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: patient recorded as having no known allergies to drugs attending: chief complaint: icd firing major surgical or invasive procedure: pacer interrogation cardiac catheterization (no intervention) central venous line placement in coronary care unit history of present illness: 57 yo m with non-ischemic dilated cmp (ef 20% in with 4+ mr) secondary to chagas disease, s/p ppm-icd for cardiac arrest , multiple ed evaluations for orthostasis, presenting s/p icd discharges on and . both shocks were preceded by prodrome of dizziness without chest pain, palpitations, or sob, or syncopal event, and was shocked once. ep evaluation on revealed appropriate vt therapy on both occasions. on , amiodarone was increased from 200 mg qd to 400 mg x2 weeks for reloading. ep also adjusted anti-tachycardia pacing threshold and rv pacing output (given increase in threshold). has not had icd firing prior to these events since implant, but has had ? regular fast palpitations in chest over past 2 weeks. on ros, only other symptom noted was recent uri, for which he started started zithromax on . past medical history: 1. heart failure (ef 20%, 4+ mr) primary cardiologist dr. 2. chagas disease (travel history in , se , s. america) 3. tuberculosis exposure (in travel), +ppd s/p inh. 4. multiple ed evaluations for orthostasis in setting of medications social history: does not smoke, drink, or use drugs. previously worked as sniper/anti-narcotics in , , and . born in . past exposure to tuberculosis in colleagues, never had active tuberculosis, was treated with inh x 12 months family history: no history of cad. mother died of diabetes complications. father died from prostate ca physical exam: pe: vs: 100.2 (100.6) | 106/67 | 79 | 24 | 95% on ra; wt. 205 lbs. gen: nad, resting comfortably in bed. heent: perrl/eom intact, op clear, mmm, no jvd, no carotid bruit. neck: no masses, no lad. cv: rrr, nl s1s2, no murmurs. chest: cta b/l, no crackles or wheezes. abd: soft, nt/nd, +bs, no organomegaly. extr: warm well perfused, 2+ dp pulses, no cyanosis, no le edema. neuro: a&ox3, cn ii-xii intact; motor, sensory, coordination, and language grossly non-focal pertinent results: admission labs: =============== wbc-8.8 rbc-4.43* hgb-13.6* hct-39.8* mcv-90 plt ct-211 pt-12.8 ptt-21.9* inr(pt)-1.1 glucose-64* urean-21* creat-1.5* na-140 k-4.7 cl-105 hco3-25 calcium-9.7 phos-3.5 mg-2.0 tsh-0.47 digoxin-0.5* . cardiac enzymes: =============== 06:30am ck-mb-4 ctropnt-<0.01 05:00pm ck-mb-4 ctropnt-<0.01 09:00pm ck-mb-3 ctropnt-<0.01 04:48am ck-mb-4 ctropnt-<0.01 12:00am ck(cpk)-195 06:30am ck(cpk)-183 05:00pm ck(cpk)-165 . echo - conclusions: =========== 1. the left atrium is elongated. la 6.6 cm. 2. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated (diastolic dimension 8.9cm). overall left ventricular systolic function is severely depressed (ef 15-20%). resting regional wall motion abnormalities include lateral, inferolateral and apical akinesis. the remaining left ventricular segments are hypokinetic. 3.right ventricular chamber size is normal. right ventricular systolic function is normal. 4.the mitral valve leaflets are mildly thickened. severe (4+) mitral regurgitation is seen. 5.there is mild pulmonary artery systolic hypertension. 6.there is no pericardial effusion. 7. there is an echogenic density in the right ventricle consistent with an aicd. . cxr =========== there is a dual lead left-sided pacemaker, unchanged in position. there is a new right-sided ij central venous catheter with the distal tip in the proximal right atrium. no pneumothoraces are identified. there is marked cardiomegaly which is unchanged. there has been interval increase in the pulmonary vascular markings consistent with edema. there is again seen a linear density within the right mid lung zone which may represent atelectasis or scarring. this is unchanged. the left cp angle has been cut off from the study. there is some mild elevation of the right hemi-diaphragm and blunting of the right cp angle which may be secondary to atelectasis, scarring, or pleural fluid . cath : indications for catheterization: 1. ventricular tachycardia 2. dilated cardiomyopathy. 3. severe mitral regurgitation 4. pre-operative evaluation. hemodynamics results body surface area: 2.11 m2 hemoglobin: 33.3 gms % fick **pressures right atrium {a/v/m} 19/17/15 right ventricle {s/ed} 67/19 pulmonary artery {s/d/m} 67/37/49 pulmonary wedge {a/v/m} 32/38/30 left ventricle {s/ed} 98/32 aorta {s/d/m} 98/50/69 **cardiac output heart rate {beats/min} 80 rhythm sinus o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 70 card. op/ind fick {l/mn/m2} 3.8/1.8 **resistances systemic vasc. resistance 1137 pulmonary vasc. resistance 400 **% saturation data (nl) svc low 50 pa main 52 ao 95 **arterial blood gas inspired o2 concentr'n 24 po2 72 pco2 50 ph 7.4 **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca diffusely diseased 10 2) mid rca diffusely diseased 10 2a) acute marginal normal 3) distal rca diffusely diseased 10 4) r-pda diffusely diseased 10 4a) r-post-lat normal 4b) r-lv normal **arteriography results morphology % stenosis collat. from **left coronary 5) left main diffusely diseased 20 6) proximal lad diffusely diseased 10 6a) septal-1 normal 7) mid-lad diffusely diseased 10 8) distal lad diffusely diseased 10 9) diagonal-1 normal 10) diagonal-2 normal 12) proximal cx diffusely diseased 10 13) mid cx diffusely diseased 10 13a) distal cx diffusely diseased 10 14) obtuse marginal-1 diffusely diseased 10 15) obtuse marginal-2 diffusely diseased 10 comments: 1. selective coronary angiography revealed a right dominant system with minimal luminal irregularities. the lmca had mild plaquing up to 20%. the lad had minimal luminal irregularities with a distal myocardial "bridge" with systolic compression. the apical lad wrapped well around the apex. the lcx had minimal luminal irregularities. the rca had minimal luminal irregularities, it had a twin distal system with rpda and rpl. 2. hemodynamics demonstrated severely elevated left and right heart filling pressures, severely elevated pulmonary artery pressures and large v waves on the pulmonary capillary wedge pressure. cardiac index was depressed. the arterial waveform demonstrated narrow pulse pressure with low normal systolic systemic arterial pressure. there was no gradient across the aortic valve on pull-back of the catheter from the lv to the aorta. 3. left ventriculography was not done as the filling pressures were too elevated. final diagnosis: 1. coronary arteries are normal. 2. severe mitral regurgitation. 3. severe systolic and diastolic ventricular dysfunction. brief hospital course: mr. was admitted to the on andk initially underwent device interrogation by ep, followed by iv amiodarone loading over 24 hours. he subsequently experienced two episodes of vt/vf the night during amiodarone loading at 12:30, then subsequently at 7:30 the following morning, 30 min after iv amiodarone was completed. anti-tachycardia pacing failed on both attempts and he was shocked into sr. lidocaine was initiated with 100mg bolus and 1mg/min maintenance infusion. he was transitioned to oral mexilitine. one hour following mexilitine dose, pt was found by care assistant c/o sob, nausea, dizzy and "looking poorly." nurse found pt to be hypotensive, diaphoretic, and non-verbally responsive, lidocaine infusion turned off, no events noted on telemetry. upon finding pt, vitals noted to be bp 70/50s hr 70s. code blue was initiated, pt was able to speak minimally with femoral pulses present. bs 123. placed on nrb with good sats. received atropine 1 mg and 1l ns without effect, and was started on levophed gtt 1.0 mcg/kg/min, with improvement in bp to map 60s. abg noted 7.39/41/230, lactate 1.0. pt was tranferred to ccu for pressor management. on , the patient was transferred to the ccu. upon arrival to ccu, all 3 peripheral iv access was lost, thus levophed drip held and pts map remained > 60 with no further symptoms. he was transferred back to ther cardiology service the following day. amiodarone and mexilitine were continued and he had no further episodes of vt/vf. he did have episodes of lightheadedness and nausea following mexilitine doses but no further hypotensive episodes. patient went to cardiac catheterization and ep study on for vt ablation and right and left heart catheterization for pre-operative preparation for mvr, but eps could not isolate endocardial source. ep recommendation at that time was to treat hf as a possible trigger of vt, discontinue mexilitine and re-load amiodarone. at that time, his right-heart hemodynamics revealed severe congestion, mitral regurgitation, and cardiogenic shock . cardiac surgery was consulted for possible mvr given persistent hf in setting of mr, and preferred minimally invasive mvr, without epicardial vt ablation (per ep). patient was transferred back to ccu post-procedure. overnight on , the patient had another episode of 30 beat nvst without icd firing. the patient was maintained on amiodarone and diuretics for hypervolemic status. he was diuresed and evaluated for surgery. on , the patient experienced an 18 beat run of vt followed by atp pacing and successful conversion to nsr. on the morning on , the patient had recurrent vt and failed vt therapy atp and required external cardioversion by single 30j shock. the patient was transferred back to the ccu on and remained asymptomatic in preparation for cardiac surgery. on , the patient was taken to the operating room, where he underwent mitral valve repair with 28mm annuloplasty ring. please see operative note for full details. the patient tolerated this procedure, and was taken to the cardiac surgery recovery unit on epinephrine, levophed, vasopressin and lidocaine drips. on post-op day #1, the patient was able to self-extubate, and required emergent re-intubation. his lidocaine drip was stopped, and his epinepherine drip was increased. on post-op day #3, the patient experienced another 27 beat run of vt. an amiodarone drip was initiated, and his pitressin drip was titrated up for hypotension. on post-op day #4, the patient was briefly extubated, but was re-intubated for hypercarbic respiratory failure. on post-op day #5, a palpable cord was noted on the patient's left arm from an infiltrated iv site. iv vancomycin was started. blood cultures were drawn, which resulted in one set positive for coag(-) staph. subsequent blood cultures were all negative. on post-op day #6, the patient was diuresed with lasix, and tube feeding was initiated. on post-op day #8, the patient suffered recurrent runs of vt with unsuccessful atp x2 along with one unsuccessful attempt at external shock with 30j before final control with a second external shock. a lidocaine drip was re-initiated. on post-op day #9, heparin sc was started, and the patient was extubated. eps recommendations were to start po amiodarone 400mg qd along with mexilitine 200mg po q8h. shortly after initiating these changes, the patient again suffered vt, and the amiodarone and lidocaine drips were restarted. though the patient was considered for ablation, these interventions were felt to be too risky. based on eps recommendations, the lidocaine drip was stopped. on pod#11, an infectious diseases consult was obtained for ongoing fevers to 101.5f. his antibiotic coverage was broadened, and he was pan-cultured, though these all failed to show any causative organism. the patient was re-intubated for respiratory failure, and he patient suffered another episode of vt requiring defibrillation. on post-op day #12, his amiodarone drip was increased, and his lft's were checked. this revealed normal transaminases but an amylase of 587. the patient was made npo. this was rechecked on post-op day #13 and was found to be 526. a right-upper quadrant ultrasound was performed, but failed to visualize the gallbladder. no common bile duct dilation was noticed. the patient's medication regimen was reviewed, and all non-essential drugs with possible hepatotoxicity were stopped. on post-op day #15, the amylasemia continued to rise to 724 with a lipase of 827. a ct scan was performed, but this failed to show any evidence of pancreatitis. the patient remained clinically benign. on post-op day #16, a clear liquid diet was initiated. on post-op day #17, the amylase and lipase continued to rise slightly, and a gi consult was obtained. no specific etiology was noted, and the patient was again made npo. on post-op day 18, the patient again suffered 3 rounds of vt. the amylase and lipase continued to rise to the 800's and 1000's respectively. he remained npo. on post op day 19 his amylase remained elevated at 780. gi medicine recommmended beginning the diet when the diet is restarted and t/c discontining the ngt. he was transferred to for transplant consideration. medications on admission: 1. carvedilol 3.125 mg 2. lasix 20 mg qod 3. aldactone 50 qd 4. amiodarone 200 mg qd changed to 400 mg daily 5. digoxin 0.1 mg qhs discharge medications: 1. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days. disp:*5 tablet(s)* refills:*0* 2. lidocaine in d5w 4 mg/ml parenteral solution sig: one (1) ml/min intravenous infusion (continuous infusion). 3. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) gm intravenous q 24h (every 24 hours). 4. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 5. docusate sodium 150 mg/15 ml liquid sig: five (5) cc po bid (2 times a day). cc 6. amiodarone 50 mg/ml solution sig: one (1) mg/kg/min intravenous infusion (continuous infusion). 7. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: four (4) puff inhalation q6h (every 6 hours). 10. bumetanide 0.25 mg/ml solution sig: one (1) mg injection (2 times a day). discharge disposition: extended care facility: discharge diagnosis: non-ischemic dilated cardiomyopathy, chagas disease vt with aicd cardiogenic shock discharge condition: good discharge instructions: please report chest pain, palpitations, aicd firing, shortness of breath or other concerning symptoms to your primary physician. you have been started on two new medications called amiodarone and mexilitine. please continue to take these as scheduled until otherwise directed by your cardiologist. please follow-up with dr. as scheduled below. followup instructions: provider: . phone: date/time: 1:00 provider: clinic phone: date/time: 9:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances other electric countershock of heart catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach cardiac mapping open heart valvuloplasty of mitral valve without replacement injection or infusion of nesiritide infusion of vasopressor agent diagnoses: pneumonia, organism unspecified mitral valve disorders atrial fibrillation other chronic pulmonary heart diseases paroxysmal ventricular tachycardia bacteremia cardiogenic shock unspecified disorder of kidney and ureter acute combined systolic and diastolic heart failure other nonspecific abnormal serum enzyme levels fitting and adjustment of automatic implantable cardiac defibrillator cardiomyopathy in other diseases classified elsewhere chagas' disease with heart involvement 

Answer: The patient is high likely exposed to