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: chief complaint: pre syncope reason for ccu transfer: pericardial effusion, hemodynamic monitoring major surgical or invasive procedure: - pericardiocentesis, drain placement - right heart catheterization - drain removal history of present illness: mr is a 71-year-old man with a history of high degree av block, s/p ppm implantation and recent rv lead extraction with re-implantation, who presented with presyncope and was found to have a moderate/large pericardial effusion and is transferred to the ccu for hemodynamic monitoring. . per admission note, patient reports that since his last lead extraction and revision on for a fractured rv lead, he has been having chest pain, described as a stinging sensation in his chest wall. he was evaluated by outpatient ep and had pacer output reduced, with some improvement in his sypmtoms but still with a noticeable chest sensation that coincided with his pulse. he remained active and observed post pacemaker precautions, however started performing situps on a daily basis. about one week ago he felt a muscle sprain and started taking over the counter ibuprofen 600mg three times daily. . on the day of admission, he activated ems after developing abdominal discomfort and severe nausea, followed by diaphoresis, weakness, and light-headedness. he was brought into ed for further evaluation. . in the ed, vs: 75 18 99% 100/77. he complained of nausea and was found to be hypotensive to 60's systolic. fluid boluses were given and bedside ultrasound performed which was concerning for large effusion and rv collapse. cardiology was consulted and a stat echo was performed, which confirmed a large effusion but did not find evidence of tamponade with a pulsus of 8. his blood pressure improved with fluids and he was admitted to cardiology for further evaluation. of note, he recently underwent rv lead extraction and implantation of a dual chamber adapta l pacemaker. . on arrival to the ccu, he is comfortable and free of chest pain or shortness of breath. . on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: complete heart block -- s/p multiple lead and generator changes gi bleed social history: retired investment banker, does not smoke, drink alcohol, or use drugs, exercises at least 5 times per week. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: vs - 97.8 120/70 55 16 96% ra pulsus 8mmhg gen: wdwn middle aged male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of approximately 20cm at 60 degrees. cv: distant heart sounds, regular rate, no murmurs, rubs or gallops. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: 12:20am blood wbc-11.0# rbc-4.27* hgb-12.7* hct-39.3* mcv-92 mch-29.9 mchc-32.4 rdw-14.3 plt ct-212 07:40am blood pt-12.7 ptt-25.8 inr(pt)-1.1 12:20am blood glucose-138* urean-42* creat-1.5* na-139 k-4.5 cl-103 hco3-26 angap-15 12:20am blood ck-mb-3 12:20am blood ctropnt-<0.01 12:20am blood ck(cpk)-110 07:40am blood calcium-8.9 phos-3.9 mg-2.1 cxr pa/lat : findings: as compared to the previous radiograph, there is no relevant change. unchanged course of the old and new leads. borderline size of the cardiac silhouette, no pulmonary edema, no pneumothorax. tte : the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is a moderate to large sized circumferential pericardial effusion with left atrial and right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. there is also significant, accentuated respiratory variation in mitral valve inflows, consistent with impaired ventricular filling. compared with the prior intraoperative tee study (images reviewed) of , the pericardial effusion is new and c/w tamponade physiology. cardiac cath : 1. pericardial tamponade with improvement in hemodynamics after removal of 400 cc of bloody pericardial fluid. 2. mild biventricular diastolic dysfunction. 3. mild pulmonary hypertension. tte : overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a moderate sized pericardial effusion. there are no echocardiographic signs of tamponade. the patient is s/p pericardiocentesis from image 10 and on. there is minimal residual pericardial fluid. there is still no tamponade seen. compared with the prior study (images reviewed) of , the pericardial fluid is now drained. tte : overall left ventricular systolic function is normal (lvef>55%). with borderline normal free wall function. the aortic valve leaflets (3) are mildly thickened. mild (1+) aortic regurgitation is seen. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , no change post drainage. 2:30 pm swab pericardial fluid. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (preliminary): a swab is not the optimal specimen collection to evaluate body fluids. no growth. anaerobic culture (preliminary): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. fungal culture (preliminary): no fungus isolated. no growth in pericardial fluid cytology negative for malignant cells brief hospital course: mr is a 71-year-old gentleman with a history of high degree av block, s/p ppm implantation and recent rv lead extraction with re-implantation, who presented with presyncope and was found to have a moderate/large pericardial effusion, transferred to the ccu for hemodynamic monitoring. 1. pericardial effusion: there was no evidence of pericardial effusion on prior echo on . the new effusion was likely related to pacemaker lead extraction/revision with micoperforation of rv free wall, exacerbated by ibuprofen use, herbal supplements (some of which have antiplatelet and anticoagulant properties), and strenuous physical exercises at home. patient likely with active tamponade on ed presentation with the hypotension to the 60s and the rv collapsed that became compensated after ivf. repeat echo taken after fluid given is probable the reason why rv collapse is gone. differential for effusion also included infectious and inflammatory processes though much less likely given clinical history. the patient went to the cath lab on in which a rhc revealed equalization of pressures of the pericardial and right heart pressures to 22mmhg prior to pericardiocentesis. pericardial pressure was 20mmhg. the patient underwent a pericardiocentesis the following morning whereby 400cc of sanguinous fluid was drained. post procedure pericardial pressure was 0-2mmhg and post-procedure echo revealed resolution of the pericardial effusion. pericardial drain was left in place. pericardial fluid studies were negative for bacterial growth and afb. cytology was negative for malignant cells. 2. complete heart block: pacemaker functioning properly per report. ep team to weigh in on plans for lead adjustment, pending plan for management of above. suspect that if open procedure is pursued, extraction of old leads and revision of new leads could be performed simultaneously. patient underwent rv lead revision w/ ep on and had pericardial drain pulled. he was discharged on after pacer interrogation by ep, with 7-day course of cephalexin to end on post-procedure, as well as follow-up in clinic within one week. 3. presyncope: this was likely secondary to tamponade leading to hypotension and cerebral hypopefusion. would also consider arrhythmias though pacemaker functioning properly per report. he had no further episodes of syncope or pre-syncope during his hospital course. 4. acute renal failure: creatinine 1.5 on admission from baseline of 1.0, likely in setting of hypoperfusion, volume depletion, and nsaid use. creatinine impoved with hydration and was 0.9 at the time of discharge. medications on admission: current medications: acetylcarnitine - (prescribed by other provider) - 250 mg capsule - 1 (one) capsule(s) by mouth daily ascorbate calcium -c] - (prescribed by other provider) - 500 mg tablet - one tablet(s) by mouth twice daily aspirin - 81 mg tablet, chewable - 1 tablet(s) by mouth once a day calcium-magnesium - (prescribed by other provider) - dosage uncertain choline - (prescribed by other provider) - capsule - one capsule(s) by mouth twice daily coenzyme q10 - (prescribed by other provider) - 100 mg capsule - 1 capsule(s) by mouth cranberry - (prescribed by other provider) - 500 mg capsule - one capsule(s) by mouth twice dialy evening primrose oil - (prescribed by other provider) - dosage uncertain garlic - (prescribed by other provider) - tablet - two tablet(s) by mouth daily ginger (zingiber officinalis) - (prescribed by other provider) - 500 mg capsule - one capsule(s) by mouth daily ginkgo biloba - (prescribed by other provider) - 60 mg capsule - one capsule(s) by mouth twice daily ginseng - (prescribed by other provider) - 100 mg capsule - two capsule(s) by mouth daily glucosamine-chondroitin - (prescribed by other provider) - 500 mg-400 mg capsule - 2 capsule(s) by mouth once a day glutamine - (prescribed by other provider) - 500 mg capsule - 2 (two) capsule(s) by mouth daily green tea leaf extract - (prescribed by other provider) - 315 mg capsule - one capsule(s) by mouth daily inositol - (prescribed by other provider) - 500 mg tablet - one tablet(s) by mouth daily lecithin - (prescribed by other provider) - 518 mg capsule - one capsule(s) by mouth daily milk thistle - 200 mg one capsule by mouth daily multivitamin once daily omega-3 fatty acids 300 mg capsule by mouth saw 160 mg capsule by mouth twice daily soy protein discharge medications: 1. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 6 days. disp:*24 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: pericardial effusion, presyncope, acute renal failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure being involved in your care, mr. . you were admitted to the hospital because you were feeling dizzy, nauseous and lightheaded which was caused in part by fluid accumulation around your heart (pericardial effusion). this was drained by a needle (pericardiocentesis) followed by a drain, and you had serial echocardiograms (ultrasounds of your heart) to make sure the fluid went away. you also underwent cardiac catheterization. your medications have changed as follows: 1. please discontinue all herbal supplements until speaking with your cardiologist. 2. please discontinue taking aspirin 81mg daily. 3. we added cephalexin (keflex) an antibiotic you will need to take for the next 6 days. (start , end ) please make an appointment to see your primary care doctor, dr. . the electrophysiology (ep) doctors would to see you back in clinic within one week. they will call you to make the appointment. followup instructions: the electrophysiology (ep) doctors would to see you back in clinic within one week. they will call you to make the appointment. device clinic phone: date/time: 4:00 device clinic phone: date/time: 2:00 , m.d. phone: date/time: 2:20 procedure: pericardiocentesis revision of lead [electrode] right heart cardiac catheterization diagnoses: acute kidney failure, unspecified atrioventricular block, complete cardiogenic shock cardiac pacemaker in situ acute pericarditis, unspecified cardiac tamponade 

Answer: The patient is high likely exposed to