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: all allergies / adverse drug reactions previously recorded have been deleted attending: chief complaint: syncope major surgical or invasive procedure: ppm placement history of present illness: mr. is a very pleasant 61 year old gentleman with pmh significant for dmii and hypothyroidism s/p thyroidectomy and rai for graves' disease who was in his normal state of health until around 12 pm . he woke up that morning feeling fine, and had attended a computer conference in the am. when he came back home, he had bent down to pick up a video from the floor and subsequently "fell asleep." he denies hitting his head, and is not certain how long he remained unconcious. he denied any chest pain or shortness of breath before falling. he has never passed out before. he denies any tounge biting, shaking, or urinary or fecal incontience. when he awoke, he noted that his breathing was hard, he was not in any pain, and that he was clammy. he laid down, but his breathing did not improved. after 30 minutes, he decided to call ems. ems found him to be in complete heart block with a ventricular escape rhythm, and started tcp with an inital pulse rate 21. . upon arrival to osh ed, he was found to be in 3rd degree heart block. a rij was placed at with a transvenous pacer @ 70 bpm 20 mv with good capture. labs at osh notable for k 3.7, bicarb 19.6, bun/cr 13/1.5, anion gap of 14, ck 80, mb .7, and trop t <0.01. alt 137 ast 70 ap 91, tbili 0.43. lactate 7.6. cxr at that time showed mild pulmonary edema, with a pacer wire in the rv, without ptx. transferred for further management of chb. . upon arrival to our ed, labs notable for an improved ag 7, bun/cr 13/1, with tropt 0.02. phos low at 1.4. hct at baseline, with a u/a notable for trace ketones. prelim cxr read pending, but wire appears in appropriate location. transferred to the icu for further management of chb. ekg in our ed shows v-paced rhythm in the 70s, but with the pacer mv turned down, the patient is noted to be in nsr, without prolongation of the pr, and without any st elevation or depression, widenened qrs interval, left axis, with a left fasicular hemiblock. . on review of systems, 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 endorses a low grade fever 3 weeks ago after having eaten chiense food, as well as some abdominal cramping while standing at the time. denies chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations. notable to syncope, which has never occured for him before. . past medical history: 1. cardiac risk factors: + diabetes, + dyslipidemia, hypertension 2. cardiac history: - cabg: none - percutaneous coronary interventions: none - pacing/icd: none 3. other past medical history: - rosacea - keratoconus, unspec - hypercholesterolemia - diabetes mellitus, type 2 - obesity unspec - bifascicular block - diverticulosis - hypothyroidism grave's disease (underwent 90% thyroidectomy and several years later rai for recurrence) - amblyopia - strabismic - family history colon cancer . social history: married with 2 children. smoking: tobacco-pipe for 2 years in the early , no longer ethanol: quit 1.5 months ago; prior to that had been drinking 1.5 l of single malt scotch a week. drugs: no history of illicit drug use . family history: - father passed away from an mi at age 89. - mother passed from colon cancer at age 65. no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. no family history of conduction disease. . physical exam: vs: t 98 bp 128/81 hr 64 rr 13 98% on 3 l nc general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. pacer wire in r ij, site is without ttp. neck: supple without jvp. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. very slight crackles, left greater than right. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid popliteal 2+ dp 2+ pt 2+ neuro: cn ii-xii grossly intact. muscle strength with flexion/extention of upper arms, 5/5 strength in quadraceps bilaterally. . pertinent results: admission labs: 06:05pm glucose-134* urea n-13 creat-1.0 sodium-139 potassium-4.1 chloride-108 total co2-24 anion gap-11 06:05pm estgfr-using this 06:05pm alt(sgpt)-122* ast(sgot)-70* ck(cpk)-92 alk phos-64 tot bili-0.3 06:05pm ctropnt-0.02* 06:05pm ck-mb-3 06:05pm calcium-8.3* phosphate-1.4* magnesium-1.9 06:05pm tsh-3.3 06:05pm free t4-1.6 06:05pm wbc-10.2 rbc-4.34* hgb-14.3 hct-39.7* mcv-91 mch-32.9* mchc-36.0* rdw-12.5 06:05pm neuts-84.6* lymphs-11.9* monos-2.5 eos-0.2 basos-0.8 06:05pm plt count-240 06:05pm pt-13.0 ptt-22.0 inr(pt)-1.1 06:05pm urine color-straw appear-clear sp -1.009 06:05pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 06:05pm urine rbc-1 wbc-2 bacteria-none yeast-none epi-0 06:05pm urine mucous-rare . . 14:50 ( ekg) - sinus tachycardia at 150 bpm with 3rd degree avb with wide complex escape rhythm at 25 bpm . non-paced ekg - sinus rhythm ~60 bpm with left axis deviation, nl pr interval, widened qrs interval, poor r wave progression without st segement changes, iv conduction defect . echo this admission: the left atrium and right atrium are normal in cavity size. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. . impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. no structural cardiac cause of syncope or pathologic flow identified. historical info: date: ekg (atris report): normal sinus rhythm nonspecific intraventricular block abnormal ecg when compared with ecg of 12:15, nonspecific t wave abnormality has replaced inverted t waves in inferior leads . ekg (atris report): normal sinus rhythm right bundle branch block left anterior fascicular block *** bifascicular block *** left ventricular hypertrophy with qrs widening abnormal ecg compared to prior tracing of , bifascicular block now present- ecg: . . - echo: - stress echocardiogram w exercise test 1. there is mild concentric left ventricular hypertrophy. 2. overall left ventricular systolic function is normal, with an estimated lvef of 55-60%. 3. tissue and transmitral doppler demonstrate impaired lv relaxation ( grade i diastolic dysfunction) 4. no significant valvular heart disease visualized on this study. 5. no prior report available for comparison. 6. no 2d echocardiographic evidence of inducible ischemia at the level of stress achieved. sensitivity limited by suboptimal endocardial resolution. . . - cardiac cath: no prior caths . - laboratory data: - (atrius records) chol 189 hdl 41 ldl 125 trig 116 hgba1c 5.9 . total protein 7.1 albumin 3.9 bilirubin total 0.5 alt 101* ast 83* alk phos 66 . hepatitis a ab, total negative hepatitis b surface ab, <1.00 (a) >=10 miu/ml hepatitis a ab, igm negative hepatitis b core ab, total negative hepatitis b surface ag negative hepatitis c ab 0.08 negative . ruq u/s - moderate marked diffuse fatty infiltration of the liver. othreewise normal abd. u/s . . brief hospital course: this is a 61 year old gentleman with pmh significant for dmii and hypothyroidism who p/w with syncope which was found to be 3rd degree heart block requiring permanent pacemaker placement. . # complete heart block: initially presented to after episode of syncope with bradycardia consistent with 3rd degree hb with a ventricular escape rhythm in the 20s. was probably in mild hf on presentation as evidence by sob, pulmonary congestion and mild pre-renal failure in ed. patient was treated with transvenous pacing and transferred to . as for etiology for his heart block most likely this was d/t natural progression of his underlying conduction system disease as evidenced by per pre-existing lahb + ivcd. echocardiography was undertaken to r/o structural defects especially in the context of his h/o of alcohol consumption this was unremarkable except for mild lvh. he does not have known ihd but his ce were flat thus bradycardia to ischemic event was not likely. he was not on any av-slowing drugs. his tsh and ft4 were normal. he had no electrolyte abnormalities. lyme serology was negative. patient had permanent pacemaker placed without complications. he was given vancomycin on day of procedure followed by clindamycin for 48 hour course. post procedure cxr was unremarkable and pacemaker interrogation revealed good function. patient is discharged home and will be followed up in the device clinic 1 week post dicharge. . # elevated lfts: mild elevation in alt/ast on admission which subsequently trended down. patient has known underlying steatohepatitis and likely had some liver congestion to heart failure on presentation. patient has h/o of alcohol consumption (1.5l of scotch per week untill 1.5 months prior) but reported that had been sober for 1.5 months and alt/ast ratio was not suggestive of alcoholic hepatitis. will continue out patient follow-up. . # dmii: on iss during admission, discharged on home metformin. . # hypothyroidism: tsh/t4 are wnl. continued on home 175 mcg of levothyxine daily. . # dvt prophylaxis: recieved heparin sq during this admission. . # code status: full during this admission medications on admission: - tetracycline 250 mg - metformin 500 mg - levothyroxine 175 mcg daily - vitamin d 200 iu daily - fish oil supplementation - fibertabs discharge medications: 1. levothyroxine 175 mcg tablet sig: one (1) tablet po daily (daily). 2. metformin 500 mg tablet sig: one (1) tablet po twice a day. 3. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. clindamycin hcl 300 mg capsule sig: one (1) capsule po four times a day for 6 doses. disp:*6 capsule(s)* refills:*0* 5. vitamin d 400 unit capsule sig: one (1) capsule po once a day. 6. fish oil 1,000 mg capsule sig: one (1) capsule po once a day. discharge disposition: home discharge diagnosis: complete heart block transaminitis dm ii hypothyroid discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you. you came to the hospital with very concerning heart rhythm known as complete heart block. we have placed a permanent pacemaker for you to maintain your heart rhythm in the normal range. you tolerated the procedure well and was discharged in stable condition. please follow up with the following doctors listed below. please note we made the following changes to your medications. stopped: - tetracycline 250 mg by mouth twice a day (restarted at the discussion with dr. start: - clindamycin 300 mg by mouth four times a day for 6 doses - lisinopril 5mg by mouth once a day followup instructions: please follow up with dr. in one week time (. please follow up in device clinic for ppm monitoring (to be arranged with dr. . md procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrioventricular block, complete left bundle branch hemiblock postsurgical hypothyroidism alcoholic fatty liver 

Answer: The patient is high likely exposed to