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: past medical history: 1. mechanical mitral valve replacement. 2. history of cad with coronary artery bypass grafting in with an svg to the lad. 3. chronic atrial fibrillation. 4. cva in . 5. diabetes mellitus. 6. history of pulmonary embolus in . 7. history of pneumonia. social history: the patient lives with her husband. she denied any current tobacco, alcohol, or other drug use. she says that she quit smoking 30 years ago. she reports minimal exercise, however, is never restricted in her activities of daily living. family history: there is no family history of coronary disease, hypertension, or diabetes. home medications: 1. 100 meq q.d. 2. digoxin 0.125 mg q.d. 3. atenolol 50 mg q.d. 4. aldactone 50 mg q.d. 5. glyburide 6 mg q.d. 6. lipitor 80 mg q.d. 7. allopurinol 300 mg q.d. 8. isosorbide 30 mg b.i.d. 9. lasix 80 mg q.d. 10. coumadin 5 mg q.d. 11. aspirin 81 mg q.d. allergies: she has an allergy to vancomycin which causes anaphylaxis. she also has an allergy to clindamycin and gentamicin, both of which reportedly caused anaphylaxis. she has an allergy to penicillin which causes a rash. she also has an allergy to cefotaxime with an unknown reaction. physical examination on admission: vital signs: temperature 99.0, blood pressure 122/49, heart rate 70, respiratory rate 25, oxygen saturation of 96% on 40% face mask. general: she appeared somewhat uncomfortable and was speaking in choppy sentences. she was alert and oriented times three. there was no evidence of accessory muscle use. heent: the pupils were equally round and reactive to light. the extraocular muscles were intact. the oropharynx revealed moist mucous membranes. there were no lesions or exudates. lungs: she had a poor effort; however, she had decreased breath sounds at the bases bilaterally and bibasilar crackles. no wheezes were appreciated. heart: irregular, with a normal s1 and s2. there was a mechanical click of her mitral valve. she had no appreciable gallops. she had a ii/vi systolic murmur heard at the apex with radiation to the axilla. abdomen: soft, nontender, nondistended, and she had good bowel sounds. extremities: warm and without clubbing, cyanosis or edema. she had 2+ palpable pulses peripherally. laboratory/radiologic data: cbc with a white count of 10, hematocrit 35.7, platelets 222,000. she had a sodium of 136, potassium 3.8, chloride 99, bicarbonate 29, bun 15, creatinine 0.7. she had a bnp at which was from 136 to 260, and then declined to 219 on . she had a ck which peaked at 298 at the outside hospital. the ck had a corresponding mb of 13.4. at the time of admission to , she had a ck of 37 with a troponin i of 0.3. ekg on admission to revealed that she was in atrial fibrillation with a rate of 74. she had normal axis. she had normal intervals. she had 0. depressions in v4 through v6. she also had t wave inversions in leads i, ii, and avl. chest x-ray on admission revealed bilateral alveolar infiltrates, and evidence of peribronchial cuffing, all consistent with congestive heart failure. hospital course: 1. cardiovascular: cad-the patient was admitted with a non-st elevation mi in the setting of a pulmonary process with a peak ck of 298, which had declined to 37 at the time of arrival at . she was without anginal symptoms. she has a known occluded svg on a recent catheterization in as well as known rca disease. she is continued on aspirin, statin, and beta blocker. she was weaned off her nitroglycerin drip once she was admitted. she went to catheterization on which revealed an rca with 50% diffuse proximal lesion, distal rca which was diffusely diseased, mid rca tubular lesion that was 70-80%, mid lad 100% occlusion, mid circumflex 60% lesion, and the known svg to lad totally occluded. her hemodynamic catheterization revealed an ra pressure of 24, rv pressure of 70/24, pa pressure of 70/25, wedge of 34, cardiac output of 4.6, cardiac index of 2.4, and an ejection fraction of 51%. no intervention was done at the time of cardiac catheterization. it was felt that the ischemia that she had at the time of her initial presentation to was most likely demand ischemia in the setting of congestive heart failure and pneumonia, and did not represent an active thrombotic ischemic process. it was recommended that she have repeat catheterization in four to six weeks with possible intervention at that time. this was discussed with the patient and she preferred to go home and come back for catheterization at a later date. pump: the patient has an ejection fraction of 51%, however, her chest x-ray, wedge pressure, and other hemodynamics at the time of catheterization reflected that she was in congestive heart failure. she was diuresed approximately 6 liters while admitted. her respiratory status improved significant and at the time of discharge she was without an oxygen requirement. she was bolused with lasix p.r.n. throughout admission, and then several days before discharge was placed on lasix 40 mg b.i.d. it is unclear why she was on aldactone and digoxin at the time of admission, and both of these were stopped due to the lack of evidence of class iii or class iv heart failure. she will also be sent home with potassium supplements in the setting of chronic lasix use. she was continued on a beta blocker, however, was not able to tolerate an ace inhibitor at the time of discharge due to low blood pressures. this should possibly be restarted as an outpatient, and she will follow-up with her pcp. rhythm: the patient has a history of chronic atrial fibrillation for which she has been on coumadin in the past. her coumadin had been held and she was on a heparin drip at the time of admission. after catheterization, she was restarted on coumadin and overlapped with heparin and became therapeutic at the time of discharge. she was rate controlled with a beta blocker. mechanical mitral valve: the patient's mitral valve was okay by echo. as mentioned above, she was on anticoagulation throughout her admission and prior to discharge it was overlapped with coumadin and heparin and was discharged once her inr was fairly therapeutic at 2.6, within the desired range of 2.5 to 2.3. she will follow-up with her pcp the day after discharge for an inr check. 2. pulmonary: when the patient was transferred from , it was felt that she had possible left lower lobe pneumonia on her chest x-ray, in the setting of being febrile with a white count and hypoxia. she had been started on levofloxacin, and was continued on levofloxacin for a complete ten day course. she was unable to submit a sputum sample, therefore, no micro data was ever obtained. she was continued on p.r.n. atrovent and albuterol nebulizers which had been started at and very infrequently required them. by the time of discharge, she was saturating 96% on room air. as mentioned above, she also had congestive heart failure contributing to her hypoxia which was significantly improved at the time of discharge. 3. endocrine: the patient was with a history of diabetes mellitus requiring glyburide at home. at the time of admission, she was n.p.o. for catheterization, was placed on q.i.d. accu-cheks with regular sliding scale of insulin. once she was eating a normal diet, she was continued on her glyburide 5 mg q.d. 4. hematologic: the patient was anticoagulated, as mentioned above, for her atrial fibrillation and mechanical mitral valve. three days after her cardiac catheterization, she was noted to have venous and arterial oozing from her right groin site. her heparin was held intermittently on two different episodes, and pressure was applied with good stasis. at the time of discharge, she had a small approximately 2 by 3 cm right groin hematoma which had not expanded in size. her goal inr for anticoagulation is 3.5 to 5.5, and she will have follow-up with her pcp the day after discharge for an inr check. 5. infectious disease: as mentioned above, the patient was admitted with a questionable diagnosis of pneumonia on levofloxacin. she was continued on levofloxacin to complete a ten day course. she had no signs of infection. condition on discharge: at the time of discharge, the patient was without chest pain or shortness of breath. she was able to ambulate in the with physical therapy and was felt to be discharged home without any services. discharge diagnosis: 1. myocardial infarction. 2. congestive heart failure. 3. pneumonia. 4. atrial fibrillation. 5. mechanical mitral valve. 6. diabetes mellitus. discharge medications: 1. aspirin 325 mg q.d. 2. lasix 40 mg b.i.d. 3. lipitor 80 mg q.d. 4. 40 meq q.d. 5. allopurinol 300 mg q.d. 6. glyburide 5 mg q.d. 7. toprol xl 50 mg q.d. 8. coumadin 5 mg q.h.s. 9. imdur 30 mg q.d. follow-up: the patient's pcp, . , was contact the day of discharge, and she will have follow-up in his clinic for inr check the day after discharge. she will also follow-up with him the week after discharge. she will discuss repeat cardiac catheterization with dr. and dr. the week after discharge. all of her active issues and follow-up was discussed with her pcp. , m.d. dictated by: medquist36 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified atrial fibrillation hematoma complicating a procedure heart valve replaced by other means other complications due to other cardiac device, implant, and graft pneumococcal pneumonia [streptococcus pneumoniae pneumonia] acute diastolic heart failure 

Answer: The patient is high likely exposed to