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: patient recorded as having no known allergies to drugs attending: chief complaint: esophageal cancer major surgical or invasive procedure: transthoracic esophagectomy with cervical anastomosis ( procedure). esophagogastroduodenoscopy. multiple paracenteses abdominal washout. 2. placement of left chest tube. 3. esophagogastroduodenoscopy. 4. bronchoscopy. abdominal wash out. 2. placement of bovine pericardial mesh ( tracheostomy (#7 portex cuffed). 2. therapeutic bronchoscopy. 3. vac dressing change. history of present illness: the patient is a 67-year old male who was recently diagnosed with stage t3n1 distal esophageal adenocarcinoma by eus and biopsy who underwent preoperative chemo/radiation treatment. the patient also had a feeding jejunostomy placed in and was able to tolerated p.o. intake. he was admitted electively for a three hole esophagectomy. past medical history: - duodenal ulcer '; ', tx for h pylori ' - hiatal hernia, gastritis, duodenitis ' - asthma, exercise induced (well controlled w/ pulmicort, albuterol prn, no o2) - adhd - s/p mva w/ depressed skull fx ' - sbo '70s, managed conservatively - colonic polyps, s/p colonoscopy & excision (adenoma), last colonoscopy ' - no polyps, hemorrhoids psh: - s/p appy - s/p ing hernia repair social history: former smoker (1ppd x 10yrs, quit 35yrs), etoh one wine or beer/day; denies drugs; married w/ 3 children, realtor family history: mother w/ gastric or uterine ca ', s/p surgery, mi - deceased father w/ resp disease, attributed to occupational exposure to dust or mold brief hospital course: operations during admission: transthoracic esophagectomy with cervical anastomosis ( procedure). esophagogastroduodenoscopy (3-hole esophagectomy) ex-lap, abdominal wash-out abdominal wash-out abdominal wash-out, bovine pericardium abdominal closure, vac dressing placement trach placement colocutaneous fistula w/leaking feces s/p vac, skin, and pericardium takedown with bedside placement of red rubber tube in fistula portacath out, picc out bronch neg consultations during admission: interventional pulmonology acute pain service nephrology service x2 surgical icu trauma-surgical icu general surgery infectious disease cardiology hospital course: the patient was admitted to the hospital for known esophageal cancer (t3n1mo) s/p portacath placement and j-tube placement in , followed by neoadjuvant chemo (f5u/cisplatin) and radiation for an esophagectomy with cervical anastomosis ( procedure). postoperatively he went into acute renal failure and was seen by the nephrology service. he was also seen to develop loculated pleural effusions, and so he had a pigtail placed on ; cxr post placement revealed a right lung fluid in new loculated effusion/ hydropneumothorax towards apex with the left effusion unchanged. the patient then had a chest tube placed on the left for drainage of that effusion. when drainage had decreased significantly and there were no signs of pneumothorax, the patient's left and then right pigtails were removed, which he tolerated well. he remained on the ventilator and had a tracheostomy placed on , which he tolerated well. on the patient went into septic shock and was transferred to the cvicu. he triggered 6x on the floor for dyspnea and hypotension. pressures noted to be in the 70s. pt given albumin for volume expansion transiently resulting in an increase in bp into the 90s. pt was noted to have a burst of svt with hr in 160s which improved with carotid massage. overwhelming nursing concern, transient hypotension, concern for worsening hypercarbia, decrease in mental status, pt transferred to icu for further management. placed us guided l ac 18 gauge. pt intubated for hypercarbia and for fluid management concern as latest cxr revealed volume overload versus underlying pna(no fevers) - pt self-extubated in am, reintubated in cvicu, was hypotensive, femoral a-line and rij triple lumen placed. pt taken back to or for ~5hr exploration as to acute decompensation, bronchoscopy unrevealing, on ex-lap multiple loculated abscesses found and drained, jps left in place, anastomosis no leak. pt hypotensive during abdominal closure --> asystolic arrest, cpr initiated, epi/atropine given --> vtach, defib into sinus rhythm. abd left open. then had episode of svt during transfer from or table to bed -afib w/ rvr w/ hypotension, cardioverted back to sinus. overnight in cvicu had a slight dropoff of uop and mild hypotension, responded to fluid bolus. remains sedated on fent/midaz, with slow weaning of levophed. postop hct 33 --> midnight hct 30, inr 1.5, lytes wnl, abgs improving - last 7.54/34/110/30/+7. -off pressors, excellent urine output, transfused 1uprbc, continues on tpn, started on lasix gtt to augment diuresis for possible closure, vanc trough appropriate -transfused 1 unit of prbc's with goal of keeping patient above goal of 30. diuresed to goal of 100cc/hour of urinary output with a cvp greater than 10 and an sbp > 100. - likely washout on sunday or monday with closure; autodiuresis >2l, off lasix. 4am rn noticed slightly uneven pupils and less reliable response to voice/command on neuro check. communicated with primary service which will decide on course in am as per dr. . washout monday with closure; diuresis augmented with lasix gtt and diamox, rate increased to blow off more co2, tpn concentrated, non contrast head and chest shot, negative 3+l over 24h -pt to or for attempted closure. failed. had left chest tube placed for pleural collection. 300cc's of yellow serous fluid drained from site. pt still not on pressors making 50-80cc's hour. - albumin added in attempt to decrease edema, lasix bolus to albumin as neg balance reaching even. diamox d/c'ed. lasix boluses d/c'ed in favor of lasix gtt, patch tightened, ir/ct guided drainage deferred to tomorrow am, vivonex 20cc/hr to be held at midnight started. - stool for guaiac, search for source of anemia. for ip drainage of right apical effusion today, if drainage successful chest tube to be d/c'ed by thoracic. - maintained negative, r chest tube removed by thoracic surgery - continue to make 1/2l negative, follow bun/cr, daily cxr -started vanc--goals remain similar as yesteday. - tpn reordered, lasix gtt to continue per thoracic, titrate to goal 0-1l negative. cvl displaced in pm, new rij cvl placed. also noted to be jaundiced - lfts elevated, tuberculosis 4.7, ast/alt in 80s, primary team requests to repeat lfts in am. post-line cxr - small line near left heart border, rads resident read as possible pneumomediastinum, again line on repeat cxr. possible pneumomediastinum unlikely related to line placement, pt w/ esophagectomy, ?air tracking from open abdomen or surgical site, pt remain hemodynamically stable overnight. discussed with primary team, agree to plan to monitor and manage conservatively until repeat cxr in am or further plan by dr . plan for or for possible abdominal closure. : unable to take back to or, will go back for closure of negative pressure therapy, d/c'ed versed gtt in favor of intermittent ativan with minimal requirement of usage, tf off after mn/npo p mn for or . went back to or today, dc left chest tubes, dc both jp drains, dc ng tube, placed bovine pericarial matrix on superior portion of wound, and closed the infraumbilical portion. attached vac dressing to superior portion. for vac change on the 18th. consideration of add on for trach on friday. want to continue vanc, zosyn, fluconazole for a few more days. goal for euvolemia. per nursing, pt was tried on cpap which was not tolerated. fentanyl was weaned from 200 to 150. tf advanced w/ tpn x 1 more day. picc attempted on r arm at bedside but unable, ir order placed, will need bicarb to be written at time of procedure. no or cultures to follow. no change in vent setting (kept on cmv) as npo for trach in am. trach'ed, picc line in place, vac changed in or, sedation weaned, resp weaning as much as possible - on the patient was noted to be febrile to 103 - though with a stable blood pressure, and he was pancultured for concern with sepsis. on the patient was noted to have copious amount of frank green thick feces emanating from his vac dressing. he underwent takedown of the vac dressing and the pericardial mesh with opening of the skin closure on at the bedside. he was found to have a colocutaneous fistula, from which was emanating the stool. that day he underwent a ct abd/chest with contrast that revealed leakage of contrast to anterior abdomen from transverse colon; no biliary dilatation or gallbladder distension. - kept on amp/zosyn/fluconazle per thoracic (vanco denied by id). ct c/a/p w/ small perf transverse colon to anterior abdomen, kept npo, tpn restarted. hida scan ordered per thoracic. left radial a-line placed. - no hida scan, ostomy nurse creates large vacuum sump for ec fistula, 2uprbc xfused, tpn continues, no tube study necessary for ec fistula as prior contrast passes distal to the fistula, currently on only zosyn - added vanco due to new culture data from cath tip - pt taken by ir for placement of cholecystostomy tube. pt off pressors, making good urine with no other o/n issues. - bactrim started for stenotrophomonas. lasix gtt started for diuresis. - id consulted, caspo bactrim started, hemodynamically stable so far, weaned of versed gtt with intermittent ativan used for sedation, daily cultures to be obtained with sputum per id - tolerating ps (ps18/peep5/50%) x 12 hours overnight. - became intolerant of cpap+ps placed back on the vent, spiked to 102 pan cultured, lasix gtt restarted with goal -500/-1l negative, cxr in am to be obtained, nutrition labs obtained, ot consulted, abx continue : dc vanco, dc , started vivonex tube feeds for nutrition; dr. wants daily plan update emailed to him from team. sp family meeting yesterday. o/n patient had bun/creat ration of 35/1. he was producing 20cc's hour of urine. given albumin with hope of mobilizing extravascular fluid(albumin 2.0). started patient on methadone 20 q 8 and po valium 10 q 6. dc fentanyl and versed drip. wrote for prn fentanyl/versed. : vent regimen to ps20 (from ps25) 2-3x/day for diaphragm exercise. cr to 1.2 today - hold lasix gtt; good uop. bowel regimen started (mom, colace, dulcolax), enema next; received 2 units prbc; restarted lasix gtt at low dose in pm for net pos 3 l --> aim for euvolemia. : continued to tolerate ps20 throughout the day and night; lasix gtt held to reduced effect and rising bun/cr over the course of the day; speciation of sputum culture from shows bactrim resistance -> tobramycin added - tobra d/c'ed, increasing cr, lasix gtt d/c'ed. o/n high peak pressures (pip 40s, plateau 30s), severe resp acidosis + metab acidosis, anuria/oliguria, back to pressure controlled ventilation 10/31 - hypothermic x 2 (both axillary temps), bedside echo adequate intravascular filling with nl contractility; bronch for elevated airway pressures, no plugs, minimal thin secretions, bal sent; left ij placed w/ svo2 monitoring, svo2 80s. remains oliguric. bicarb 2 amps x 2. renal consulted - atn w/ granular non-muddy cast, monitor, cvvh/hd if needed. concern for ards, arf. - - off caspo, tobramycin d'c'd. reamined on pressure support ventilation, poor tidal volumes. unable to wean off vent - increasing acidemia with hco3 to low of 15. the patient's creatinine increased to 3.6 and he failed to respond to 200 iv lasix. he required increasing sedation to fentanyl 400/hr. the patient also underwent a gastrograffin study that revealed free flow of contrast from the rectum to the distal transverse colon with drainage into the anterior abdominal wound via colocutaneous fistula without evidence for an obstructing lesion in the left colon. the patient's acute renal failure worsened to a creatinine of 3.9 with clonus on exam and concern for uremic encephalopathy as per the renal fellow. he was started on cvvh. the output from his ngt was concerning for possible stool. his antibiotics were continued. he remained on pcv ventilation but became hypocapnic but also with a low bicarb. - bilirubin up to 14.7, becoming more jaundiced; had ruq u/s and evaluation of perc choly tube that was negative for cholecystitis or infection or abnormality of the biliary tract. on half dose tube feeds with fat free tpn. feces out of abdominal fistula. creatinine decreasing to 2.7 on cvvh. changed from pcv to ac. pt suffering from ards, arf, hepatic failure. - cvvh continued with 1.5l of fluid removed. open abdomen developed small but persistent area of bleeding lateral and slightly superior to the fistula. hemostasis was achieved through application of surgicell. - patient remained on cvvh with goal net negative 2l. dressing changes continued. sedation decreased slightly from 300 fentanyl to 200 fentanyl. - vac dressing applied to abdominal wound by general surgery service - atrial flutter, low blood pressure. failed attempted cardioversion at 50, 100 and 200j. started on neo gtt, continuing sedation. placed on amio gtt per cardiology rec. tf stopped prior, now progressing to full tpn. : ct torso - no changes/new acute issues very hypotensive, tachycardic overnight, was in a flutter, cardioversion x 2. cvvhdf running : aflutter cardioverted, started on amio again, changed pressors from neo to levophed and vasopressin. remains in nsr. family meeting on , no escalation of care, but full code currently. lfts continuing to rise. patient continued on pressors, tpn, amiodarone for afib, stable ventilartory setting but continued to have rising liver finction tests and required increased doses of pressors so that he also had a very positive fluid balance for a few days in a row. there were continued daily family discussions during this time. on the family decided that it was time to make the patient cmo. care was withdrawn with multiple family memebers present and he expired just before 6pm on . dr was present during the family meetings and was notified of his passage. the family declined an autopsy. discharge disposition: expired discharge diagnosis: esophageal cancer discharge condition: death 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 other endoscopy of small intestine insertion of endotracheal tube fiber-optic bronchoscopy fiber-optic bronchoscopy thoracentesis temporary tracheostomy bronchoscopy through artificial stoma bronchoscopy through artificial stoma other cholecystostomy delayed closure of granulating abdominal wound percutaneous aspiration of gallbladder total esophagectomy other irrigation of wound application of other wound dressing other antesternal anastomosis of esophagus diagnoses: pneumonia, organism unspecified hyperpotassemia acute kidney failure with lesion of tubular necrosis other postoperative infection unspecified pleural effusion unspecified protein-calorie malnutrition severe sepsis asthma, unspecified type, unspecified acute respiratory failure other specified septicemias other respiratory complications other encephalopathy hyperosmolality and/or hypernatremia acute cholecystitis malignant neoplasm of lower third of esophagus 

Answer: The patient is high likely exposed to