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: patient recorded as having no known allergies to drugs attending: chief complaint: 74 year old female admit to micu in resp distress, pna, uti, mild chf initially on nrb, but then intubated on (extubated ). hosp course noted for bradycardia (av block) during swan placement, chf. pmh: recent mi, chf, a fib, cva, gerd, gastritis, tias, bell's palsy, lower gi polyps. major surgical or invasive procedure: cardiac catheterization aortic valve replacement (21mmm pericardial valve) history of present illness: 74 year old female transfered from outside hospital status post embolecotomy for r brachial emboli with history of severe aortic stenosis and anemia for cardiac work-up. patient of dr. , found to have colonic polyps on colonoscopy for anemia work-up at osh. pt admitted to receive medical clearance for future procedure. found to have a urinary tract infection with signs of sepsis severe respiratory difficulty and severe aortic stenosis. past medical history: chf tia htn gerd cva as ai anemia ^chol s/p ccy, laminectomy, appy social history: lives alone in , ma has 10 children. family history: unremarkable. physical exam: gen: intubated , sedated lungs: clear to auscultation heart: rrr, iii-iv/vi systolic murmur abd: soft, nontender, nondistended, normoactive bowel sounds ext: surgically absent bilateral greater saphenous veins, 1+ edema. pertinent results: hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:40am 12.7* 4.31 11.1* 35.9* 83 25.7* 30.8* 18.2* 305 basic coagulation (pt, ptt, plt, inr) plt ct 05:40am 305 chemistry renal & glucose glucose urean creat na k cl hco3 angap 05:40am 89 37* 1.2* 138 5.3* 105 21* 17 cardiology report echo study date of measurements: left atrium - long axis dimension: *4.6 cm (nl <= 4.0 cm) left atrium - four chamber length: *5.9 cm (nl <= 5.2 cm) right atrium - four chamber length: *5.3 cm (nl <= 5.0 cm) left ventricle - ejection fraction: 30% (nl >=55%) aortic valve - peak velocity: *4.2 m/sec (nl <= 2.0 m/sec) aortic valve - peak gradient: 69 mm hg aortic valve - mean gradient: 45 mm hg aortic valve - lvot peak vel: 0.80 m/sec aortic valve - lvot diam: 2.1 cm aortic valve - valve area: *0.7 cm2 (nl >= 3.0 cm2) mitral valve - e wave: 1.0 m/sec mitral valve - a wave: 1.3 m/sec mitral valve - e/a ratio: 0.77 mitral valve - e wave deceleration time: 210 msec interpretation: findings: left atrium: mild la enlargement. right atrium/interatrial septum: mildly dilated ra. left ventricle: mild symmetric lvh. moderate global lv hypokinesis. no resting lvot gradient. no lv mass/thrombus. no vsd. right ventricle: normal rv chamber size and free wall motion. paradoxic septal motion consistent with conduction abnormality/ventricular pacing. aorta: normal aortic root diameter. focal calcifications in aortic root. aortic valve: severely thickened/deformed aortic valve leaflets. severe as. moderate (2+) ar. mitral valve: moderately thickened mitral valve leaflets. no mvp. moderate mitral annular calcification. mild thickening of mitral valve chordae. calcified tips of papillary muscles. no ms. moderate (2+) mr. lv inflow pattern c/w impaired relaxation. tricuspid valve: mildly thickened tricuspid valve leaflets. mild to moderate +] tr. pericardium: no pericardial effusion. general comments: suboptimal image quality - bandages, defibrillator pads or electrodes. conclusions: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. there is moderate-to-severe global left ventricular hypokinesis (ejection fraction 30 percent). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis. moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. compared with the findings of the prior study (tape reviewed) of , no major change is evident. electronically signed by , md on 13:59. physician: , . cardiac catheterization 1. coronary angiography of this co-dominant system revealed two vessel coronary artery disease. the left main coronary artery was very short in length and had a 30% stenosis in the proximal vessel. the lad had a 40-50% stenosis in the proximal vessel involving the origin of a large d1 while the d1 had a 50-60% stenosis. the lcx had no angiographically apparent flow limiting stenoses. the rca had a 70% stenosis in the proximal vessel. 2. limited resting hemodynamics were performed secondary to the incidence of complete heart block with a previous attempt at pulmonary artery catheterization. the tricuspid valve was not crossed. right sided filling pressures were normal (mean ra pressure was 5 mm hg). left sided filling pressures were mildly elevated (lvedp was 16 mm hg). cardiac index was normal (at 3.2 l/min/m2) (calculated using an ra oxygen saturation, assuming no intracardiac shunt). 3. the aortic valve was evaluated and had a mean gradient of 49 mm hg and an aortic valve area of 0.8 cm2. brief hospital course: 74f transfer from osh s/p embolectomy for r brachial emboli, h/o severe as and anemia for cardiac work-up. pt of dr. , found to have colonic polyps on colonoscopy for anemia work-up at osh. pt admitted to receive medical clearance for future procedure. found to have uti, with signs of sepsis severe respiratory difficulty and severe aortic stenosis. admitted to mi cu 3/23/5 for respiratory distress intubated on . found to have uti with vre, and e coli multiresistant. at that point id consult was called and recommendations were followed. received full course of antibiotic treatment until bc and uc were cleared. patient was extubated on /5. since then patient was persistently disoriented, seen by psychiatry multiple times diagnosis of delirium was made. we minimized pain medications and pt was placed on haldol for a couple of days. on max dose of haldol he mental status did not improved nor sedation was archived so pt was placed on ativan that met her sedation requirements. patient since extubation was placed on tf to meet her caloric requirements impact with five 3.4 strength.pt underwent cath on aborted for agitation of patient echo done on 4 11 05 showing;the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. there is moderate-to-severe global left ventricular hypokinesis (ejection fraction 30 percent). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis. moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion cath repeated on /5 showing:1. two vessel coronary artery disease. 2. severe aortic stenosis. we keep pt in icu monitoring for optimization of her cardiac, and nutritional status before surgery avr. during this period of time c diff was send ed several times found to be negative. her mental status remained uncharged, having to restrain her and requiring a sitter at all times. pt pulled her feeding tube multiple times. finally antibiotic course with linezolid was archived and negative blood and urine cul tires were found to be negative. her nutritional status was improved with transferrin of 174 albumin of 2.7. on , ms. was taken to the operating room where she underwent an aortic valve replacement utilizing a 21mm pericardial bioprosthesis. postoperatively she was taken to the cardiac surgical intensive care unit for monitoring. on postoperative day one, ms. and was extubated. she was transfused for postoperative anemia. beta blockade was started and titrated for optimal heart rate and blood pressure support. she developed atrial fibrillation and underwent cardioversion on . ms. was only able to hold a normal sinus rhythm for less then two minutes and amiodarone was started. heparin and coumadin were started for anticoagulation with the plan for a repeat cardioversion in a month. tube feeds were started for nutritional support and calorie counts were started. on postoperative day seven, ms. was transferred to the cardiac surgical step down unit for further recovery. se continued to be gently diuresed towards her preoperative weight. the physical therapy service was consulted for asssistance with her postoperative strength and mobility. ms. remained in a rate controlled atrial fibrillation and was anticoagulated on heparin. on pod#18 she developed brbpr, her heparin was d/c'd and it resolved. she continued to make steady progress, but had some agitation at night. she was followed closely by the geriatric medicine service and her medications were adjusted. she was discharged to rehab on pod#34. she will follow-up with dr. , dr. , her cardiologist and her primary care physician as an outpatient. medications on admission: 1. escitalopram oxalate 10 mg tablet sig: one (1) tablet po daily (daily). 2. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 3. amlodipine besylate 5 mg tablet sig: 0.5 tablet po daily (daily). 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 6. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 7. warfarin sodium 2.5 mg tablet sig: one (1) tablet po hs (at bedtime). 8. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 weeks. 9. ampicillin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 2 weeks. discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 4. nystatin-triamcinolone 100,000-0.1 unit/g-% cream sig: one (1) appl topical (2 times a day) as needed. 5. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 7. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po hs (at bedtime). 8. olanzapine 5 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for agitation. 9. ipratropium bromide 0.02 % solution sig: two (2) inhalation q6h (every 6 hours) as needed. 10. trazodone hcl 50 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed. 11. olanzapine 2.5 mg tablet sig: one (1) tablet po q8a/4p/10p (). 12. prednisone 1 mg tablet sig: two (2) tablet po q4pm (). 13. prednisone 1 mg tablet sig: six (6) tablet po qam (once a day (in the morning)). 14. mirtazapine 15 mg tablet sig: one (1) tablet po 8 pm (). 15. trazodone hcl 50 mg tablet sig: 0.5 tablet po hs (at bedtime). discharge disposition: extended care facility: nursing & rehabilitation center - discharge diagnosis: aortic stenosis status post avr. discharge condition: good discharge instructions: monitor wounds for signs of infection. these include redness, drainage or increased pain. monitor vital signs. report any fever greater then 100.5. report any weight gain of more the 2 pounds in 24 hours. follow medications on discharge instructions. shower regularly and pat wounds with a towel. do not use lotions, creams, or powders on wounds. p instructions: follow-up with dr. in 4 weeks after discharge. follow-up with dr. as instructed. follow-up with you cardiologist in 2 weeks follow up with dr. in weeks. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances other electric countershock of heart insertion of temporary transvenous pacemaker system arterial catheterization open and other replacement of aortic valve with tissue graft pulmonary artery wedge monitoring extraction of other tooth transfusion of packed cells debridement of nail, nail bed, or nail fold injection or infusion of oxazolidinone class of antibiotics diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension unspecified septicemia severe sepsis atherosclerosis of aorta atrial fibrillation rheumatic heart failure (congestive) acute respiratory failure atrioventricular block, complete mitral valve insufficiency and aortic valve stenosis delirium due to conditions classified elsewhere dental caries, unspecified dermatophytosis of nail 

Answer: The patient is high likely exposed to