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: amoxicillin / paxil / sulfa(sulfonamide antibiotics) / penicillins attending: chief complaint: line infection and bradycardia major surgical or invasive procedure: removal of pacemaker and wires placement of picc line history of present illness: patient is a 42yo male with pmh of down's syndrome, sick sinus syndrome, and hypothyroidism who presented to osh because of increased drainage from a shoulder wound associated with recent manipulation of his pacemaker. . patient received the dual-chamber sigma, serial number pjd , placed initially in , insertion of a new atrial lead because of fractured wire was done on . in , the tie down sleeve of the atrial lead was noted to be visible at the site of the right clavicle. there had previously been granulation tissue/eschar there since the previous year. he reportedly is always picking at the site. he presented to his pcp and was treated with a 10-day course of keflex 500mg po qid for 10 days. wound culture was negative before that treatment. he presented to his electophysiologist on where he was noted to have an obviously exposed pacemaker lead. a lead extraction was planned on . however, patient noted increased drainage from the wound site prior to the scheduled date and presented to osh on for evaluation. at that time he had no fevers/chills, no abdominal pain, no nausea and vomiting, and no other pain. he was placed on mupirocin ointment and iv cephazolin. he was transferred to for lead removal. . on arrival to the floor, patient is accompanied by two people who work for his home aid/group home services. his vitals on arrival are t98.1, bp123/77, hr59, rr20, o2sat 98%ra. he reports diffuse pain symptoms but staff that know him and report that his expression of "pain" is in fact an obsessive/compulsive discomfort with the sticky leads on his body. he reportedly will point and react with grimace when is feeling pain. he knows not to pick at the leads. . ros: difficult to assess, but staff reports he has not had pain, shortness of breath, or fever. past medical history: down's syndrome hypothyroidism sinus node dysfunction s/p pacemaker with lead revision social history: lives in a group home no tobacco no alcohol family history: father had leukemia, mother has multiple cardiac stents, no fh of pacemaker physical exam: physical exam on admission: vitals: t98.1, bp123/77, hr59, rr20, o2sat 98%ra general: nad, resting comfortably in chair heent: prominant facial features stereotypic of down's syndrome, large, semi-protuberant tongue, atraumatic skull, perrl, eomi, mmm neck: no jvd, no lad chest wall: dime to quarter-sized area of exposed granulation tissue over the right anterior chest wall heart: rrr, no m/r/g lungs: ctab abdomen: soft, nontender, nondistended, nabs, no organomegaly extremities: no peripheral edema, no lesions or splinter hemorrhages. physical exam on discharge vitals: t:97.7, bp:99/59, hr68, rr18, o2sat:100%ra chest wall: steristrips covering a wound that appears clean, dry, intact with no surrounding erythema extremities: venous catheter in place on left arm pertinent results: labs on admission: 06:10pm blood wbc-5.3 rbc-3.87* hgb-13.9* hct-43.7 mcv-113* mch-35.9* mchc-31.8 rdw-14.5 plt ct-194 07:55pm blood pt-11.6 ptt-33.2 inr(pt)-1.1 06:10pm blood glucose-115* urean-19 creat-1.0 na-143 k-4.0 cl-109* hco3-28 angap-10 06:10pm blood calcium-8.7 phos-2.8 mg-2.2 tte : the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. visualization of the pacemaker leads throughout their course is incomplete, but no large pacer vegetations are seen. impression: no vegetations seen. normal global and regional biventricular systolic function. mild functional tricuspid regurgitation. tee : the left atrium is normal in size. a probable thrombus is seen in the wall of the right atrium. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is a probable thrombus or vegetation on the tricuspid valve. there is a very small pericardial effusion. micro: 4:00 pm swab right shoulder. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): no growth. , , bc: no growth 2/14uc: negative stool c. diff: negative 10:46 -like virus (nlv) antigen, eia test name in range out of range reference range --------- -------- ------------ --------------- norovirus, eia (stool) norovirus antigen positive lab results on discharge: radiology report chest port. line placement study date of 12:04 pm impression: ap chest reviewed in the absence of prior chest radiographs: tip of the right pic line ends near the superior cavoatrial junction, would need to be withdrawn 2 cm to competently re-position it in the low third of the svc. lungs clear. heart size normal. no pneumothorax. radiology report chest (portable ap) study date of 7:30 pm impression: ap chest compared to : previous left long line catheter or lead has been removed. normal heart, lungs, hila, mediastinum, and pleural surfaces. radiology report portable abdomen study date of 9:47 am impression: focally dilated loops of small bowel and colon within the mid abdomen with otherwise gasless abdomen raises concern for obstruction. ct is recommended for further delineation of etiology as clinically indicated. radiology report ct abd & pelvis with contrast study date of 6:04 pm impression: 1. no small-bowel obstruction. 2. abnormal location of the small bowel suggestive of an internal hernia; however, this is uncomplicated. there is no evidence of strangulation or obstruction and is probably congenital in origin. 3. small fat-containing umbilical hernia. 4. air within the bladder may relate to recent catheterization. cxr: read over the phone, tip of picc is at upper svc, showing that the line is central lab results on discharge: 02:59am blood wbc-3.1* rbc-3.02* hgb-11.0* hct-34.0* mcv-113* mch-36.4* mchc-32.3 rdw-14.8 plt ct-215 02:59am blood plt ct-215 02:59am blood glucose-75 urean-12 creat-0.9 na-142 k-3.8 cl-114* hco3-24 angap-8 02:59am blood ck(cpk)-26* 02:59am blood albumin-3.2* calcium-7.9* phos-3.4 mg-2.1 06:40am blood vitb12-801 folate-greater th brief hospital course: primary reason for hospitalization: mr. is a 42yo male with pmh of down's syndrome, sick sinus syndrome and hypothyroidism who presented for extraction of exposed and infected pacer wires. the leads were extracted and though patient remains bradycardic, he is asymptomatic and has not experienced any episodes of light-headedness or fainting. he is afebrile and on abx and shows no signs of systemic disease. . acute care: 1. infected pacemaker leads: patient has a long-standing implanted pacemaker because he previously had experienced syncopal episodes related to sick-sinus syndrome. he had begun to pick at an area where the pacer wires were close to the skin and developed a complicated infection with exposed pace wires. there was granulation tissue over the site of patient's previous intervention and a previous wound culture grew mssa for which he had undergone a course of keflex. this is in addition to multiple antibiotic treatment course in sequence beginning in spring of . because of inability to eliminate infection and continued exposure of the pacer wires, a scheduled explant of the pacemaker was planned. because patient had increased purulent drainage from the site, he presented to where he was started on vanc and cefazolin. upon transfer to , a tee was performed that showed a potential vegetation on the tricuspid valve vs. fibrous tissue from exposure to pacemaker leads. his pacemaker was explanted on , procedure complicated by hematoma at right groin site which self-resolved with some inital pressure and asymptomatic bradycardia to 30s-40s. microbiology records show that blood cultures drawn prior to the initation of antibiotics were all no growth final. blood cultures drawn here are ngtd. iv cefazolin and topical mupirocin was continued, and patient was switched to iv daptomycin. he remained afebrile and with no signs of systemic infection. he is to receive a total of 6 weeks of iv daptomycin for treatment of potential endocarditis given the finding of vegetation vs. fibrous tissue on the tricuspid valve. chest x-ray on confirmed that the tip of the picc is in a central location. 2. sick sinus syndrome: patient is s/p pacer explantation on . intra-operatively, his hr was noted to be in 30s-40s, but he was asymptomatic. he was sent to the ccu for closer bradycardia monitoring overnight after the procedure, and hr remained in the 50s with no arrhythmic events. on the medical floors, he remained with bradycardia to the 50's and sometimes 40's without symptoms. telemetry was discontinued because patient was assymptomatic for days with this bradycardia. patient should be considered for reimplantation of pm once infection is cleared. 3. norovirus: patient contracted norovirus during his hospital stay. he experienced fever to 104f, vomiting, abdominal pain, and diarrhea that all resolved in 24 hours time. his last symptom was diarrhea on the morning of and has been asymptomayic since. chronic care: 1. mental disability: patient has downs syndrome, and at baseline is able to respond to many questions and communicates needs well with provider. caregivers from his group home are often with him and understands his needs. per his mother, he has mood disturbances secondary to down's and takes mood stabilizers; he has been stabilized on this regimen. he was continued on lithium and topomax per home regimen. he was written for oral ativan prn agitation which he rarely required as he responded to redirection very well when having episodes of agitation. . 2. hypothyroidism: patient was continued on home levothyroxine. . 3. skin care: patient has chronic problems with skin dryness likely related to obsessive cleaning behaviors and picking at his skin. per group home, patient's skin becomes red/irritated, and this is his baseline. he was continued on antifungal and moisurizing agents per home regimen. . transitions in care: 1. code status: full code (mother is still thinking about this issue and will get back to us if things change) 2. contacts: , mother and legal guardian (cell) nursing supervisor at patient's group home 3. medication changes: 1. start daptomycin 400mg iv daily until . 4. follow-up: department: cardiac services when: tuesday at 12:40 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage department: infectious disease when: tuesday at 9:30 am with: , md building: lm campus: west best parking: garage department: infectious disease when: monday at 10:30 am with: , md building: lm bldg () campus: west best parking: garage department: cardiac services when: tuesday at 12:40 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage you should have the rehab schedule a follow-up appointment with your pcp on discharge. 5. outstanding clinical issues: -patient expected to stay at rehab for less than 30 days. -monitoring of cbc, cmp, and cpk weekly while on daptomycin -follow-up with infectious disease and cardiology medications on admission: lithobid 600 mg q.h.s buspirone 10 mg twice a day topamax 100 mg in the morning and 50 mg in the evening levoxyl/synthroid 75 mg daily metamucil two tablets daily colace 100 multivitamins potassium 20 meq b.i.d. folic acid 1 mg daily ferrous gluconate 325 lamisil cream hydrocortisone ointment ketoconazole cream, lactaid acetaminophen eucerin cream denorex shampoo. discharge disposition: extended care facility: livingcenter - discharge diagnosis: vegetative endocarditis 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 part in your care. you were admitted to the hospital because there was an infection around your pacemaker wires that extended to your heart. this type of infection requires removal of the pacemaker and wires to allow healing. the pacemaker was removed and you will need to complete a course of iv antibiotics to completely treat the remaining infection on the heart. please make the following changes to your medications: 1. start daptomycin 400mg iv daily until . please take all other medications as previously prescribed. you will need lab work done at the outside facility and have the results faxed to the number provided. please keep all follow-up appointments. followup instructions: please have the rehab facility schedule a primary care follow-up for you on discharge. department: cardiac services when: tuesday at 12:40 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage department: infectious disease when: tuesday at 9:30 am with: , md building: lm campus: west best parking: garage department: infectious disease when: monday at 10:30 am with: , md building: lm bldg () campus: west best parking: garage department: cardiac services when: tuesday at 12:40 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: replacement of any type pacemaker device with dual-chamber device replacement of transvenous atrial and/or ventricular lead(s) [electrode] diagnoses: unspecified acquired hypothyroidism other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation accidents occurring in other specified places acute and subacute bacterial endocarditis mechanical complication due to cardiac pacemaker (electrode) down's syndrome infection and inflammatory reaction due to cardiac device, implant, and graft 

Answer: The patient is high likely exposed to