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: history of present illness: patient is admitted with a chief complaint of fever. this is a 44-year-old male with multiple medical problems including several episodes of endocarditis, status post homograft aortic valve replacement times two, status post av outflow tract route debridement, status post pseudomonal pneumonia, intermittent pancreatitis, diabetes mellitus type 2, coronary artery disease status post coronary artery bypass graft, hypercalcemia, critical care neuropathy, who was recently cared for at from to following his pseudomonal pneumonia who presented on with fevers, chills, dizziness, and a nonproductive cough as well as one-day history of vomiting. patient denied any headache, visual changes, chest pain, pleuritic pain, back pain, abdominal pain, diarrhea, melena, dysuria, rash, or joint pain. in the emergency department he was found to have a temperature of 103.2f and was started on empiric antibiotics consisting of vancomycin and cefepime. he became hypotensive with a systolic blood pressure that fell to the 80s and was given normal saline bolus as well as continuous normal saline. a right ij central line was placed, and the patient was transferred to the intensive care unit for further management of his sepsis. past medical history: 1. several episodes of endocarditis with root abscess status post aortic valve replacement times two and root debridement with homograft in 02/. his endocarditis was complicated by septic emboli to the central nervous system to the lungs and the kidneys, and patient was noted to have transient atrial fibrillation during part of his hospitalization for endocarditis. 2. congestive heart failure. the patient has 4+ mitral regurgitation, mild tricuspid regurgitation, and mild pulmonary artery hypertension. 3. coronary artery disease status post coronary artery bypass graft in when patient had an saphenous vein graft to his left anterior descending and an saphenous vein graft to an right coronary artery. 4. status post chronic ventilator dependence with pseudomonal colonization. 5. cryptogenic hypercalcemia. patient was noted to have a low pth, low 25 hydroxy vitamin d, and pth rp that was negative. he was found to have a heterotopic calcification of his left shoulder and responded to pamidronate as well as active vitamin d repletion. 6. patient was diagnosed with seizure disorder at age 12 and has been seizure free since diagnosis with maintenance on keppra. 7. patient has history of fungemia. 8. patient has history of bowel dysmotility that was previously treated with reglan and erythromycin. 9. malnutrition. 10. history of ileocolectomy in . 11. diabetes mellitus type 2. 12. history of type 1 rta. 13. gastric outlet obstruction secondary to gj tube abutting pylorus. 14. history of hypoxic encephalopathy. 15. chronic intermittent chemical pancreatitis. 16. history of multiple pneumoniae. 17. history of severe esophagitis (? ischemic esophagus 02/). 18. prepyloric ulcer in 03/. 19. depression. 20. ? tia in . 21. ards. allergies: patient has no known drug allergies. medications on admission: 1. lexapro 10. 2. nortriptyline 50. 3. iron sulfate 325 mg q. day. 4. lisinopril 10 mg q. day. 5. calcitriol 0.25 mg q. day. 6. keppra 500 mg b.i.d. 7. protonix 40 q. day. 8. reglan 10 q.i.d. 9. flovent b.i.d. social history: the patient lives at home with his girlfriend. is divorced. no tobacco or ethanol history. family history: has a brother and a sister. there is no known history of immunodeficiency or valve disease. physical examination on admission: temperature 98.0 f, pulse 64, blood pressure 93/37, oxygen saturation 96% on 2 liters oxygen. general: middle-aged, thin male in no acute distress. heent: pupils equal, round, reactive to light; extraocular movements intact; sclerae anicteric; mucous membranes moist; oropharynx is clear. neck is supple. trach site is clear; no erythema; no lymphadenopathy. pulmonary exam: crackles at the right base, otherwise clear to auscultation. cardiac exam: regular rate and rhythm; grade iv/vi holosystolic murmur heard best at the apex with radiation to the axilla. abdomen and back: grade i/vi diastolic murmur heard best at the left lower sternal border. abdomen is soft, nontender, nondistended with positive bowel sounds. extremities: no edema. skin: no rash, no stigmata of endocarditis, no vitreous hemorrhages, no lesions, no osler's nodes. mental status exam: patient is awake and alert, oriented times three; exam is nonfocal. hospital course: 1. patient was admitted to the intensive care unit for treatment of his sepsis. source of his sepsis remains unclear but responded to broad spectrum empiric antibiotics that consisted of vancomycin, tobramycin, and flagyl. a radial arterial line was briefly in place for invasive blood pressure monitoring while the patient was in the icu. patient rapidly defervesced and had a white count that declined from 14.2 on peaking at 15.1 on and then subsequently declined to 6.4 on the day of discharge. all blood cultures remained negative. fungal culture was negative, and central catheter tip culture was also negative. sputum cultures were likewise negative. urine culture was negative as well. given the patient's history of multiple episodes of endocarditis and his presentation with fever of uncertain etiology, a transthoracic echocardiogram was carried on . the echocardiogram demonstrated an ejection fraction of greater than 55% with a mildly dilated left atrium and mild symmetric left ventricular hypertrophy as well as left ventricular cavity that was mildly dilated and depressed right systolic function with thickened prosthetic aortic valve leaflets but no masses or vegetation seen on his aortic valve. there was 1+ aortic regurgitation. there was 4+ severe mitral regurgitation but no vegetation seen on the valve. there was trace tricuspid regurgitation, and again no vegetations on the valve, and likewise there was physiologic tr without any vegetation of the pulmonic valve. given the patient's history, however, of multiple episodes of endocarditis, a follow-up transesophageal echocardiogram was obtained on and demonstrated again an lvf of greater than 55% and again demonstrated the absence of any masses or vegetation on any of his heart valves. here again noted was severe mitral regurgitation with partial flail of the anterior leaflet, mild aortic regurgitation. the patient remained afebrile off antibiotics from through the day of discharge. 2. renal: the patient was found to be in mild acute renal failure on admission. his creatinine was up from his baseline of 0.6 to 1.6 on the day of admission and decreased to 1.1 on the day of discharge. it was thought that he was having acute renal failure secondary to prerenal azotemia related to his sepsis on admission. his dose of his ace inhibitor, lisinopril, was decreased from 10 mg to 5 mg on the day of discharge. 3. diabetes mellitus: patient was maintained on a regular insulin sliding scale with excellent control of his blood sugars. 4. gastrointestinal: patient was maintained on a bowel regimen and was continued with his q.i.d. reglan. 5. depression: the patient was continued on his outpatient anti-depression regimen. 6. malnutrition: a nutrition consult was obtained, and the patient was given p.o. caloric supplementation. patient was adequately tolerating p.o. intake for several days prior to discharge. 7. neurological: the patient was maintained on keppra. 8. physical therapy: a pt consult was obtained and, although the patient had decreased function and mobility, he was able to ambulate 500 feet and maintained adequate room air oxygen saturation as well as to climb a flight of stairs and was cleared for discharge to home. discharge condition: stable. primary diagnosis: fever. secondary diagnoses: 1. sepsis. 2. hypertension. 3. aortic insufficiency. 4. anemia in chronic illness. 5. renal failure, acute. 6. pneumonia, organism unspecified. 7. diabetes mellitus. 8. malnutrition. discharge medications: the patient's medications on discharge are the same as those prior to admission with the exception of: 1. decrease in his lisinopril dose to 5 mg p.o. q. day. 2. he will continue to take his escitalopram oxylate 10 mg q. day. 3. nortriptyline 50 mg q. h.s. 4. ferrous sulfate 325 mg b.i.d. 5. calcitriol 0.25 mcg p.o. q. day. 6. levetiracetam 500 mg p.o. b.i.d. 7. metoclopramide 10 mg q.i.d. 8. fluticasone 110 mcg, two puffs, b.i.d. 9. pantoprazole 40 mg p.o. q. day. discharge instructions: 1. follow up with primary care physician, . . 2. have an ear, nose, and throat appointment for follow up on his hearing loss. the appointment is scheduled for at 2:30 p.m. with dr. of the ent division. 3. the patient will have a physical therapy home consult for home safety evaluation. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart arterial catheterization diagnoses: pneumonia, organism unspecified anemia of other chronic disease acute kidney failure, unspecified unspecified septicemia unspecified protein-calorie malnutrition other convulsions rheumatic heart failure (congestive) mitral valve insufficiency and aortic valve stenosis heart valve replaced by transplant 

Answer: The patient is high likely exposed to