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: azithromycin / zosyn attending: chief complaint: peri-ampullary mass major surgical or invasive procedure: 1. whipple's resection. 2. open cholecystectomy. 3. enteroenterostomy x2 (with formation of roux limb for pancreaticobiliary drainage). 4. extended adhesiolysis. 5. reduction of internal hernia. history of present illness: this 69-year-old retired gentleman was referred to dr. for consultation for his bile duct obstruction problem by dr. . he has a very interesting history of prior abdominal surgeries including a gastric resection for peptic ulcer disease followed by a revision with a roux-en-y and partial gastrectomy in . he had thrived since then but recently was admitted last month for pruritus, pain, and jaundice. he also had sepsis at that point. an ercp was attempted to analyze the bile duct, but was unsuccessful due to the reroute in his gastrointestinal system. a percutaneous transhepatic cholangiogram tube was placed to drain this and remains in place now. he was treated with antibiotics, and he stabilized out. this has been analyzed radiographically, and there is an obstruction in the bile duct at the area of the ampulla. there is clearly a mass there, and it appears to be growing into the lumen of the duodenum. past medical history: htn pud s/p perforation social history: he used to work as property manager but is now retired. married; wife and grown children very involved. he has 40 pack-year smoking history; quit a while back. no alcohol use. family history: non-contributory. physical exam: vs: t:, bp:, hr:, p:, rr:, sao2: % ra gen: thin, gaunt gentleman appearing older than stated age in nad. heent: sclerae anicteric. o-p moist, intact. neck: supple. no lymphadenopathy. no jvd or bruits. lungs: cta(b). cardiac: rrr; nl s1/s2 w/o m/c/r. abd: scaphoid. multiple, well-healed surgical scars across abdomen. drain (r)uq intact with miniaml tan drainage. dsd in place w/o significant staining. normoactive bsx4. soft/nt/nd. extrem: no c/c/e. ms: marked generalized muscle atrophy. gait stable with assistance and walker. skin: as aboev, otherwise intact. neuro: a+ox3. pleasant, interacts appropriately. non-focal/grossly intact. pertinent results: 08:21pm blood wbc-11.5* rbc-2.85*# hgb-8.5* hct-25.2* mcv-89 mch-29.8 mchc-33.6 rdw-14.5 plt ct-400 06:00am blood wbc-21.2* rbc-2.99* hgb-8.8* hct-26.6* mcv-89 mch-29.4 mchc-33.1 rdw-14.6 plt ct-469* 04:24am blood wbc-13.0* rbc-2.80* hgb-8.1* hct-24.4* mcv-87 mch-28.9 mchc-33.2 rdw-14.9 plt ct-950* 05:13pm blood wbc-15.6* rbc-3.28* hgb-9.4* hct-28.3* mcv-86 mch-28.8 mchc-33.3 rdw-14.3 plt ct-1199* 04:24am blood glucose-157* urean-17 creat-0.9 na-133 k-4.0 cl-99 hco3-26 angap-12 04:24am blood calcium-7.8* phos-3.0 mg-1.7 05:49am blood triglyc-173* . specimen submitted: fs ampullary adenoma, duodenal mass, gall bladder, whipple specimen. diagnosis: i. ampullary adenoma (a-b): adenoma with small focus of intramucosal adenocarcinoma. ii. pancreaticoduodenectomy (c-an): adenocarcinoma of the duodenum, arising in an adenoma, see synoptic report. focal inactive pancreatitis with ductal mucinous metaplasia. dilation of common bile duct. rest of duodenum including margins, bile duct margin and pancreas free of tumor. iii. duodenal mass (ao-as): adenocarcinoma arising in an adenoma with invasion into the duodenal wall. iv. gallbladder (at-au): chronic cholecystitis. choledochal cyst lymph node with hyperplasia. no calculi or tumor. . radiology report ct abdomen w/contrast study date of 9:55 pm impression: 1. negative for pe. 2. right lower lobe atelectasis and consolidation. there is obstruction of the right bronchus intermedius. bronchoscopy should be considered. . 3. small amount of pleural fluid on the left with associated atelectasis. 4. unusual appearance of the left humerus, which is felt to be the result of the artifact. however, plain radiography of the left humerus is suggested when the patient's clinical condition permits in order to confirm this suspicion. 5. collection of gas and fluid subjacent to the anterior abdominal wall in the vicinity of several of the anastomotic sites. a drainage procedure has been planned. . radiology report ct guidance drainage study date of 2:09 pm impression: 1. the more inferior component of the complex gas and fluid collection (the portion which was mostly fluid) was aspirated, yielding, cloudy, pink fluid. this was sent for gram stain, culture, and amylase. 2. a 10 french drainage catheter was placed into the more superior aspect of the collection. aspiration of the catheter yielded bilious appearing fluid, which was sent for gram stain, culture, and amylase. 3. injection of the percutaneous biliary drain, demonstrated extravasation of contrast outside of the confines of the hepaticojejunostomy, with free extravasation outside of the jejunal limb, collecting around the region of the pigtail drainage catheter within the complex gas and fluid collection. . radiology report t-tube cholangio (post-op) study date of 11:23am impression: persistent bile leak at the anastomosis . small intestine: polypectomy; segmental resection; whipple procedure (pancreaticoduodenectomy, partial or complete, with or without partial gastrectomy synopsis macroscopic specimen type: whipple procedure. tumor site: duodenum. tumor configuration: exophytic (polypoid). tumor size greatest dimension: 5.5 cm. microscopic histologic type: adenocarcinoma (not otherwise characterized). histologic grade: g2: moderately differentiated. extent of invasion primary tumor: pt2: tumor invades muscularis propria. regional lymph nodes: pn0: no regional lymph node metastasis. lymph nodes number examined: 23 (plus 1 choledochal cyst lymph node). number involved: 0. distant metastasis: pmx: cannot be assessed. margins proximal margin: uninvolved by invasive carcinoma. distal margin: uninvolved by invasive carcinoma. circumferential/radial (mesenteric or retroperitoneal) margin: uninvolved by invasive carcinoma. bile duct margin: margin uninvolved by invasive carcinoma. pancreatic margin: margin uninvolved by invasive carcinoma. distance of carcinoma from closest margin: 30 mm. specified margin: retroperitoneum. venous (large vessel) invasion: absent. perineural invasion: absent. brief hospital course: this is a 69 year old male with a pancreatic mass who went to the or on for a whipple procedure and extended adhesiolysis. following the procedure, he was kept intubated and intermittently on vasopressors and kept in the pacu overnight for close monitoring post operatively. he was transfused 2 units rbc overnight for a low hematocrit. he was extubated on pod 1. he had a foley catheter in place, ng tube in place, ivf for hydration and pca for pain control and was transferred to the surgical floor. : ng tube removed : foley catheter removed, diet advanced to sips : diet advanced to clears, vancomcin and zosyn started, po medication started, d/c pca, ct torso performed for tachypnea and fever demonstrating no pulmonary embolus right lower lobe atelectasis, consolidation, obstruction of the right bronchus intermedius, and collection of gas and fluid adjacent to the anterior abdominal wall in the vicinity of several of the anastomotic sites. bronchoscopy performed. : diet npo, foley catheter replaced, ct guided drainage of abdominal fluid collection performed, also injection of the percutaneous biliary drain performed demonstrating extravasation of contrast outside of the confines of the hepaticojejunostomy, with free extravasation outside of the jejunal limb, collecting around the region of the pigtail drainage catheter within the complex gas and fluid collection. continued vancomycin, zosyn : picc line placed, tpn started, central line removed : continued tpn, vancomycin and zosyn : continued tpn, abx, t tube study performed demonstrating persistent leak, lenis performed demonstrating no dvt - : diet advanced to clears and then to regular, cont tpn, vancomycin, zosyn, started gentamicin : t tube study performed showing massive leak at hepaticojejunostomy anastomosis, biliary catheter exchanged, continued tpn, vancomycin, zosyn, gentamicin and regular diet : ct performed demonstrating new collection adjacent to multiple mesenteric vessels concerning for a large pseudo-aneurysm. new placement of an anterior abdominal drain, with persistent fluid and gas within the abdomen, and small areas of loculated fluid collections. : transfused one unit rbc for low hematocrit, fluconazole started (in addition to vancomycin, gentamicin and zosyn, brought to the operating room for open drainage of intra-abdominal abscess, repair of pancreaticojejunostomy through a bridge stent technique, and mass closure of the abdominal wall. he remained intubated following the procedure and was transferred to the icu for close monitoring. he had intermittent use of propofol and vasopressors. octreotide drip started. : the patient was extubated, continued on vancomycin, zosyn, gentamicin, fluconazole, transfused one unit of rbc, pca for pain control : resumed tpn, continued vancomycin, zosyn, gentamicin, fluconazole, octreotide : transferred to the floor with tpn, octreotide, vancomycin, zosyn, gentamicin, fluconazole : d/c octreotide drip and started octreotide sq, picc line placed, cont tpn, octreotide, vancomycin, zosyn, gentamicin, fluconazole : ct performed showing large collection anterior to the pancreas containing oral contrast material, from presumed leak, cont tpn, octreotide, vancomycin, zosyn, gentamicin, fluconazole : cont tpn, octreotide, vancomycin, zosyn, gentamicin, fluconazole, ct guided drainage performed with 8f pigtail catheter into a leaking bowel loop adjacent to the enterostomy site. 2 units rbc transfused : diet advanced to clears : diet reverted to npo, cont tpn, octreotide, zosyn, fluconazole, discontinued vancomycin, gentamicin : drain study performed showing pigtail catheter in the right upper quadrant, drainage tube in the right upper quadrant, two surgical drains in the left upper quadrant. injection of the drain showed prompt extravasation into the known intraperitoneal collection : cholangiogram performed demonstrating a persistent leak within the hepaticojejunostomy or pancreaticojejunostomy anastomotic region. uncomplicated exchange of existing biliary drain for a 10 french, 25-cm internal-external biliary drain. continued tpn, zosyn, fluconazole : discontinued zosyn, started meropenem, continued fluconazole and tpn : ugi study performed showing no evidence of obstruction. no extravazation of contrast identified in the upright position. onpassage of contrast beyond the proximal jejunum on supine imaging. : renal u/s performed for rising creatinine - grossly normal son evaluation of the kidneys and bladder, continued tpn, fluconazole, started ciprofloxacin and flagyl, discontinued meropenem : extensive whole body rash noted, dermatology started and felt to be drug reaction, continued tpn, cipro, flagyl, fluconazole : dialysis catheter placed and started hemodialysis q 3days, transferred to the unit for tachypnea, tachycardia and confusion : intermittently on vasopressors, started levofloxacin, discontinued ciprofloxacin, continued tpn, flagyl, fluconazole, transfused 2 units rbc, ct performed demonstrating persistent collection of extraluminal oral contrast material and gas within the anterior abdomen, just subjacent to anterior abdominal wall. the collection is smaller when compared to the most recent prior exam. : dermatology performed punch biopsies of skin demonstrating reactive drug rash : ir replaced biliary catheter, continued tpn, flagyl, fluconazole, started vancomycin enemas due to c diff positive, discontinued levofloxacin : transferred to the floor out of the icu, continued tpn, vanco enemas, flagyl, fluconazole, hemodialysis : diet advanced to clears, continued tpn, fluconazole, vanc enemas, flagyl, hemodialsis : transferred to icu for desatting; needs dialysis. : dialysis, 2 units prbc. ? aspiration event, resp arrest with intubation. : 2 units prbc. during afternoon, pt became hemodynamically unstable. started on neo gtt. evaluated with ecg, leni, xray, enzymes. : s/p ir for ptc replacement, more lethargic, cosyntropin stim test : hd, extubated, neo for hypotension : ptc cath pulled back, mrsa in sputum and bile, reintubated, on neo for hypotension, stress dose steroids started. : remains neutropenic from unknown etiology, hematology consulted, ct scan, sputum/blood cx sent, transient episode of bradycardia and hypotension with few seconds of unresponsiveness after turning : neupogen started, mucous plug - recovered after suctioning, stim 17.7-22 but endo believes test was not accurate. remains on dexamethasone 2.5mg , s/p dialysis, tpn : desat with mucus plug. restarted hydrocort 50 , lopressor3/5: tbili decreased despite ptc capped. renal signed off. continue water sips, no advancement for now. to repeat urine cx from new foley. : consent for trach, hydrocortisone discontinued, vancomycin discontinued, held off on hd, lasix 100 mg given with good diuresis, neutropenia resolved, neupogen dose 3 held : trach done. run of svt treated with 5 lopressor. spiked temp. pan cultured. : cipro/fluc d/ced, no dialysis per renal : passed pmv eval. : foley changed, ptc drain capped : no events : transferred out of icu to floor. diet advanced to clears. : diet put back to sips. pt on board. speech & swallow consult ordered. foley d'ced. : diet readvanced to clears. : transfused 2 units prbcs due to low crit. chest xray done as per speech/swallow. : ptc uncapped. id brought on board due to question of pneumonia as seen on chest xray. patient put on po medications, including lopressor . down for cholangiogram - normal tube cholangiogram demonstrating non-dilatation of the intrahepatic biliary tree and free passage of contrast; no obstruction or leak. biliary catheter replaced with the tip in the common hepatic duct. : transferred to tsicu with fever, rigors, hypotension, tachycardia, leukocytosis secondary to sepsis. started albumin 5% administered q8hours x 24 hours. urine output remained stable greater than 100ml/hr. cefipime added to iv vancomycin, flagyl, levaquin; patient defervesced. psychiatry continued to follow for delerium, hopelessness. : blood culture x1 with gram negative rods; continued on iv antibiotic therapy. remained hemodynamically stable. no events. passed speech & swallow study with dietary recommendations updated. : urinalysis positive for e.coli; creatinine improved. iv vanco changed to po; other iv antibiotics continued. albumin continued for tachycardia. picc placed; tpn started. remained hemodynamicaly stable. : levaquin and cefepime discontinued, iv bactrim started. continued on vanco po and flagyl. tolerating regular diet; tpn continued. arf resolving. hemodynamically stable with improving hct. : trasferred back to floor. heart rate consistently in 120s; hemodynamically stable. minimal po intake due to episodic nausea; prescibed reglan and zofran. continues on tpn. : stay-sutures discontinued. urine output stable. foley discontinued, replaced with condom catheter. po intake improving; continues on tpn. remianed stable. vanc oral liquid discontinued. : patient transfused two units prbc due to low crit. lasix administered. : pt. out of bed to chair. no other events. : ct scan of pelvis and abdomen done. no new collections seen. pt. hyperkalemic and given protocol of insulin, bicarb., etc. in evening, due to tachycardia and tachypnea, pt. transferred back to icu with suspected sepsis. cefepime begun as per id. : pt. given albumin for low pressures. pt. continued on vanc and bactrim. : cefepime discontinued. pt. stable and transferred back to the floor. : all antibiotics other than flagyl discontinued as patient's cultures negative. : pt. ambulatory with physical therapy treating. flagyl d'ced as per id. pt. hep locked and placed on po meds. : picc placed, tpn restarted. po lopressor begun and iv lopressor discontinued : eating well. tpn continued. foley discontinued; voided without problem. spiked fever to 101.7 po in evening; blood and urine cultures sent. : heart rate greater than 150; defervesced with po tylenol and heart rate returned to baseline. remined stable. cxr unremarkable. bile culture with gnr and gpc. id re-consulted. : went for chalnagiography/tube cholangiogram study in ir; ptc removed. received prophylactic iv antibiotics prior to study, otherwise antibiotics were not restarted on a regular basis. tolerated procedure well. : remined afebril/stable. no events. improved activity tolerance with physcial therapy. : continues stable on tpn, ambulating with pt, improving po intake. no events. : octreotide discontinued. continued on tpn, regular diet, phsycial therapy. : tracheostomy decannulated under medical supervision at the bedside without complication; patient remained stable w/o dyspnea. monitored by telemetry and continuous sao2 remainder of day and over night without incident. : appetite fair today. tpn discontinued. discharge planning underway. no events. : complaint of (r)uq abdominal pain when eating. no nausea, vomiting. no events. patient ready for discharge home with services. at the time of discharge, the patient was doing well, afebrile with stable viral signs. the patient was tolerating a regular diet, ambulating with assistance and a walker, voiding without assistance, and pain was well controlled. he will discharged home with and physical therapy. the patient and family received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: atenolol 25 po daily discharge medications: 1. one touch ultra 2 kit sig: one (1) kit miscellaneous asdir: glucometer testing qid. disp:*1 * refills:*0* 2. one touch ultrasoft lancets misc sig: one (1) lancet miscellaneous asdir achs: glucometer supplies. disp:*1 box* refills:*2* 3. one touch ultra test strip sig: one (1) strip in asdir achs: as directed per insulin sliding scale. disp:*100 strips* refills:*2* 4. alcohol pads pads, medicated sig: one (1) pad topical asdir: for use with glucometer testing. disp:*1 box* refills:*2* 5. dronabinol 5 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*0* 6. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed. disp:*1 bottle, large* refills:*2* 7. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever or pain. 8. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*70 tablet(s)* refills:*0* 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 10. zofran 8 mg tablet sig: one (1) tablet po q8hours as needed for nausea. disp:*60 tablet(s)* refills:*2* 11. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 12. insulin regular human 100 unit/ml solution sig: one (1) injection injection asdir (as directed): as directed per insulin sliding scale. disp:*1 vial* refills:*2* 13. insulin syringe ultrafine ml 29 x syringe sig: one (1) injection miscellaneous asdir insulin administration. disp:*1 box* refills:*1* discharge disposition: home with service facility: discharge diagnosis: 1. ampullary adenoma. 2. bile duct stricture. 3. adenocarcinoma of the ampulla. 4. extensive adhesions, status post multiple operations. discharge condition: good discharge instructions: please call your doctor or nurse practitioner or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain in not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon. avoid driving or operating heavy machinery while taking pain medications. fingerstick blood sugar monitoring: please check your fingerstick blood sugar first thing in the morning before eating breakfast, and just before dinner. record sugar greater than 170. jp drain care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever) or skin breakdown. *apply ostomy collection bag over jp tube as directed with rn assitance. *note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or nurse if the amount increases significantly or changes in character. *you may shower; cover ostomy pouch with water-proof barrier, such as saran wrap. keep area clean and dry. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. followup instructions: please call ( to schedule a follow-up appointment with dr. in weeks. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis percutaneous abdominal drainage percutaneous abdominal drainage radical pancreaticoduodenectomy other nonoperative replacements cholecystectomy temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus other lysis of peritoneal adhesions reopening of recent laparotomy site other laparotomy anastomosis of pancreas closed biopsy of skin and subcutaneous tissue repair of other hernia of anterior abdominal wall other cholangiogram other cholangiogram suture of laceration of small intestine, except duodenum other percutaneous procedures on biliary tract replacement of stent (tube) in biliary or pancreatic duct cannulation of pancreatic duct diagnoses: thrombocytopenia, unspecified anemia, unspecified esophageal reflux acute kidney failure with lesion of tubular necrosis other postoperative infection unspecified pleural effusion unspecified septicemia severe sepsis depressive disorder, not elsewhere classified pulmonary collapse acute respiratory failure peritoneal adhesions (postoperative) (postinfection) surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation intestinal infection due to clostridium difficile other specified disorders of biliary tract dermatitis due to drugs and medicines taken internally obstruction of bile duct other specified antibiotics causing adverse effects in therapeutic use malignant neoplasm of ampulla of vater peritoneal abscess other diseases of trachea and bronchus foreign body in larynx persistent postoperative fistula benign neoplasm of liver and biliary passages inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation methicillin resistant pneumonia due to staphylococcus aureus penicillins causing adverse effects in therapeutic use hernia of other specified sites without mention of obstruction or gangrene 

Answer: The patient is high likely exposed to