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: no known allergies / adverse drug reactions attending: chief complaint: pacer infection major surgical or invasive procedure: removal of icd generator removal of biventricular leads history of present illness: 51 y.o. with familial non ischemic cardiomyopathy , htn, af, with heart block s/p biv pacer with gen change on . by reports fromt he osh, his ef was initially 35% which improved to normal following biv. sent home with keflex post gen change. apparently the patient developed some loose stools and stopped takign the keflex. . presented back to ri on with fever, rigors, hypokalemia, creat of 1.8, and pacer pocket draining small amt of serous/sang from medial aspect of incision. . a tee was reportedly neg for veg. on evenign prior to transfer patient developed a fever to 102 and rigors. hr to 150 with telemetry showign widecomplex tachycardia. out of concern for vt he was lidocaine 100mg x2, amiodarone 300mg x2 and received a 125j dccv with premedication with versed with no effect. then they evaluated an old ekg which showed preexisting lbbb. his rhythm was then classified as svt with abberency. they gave him 6mg adenosine followed by another 12mg with no effect. they then gave him 5 mg lopressor which slowed the rhythm to 120's. he was started on vanc and zosyn. blood cultures from admission grew out gnrs in 2 out of 2 bottles and wound culture from his pacer site grew out gnr as well. . patient was also noted to have thrombocytopenia with platelets of 100 on admission trending down to 61 by hd #3. he received no heparin products while at the osh on this admission. prior heparin my have been given several weeks ago during his generator change. he also had reported anemia with hct down trending from 38.2 to 32.1 to 30.6. work up was notable for normal retic count, elevated ldh, elevated haptoglobin, negative direct coombs, elevated d-dimer, elevated fibrinogen adn normal coag panel. at time of transfer he was reportedly feeling well and hd stable. . on arrival to the icu he was febrile to 103 and rigoring with hr in the 150-180. he had two tenuous pivs. he became acutely delirious with severe agitation and combativness and refused placement of peripheral ivs. his hr remained elevated and was wide complex and regular/irregular with intermittent pacing consistent with svt with abberency. he was hd stable. patient was given 5mg iv lopressor x1 with correction of his hr to 160's, also received 1g iv tylenol through one remaining peripheral and 0.5mg of iv ativan. with the assistance of the cvic intensivist a 16 guage piv was placed in his left forearm and he was bolues 1l lr. his hr and mental status normalized significantly. he was given 1g iv vancomycin and 500mg meropenam iv. the ep fellow was contancted to discuss the possibility of emergency explantation for source control. given his improved clinical status and hd stability the explantation was scheduled for first thing in the morning. . central access was discussed with the patient but he adamently refused. we were able to obtain excellent peripheral access and clinical stabilization and improvement so no further access is being sought at this time. past medical history: 1. cardiac risk factors: hypertension 2. cardiac history: - pacing/icd: biv icd 3. other past medical history: - a fib - famililal cm social history: - tobacco history: unknown - etoh: yes occasionally - illicit drugs: marijunan occasionally family history: - no family history of early mi, arrhythmia, or sudden cardiac death; otherwise non-contributory. physical exam: on admission vs: 115 93% on 2l nc 121/64 general: middle agend gentleman diaphoretic with marked agitation and waxing and mental status. heent: ncat. dry mucous membranes. sclera anicteric neck: supple, difficult to assess jvp cardiac: tachycardic, irregular rate and rhythm lungs: cta bl abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: warm with 3+ pulses at all extremities skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: intermittent orientation with waxing and mental status. during brief periods of clarity he had no focal neurologic defects. his mental status complicated a through neurologic exam. on discharge: afebrile, bp 90-110s/70s, hr 90s-100s, tachycardic when ambulating, saturations >93% ra exam as above except for: mental status was cleared. alert and oriented x3, cn 2-12 intact, muscle tone normal, strength 5/5 in bilateral deltoids, biceps, triceps, and hand grip, 4/5 strength in bilateral hip flexors, in knee extension, plantar and dorsiflexion. sensation intact to light touch in bilateral c5-t1 and l4-s1. pertinent results: admission labs: 11:06pm blood wbc-6.4 rbc-3.46* hgb-11.3* hct-33.4* mcv-97 mch-32.7* mchc-33.9 rdw-13.0 plt ct-76* 11:06pm blood neuts-85.6* lymphs-10.7* monos-3.2 eos-0.2 baso-0.4 11:06pm blood pt-11.1 ptt-25.1 inr(pt)-1.0 11:06pm blood fibrino-642* 11:06pm blood glucose-105* urean-11 creat-1.1 na-138 k-3.2* cl-107 hco3-19* angap-15 11:06pm blood alt-57* ast-145* ld(ldh)-338* alkphos-105 totbili-0.7 11:06pm blood calcium-7.5* phos-0.4* mg-1.6 11:18pm blood lactate-2.4* urine: 11:32pm urine color-yellow appear-clear sp -1.012 11:32pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-40 bilirub-neg urobiln-neg ph-6.0 leuks-neg 11:32pm urine rbc-4* wbc-1 bacteri-none yeast-none epi-0 micro: enterobacter cloacae complex (amoxicillin r, cefazolin r, cefepime <=1 s, ceftriaxone <=1 s, ciprofloxacin <=0.25 s, gentamicin <=1, levofloxacin <=0.12 s, meropenem <=0.25 s, piperacillin-tazobactam 2 s, bactrim <=20 s pertinent reports: cxr: biventricular pacemaker is demonstrated with the leads terminating in right atrium, right ventricle and epicardial location of the left ventricle. no definitive interruption of the pacemaker leads is demonstrated, but proximal lead to the pacemaker battery, there is questionable irregularity in the defibrillator lead that should be further assessed with dedicated radiographs and lateral views as well. heart size and mediastinum are unremarkable. lungs are essentially clear except for minimal bibasilar atelectasis. mild degree of volume overload cannot be excluded. no appreciable pneumothorax is seen. echo: left ventricle - ejection fraction: 45% to 50% >= 55% findings left atrium: no spontaneous echo contrast in the body of the laa. good (>20 cm/s) laa ejection velocity. right atrium/interatrial septum: no asd by 2d or color doppler. left ventricle: normal lv wall thickness. normal lv cavity size. normal regional lv systolic function. mildly depressed lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. normal descending aorta diameter. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: mildly thickened mitral valve leaflets. moderate (2+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: physiologic (normal) pr. pericardium: no pericardial effusion. general comments: written informed consent was obtained from the patient. the patient was under general anesthesia throughout the procedure. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. conclusions tee performed for icd lead extraction. no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is mildly depressed (lvef= 45-50 %). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results at time of procedure. post lead extraction: no pericardial effusion is seen. tricuspid regurgitation is unchanged. cxr: as compared to the previous radiograph, there is no relevant change. status post lead extraction. no evidence of pneumothorax. borderline size of the cardiac silhouette. mild enlargement of the left ventricle. no pleural effusion. no parenchymal opacities brief hospital course: principle reason for admission mr. is a 51 year old male with history of non-ischemic cardiomyopathy status post biventricular pacemaker/icd (biv icd) and normalization of ejection fraction with recent generator change complicated by pocket infection with enterobacter bacteremia. he was transferred from osh for sepsis management as well as explantation of generator. active problems # icd pocket infection: patient presented to hospital on with pacer pocket infection. he was started on vancomycin and piperacillin/tazobactam and transferred to on for further management. on transfer, patient met sirs criteria (hr, fever, rr) with altered mental status. his ef was documented as normal by osh so received liberal fluid resuscitation. antibiotics were changed to vancomycin and meropenem on transfer. cultures from osh grew enterobacter and his antibiotics were narrowed to meropenem 500 mg q6h. infectious disease recommendations were for 4 week course of antibiotics from time of lead extraction on because this patient had bacteremia documented on and , ongoing fevers, and leukocytosis. because he was self-pay and unable to afford iv abntibiotics for the full course, he insisted on being switched to po antibiotics. the enterobacter was sensitive to ciprofloxacin so he was discharged to home with a script for ciprofloxacin 750mg po q12h for a 4 week course from . he should follow-up with infectious disease as well as his doctors in . # thrombocytopenia: there was concern at the outside hospital for hit and dic. however his pretest probability of hit was low given 4t score of 1 point for degree of thrombocytopenia. also dic unlikely given elevated fibrinogen, no evidence of hemolysis, and normal coags. no fever or evidence of hemolysis to raise concern for ttp/hus and his mental status resolved with control of fevers. likely his thrombocytopenia was secondary to sepsis. platelets trended from 76 on admission to 350 on discharge. # delirium: patient presented to with marked delirium in setting of fever and tachycardia. his agitation improved with control of fever. # dilated cardiomyopathy: patient with history of dilated non-ischemic cardiomyopathy. his metoprolol was changed to long acting metoprolol succinate 100 mg daily, and he was started on lisinopril 5 mg daily for heart failure. he was not started on aspirin or statin because his failure is non-ischemic. currently, he is not in biventricular synchrony because his biv pacer has been removed due to infection above. he will be expected to have worse ef now. he should be evaluated for placement of a new biv-icd when his infection has cleared. he did not have any symptoms of heart failure during this admission. # paroxsymal atrial fibrillation (paf): he had intermittent afib, which never persisted. he had no symptoms. his chads2 score was only 1 so he did not need anticoagulation. he could be considered for aspirin daily as an outpatient. transitional issues: - he should be evaluated for placement of a new biv-icd when his infection has cleared. - a standing order for labwork including cbc w/diff, bmp, and lfts qweek should be given to the patient so that he can have labwork done locally and then faxed to infectious disease at . - continue ciprofloxacin 750mg po q12h for a 4 week course from - he should be monitored for symptoms of heart failure and his medications should be adjusted as needed for fluid management until a biv-icd can be reimplanted. medications on admission: metoprolol tartate 50 mg omeprazole 20mg ecqd discharge medications: 1. outpatient lab work check cac with diff, chem-7, lft's every week starting . please fax results to infectious disease office at md 2. acetaminophen 650 mg po q6h:prn pain or fever 3. metoprolol succinate xl 100 mg po daily rx *metoprolol succinate 100 mg daily disp #*30 tablet refills:*2 4. omeprazole 20 mg po daily 5. lisinopril 5 mg po daily hold for sbp<100 rx *lisinopril 5 mg daily disp #*30 tablet refills:*2 6. ciprofloxacin hcl 750 mg po q12h duration: 4 weeks rx *ciprofloxacin 750 mg twice a day disp #*56 tablet refills:*0 discharge disposition: home discharge diagnosis: primary diagnosis icd pocket infection non-ischemic chronic systolic heart failure--ef 35% without biv pacer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital because you were having fevers and your biventricular pacemaker/icd was infected. you had the device removed and you were treated with antibiotics which helped to make your fevers and infection clear. you were started on some heart failure medications. right now, your heart will not have the biventricular pacing which was helping it pump more effectively, you will need to have another device placed once you clear the infection. the following changes were made to your medications: - change your metoprolol to the long-acting formulation. you will now be taking metoprolol succinate 100 mg once a day for heart failure - start taking lisinopril 5 mg daily for heart failure - start ciprofloxacin twice daily until . . you will need to have labs checked every week. a prescription was given to you that you can bring to any lab and have the results faxed to the infectious disease doctor here at . you should keep all of the follow-up appointment listed below. you can postpone the appt with dr. if you wish. bring your medications to each appointment so your doctors update their records and adjust the doses as needed. it was a pleasure taking care of you in the hospital! followup instructions: department: infectious disease when: at 9:00 am with: , md building: lm campus: west best parking: garage department: infectious disease when: thursday at 10:00 am with: , md building: lm bldg () campus: west best parking: garage pcp : , at 11am . with: ,md location: medical associates address: one st, , phone: department: cardiac services when: tuesday at 3:20 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: removal of lead(s) [electrode] without replacement revision or relocation of cardiac device pocket diagnoses: other primary cardiomyopathies thrombocytopenia, unspecified esophageal reflux congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation sepsis other specified septicemias chronic systolic heart failure surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation lumbago other alteration of consciousness orthostatic hypotension infection and inflammatory reaction due to cardiac device, implant, and graft 

Answer: The patient is high likely exposed to