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You need to rebuild the box, unless you just have an open relay. My guess would be an open port that they gained access or hacked the box and created a relay. In the future hire someone to lockdown your machine. Close all unnecessary ports, make sure all directories have the right permissions and only allow specific IP's to come in remote for admin.
Although anything (like exploits or a simple admin mistake) can leave you open, most hackers are looking for easy access (they have plenty of other choices) and will not spend time on a pretty secured box.
My two cents....
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