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: symptomatic bradycardia, syncopal episode major surgical or invasive procedure: craniotomy , temporary pacing wire placed in r ij and removed history of present illness: this is a 56yom w/recent h/o fall evaluated here and found to have subdural hematoma (treated conservatively) who presented with syncopal episode. he reports that he was home yesterday afternoon napping when the phone rang, and he woke up to answer it. as he stood up and walked to the other room, he grabbed the door, "spun around" and fell. he reports no loc with this fall. reports hitting his head on the ground. denies sob, chest pain or palpitations prior to the fall but felt very lightheaded post fall. denies any loss of continence. denies seizure like activity but fall was unwitnessed. denies visual changes. +mild headache. he sat on the ground post fall and then called his girlfriend who brought him to the er. . of note, pt does report use of klonopin (unclear #) since discharge from for "anxiety". also reports ongoing headaches that occured during hospitalization and persisted on discharge. . in the ed, vitals were t hr 44 bp 114/78 rr14; ekg showed sinus bradycardia, no st/t changes, no evidence of heart block. serum tox +benzos. ct head with possible increase in midline shift; improved sdh. neurosurgery evaluated and felt sdh stable. he received morphine 2mg and acetaminophen 1000mg. . on review of symptoms, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies cough, sputum production, dysuria, nausea/vomiting, diarrhea or constipation. denies any sick contacts. past medical history: oxycodone/percocet abuse s/p left knee surgery s/p right hip replacement 2 lumbar spine surgeries (?fusion, last one 3 years ago) ear surgery for otitis media externa 20 years ago social history: social history is significant for the 1ppd current tobacco use. + h/o oxycodone and percocet abuse (previously on suboxone; reports none in past few years. lives with girlfriend, has 3 children; 1 past away and 2 daughters alive; one in and one in ma. former fisherman. drinks 4 drinks/week; used to drink heavily when fishing but not in past 10 years. family history: non-contributory physical exam: vs: t 98, bp 125/56 , hr 57 , rr 20 , 96 o2 % on ra gen: white middle aged male, nad, slightly disheveled. mood, affect appropriate. heent: ncat. sclera anicteric. perrl (5mm->3mm b/l), eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple, jvp flat, + carotid bruit b/l. cv: pmi located in 5th intercostal space,2/6 sem heart at rusb chest: clear to ausculatation bilaterally. no crackles, wheeze, rhonchi. abd: soft, ntnd, no hsm or tenderness. ext: no le edema/clubbing skin: large ecchymosis on forearms bilaterally pulses: 2+dp/pt pulses bilaterally neuro: a&o x3, knows president is "" cn 2-12 grossly intact sensation intact throughout 5/5 strength in both ue/le equally, bilaterally possibly mild asterixis pertinent results: ekg demonstrated bradycardia, no evidence of heart block or st/t changes. . ct head on admission(wet read): interval evolution of the recent left subdural hematoma without significant increase in size. minimal increase in the rightward subfalcine herniation, now measuring 8 mm compared to prior 6 mm. the temporal parenchymal contusion has also evolved appearing less dense today. no other interval changes. . ct c-spine on admission(wet read):no acute fractures or dislocations. post surgical changes from c4 to c6 laminectomy. . cxr on admission(my read): bases not visualized, o/w no evidence of pleural effusion/edema, no consolidations noted . laboratory data: ck: 67 mb: notdone tni:<.01 wbc 13.2 (77n, 15l) hct 38.1 plts 270 . 136 / 99 / 13 / --------------- 4.1 / 26 / 0.7 . ck: 67 trop <.01 . alt 42, ast 27 alk phos 79, t. bili 0.4 u/a negative dilantin 14.9 serum tox- positive for benzos urine tox- positive for benzos 10:40pm tsh-1.0 06:34am glucose-120* urea n-12 creat-0.7 sodium-137 potassium-3.9 chloride-100 total co2-28 anion gap-13 06:34am albumin-4.2 06:34am wbc-9.8 rbc-4.08* hgb-12.2* hct-34.1* mcv-84 mch-29.9 mchc-35.8* rdw-13.1 04:00am urine bnzodzpn-pos barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 10:40pm ck-mb-notdone ctropnt-<0.01 brief hospital course: a/p: 56 yo male with no signficant pmh who recently sustained sdh s/p fall who now presents with syncopal episode and fall and found to have sinus bradycardia. . # syncope: new onset sinus bradycardia. likely related to increased vagal tone from recent sdh + sinus bradycardia related to dilantin. no structural heart disease (had tte w/ ef of >55%, no lv dysfunction or aortic stenosis, no septal defects or vegetations), no ischemia (ekg w/o any evidence of this, all cardiac enzymes were negative), ingestions of medications, (pts serum benzo positive). he was also found to be orthostatic. less likely seizure given no incontinence/post-ictal period/therapeutic dilantin levels. the patient was given 1 l ns bolus, q2-4 hour neuro checks, and monitored on telemetry. his dilantin was changed to keppra 500 . patient has no carotid bruits on exam. tia and seizure were considered less likely on the differential, so carotid doppler u/s and eeg were deferred and can be done on an outpatient basis. due to continued bradycardia w/ symptomaticity (hypotension), and a rpt head ct on 7.25 showing increased midline shift, he was taken to the or on 7.25 for sdh evacuation and given a pacer. pts bradycardia subsequently improved and temporary pacer was removed . pt was transferred to the floor on and telemetry documented a hr between mid 40's to high 80s. he had no more symptomatic bradycardic events before discharge. . # rhythm: sinus bradycardia w/o evidence of avb; likely due to increased vagal tone in setting of sdh. other etiology may include recently started dilantin which can also contribute and cause bradycardia. dilantin level was therapeutic at time of admission and albumin was wnl, but this medication can still cause sinus bradycardia even when not at toxic levels. hypothyroidism was unlikely given his tsh was normal. pacer pads were kept in place, and atropine and dopamine were kept at bedside, but were never required. his opiod medications were also held. because the patient lives in , lyme serologies were sent and were found to be negative. the patient was evaluated by the ep service, and the initial recommendation was to not place a pacer, and to have holter monitering 2 weeks after discharge. the patient was sent to the floor, and proceeded to have bradycardia to the 20s while he slept, responsive to atropine. he was then transferred back to the micu. following this, he was found to be bradycardic and symptomatic (hypotensive) requiring a dopamine gtt to increase heart rate. at this point ep decided it was appropriate to to place a temporary pacing wire. he was then re-transferred back to the micu for monitoring, and after sdh evacuation, his hr improved and his temporary pacing wire was removed. he was transferred back to the floor and monitored on telemetry, where his hr remained in the mid 40s to high 80s. # ms changes: unclear if this patient truly has any ms changes; per notes, there was a question of a personality change; however exam unrevealing. lfts were within normal limits. family believes patient's ms is at baseline. . # sdh/ha: his sdh from fall was stable in size from previous admission, with a minimal midline shift only slightly increased from admission per head ct. pts phenytoin level 14.9 on admisison. neurosurgery evaluated pt in ed and felt sdh stable and its undergoing chronification process that can cause minimal increased in mass effect but currently w/o symptoms except for headache. dilantin was changed to keppra (see above), and patient was given tylenol and codeine (low dose and as needed to prevent increased bradycardia) for chronic headache likely related to sdh. he also received an evacuation of the sdh (see above "seizure/sinus bradycardia") on . # leukocytosis: predominant lymphocytosis (wbc 13) more c/w viral etiology/stress response. he was afebrile during his hospital course. wbc trended down to 9.8 on discharge. no source of infection at this time. his cxr showed no evidence of pna, and urine analysis was negative. no antibiotics were given. his wbc increased to 14 on and trended down to 10.2 on the day of discharge. he remained afebrile on the floor. . # pt was mildly hypertensive in the ed, and received hydralazine. he was subsequently hypotensive and orthostatic. his bp improved w/ 1 liter ns bolus x1. dopamine and atropine were kept at his beside, but his bps remained stable w/ maps > 60 while in the icu and did not require pressors. on the floor, his blood pressure was stable and he did not require further anti-hypertensive medication. . # pt required occasional percocet to control ha on the medicine floor. ha did not change in character, and was classified as dull, l sided, constant, nonphotophobic and without n/v and neurological symptoms. . # fen: regular diet. electrolytes checked daily. . # prophylaxis: pneumoboots (no asa or heparin sc given recent sdh). no ppi or bowel reg necessary. . #access- 2 pivs . # code: full (confirmed with pt) . # communication: daughter jacks . # dispo: home with at home safety evaluation medications on admission: dilantin 100mg tid x10 days (started ) klonopin 1mg prn ativan 2mg prn . discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain. disp:*30 tablet(s)* refills:*0* 2. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: sinus bradycardia subdural hematoma discharge condition: good, normal vital signs discharge instructions: you were admitted to the with the diagnosis of bradycardia (low heart rate.) this is likely related to the initiation of the anti-seizure drug dilantin, which can sometimes cause low heart rates, and your nervous sytem reaction to the recent subdural hematoma (head bleed). you had a pacer placed on to stabilize your heart rate and this was removed on . your head bleed is stable on imaging, but was causing some increased brain swelling and continued low heart rate, so you underwent an drainage of the bleed. and has not increased in size. the dilantin was changed over to another medication called keppra which does not have the same heart slowing effects. you were discharged in good health. please return to the nearest ed or contact your primary care physician if you experience another fall where you injure your head or another part of your body, dizziness, loss of consciousness/blackouts, palpitations, chest pain, or any other symptoms not listed here that are concerning to you. . . please do not drive a car, operate any heavy machinery or any other automated vehicles in the next 6 months or until you are cleared by your primary care physician or cardiologist that you can operate these vehicles safely. followup instructions: please make an appointment to follow up with your primary care physician. , . . you should have your pcp contact the microbiology laboratory at ( to follow up on the results of the tests for lyme disease that were still pending at the time of your discharge. . provider: scan phone: date/time: 9:45 . please follow up with the neurosurgeons who treated you for your subdural hematoma. provider: , md phone: date/time: 11:45. . please follow up with cardiology, as they would like to do a holter monitering assessment for you in about 2 weeks after you are discharged. the cardiology fellow who was following you was dr. . procedure: incision of cerebral meninges insertion of temporary transvenous pacemaker system diagnoses: anemia, unspecified unspecified essential hypertension compression of brain hypotension, unspecified sinoatrial node dysfunction subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness fall from other slipping, tripping, or stumbling home accidents hip joint replacement arthrodesis status 

Answer: The patient is high likely exposed to