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: no known allergies / adverse drug reactions attending: chief complaint: 74m w/bilateral renal masses major surgical or invasive procedure: procedures: left laparoscopic radical nephrectomy and left laparoscopic para-aortic lymph node dissection. procedure: open splenectomy for splenic rupture history of present illness: 1. peripheral vascular disease. 2. 2.5 cm right renal mass. 3. 3.2 and 1.6 solid left renal masses. 4. mri left kidney: 3.1 and 2.1 solid lesion suspicious for papillary rcc, right kidney: 1.9-cm solid lesion in the mid kidney suspicious for rcc. 5. mri, significant increase in mass, 4.9 cm with perinephric nodules. past medical history: pmh: htn, bilateral renal masses, hld psh: splenectomy , lap left radical nephrectomy , r cea () , hernia repair x 2 social history: he is a senior project coordinator for the department of mental health, specializes in networks. he has a 50-pack-year smoking history, continues to smoke one pack per day, occasional alcohol, no drug use. he drinks rare alcohol. he is retired but still works two days a week. family history: not available at time of dictation physical exam: wdwn male, nad, avss interactive, cooperative abdomen soft, appropriately tender along incisions incisions c/d/i w/out evidence hematoma, infection foley catheter in place, urine yellow/clear jp to bulb in place. extremities w/out edema or pitting and no report of calf pain pertinent results: 3:25 pm stool consistency: watery source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). 11:00 am urine site: clean catch clean catch. **final report ** urine culture (final ): <10,000 organisms/ml. 05:20am blood wbc-17.9* rbc-2.90* hgb-9.0* hct-26.3* mcv-91 mch-31.0 mchc-34.2 rdw-13.5 plt ct-555* 03:06am blood wbc-18.5* rbc-3.04* hgb-9.0* hct-27.6* mcv-91 mch-29.5 mchc-32.5 rdw-13.4 plt ct-549* 03:47am blood wbc-18.8* rbc-2.82* hgb-8.5* hct-25.4* mcv-90 mch-30.2 mchc-33.4 rdw-13.8 plt ct-371 05:20am blood glucose-151* urean-14 creat-1.0 na-134 k-4.0 cl-97 hco3-29 angap-12 03:06am blood glucose-75 urean-18 creat-1.1 na-137 k-4.1 cl-98 hco3-28 angap-15 03:47am blood glucose-81 urean-15 creat-1.2 na-138 k-4.1 cl-103 hco3-28 angap-11 03:06am blood calcium-8.1* phos-2.3* mg-2.4 brief hospital course: mr. was admitted to urology after undergoing laparoscopic left nephrectomy. there was splenic bleeding intra-op with 50-100cc extravasation, controlled with packing and dry at the end of the case. post-operatively mr. had hypotension, poor urine output, and 10-point drop in hct over 3 hours, so he was taken for emergent splenectomy. total received 3u prbc and 2l crystalloid resuscitation. excellent hemostasis at the end of splenectomy but had 350cc bloody jp output immediately post-op. remained asymptomatic and jp output slowed. the patient received perioperative antibiotic prophylaxis. the patient was transferred to the intensive care unit from pacu in stable condition. on pod1 he was hydrated for urine output >30cc/hour, provided with pneumoboots and incentive spirometry for prophylaxis. he was monitored with serial hematocrits. he was eventually transferred from the icu to the general surgical floor where he made a gradual recovery and was advanced with diet. basic metabolic panel and complete blood count were checked, pain control was transitioned from pca to oral analgesics, diet was advanced to a clears/toast and crackers diet. abdominal drain output was monitored and checked for creatinine and amylase and at discharge was left in place. urethral foley was removed on day prior to discharge but he failed the voiding trial so it was replaced. diet was slowly advanced but by discharge he was on a regular house diet. the remainder of the hospital course was relatively unremarkable. the patient was discharged in stable condition, eating well, ambulating independently, and with pain control on oral analgesics. on exam, incision was clean, dry, and intact, with no evidence of hematoma collection or infection. the patient was given explicit instructions to follow-up in clinic with dr. for trial of void and staple removal and with dr. for abdominal drain removal. medications on admission: metoprolol 25 mg po bid simvastatin 20 mg po qhs vitamin b12 1000 mcg po daily asa 325 mg po daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for heartburn. 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever. 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 5. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 6. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily): do not smoke while concurrently wearing patch. disp:*14 patch 24 hr(s)* refills:*2* 7. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 8. vitamin b-12 1,000 mcg tablet sig: one (1) tablet po once a day. 9. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 10. aspirin 325 mg tablet sig: one (1) tablet po once a day: do not resume until cleared by dr. &/or dr. . 11. outpatient lab work -please empty and measure and record the daily output of the drain and be prepared to share these findings with dr. at your appointemnt. discharge disposition: home discharge diagnosis: : renal cell carcinoma : splenic rupture discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: -please also refer to the provided written instructions on post-operative care, instructions and expectations made available from dr. ??????s office. -the drain will remain in place until your follow-up appointment with dr. and the foley will be removed when you see dr. later this week. -please empty and measure and record the daily output of the drain and be prepared to share these findings with dr. at your appointemnt. -resume your pre-admission/home medications except as noted. always call to inform, review and discuss any medication changes and your post-operative course with your primary care doctor. -do not resume your pre-admission dose of aspirin 325mg po daily until explicitly cleared by dr. &/or dr. -do not lift anything heavier than a phone book (10 pounds) or drive until you are seen by your urologist in follow-up -resume all of your pre-admission/home medications except as noted. do not take aspirin or non-steroidal anti-inflammatories (ibuprofen, etc.) unless advised to do so. -call your urologist's office today to schedule/confirm your follow-up appointment in 3 weeks and if you have any questions. -do not eat constipating foods for 2-4 weeks, drink plenty of fluids to keep hydrated -no vigorous physical activity or sports for 4 weeks or until otherwise advised -tylenol should be your first line pain medication, a narcotic pain medication has been prescribed for breakthrough pain >4. replace tylenol with narcotic pain medication. -max daily tylenol (acetaminophen) dose is 4 grams from all sources, note that narcotic pain medication also contains tylenol -if you have been prescribed ibuprofen (the ingredient of advil, motrin, etc.) , you may take this and tylenol together (alternating) for additional pain control---please try tylenol first and take the narcotic pain medication as prescribed if additional pain relief is needed. -ibuprofen should always be taken with food. please discontinue taking and notify your doctor should you develop blood in your stool (dark tarry stools) -you may shower normally but do not immerse your incisions or bathe -do not drive or drink alcohol while taking narcotics and do not operate dangerous machinery -colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. discontinue if loose stool or diarrhea develops. colace is a stool-softener, not a laxative -if you have fevers > 101.5 f, vomiting, or increased redness, swelling, or discharge from your incision, call your doctor or go to the nearest emergency room. followup instructions: -please call dr. office to arrange for trial of void and surgical skin clip removal for thursday this week; . -the drain will remain in place until your follow-up appointment with dr. . your appointment has been made for at 10:30 am. -call dr. office at ( for follow-up and if you have any urological questions. dr. ??????s nurse practitioner may be reached at the same number. procedure: nephroureterectomy division or crushing of other cranial and peripheral nerves regional lymph node excision total splenectomy diagnoses: other iatrogenic hypotension tobacco use disorder unspecified essential hypertension acute posthemorrhagic anemia peripheral vascular disease, unspecified malignant neoplasm of kidney, except pelvis accidental puncture or laceration during a procedure, not elsewhere classified pulmonary collapse other and unspecified hyperlipidemia hemorrhage complicating a procedure retention of urine, unspecified removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation unspecified disease of pancreas other diseases of spleen 

Answer: The patient is high likely exposed to