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: elevated lft's, admitted for ptc major surgical or invasive procedure: - : ir biliary drainage / ptc placement - : ir removal of r biliary drains after balloon angioplasting stents, tracts plugged with gelfoam, angioplasty of l drain with replacement of l biliary drain, placement of r pleural pigtail drain - : l chest pigtail placed at bedside - : open tracheostomy history of present illness: mr. is a 79 m s/p whipple for low grade ampullary adenoca c/b biliary strictures s/p stenting recently found to have now w/ elevated lfts. pt had an excision of subcutaneous nodule in r posterior chest wall which showed adenoca. he was planned for systemic chemotherapy (gemcitabine/cisplatin). on a pet ct demonstrated multiple fdg avid liver masses as well as an enlarged fdg avid gastrosplenic lymph node and uptake in the left adrenal gland. a follow up mri did not show any discrete hepatic masses but a mass could not be exclude. there are areas of peripheral peribiliary enhancement within the liver which correspond to the areas of fdg avidity more suggestive of inflammation or infection. there is severe atrophy of the r hepatic lobe with severe biliary dilation and moderate biliary dilation of the l hepatic lobe. the mri again demonstrated the enlarged 2.1-cm gastrosplenic lymph node, concerning for metastasis as well as a 11-mm subcu nodule within the anterior abdominal wall along the previously placed left biliary catheter which may represent scar tissue or metastasis. on the patient had elevated lft's (bili 5) and he was jaundiced. he was planned to be directly admitted to the west 1 surgical service (dr. for ptc, brushings and biopsy. the patient reports intermittent fevers/chills over the past 2 weeks with a decrease in energy level over the past 3 months. he has had no new nausea or emesis, but reports loose stools per day. he denies brbpr or melena. his appetite and weight have been stable. past medical history: pylorus-preserving pancreaticoduodenectomy on for a well-differentiated adenocarcinoma of the ampulla benign prostatic hypertrophy, schistosomiasis, past surgical hx: pylorus-preserving pancreaticoduodenectomy and cholecystectomy l biliary duct dilation and stent placement social history: he has an occasional social alcoholic beverage. he has no history of smoking, iv drug use, marijuana use, tattoos, hepatitis, or piercing. he does have a history of blood transfusions. his social history is significant for the fact that he has some college courses. he is mandarin and does not speak english. he is married and has two children, ages 45 and 49. he is a retired accountant. family history: mother who died of ? gi cancer. father also died of ? gi cancer. he had a brother who died of pancreatitis in his 40s and a sister who died of liver cancer in her 60s. physical exam: on admission vitals: afebrile, vital signs stable gen: nad, aox3, jaundiced heent: icteric sclera. mmm, neck supple, non-tender, trachea midline. + r anterior cervical lad, no supraclavicular lad cvs: rrr pulm: ctab, no resp distress abd: softly distended, non-tender. well healed incision c/w surgical history. le: no edema pertinent results: : 8.2>29.6<149 132 102 9 agap=11 -------------< 156 3.9 23 0.8 ca: 8.0 mg: 2.1 p: 2.8 alt: 44 ap: 311 tbili: 8.2 alb: 2.3 ast: 102 ldh: 150 dbili: 6.9 tprot: : 27 lip: 6 pt: 19.8 ptt: 37.2 inr: 1.8 labs from : alt: 40 ap: 318 tbili: 5.3 alb: 2.5 ast: 101 ldh: 168 gran-ct: 6030 tsh:1.4 vit-b12:1113 %hba1c: 5.9 pet scan: impression: 1. multiple mass-like areas of fdg uptake in the liver, highly concerning for metastases. biliary dilation and vessel patency cannot be assessed on this noncontrast study. 2. 2.3 cm fdg avid gastrosplenic lymph node,concerning for metastasis. 3. non-fdg avid 8mm right lower lobe nodule, probable 4mm left upper lobe nodule and small left pleural effusion. 4. fdg uptake of the left adrenal gland without definite mass. attention on follow-up studies is recommended. 5. focal right posterolateral chest wall fdg uptake, likely corresponding to the site of chest wall nodule excision. mri abdomen: 1. areas of peripheral peribiliary enhancement within the liver correspond to the areas fdg avidity and are more suggestive of inflammation/infection rather than tumor. no discrete hepatic masses are seen though cannot be excluded. the area of fdg avidity within the right lobe corresponds to the region of severe biliary dilation and more is not excluded, though no mass is discretely visualized. 2. severe atrophy of the right hepatic lobe with severe biliary dilation and right metallic hepatic biliary stent in place. moderate biliary dilation of the left hepatic lobe. 3. enlarged 2.1-cm gastrosplenic lymph node, concerning for metastasis. 4. 11-mm subcutaneous nodule within the anterior abdominal wall along the previously placed left biliary catheter. this focus is nonspecific and may represent scar tissue, but is concerning for metastasis, particularly given that the right lateral subcutaneous nodule (which also appears likely to have been along a prior right ptbd course) is biopsy proven adenocarcinoma. 5. 9-mm hypoenhancing focus within the interpolar region of the right kidney which may represent a small focus of inflammation or infection. brief hospital course: mr. returned to oncology clinic (dr. on in anticipation of beginning systemic chemotherapy with gemcitabine/cisplatin. he was found to have elevated bilirunbin (5.3). patient was then admitted to hepatobiliary service (dr. on for planned ptc on . patient was afebrile with normal vital signs on admission. however, later that evening, patient became febrile with elevated wbc (18.7k, from 8.2k). patient then was transferred to the icu resuscitation. iv vanco/zosyn was emperically started. on , patient was given ffps for inr 1.8 and underwent ptc with placement of r anterior, posterior and l biliary drains. patient remained hypotensive after the procedure. he was briefly weaned off levophed on the next day, however, his bilirubin continued to increase and patient returned to ir for cholangiogram, which showed hemobilia and obstruction of the drains that was resolved with aspiration/flushing. the drained was also advanced centrally. patient was then weaned off levophed on the next day. his drains continued to put out ~200-250ml of bilious material. however, his bilirubin continued to be elevated. what follows is a summary of this patient's complicated sicu course: : lactate trending down, weaning levophed, weaning vent, switch to d5w : rec'd 25g albumin, weaned off pressors, biliary drains checked & cleared of clots by ir : 1 u prbc's, start tpn :started on 25g albumin q8h,continued advancing tpn,laxix 10mgiv, us liver shows patent vessels, cx swann to triple lumen; failed decreasing peep fto 8 (desatted) & failed decreasing ps to 8 (desatted) : r ptc began pouring out serosanguinous fluid, hct stable, thought to be pleural effusion through sidehole. tbili continuing to rise. pt went to ir for removal of r drains, replacement of l drain and placement of r pleural pigtail catheter. bp somewhat labile with fluid shifts requiring some levo intermittently. given albumin bolus in early am as patient significantly negative over day. : persisting abd distension, bladder pressure 14-15; pleural fluid cultured, start tpn w/ lipids on , pigtail to suction : biliary fluid from et - f/u serum and sputum tbili. added flagyl for c. perfringens in bile, d/c'd zosyn & started meropenem. added fluconozole. sputum from grew 2 types of gnr & sparse growth of yeast. episode of hypotension: 1x albumin 12.5 g. started nicom. : increased sedation to help with vent compliance as changed over to pressure control ventilation. required increasing pressors due to propofol. started cisatricurium drip to improve vent synchrony and decreased sedation. continued on vanc//fluc/flagyl. : d/c'd flagyl (adequate anaerobic coverage w/ ). us shows large pleural effusion but primary team does not want to tap. concentrating fluids (e.g., abx) to reduce inputs. continued on cmv. no am cxr per primary team. ecoli, yeast in sputum from : vanc trough 27.6, held today's dose and redosed q24hrs. continue pcv.,surv bl cx sent. at 4pm acute desat, improved w/ suctioning. cxr showed rul collapse (mucous plug). bronch done & bal sent. repeat cxr showed improved lung fields but required 100% fio2 for 3 hrs before being able to wean slowly to 70%. cisatrocurum stopped and propofol increased slightly to 50. sqh started, slight increase in norepi to 0.12. : persistent b/l plueral effusions. continue pcv. cr trending up from 1.4 to 1.7. meropenem decreased to 500 mg iv q6h. coags trending up. on ards rotator bed, with some improvement in pulmonary function over day. intermittently dropping blood pressures upon turning but recovers quickly. levo adjusted up and down prn. : episode of hypotension when levophed decreased 0.09; increased, then bp stablized at 0.1; hyperk - tx w/ insulin/glucose x2 and bicarb; renal to eval for cvvh - per their recs, can start when hyperk worsens; no st changes : k 6.3 - more ins/glucose, hco3; albumin 12.5g tid, lasix 40mg x1=400 urine above baseline but pt also turned in am so actually decreased in po2 & cxr, creatinine bump to 2.1; repeat dose lasix yielded another 440 urine above baseline. continued discussion re: cvvh; discussed w/ t-plant ct chest to look for loculations (right pleural pigtail not draining for ~ 24 hrs but overnight started draining for total 200cc), not agreed upon. added albuterol mdi q6h prn. am gas much improved : hct 24 --> txf 2u prbc. d/c albumin. iv lasix 40mg iv twice today. holding off on cvvh. ip placed pigtail to l chest. : slowly weaning vent settings. l and r chest tubes continue to drain. - 700 over day. cxr improving : no longer on propofol, requiring lower dose of norepi; penile ulcer/necrosis noted, wound consult requested. diuresed to negative 1.9l as of midnight from the am dose of 40 iv lasix. pt has withdrawl to pain response now that propofol off for 18 hours. off norepinephrine. : went to ir for drain study, drain patent. also attempted to advance dobhoff tube to post-pyloric position, however unable to pass despite multiple attempts. left in stomach. started d5w for sodium of 150. on recheck, trending down 149->148. : s/p open trach. urology c/s w/wound recs for penile necrosis. : did well on trach collar. still needs jejunal dobhoff. : dubhoff still gastric after reglan x2; gi to advance at bedside on : endoscopy guided advancement of dht by gi, however, dht still coiled in stomach. likely j-tube will be needed. : successful endoscopic advancement of nj tube-->tube feeds started : increasing tf 10cc q8h to a goal of 65 ml/hr. cont'd tpn. : fluids to 50cc/hr ns per transplant : chest tube replacement cc:cc w/ 1/2ns : ct output replacement held o/n for + fluid balance : ruq us shows mild-mod right but not left biliary dilatation. cholangiogram shows left biliary duct is patent, r not patent. two units rbc's given for decreasing sbp & decreasing crit. in evening pt had acute desat to 80%, brady to 40, hypotension to 60 sbp. resolving w/ bagging. ekg shows afib. pt later developed hypotension, sinus rhythm. given fluid boluses. vanc/ started for sepsis. finally levophed started. overnight insulin given for hyperkalemia. developed bleeding from central line site, so coags and fibrinogen sent. consider d/c central line. bicarb given for 7.26, repeated insulin, d50 for repeat k=6.1. : r pigtail output dropped off, likely clogged. r sided whiteout. pigtail stripped. both pigtails put to 20mmhg sxn per tranplant. d/c'd cipro. 3amps bicarb; bili/amylase/cytology for pleural fluid sent : gpcs in blood cx from rij, r sc tlc placed; d10 @ 20ml/hr for hypoglycemia; 1:1 fluid replacement for increased ct output which then decreased over the day, sputum cx for green sputum. weaned vent to cpap fio2 40% and . could not wean levo to off but down to 0.03. : tolerating trach collar. bicarb decreasing, so given 1 amp bicarb. : tolerating trach collar, still on 0.03 levophed, d/c d10, ordered flexiseal, tfs to goal at 35ml/hr; started nahco3 in ns @ 75ml/hr; decreasing uop - gave 500ml ns, increasing cr 3.3 : 1 amp bicarb : gave 2 amps bicarb. consulted renal - atn vs prerenal vs obtruction from mets. fena 0.35. recs include urine lytes, osms, sediment; salt poor albumin with lasix to decrease k if needed. minimal uop, but cr and bun mildly improved. no hd per primary team. low albumin - started 25g 25% albumin tid. also started tpn. started cipro for ptc prophylaxis and dosed vancomycin. : renal us showed no hydronephrosis or stone. renal reconsulted:no hd indicated : recomendation to consider palliative care consult, tpn d/ced : renal agrees hd is not indicated, albumin given x 3, 2 amps bicarb for level of 14, put back on vent. restarted levo and placed r radial aline. bp did not respond to last albumin : family meeting planned for , spaced to q24h secondary to renal failure : moving towards cmo, dnr/dni confirmed. no further lab tests or blood draws. : removed aline and d/c'd abx. started morphine gtt for agonal breathing. medications on admission: creon capsule po tid w/ meals & snacks, omeprazole 20mg po daily ondansetron 8mg prn nausea prochloroperazine maleate 10 mg q6h prn nausea ursodiol 300mg po bid calcium mvi 1 tab po daily omega-3-fa's discharge medications: none, pt expired. discharge disposition: expired discharge diagnosis: cholangitis sepsis metastatic cholangiocarcinoma liver failure acute renal failure respiratory failure discharge condition: expired discharge instructions: none followup instructions: none md, procedure: insertion of intercostal catheter for drainage insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine enteral infusion of concentrated nutritional substances thoracentesis temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus other cholangiogram other percutaneous procedures on biliary tract other percutaneous procedures on biliary tract other percutaneous procedures on biliary tract other percutaneous procedures on biliary tract dorsal or lateral slit of prepuce diagnoses: thrombocytopenia, unspecified malignant neoplasm of liver, secondary acute kidney failure with lesion of tubular necrosis unspecified pleural effusion acute and subacute necrosis of liver acquired coagulation factor deficiency severe sepsis atrial fibrillation secondary malignant neoplasm of other specified sites other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure cardiogenic shock other specified septicemias septic shock pneumonia due to escherichia coli [e. coli] hyperosmolality and/or hypernatremia ventilator associated pneumonia cholangitis obstruction of bile duct personal history of malignant neoplasm of other gastrointestinal tract other candidiasis of other specified sites foreign body accidentally entering other orifice secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes foreign body in larynx redundant prepuce and phimosis other fluid overload secondary malignant neoplasm of adrenal gland edema of penis other specified disorders of penis 

Answer: The patient is high likely exposed to