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: sulfonamides / wellbutrin / tape / latex attending: chief complaint: syncope, nausea, vomiting major surgical or invasive procedure: ep study history of present illness: this is a 64-year-old gentleman with a history of metastatic rcc on bevacizumab/temsirolimus, sick sinus syndrome s/p ppm in , htn, and hypothyroidism who is transferred here from after syncopal event. patient reports that he had just finished showering and entered his walk-in closet when everything went blank. his wife heard a "thud" and went upstairs to find her husband unconscious. wife called 911 and began administering rescue breaths. according to wife, patient was making gurgling noises and was cyanotic. ems arrived and transported patient to (no note of cpr or shock, but per report, patient was bagged). wife denies seizure-like activity or bladder/bowel incontinence. at , ct head, ct spine, and cxr were negative. patient was transported to without incident. . in ed vs 98, bp 140/98, hr 70, rr 19, sat 98%2l. (p 36 to 72 in ed). repeat ct head without new pathology. seen by ep fellow in ed, interrogation showed normally functioning duel chamber pm with occasional ventricular bigeminy with normal pm inhibition. there is also a question of ventricular tachycardia at the onset of the syncopal episode. . admitted to medicine to and again to for lightheadness. attribued to dehydration poor po intake and diarrhea in setting of chemo. of note at that time, "his pacer was interrogated without any brady or tachyarrhythmias. he was noted to have a hr of 30 but this was false, it was related to pvcs in a bigemy pattern which would lead to a peripheral pulse or pulse oximeter recording a pulse of 30, but an ekg revealed a rate of 60." . pt has had > 5 bouts of non-bloody diarrhea for last 3 days. did note small blood on tp x 1. poor po intake as well last few days. he reports that 3 nights ago he has multiple episodes of seconds long dull chestpain radiating from right to left chest occuring in bed without sob, diaphoresis or n/v. no palpatations. ros: + chronic frontal ha. no change in vision or hearing. no focal weakness or loss of sensation. + n/v at . + diarrhea x 3 days. no dysuria or hematuria. past medical history: hypertension metastatic papillary renal cell cancer on chemo (initially diagnosed ) syncope, sss s/p pacer (ddd) in , generator change in paf a flutter s/p ablation vea, ??????triggered ventricular tachycardia?????? remote ??????seizure??????- treated at , attributed to wellbutrin : removal of colon polyps tobacco abuse (1ppd x approximately 40 years) hypothyroid s/p tonsillectomy social history: patient has a 40-pack-year history, quit in . occasional etoh, none in months. lives with wife and works in it at power plant. family history: father had stroke in 70s. mother had colitis. sister has -valvular disease. physical exam: vs - 98.1, 125/82, 78, 18, 96% ra orthostatics lying 99/70, 83 sitting 120/83, 84 standing 112/78, 46 gen: nad. heent: non icteric. eomi, perrl, op clear. no trauma neck: no jvd cv: rrr, no m/r/g chest: cta abd: mild ttp in llq, pt says chronic since operation ext: no edema skin: no rash neuro: a+ox3, cn intact, strenght, nl sensation, nl f to n. 2+ dtrs throughout. nl babinski. pulses: right: dp 2+ left: dp 2+ rectal: guaiac negative pertinent results: 11:34pm ck(cpk)-143 11:34pm ck-mb-3 ctropnt-0.01 03:18pm k+-4.9 03:10pm glucose-116* urea n-22* creat-1.3* sodium-140 potassium-4.9 chloride-108 total co2-22 anion gap-15 03:10pm ck(cpk)-139 03:10pm ctropnt-0.03* 03:10pm ck-mb-3 03:10pm wbc-6.6# rbc-4.47* hgb-12.1* hct-37.2* mcv-83 mch-27.0 mchc-32.5 rdw-14.6 03:10pm neuts-90.1* lymphs-6.7* monos-2.6 eos-0.6 basos-0.2 03:10pm plt count-141* 03:10pm pt-22.7* ptt-24.8 inr(pt)-2.1* . ct head : impression: 1. no acute intracranial process. stable findings of chronic small vessel ischemic changes and old prior right cerebellar infarct. 2. slight progression of pansinus mucosal thickening. the study and the report were reviewed by the staff radiologist. . cxr : one portable view. the right chest is not entirely included. comparison is made with the previous study of . there is minimal streaky density at the lung bases consistent with subsegmental atelectasis or scarring, as before. the heart and mediastinal structures are unchanged. spinal fusion hardware remains in place. a bipolar transvenous pacemaker is present as demonstrated earlier. there is no acute change. impression: no acute change. . tte : the left atrium is dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is severe regional left ventricular systolic dysfunction with near akinesis of the inferior and inferolateral wall and hypokinesis of the mid to distal anterior septum and anterior wall. there is no left ventricular outflow obstruction at rest or with valsalva. right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the prior study ( echo - limited images reviewed) of , the above mentioned wall motion abnormalities were present in a milder form on the prior echo. the ejection fraction has decreased. . tee : no atrial septal defect is seen by 2d or color doppler. there is mild regional left ventricular systolic dysfunction with basal to mid inferior hypokinesis. right ventricular chamber size and free wall motion are normal. there are complex (>4mm) atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is a trivial/physiologic pericardial effusion. impression: good quality study. no valvular vegetations or perivavlar abcesses seen. no vegetations seen on ra/rv pacer leads. mild mitral regurgitation. mild focal left ventricular dysfunction with basal to mid wall hypokinesis. compared to the transthoracic echo of /9, the anterior wall motion looks normal and the inferior wall is less hypokinetic. brief hospital course: this is a 64-year-old gentleman with metastatic rcc, sss s/p pacemaker, history of seizure x 1, who is transferred here from for an episode of syncope, agonal breathing, and cyanosis. upon interrogation of ppm, appears as though patient had an episode of v-tach at symptom onset. . #) syncope/ventricular tachycardia: initially his symptoms appeared consistent with cardiac etiology (history of sick sinus syndrome, no prodrome, "drop attack," cyanosis). according to ep, his pacermaker was functioning normally, but there was concern that he may have an an ectopic focus possibly near left coronary, causing dysrhythmia. the initial plan was for him to undergo an ep study, however over the weekend prior to his ep study, he developed fevers, rigors, and a new rash. he was febrile to 104, tachycardic to 120s, and became hypotensive. the rash on his arms appeared at the sites of venipuncture. that afternoon he was transferred to the icu for further management. in the icu he initially required pressors, and his blood cultures became positive for , his antibiotic coverage was changed to nafcillin. however, during his stay in the icu when he became febrile, he would go into ventricular tachycardia, become hypertensive and required esmolol drips. after the patient defervesced in the icu, he had no further episodes of ventricular tachycardia. in the icu he was also started on amiodarone and metoprolol for the ventricular tachycardia. after he was well enough to leave the icu, ep did not feel that he needed an ep, because they believed that his ventricular tachycardia was all in the setting of his sepsis. at the time of discharge he was sent home on an oral amiodarone regimen to complete his loading, and then on maintenance amiodarone, continued on metoprolol and would see his outpatient cardiologist about an icd placement six weeks after discharge. . # sepsis/cellulitis: when he became febrile and hypotensive, he also developed areas of erythema and induration around the sites of prior venipuncture, and he was transferred to the icu for further management. blood cultures then became positive in bottles for . he was started on nafcillin after the sensitivities returned. infectious disease was consulted and recommended a 4 week course of iv antibiotics due to his bacteremia complicated by septic thrombophlebitis. hand surgery was consulted for evaluation of the septic thrombophlebitis of his hand, an ultrasound was done that showed only superficial involvement, and they recommended conservative management. # rcc: the patient's primary oncologist was contact who suggested that the patient's normal chemotherapy be held until he was well enough to restart as an outpatient. # afib: patient was initially maintained on a bb (at a decreased dose) and coumadin while on the cardiology service. his coumadin was stopped and his inr reversed in anticipation of his ep study, then his coumadin continued to be held through his icu course, his coumadin was restarted prior to discharge. . # htn: patient was continued on lisinopril and metoprolol, though this was discontinued upon admission to the micu. metoprolol was restarted as his blood pressure tolerated. . # thrombocytopenia: during his course in the micu, the patient's platelets gradually trended down to a nadir of 66 from an admission level of 141. a hit antibody was sent that was negative, and he clinically improved his platelet count increased and had returned to the normal range by the time of discharge. . # hypothyroid: home synthroid was continued. . medications on admission: bevacizumab (avastin) 10mg/kg q2wks. citalopram 20mg po daily fluticasone 50mcg gemfibrozil 600mg po daily levothyroxine 88mcg po daily lisinopril 20mg po dailiy metorpolol succinate 100mg po daily mirtazapine 15mg po qpm temsirolimus (torisel) 25mg iv weekly (resumed ) warfarin 3mg daily except for 4mg monday, thrusday. zolpidem 10mg po qpm colace glucosamine chondriotin hexetidine ibuprofen 200mg po q6h prn lecithin 1200mg po daily omega 3 fatty acid 360mg-1200mg po daily prasterone (dhea) 50mg po daily selenium 200mcg po daily vitamin e 400 unit po daily discharge disposition: home with service facility: vna discharge diagnosis: primary: 1. bacteremia complicated by superficial thrombophlebitis 2. sustained ventricular tachycardia . secondary: 1. hypertension 2. metastatic papillary renal cell cancer on chemo (initially diagnosed ) 3. syncope, sss s/p pacer (ddd) in , generator change in 4. paf 5. a flutter s/p ablation discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: dear mr. , it was a pleasure taking care of you on this admission. you were transferred to from an outside hospital because of syncope and nausea. you most likely had a heart arrythmia, which caused you to lose consciousness. shortly after your admission you were found to have a fever, areas of redness on your right hand/left arm and then had blood cultures that showed bacteria growing in your blood stream. you were than transferred to the icu for closer monitoring, and you also needed medications to help keep your blood pressure in the normal range. while in the icu when you had a fever it was found that your heart went into an abnormal rhythm called ventricular tachycardia. to help treat this rhythm you were started on two new medications, amiodarone and metoprolol. the electrophysiologists (heart rhythm doctors) saw you and felt that the abnormal heart rhythm was likely related to the infection. after you finish your course of antibiotics for the bacteria in your bloodstream, you will follow up with dr. to discuss putting in a defibrillator. . the following changes were made to your medications: 1. start taking metoprolol 12.5mg three times per day instead of toprol xl 100mg 2. start amiodarone 400mg a day for one week, then change to 200mg a day from then on 3. decreased warfarin dose to 3mg daily as you are on new medications that can interact with warfarin 4. started loperamide 2mg every 4 hours as needed for diarrhea . please take all of your medications as prescribed. please keep all of your follow-up appointments. . return to the hospital if you develop chest pain, shortness of breath, syncope or near syncope, headache, nausea, vomiting, diarrhea, bright red blood in urine or stool, fevers, chills, or any other concerning signs or symptoms. followup instructions: department: infectious disease when: friday at 10:00 am with: , md building: lm bldg () campus: west best parking: garage department: cardiac services when: tuesday at 2:30 pm with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: tuesday at 3:00 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage md, procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnostic ultrasound of heart arterial catheterization artificial pacemaker rate check diagnoses: thrombocytopenia, unspecified abnormal coagulation profile congestive heart failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation chronic kidney disease, unspecified paroxysmal ventricular tachycardia dysthymic disorder other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site right bundle branch block cellulitis and abscess of upper arm and forearm antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use chronic systolic heart failure long-term (current) use of anticoagulants cardiac pacemaker in situ diarrhea other vascular complications of medical care, not elsewhere classified phlebitis and thrombophlebitis of superficial veins of upper extremities accidents occurring in residential institution personal history of malignant neoplasm of kidney cellulitis and abscess of hand, except fingers and thumb secondary malignant neoplasm of retroperitoneum and peritoneum infection following other infusion, injection, transfusion, or vaccination secondary malignant neoplasm of kidney shock, unspecified 

Answer: The patient is high likely exposed to