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: morphine attending: chief complaint: dizziness major surgical or invasive procedure: none history of present illness: the patient is a 73 yo man with a h/o rheumatic heart disease s/p bioprosthetic avr, non-ischemic cardiomyopathy with an ef of 20%, and s/p aicd in who presented to hospital on with dizziness. per the patient's daughter, the patient was in his normal state of health until approximately one week ago, when he began to experience periodic episodes of dizziness associated with tachycardia, nausea, weakness, and urinary incontinence. the day of admission, mr. was noted by his daughter to be "grey" during one of these episodes, so ems was called and he was brought to hospital for further evaluation. . at hospital, his aicd was interrogated and demonstrated sustained monomorphic vt, the longest of which lasted for 19 minutes. this rate was apparently slower than the vt detect rate on his defibrillator, so he was not shocked. his pacemaker was reprogrammed to a slower rate, and he was thereafter cardioverted once in the ed. he was started on an amiodarone gtt and was admitted to the ccu. . in the osh ccu, he was started on lopressor iv and was continued on the amiodarone gtt to suppress his arrythmia. he then became febrile to 104.9, hypotensive to 81/35 and was found to have bottles of gpcs in chains in his blood. he was started on ctx/vancomycin and was transferred to for further evaluation. . on arrival to the ccu, the patient was very uncomfortable with his foley in place, and he was occasionally speaking in polish. he stated that he had occasional nausea and dizziness but otherwise had no acute complaints. of note, he was alert and oriented to person, place, and date but did not demonstrate insight into his condition. . on review of systems, he denied 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 denied recent fevers, chills or rigors. he denied exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems was notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: -diabetes, -dyslipidemia, -hypertension 2. cardiac history: - pacing/icd: vvi pacer/aicd, placed in - non-ischemic cardiomyopathy with ef of 20% - rheumatic heart disease (in childhood) s/p bioprosthetic avr years ago in fl - paroxysmal atrial fibrilation on coumadin (confirmed by phone by his cardiologist dr. (holywood, ) - ventricular tachycardia 3. other past medical history: - gout - hypothyroidism - traumatic injury to his left arm 30 years ago social history: the patient's girlfriend lives in fl. he lived in up until recently, when he moved to to live with his daughter. does not smoke cigarettes. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: general: restless, oriented x3 heent: ncat. sclera anicteric. pin-point pupils, round, reactive to light b/l; eomi. clear oropharynx without exudates. neck: supple, no jvd. lymph: no cervical, axillary, or inguinal lymphadenopathy. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. soft systolic ejection murmur (grade ii/vi) at rusb. no r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. extremities: well-healed scar around left ante-cubital fossa, with large circumferential bulbous area of erythema distally; non tender, no crepitus, but warm to touch. area of discoloration and mild erythema w/o tenderness on extensor surface of left arm. no c/c/e. several toes b/l with onychomycosis. no splinter hemorrhages, no osler nodes/ lesions. skin: well-healed surgical incision near icd/pacer. pacemaker pocket without erythema, exudate, fluctuance, or tenderness. no stasis dermatitis, ulcers, or xanthomas. pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ . on discharge: heent: ncat. sclera anicteric. pin point pupils, round, reactive to light b/l; eomi. clear oropharynx w/o exudates. neck: supple, no jvd. lymph: no cervical, axillary, or inguinal lymphadenopathy cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. soft systolic ejection murmur (grade ii/vi) at rusb. no r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. extremities: well healed scar around left ante-cubital fossa, with large circumferential bulbous area of erythema distally; non tender, no crepitus, minimal warmth. area of discoloration and mild erythema w/o tenderness on extensor surface of left arm. no c/c/e. several toes b/l with onychomycosis. no splinter hemorrhages, no osler nodes/ lesions. skin: well healed surgical incision near icd/pacer. pacemaker pocket without erythema, exudate, fluctuance, or tenderness. no stasis dermatitis, ulcers, or xanthomas. pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ pertinent results: osh: - osh cx - blood: pansensitive beta hemolytic gas - urine: pansensitive e.coli enterococcus faecalis: levofloxacin r ciprofloxacin r tetracycline r . on admission: 04:00pm wbc-7.9 rbc-5.07 hgb-13.5* hct-40.1 mcv-79* mch-26.7* mchc-33.7 rdw-15.8* 04:00pm neuts-68.0 lymphs-21.6 monos-6.7 eos-3.2 basos-0.5 04:00pm plt count-171 04:00pm glucose-92 urea n-16 creat-1.1 sodium-135 potassium-4.5 chloride-102 total co2-25 anion gap-13 04:00pm calcium-8.7 phosphate-3.0 magnesium-2.1 04:00pm alt(sgpt)-15 ast(sgot)-28 ld(ldh)-203 alk phos-78 tot bili-0.5 04:00pm tsh-0.74 04:14pm lactate-1.7 04:00pm pt-30.9* ptt-34.1 inr(pt)-3.0* . micro: 5:56 am stool consistency: loose source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . blood cxs: ngtd . tte the left atrium is moderately dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. there is severe global left ventricular hypokinesis (lvef = 25-30 %) with akinesis of the basal inferior, inferolateral and lateral segments. the right ventricular cavity is moderately dilated with depressed free wall contractility. the aortic root is moderately dilated at the sinus level. a bioprosthetic aortic valve prosthesis is present. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. the mitral valve leaflets are mildly thickened. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: no echocardiographic evidence of endocarditis with suboptimal visualization of valvular structures and of the prosthetic aortic valve. if clinically indicated, a transesophageal echocardiogram may better assess for valvular vegetations. basal inferior/inferolateral and lateral akinesis with moderate hypokinesis of the other segments. mild pulmonary artery systolic hypertension. . tee the left atrium is dilated. mild to moderate spontaneous echo contrast is seen in the body of the left atrium. no mass/thrombus is seen in the left atrium or left atrial appendage. no spontaneous echo contrast or thrombus is seen in the body of the right atrium or the right atrial appendage. lv systolic function appears depressed. right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch and descending thoracic aorta. a bioprosthetic aortic valve prosthesis is present with normal appearing aortic valve prosthesis leaflets and normal leaflet motion. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. there is no aortic valve stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. there is no pericardial effusion. . impression: no discrete vegetations on the valves or icd lead wires seen. image quality of pacer wires was suboptimal due to patient agitation. well seated aortic bioprosthesis with normal leaflet motion. depressed left ventricular global systolic function. . ct head impression: 1. no acute intracranial hemorrhage or mass effect. if there is a high clinical concern for septic emboli, mri can be considered as a more sensitive test if not contra-indicated. 2. difference in the attenuation of the bones as mentioned above- consider follow up to confirm if this is artifatual/real and further work up to be based on the follwo up study and clinical correlation for metabolic /metastatic disease. . chest us: impression: no evidence of fluid collection to suggest abscess or hematoma. . upper extremity us: impression: 1. no deep venous thrombosis within the right upper extremity. 2. partially occlusive thrombus within the right cephalic vein. 3. superficial thrombophlebitis of a right forearm vein, at the site of prior iv attempt. 4. asymmetry of the left subclavian waveforms compared to the right is likely due to the presence of pacing leads within the left subclavian vein . on discharge 07:15: . wbc rbc hgb hct mcv mch mchc rdw plt ct 5.1 5.49 14.4 43.9 80* 26.2* 32.7 15.4 199 . glucose urean creat na k cl hco3 angap 99 15 1.2 136 4.7 100 30 11 . inr: 1.9 . tsh: 0.74 brief hospital course: mr is a 73 year old man with h/o rheumatic heart disease s/p bioprosthetic avr, non-ischemic cardiomyopathy with an ef of 20%, and s/p aicd in transferred from osh for management of group a strep bacteremia in the setting of ventricular tachycardia/icd firing and prosthetic aortic valve. . # group a strep bacteremia: on arrival, the patient was broadly covered with vanco/ctx/clinda. osh microbiology data returned with pansensitive group a strep and was narrowed to ceftriaxone 2gm iv q24hrs with plan to complete a 6 week course. work-up here largely negative as surveillance cultures ngtd, tte and tee w/o evidence of vegetations on valves or icd wires. ct head was negative for obvious embolic events. pacemaker pocket ultrasound negative for fluid collection. the source was most likely thought to be from the arm cellulitis which was slowly starting to improve prior to discharge. at time of discharge patient afebrile with wbc wnl. continued ctx 2 g iv q24hr for 6 week course. picc line placed on . . outpatient issues: -- follow-up with id (see appts); weekly bun/creatinine, lfts, cbc . # ventricular tachycardia/icd firing: no evidence of vegetations on leads or fluid collection in pacemaker pocket. reset on with permanent pacing at 3v both from rv and lv. patient with intermittent runs of symptomatic vt lasting seconds. decision made to repeat amiodorone load and continue with 200mg po tid for one week then 400mg daily subsequently in additional to home mexilitine. . outpatient issues: -- continue amiodarone 200 mg tid for one week (day 1 = ) and then 200 mg for 1 week then 200 mg daily subsequently. -- close outpatient ep follow-up (see appts) . # left arm erythema: on arrival patient with evidence of left forearm cellulitis around site of old traumatic injury. seen by surgery; wrapped and elevated arm, physical exam without evidence of necrotizing fascitiis. patient started on antibiotics and upper extremity cellulitis slowly improved. . outpatient issues: -- monitor upper extremity closely . # non-ischemic cardiomyopathy per osh records: echo on demonstrated mildly dilated left ventricular cavity, severe global left ventricular hypokinesis (lvef = 25-30 %) with akinesis of the basal inferior, inferolateral and lateral segments; moderately dilated right ventricular cavity with depressed free wall contractility. in house patient continued on home carvedilol 25 mg po bid, digoxin 0.125mg daily, as well as coumadin for anticoagulation at 5 mg daily (home dose is 7.5, but given amiodarone drip and interaction are going lower for now), inr at time of discharge: 2.0. patient without signs of volume overload during hospital stay and continued on home lasix. lisinopril 2.5 mg daily was started for afterload reduction. outpatient issues: -- monitor k on new lisinopril and lasix dose . # paroxysmal atrial fibrilation - continued coumadin and carvedilol, was also reloaded with amiodarone as outlined above. . outpatient issues: -- monitor inr and adjust coumadin dose to goal inr . # restless leg syndrome: patient with worsening complaints in-house. improved with higher dose of home requip (0.5mg -> 1.0mg qhs). . # cad: no known cad per osh. patient contined on aspirin for primary prevention as well as home carvedilol. he was without complaint of chest discomfort in-house. . # hypothyroidism: admission tsh wnl at 0.74. continued on home levothyroxine. . # gout: continue on home colchicine. . code: full during this admission medications on admission: protonix 40 mg daily requip 0.5 mg qhs asa 81 mg daily coumadin 7.5 mg daily amiodarone 200 mg daily carvedilol 25 mg po bid colchicine 0.6 mg daily lasix 40 mg daily digoxin 0.25 mg daily klor-con 20 meq daily levothyroxine 25 mcg daily mexiletine 250 mg roxicet prn for pain discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po see other instructions: take one tablet three times daily for 3 days, then one tablet twice daily for 7 days, then continue taking 1 tablet once daily. . 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). 5. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). 6. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 7. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 8. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 9. ropinirole 0.5 mg tablet sig: two (2) tablet po once a day. 10. mexiletine 250 mg capsule sig: one (1) capsule po q12h (every 12 hours). 11. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 12. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. 13. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: one (1) dose intravenous q24h (every 24 hours) for 34 days. 14. klor-con 20 meq packet sig: one (1) po once a day. 15. outpatient lab work cbc with diff, chem-7, lft's, esr and crp weekly starting on , please fax results to infectious disease r.ns. at (. discharge disposition: extended care facility: discharge diagnosis: primary: ventricular tachycardia bacteremia urinary tract infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory with assitance discharge instructions: dear mr it was a pleasure taking care of you. . you were admitted to for management of bacteremia (infection in the blood) and urinary tract infection in the setting of ventricular tachycardia/icd firing. the abnormal heart rhythm as well as icd firing was attributed to your underlying infection, the source of which is thought to be the skin on your left arm. close inspection of your heart valves as well as icd pocket was negative for infection. you were treated with iv antibiotics to treat the underlying infection. you were also started on an anti-arrhythmic to better control your heart rate and rhythm. . changes to your medications: to treat your infection: start taking ceftriaxone 2 gm iv q24h . to better control your heart rhythm: take amiodarone 200 mg tablet. take one tablet three times daily for 3 days, then 1 tablet twice daily for 7 days, then continue taking 1 tablet once daily. . to treat your restless legs: your requip 0.5mg tablet dose was increased from one to two tablets once daily. . for anti-cooagulation: your warfarin (coumadin) dose was decreased from 7.5mg once daily to 5mg once daily. please take one 5mg tablet once daily. . for you heart function: - digoxin was decreased from 250 mcg to 125 mcg tablet. please take one 125 mcg tablet once daily. - lisinopril 2.5mg tablet was started to help your heart pump better. please take one tablet once daily. followup instructions: ep: department: cardiac services: electrophysiology when: thursday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage . department: infectious disease when: monday at 10:10 am with: , md building: lm campus: west best parking: garage department: infectious disease when: thursday at 11:00 am with: , md building: lm bldg () campus: west best parking: garage procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified unspecified acquired hypothyroidism gout, unspecified atrial fibrillation sepsis cellulitis and abscess of upper arm and forearm long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ heart valve replaced by transplant phlebitis and thrombophlebitis of superficial veins of upper extremities other and unspecified infection due to central venous catheter streptococcal septicemia acute on chronic systolic heart failure acute venous embolism and thrombosis of superficial veins of upper extremity 

Answer: The patient is high likely exposed to