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: upper gi bleed major surgical or invasive procedure: endoscopy history of present illness: 64yo man with advanced colon cancer on chemo/radiation (dx 1.5 yrs ago), s/p repeat surgery 6 months ago, presented to the ed with one week of progressive n/v/d, weakness, coffee ground emesis and black stools. he has been unable to tolerate pos for 1 week and has been getting iv fluids at home. also with weakness, exertional dyspnea, intermittent chest pain approximately 2 days ago, which has since resolved. the patient states that he has a tumor pushing on his stomach and another on his abdominal wall. his most recent egd in showed esophagitis, semi-solid food material, and extrinsic compression of antrum. his previous colonoscopy in showed noduar mucosa at anastamosis, and a biopsy showed adenoca. he underwent a laporotomy in with diffuse metastatic disease, bx of abdominal wall mass showed metastatic adenoca. in the ed, he was tachycardic with hr 100 to 110s, hypotensive bp 90s/70s, which responded to sbp 120 with iv fluids. exam was notable for a frail patient with dry mm, abdominal tenderness at scar on abdomen, bilateral edema. labs were significant for hct 27.9 (baseline mid-20 to mid 30s), wbc 20.0 (91% pmns), bun 34, cr 1.0, hco3 42, k 2.3, lactate 2.9, normal lfts, positive ua. he was admitted to the omed medicine service, where he had a drop in hematocrit from 27.9 to 23.8. plt 365. he threw up 400cc of maroon colored / coffee ground emesis. gi assessed, and recommended transfer to the for egd in the am. the patient received 2 units prbcs before transfer to the . upon transfer to the , his vitals were t 97.3, bp 119/86, hr 07, rr 18, o2 95% /ra past medical history: past oncologic history: - developed nausea, vomiting diarrhea - saw gi and decided on watchful waiting - developed worsening abdominal pain, n/v intermittently - kub consistent with sbo, ct scan showing poa large bowel obstruction with concern for mass - exploratory laparotomy with right hemicolectomy and ileocolic anastomosis. tumor in proximal transverse colon with no intra-abdominal findings to suggest metastatic disease; pathology showed that tumor invaded through muscularis propria specifically, the tumor was invading through into the subserosa or the non-peritonealized pericolic or perirectal soft tissues and so it was pathologically stage t3. 21 lymph nodes were examined and 2 out of the 21 were positive for malignancy and so he had a pathologic n1b disease. - received 3 cycles of folfox that was changed to 5fu/leucovorin due to allergic reaction to the oxaliplatin. complete 6 cycles of chemotherapy on . last cycle was incomplete. - : ct: disease recurrence at prior surgical site - : operation:unresectable tumor, peritoneal spread and carcinomatosis - : start on irinotecan 125mg/m2 3 wks on/1 wk off past medical history: htn rosacea erectile dysfunction social history: retired school teacher. former smoker, quit in . also quit etoh in . denies illicits. two grown children in the area. wife is his hcp. family history: denies history of malignancy or bleeding diathesis physical exam: vitals: t 97.3, bp 119/86, hr 07, rr 18, o2 95% /ra general: alert, oriented, pleasant man, appears chronically ill but in in nad. heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, normal s1 + s2, 3/6 systolic murmur heard best over rusb lungs: appears nonlabored on ra. good air movement with coarse expiratory rhonci which clear with cough. abdomen: soft, non-distended, tender irregular mass palapated just right of midline in epigastrum. bowel sounds present, no organomegaly, no rebound or guarding gu: no foley ext: warm, well perfused, left leg markedly more swollen than right. neuro: aaox3. cnii-xii intact, moving all extremities with equal strength against gravity, grossly normal sensation. pertinent results: 08:20am blood wbc-9.4 rbc-2.90* hgb-8.2* hct-25.4* mcv-88 mch-28.4 mchc-32.4 rdw-18.2* plt ct-318 06:38am blood wbc-14.6* rbc-3.01* hgb-8.4* hct-26.2* mcv-87 mch-27.8 mchc-32.0 rdw-18.4* plt ct-254 09:50pm blood wbc-13.8* rbc-3.33* hgb-9.3* hct-28.6* mcv-86 mch-27.9 mchc-32.5 rdw-17.8* plt ct-279 12:09pm blood wbc-12.1* rbc-3.12* hgb-8.9* hct-26.9* mcv-86 mch-28.4 mchc-33.0 rdw-17.8* plt ct-270 07:39am blood wbc-15.0* rbc-3.29* hgb-9.2* hct-28.3* mcv-86 mch-27.9 mchc-32.5 rdw-17.8* plt ct-295 01:20am blood wbc-17.6* rbc-2.71* hgb-7.4* hct-23.8* mcv-88 mch-27.1 mchc-30.9* rdw-19.2* plt ct-365 04:20pm blood wbc-20.0*# rbc-3.19* hgb-8.7* hct-27.9* mcv-87 mch-27.2 mchc-31.2 rdw-18.8* plt ct-487* 04:20pm blood neuts-90.6* lymphs-6.6* monos-2.6 eos-0.1 baso-0.1 08:20am blood pt-12.2 ptt-40.4* inr(pt)-1.1 06:38am blood pt-12.0 ptt-28.8 inr(pt)-1.1 12:09pm blood pt-15.7* inr(pt)-1.5* 07:39am blood pt-15.8* ptt-26.5 inr(pt)-1.5* 08:20am blood glucose-85 urean-23* creat-0.7 na-141 k-3.3 cl-108 hco3-26 angap-10 05:56am blood glucose-103* urean-24* creat-0.8 na-138 k-3.4 cl-103 hco3-26 angap-12 06:38am blood glucose-106* urean-18 creat-1.0 na-137 k-3.1* cl-100 hco3-33* angap-7* 04:26am blood glucose-125* urean-19 creat-0.8 na-143 k-3.6 cl-104 hco3-36* angap-7* 12:09pm blood glucose-127* urean-27* creat-0.7 na-146* k-3.2* cl-104 hco3-38* angap-7* 07:39am blood glucose-126* urean-30* creat-0.7 na-149* k-3.1* cl-102 hco3-42* angap-8 01:20am blood glucose-105* urean-34* creat-0.9 na-150* k-2.3* cl-102 hco3-40* angap-10 04:20pm blood glucose-109* urean-34* creat-1.0 na-146* k-2.3* cl-92* hco3-42* angap-14 04:20pm blood alt-11 ast-24 alkphos-95 totbili-0.7 06:38am blood calcium-8.3* phos-2.7 mg-1.9 04:26am blood calcium-7.2* phos-2.7 mg-1.8 04:20pm blood albumin-3.3* calcium-9.1 phos-3.0 mg-1.9 04:29pm blood lactate-2.9* 05:10pm urine color-dkamb appear-hazy sp -1.023 05:10pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-40 bilirub-sm urobiln-8* ph-6.0 leuks-neg 05:10pm urine rbc-1 wbc-11* bacteri-few yeast-none epi-<1 05:10pm urine castgr-2* casthy-98* 09:10am pleural wbc-50* rbc-77* polys-65* lymphs-19* monos-9* plasma-1* meso-2* macro-3* other-1* 09:10am pleural totprot-2.1 glucose-96 ld(ldh)-67 cholest-36 triglyc-22 4:20 pm blood culture **final report ** blood culture, routine (final ): pseudomonas putida . final sensitivities. sensitivity testing performed by microscan. meropenem <= 1 mcg/ml. sulfa x trimeth > 2/38 mcg/ml. amikacin <= 4 mcg/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas putida | amikacin-------------- s cefepime-------------- 4 s ceftazidime----------- 2 s ceftriaxone----------- <=4 s ciprofloxacin--------- <=0.5 s gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin---------- 2 s meropenem------------- s piperacillin/tazo----- <=8 s tobramycin------------ <=1 s trimethoprim/sulfa---- r 4:20 pm blood culture **final report ** blood culture, routine (final ): pseudomonas putida . identification and sensitivities performed on culture # 351 0199m . aerobic bottle gram stain (final ): gram negative rod(s). 5:21 pm urine site: not specified **final report ** urine culture (final ): no growth. 1:08 am urine source: cvs. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. (reference range-negative). performed by immunochromogenic assay. a negative result does not rule out infection due to other l. pneumophila serogroups or other legionella species. furthermore, in infected patients the excretion of antigen in urine may vary. 6:40 am blood culture port #1. blood culture, routine (pending): 9:10 am pleural fluid gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): anaerobic culture (preliminary): brief hospital course: 1. pseudomonal bacteremia - the most likely source was his probiotics shakes, which do contain this bacteria, although not on the bottle. - id was consulted, and the patient was changed from zosyn to ceftazidime to complete a 14 day course - given the indwelling port, surveillance cultures of the port were obtained, and will followed up in clinic 2. acute blood loss anemia due to esophagitis with gi bleeding - he present with maroon emesis and decreasing hematocrit. likely due to recent xrt to abdomen (gastritis) although also likely a major component of regurgitation from the gastric obstruction from the cancer - egd in showed only extrinsic compression of the antrum of the stomach and some mild reflux changes with no vacies or ulcers. he was transferred to micu and received 2 units of prbc with appropriate response in his hematocrit. he was started on protonix gtt. gi was consulted and performed an egd on showed esophagitis, but unable to fully visualize stomach as there was some food in it. after egd, he was placed on sucralfate qid and pantoprazole 40mg . his hct was stable and was transferred out of micu. - the gastric obstruction was treated with reglan with moderate effect, and he was able to eat a fair amount of pureed diet 3. pleural effusion - the precense of the effusion is concerning given the bacteremia, so he underwent thoracentesis with 700cc removed. cytology was sent given concern for malignant effusion 4. bacterial uti: he has positive ua with 11 wbc and few bacteria with an elevated wbc of 20, which most likely is due to the pseudomonas. the antibiotics for pseudomonas bacteremia should cover the bacteria for uti even if it is a different organism. 5. bilateral leg edema: - le edemas has been present for the past two months since his ex lap for colon resection. b/l lenis showed no evidence of thrombosis. 6. chest pain: transient bilateral chest pain on evening in the setting of xrt/ugib. his pain lasted 1/2 hour and has since resolved. tropnin was negative and ekg showed no st elevations. 7. colon cancer: he has completed a 10-day course of xrt, as well as doses of chemotherapy which is likely how he got immunosuppressed causing the bacteremia from the probiotic. 8. benign hypertension: transitional issues ============================ follow up with id on the surveillanc cultures follow up with pcp about ability to eat (as reglan takes effect) follow up with ip regarding his pleural effusion full code medications on admission: - azelaic acid 15% gel apply to face twice a day. - citalopram 10 mg - doxycycline 100 mg twice a day - ergocalciferol (vitamin d2) - 50,000 unit capsule - weekly - lorazepam - 0.5 mg tablet - tablet(s) q4h prn - omeprazole - 20 mg capsule daily - ondansetron hcl - 4 mg tablet daily - potassium chloride - 20 meq tablet daily - prochlorperazine maleate - 10 mg tablet q6h prn nausea - tadalafil - 20 mg tablet q36h hours prn - tretinoin - 0.05 % gel - pea sized amount at bedtime discharge medications: 1. ceftazidime 1 g iv q8h rx *fortaz in d5w 2 gram/50 ml 2 grams iv every eight (8) hours disp #*22 each refills:*0 2. citalopram 10 mg po daily 3. doxycycline hyclate 100 mg po q12h 4. loperamide 2 mg po qid:prn diarhea 5. tretinoin 0.05% cream 1 appl tp qhs 6. heparin flush (10 units/ml) 5 ml iv prn line flush indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. 7. heparin flush (100 units/ml) 5 ml iv prn de-accessing port indwelling port (e.g. portacath), heparin dependent: when de-accessing port, flush with 10 ml normal saline followed by heparin as above per lumen. 8. sucralfate 1 gm po qid cannot be given with any other medications or two hours following. rx *sucralfate 1 gram 1 tablet(s) by mouth four times a day disp #*28 tablet refills:*0 9. lorazepam 0.5 mg po q4h:prn anxiety 10. ondansetron 4 mg po q8h:prn nausea 11. prochlorperazine 10 mg po q6h:prn nausea 12. tadalafil *nf* 20 mg oral q8h:prn sexual intercourse discharge disposition: home with service facility: steward home care discharge diagnosis: pseudomonal bacteremia acute blood loss anemia gi bleeding esophagitis moderate malnutrition colon cancer metastatic to bowel/retroperitoneum discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you have been started on reglan which should make your stomach move food more easily. this takes some time to fully work, so do not be suprised that you may have some intermittant nausea you had a thoracentesis to remove fluid from your chest. if you epxerience sudden difficulty breathing, please go directly to the ed. you should not take your probiotic supplement anymore as this may have been the source of the infection followup instructions: department: when: monday at 2:40 pm with: , md building: (, ma) campus: off campus best parking: on street parking department: infectious disease when: tuesday at 11:00 am with: , md building: lm bldg () campus: west best parking: garage we are working on a follow up appointment for your hospitalization in interventional pulmonary with dr. . you need to be seen in 1 month of discharge. the office will contact you at home with an appointment. if you have not heard within a few business days please call the office at . procedure: parenteral infusion of concentrated nutritional substances other endoscopy of small intestine thoracentesis diagnoses: unspecified pleural effusion urinary tract infection, site not specified acute posthemorrhagic anemia secondary malignant neoplasm of other specified sites hypopotassemia constipation, unspecified hypotension, unspecified bacteremia personal history of malignant neoplasm of large intestine hyperosmolality and/or hypernatremia other specified disorders of stomach and duodenum personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health leukocytosis, unspecified pseudomonas infection in conditions classified elsewhere and of unspecified site esophageal hemorrhage secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other esophagitis mixed acid-base balance disorder secondary malignant neoplasm of retroperitoneum and peritoneum other specified gastritis, without mention of hemorrhage benign essential hypertension edema secondary malignant neoplasm of large intestine and rectum impotence of organic origin malnutrition of moderate degree secondary malignant neoplasm of small intestine including duodenum acquired absence of intestine (large) (small) rosacea body mass index between 19-24, adult personal history of contact with and (suspected) exposure to potentially hazardous body fluids 

Answer: The patient is high likely exposed to