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: morphine attending: chief complaint: dizziness, palpitations, defibrillator firing major surgical or invasive procedure: endocardial ablation epicardial ablation history of present illness: mr. is a 73 year old gentleman with a past medical history significant for rheumatic heart disease c/b bioprosthetic avr, chf with a lvef 20%, vf with aicd/biv, paf on coumadin, and a recent admission for symptomatic vt complicated by gas baceteremia treated with ctx now admitted for vt. the patietn was hospitalized at from , during which he had a negative tee and icd pocket ultrasound with plan for 6 weeks of antibiotics ending on . between , he was noted to have several episodes of vt treated either with atp or defibrillation, during which he was admitted to an osh. he has been followed by dr. as an outpatient, and on his atp was increased. today, the patient reports that he was at for an id appointment when he had an episode of palpitations and lightheadedness with possible syncope for which he presented to the ed. . in the ed, initial vs 97.9 72 115/56 18 100%ra. ep was consulted, and interrogation of the aicd demonstrated 4 episodes of vt today treated with atp. the patient was then admitted for further management. . past medical history: 1. cardiac risk factors: -diabetes, -dyslipidemia, -hypertension 2. cardiac history: - pacing/icd: vvi pacer/aicd, placed in - non-ischemic cardiomyopathy with ef of 20% - rheumatic heart disease (in childhood) s/p bioprosthetic avr years ago in fl - paroxysmal atrial fibrilation on coumadin (confirmed by phone by his cardiologist dr. (holywood, ) - ventricular tachycardia 3. other past medical history: - gout - hypothyroidism - traumatic injury to his left arm 30 years ago social history: the patient lives in but recently moved to to live with his daughter. is a lifelong nonsmoker and does not drink alcohol. he denies any illicit drug use. he has a girlfriend who lives in . family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission physical exam: vs: 95.7 135/93 72 20 95%2lnc gen: age appropriate male in nad heent: mmm, op clear without lesions, exudate, or erythema. neck supple without lad cv: nl s1+s2, no m/r/g. indeterminate jvp. pmi not laterally displaced. pulm: ctab abd: s/nt/nd +bs ext: 1+ peripheral edema. neuro: aox3, cn ii-xii grossly intact. . discharge physical exam: vs: t 99.0, bp 102-133, hr 67-82, rr 18-20 97-100% on ra/2l gen: nad, comfortable sitting up without oxygen heent: sclerae anicteric and without injection, oropharyx clear and without exudate or erythema. neck supple without lad. cv: s1, s2, no murmurs auscultated. pulm: clear to auscultation bilaterally. abd: soft, non-tender, bowel sounds positive. ext: no peripheral edema, substantial deformity and scarring of left arm. right groin ecchymoses, clearing, but no hematoma to palpation. msk: left knee has no effusion, not tender to touch this morning. pertinent results: admission labs: 10:43am wbc-2.2*# rbc-5.49 hgb-14.4 hct-43.9 mcv-80* mch-26.3* mchc-32.8 rdw-16.3* 10:43am neuts-8* bands-0 lymphs-44* monos-31* eos-16* basos-1 atyps-0 metas-0 myelos-0 10:43am calcium-9.4 phosphate-2.7 magnesium-1.8 10:43am alt(sgpt)-20 ast(sgot)-37 ld(ldh)-226 alk phos-91 tot bili-0.4 10:43am glucose-153* urea n-16 creat-1.0 sodium-138 potassium-4.0 chloride-103 total co2-24 anion gap-15 . 05:19am blood gran ct-3390 06:13am blood gran ct-1619* 04:43am blood gran ct-928* . 10:43am probnp-944* 10:43am ctropnt-<0.01 06:06am blood ck-mb-2 ctropnt-<0.01 . 05:19am blood vanco-9.6* 06:13am blood vanco-15.3 04:43am blood vanco-12.2 05:01am blood vanco-8.6* . discharge labs: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:47 3.7* 4.61 12.5* 37.0* 80* 27.1 33.8 16.0* 171 renal & glucose glucose urean creat na k cl hco3 angap 06:47 91 12 0.9 138 4.1 103 25 14 . cxr: findings: single ap upright portable view of the chest was obtained. the costophrenic angle is not fully included on the image. given this, left-sided aicd is again seen, grossly unchanged in position. patient is status post median sternotomy. no focal consolidation, large pleural effusion, or evidence of pneumothorax is seen. there is no overt pulmonary edema. there has been interval placement of a right-sided picc line, distal aspect not well seen due to overlying pacer leads but appears to extend at least into the svc. . cxr: there is a right-sided picc line with distal lead tip in the distal svc. there is a left-sided dual-lead pacemaker as well as several old pacemaker wires. cardiac silhouette is enlarged. tortuous thoracic aorta. there is some increased density at the lung bases, degenerative change of the lower lumbar spine is also identified. . left hip x-ray: findings: there are no signs for acute fractures or dislocations. there are degenerative changes of bilateral hip joints with spurring of the superolateral acetabuli. degenerative changes of the lower lumbar spine is also identified. no focal lytic or blastic lesions are present. . cxr: findings: as compared to the previous radiograph, there is no relevant change. borderline size of the cardiac silhouette. the pacemaker and central venous access line is in unchanged position. no pulmonary edema. no pleural effusions, no pneumonia. moderate tortuosity of the thoracic aorta. . echo: overall left ventricular systolic function is severely depressed (lvef= 25-30 %). a bioprosthetic aortic valve prosthesis is present. the mitral valve leaflets are mildly thickened. there is no pericardial effusion. impression: severe global left ventricular hypokinesis with inferior and inferolateral akinesis. bioprosthetic avr. no pericardial effusion. compared with the prior study (images reviewed) of , the current study is a limited study assessing possible pericardial effusion. the findings are similar. . cxr: findings: in comparison with the study of , there is continued enlargement of the cardiac silhouette with some increased indistinctness of pulmonary vessels suggesting mild elevation of pulmonary venous pressure. the monitoring and support devices are unchanged. . echo: the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with moderate cavity dilation. there is severe regional systolic dysfunction with severe hyopkinesis of the inferior and inferolateral walls and mild hypokinesis of the anterolateral wall. the remaining segments contract normally (lvef = 25-30 %). no masses or thrombi are seen in the left ventricle. the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the aortic root is severely dilated at the sinus level. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet motion and transvalvular gradients. a paravalvular jet of mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is no pericardial effusion. . impression: left ventricular hypertrophy with cavity enlargement with extensive regional systolic dysfunction c/w multivessel cad. well seated aortic valve bioprosthesis with normal gradient and mild paravalvular aortic regurgitation. dilated aortic sinus. mild mitral regurgitation. pulmonary artery hypertension. right ventricular cavity dilation with free wall hypokinesis. compared with the prior study (images reviewed) of , a paravalvular jet of mild aortic regurgitration and mild mitral regurgitation are now see. (left ventricular was 6.8cm on review and the aortic root diameter was 5.8cm). . clinical implications: the left ventricular ejection fraction is <40%, a threshold for which the patient may benefit from a beta blocker and an ace inhibitor or . the patient has a severely dilated ascending aorta. based on accf/aha thoracic aortic guidelines, if a candidate, surgery should be considered. based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. . ct chest: 1. limited non-contrast examination in this patient demonstrating bioprosthetic aortic valve replacement. 2. no acute pulmonary pathology. 3. status post median sternotomy, with multiple intact sternotomy wires. there is near-complete fusion of the sternotomy defect. . brief hospital course: ccu course: patient was transferred to ccu after becoming hypotensive with sbps in 70s in ep lab after endocardial ablation. after arrival to the unit, levophed was quickly weaned off. he was given a 500 cc bolus with improvement in his bps w/ sbps in the 100s. he remained asymptomatic overnight with sbps 100-110s/40-60s. he received an additional 500 cc bolus the next morning for sbps in the 90s. he was asymptomatic during this time. after discontinuation of ceftriaxone, anc improved to > 3000 and precautions were removed. he remained in the ccu without event until epicardial ablation was attempted on . the procedure was not successful due to adhesions. the patient was again mildly hypotensive on return to the ccu and 500 cc fluid bolus was given with good response. on pm, the patient was febrile to 102. blood and sputum cultures showed no growth to date. cxr was without infiltrate. the patient was continued on amiodarone 200 mg qday, lisinopril 2.5 mg qday, digoxin 0.125 mcg qday, and coreg 12.5 mg . coumadin was restarted on after it was determined the patient would not go to the or this admission. . the rest of hospital course: ventricular tachycardia: ep attempted endocardial ablation and then an epicardial ablation. the epicardial ablation could not be completed due to adhesions. consideration being given to open procedure, but that procedure will not occur this hospitalization. amiodarone has been continued, but mexiteline has been stopped. the patient is being worked up by surgery for an open chest ablation. during his hospitalization, he never had significant ventricular tachycardia on telemtery amd his defibrillator did not fire. the patient has follow up with cardiac surgery in early . . # neutropenia: the patient's neturopenia was thought to be caused by ceftriaxone, given normal anc and differential , as his ceftriaxone therapy for bacteremia was initiated. heme/onc was consulted and agreed with the discontinuation of his ceftriaxone. the patient responded to discontinuation of ceftriaxone: anc improved from 176 to 928 quickly after discontinuation. his neutropenia has resolved now that his ceftriaxone has been stopped, although the patient still has occasional leukopenia. . # left knee pain: likely due to osteoarthritis, with perhaps a component of gout. the initial differential included septic joint vs crystal joint disease vs rheumatoid. unlikely to be rheumatoid arthritis with the clinical presentation and monoarticular large joint presentation. physical examination and vitals not consistent with septic joint. the patient had a mildly elevated uric acid level and is already on colchicine therapy. his osteoarthitis will be treated symptomatically with tylenol 1000 mg po tid. . # group a streptococcus bacteremia: originally planned to have six-week course of ceftriaxone, but that medication has been stopped due to concern that ceftriaxone is the causing neutropenia. the patient was changed to iv vancomycin. continue vancomycin iv until . the patient has follow-up with infectious disease on . . # paroxysmal atrial fibrillation: currently av paced. continue carvedilol for rate control and amiodarone for rhythm control. . # apnea: pt with identified apnea during sleep. o2 with sleep. outpatient sleep study. . # chf: stable nyha class ii-iii. continued home regimen of furosemide, lisinopril, digoxin, asa, carvedilol. medications on admission: amiodarone 200 mg once daily mexiletine 250 mg b.i.d. furosemide 40 mg daily levothyroxine 25 mcg daily warfarin 5 mg daily as per inr ropinirole 1 mg daily carvedilol 12.5 mg b.i.d. lisinopril 2.5 mg daily ceftriaxone 2 grams q. 24h. until klor-con 20 meq daily digoxin 125 mcg daily colchicine 0.6 mg daily aspirin 81 mg daily. discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 3. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 4. ropinirole 1 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 5. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 6. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 7. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 8. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. klor-con m20 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day. 11. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 12. vancomycin 500 mg recon soln sig: 1250 (1250) mg intravenous q 12h (every 12 hours) for 4 days: continue through . 13. acetaminophen 500 mg tablet sig: two (2) tablet po q8h (every 8 hours). discharge disposition: extended care facility: rehab in discharge diagnosis: ventricular tachycardia neutropenia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure participating in your care at . . you were hospitalized because you had some lightheadedness and palpitations during your visit to the infectious disease clinic. also, your aicd had been working to get your heart in a proper rhythm. the electrophysiology specialists tried procedures to get your heart back into a better rhythm, but they could not because of your anatomy. in order to try again, surgery will be necessary. the work-up for that surgery has begun. in the meantime, you will go to rehabilitation to get stronger and complete the antibiotic course. . you also presented with a low white blood cell count. we think this was caused by the antibiotic, ceftriaxone. you will need to continue a different antibiotic, vancomycin, until to make sure your previous infection has cleared. . medications: stop mexiteline. stop ceftriaxone. vancomycin. . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: department: infectious disease when: thursday at 11:00 am with: , md building: lm bldg () campus: west best parking: garage . department: cardiac surgery when: tuesday at 2:30 pm with: , md building: lm campus: west best parking: garage procedure: catheter based invasive electrophysiologic testing catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach cardiac mapping diagnoses: congestive heart failure, unspecified unspecified acquired hypothyroidism gout, unspecified atrial fibrillation paroxysmal ventricular tachycardia bacteremia unspecified sleep apnea chronic systolic heart failure long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ heart valve replaced by transplant neutropenia, unspecified restless legs syndrome (rls) osteoarthrosis, localized, not specified whether primary or secondary, lower leg streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group a 

Answer: The patient is high likely exposed to