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: ciprofloxacin / zometa / keflex / tetracycline / erythromycin / iodine containing agents classifier attending: chief complaint: ventricular tachycardia, icd generator change major surgical or invasive procedure: icd generator change history of present illness: the patient is a 68 y/o f with pmhx significant for niicmp (ef5-10%) s/p aicd/biv pacer, paf s/p ablation, who presented to osh on with worsening doe, cough, runny nose, diarrhea, fatigue. bnp was noted to be elevated at 1000, and there was some concern for dietary indiscretion during a recent trip. symptoms were initially attributed to chf exacerbation, and she was treated with lasix. given leukocytosis, there was also concern for underlying respiratory infection, for which she was started on doxycycline. . however, on the day after admission, the patient had a syncopal event while in the bathroom, hitting her head on the door. during this event, telemetry recorded vt/?torsades and she received a shock from her aicd. she endorseded lightheadedness prior to the event, denies any chest pain, palpitations, or shortness of breath. given that she was scheduled to have and aicd generator change at in the next few weeks, her cardiologist was contact and recommended transfer to . icd was interrogated at osh and reported to episodes of device-classified vt (vs. afib with rvr). . of note, imaging performed after the patient's head strike was significant for anterior c4 fracture of unclear chronicity. telephone neurosurgery consult was placed at osh, and it was recommended that patient be placed in a neck collar. patient also experienced a significant head laceration, which was sutured prior to transfer. vs at the time of transfer were hr 80s - 100s with sbp 100s - 110s. she has been experiencing significant nausea and diarrhea; her doxycycline has been stopped out of concern that it could be contributing to her gi symptoms. . on arrival to the ccu, the patient's vs were . she denies any shortness of breath or chest pain. she reports pain in the area where she struck her forehead. she denies any other complaints. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations. past medical history: past medical history: 1. cardiac risk factors: -diabetes, -dyslipidemia, -hypertension 2. cardiac history: - cabg: none - percutaneous coronary interventions: none - pacing/icd: aicd and biv pacer 3. other past medical history: - nonischemic idiopathic cardiomyopathy, ef 5-15%, s/p aicd and biventricular pacer - paroxysmal atrial fibrillation status post ablation - severe asthma - old compression fractures of t8 and t10 - venous stasis disease - anxiety - depression - restless legs syndrome - recent septic bursitis of right knee social history: used to work as a jeweler. lives with son. - tobacco history: remote, 1 ppw, quit 42 years ago. - etoh: approx. 1-2 drinks 4 times a week - illicit drugs: none family history: father had "heart problems" and died at 69. brother had some form of arrhythmia. no other cardiac history. physical exam: physical examination (on admission): vs: t=96.4 bp=105/62 hr=94 rr=20 o2 sat=95%2l general: nad. oriented x3. mood, affect appropriate. heent: cervical collar in place. ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. abrasions and sutured laceration on right forehead. neck: unable to asses jvp 2/2 cervical collar. cardiac: irregular rhythm, 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. some bibasilar crackles anteriorly. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ left: dp 2+. . on discharge: unchanged except of note: cervical collar no longer in place. pertinent results: 11:51pm blood wbc-11.8* rbc-4.64 hgb-15.1 hct-43.4 mcv-93 mch-32.6* mchc-34.9 rdw-14.2 plt ct-180 . 11:51pm blood pt-26.7* ptt-37.6* inr(pt)-2.6* . 10:00am blood glucose-198* urean-21* creat-1.2* na-135 k-4.6 cl-96 hco3-30 angap-14 . 10:00am blood albumin-3.6 calcium-8.4 phos-2.7 mg-2.1 . 10:00am blood alt-36 ast-51* alkphos-89 totbili-1.8* . osh cxr - cardiomegaly with pulmonary vascular congestion (per d/c summary) . osh cervical xray - limited exam, not visualizing c7. moderate degenerative change. no fracture seen. . osh ct head and c-spine - no acute intracranial finding. right forehead soft tissue swelling. bilateral maxillary sinusitis. fracture line through the anterior osteophyte of the inferior endplate of the c4, age-indeterminate. no visible associated soft tissue swelling. no prior study available for correlation. cervical spondylosis. . cxr - left dual-lead pacemaker has its leads terminating over the expected location of the right atrium and right ventricle respectively. an external pacing wire also is unchanged. heart remains enlarged. there is worsening indistinctness of the perihilar and pulmonary vasculature which is suggestive of moderate pulmonary edema. no evidence of pleural effusions. discharge labs 06:55am blood wbc-10.9 rbc-4.18* hgb-13.2 hct-39.3 mcv-94 mch-31.5 mchc-33.5 rdw-14.1 plt ct-205 06:55am blood plt ct-205 06:55am blood pt-15.1* ptt-33.4 inr(pt)-1.4* 06:55am blood glucose-122* urean-23* creat-1.2* na-137 k-4.3 cl-99 hco3-29 angap-13 07:57am blood alt-31 ast-39 totbili-1.4 06:55am blood calcium-8.9 phos-3.2 mg-1.9 brief hospital course: 68f with with a pmh significant for non-ischemic and ischemic cardiomyopathy (lvef 5-10%) s/p aicd and biventricular pacer, paroxysmal atrial fibrillation s/p ablation, admitted to an outside hospital with worsening dyspnea on exertion, cough, rhinorrhea, diarrhea and fatigue who was initially treated for a chf exacerbation but through her hospital course she developed ventricular tachycardia and torsades de pointes with firing of her icd and a shock successfully delivered with maintenance of her circulation; thus, she was transferred to for further monitoring and aicd generator change. . # ventricular tachycardia / torsades de pointes - the event on telemetry strip from her outside hospital appears to be polymorphic ventricular tachycadia with a torsades de pointes morphology. there was no clear inciting event noted. the patient is not on any new qt-prolonging medications (although sertraline and zofran have been known to prolong the qt), and only new medication was doxycycline. she had no significant electrolyte abnormalities noted (k was 3.5 the morning of admission to the outside hospital and her magnesium was reassuring). the most likely etiology at this point seems to be patient's underlying ischemic cardiomyopathy and prior scarring. her electrolytes were optimized with a magnesium of greater than 2.0 and potassium greater than 4.0 to 4.5. we consulted the electrophysiology team and planned for icd generator change early in the week. she was maintained on telemtry and had serial ekg monitoring. . # coronaries - the patient had no documented history of coronary disease in our records; or cardiac catheterizations. on admission, she denied any chest pain and her ekg was without ischemic changes. . # dyspnea on exertion - the patient has a known history of non-ischemic and ischemic cardiomyopathy with an lvef of %. on presentation to the outside hospital, she was noted to have worsening dyspnea on exertion, an elevated bnp, and fluid overload on cxr. she was treated with iv lasix. on admission to the ccu, her exam still was notable for bibasilar crackles, a cxr showing mild fluid overload. of note, the patient also has history of asthma and was recently on a steroid taper; however, her exam did not reveal any wheezing or evidence of asthma exacerbation. while she was started on vancomycin and cefepime empirically at the outside hospital, there did not appear to be any evidence of infection (afbrile and she was without leukocytosis). we continued her home dosing of lasix 80 mg po twice daily. she had no indication for steroids. she was also maintained on her home advair medication. we did not feel she warranted antibiotic treatment. . # nausea & diarrhea - an infectious process vs. medication effect from her doxycycline is the most likely etiology. if infectious, a viral process seems more likely than bacterial. a c.diff was negative at the outside hospital; while her other stool cultures were pending. she was given iv anti-emetics and her loose stools and nausea steadily improved. she did not warrant antibiotic therapy. . # c-spine fracture on c-spine imaging - the patient presented with a syncope episode that resulted in a presumed head injury and ct head with c-spine imaging showed evidence of a c4-fracture of unknown chronicity. the neurosurgery team and neurology service were consulted at the outside hospital, at which time a -j hard collar was recommended and she was transferred with that in place. on exam in the ccu at , she had no evidence of neurologic compromise. ortho-spine was consulted here and they reviewed the outside hospital imaging in our pacs system, noting that a likely osteophyte was probable and that the fracture was chronic. they recommended a soft collar while active for 3-months for comfort only. . # paroxysmal atrial fibrillation - history of paroxysmal atrial fibrillation with rate control with beta-blocker; we maintained her on metoprolol and monitored her via telemtry with electrolyte optimization. . # restless leg syndrome - we continued ropinirole at her home dosing. . # depression/anxiety - we continued zoloft at her home dosing. . # chronic back pain - we continued oxycodone 2.5 mg by mouth in the evenings as needed, which was her home dosing. # code status: full confirmed # communication: patient, # pending studies: osh culture data # issues to address at follow up: - vna for inr checks, weights, electrolytes, dressing changes - magnesium oxide daily use - bactrim x1 week from day of discharge medications on admission: home medications: - advair 500/50 1 puff - ferrous sulfate - mvi - vitamin d 1000 units - tums 3 times per day - lasix 80 mg po bid - aspirin 81 mg daily - zoloft 100 mg daily - magnesium oxide 400 mg daily - aldactone 25 mg - diovan 40 mg daily - claritin 10 mg daily - protonix 40 mg daily - digoxin 0.125 mcg daily - singulair 10 mg at night - requip 0.25 mg at night - trazodone 50 mg - tablet as needed for anxiety, 1 tablet at bedtime as needed for insomnia - metoprolol succinate 12.5 mg at night - warfarin at night - oxycodone 2.5 - 5 mg as needed for pain - gabapentin 300 mg up to 3 a day at night discharge medications: 1. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 2. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. 5. calcium carbonate oral 6. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. sertraline 50 mg tablet sig: two (2) tablet po daily (daily). 9. spironolactone 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. valsartan 40 mg tablet sig: one (1) tablet po daily (daily). 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 13. ropinirole 0.25 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 14. trazodone 50 mg tablet sig: 0.25 tablet po bid (2 times a day) as needed for anxiety: or take one tablet at bedtime for insomnia. 15. metoprolol succinate 25 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po hs (at bedtime). 16. oxycodone 5 mg tablet sig: 0.5 tablet po qhs (once a day (at bedtime)) as needed for pain: do not drive or drink alcohol while you are on this medication. 17. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm: please discuss dosing with your pcp. 18. singulair 10 mg tablet sig: one (1) tablet po at bedtime. 19. claritin 10 mg tablet sig: one (1) tablet po once a day. 20. gabapentin 300 mg capsule sig: one (1) capsule po three times a day as needed for pain: use up to three times a day. 21. clindamycin hcl 300 mg capsule sig: one (1) capsule po every six (6) hours for 1 weeks. disp:*28 capsule(s)* refills:*0* discharge disposition: home with service facility: hospice program discharge diagnosis: primary diagnosis: non-ischemic and ischemic cardiomyopathy, atrial fibrillation, cervical compression fracture, depression, anxiety discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms , you were transferred to because your heart went into an abnormal rhythm at an outside hospital and you required a generator change in your icd at . t change of your icd generator without issue. weigh yourself every morning, md if weight goes up more than 3 lbs. please note the following changes to your medications: - start clindamycin for one week after your day of discharge - discuss with your pcp whether you should continue to take magnesium daily - continue the remainder of your medications as directed by your physicians. please be sure to follow up with your physicians. followup instructions: name: , h. address: 131 ornac , ste#800 jcb bldg, , phone: *it is recommended that you see your pcp within one week. someone from dr. office will call you to schedule an appointment. you should follow up at the device clinic regarding your icd as well. name: , department: cardiology/conord location: 131 ornac, phone: when: thursday at 4:00 pm name: , and np department: cardiology/conord location: 131 ornac, phone: when: thursday at 3:00pm procedure: implantation or replacement of cardiac resynchronization defibrillator pulse generator only [crt-d] diagnoses: other primary cardiomyopathies other chronic pain congestive heart failure, unspecified atrial fibrillation asthma, unspecified type, unspecified depressive disorder, not elsewhere classified hypopotassemia paroxysmal ventricular tachycardia other specified forms of chronic ischemic heart disease anxiety state, unspecified accidents occurring in residential institution acute on chronic systolic heart failure backache, unspecified fall from other slipping, tripping, or stumbling closed fracture of fourth cervical vertebra restless legs syndrome (rls) fitting and adjustment of automatic implantable cardiac defibrillator 

Answer: The patient is high likely exposed to