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: penicillins / simvastatin attending: chief complaint: abdominal pain x 2-3 weeks major surgical or invasive procedure: placement of percutatenous chole drain history of present illness: 78 y/o cantonese speaking man with history of cad s/p cabg (), htn, hld, and emphysema who presented on to the medical floor with 2 weeks epigastric pain. ct abdomen showed severe duodenitis; surgery and gi were consulted. his original abdominal exam was consistent with guarding and surgery was concerned about a perforation but a repeat ct and abdominal x-ray were not consistent with free air. however, gallbladder wall thickening with pericholecystic fluid were noted, and his lfts were consistent with obstruction, leading to concern for cholecystittis/cholangitis, and the patient was started on meropenem and vancomycin. shortly after his repeat ct scan, he developed sob and was tachycardic to the 140s with 3mm st elevations in the lateral leads but troponins were negative and he did not complain of chest pain. there was a concern for demand ischemia and he was started on heparin gtt. the patient became hypotensive to an sbp in the 80s after he received metoprolol, and was transferred to the icu. he was bolused with iv fluids and his metoprolol and lisinopril were held; he received a percutaneous chole drain and he continued to receive meropenem and vancomycin pending results of blood cultures. his vital signs stabilized nicely and he was transferred to medicine for further management. on arrival to the medicine floor, his vitals were t99 bp 101/47 hr 75 94% 4l. he complains of ruq pain. he denies sob or chest pain. past medical history: - coronary artery disease s/p cabg (lima to the lad and -separate svgs to the pda and an om) - hld - htn - bph - emphysema per ct scan - tuberculosis many years ago, treated for 2 years social history: 20-pack-year smoker, discontinued 20 years ago. occupation, retired machine operator. lives with his family. alcohol, none. exposure, none. family history: mother had hypertension and history of cancer. coronary artery disease in the family. physical exam: admission physical exam: vitals: 98.5 74 137/54 18 96%5l. general: elderly chinese man, alert oriented, uncomfortable with movement in bed, ambulatory heent: perrl, eomi +arcus senilis neck: no carotid bruits, jvd lungs: cta b/l no wrc heart: rrr, normal s1 s2, no mrg. sternal scar c/w cabg abdomen: tense abdomen with guarding diffusely. ttp diffusely, more so in epigastrium. moderate distension. +bs. no palpable masses. extremities: no c/c/e neurologic: a+ox3 discharge exam: pertinent results: admission labs: 06:00pm blood wbc-10.2# rbc-4.79 hgb-15.3 hct-44.4 mcv-93 mch-31.8 mchc-34.4 rdw-13.5 plt ct-294 06:00pm blood neuts-88.6* lymphs-7.8* monos-2.8 eos-0.7 baso-0.1 06:00pm blood plt ct-294 06:00pm blood glucose-126* urean-15 creat-0.9 na-137 k-3.9 cl-101 hco3-26 angap-14 06:00pm blood alt-31 ast-26 alkphos-99 totbili-0.4 06:00pm blood ctropnt-<0.01 06:00pm blood ctropnt-<0.01 06:00pm blood albumin-4.2 10:15am blood calcium-8.4 phos-2.6* mg-1.7 08:09pm blood lactate-2.9* ct ap () ======================== indication: abdominal pain for two to three weeks. comparison chest ct available from . technique: mdct-acquired 5-mm axial images through the abdomen and pelvis were obtained following the uneventful administration of 130 ml of omnipaque intravenous contrast. coronal and sagittal reformations were performed at 5-mm slice thickness. ct of the abdomen with iv contrast: included views of the lung bases demonstrate moderate-to-severe emphysema with superimposed bibasilar fibrosis which has progressed since the most recent chest ct examination from . there is no pericardial or pleural effusion. the heart size is top normal. extensive stranding surrounds the proximal duodenum (2:26, 27). no focal fluid collections are identified. there is no free air. perihepatic free fluid is present. a short segment of the proximal jejunum is mildly distended (2:48), with neighboring loops demonstrating mild fecalization (2:31). no transition point is seen. the remaining loops of small and large bowel are within normal limits. the stomach, spleen, pancreas, adrenal glands, kidneys, and gallbladder are normal. a well-circumscribed hypodense hepatic lesion within segment (2:11) is minimally enlarged since , likely representing a small cyst or biliary hamartoma. a 15 mm partially exophytic cyst arising from the interpolar region of the right kidney (2:35) is slightly enlarged since . there are moderate atherosclerotic calcifications throughout the abdominal aorta and iliac branches. the celiac trunk, sma, and are patent and normal in caliber. there is no mesenteric or retroperitoneal lymphadenopathy. ct of the pelvis with iv contrast: the rectum, sigmoid colon, urinary bladder, intrapelvic loops of small and large bowel are normal. the prostate is moderately enlarged (2:83). there is no intrapelvic free fluid or lymphadenopathy. osseous structures: the patient is post-median sternotomy. no acute fracture is detected. there are no bony lesions concerning for malignancy or infection. impression: 1. severe duodenitis. no secondary signs of perforation. egd is recommended to assess for further evaluation. 2. mild dilatation of a short segment of jejunum, with fecalization of contents without transition point. findings may represent a focal ileus. 3. progression of moderate to severe emphysema and bibasilar interstitial fibrosis compared to the ct chest examination. 4. small amount of perihepatic ascites. no drainable fluid collections. 5. moderately enlarged prostate. the study and the report were reviewed by the staff radiologist. dr. dr. kub ====================== abdomen indication: duodenitis, evaluation for free air. comparison: no comparison available at the time of dictation. findings: documentation is provided by two radiographic images. no free intra-abdominal air. several small air-fluid levels projecting over nondistended bowel loops in the mid abdomen. colonic air filling and stool filling of the ascending and descending colon. contrast material in the bladder. diffuse gas feeling of small bowel loops without evidence of wall thickening. no pathologic calcifications. no foreign bodies. ct ap ========================== indication: duodenitis with increasing abdominal tenderness. comparison: ct available from . technique: mdct-acquired 5-mm axial images of the abdomen and pelvis were obtained following the uneventful administration of gastrografin and 130 ml of omnipaque intravenous contrast. coronal and sagittal reformations were performed at 5-mm slice thickness. dlp: 363 mgy-cm ct of the abdomen with iv contrast: moderate right basilar atelectasis is new since the examination (2:5). again seen is moderate-to-severe bibasilar emphysema with superimposed peripheral fibrosis. there is no pericardial or pleural effusion. the heart size is normal. mild heterogenous liver perfusion is noted, predominantly in the right anterior and left medial lobes (2:19). a well-circumscribed subcentimeter hypodense hepatic lesion within segment (2:11) likely represents a small cyst or biliary hamartoma. the portal and hepatic veins remain patent. again seen is moderate stranding around the proximal duodenum (2:27), minimally changed since , now with new mild stranding about the proximal cbd and gallbladder. the gallbladder and cbd remain non-distended though gallbladder is mimially hyperemic. the pancreas, adrenal glands, kidneys, and intraabdominal loops of small and large bowel are normal. a 15 mm partially exophytic cyst arising from the interpolar region of the right kidney (300b:40) is unchanged. there is no free air or free fluid. there is no mesenteric or retroperitoneal lymphadenopathy. ct of the pelvis with iv contrast: a small amount of intrapelvic free fluid (2:83) is new since . the rectum and bladder are normal. moderate prostate hypertrophy is again seen (2:86). there is no intrapelvic lymphadenopathy. small fat-containing bilateral inguinal hernias are again seen (2:81). osseous structures: there is no fracture. there are no bony lesions concerning for malignancy or infection. the patient is post-median sternotomy. impression: 1. moderate stranding about the proximal duodenum appears minimally changed since , but hyperemia and minimal stranding about the gallbladder and proximal cbd appears new. cholecystitis would be somewhat unusual given the non-distended appearance of the gallbladder. nonethelesse, correlate with clinical presentation and consider us examination for further evaluation. 2. small amount of intrapelvic free fluid is new since . 3. slight hyperenhancement of the right anterior and left medial liver of uncertain significance. it is unclear if this is related to the adjacent gallbladder. 4. no free air. 5. moderate prostate hypertrophy. the study and the report were reviewed by the staff radiologist. cxr () ======================= chest radiograph indication: hypoxemia, evaluation for pulmonary edema. comparison: . findings: as compared to the previous radiograph, the lung volumes have decreased, likely reflecting a lesser inspiratory effort. widespread bilateral interstitial opacities, better characterized on previous ct examinations. no additional or secondary parenchymal opacities. sternal wires, moderate cardiomegaly, no larger pleural effusions. no pneumothorax. dr. - cxr findings: compared to the previous radiograph, there are new focal parenchymal opacities that have occurred in both the left lung and at the right lung base. the distribution and morphology of these opacities are highly suspicious for pneumonia. unchanged borderline size of the cardiac silhouette without overt pulmonary edema. no pleural effusions. no pneumothorax. unchanged mild right apical pleural thickening. ekg : sinus rhythm. non-specific anterior t wave changes. compared to the previous tracing of anterior t wave changes are new. clinical correlation is suggested. rate pr qrs qt/qtc p qrs t 66 148 82 32 brief hospital course: 78 yo cantonese-speaking male w/ pmh htn, bph, cad s/p cabg p/w 2-3 weeks abdominal pain, found to have cholecystitis. active issues: #acute cholecystitis with septic shock: patient presented complaining of new ruq pain and was found to have leukocytosis (15-17) with fever (t101) while on medicine floor. repeat ct done on showed gallbladder wall thickening and pericholecystic fluid and lfts were drawn and found to be elevated. shortly after repeat ct the patient triggered for low oxygen saturation, tachycardia, and hypotension and was found with st changes on ekg. he was transferred to the icu. in the icu, the patient was put on meropenem and vancomycin, and had a percutaneous chole drain placed with ir with bile cultures positive for e. coli. he drained serosanguinous fluid until until he started to drain bile. he stabilized nicely in the icu with fluid boluses and did not require pressor support. he was transferred back to the floor and switched to cefepime once e. coli sensitivities returned. he will need cefepime until and he is planned to have a cholecystectomy on . #ileus: on the evening of , patient complained of epigastric pain. kub showed ileus. bowel regimen was started and his pain resolved and bowel movements became regular. # duodenitis: patient reported 2-3 weeks of intermittent epigastric abdominal pain and nausea, with no noted melena, hematemesis, hematochezia. on abdominal ct, the patient was noted to have severe duodenitis although no free air/fluid and surgery and gi were consulted. surgery felt no intervention necessary at that time, and gi plans to do egd on . an abdominal plain film was done to evaluate for free air which was negative. a repeat ct was also obtained which showed no signs of perforation, minimal change in duodenitis from prior study, no free air/fluid. h. pylori serology was sent and was positive, but stool antigen remains pending. # myocardial strain: patient triggered on - nursing found patient did not look well after returning to floor from ct, found with oxygen saturation in 60s and hr 150s; patient reported shortness of breath but not chest pain. ekg showed st-depressions in v3-v6, i, avl, ii. nebulizers, aspirin, morphine, and metoprolol were given, and repeat ekg was improved but still with st-changes, and the patient had troponins of 0.05 x2. these changes resolved on his next ekg. troponins 0.05 x 2. cardiology was consulted felt that the ekg changes were secondary to demand ischemia. the patient was started on heparin gtt in addition to his regimen. his heparin was drip was discontinued after transfer to medicine and the patient has not complained of shortness or chest pain and was stable on tele and repeat ekgs were unchanged. # pna: the patient was diagnosed with bilateral pneumonia on hospital day 2 and developed hemoptysis. because of his history of tuberculosis, the patient was placed in respiratory isolation and ruled out for tuberculosis with 4 negative sputums. because of concern for mrsa pneumonia, pt was started on vancomycin, which was continued until . he has no respiratory symptoms on discharge. chronic issues: # coronary artery disease s/p cabg. # hld - on atorvastation per cardio reccs. # htn - cont lisinopril, metoprolol # bph - held doxazosin given hypotension. # restless leg syndrome - held requip. transitional issues: he will need to obtain a follow up appointment with cardiology egd on cholecystectomy on cefepime to continue until (total 14 day course) medications on admission: preadmission medications listed are correct and complete. information was obtained from family/caregiver. 1. doxazosin 4 mg po daily 2. ropinirole 1 mg po tid 3. omeprazole 40 mg po daily 4. lisinopril 2.5 mg po daily 5. aspirin 81 mg po daily 6. metoprolol succinate xl 25 mg po daily discharge medications: 1. aspirin 81 mg po daily 2. lisinopril 2.5 mg po daily 3. metoprolol succinate xl 25 mg po daily 4. doxazosin 4 mg po daily 5. omeprazole 40 mg po daily 6. ropinirole 1 mg po tid 7. albuterol 0.083% neb soln 1 neb ih q6h:prn sob/wheezing 8. atorvastatin 10 mg po daily 9. cefepime 2 g iv q12h duration: 9 days 10. docusate sodium 100 mg po bid:prn constipation 11. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 12. ipratropium bromide neb 1 neb ih q6h:prn sob/wheeze 13. oxycodone (immediate release) 5 mg po q4h:prn pain rx *oxecta 5 mg 1 tablet(s) by mouth q6h prn pain disp #*15 tablet refills:*0 rx *oxycodone 5 mg 1 tablet(s) by mouth q6h prn pain disp #*15 tablet refills:*0 14. polyethylene glycol 17 g po daily:prn constipation 15. senna 1 tab po bid:prn constipation 16. pantoprazole 40 mg po q24h discharge disposition: extended care facility: healthcare center - discharge diagnosis: cholecystitis pneumonia demand myocardial ischemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you during your stay at the . you were admitted for evaluation of abdominal pain. you were found to have an infection in your gallbladder which was treated with placement of a drain and use of antibiotics. you were also found to have developed pneumonia and were treated for antibiotics. you tested negative for tuberculosis. the stress associated with your gallbladder and infection caused your blood pressure to decrease during your stay and may have lead to minor damage to your heart. please follow up with surgery for evaluation for surgery to remove your gallbladder on , at 3:15 pm. in addition, please make an appointment to follow up with cardiology in the future. followup instructions: department: west procedural center when: thursday at 1:15 pm with: wpc room three building: building ( complex) campus: west best parking: garage department: gi-west procedural center when: thursday at 1:15 pm with: , md building: building ( complex) campus: west best parking: garage department: general surgery/ when: thursday at 3:15 pm with: acute care clinic building: lm bldg () campus: west best parking: garage procedure: percutaneous aspiration of gallbladder central venous catheter placement with guidance diagnoses: anemia, unspecified unspecified essential hypertension unspecified septicemia severe sepsis aortocoronary bypass status personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) constipation, unspecified other and unspecified hyperlipidemia septic shock other emphysema paralytic ileus hypoxemia duodenitis, without mention of hemorrhage acute cholecystitis obstruction of bile duct leukocytosis, unspecified helicobacter pylori [h. pylori] restless legs syndrome (rls) personal history of tuberculosis other acute and subacute forms of ischemic heart disease, other methicillin resistant pneumonia due to staphylococcus aureus other and unspecified escherichia coli [e. coli] 

Answer: The patient is high likely exposed to