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: tetracycline attending: chief complaint: aortic valve endocarditis major surgical or invasive procedure: aortic valve replacement with a size 21 st. regent mechanical valve for aortic valve endocarditis history of present illness: mrs. is a 62 yo female who reports 2 months of not feeling well. she states that she stopped driving 2 months ago and nearly 1 month ago began feeling poorly with decreased appetite, decreased mobility and really started feeling badly about 1-2 weeks prior to admission with very limited mobility and a 30 pound weight loss in 1 month. she has been dizzy and short of breath. she was found to be in acute renal failure with a creatinine of 6.6 and anemic with hematocrit of 23. she was hydrated and transfused 3 units prbc. her renal failure was thought to be due to acute interstitial nephritis. she had blood cultures positive for entercoccus on and , with negative blood cultures since. the source of enterococcus has not been found. she has developed worsening le edema, and recurrent rapid atrial fibrillation and a repeat echocardiogram showed worsening ai. she is transfered for surgical evaulation. past medical history: past medical history diabetes-followed by chronic diastolic heart failure fibromyalgia gerd obesity asthma pneumonia past surgical history appendectomy tonsillectomy stomach surgery as a child arthroscopic knee surgery social history: the patient lives in , ma with her family. she does not currently smoke or drink alcohol. no illicit drug use. she has a distant smoking history (over 30 years ago). she has no tattoos. she has one dog and has not recently traveled. family history: father and mother had diabetes and one sister had cervical cancer and the other sister has ovarian cancer. physical exam: physical exam: vs: tc 98.5, bp 124-145/48-60, hr 65-75, rr 18, 98% ra gen: pleasant, nad heent: perrl, eomi, sclerae anicteric, neck supple, mmm, no ulcers/lesions/thrush, pale conjunctiva cv: rrr, audible s1 with diastolic murmur best heard at the left lower sternal border pulm: cta bilat with few crackles at the bases back: no focal tenderness, no cvat gi: normoactive bs, soft, non-tender, non-distended msk: no joint swelling or erythema. slight left upper back pain to palpation. this is not over the bone, but over the muscle. there is no point tenderness over the spine. ext: warm and well perfused, 2+ edema in both feet, faint dp pulses palpable bilaterally. slight r plantar erythema. lymph: no cervical lymphadenopathy skin: no rashes, no jaundice neuro: aaox3, cn 2-12 intact, normal sensitivity in the feet. psych: non-anxious, normal affect pertinent results: 05:54am blood wbc-12.8* rbc-2.92* hgb-8.3* hct-25.0* mcv-86 mch-28.3 mchc-33.1 rdw-17.4* plt ct-254 05:16am blood wbc-15.7* rbc-3.07* hgb-8.9* hct-26.1* mcv-85 mch-28.9 mchc-34.1 rdw-17.6* plt ct-239 06:18am blood pt-23.7* inr(pt)-2.3* 05:54am blood pt-21.2* ptt-46.9* inr(pt)-2.0* 05:16am blood pt-18.1* inr(pt)-1.6* 03:50am blood pt-15.5* inr(pt)-1.4* 02:10am blood pt-15.5* ptt-38.3* inr(pt)-1.4* 05:20pm blood pt-15.2* ptt-32.9 inr(pt)-1.3* 03:54pm blood pt-16.7* ptt-46.1* inr(pt)-1.5* 03:55am blood pt-15.6* ptt-79.8* inr(pt)-1.4* 05:46am blood pt-15.8* ptt-74.2* inr(pt)-1.4* 05:30pm blood pt-16.6* ptt-55.9* inr(pt)-1.5* 06:18am blood glucose-88 urean-31* creat-2.3* na-139 k-4.4 cl-100 hco3-26 angap-17 05:54am blood glucose-125* urean-33* creat-2.4* na-136 k-3.9 cl-100 hco3-29 angap-11 echocardiography report , (complete) done at 2:26:15 pm final referring physician information , division of cardiothoracic , status: inpatient dob: age (years): 63 f hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: aortic valve disease. congestive heart failure. left ventricular function. mitral valve disease. prosthetic valve function. icd-9 codes: 424.90, v43.3, 424.1, 424.0 test information date/time: at 14:26 interpret md: , md test type: tee (complete) 3d imaging. son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2011aw2-: machine: echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.0 cm <= 5.6 cm left ventricle - ejection fraction: 50% to 55% >= 55% aorta - ascending: 3.0 cm <= 3.4 cm findings multiplanar reconstructions were generated and confirmed on an independent workstation. left atrium: mild la enlargement. moderate to severe spontaneous echo contrast in the body of the la. depressed laa emptying velocity (<0.2m/s) all four pulmonary veins not identified. right atrium/interatrial septum: normal ra size. no asd by 2d or color doppler. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv cavity size. low normal lvef. right ventricle: normal rv chamber size and free wall motion. aorta: mildy dilated aortic root. normal ascending aorta diameter. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. severely thickened/deformed aortic valve leaflets. large vegetation on aortic valve. no aortic valve abscess. no as. moderate to severe (3+) ar. mitral valve: moderately thickened mitral valve leaflets. no ms. mild to moderate (+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions pre-bypass: the left atrium is mildly dilated. moderate to severe spontaneous echo contrast is seen in the body of the left atrium. the left atrial appendage emptying velocity is depressed (<0.2m/s). no atrial septal defect is seen by 2d or color doppler. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is a large vegetation on the aortic valve. no aortic valve abscess is seen. there is no aortic valve stenosis. moderate to severe (3+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. post cpb: 1. unchanged lv and rv function. lvef = 55% 2. bileaflet mechanical valve in aortic position. well seated and stable with good leaflet excursion. trace aortic regurgitation and no discernible gradient across the valve. 3. no other change electronically signed by , md, interpreting physician 16:46 ?????? caregroup is. all rights reserved. brief hospital course: this 63-year-old patient with a recent onset of cardiac symptoms was investigated and found to have aortic valve endocarditis with large vegetations and severe aortic regurgitation. infectious disease was consulted for antibiotic recommendations. preoperative workup included a dental consult that was done and teeth #12,20,21 were extracted. pulmonary was consulted for recommendations regarding possible sleep apnea. initially she was managed with medically for the enterococcus which was grown in the blood, but the aortic incompetence was getting worse along with worsening acute renal failure and she was taken for urgent aortic valve replacement. on ms. was taken to the operating room and underwent an urgent aortic valve replacement with a size 21 st. regent mechanical valve for aortic valve endocarditis with dr.. please refer to operative report for further surgical details. she tolerated the procedure well and was transferred to the cvicu intubated and sedated in critical but stable condition. she awoke neurologically intact and was extubated without difficulty. all lines and drains were discontinued in a timely fashion. she was weaned off pressors and beta-blocker/statin/ aspirin and diuresis were initiated. renal continued to follow postoperatively. anticoagulation with coumadin was initiated for her mechanical aortic valve. she was transferred to the step down unit on pod#1 for further monitoring. physical therapy was consulted for evaluation of strength and mobility. id was consulted for bacteremia: sensitive enterococcal nve would warrant therapy with both ampicillin + aminoglycoside to utilize synergy to improve treatment outcomes. the patient with recent severe renal insufficiency, aminoglycoside was held because of this. renal consult was obtained for atn. at its worst, her renal function was marked by a creatinine of 6.6 on from a baseline of 1.1-1.4. since then her renal function has improved to a creatinine of 2.3 to 2.7. because of her renal function consistant in the mid 2 range the recommendation of holding the aminoglycoside therapy was adhered to. the remainder of her hospital course was essentially uneventful. on pod 5 she was cleared for discharge to ne , . all follow up appointments were advised. medications on admission: avapro 150mg daily, aspirin 81mg daily, glucophage 500mg twice daily, hydrochlorothiazide 25mg daily, insulin sliding scale, lasix 40mg daily, lopressor 50mg twice daily, multivitamin, prilosec 20 mg twice daily, savella 50 mg twice daily, ultram 50mg twice daily discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 4. rosuvastatin 5 mg tablet sig: two (2) tablet po hs (at bedtime). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 7. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po q12h (every 12 hours) for 7 days. 8. lasix 20 mg tablet sig: one (1) tablet po twice a day for 7 days. 9. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain/temp. 10. ampicillin sodium 2 gram recon soln sig: one (1) recon soln injection q6h (every 6 hours) for 1 months: untill . 11. insulin sliding scale & fixed dose fingerstick qachs insulin sc fixed dose orders breakfast glargine 10 units insulin sc sliding scale breakfast lunch dinner bedtime regular glucose insulin dose 0-70 mg/dl proceed with hypoglycemia protocol 71-119 mg/dl 0 units 0 units 0 units 0 units 120-159 mg/dl 3 units 3 units 3 units 0 units 160-199 mg/dl 6 units 6 units 6 units 3 units 200-239 mg/dl 9 units 9 units 9 units 6 units 240-280 mg/dl 12 units 12 units 12 units 9 units > 280 mg/dl notify m.d. 12. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 13. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 14. picc care heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 15. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm: md to dose daily for goal inr 2.5-3 for mechanical aortic valve. 16. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 17. calcium carbonate 200 mg (500 mg) tablet, chewable sig: tablet, chewables po qid (4 times a day) as needed for gi upset. 18. diltiazem hcl 240 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). 19. furosemide 40 mg iv q12h discharge disposition: extended care facility: - discharge diagnosis: endocarditis, aortic insufficiency s/p aortic valve replacement past medical history: acute renal failure diabetes-followed by chronic diastolic heart failure fibromyalgia gastroesophageal reflux disease obesity asthma pneumonia past surgical history appendectomy tonsillectomy stomach surgery as a child arthroscopic knee surgery discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema: 2+ bilateral les discharge instructions: please shower daily including washing incisions 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 females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. on date/time: 2:30 pcp: dr. at 1:30pm dr. will recommend cardiologist dr. will follow coumadin/inr on discharge from rehab (confirmed with ) required laboratory monitoring: lab tests: cbc, bun, crea, lfts, esr and crp frequency: qweekly all laboratory results should be faxed to infectious disease r.ns. at ( follow up appointments scheduled: 10:30a id, lm bldg (), basement id west (sb) 09:30a id,, lm , basement id west (sb) sleep medicine: dr. and on at 2pm building **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** md procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve other surgical extraction of tooth diagnoses: anemia, unspecified esophageal reflux acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation asthma, unspecified type, unspecified personal history of tobacco use bacteremia long-term (current) use of insulin osteoarthrosis, unspecified whether generalized or localized, site unspecified acute and subacute bacterial endocarditis other postprocedural status streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] obesity, unspecified dehydration myalgia and myositis, unspecified chronic diastolic heart failure unspecified analgesic and antipyretic causing adverse effects in therapeutic use acquired absence of teeth, unspecified body mass index 40.0-44.9, adult partial edentulism, unspecified other dental caries retained dental root cracked tooth 

Answer: The patient is high likely exposed to