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: iodine dye attending: chief complaint: shortness of breath major surgical or invasive procedure: tracheal intubation history of present illness: hpi: mr. is 84m with history of cad s/p 5v cabg (), 3v redo cabg in with porcine avr, ischemic cm (ef 45%), htn, hld, r aka amputation presents with dyspnea x 2-3 days to hospital. as per report, the patient has been getting more dyspneic with exertion, with his lasix recently increased by his cardiologist. over the last three days, the patient reports having increasing edema, orthopnea, and doe with ambulation from bed to bathroon. denies any cp, no syncope, palpitations, or prn. does endorse throat pain, ?anginal equivalent. at hospital he was in acute heart failure, with o2 saturations of 94% on 6l, trop 0.35. cxr notable for b/l effusions, pulmonary congestionwas given lasix. while there the patient received asa 162 mg, lasix 40 mg, rocephine 1 gm, and was started on heparin drip. of note, in response to diuresis was noted to have systolic pressures dip into the 90s, at which point he was transferred to . of note patient had admission in and diagnosed with meningioma and intracerebral aneurysms. in the ed, vitals were: 97.9 ??????f (36.6 ??????c), pulse: 76, rr: 20, bp: 90/60, rhythm: sinus rhythm, o2sat: 96, o2flow: 4l , pain: 0 the pt given asa 325, rocephin 1 gm for cxr from outside hospital showing possible pna?, and heparin 4200 unit bolus and gtt @ 12u/kg/hr. ed cardiologist saw him here and noted hypotension to the 80s although the patient was mentating and had good urine output. an echocardiogram was done in the ed (by the cardiology fellow) which showed reduced ef from and septal wma consistent with possible missed anterior mi. in ed patient became hypotensive sbps 70s and given 750 cc ivf bolus after no response dopamine was started. later pt's 02 sat dropped to 80s, ?evolving ekg changes, non rebreather was tried which didnt work then pt was intubated. pt sbp dipped into the 60s levofed was started in addition to dopamine past medical history: -htn -hld -cad: s/p cabg x2 ( - 3 vessel bypass w/ aortic valve replacement with porcine valve, - 5 vessel bypass) -right aka gangrene 3 years ago -left lower extremity bypass graft peripheral vascular disease -prostate cancer - diagnosed in , total prostatectomy, no chemotherapy or radiation -remote left eye surgery, patient unable to recall what was done social history: patient lives with wife in a three floor building with his daughter and grandchildren living in the building. he recently moved into his daughter's house in . the patient worked as an electrician. retired 22 years ago. smoked 1ppd in 20s and 30s. stopped 40 years ago. no alcohol abuse in past. had not drank for many years. no elicit drug use. family history: brother - died in 50s from chf father - died in 70s from prostate cancer mother - died in 80s after hip fracture denies history of neurologic disease such as seizures, brain tumors, or ms. physical exam: general: intubated unresponsive. heent: ncat, no scleral icterus noted, mmm, no lesions noted in oropharynx. neck: no carotid bruits heard. pulmonary: intubated cardiac: third heart sound heard on exam, tachy abdomen: soft, normoactive bowel sounds, no masses or organomegaly noted. extremities: pulse appreciated in left foot by doppler, right leg aka ext warm skin: no rashes or lesions noted. neurologic: mental status: intubated pertinent results: 07:45pm pt-11.6 ptt-51.9* inr(pt)-1.1 07:45pm plt count-152 07:45pm wbc-15.0* rbc-3.41* hgb-10.0* hct-30.2*# mcv-89 mch-29.2 mchc-33.0 rdw-18.5* 07:45pm wbc-15.0* rbc-3.41* hgb-10.0* hct-30.2*# mcv-89 mch-29.2 mchc-33.0 rdw-18.5* 07:45pm calcium-8.2* phosphate-3.6 magnesium-2.2 07:45pm ctropnt-0.59* 07:45pm estgfr-using this 07:45pm glucose-110* urea n-34* creat-1.2 sodium-128* potassium-3.3 chloride-95* total co2-26 anion gap-10 09:50pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 09:50pm urine color-straw appear-clear sp -1.004 brief hospital course: assessment and plan assessment: mr. is 84m with history of cad s/p cabg x2, avr in , ischemic cm (ef 45% in ) p/w worsening dyspnea, worse ef 20% found to be in cardiogenic and septic shock, has strep bovis positive blood cultures concerning for prosthetic valve endocarditis. acute issues #shock: multifactorial: the initial presentation included a broad differential of cardiogenic shock, septic shock, and adrenal insuffiency. cardiogenic shock in the setting of recent anterior mi causing hypokinesis of anterior wall and cardiomyopathy and poor outflow from the heart. septic in setting of positive blood culutures growingout strep bovis. source of infection could be prostetic aortic valve endocarditis, initially coming from gut vs mouth. he was initially intubated after flash pulmonary edema ensued in the ed s/p fluid bolus for hypotension and then put on levophed and dopamine for pressor support while concominantly adding a lasix gtt for diuresis of pulmonary edema. stress dose steroids were also initiated as the patient was chronically on decadron for menigiomas. a central line was placed for adequate pressor administration. the patient's blood pressures and urine output were adequate and the dopamine and levophed were titrated off. he then self-extubated without complications. shortly after, troponin and ck-mb were noted to be drastically elevated at 7.58 and 99. however, because of goals of care (family did not want major surgery and interventions), no cardiac catheterization was undertaken. and although there was evidence of septic shock on initial presentation as he met sirs criteria and we had bcx positive for strep gallalyticus, he clinically did not appear septic as there were no pressor requirements and no ivf was given. the patient was initiated with ceftriaxone to treat his bacteremia and the steriods were tapered down to his home dose. the central line was removed and a picc line was placed for possibility of needing home iv antibiotics. id was consulted and patient can go home on po amox 1 g indefinitely because he is goign home on hospice. before discharge, the picc line was removed as no iv abx will be given at home. radiology called right before discharge and noted a possible infiltrate on latest cxr. patient was discharged on levaquin (10 day regimen) for treatment of possible community acquired pneumonia. #end of life care: pt's family wanted pt to be dnr dni after pt was extubated. pt's family wanted home hospice so we got palliative care involved. he will be discharged on all oral medications to treat his presumptive bacteremia/endocarditis and pneumonia. hospice will initiate his home o2 requirement #episodes of resp distress: the patient had multiple episodes of shortness of breath and anxiety after extubation. pt has tachy, htn and incr rr and lower sats in the 80s when these occurred. it was felt to be episodes of flash pulmonary edema which responded to morphine, nitro dri, lasix. it is unclear why pt continues to have these episodes. possibly acs related. likely a combination of anxiety, tachycardia/htn causing increase in afterload, and ongoing ischemia which ultimately led to flash pulmonary edema. along with addition of metoprolol 50 mg , we added captopril to decrease his flash pulmonary edema. we gave lasix prn and morphine prn for episodes of resp distress. to help with his anxiety and delerium we started him on zyprexa. # rhythm: pt had episodes where he had pvcs and also had episodes of atrial tachy and pt was started on amiodarone. plan for amiodarone: 200 tid (day 1 was ) for 3 wks then 200 daily starting on . # coronaries: patient presenting with acute cardiac decompensation in setting of ischemic/septic embolic cardiomyopathy. he likely had a missed anterior mi vs septic embolic event with worsening ef new septal akinesis-dyskinesis. family did not want any interventions did not want cath lab # : likely from chf with intravascular low volume. his cr improved around discharge. #hyperglycemia pt was put on insulin sliding scale chronic issues: # meningiomas: at first we gave stress dose steroids in setting of shock then we he was better we continued home decadron 3mg. #mca aneurysms: during hospital stay we focused on the bigger issues: cardiogenic shock, septic shock. pt was placed onhep drip for a couple of hours at the beginning of hospital stay bc of concern of possible mi. this was discontinued a couple of hours later as pt got worse and went into cardiogenic shock. #anemia: hct was around his baseline. transitional issues -amiodarone: amiodarone 200 mg tid for 3 weeks (day 1: ) , 200 (start on for 2 weeks) then 200 mg daily after (start on ) -f/u presumed endocarditis -f/u mca aneurysms medications on admission: amlodipine 5 mg atorvastatin 10 mg docusate 100 mg daily ferrous sulfate 325 mg daily lorazepam 0.5 mg q6h prn losartan 50 mg daily magnesium oxide 400 mg daily metoprolol 50 mg tid mirtazapine 30 mg qhs mvi daily ranitidine 150 mg lasix 40 mg daily decadron 3 mg daily asa 81 mg discharge medications: 1. amiodarone 200 mg po tid rx *amiodarone 200 mg 1 tablet(s) by mouth three times a day disp #*60 tablet refills:*0 rx *amiodarone 200 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 2. amoxicillin 1000 mg po q12h rx *amoxicillin 500 mg 2 capsule(s) by mouth every 12 hours disp #*30 tablet refills:*3 3. aspirin 81 mg po daily rx *adult low dose aspirin 81 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 4. dexamethasone 3 mg po daily rx *dexpak 1.5 mg (51 tabs) 2 tablets(s) by mouth daily disp #*30 tablet refills:*0 5. furosemide 80 mg po daily please start rx *furosemide 80 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 6. levofloxacin 750 mg po q48h duration: 10 days rx *levaquin 750 mg 1 tablet(s) by mouth every 48 hours disp #*5 tablet refills:*0 7. lisinopril 5 mg po daily rx *lisinopril 5 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*0 8. metoprolol succinate xl 150 mg po daily hold if bp <90 and hr <60 rx *metoprolol succinate 100 mg 1.5 tablet(s) by mouth daily disp #*30 tablet refills:*0 9. mirtazapine 30 mg po hs rx *mirtazapine 30 mg 1 tablet(s) by mouth once at night disp #*30 tablet refills:*0 10. morphine sulfate (concentrated oral soln) 5-10 mg po q2h:prn anxiety, sob, air hunger sub-lingual rx *morphine concentrate 100 mg/5 ml (20 mg/ml) 0.25-.5 ml by mouth every 2 hours disp #*6 bottle refills:*0 11. olanzapine (disintegrating tablet) 2.5 mg po qhs rx *olanzapine 2.5 mg 1 tablet(s) by mouth at night disp #*30 tablet refills:*0 12. olanzapine (disintegrating tablet) 2.5 mg po once a day prn anxiety rx *olanzapine 2.5 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*0 13. home oxygen dx: chf rx: please take 2-5l nc titrate to comfort 14. ranitidine 150 mg po bid discharge disposition: home with service facility: discharge diagnosis: primary: decompensated chf, endocarditis secondary: coronary artery disease,pneumonia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it was a pleasure taknig care of you here at . you came to the hospital because you had shortness of breath. we did special imaging and saw that your heart wasnt squeezing well. you needed a breathing tube for a day and then you were able to breathe on your own. while you were here we found a bacteria growing in your blood and we treated you with iv antibiotics called ceftriaxone. it is most likely that the bacteria in your blood is from an infection in your heart called endocarditis. while you were here you also became agitated and upset at times and then became short of breath. we think you will start to feel more calm when you are home. we took a photo of your lungs the day befor eyou left and it showed you may have a new pneumonia. we are going to treat you for it with oral antibiotics because you are going home on hospice. weigh yourself every morning, md if weight goes up more than 3 lbs. we made the following changes to your antibiotics: please start amoxacillin 1 g will likely be on indefinitely. this is for your infection of the heart please start amiodarone 200 three times a day which you will take for 3 wks then 200 daily starting on this is for your heart rate which can become fast at times please start zyprexa please start levofloxacin 750 mg every other day for 10 days followup instructions: we have schedule cardiology and infectious disease appointments for you. you can cancel these appointments if you do not think they are necessary and if you find it is difficult to transport out of the house. department: neurology when: monday at 1:30 pm with: , md building: sc clinical ctr campus: east best parking: garage department: radiology when: monday at 11:55 am with: radiology mri building: sc clinical ctr campus: east best parking: garage department: radiology when: monday at 11:15 am with: radiology mri building: sc clinical ctr campus: east best parking: garage we are working on a follow up appt with dr. in the week. you will be called at home with the appointment. if you have not heard or have questions, please call . department: infectious disease when: thursday at 10:00 am with: , md building: lm bldg () campus: west best parking: garage we are working on a follow up appt with dr. in the week. you will be called at home with the appointment. if you have not heard or have questions, please call . department: infectious disease when: thursday at 10:00 am with: , md building: lm bldg () campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: pneumonia, organism unspecified anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis acute myocardial infarction of other anterior wall, initial episode of care personal history of malignant neoplasm of prostate coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status personal history of tobacco use other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia heart valve replaced by other means other specified cardiac dysrhythmias cerebral aneurysm, nonruptured cardiogenic shock septic shock other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation benign neoplasm of cerebral meninges acute systolic heart failure glucocorticoid deficiency streptococcal septicemia other abnormal glucose above knee amputation status acute edema of lung, unspecified infection and inflammatory reaction due to cardiac device, implant, and graft 

Answer: The patient is high likely exposed to