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: bactrim attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: redo sternotomy, aortic valve replacement (st. 21 mm mechanical) cardiac catherization history of present illness: 44 year old male on he was hospitalized at following an episode of chest pain/pressure while walking to his car. he was completely rulled out for an mi and followed up with cardiology as an outpatient (cardiology believes reflux related). after discharge he was worked up: cta showed no aortic pathology, egd normal mucosa, coronary cath showed patent stent with to evidence of cad, and pfts showed obstructive defect. additionally, he underwent an alcohol rehabilitation program at . since hospitalization, he has had increasing shortness of breath on exertion. he used to only notice it while walking, now he get short of breath while giving presentations sitting down. when he gets short of breath it feels like a pressure on his chest and pain in the epigastric region. when he rests the symptoms resolve. he denies le edema, has orthopnea (two pillows to sleep), notes abdominal distention/bloating over the previous 6 mo, denies any weight gain/loss, restless sleep, decreased appetite. he has never been jaundiced and received the hepb vaccination. except for hiv, he has never had any other sti. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. over the past 3-4 weeks he has developed a productive cough with yellow sputum. he also notes he can hear expiratory wheezes at night. he denies sick contacts, fevers, or night sweats. over the past few days, he has been feeling nausea after eating. he notes multiple episodes of dry heaves where he just spit up clear liquid. he vomited twice and denies any frank blood, coffee grounds or different colored material. past medical history: hiv - cd4:532 . on haart bicuspid aortic valve repair and ascending aortic graft - cad s/p des in lad htn - treated. normal pressure 125/80 hyperlipidemia - treated on atorvastatin gerd - hiatal hernia (surgery not needed as per dr. depression/anxiety alcohol abuse - drinks 1 large bottle of wine/day. rehab program at early . wants to quit. never caused problems at work or with law enforcement social history: works as lawyer married etoh - peak 2 large bottles wine/night, currently glasses wine/day tobacco - never illicits - nasal cocaine (never iv), no use +20 years family history: heart attacks - maternal grandparents, maternal aunts x2, mother, brothers x2 (non-fatal mi and 50yo). psychiatric illness - father cancer - paternal grandfather dx50s ms - mother physical exam: vitals: t:96.1 bp:95/69 p:101 r:32 o2:93ra general: alert, oriented, no acute distress, sitting up in bed heent: sclera anicteric, mmm, oropharynx clear, perrl, eomi neck: supple, jvp not appreciated, no lad lungs: thorax expands symetrically, ressonant to percussion, bilateral crackles lung fields, forced expiratory wheezes, cv: regular rate and rhythm, normal s1 + s2, ?systolic murmur at base, no rubs or gallops abdomen: +bs; soft, distended, tender to deep palpation, no rebound tenderness or guarding, no organomegaly. ruq produces sharp pain in the epigastric region ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: no lesions or rashes, no palmar erythema or telangectasias neuro: a/ox3, cns intact, strength and sensation intact throughout, downgoing babinski, no asterixis pertinent results: admission labs 03:30pm blood wbc-6.8# rbc-3.96* hgb-13.5* hct-39.9* mcv-101*# mch-33.9* mchc-33.7 rdw-15.9* plt ct-213 03:30pm blood neuts-68.4 lymphs-23.2 monos-6.5 eos-1.2 baso-0.7 03:30pm blood glucose-136* urean-20 creat-1.2 na-132* k-4.6 cl-96 hco3-21* angap-20 03:30pm blood alt-307* ast-601* ck(cpk)-181* alkphos-121* totbili-1.3 03:30pm blood ck-mb-7 probnp-* 06:10am blood calcium-8.4 phos-5.0* mg-2.0 05:15am blood triglyc-74 hdl-40 chol/hd-2.0 ldlcalc-26 03:30pm blood vitb12-780 folate-10.8 06:10am blood hbsag-negative hbsab-negative 12:40pm blood hav ab-positive igm hav-negative 05:15am blood hbcab-negative igm hbc-negative 03:30pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 06:49pm blood lactate-2.8* 09:15am urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg 12:15pm pleural wbc-145* rbc-1600* polys-4* lymphs-53* monos-0 meso-33* macro-4* other-6* 12:15pm pleural totprot-1.3 glucose-137 ld(ldh)-104 albumin-less than . echocardiography : the left atrium is moderately dilated. the interatrial septum is aneurysmal. the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild to moderate global left ventricular hypokinesis (lvef = 35 %). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. a bioprosthetic aortic valve prosthesis is present with thickened leaflets and markedly increased gradient (peak 100mmhg) c/w severe aortic valve stenosis (valve area <0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. the tricuspid regurgitation jet is eccentric and may be underestimated. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the gradient across the aortic valve is markedly increased and c/w severe aortic valve stenosis. aortic regurgitation and global left ventricular systolid dysfunction are now seen as well as moderate mitral regurgitation and moderate pulmonary artery systolic hypertension. . coronary catheterization : 1. coronary angiography of this right dominant system revealed no angiographically signicant cad. 2. severe prosthetic valve aortic stenosis with markedly elevated filling pressures and very low cardiac output. . brief hospital course: presented with six months of progressive dyspnea on exertion and 2-pillow orthopnea. he was given asa 325mg, ceftriazone (to cover sbp), zofran and ativan in the ed. on the floor, he was given azithromycin (to cover cap), lasix 10mg (to diurese pulmonary edema and ascites), albuteral nebs (for wheezes) and multivitamin. he responded well to diuretics. on day 2 of hospitalization, a diagnostic thoracentesis was performed to clarify the cause of the pleural effusions. during the procedure, he became diaphoretic and syncopized. he then appeared to seize and was incontinent of urine and stool. a code blue was called but the patient was never asystole. once he was stable he was transfered to the icu where he seized again. of note, the pleural chemistry was consistent with a transudate, as per light's criteria. as part of his work-up in the micu, the patient got an echocardiogram. the echo showed that the patient's bioprosthetic aortic valve prosthesis was present with thickened leaflets and markedly increased gradient consistent with severe aortic valve stenosis. cardiology and cardiac surgery were consulted so that a plan could be developed to replace the patient's sclerosed aortic valve. after his second day in the micu, the patient was transferred to a step down unit where it was decided that he should undergo cardiac catheterization to rule out ischemia and better assess his aortic valve. cath showed clean coronaries, critical aortic stenosis (valve area 0.3cm) and a cardiac output of 1.3. the patient was then transferred to the ccu for close monitoring of his hemodynamics. in the ccu he was diuresed with a heparin drip and diuril 500mg iv to a total -3.5l. this provided symptomatic improvement in his respiratory status and abdominal distention, and his lfts continued to trend down. he was cleared by hepatology and id for surgery and carotid ultrasounds were negative. lasix gtt was stopped on hypotension (sbp 80s), sinus tachycardia (hr90s) and creatinine bump to 1.4. creatinine went back down to 1.2 that same day but lasix gtt continued to be held. he was otherwise stable while awaiting surgery. in addition, he had a rapidly increasing transaminitis. on admission his statin was held due to concerns of liver toxicity. a ruq us showed heterogeneous architecture suggestive of fatty liver and small ascites. the 2nd day of admission his hiv medications and buspar dose was reduced from 15mg to 10mg for toxicity concerns. hepatitis serologies were not suggestive of an acute infection. urine and serum tox screens were negative. upon transfer to the icu, more of the patient's medications were weaned, including buspirone and paroxetine. however, after the patient's echocardiogram revealed the significant sclerosis that had occured on his prosthetic aortic valve, it was believed that his transaminitis was most likely secondary to shock liver. after he was transferred out of the unit his lfts slowly trended down with diuresis and improving hemodynamics. pattern of injury most consistent with alcoholism and congestion. also hyponatremia, likely in the setting of diuresis. also possibly med effect (ssris). could also be secondary to liver disease. hyponatremia persisted throughout stay but improved slightly, na 132 by prior to or. ------------------- cardiac surgery: he was taken to cardiac surgery on for a re-do sternotomy for placement of mechanical avr on . refer to operative notes for details. he received vancomycin perioperative as he was in the hospital preoperatively. post operatively, he was admitted to the cardiovascular icu for intensive post-operative care. he was weaned and extubated without difficulty. his chest tubes and temporary pacing wires were removed per protocol. he was started on coumadin with iv heparin bridge. he was discharged to home on postoperative day seven when his inr was therapeutic. target inr is 2.5-3.0 for mechanical aortic valve. coumadin /inr will be followed by dr. . first blood draw is with results called to dr. . medications on admission: abacavir-lamivudine 600 mg-300 mg tablet daily atorvastatin 80 mg daily buspirone 15 mg efavirenz 600 mg daily ezetimibe 10 mg daily lisinopril 20 mg daily lorazepam 1 mg tablet daily omeprazole 20 mg tablets, 3 tablets daily paroxetine hcl 40 mg tenofovir disoproxil fumarate 300 mg daily zolpidem 10 mg daily prn aspirin 325 mg daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 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. epzicom 600-300 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 4. lipitor 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 5. buspirone 15 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* 6. sustiva 600 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 7. ezetimibe 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 8. prilosec 20 mg capsule, delayed release(e.c.) sig: three (3) capsule, delayed release(e.c.) po once a day: 40 mg in am and 20 mg in pm . disp:*90 capsule, delayed release(e.c.)(s)* refills:*0* 9. paroxetine hcl 40 mg tablet sig: one (1) tablet po once a day. disp:*60 tablet(s)* refills:*0* 10. viread 300 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 11. warfarin 5 mg tablet sig: inr 2.5-3.0 tablets po once a day: dosing adjusted based on inr . disp:*60 tablet(s)* refills:*0* 12. warfarin 2 mg tablet sig: inr 2.5-3.0 tablets po once a day: dose adjusted based on inr . disp:*60 tablet(s)* refills:*0* 13. outpatient work pt/inr for coumadin dosing with goal inr 2.5-3.0 for mechanical aortic valve first draw with results to dr for further dosing 14. coumadin you are receiving two different doses of coumadin 2mg and 5 mg tablets so that your dose can be adjusted - you are to have drawn thrusday and then dosing to be decided by dr 15. percocet 2.5-325 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain. disp:*30 tablet(s)* refills:*0* 16. furosemide 20 mg tablet sig: one (1) tablet po once a day: continue until follow up with cardiologist in 2 weeks . disp:*30 tablet(s)* refills:*0* 17. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day: continue until follow up with cardiologist in 2 weeks . disp:*30 tab sust.rel. particle/crystal(s)* refills:*0* 18. lisinopril 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 19. carvedilol 3.125 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: aortic stenosis s/p avr acute on chronic systolic heart faiure hyponatremia preoperatively acute renal failure preoperatively hepatitis alcohol abuse hypertension hyperlipidemia gastroesophageal reflux disease coronary artery disease s/p stent s/p ascending aorta andaortic valve replacement depression anxiety discharge condition: good discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 100.5 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month, and while taking narcotics no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: dr. in 4 weeks () dr. in 1 week () dr. in weeks *** pt/inr for coumadin dosing with goal inr 2.5-3.0 for mechanical aortic valve first draw with results to dr for further dosing wound check appointment 6 as instructed by nurse () md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters thoracentesis open and other replacement of aortic valve diagnoses: pneumonia, organism unspecified acidosis other iatrogenic hypotension coronary atherosclerosis of native coronary artery esophageal reflux unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension alcoholic cirrhosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia other chronic pulmonary heart diseases other convulsions percutaneous transluminal coronary angioplasty status dysthymic disorder iatrogenic pneumothorax disorders of phosphorus metabolism cardiogenic shock other acquired absence of organ long-term (current) use of anticoagulants mitral valve insufficiency and aortic valve stenosis family history of ischemic heart disease other ascites acute on chronic systolic heart failure diseases of tricuspid valve asymptomatic human immunodeficiency virus [hiv] infection status other and unspecified alcohol dependence, continuous acute alcoholic hepatitis unspecified deficiency anemia other diuretics causing adverse effects in therapeutic use personal history of methicillin resistant staphylococcus aureus panic disorder without agoraphobia chronic passive congestion of liver 

Answer: The patient is high likely exposed to