication-induced (gentamicin, nsaids, contrast). 1)aortic valve endocarditis: mr came to us from an outside hospital; both here and there, cultures have been negative, but mr did apparently receive antibiotics before cultures. a tee was performed which showed a vegetation on his aortic valve as well as 4+ar and 3+tr. there was no indication of aortic root involvement; pr intervals were lengthened on arrival but stayed at ~0.22 through his admission. vancomycin and gentamicin were started on with a plan for at least a six-week course for vancomycin. mr developed acute renal failure (see below), gentamicin was stopped and the vancomycin dosing schedule was changed. ciprofloxacin was eventually started on to cover possible hacek organisms. he eventually went on to develop rash and fevers,associated with eosinophilia and worsening pancytopenia which was attributed to vancomycin. given his renal insufficiency, vancomycin was switched to daptomycin 2)infectious disease: mr had extensive testing for possible causative or associated pathogens, which was mostly negative. among the tests was one for hepatitis c; he had antibody to hepatitis c but a negative viral load, perhaps suggesting clearance. this should be followed up as an outpatient. additionally he tested hiv-negative. rpr, fungal cultures, and igm for bartonella, coxiella and mycoplasma were all negative; he did have igg positive for mycoplasma. brucella was found on cultures and awaiting pcr results. id service will follow up with him at rehab. 3) acute renal failure - on (hospital day 4), mr creatinine climbed to 2.7 from 0.7 approximately 36 hours earlier. we suspected that this was secondary to ct contrast, gentamicin, and nsaids, and that this was atn. the renal service was consulted and confirmed the presence of atn by microscopy of urine sediment. gentamicin was held. his creatinine peaked at 4.1 on the , after which it began a slow steady decline, reaching 2.0 by . continued to improve prior to going to the operating room. postoperative course: on he was brought to the operating room and underwent bentall procedure, see operative report for further details. he continued on cipro and daptomycin treatment per infectious disease recommendations. he was started on amiodarone for atrial fibrillation in the operating room. in the first 24 hours post operative he was weaned from sedation, awoke neurologically intact and was extubated without complications. he was weaned from vasoactive medications and was transferred to the floor on pod 2. his chest tubes and pacing wires were removed, and he was started on anticoagulation for his mechanical valve. psychiatry was consulted for management of anxiety and his medications were adjusted with improvement in symptoms. it was recommended that he follow-up with a neurologist as an outpatient for evaluation of possible tourette's syndrome. he continued to improve and was ready on pod 5 to be discharged to rehab for continued antibiotic therapy. plan for infectious disease to follow up with rehab when pcr results are returned. medications on admission: none discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po once a day. 2. daptomycin 500 mg recon soln sig: four hundred (400) mg) intravenous q24h (every 24 hours) for 2 weeks: . 3. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 weeks: . 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 6. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). 9. lasix 20 mg tablet sig: one (1) tablet po once a day for 7 days. disp:*7 tablet(s)* refills:*0* 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 11. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed. disp:*60 tablet(s)* refills:*0* 12. ibuprofen 400 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*0* 13. potassium chloride 20 meq packet sig: one (1) po once a day for 7 days. disp:*7 packets* refills:*0* 14. diazepam 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. disp:*30 tablet(s)* refills:*0* 15. diphenhydramine hcl 12.5 mg/5 ml elixir sig: one (1) po q6h (every 6 hours) as needed. disp:*30 elixir* refills:*0* 16. warfarin 2 mg tablet sig: two (2) tablet po once (once) for 1 doses: titrate for an inr goal of 2.5-3 for his mechanical avr. disp:*30 tablet(s)* refills:*0* discharge disposition: extended care facility: house of discharge diagnosis: aortic valve endocarditis biscupsid aortic valve, aneurysm of ascending aorta and aortic root acute renal insufficiency hepatitis c, history of ivda/herion abuse history of vsd/aortic coarctation - s/p repair as a teenager discharge condition: good discharge instructions: 1)please shower daily. no baths. pat dry incisions, do not rub. 2)avoid creams and lotions to surgical incisions. 3)call cardiac surgeon if there is concern for wound infection. 4)no lifting more than 10 lbs for at least 10 weeks from surgical date. 5)no driving for at least one month. followup instructions: dr. in 4 weeks, call for appt cardiologist dr. after discharge from rehab dr after discharge from rehab provider: . blood phone: date/time: 10:30 please have patient follow-up with a neurologist to evaluate for tourette's syndrome. procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart diagnostic ultrasound of heart diagnostic ultrasound of heart open and other replacement of aortic valve resection of vessel with replacement, thoracic vessels other repair of vessel diagnoses: acute kidney failure with lesion of tubular necrosis thoracic aneurysm without mention of rupture unspecified viral hepatitis c without hepatic coma other specified disorders of arteries and arterioles atrial fibrillation aortic valve disorders anxiety state, unspecified dermatitis due to drugs and medicines taken internally acute and subacute bacterial endocarditis other specified antibiotics causing adverse effects in therapeutic use opioid abuse, unspecified personal history of surgery to heart and great vessels, presenting hazards to health adhesive pericarditis cramp of limb tourette's disorder 

Answer: The patient is high likely exposed to