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: ativan attending: chief complaint: carcinoma of the distal esophagus major surgical or invasive procedure: 1. bronchoscopy 2. attempted transhiatal esophagectomy with conversion to ivor- transthoracic esophagectomy 3. feeding jejunostomy 4. pyloromyotomy bronchoscopy 1. bronchoscopy 2. esophagogastroduodenoscopy 3. exploratory thoracotomy with drainage of pleural and mediastinal abscesses, revision of esophagogastric anastomosis, reinforced with pericardial thymic flap and total right lung decortication 1. exploratory thoracotomy with evacuation of hemothorax 2. control of bleeding 3. intercostal muscle flap reinforcement of esophagogastric anastomosis flexible bronch with aspiration of secretions 1. egd 2. ercp with unsuccessful stent placement in pancreatic duct due to papilla edema 1. egd with esophageal stent placement 2. ercp with pancreatic duct stent placement edg with successful esophageal stent removal edg with new esophageal stent placement history of present illness: mr. is a 69-year-old gentleman with multiple prior abdominal procedures including nissen fundoplication and open cholecystectomy, who presents with biopsy-proven adenocarcinoma of the distal esophagus. preoperative staging suggested a t2 n0 lesion and given his good performance status he was recommended for primary resection with a decision regarding adjuvant therapy based on true pathologic stage. he agreed to proceed. dr. discussed a transhiatal approach given the distal nature of this lesion. his preoperative workup did show that he had a prior nissen fundoplication which had slipped up into the chest. past medical history: 1. invasive ca of ge junction, barrett's esoph s/p remote fundoplication (20 yrs ago @) 2. open cck 3. diverticulitis 4. benign colon polyps 5. b/l cataracts family history: non contributory physical exam: general: well appearing man in nad heent: unremarkable cor: rrr s1, s@ abd: extrem: no c/c/e neuro: no focal deficits pertinent results: imaging as follows: : echo: conclusions: the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). the right ventricular cavity is dilated. right ventricular systolic function is normal. the aortic root is moderately dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is an anterior space which most likely represents a fat pad. esophageal tissue pathology: diagnosis: a. distal esophagus (a-c): 1. esophagus segment with gangrenous necrosis and focal bacterial overgrowth. 2. no evidence of malignancy. b. proximal stomach (d-h): 1. stomach segment with gangrenous necrosis and bacterial overgrowth. 2. no evidence of malignancy. torso ct scan : ct of the chest: the large fluid collection in the right pleural space that extended across the midline into the mediastinum and into the abdominal cavity has decreased in size. three chest tubes in the right hemithorax are identified and one chest tube on the left is identified. there is fluid seen in bilateral major fissures. the area of ground-glass change in the left upper lobe anterior segment has resolved. there is air present in the extrapleural anterior mediastinal space. re-identified are multiple lymph nodes within the mediastinum, which are likely reactive. no pulmonary nodules are seen. there is no pericardial effusion. ct of the abdomen: although the study is limited by lack of contrast, the liver, spleen, adrenals appear unremarkable. the peripancreatic fluid has decreased in size. the portocaval fluid is unchanged. a jejunostomy drain is in place. the small bowel and large bowel is unremarkable. re-demonstrated is stranding and infiltration of the anterior omentum likely secondary to post-op changes. there is no free air. ct of the pelvis: there is a small amount of free fluid in the dependent portion of the pelvis. the rectum, sigmoid, bladder, seminal vesicles, and prostate appear unremarkable. bone windows: no evidence of suspicious lytic or sclerotic lesions. impression: 1. interval improvement of right pleural space fluid collection secondary to leak. small bilateral pleural effusions are visualized status post esophagectomy and gastric pull-up. 2. small amount of mediastinal/extrapleural air has developed in the left anterior hemithorax. ercp : five spot fluoroscopic images were obtained in the gastroenterology without a radiologist present. very limited biliary cholangiogram demonstrates a slightly prominent distal cbd with no filling defects. pancreatic duct cholangiogram demonstrates slightly dilated pancreatic duct without evidence of stricture or filling defects and evidence of active extravasation of contrast noted within the region of the pancreatic body/tail. for further details, please consult the ercp report available on careweb. torso ct scan : impression: 1. interval worsening of the esophageal leak adjacent to the right pleural cavity which is drained through right chest tube. 2. unchanged moderate bilateral atelectatic changes at lung bases, which is more severe on the right side. small bilateral pleural effusion is unchanged. extension of inflammation within the right posterior chest wall is also unchanged. 3. pancreatic stent is in place. unchanged appearance of peripancreatic edema and small pseudocyst. 4. no intraabdominal or pelvic fluid collection is identified. 5. small amount of free fluid tracking along the porta hepatis is unchanged. ercp : ercp: two spot fluoroscopic images were obtained during endoscopy for guidance of procedure without a radiologist present and was subsequently sent for review. the images are limited due to overlying artifact from wires and the patient's hand superimposed over the abdomen. the images demonstrate endoscope within the region of the esophagus with a stent in the upper portion of the esophagus. per endoscopy report, the stent was removed with a new stent placed successfully. impression: per endoscopy report, a previously placed stent in the upper third of the esophagus was removed and was replaced by a new esophageal stent successfully. ct torso 1. resolution of previously identified periesophageal contrast collection. slight decrease in amount of periesophageal stranding with interval replacement of esophageal stent which contains debris distally. 2. no significant interval change to bilateral small-to-moderate simple pleural effusions with probable subjacent atelectasis. medial and lateral components on the right side raise concern for loculation. remaining right- sided chest tube tip is retracted when compared to prior examination. 3. persistent peripancreatic inflammatory changes with identification of known leak/small fluid collection and tract anteriorly where the surgical drain now terminates. no evidence of pseudocyst or pancreatic necrosis. 4. decreased air component within presumed omental infarction. 5. wall thickening of ascending and proximal transverse colon suggestive of early colitis although evaluation is slightly limited due to lack of contrast progression into the large bowel. recommend clinical correlation. labs: hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:11am 17.4* 2.81* 8.2* 25.7* 92 29.1 31.7 17.3* 696* 06:32am 25.1*# 2.95* 8.7* 27.1* 92 29.6 32.2 17.5* 721* 06:06am 12.3* 2.58* 7.9* 23.6* 92 30.7 33.6 17.3* 56 chemistry renal & glucose glucose urean creat na k cl hco3 angap 05:11am 101 17 0.8 136 3.8 101 29 10 source: line-picc 06:32am 100 12 0.9 133 4.0 97 30 10 06:06am 107* 9 0.6 136 4.1 101 31 8 enzymes & bilirubin alt ast (ldh) alkphos amylase totbili dirbili indbili 06:32am 12 29 199 213* 84 0.3 05:50am 14 28 210* 58 0.2 cultures: 9:19 pm fluid,other source: empyema tube fluid. gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. fluid culture (pending): anaerobic culture (pending blood cultures: pending 8:02 am stool consistency: soft source: stool. clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. 5:31 pm pleural fluid gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram negative rod(s). 3+ (5-10 per 1000x field): gram positive cocci. in pairs, chains, and clusters. fluid culture (final ): klebsiella pneumoniae. heavy growth. trimethoprim/sulfa sensitivity testing available on request. enterococcus sp.. moderate growth. staphylococcus, coagulase negative. quantitation not available. _________________________________________________________ klebsiella pneumoniae | enterococcus sp. | | ampicillin------------ <=2 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin---------<=0.25 s daptomycin------------ s gentamicin------------ <=1 s imipenem-------------- <=1 s meropenem-------------<=0.25 s penicillin------------ 4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- s vancomycin------------ <=1 s anaerobic culture (final ): no anaerobes isolated. fungal culture (final ): albicans. fluconazole sensitive by - brief hospital course: mr. was admitted on and underwent attempted transhiatal esophagectomy with conversion to ivor- transthoracic esophagectomy and a feeding jejunostomy. he tolerated the procedure and was transferred to the sicu intubed. his post-operative course was complicated by an anastomotic leak and a pancreatic fistula. neurological: pain control was initially achieved with an epidural and dilaudid pca. he was then transitioned over to roxicet elixir via the j-tube. cardiovascular: he went into rapid a-fib and was placed on a diltiazem drip in the icu, which converted him to sinus rhythmn. he was later switched to iv lopressor which provided adequate rate control. in the icu his hypotension was managed with fluid boluses rather than vasopressors. pulmonary: on he underwent a right thoracotomy, right decortication, and drainage of right chest empyema. on he underwent an exploratory thoracotomy for evacuation of a hemothorax and control of bleeding. gastrointestinal: a jp drain was left to drain the abdomen just superior to the pancreas. tube feeds were started on pod #4 and advanced to goal rate. on pod #15 () he was taken to the or for an esophagogastric leak where he underwent an anastomotic revision. on during an exploratory thoracotomy, an intercostal muscle flap reinforcement of the esophagogastric anastomosis was performed. on an egd showed a chest tube in the esophageal lumen, which was pulled back and an ercp was performed on the same date and a pancreatic stent was unable to be placed due to papilla edema. on an esophageal stent was placed via egd and a pancreatic duct stent was placed via ercp. a ct scan obtained on revealed a persistent esophageal leak. on the esophageal stent was removed via egd. on a new esophageal stent was placed via egd. on pod #57 he passed a bedside swallowing test and was started on clear liquids. on the esophageal stent was removed via egd. on the esophageal stent was replaced and the pancreatic stent was replaced. genitourinary: good diuresis with lasix. his renal function remained within normal limits throughout his hospital course. endocrine: his blood sugars were well controlled with sliding scale insulin. hematologic: he was started on sq heparin for dvt prophylaxis. he was transfused 3 units of prbcs on for his initial operation and 2 units of ffp on . another unit of prbcs was transfused on after his hematocrit dropped from 32 to 27. he received 3 units of prbcs and 4 units of ffp on . he received 14 units of prbcs, 6 units of ffp, 1 unit of platelets, and 1 unit of cryo on . infectious disease: an id consult was obtained and he was placed on an antibiotic regimen of vancomycin, cipro, and fluconazole for the anastomotic leak and mrsa and non-fermenting gram-negative rods isolated on pleural fluid culture. on he developed a , the cipro was discontinued and meropenem was added. on vancomycin was stopped and daptomycin was started to cover enterococcus and mrsa; the meropenem was continued to cover gnr's in pleural fluid. on fluconazole was discontinued and caspofungin was started. the course of antibiotics was completed on . he remained afebrile until when he developed fevers. infectious disease was reconsulted and recommended restarting daptomycin until cultures return. the picc line was changed and the tip culture revealed no growth. on the empyema culture grew klebsiella, enterococcus and albicans. infectious disease recommended changing daptomycin, meropenum to unasyn 3gms and starting diflucan 200 mg once through for a three week course. on after his chest ct he developed a temp of 102.3, was pancultured. the preliminary cultures grew gnr and gpc in pairs, chains and clusters no change from previous cultures. the ua was negative, cultures pending. he remained afebrile and the white count was trending down. infectious disease recommended to continue present course of antibiotics and follow cultures. disposition: he continued to work with physical therapy and was transferred to . medications on admission: omeprazole, lisinopril, amitriptyline, zocor, asa, mvi discharge medications: 1. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) inhalation every 4-6 hours as needed. 2. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day): hold for loose stools. 3. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 4. ipratropium bromide 0.02 % solution : one (1) inhalation every 4-6 hours. 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily): via j-tube. 6. oxycodone-acetaminophen 5-325 mg/5 ml solution : 5-10 mls po q4h (every 4 hours) as needed. 7. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed. 8. ampicillin-sulbactam 3 gm iv q6h end date 9/31/07 9. fluconazole in saline(iso-osm) 200 mg/100 ml piggyback : one (1) intravenous q24h (every 24 hours). 10. amitriptyline 50 mg tablet : 0.5 tablet po hs (at bedtime) as needed. 11. insulin regular human 100 unit/ml solution : per sliding scale injection asdir (as directed). 12. heparin lock flush (porcine) 100 unit/ml syringe : one (1) ml intravenous daily (daily) as needed. 13. lasix 20 mg tablet : one (1) tablet po twice a day: via j-tube: crush fine. 14. lopressor 50 mg tablet : one (1) tablet po twice a day: via j-tube hold for hr < 60 sbp < 100. 15. ativan 1 mg tablet : one (1) tablet po at bedtime: via j-tube. 16. ativan 0.5 mg tablet : one (1) tablet po twice a day: via j-tube crush fine. 17. potassium chloride 20 meq packet : one (1) po once a day. 18. potassium chloride 20 meq packet : one (1) po once a day. 19. potassium chloride 20 meq packet : two (2) packet po once (once) for 1 doses. discharge disposition: extended care facility: discharge diagnosis: barrett's esophagus s/p transthoracic esopagectomy esophageal anastomic leak s/p stent placement diverticulitis appendectomy benign colon polops s/p open cholecysectomy s/p fundoplication 20 yrs ago discharge condition: deconditioned discharge instructions: call dr. office if experience -fever > 101 or chills -increased shortness of breath, cough or sputum production -chest pain chest tube (empyema tube):monitor daily output. chest tube site change freuently to keep site clean and dry pancreatic drain please keep safety pin in place. pancreatic drain site: convatec active life pouch and seal. change as needed. j-tube: flush with 50cc q8hrs with water. flush with 50cc of water before and after meds. should j-tube fall out replace immediately. picc line 5 french double lumen via left basilic vein (43 cm) located in the distal svc: flush qshift as needed with heparin flush monitor cbc, lytes, bun/cre & lft's complete antibiotics course through followup instructions: follow-up with dr. on @ 11:00am the clinical center report to the radiology department for a chest x-ray 45 minutes before your appointment follow-up with dr. call for an appointment follow-up with your pcp . procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other enterostomy other endoscopy of small intestine enteral infusion of concentrated nutritional substances endoscopic sphincterotomy and papillotomy other intubation of respiratory tract decortication of lung incision of mediastinum incision of mediastinum reopening of recent thoracotomy site other incision of pleura total esophagectomy other pyloroplasty endoscopic retrograde cholangiopancreatography [ercp] insertion of sengstaken tube other repair of esophagus other repair of esophagus endoscopic insertion of stent (tube) into pancreatic duct diagnoses: other iatrogenic hypotension unspecified essential hypertension cardiac complications, not elsewhere classified atrial fibrillation infection with microorganisms resistant to penicillins hemorrhage complicating a procedure dermatitis due to drugs and medicines taken internally diarrhea empyema without mention of fistula malignant neoplasm of lower third of esophagus persistent postoperative fistula 

Answer: The patient is high likely exposed to