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: complete heart block major surgical or invasive procedure: sensia rod 01: dual chamber history of present illness: m with pmh htn ckd and possible recent pneumonia (dx ) presented to with altered mental status. tele revealed chb with hr 25-40, sbp 150-190 mmhg. no reversible etiology thus far (no nodal agents, no metabolic abnormalities, no ischemic ekg changes). transfer for consideration of temp wire/ppm. family initially declined, but now want ppm. only home medication is lisinopril 10. no cardiac hx. he has been afebrile, ua was negative and bcx are pending. no cxr was done. . on arrival to the ccu he was noted to be in 2nd degree heart block with 2:1 conduction. his temp is 95.1 bp 131/50, rr18 100% on 4l. he is a&ox1 but pleasant. he is unable to provide further history. . he denies cp, sob, cough, diarrhea constipation, urinary symptoms though he is not a reliable historian. . of note he presented to for weakness and s/p fall. ekg at that time showed sinus bradycardia wih pr prolongation. a cxr showed a rll opacity which was treated as a presumed pna with a course of azithromycin and ceftin which he would have just finished 1-2 days ago. fianl read from cxr was atelectasis and not consolidation. during this admission he required a 1:1 sitter for delirium. past medical history: past medical history: 1. cardiac risk factors: -diabetes, -dyslipidemia, +hypertension 2. cardiac history: - cabg: - percutaneous coronary interventions: - pacing/icd: 3. other past medical history: - ckd baseline cre (1.4-1.7) - remote colon ca - elevated psa (11.1 on ) social history: - tobacco history: none - etoh: none - illicit drugs: none lives with wife who is his hcp. ambulates with walker family history: non-contributory physical exam: admission physical exam: general: nad. oriented x0. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvd not appreciated. cardiac: pmi located in 5th intercostal space, midclavicular line. bradycardic, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ . discharge physical exam: vs t 96.6 hr: 86-94 bp: 130-165/73-98 rr: 18 02 sat: 99% ra general: yo male sitting in chair in no acute distress heent: perrla, mucous membranes moist, no lymphadenopathy, jvp non elevated chest: ls clear throughout, no wheezes, no rales, no rhonchi cv:rrr, nl s1s2, no murmurs rubs or gallops abd: soft, non-tender, non-distended, bs normoactive ext: warm and dry, 2+ dp/pt, no pedal edema neuro: alert, oriented to person only, answers questions appropriately, pt poorly compliant with neurological exam. skin: no rash, no open sores psych: pt alert to person only pertinent results: admission exam: 03:46am glucose-116* urea n-36* creat-1.4* sodium-142 potassium-4.2 chloride-109* total co2-22 anion gap-15 03:46am alt(sgpt)-36 ast(sgot)-35 ck(cpk)-54 alk phos-47 tot bili-1.5 03:46am calcium-8.8 phosphate-2.9 magnesium-2.1 03:46am wbc-5.4 rbc-3.89* hgb-12.4* hct-36.2* mcv-93 mch-31.9 mchc-34.3 rdw-12.5 03:46am neuts-70.8* lymphs-19.8 monos-5.9 eos-3.0 basos-0.5 03:46am pt-13.6* ptt-26.6 inr(pt)-1.2* 03:46am plt count-120* . pertinent labs: 03:46am blood ck-mb-3 ctropnt-<0.01 05:34am blood ck-mb-8 ctropnt-0.11* 05:34am blood vitb12-434 folate-greater th 05:34am blood tsh-2.5 03:04pm urine blood-tr nitrite-neg protein-30 glucose-neg ketone-10 bilirub-neg urobiln-neg ph-5.5 leuks-neg rapid plasma reagin test (final ): nonreactive. . discharge labs: 07:10am blood wbc-8.7 rbc-3.49* hgb-11.0* hct-32.1* mcv-92 mch-31.4 mchc-34.1 rdw-12.8 plt ct-117* 07:10am blood plt ct-117* 07:10am blood glucose-113* urean-49* creat-1.5* na-146* k-4.0 cl-113* hco3-27 angap-10 . micro/path: . mrsa screening: negative cdiff antigen : negative rpr : negative . imaging/studies: . ekg: one hundred percent ventricular paced rhythm. compared to the previous tracing of the patient has gone from 2:1 a-v block with ventricular rate of 40 to one hundred percent a-v pacing, rate 66. . cxr findings: the patient received a new dual-lead left pectoral pacemaker lead with one of the leads terminating into the right ventricle and other lead into the right atrium. on the lateral view, though the tip of the ventricular lead is seen clearly, atrial lead tip is seen as a faint opacaity at the level where the ventricular pacemaker lead takes anterior curve. there is no pneumothorax. bilateral lungs are clear. there are no lung opacities of concern for pneumonia/pulmonary edema. posterior costophrenic angles are blunted, likely small effusions. heart size is top normal. aorta is generally large but there is no focal aneurysmal dilatation. the visualized part of the abdomen is remarkable for air filled and mild dilation of the bowel loops. . obliques views are recommended to further confirm the location of atrial lead which was less distinct on lateral view. radiograph of the abdomen is recommended for further evaluation of mildly dilated bowel loops. . cxr findings: an oblique view also of the lateral clearly shows both the atrial and ventricular catheter heading anteriorly in the appropriate position. . dilatation of gas-filled loops of bowel persists. if there is clinical concern for severe adynamic ileus or mechanical obstruction, an abdominal series or even ct could be obtained. brief hospital course: m with htn, ckd, and new ams likely from dementia/delrium and new high grade av block now s/p pacemaker placement. . active issues: . # high grade av block: initially presented in high grade av block with 2:1 and 3:1 conduction. he underwent uncomplicated pacemaker placement. ekg demonstrated 100% capture and cxr demonstrated good lead placement. he should follow up in device clinic in one week after discharge. he will also need pcp in the next week or two. . #delerium: mr. has a history of several months of cognitive decline which was felt to most likely be from microvascular vs. alzheimers dementia. his hospitalization has been complicated by acute delirium requiring antipsychotic medications and soft restraints. work up this hospitalization included a negative cxr, ua, rpr, normal tsh, folate/b12. he is curently on low dose seroquel which seems to have helped his agitation but may be contributing to his urinary retention. please attempt to d/c seroquel and follow mental status. . #acute kidney injury on ckd: mr. creatinine rose briefly to a peak of 2.1 which was believed to be from poor po intake. he was given ivf and his lisinopril was held with improvement of his creatinine back to 1.4 on the day of discharge. . #acute urinary retention: mr. developed acute urinary retension 3 days into his hospitalization thought to be related to anti-cholinergic side effects of atypical antipsychotics he recieved including seroquel. he had a foley placed with a plan for a temporary 5 day course. he was also started on tamsulosin. we anticipate his foley can be d/c'd in 5 days time but he may need formal follow-up for urinary retension as an outpatient. . chronic issues: . #htn: lisinopril was held on admission because he was hypotensive in the setting of heart block. after his procedure his lisinporil was restarted after being held briefly for as above. . #elevated psa: last psa >11 1/. does not want treatment or biopsy of potential prostate ca but metastatic disease could be a consideration if lft abnormalities do not resolve. rectal exam evealed an irregularly shaped and enlarged prostate. unclear if this is contributing to his urinary retention although the medications are more likely the cause. . #anemia: mild chronic anemia. stable . #thrombocytopenia: mild chronic thrombocytopenia. stable . transitional issues: # foley/urinary retention: patient developed urinary retention thought to be related a few doses of seroquel in house. he was started on tamsulosin and a temporary foley was placed with a plan to remove after 5 days. . #pacemaker follow up: he should follw up with device clinic in one week. . #dementia: mr may benefit from a formal evaluation of his dementia, as well as possible long term care placement after rehab. medications on admission: lisinopril 10 mg daily discharge medications: 1. lisinopril 5 mg tablet sig: one (1) tablet po once a day: please increase to 10 mg if creatinine stable. . 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. quetiapine 25 mg tablet sig: 0.25 tablet po hs (at bedtime). 4. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po at bedtime. 5. outpatient lab work please check chem-7 and cbc on monday discharge disposition: extended care facility: at discharge diagnosis: delirium second degree heart block s/p pacemaker hypertension discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the hospital with a block in the conduction system of your heart and required a pacemaker. this was placed on and it is functioning well. you can remove the dressing on and take a shower, do not remove the tape over the incision area. you cannot lift more than 5 pounds or lift your left arm over your head for 6 weeks. if you have any discomfort at the incision site, you can take tylenol for the pain. while you were hospitalized, you developed a severe confusion called delerium. you needed some new medicines to help you stay calm and the gerontology team evaluated you. . we made the following changes to your medicines: 1.start taking tamsulosin to help you urinate 2. start taking seroquel to help you stay calm at night 3. decrease lisinopril to 5 mg daily 4. start a multivitamin. followup instructions: department: cardiac services when: tuesday at 4:00pm with: device clinic () building: hospital, best parking: outside lot department: cardiac services when:tuesday 3pm with: dr. building: hospital, best parking: outside lot procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: thrombocytopenia, unspecified anemia, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, stage iii (moderate) other specified cardiac dysrhythmias atrioventricular block, complete retention of urine, unspecified personal history of malignant neoplasm of large intestine dehydration other alteration of consciousness other nonspecific abnormal serum enzyme levels unspecified persistent mental disorders due to conditions classified elsewhere physical restraints status elevated prostate specific antigen [psa] other antipsychotics, neuroleptics, and major tranquilizers causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to