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: roxicet attending: chief complaint: fevers, fatigue major surgical or invasive procedure: implantation ddd electrophysiology study history of present illness: mr. is a 64 yo man with history of bicuspid av s/p and mssa endocarditis and repeat , afib on coumadin and amiodaron, bronchiectasis and gib who presented to complaining of fatigue and fevers. he was recently admitted to with a gib in which resolved. he was in his usual state of health until about two days ago when he began feeling subjective fevers and weakness. today he decided to call ems because he could not walk more than 10 steps. in the ed, he was found to be febrile, to have a leukocytosis and hypotensive with a pulse in the 30's. ekg showed a sinus rate of 140 and 1:3 block. levaquin, gentamycin and were given. a rij was placed despite an inr of >4. . on arrival to the ccu he was febrile, hypotensive, and bradycardic. tele showed complete heart block. ep was consulted and a transvenous pacing wire was placed at the bedside with fluoroscopic guidance. past medical history: 1. bicuspid av-s/p in 92, mssa endocarditis and abscess- s/p redo in 5/00 2. afib on amiodarone 3. bronchomalecia and bronchiectesis 4. gastritis 5. cabg times 3- (, lvef>55%) 6. hypercholesterolemia 7. htn 8. diverticulosis and lymphoid aggregates on colonoscopy in 9. impotence 10. hernisted disc 11. stroke () ax 12. thoracic aneurysm social history: divorced, 2 sons, etoh (per pt) but + h/o drinking 1 gallon of wine daily in that pt always denied, no current tobacco, 4ppd times 30 years and quit in 92, no ivdu, divorced, can do all adls. at baseline he walks a quarter of a mile every day. he will get short of breath on walking quickly blocks. family history: nc per patient pertinent results: 08:07pm pt-52.3* ptt-66.0* inr(pt)-6.2* 01:48pm glucose-102 urea n-15 creat-1.0 sodium-139 potassium-4.3 chloride-109* total co2-23 anion gap-11 06:30pm wbc-23.0*# rbc-3.83* hgb-11.3* hct-33.2* mcv-87 mch-29.5 mchc-34.0 rdw-15.2 06:27am glucose-92 urea n-19 creat-1.4* sodium-141 potassium-4.0 chloride-111* total co2-21* anion gap-13 renal u.s. 1:08 pm impression: no masses, stones, or hydronephrosis present within the kidneys. chest (portable ap) 5:16 pm impression: no significant interval change. ecg study date of 10:41:52 am regular ventricular pacing rhythm - no further analysis since previous tracing, ventricular paced rhythm present unilat up ext veins us right port 12:59 pm impression: 1) no evidence of deep venous thrombosis in the right upper extremity. 2) large hetergenous round area within the right axilla, likely a hematoma. right axillary vein was not visualized. echo study date of conclusions: there are complex (>4mm) atheroma in the descending thoracic aorta. a well-seated bileaflet aortic valve prosthesis is present. the aortic prosthesis discs appear to move normally. there is a small 3mm fluttering echodensity is seen on the lvot side of the valve consistent with vegetation/thrombus. no aortic valve abscess is seen. mild (1+) aortic regurgitation is seen. mild to moderate (+) mitral regurgitation is seen. impression: small echodensity on the aortic valve disc consistent with a vegetation (or thrombus) as described above. mild aortic regurgitation. moderately dilated aortic arch and proximal descending aorta. ct abdomen w/contrast 2:06 pm impression: 1. no evidence of abscess, as clinically questioned. 2. gallstone. 3. bilateral renal cysts. 4. mild dependent atelectasis. ct head w/o contrast 10:06 am impression: no evidence of acute intracranial hemorrhage. no ct evidence of brain ischemia. brief hospital course: a/p: 64m w/ cad s/p cabg, , mssa endocarditis, repeat and bentall procedure, who presented with bradycardia, hypotension and fever/leukocytosis. found to have a likely vegetation on his av by tee with chb s/p pm on . . #)av node dysfuction, complete heart block evolved back to type 2, then type 1 heart block. pt required a temporary wire early in hospital course. pt had eps which showed h-v interval in the 80's (prolonged) and on faster rhythm he went in 2:1 block. had permanent on , heparin restarted. also on coumadin. - in nsr on , intermittently v paced - interrogated by ep on . - outpatient follow up. - beta-blocker restarted without difficulty. in nsr on discharge. #) hematoma right arm - the patient developed a spontaneous hematoma on heparin on . he was evaluated by vascular who recommended arm elevation and ace wrap. his hct dropped from 31 to 26 but has remained stable at 26. - an ultrasound was obtained on which showed no clot. - given his high risk of stroke with an , the heparin was restarted around pm on . - improved on and resolved by the time of discharge. . #) af: the patient had been on amiodarone- this was dc'd on as he developed 2nd degree av block on tele but restarted on without event post . he was discharged on coumadin. #) htn: . his hctz and beta-blocker were restarted. ace was held with acute renal failure. . #) arf - cr rose to 1.4 from 1.1 which was felt to be most likely from gentamycin toxicity. - his fena was <1 with rare eos on ua. he was given ivf with no improvement of his kidney function. - we continue to hold his ace. - renal ultrasound on showed no acute abnormalities. - a cr of 1.4 was deemed to be his new baseline. . #) culture negative endocarditis: id evaluated him inhouse and subsequently signed off. vegetation seen on tee. -the plan is for 6 weeks of cefepime, vanco, and initially 2 wks gentamycin. - no rifampin per id given multiple drug interactions. - had acute rise in cr on , therefore dc'd gentamycin and he did not receive this for the remainder of his stay. - his vanco was dosed by level, trough <15 with results as an outpatient to be faxed to his id specialist per their request. - prior to dc, his level had been greater than 15 and was held two days prior to dc with permission to be restarted at 750 mg iv qd as an outpatient. -picc placed on tuesday in rue. . #) cad - restarted asa 81 mg on . resarted bb. held ace with arf. zetia, statin. . #) h/o gi bleed: the patient has known angioectasia and had gi bleed without multiple diverticula as well. was to have outpt appointment with in surgery but missed it because of hospitalization. this was rescheduled prior to dc. - gi had seen the patient on and felt no need for scope this admission. - - on , the patient noted black appearing stool (started iron day before). guaiac negative, hemo stable. hct stable and required no transfusions for this reason. - this was not an active issue for the remainder of his stay. . #) mechanical av valve: required prolong hospitalization for heparin/coumadin bridge pre and post procedure. he required up to 10 mg of coumadin in-house to get a therapeutic inr, goal 2.5-3.5. - he formerly took 5 and 7.5 mg of coumadin at home. - he will have his inr checked in 2 days and have the results faxed to the coumadin clinic to adjust his coumadin dose accordingly. - although coumadin 10 mg was required to achieve a therapeutic inr, he will be discharged on coumadin 7.5 mg. . #) anemia - concerning drop from 30->26 on to 22 on . guaiac negative. the hct drop was felt to be secondary to his right arm hematoma. - he was transfused 2 units from to . his hct remained stable thereafter and he required no further transfusions. . #) code status: full code. . #) dispo: home with vna. medications on admission: amiodarone 200mg daily, dicloxacillin 25omg q8, hctz 25mg daily, lipitor 80mg, lisinopril 5mg daily, metoprolol xl 12.5mg daily, mvi, protonix, coumadin 2.5mg daily, zetia 10mg daily discharge medications: 1. cefepime 2 g recon soln sig: one (1) intravenous twice a day for 3 weeks. disp:*56 * refills:*0* 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 4. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 5. tramadol 50 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 7. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily). 8. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed. disp:*30 ml(s)* refills:*3* 11. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed. 12. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: five (5) ml po q6h (every 6 hours) as needed for 5 days. disp:*50 ml(s)* refills:*0* 13. metoprolol tartrate 25 mg tablet sig: 0.25 tablet po bid (2 times a day). disp:*15 tablet(s)* refills:*2* 14. acetaminophen 500 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain. 15. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q4-6h (every 4 to 6 hours) as needed. disp:*2 * refills:*1* 16. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 17. outpatient lab work inr check 2 days after discharge with results faxed to pcp. vanco trough checked 2 days after discharge with results faxed to pcp. should continue for trough <15. 18. sodium chloride 0.9 % parenteral solution sig: one (1) 3 cc intravenous once a day. disp:*30 * refills:*3* 19. 500 mg recon soln sig: 1.5 intravenous once a day for 3 weeks: 750 mg iv qd. hold for trough >15. disp:*30 * refills:*3* 20. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 21. warfarin 5 mg tablet sig: 1.5 tablets po hs (at bedtime). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: culture negative endocarditis complete heart block with implantation paroxysmal atrial fibrillation gentamicin-induced renal insufficiency discharge condition: stable discharge instructions: please continue your antibiotics and cefepime for a total of 6 weeks (last dose ). please fax troughs to dr. , your infectious disease specialist, weekly. her fax is . the rn will call you at home to check pm (see below). followup instructions: please follow up with the infection specialist - provider: , md phone: date/time: 9:00 provider: call phone: date/time: 11:30 you have an appointment with your cardiologist, dr. , on at 2:00pm. his office is located on the of the building. please call ( should you have any questions. you have an appointment with your electrophysiologist, dr. , on ***. his office is located on the of the building. please call ( should you have any questions. provider: md phone: date/time: 10:00 provider: , m.d. phone: date/time: 8:30 provider: , md phone: date/time: 2:30 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnostic ultrasound of heart catheter based invasive electrophysiologic testing initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of temporary transvenous pacemaker system transfusion of packed cells diagnoses: unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation aortocoronary bypass status hematoma complicating a procedure hypotension, unspecified atrioventricular block, complete long-term (current) use of anticoagulants infection and inflammatory reaction due to cardiac device, implant, and graft 

Answer: The patient is high likely exposed to