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: no known allergies / adverse drug reactions attending: chief complaint: nausea/vomiting/diarrhea/fever major surgical or invasive procedure: transesophageal echocardiogram history of present illness: 23m, ho aortic valve/pulmonic valve replacement ( procedure) at age 12, presented with 3 days of gi symptoms with fever and chill. pt reported that three days prior to admission, he felt nausea and had several nonbloody / nonbilious emesis. he subsequently developed diarrhea, which was watery but non-bloody. diarrhea persisted for two days, but has waned down today. he also complained of headache, that started after emesis, which primarily located in the neck/occipital region, described as throbbing (), positional. the headache is better now. pt had subjective fever with chills in the past three days, and has not been able to tolerate much po other than water. he also felt unsteady while walking. pt denies photophobia, chest pain, shortness breath, cough, sore throat, sneezing, abdominal pain at rest or new rash. pt was on a bus tour to over the weekend, and had many seafood, but otherwise no recent travel history. pt did not recall any other unusual food intake prior to the illness. pt had a dental procedure in , but he had antibiotics for that. . in the ed, initial vs were: 102.6 118 98/63 16 100% ra. the patient underwent an lp, which showed wbc 3, poly 36, lymphs 25, monos 39. his sbp dropped to 80s in the ed. he received 4 l ns, right ij was placed, and levophed was started. pt also received vancomycin, ceftriaxone, gentamycin and oseltamivir. . on arrival to the micu, pt's vs were 100.6, 110, 112/63, 22, 97% on ra. past medical history: aortic valve calcification s/p balloon angioplasty & bioprosthetic aortic valve replacement ( procedure) bicuspid aortic valve social history: pt came to us 4 months ago from to work in a lab at . pt works on a melanoma research project that deals with fish. pt lives in an apartment in by himself. he is current not in a relationship and not sexually active. pt denies smoking or iv/illicit drug use. he is a social drinker, and last alcohol consumption was three weeks ago. family history: prostate cancer in grandfather, no hematologic malignancy, heart disease physical exam: admission physical exam vitals: t: 98.2 bp: 96/55 p: 77 r: 16 o2: 97%ra general: alert, oriented, no acute distress heent: sclera mildly icteric, dry oral mucosa, oropharynx clear, eomi, perrl, petichiae on the soft palate neck: supple, jvp not elevated, no lad, no tenderness over occipital or neck cv: regular rate and rhythm, crescendo/decrescendo murmur throughout the precordium lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, ruq tenderness with ? sign, (no resting tenderness), no rebound, guarding, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge physical exam vitals: t: 98.7 bp: 92/56 p: 82 r: 18 o2: 99%ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, no o/p lesions, no mucosal petechiae neck: supple, jvp not elevated, no lad, no tenderness over occipital or neck cv: regular rate and rhythm, 3/6 systolic murmur throughout the precordium lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, non-tender ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation pertinent results: admission labs: 11:55am blood wbc-8.2 rbc-4.79 hgb-14.8 hct-45 mcv-88 mch-30.8 mchc-35.1* rdw-11.9 plt ct-24* 11:55am blood neuts-92.4* lymphs-5.0* monos-2.5 eos-0 baso-0.1 11:55am blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-occasional polychr-normal burr-occasional 02:42pm blood pt-13.0 ptt-30.4 inr(pt)-1.1 02:42pm blood fibrino-1214* 06:25pm blood parst s-neg 05:50pm blood parst s-neg 06:00am blood parst s-negative 06:25pm blood ret aut-0.8* 11:55am blood glucose-123* urean-42* creat-1.5* na-130* k-3.5 cl-94* hco3-25 angap-15 11:55am blood alt-16 ast-17 ld(ldh)-201 alkphos-95 totbili-2.4* dirbili-0.7* indbili-1.7 11:55am blood lipase-19 03:35am blood ck-mb-1 ctropnt-<0.01 06:25pm blood calcium-7.0* phos-0.8* mg-1.4* 11:55am blood hapto-267* 06:25pm blood ferritn-1005* 06:25pm blood hiv ab-negative 02:42pm blood type-mix po2-54* pco2-30* ph-7.39 caltco2-19* base xs--5 comment-green top 12:15pm blood lactate-2.4* 02:42pm blood lactate-1.3 02:42pm blood hgb-11.9* calchct-36 o2 sat-86 pertinent interval labs: 06:00am blood fibrino-588*# 06:00am blood ret aut-0.3* 03:35am blood alt-71* ast-75* ld(ldh)-144 alkphos-65 totbili-3.1* dirbili-2.7* indbili-0.4 06:00am blood alt-42* ast-23 alkphos-55 amylase-27 totbili-2.1* dirbili-1.3* indbili-0.8 06:00am blood lipase-33 06:00am blood caltibc-159* ferritn-515* trf-122* 06:00am blood triglyc-269* 03:35am blood cortsol-15.9 03:35am blood hbsag-negative hbsab-positive hbcab-negative hav ab-positive 06:25pm blood hiv ab-negative discharge labs: 05:11am blood wbc-10.3 rbc-3.83* hgb-12.2* hct-35.1* mcv-92 mch-31.9 mchc-34.8 rdw-12.9 plt ct-240 05:11am blood neuts-79* bands-0 lymphs-11* monos-6 eos-2 baso-0 atyps-0 metas-2* myelos-0 05:11am blood glucose-114* urean-17 creat-0.8 na-133 k-4.5 cl-99 hco3-27 angap-12 05:11am blood calcium-8.9 phos-4.1 mg-2.0 urine: 12:00am urine color-yellow appear-hazy sp -1.022 12:00am urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirub-sm urobiln-2* ph-5.5 leuks-neg 12:00am urine rbc-3* wbc-3 bacteri-none yeast-none epi-0 12:00am urine castgr-3* csf: analysis wbc rbc polys lymphs monos 12:36 31 02 36 25 39 tube#4 clear and colorless tube #1 not counted chemistry chemistry totprot glucose 12:36 35 69 micro: positive blood cultures from 2 bottles from ed and one collection on . all other subsequent surveillance blood cultures ngtd. blood culture, routine (preliminary): this is a corrected report . reported to and read back by dr. () 2:20pm . haemophilus parainfluenzae. identification and sensitivities performed on culture # 333-1490v . presumptive identification. identification being confirmed. previously reported as haemophilus influenzae . negative influenza, lyme, mrsa. positive igg cmv and ebv (negative for igm). negative legionella urinary antigen. negative urine cx. negative anaplasma, leptospira and rmsf serologies. fecal culture (final ): no enteric gram negative rods found. no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. ova + parasites (final ): no ova and parasites seen. this test does not reliably detect cryptosporidium, cyclospora or microsporidium. while most cases of giardia are detected by routine o+p, the giardia antigen test may enhance detection when organisms are rare. fecal culture - r/o vibrio (final ): no vibrio found. fecal culture - r/o yersinia (final ): no yersinia found. fecal culture - r/o e.coli 0157:h7 (final ): no e.coli 0157:h7 found. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). radiology: tee : impression: poorly visualized pulmonic prosthesis with pulmonic regurgitation. no mass or vegetation seen on mitral, tricuspid or aortic valves. dilated right ventricle with preserved systolic function. moderately dilated aortic root with a trivial amount of central aortic regurgitation. mrcp : impression: 1. contracted gallbladder with mild pericholecystic fluid, likely related to third spacing. no gallbladder wall thickening identified. 2. trace intra-abdominal ascites, stable in volume since prior ct examination. 3. bilateral lower lobe atelectasis and bilateral pleural effusions. cta chest : 1. no pulmonary embolus detected to the subsegmental levels. 2. no dissection. 3. small bilateral pleural effusions with adjacent compressive atelectasis. areas of ground-glass and tree-in- opacities of the right upper, middle, and bilateral lower lobes may represent an atypical pneumonia. 4. splenomegaly. 5. moderate amount of intrapelvic free fluid, however no acute intra-abdominal or intrapelvic processes detected. the appendix is not visualized. tt echo : conclusions the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. the right ventricular cavity is dilated with borderline normal free wall function. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. a bioprosthetic aortic valve prosthesis is present. the prosthetic aortic valve leaflets appear normal.the transaortic gradient is normal for this prosthesis. no masses or vegetations are seen on the aortic valve. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. an eccentric, posteriorly directed jet of mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. no masses or vegetations are seen on the pulmonic valve, but cannot be fully excluded due to suboptimal image quality. a pulmonic valve bioprosthesis is suggested. the pulmonic prosthesis is abnormal with thickened leaflets and mildly increased gradients. no pulmonic valve vegetation is seen. significant pulmonic regurgitation is seen. there is no pericardial effusion. ruq us : impression: 1. mild intrahepatic biliary duct dilation without common bile duct dilation. mrcp is recommended for further evaluation. 2. nondistended gallbladder with severe gallbladder wall thickening. this could be due to underlying hepatic dysfunction such as in the setting of hepatitis and correlation with lfts is recommended. third spacing could also cause a similar appearance. this appearance would not be compatible with acute cholecystitis. 3. splenomegaly. brief hospital course: =========================== brief hospital summary =========================== mr. is a 23m w/ hx sig for bicuspid aortic valve s/p procedure over a decade ago (non-native aortic and pulmonic valves) who presented in septic shock, found to have h. parainflunza bacteremia and likely prosthetic valve endocarditis (pulmonic) in the setting of a new pulmonic valve regurgitation. the patient stabilized and was discharged on 6 weeks of antibiotics (ceftriaxone) with id and cardiology follow-up. ============================ active issues ============================ # # h. influenza sepsis / prosthetic valve endocarditis: pt initially presented w/ fever to 102, gi symptoms and generalized ill feeling. in the ed, the patient underwent an lp, which showed wbc 3, poly 36, lymphs 25, monos 39. his sbp dropped to 80s in the ed. he received 4 l ns, right ij was placed, and levophed was started. pt was admitted to the micu, where he was started on vancomycin, zosyn, and doxycycline. he had a ruq us which showed mild intrahepatic biliary duct dilation without common bile duct dilation. id was consulted and they recommended recommended ct torso, parasite smears x 3, stool cultures (smears and stool negative). he had an mrcp, which was largely unremarkable. urine legionella antigen, lyme serology and ehrlichiosis serology were all sent out in addition to ebv, cmv, and hiv, all of which were negative (ebv/cmv igg pos, but not igm). an echo was done out of concern for endocarditis and it showed a preserved ejection fraction (>55%) and no vegetations. he had a ct torso which showed no pe, no dissection, small bilateral pleural effusions, splenomegaly and moderate intrapelvic free fluid but with no intra-abdominal or intrapelvic process. over the course of his stay in the micu, his clinical symptoms improved. the patient then was transferred to the floor, had a second tte that again showed no vegetations but significant pulmonic regurgitation. the patient's primary cardiologist was contact in the , mrs.. .s. hoendermis. she confirmed the patient's condition and that the patient had never had significant pr on prior echos. blood cultures from the ed grew originally h. influenza that were then classified as h. parainfluenza. pt transiently had shortness of breath that resolved throughout the hospital stay (likely large infusion of ivfs to stabilize pt initially). over the course of the hospitalization, no further e/o organisms on surveillance cxs. the patient's antibiotics were narrowed to iv ceftriaxone for presumptive pulmonic valve endocarditis. a tee was unable to visualize the pv well. a picc was placed and the patient will complete a 6 week course of ceftriaxone (2g q24hrs) (day 1 ceftriaxone = ). while hospitalized, we appreciated the recommendations of our id and cardiology colleagues. the pt will f/u in clinic for abx surveillance and in cardiology clinic upon completion of abx. . # thrombocytopenia: pt's initial platelets were only 13. heme-onc was consulted in the icu, reviewed his smears, and agreed to wait to further trend the platelets. the platelets slowly rose to over 200 by time of discharge. it is likely this could have been secondary to bone marrow suppression while the patient was in septic shock. . # : pt presented w/ cr 1.5, most likely prerenal secondary to dehydration. improved to 0.8 on discharge with rehydration. . # dyspnea: see above, likely third spacing/pulmonary edema aggressive fluid rehydration while in septic shock. resolved without intervention in the course of 48 hrs. . #nsvt: 20 beat run of vt, with some palpitations in the middle of hospital stay, isolated. pt has had palpitations before in life. be from underlying structural abnl in setting of transposition/valve replacements, vs. electrolyte abnl. none in past 72 hours prior to discharge. we appreciated our cardiologist's input and repleted electrolytes to k>4 and mg>2. . lfts elevated: very mild alt/ast and tbili elevation. mild intrahepatic biliary duct dilation on us. resolved by discharge. ========================= inactive issues ========================= none ========================= transitional issues ========================= 1. f/u in clinic . pt has scripts for outpt lab work. 2. f/u with cardiology . pt should get echo prior to visit. 3. pt should get record (cd) of echos from cards at cardiology appt to take back to . medications on admission: none discharge medications: 1. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for headache. 2. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: one (1) dose intravenous q24h (every 24 hours) for 6 weeks: six weeks starting from . disp:*42 dose* refills:*0* 3. outpatient lab work cbc w/ differential, bmp, lfts each week, and fax to (id outpatient office). discharge disposition: home with service facility: home soulutions discharge diagnosis: primary diagnoses: h. influenza septic shock prosthetic valve endocarditis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you. you were admitted to the hospital for fevers, nausea, vomiting which was the result of bacteria in your blood. you initially had a low blood pressure and were stabilized in the medical icu, and then were taken care of on the general medicine . we were able to identify the bacteria, and have tailored our antibiotics to this organism. you had three echocardiograms while you were in the hospital, and they demonstrated that there was some decreased function of your pulmonic valve. it is probable that this is endocarditis, which is an infection of your valve. we are treating you with intravenous antibiotics for a six week course. you will have support at home for the iv antibiotics. fortunately, your shortness of breath and your low platelets resolved while you were in the hospital. you will be followed in approximately five weeks in the outpatient cardiology clinic. please call the cardiology office and have them schedule an echocardiogram to be performed before this appointment. you will also be followed by the infectious disease specialists. medications: - add ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback. one (1) dose intravenous q24h (every 24 hours) for 6 weeks: six weeks starting from . final dose will be . - continue all other medications as you had previously been taking. followup instructions: you should call the number below to have an echocardiogram scheduled for the last week of (done before your cardiologist's appt). department: cardiac services when: thursday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: infectious disease when: friday at 9:30 am with: , md building: lm campus: west best parking: garage department: infectious disease when: thursday at 10:30 am with: , md building: lm bldg () campus: west best parking: garage procedure: spinal tap incision of lung diagnostic ultrasound of heart central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis paroxysmal ventricular tachycardia septic shock surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation infection and inflammatory reaction due to cardiac device, implant, and graft other pancytopenia septicemia due to hemophilus influenzae [h. influenzae] 

Answer: The patient is high likely exposed to