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: mold extracts attending: chief complaint: right atrium mass and inferior vena cava mass. major surgical or invasive procedure: exploratory laparotomy, mobilization of the liver, mobilization inferior vena cava, inflow occlusion. (dr. ) the remainder of the procedure performed by dr. from cardiovascular surgery included cardiopulmonary bypass, median sternotomy and resection of the right atrial tumor thrombus. history of present illness: is a 54 year old male with hepatocellular carcinoma and a right atrial tumor thrombus extending into the inferior vena cava and hepatic veins. in short, mr. has a history of hepatitis c and alcoholic cirrhosis who was found to have a 5 cm mass on ct scan in which was shown to be expanding in to 9x6 cm with multiple pulmonary nodules. afp levels were greater than 600,000 ng/ml. further imaging in , however, failed to show a mass and afp had then decreased to 2177 ng/ml. when hospitalized in for an ugi bleed he was found to have a right atrial mass on echocardiogram, confirmed to be hcc on biopsy in . he was started on multiple chemotherapy regimens thereafter which were interchanged due to side-effects and presented in with a pulmonary embolism. workup showed concern for tumor progression. he presents now for resection in a combined procedure with hepatobiliary and cardiac surgery. past medical history: # hcc - has a history of hepatitis c and alcoholic cirrhosis complicated by grade ii-iii varices - initial surveillance ct performed at an outside hospital in showed a 5-cm mass in the left liver as well as multiple satellite lesions. afp on was greater than 100,000 ng/ml. - at ct on showed a 9 x 6 cm enhancing mass in the left liver as well as innumerable pulmonary nodules, the largest measuring 9-10 mm. afp was >600,000ng/ml. however, further imaging showed improved in infiltrating liver process and afp decreased to 2177ng/ml on . no lesion was identified by chest ct, liver ct, u/s, or mri for biopsy. - he was hospitalized in with upper gi bleed, and echocardiogram during that hospitalization diagnosed a right atrial mass. hcc diagnosis was confirmed on the right atrial mass biopsy on . - he began sorafenib . dose was reduced after two weeks due to severe hand/foot syndrome and thrombocytopenia to 200mg . - mr. self discontinued sorafenib due to progressive leg cramps. his afp had begun to rise. - he began second line treatment with capecitabine . exploratory laparotomy, mobilization of the liver, mobilization inferior vena cava, inflow occlusion. the remainder of the procedure performed by dr. from cardiovascular surgery included cardiopulmonary bypass and removal of the right atrial tumor thrombus. other medical history: hepatitis c /etoh cirrhosis c/b 2 cords grade 3 esophageal varices s/p banding most recently . barrett's esophagus. hypertension. gerd. status post right bka after a motorcycle collision in requiring eight surgeries. history of hospitalization for pneumonia. h/o upper gi bleed s/p hospitalization social history: mr. is divorced and has two children. he lives with his father, mother, and brother. previously worked in an automotive repair and as a driver delivering auto parts but is currently out of work. tobacco: 35 years x1 pack per day. he continues to smoke about 1.5 ppd. alcohol: history of abuse, now about 2 beers per day. denies history of withdrawals. illicits: none. family history: the patient's father is alive at 84. the patient's mother is alive at 85 with dementia. he has a brother and sister and two children without health concerns. there is no family history of liver disease or malignancy. physical exam: 97.8 89 127/86 20 100% ra nad, aaox3 cta rrr abd soft, non-tender, non-distended right leg bka stump, well healed with skin fold extending at mid portion of stump and running to medial aspect of stump, no drainage or signs of opening no lower extremity edema 5.2>31.6<48 pertinent results: 05:25am blood wbc-7.6 rbc-3.57* hgb-11.1* hct-33.3* mcv-93 mch-31.1 mchc-33.3 rdw-21.9* plt ct-133* 07:55am blood wbc-3.3* rbc-2.88* hgb-9.6* hct-27.5* mcv-96 mch-33.4* mchc-35.0 rdw-21.7* plt ct-88* 07:05am blood wbc-3.6* rbc-2.94* hgb-9.7* hct-27.7* mcv-94 mch-32.9* mchc-35.0 rdw-21.5* plt ct-78* 05:25am blood pt-26.5* inr(pt)-2.6* 05:25am blood pt-22.3* inr(pt)-2.1* 07:55am blood pt-24.7* ptt-34.8 inr(pt)-2.4* 07:05am blood pt-26.0* ptt-35.7* inr(pt)-2.5* 05:25am blood glucose-95 urean-15 creat-0.6 na-128* k-3.7 cl-95* hco3-28 angap-9 07:55am blood glucose-90 urean-12 creat-0.6 na-126* k-4.0 cl-94* hco3-27 angap-9 07:05am blood glucose-86 urean-11 creat-0.5 na-128* k-3.8 cl-96 hco3-23 angap-13 05:40am blood alt-21 ast-60* alkphos-159* totbili-2.5* 05:25am blood alt-28 ast-65* alkphos-171* totbili-2.2* 05:25am blood alt-27 ast-58* alkphos-149* totbili-2.1* 06:12am blood lipase-30 07:05am blood calcium-8.2* phos-2.6* mg-2.0 07:50pm blood caltibc-558* ferritn-39 trf-429* 1:04 pm urine source: cvs. **final report ** urine culture (final ): citrobacter freundii complex. >100,000 organisms/ml.. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. sensitivities: mic expressed in mcg/ml _________________________________________________________ citrobacter freundii complex | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- 32 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s brief hospital course: 54 year old male with a tumor thrombus from his right atrium into his inferior vena cava to hepatic veins, involving the liver. he was admitted for procedural workup prior to his operation on . arrangements for cardiac catheterization and carotid duplex ultrasound on were made prior to his operation on . cardiac catheterization demonstrated the following: no angiographically apparent flow-limiting coronary disease. 2. catheter-induced spasm at ostium of rca with 60% mid-segment 3. normal systemic arterial pressures. 4. vagal reaction/hypotension secondary to ic ntg administration, resolved with ivf and atropine. tee was also performed noting ef of 55-65% and a large spherical mass of 5.9 cm diameter was seen in the right atrium and a mass was seen in the liver at the junction of the hepatic vein with the ivc. carotid duplex demonstrated less than 40% stenosis in the internal carotid arteries bilaterally. he was preop'd and taken to the or on . he underwent exploratory laparotomy, mobilization of the liver, mobilization of inferior vena cava, inflow occlusion. surgeon was dr. . the remainder of the procedure was performed by dr. from cardiovascular surgery that included median sternotomy, cardiopulmonary bypass and removal of the right atrial tumor thrombus. please refer to operative reports for further details. postop, he was taken intubated with a chest tube to the cv icu under the care of dr. . on , a liver duplex was done noting the following: poor evaluation of the left hepatic vein, and residual tumor in this area cannot be excluded. 2. patent inferior vena cava as well as middle and right hepatic veins. 3. reversal flow within the left portal vein which is otherwise patent. 4. gallbladder sludge with minimal gallbladder wall thickening, the latter of which may be due to underlying chronic liver disease. a tte was then done noting ef of >55% and no residual right atrial mass seen. normal global and regional biventricular systolic function. repeat liver duplex on was performed again demonstrating the following: 1. appropriate flow is seen in the ivc and the right and middle hepatic veins. again the left hepatic vein is not well visualized which might relate to residual tumor or occlusion as previously noted. there is no change in the appearance. reverse flow again noted in the left portal vein. 2. no focal hepatic lesion and no biliary dilatation seen. 3. sludge in the gallbladder. given the liver duplex findings, a ct was performed to evaluate the hepatic vasculature. ct on showed interval right atrial and ivc tumor thrombectomy with persistent pulmonary emboli, persistent middle and left hepatic venous occlusion, unchanged from ct. no definite focal lesions were seen in the liver. portal, splenic and superior mesenteric veins were patent with gastric, splenic and esophageal varices. bibasilar ground glass opacities were demonstrated, likely mild pulmonary edema; however superimposed infection could not be excluded. he was started on heparin drip then coumadin was initiated on . heparin was stopped. inr became therapeutic on with inr 2.4. overall, he did well postop. chest tube was removed. he was transferred out of the icu. for many days, he experienced high jp ascites output for which he received albumin and iv fluid. jp output decreased to 1200. diet was slowly advanced and tolerated. he was eventually passing bms. pain management was difficult as he experienced back pain as well as abdominal pain. oxycontin was started in addition to oral pain mediation with prn dilaudid iv for break thru. he became somewhat confused and the oxycontin and dilaudid were stopped. flexeril was not given. lfts increased slightly then trended down. mental status improved. jp was removed on . the insertion site was sutured and remained dry/intact. abdomen increased in size a day after the jp was removed . home diuretics were resumed. he required potassium supplementation. the chevron incision remained intact, dry and without redness. the sternotomy site was also intact, without redness or drainage. two days after the jp drain was removed, he started to experience hyponatremia with sodium decreasing to 127 then as low as 125. abdomen appeared to have developed ascites. an attempt was made to do a therapeutic paracentesis. a diagnostic paracentesis was performed. fluid was sent for gram stain, cell count and culture. 1+ pmr were noted without organisms. hepatology was consulted for hyponatremia on . it was felt that the patient was dry. diuretics were then held. recommendations were to restrict sodium and fluid. albumin was administered. sodium trended back up to 128. on , abdomen appeared larger and patient felt a little sob. vital signs were stable. weight was up one kg as well. lasix 20 mg daily and potassium chloride 20 meq were restarted on . hepatology did not want sodium or fluid restricted. pt was initially consulted noting difficulty mobilizing patient secondary to sternal and upper abdomen (chevron)incision. his right leg was very edematous and needed pt to apply a "stump shrinker". this was successful and prosthesis was applied. his prosthesis had a belt that wrapped around his waist below the chevron. due to the two incisions, sternal precautions and bka, ambulation was difficult. please refer to pt notes. at time of discharge he was easier to move but required assist due to sternal precautions. pt recommended rehab and a bed was sought at in . a bed became available on . coumadin inr goal is . he will require daily pt/inrs until goal range is stable then ~ 3x per week. of note, he developed foul smelling urine, ua/ucx were sent isolating citrobacter on . this was pan sensitive to cipro. cipro 500 mg was started on . a ten day course was planned. medications on admission: capecitabine 1500 mg cyclobenzaprine 5-10 mg qhs prn back pain furosemide 20 mg daily nadolol 40 mg daily omeprazole extended release 20 mg daily spironolactone 50 mg daily zolpidem 10 mg qhs prn insomnia docusate sodium 100 mg prn constipation loratadine 10 mg daily multivitamin daily discharge medications: 1. outpatient physical therapy right residual limb shrinker dx: post op edema 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 6. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 8. cyclobenzaprine 10 mg tablet sig: 0.5 tablet po tid (3 times a day) as needed for pain. 9. nadolol 20 mg tablet sig: one (1) tablet po daily (daily): hold for hr<60, sbp<100mmhg . 10. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 12. insulin regular human 100 unit/ml solution sig: follow printed sliding scale units injection asdir (as directed). 13. warfarin 1 mg tablet sig: one (1) tablet po once a day: inr daily. 14. labs daily pt/inr. goal inr 15. labs weekly labs, start wed : cbc, chem 10, ast, alt, alk phos, t.bili, albumin, pt/inr fax to attn: , rn coordinator 16. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days: started . end uti. 17. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 18. potassium chloride 10 meq capsule, extended release sig: two (2) capsule, extended release po daily (daily): while on lasix. discharge disposition: extended care facility: - discharge diagnosis: right atrial tumor thrombus uti, citrobacter discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. (patient has right leg prosthesis) sternal precautions discharge instructions: you will be transferring to in for rehab please call dr office at for fever, chills, confusion, nausea, vomiting, diarrhea, constipation, incisional redness, drainage or bleeding, increased ascites, bleeding followup instructions: provider: , md, phd: date/time: 10:40 ( , rn coordinator for dr. ) provider: , md phone: date/time: 1:15 dr. (oncologist) (please schedule a follow up appointment) md, procedure: extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization percutaneous abdominal drainage excision or destruction of other lesion or tissue of heart, open approach incision of vessel, abdominal veins diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified unspecified essential hypertension chronic hepatitis c without mention of hepatic coma alcoholic cirrhosis of liver hyposmolality and/or hyponatremia secondary malignant neoplasm of other specified sites diaphragmatic hernia without mention of obstruction or gangrene long-term (current) use of anticoagulants other ascites malignant neoplasm of liver, primary esophageal varices in diseases classified elsewhere, without mention of bleeding alcohol abuse, continuous barrett's esophagus below knee amputation status other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms jaundice, unspecified, not of newborn other ill-defined heart diseases chronic pulmonary embolism other secondary thrombocytopenia hypersplenism 

Answer: The patient is high likely exposed to