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: levaquin attending: chief complaint: lightheadedness, s/p fall major surgical or invasive procedure: none history of present illness: . hpi: mr. is an 80 year old male with extensive medical history, pertinently including chronic anemia, cad s/p mi, recently discharged from on with pacer placement for afib with slow ventricular response. he presented to the er s/p fall in his bathroom. he had been feeling lightheaded all day, was reaching for something in his bathroom, was dizzy and fell over. he did not syncopize, feel palpitations, have evidence of seizures. ros was entirely negative. . on arrival to the ed his t was 100.1, hr 78, bp 84/40, rr 22, 96% on ra. his temp later rose to 102.8. labs were notable for lactate 3.7. code sepsis was called and he had a central line placed, received 5 l ns, and was given ceftriaxone, flagyl. his sbp improved to 100-110 with fluids. he had a stat abdominal us which was negative for free fluid. labs were only otherwise notable for a hct of 26.8, down from 31 on . in the setting of aggressive fluid resuscitation in the , hct dropped to 21.1, up to 28 after 3 units of prbcs. a tte was obtained at this point in the setting of some chf, and revealed 4+ mr (tte one month prior showed + mr). subsequent tee showed a 2mm vegetation, although ruptured chordae could not be definitively ruled out. initial blood cultures were negative and there were no peripheral stigmata of endocarditis, and the patient had defervesced. he was started on vancomycin and transferred to the floor in stable condition. past medical history: - cad s/p mi in - cath showing 100% proximal rca, 40% proximal lad, 60% intermedius - s/p pacemaker placement - afib- on coumadin - bradycardia in the setting of propanolol - anemia - thrombosis of the popliteal artery aneurysm - fem- bypass - admission for pna with hypertensive emergency in - aaa repair in - guaiac + stool with gastric erosions per egd - vit b12 deficiency - diverticulitis s/p colectomy - htn - cri with baseline creat 1.2-1.6, h/o pre-renal arf - hyperchol - detached retina in - gout - glaucoma - h/o etoh abuse social history: lives with niece and brother-in-law. 150 pk-yr smoker, but quit 20 yrs ago. no etoh for 15 yrs family history: family hx: he has a strong family history of cad. his sister had an mi at 55. both of his parents had mis, however he is not sure how old they were. his father died at 77, mother at 73. his father had dm. his other sister died of a cerebral hemorrhage physical exam: vitals t 98.7, tmax 99.8 70 121-152/41-52 15-19 97% ra. gen nad, aox3. neuro cn 2-12 intact. legally blind l eye. heent eomi. ncat. op clear. surgical iol on l. no conjunctival hemorrhages. neck no jvp appreciated. no bruits. chest crackles bilaterally r>l, dullness at r base, otherwise clear. cv rrr, nl s1, physiologic s2, holosystolic at apex->rlsb. abd mod obese, s, nt, nd, well healed midline scar. ext intact pulses, no edema. no peripheral stigmata of endocarditis. pertinent results: 12:00am glucose-120* urea n-28* creat-1.6* sodium-140 potassium-3.8 chloride-109* total co2-20* anion gap-15 12:00am haptoglob-203* 12:00am wbc-3.6* rbc-2.21* hgb-7.0* hct-21.1* mcv-95 mch-31.8 mchc-33.4 rdw-16.5* 12:00am neuts-72.3* lymphs-21.2 monos-5.0 eos-1.3 basos-0.1 07:50pm ck(cpk)-71 07:50pm ck-mb-notdone ctropnt-0.02* blood cultures 8/30 (on therapy) grew gp cocci (no speciation as of yet). all other blood cultures ngtd . crp 76 -cxr: cephalization, generous pa's, ?infiltrate r hilar region -ekg: afib, v-paced at 70 -tee: small 2.5 mm vegetation posterior mitral valve leaflet vs. ruptured chordae tendinae, preserved ef, + mr (which is new compared to study performed ) brief hospital course: 80 year old male with h/o chronic anemia, cad s/p mi, recently discharged on s/p pacer placement, admitted to s/p fall in his bathroom, febrile, hypotensive, on sepsis protocol. . #id: infectious disease consultation was obtained to weigh in on whether the findings on tee represented endocarditis (along with fever, elevated crp, and positive blood culture). it was felt that this would be an unusual presentation for endocarditis given mainly negative blood cultures, that the one positive culture may have been central line-related, but that it was reasonable to discontinue vancomycin therapy and follow clinically for any signs of infection with fevers and if he starts to spike, to re-culture and re-echo for change in possible vegetation. no other source of infection was identified over the hospital stay. . #hypotension: unclear source of fever and hypotension on admission. it is unlikely to have been secondary to a bacteremia - as blood cultures have been negative. one possible sequence of events is that a primary chordae tendinae rupture (due to myxomatous degeneration) may have caused a primary mixed cardiogenic and hypovolemic shock in the setting of acute mitral regurgitation and a possible febrile infection, which caused him to be hypotensive and fall. the patient was resuscitated effectively with fluids during his stay. initial exam on the floor and cxr was consistent with mild fluid overload, and the patient was effectively diuresed with 40 mg po lasix times one. on the floor, metoprolol 12.5 mg po bid was initiated for bp control and cardiovascular effects; he has been in the low 140s on this regimen and could likely be advanced to 25 mg po bid as an outpatient if he tolerates this well. . #anemia: patient with baseline anemia of unclear etiology (bone marrow normal) requiring transfusions q 2weeks. iron studies most consistent with anemia of chronic inflammation (although source of chronic inflammation somewhat unclear); pancytopenia and history consistent with a dilutional component (heme following patient, suggested role for outpatient epo). retic count on discharge 1.8. no evidence of hemolysis with normal hapto and ldh over hospital course. trending crit - baseline of 31 -> 26.8 in ed -> 21.1 in the setting of aggressive fluid resuscitation -> 30.2 on discharge after 3 units. hematocrit should be monitored at rehab and well and transfused periodically for hct<28. . #renal - patient's creatinine was 2.0 on admission. no rbc casts suggesting gn septic emboli. urine lytes with fena not consistent with pure pre-renal arf, but of note from last admission the patient had been discharged on lasix 40 mg po bid. arf thus likely to have at least a pre-renal component given resolution with fluids. on discharge cr down to 1.1. . mitral regurgitation: newly progressed 4+mr from recent echo 3 weeks prior at last admission, unclear source as above and when in unit after blood transfusions would have episodes of flash pulmonary edema which is requirining lasix. medications on admission: . aspirin 81 mg daily 2. docusate sodium 100 mg 3. gabapentin 300 mg po bid 4. pantoprazole sodium 40 mg po q24h 5. allopurinol 300 mg po daily 6. amlodipine 5 mg po daily 7. isosorbide mononitrate 120 mg tablet sustained release 24hr po hs 8. lactulose (30) ml po q8h prn 9. ascorbic acid 500 mg po bid 10. timolol maleate 0.25 % drops 1 drop 11. lisinopril 7.5 mg po daily 12. fluticasone-salmeterol 100-50 mcg 1 inh 13. furosemide 40 mg po bid 14. ferrous sulfate 325 mg daily 15. ipratropium bromide 18 mcg 2 puffs qid 16. albuterol 90 mcg 1-2 puffs q6 prn 17. warfarin sodium 2.5 mg po 3x/week (mo,we,fr). 18. warfarin sodium 5 mg po 4x/week (,tu,th,sa). discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 3. allopurinol 300 mg tablet sig: 0.5 tablet po daily (daily). 4. timolol maleate 0.25 % drops sig: one (1) drop ophthalmic (2 times a day). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. metronidazole 0.75 % gel sig: one (1) appl topical (2 times a day): apply thin layer to face over areas affected by flaking/"rash". disp:*qs 1* refills:*0* 7. selenium sulfide 2.5 % shampoo sig: 5-10 mls topical once a day for 1 months: massage 5 to 10 ml into wet scalp. allow to remain on scalp 2 to 3 minutes, rinse thoroughly and repeat. . disp:*qs ml(s)* refills:*0* 8. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*0* 9. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). 11. warfarin sodium 5 mg tablet sig: one (1) tablet po qsututhsat (). 12. albuterol sulfate 0.083 % solution sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 13. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 14. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). disk with device(s) 15. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 16. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day) as needed for constipation. 17. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 18. lisinopril 30 mg tablet sig: one (1) tablet po once a day. 19. zolpidem tartrate 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed. 20. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 21. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. discharge disposition: extended care facility: hospital tcu - discharge diagnosis: primary: 1. rule out endocarditis 2. hypotension 3. sepsis secondary: 1. coronary artery disease, status post myocardial infarction 2. hypertension 3. hypercholesterolemia 4. chronic renal insufficiency 5. chronic anemia 6. abdominal aortic aneurysm 7. left popliteal artery aneurysm, status post thrombosis, status post bypass graft 8. atrial fibrillation, status post pacemaker placement discharge condition: vital signs stable; afebrile, blood cultures with no growth, ambulating and taking po's. discharge instructions: please take all medications as prescribed. please note that we made a few changes in your medications. please follow up as listed below. please continue to have your inr (coumadin level) monitored as you did prior to the admission. please return to care if you notice chest pain, increasing shortness of breath, fevers, other signs and symptoms of infection, or neurological compromise. followup instructions: please follow up with your primary care physician . (call for appointment ) upon discharge from the rehab facility. please return to care if you notice chest pain, increasing shortness of breath, fevers, other signs and symptoms of infection, or neurological compromise. provider: , md where: hematology/oncology phone: date/time: 10:30 provider: , . hematology/oncology-cc9 where: hematology/oncology phone: date/time: 10:30 provider: clinic where: cardiac services phone: date/time: 10:00 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart transfusion of packed cells diagnoses: pure hypercholesterolemia unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia gout, unspecified atrial fibrillation mitral valve insufficiency and aortic valve insufficiency rheumatic heart failure (congestive) old myocardial infarction cardiac pacemaker in situ abdominal aneurysm without mention of rupture systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction 

Answer: The patient is high likely exposed to