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: percocet / dilaudid (pf) attending: chief complaint: altered mental status, unresponsiveness major surgical or invasive procedure: right ventricular lead revision history of present illness: -year-old white female with a recent ppm for chb, history of cad, hyperlipidemia, hypertension and arthritis who presented to with altered mental status and failure of rv capture. . per ed report, the patient had a syncopal episode at her nursing facility today. the patient just had a pacemaker placed on at after prolonged episodes of complete heart block with asystole and no escape rhythm. the patient's family subsequently reports that the patient had been complaining of some discomfort in the left lower chest/ left upper abdomen over the past 2 days. they report this is worse when the patient takes a deep breath. . ems reports that the patient's pacemaker did not appear to be functioning adequately as they found the patient's heart rate to be between the 30's and 70's. ems was not able to obtan iv access and an io was placed. there are no reports of any recent chest pain, shortness of breath, abdominal pain, new back pain, or trauma. the patient was not able to answer review of systems questions or identify exacerbating or alleviating factors. the patient did have some eccymosis about the left side of her head. . in the , the patient was successfully intubated with versed, fentanyl, and succinylcholine out of concerns that she could not protect her airway and hypotension. a temporary pacing wire was placed via the right ij. the patient was bradycardic and a cxr demonstrated a displaced right ventricular pacer wire. after consultation with the family, the patient was transferred to for further evaluation and management. . at , we noted complete loss of capture of the pacemaker rv lead, and intermittent or absent capture of the temporary pacing wire. during periods of her complete paroxysmal heart block, she was completely pacer dependent. given the tenuous situation, she was taken to the or emergently. on echo, there was concern for rv lead displacement but no evidence of tamponade or effusion. she was taken to the or and had the rv lead repositioned to the rvot. she was intubated and sedated and on dopamine. a repeat echo demonstrated no effusion or complication of lead placement. access is piv, femoral 7-french central line. . ros: unable to obtain due to intubation/sedation. past medical history: 1. cardiac risk factors: dyslipidemia, hypertension, diabetes mellitus 2. cardiac history: cad. s/p inferior microinfarction - pacing/icd: complete heart block s/p pacemaker placement in 3. other past medical history: 1. gastroesophageal reflux disease. 2. colon cancer. 3. insulin dependent-diabetes mellitus. 4. history of duodenal ulcer. 5. copd. 6. asthma. 7. history of cataracts. 8. osteoarthritis. 9. history of ventral hernia. 10. history of abdominal wall abscess. 11. depression. 12. history of colocutaneous fistula. 13. history of diverticulitis. 14. hyperlipidemia 15. cad. s/p inferior microinfarction 16. pulmonary edema, diastolic dysfunction 17. complete heart block. . past surgical history: 1. right colectomy for colon cancer. 2. ventral hernia repair with mesh. 3. bilateral hip replacements. 4. antrectomy and vagotomy with - ii reconstruction with splenectomy and partial pancreatectomy for duodenal ulcer. 5. duodenostomy tube. 6. feeding jejunostomy. 7. exploration of abdominal abscess. social history: - tobacco history: ex-smoker - etoh: no - illicit drugs: no family history: nc physical exam: vital signs: 95.1 60 111/53 100% cmv assist control 400/14 peep 5 general: intubated w/ rass of -5. heent: conjunctiva were pale. pupils reactive to light. no xanthalesma. neck: supple with jvp flat 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. pt intubated ctab, no crackles, wheezes or rhonchi on anterior lung exam. 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. neuro: intubated with rass of -5, 2+ reflexes biceps, brachioradialis, patellar, ankle. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ discharge: vital signs: 98.8 71 110/38 26 99%2l general: nad, axox1, agitated. heent: conjunctiva were pale. pupils reactive to light. no xanthalesma. neck: supple with jvp flat cardiac: irregular rr, normal s1, s2. 1/6 systolic flow murmur . lungs: no chest wall deformities, scoliosis or kyphosis. pt intubated ctab, no crackles, wheezes or rhonchi on anterior lung exam. 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. pertinent results: labs on admission: 04:30pm blood wbc-15.7* rbc-3.39* hgb-10.1* hct-30.8* mcv-91 mch-29.7 mchc-32.6 rdw-14.1 plt ct-232 04:30pm blood neuts-83.7* lymphs-11.3* monos-3.7 eos-0.9 baso-0.4 04:30pm blood plt ct-232 04:30pm blood glucose-103* urean-49* creat-1.7* na-145 k-5.3* cl-117* hco3-22 angap-11 04:30pm blood ck(cpk)-89 04:38am blood calcium-8.1* phos-5.3* mg-1.8 04:21pm blood type-art rates-16/ tidal v-400 peep-5 fio2-100 po2-472* pco2-35 ph-7.36 caltco2-21 base xs--4 aado2-206 req o2-43 intubat-intubated vent-controlled . labs on discharge: 04:22am blood wbc-12.3* rbc-2.88* hgb-8.8* hct-26.3* mcv-92 mch-30.6 mchc-33.5 rdw-14.5 plt ct-191 04:22am blood plt ct-191 04:22am blood glucose-93 urean-41* creat-1.6* na-145 k-4.3 cl-116* hco3-22 angap-11 04:22am blood calcium-7.8* phos-4.2 mg-2.9* 01:25am blood lactate-1.1 01:25am blood o2 sat-98 01:25am blood freeca-1.14 . pcxr impression: 1. ett approximately 1.7cm above the carina and should be repositioned. 2. new right ventricular lead projects medial to the ventricular apex, however it's exact position cannot be completely assessed without a lateral view. . pcxr findings: in comparison with the study of , the new right ventricular lead appears to be in good position, substantially less peripheral than on the previous study. endotracheal tube tip lies approximately 2 cm above the carina. small layering pleural effusion persists on the left and there is mild bilateral basilar atelectasis. . echo overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the right ventricular pacing lead is identified in the right ventricular cavity. it does not appear to extend beyond the free wall (but images are focused). there is a trivial pericardial effusion with no echocardiographic signs of tamponade. . compared with the prior study of earlier in the day, the right ventricular pacing lead no longer appears to extend beyond the free wall (though views are focused). . echo normal right ventricular cavity size and free wall motino. in some views (clips ), the right ventricular pacing lead appears to extend beyond the right ventricular free wall. there is no pericardial effusion. . microbiology: 4:30 pm urine site: not specified hem# 1646e . urine culture (preliminary): escherichia coli. >100,000 organisms/ml.. presumptive identification. . 3/6/012 2:43 am stool consistency: soft source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). brief hospital course: -year-old white female with a history of cad, hyperlipidemia, hypertension, dm, and arthritis with recent ppm placement at on for complete heart block (?paroxysmal av block) and syncope who presented to with altered mental status and a displaced rv pacerlead with bradycardia now s/p pacer lead revision. . # complete heart block/rv lead displacement: the patient had a ddd pacemaker placed at on approximately for symptomatic (syncope) bradycardia. she was transferred to today after being found unresponsive; it was found that her rv pacer lead had perforated her rv apex. a temporary pacing wire was placed at without complication and she was transferred to . an echo here demonstrated no pericardial effusion, but showed clear perforation of the rv lead. she underwent rv lead revision, with post-operative echo showing no complication. repeat echo demonstrates only minimal pericardial fluid, but no evidence of tamponade. patient was monitored on telemetry and with serial ekg without additional complication. she received a one time dose of vancomycin, and then on discharge, will continue keflex, renally dosed, for a total of 7 day of abx coverage for lead revision. she will have follow-up at device clinic on tuesday, . . # chf: diastolic dysfunction. patient was continued on her home bb, asa. . # : pt's cr baseline appears to be near 1.2 as per discharge from on . cr was 1.7 on admission. ddx included prerenal vs intrinsic. cr remained stable during admission, and on discharge was 1.6. . # copd - known history of copd. she was continued on albuterol and ipratropium, and discharged on her home fluticasone and salmeterol. . # e. coli uti - ua suggestive of urinary tract infection. culture grew > 100k e.coli with sensitivities pending. she received a dose of ceftriaxone, and then was changed to ciprofloxacin x 5 days on discharge. she remained afebrile, with resolving wbc. she denied urinary symptoms while here. if sensitivities are cephalosporin positive, ciprofloxacin could be discontinued, as she is on keflex x 5 days for lead revision. . # diarrhea: resolved. cdiff was checked and negative. . # code: dnr/dni, confirmed with hcp . # transitions: - e.coli sensitivities from urine culture pending - spoke with pcp, . at and updated on patient's admission. medications on admission: home medications: from d/c summary from on ; unable to confirm as pt intubated and sedated lactobacillus 1 tab metoprolol tartrate 25 mg aspirin 325 mg daily enoxaparin sodium 30 mg daily fluticasone salmeterol inh acetaminophen 650mg q4h prn oxycodone 1 tab q4h prn magnesium hydroxide nitroglycerin 0.4 mg q5m prn discharge medications: 1. lactobacillus acidophilus tablet, chewable sig: one (1) tablet, chewable po twice a day. 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. enoxaparin 30 mg/0.3 ml syringe sig: one (1) syringe subcutaneous once a day. 5. fluticasone 110 mcg/actuation aerosol sig: one (1) puff inhalation twice a day. 6. salmeterol 50 mcg/dose disk with device sig: one (1) puff inhalation once a day. 7. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 9. senna 8.6 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for constipation. 10. cephalexin 500 mg capsule sig: one (1) capsule po q8h (every 8 hours) for 5 days. 11. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual prn as needed for chest pain: can take 3 in 15 minutes. 12. ciprofloxacin 250 mg tablet sig: one (1) tablet po once a day for 5 days. discharge disposition: extended care facility: healthcare center at discharge diagnosis: primary: 1. right ventricular lead revision discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , . it was a pleasure taking care of you at . you were admitted for malfunction and displacement of your pacer lead. this was fixed with good results. you had an echocardiogram which showed no complication. . you were noted to have a urinary tract infection. you will take antibiotics for this, and also for the pacer lead revision. . medication changes: - start keflex 500 mg every 8 hours for 5 more days . please seek medical attention for any concerns. please attend your follow-up appointments below. followup instructions: department: cardiac services when: tuesday at 10:00 am with: device clinic building: sc clinical ctr campus: east best parking: garage md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours arterial catheterization revision of lead [electrode] diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified other and unspecified hyperlipidemia atrioventricular block, complete osteoarthrosis, unspecified whether generalized or localized, site unspecified personal history of malignant neoplasm of large intestine surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation diarrhea chronic obstructive asthma, unspecified do not resuscitate status diastolic heart failure, unspecified mechanical complication due to cardiac pacemaker (electrode) hip joint replacement other and unspecified escherichia coli [e. coli] 

Answer: The patient is high likely exposed to