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: heparin agents attending: chief complaint: abdominal pain major surgical or invasive procedure: acute perineal resection history of present illness: 79f with biopsy proven stage iii t3n1 rectal cancer who recently finished xrt on presents with 2 weeks of nonspecific abdominal pain. the patient is a very poor historian, but per the daughter, she has had a very poor appetite with decreased po intake over the past few days. she had been urged to be evaluated but has refused until today. she states that she has been having bowel movements but cannot remember when the last one was. she denies fever, chills, nausea, and emesis. past medical history: dementia-presumed, undergoing w/u with dr. h/o etoh abuse-pt denies newly diagnosed rectal cancer chronic intermittent diarrhea/fecal incontinence, being w/u urinary urge incontinence anxiety/depression cataracts, awaiting surgery chronic multifactorial debility arthritis, loss of function rue after fall, back pain, balance issues-mostly wheelchair, but is able to ambulate smoker s/p l ankle surgery s/p ovarian cyst removal s/p appy social history: married. h/o etoh abuse per family though pt denies, none recently as poor access to etoh. also h/o 50pack year, still occ smokes but unable to quantify. no illicits. poor mobility, mostly wheelchair bound, but is able to walk if needed. dependent on some adls and all iadls. family history: no family h/o gi malignancy, dementia, dm physical exam: 98.4, 82, 99/53, 18, 95% on room air gen: no distress, alert, appears demented, poor historian heent: perla, eomi, mucus membranes dry neck: supple chest: rrr, lungs clear abd: soft, nondistended, diffusely tender to palpation, no rebound or guarding noted rectal: patient refused ext: trace edema, feet warm . at discharge: vitals:98.1, 91, 167/89, 18, 97% on 2l gen: nad, a/ox3 cv: rrr, no m/r/g resp: coarse with bilateral rhonchi at bases, no sob. abd: soft, nd, appropriately ttp, +bs incision: small abdomen ota with dermabond, cdi. old jp site, scant serous drainage. intact with dsd. perineal incision ota with sutures, serosanguinous drainage. no exudate or purulent drainage noted. surrounding skin with improved maceration and erythema. ostomy: stoma dark red and viable, protruding out with blood clot at skin margin. profusing well. liquid brown effluence, +gas coccyx: stage ii ulcer extrem: lue edema, csm's intact. mild pedal edema bilaterally. +pulses, brisk cap refill. pertinent results: micro/imaging: picc line inserted in rue via interventional radiology rue and b/l le u/s negative lue u/s occlusive thrombus of l subclv, axillary, brachialis, and basilic urine urine culture-final {yeast} cxr no opacities. unchanged bibasilar atelctasis and pl. effusions ctchest mod b/l pl eff. loc eff on r. focal opacities ru+ ?inf vs. atelec cdif neg bcx ngtd cxr worsening opacity, ?central obstruction, b/l effusions ct chest collapse of rml, known copd, ?adrenal met b/l pl effusions ucx no growth ua:sm leuks, neg nit no bact bcx no growth cdiff neg cxr rll infiltrate ucx neg ua: mod leuks, neg nit, rare bact stool cx neg bcx ngtd ct rectal ca w/o mets, patent graft, pulmonary nodule, ?r asp pna, djd 10:40am blood wbc-7.4 rbc-4.21 hgb-12.5 hct-38.1 mcv-90 mch-29.6 mchc-32.8 rdw-14.8 plt ct-298 03:44am blood wbc-7.5 rbc-3.93* hgb-12.0 hct-36.1 mcv-92 mch-30.6 mchc-33.3 rdw-14.2 plt ct-291 06:50am blood wbc-15.9* rbc-4.01* hgb-12.0 hct-37.4 mcv-93 mch-30.0 mchc-32.2 rdw-14.7 plt ct-584* 01:30am blood wbc-26.0*# rbc-3.15* hgb-9.4* hct-29.4* mcv-93 mch-29.7 mchc-31.9 rdw-15.5 plt ct-75* 03:30am blood wbc-13.8* rbc-2.27*# hgb-6.7*# hct-21.5*# mcv-95 mch-29.5 mchc-31.0 rdw-16.1* plt ct-65* 06:10am blood wbc-14.8* rbc-3.38* hgb-10.2* hct-30.5* mcv-90 mch-30.3 mchc-33.6 rdw-15.7* plt ct-28* 05:55am blood wbc-12.3* rbc-3.47* hgb-10.4* hct-31.8* mcv-92 mch-29.9 mchc-32.5 rdw-15.4 plt ct-41* 05:25am blood wbc-12.4* rbc-3.27* hgb-9.9* hct-30.0* mcv-92 mch-30.2 mchc-33.0 rdw-15.3 plt ct-52* 05:55am blood pt-28.3* ptt-71.3* inr(pt)-2.8* 10:30pm blood pt-16.4* ptt-31.5 inr(pt)-1.5* 07:45am blood pt-12.4 ptt-26.9 inr(pt)-1.0 10:40am blood pt-11.6 ptt-28.0 inr(pt)-1.0 10:36am blood fibrino-176 01:30pm blood fibrino-270 10:36am blood fdp-0-10 03:20pm blood esr-0 05:55am blood glucose-81 urean-17 creat-0.9 na-141 k-4.2 cl-99 hco3-31 angap-15 06:10am blood glucose-79 urean-15 creat-0.9 na-141 k-3.4 cl-98 hco3-34* angap-12 05:54am blood glucose-84 urean-12 creat-0.7 na-141 k-3.9 cl-102 hco3-31 angap-12 12:49pm blood glucose-103 urean-12 creat-0.7 na-142 k-3.4 cl-102 hco3-31 angap-12 03:30am blood glucose-80 urean-13 creat-0.8 na-141 k-4.0 cl-106 hco3-25 angap-14 05:00am blood glucose-145* urean-11 creat-0.9 na-141 k-3.6 cl-105 hco3-24 angap-16 07:45am blood glucose-116* urean-8 creat-0.4 na-142 k-4.1 cl-107 hco3-30 angap-9 03:44am blood glucose-88 urean-9 creat-0.4 na-139 k-3.6 cl-102 hco3-22 angap-19 10:40am blood glucose-116* urean-12 creat-0.4 na-138 k-3.8 cl-101 hco3-28 angap-13 05:00am blood ck(cpk)-28 10:40am blood alt-25 ast-19 alkphos-54 totbili-0.6 05:00am blood ck-mb-3 ctropnt-<0.01 10:40am blood lipase-10 05:55am blood calcium-7.6* phos-3.0 mg-2.4 06:10am blood calcium-7.4* phos-3.6 mg-1.7 05:54am blood calcium-7.6* phos-3.4 mg-2.2 10:36am blood albumin-2.7* 10:40am blood albumin-3.1* calcium-8.6 phos-3.6 mg-1.5* 03:44am blood albumin-2.9* calcium-8.3* phos-3.6 mg-1.4* iron-18* 07:45am blood calcium-8.5 phos-2.5* mg-2.1 03:44am blood caltibc-194* ferritn-128 trf-149* 03:44am blood triglyc-109 brief hospital course: course 79 yo female with mild dementia, recent hap, pleural effusions with stage iii rectal cancer now s/p perineal resection (including sigmoidectomy, protectomy, resection of portion of colon) with uncomplicated operative course who was admitted to on for monitoring post-operatively. onb admission, the patient was noted to marked leukocytosis, which was believed to be post-operative change. however, given recent history of hap, the patient was pan-cultured. no antibiotics were initiated and wbc count trended down by icu day #2. the patient was given iv morphine prn for pain control. nausea was controlled with iv zofran prn. the patient was noted to have significant drop in hct from 29.4 to 20.0 on icu day #2. she was transfused with 2 units of prbcs with appropriate response. the patient also had significant thombocytopenia. because of a concern for hit due to long-term exposure to heparin in this patient, heparin was discontinued and the patient was switched to pneumoboots for dvt prophylaxis. hit antibody panel was sent and was positive. serotonin release assay was sent out. the patient was also noted to have increasing inr to 1.8, without a significant change in ptt. this was believed to be due to a poor nutritional status in this patient, although dic was considered as well. dic labs were not conclusive. the patient also received 2 units ffp, platelets. albumin and prealbumin were sent out to assess nutritional status. copd: the patient received albuterol/ipratropium nebs for her copd. anxiety/depression: the patient was seen by palliative colult team for help with anxiety/depression. the patient was called out to surgery service for further management. . patient was admitted to the general surgery service for better control of her abdominal pain and management of her nutrition prior to her scheduled surgery. she was kept npo and given ivf. her pain was well controlled with tylenol and morphine as needed. geriatics was consulted for assistance with medical management prior to surgery. they made recommendations for prevention of delirium, management of her copd and pain. . she was scheduled for surgery on , for which she prepared with a bowel prep on the preceding day. anesthesia was concerned about the patient's respiratory status. cxr in the holding area revealed an acute infilrate consistent with hospital-acquired pneumonia on top of her known severe copd. the decision was made to delay surgery. she was started on a 5 day course of iv vancomycin and zosyn and returned to a regular diet. she continued to have multiple bowel movements after the bowel prep and was given several boluses (totaling 2l) for hypotension to sbps of 60s. her creatinine rose from 0.4 to 1.5 in this setting. her fena was 2.1 and therefore her renal failure was thought to be from intrinisic renal failure, likely acute tubular necrosis. geriatrics continued to follow her. . a repeat cxr on showed persistent atelectasis with concern for central obstruction. a chest ct was recommended and preformed the same day. the ct revealed rml consolidation as well as known copd and the question of an adrenal metastasis. following this information, she was transferred to the medicine service for further management of her renal and pulmonary issues. although the patient was not an optimal surgical candidate, surgery was thought to be delayed until another time rather than cancelled. . . during her medical admission, the patient did not demonstrate any subjective shortness of breath or chest pain. her exam was remarkable for decreased lung sounds bilaterally, a heart murmur and right shoulder mass that have both been present for years. her labs were remarkable for elevated renal function findings and leukocytosis. over the next few days, the patient also complained of bilateral arm swelling and pain. the course of each issue progressed as follows: ?????? lung infiltrates. the patient hardly complained of shortness of breath or other subjective respiratory distress. over her stay, her oxygen saturation improved while on oxygen flow and peaked to 95-96% on 1-l, up to 99% after nebulizers. she never dipped below the 90s on room air. her lung exam improved over several days, with increasingly louder respiratory sounds. one chest x-ray was suggestive of a loculated lesion that was then reassessed with a chest ct. it was decided that this did not merit any draining given her overall positive picture. ?????? copd. the patient suffers from copd which continued to benefit from her nebulizer regimen. she was maintained on ipratropium bromide (q6h) and albuterol 0.083% q6h. ?????? renal function. the patient's creatinine decreased and stabilized within the range of 0.7-0.8. her gfr continued to be impaired at 43 (nml for age group is 75), but it was similarly stable. strict i/os were difficult to maintain due to her baseline incontinence. ?????? leukocytosis. the patient's wbc count was initially elevated (around 12) and then started to fall within normal levels (<10). no source of infection was identified; she was c. diff negative. the only significant correlate of this laboratory finding is her recovering pneumonia and loculated infiltrate sequelae. ?????? bilateral upper extremity swelling. the patient also complained of acute swelling of both of her arms. on exam, it was noted that the left arm appeared larger than the right, with some possible dependent edema on her abdomen. it was found that her albumin levels were below the normal range of variation (2.4). a nutrition consult was placed to improve her dietary input. nutrition is currently following. ?????? hypocalcemia/hypomagnesemia. on the second-to-last day before surgery, she patient was found to be hypomagnesemic and hypocalcemic. she received a magnesium citrate bowel prep the day before surgery. ?????? r shoulder mass - most likely a seroma. the patient reports it has been present for years. we monitored the mass and it did not change size or consistency. ?????? diarrhea. the patient has baseline diarrhea given her rectal cancer. she was c. diff negative and therefore was placed on her home regimen of loperamide. this alleviated her symptoms. ?????? pain control. over her stay, the patient complained of vague abdominal, r ankle/knee, l-thigh, back pain, bilateral arm pain, and r-shoulder pain. she did not consistently focus on any specific spot on a day-to-day basis. her pain medication regimen was limited to acetaminophen, lidocaine patches and tramadol. ?????? heart murmur. the patient has a chronic systolic heart murmur heard best in l sternal border, (), mild thrill). the location was suggestive of a right-heart process, which could be as benign as flow murmur to more insidious etiologies like pulmonic valve stenosis or tricuspid insufficiency. her ekg from normal and a subsequent echocardiogram did not show any concerning abnormalities (r/l atria nml; mild l ventricle hypertrophy; aortic and mitral valve leaflets mildly thickened; no ao. valve stenosis; no mitral regurg. moderate pulmonary artery systolic hypertension; no pericardial effusion). ?????? depression. the patient has endorsed suicidal ideation without active plans. denies homicidal ideation. she is not on any antidepressants. social work following. . . . . . . . . . . . . . . . . . . . . ................................................................ general surgery: operative course uncomplicated. admitted to stone 5 for post-op care. pain controlled with pca, quickly weaned due to cognitive status, and age. patient continued to be followed by geriatrics, palliative care, and social work post-op. recommendations were instituted as needed. . respiratory status stabilized post-op. oxygen weaned. continued with nebulizers and aggressive chest pt. completed full anitbiotic regimen for treatment of pre-op pneumonia. . upper extremity edema decreased as patient diuresed post-op. lue remained edematous. u/s negative on . edema persisted. patient also noted to have drop in platelets. noted to be hit positive. all heparin agents discontinued. platelets monitored daily. hematology/oncology consulted. patient started on an argatroban drip. lue re-scaned -extensive dvt noted. all other extremities underwent ultrasound, all negative. heme/onco advised continuing argatroban drip untile platelets above 100,000 for at least 48hours, then convert to po coumadin. patient will require about 6 months of treatment. this will be monitored by patient's pcp once discharged back home from rehab. . abdominal incision intact with staples, cdi. diet advanced gradually from sips to regular food as ostomy function and abdominal distention improved. iv fluid discontinued. foley removed. voided without issue. medications switched to oral. pain well controlled with oral ultram. activity returned to baseline. continued to work with physical therapy. patient deconditioned, and requires extensive physical and pulmonary rehab. medications on admission: tylenol, nystatin powder, imodium, potassium supplement, vitamin discharge medications: 1. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical q24 () as needed for pain. 2. tramadol 50 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for pain for 2 weeks: hold for somnolence, rr<12. 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: two (2) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 4. ipratropium bromide 0.02 % solution sig: two (2) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 5. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours) as needed for pain: do not exceed 4000mg in 24hrs. 6. fluconazole 100 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 1 weeks. 7. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for fungal infection: apply under breasts & perineal area . 8. argatroban 100 mg/ml solution sig: 0.5-2 mcg/kg/min intravenous infusion (continuous infusion): refer to attached protocol. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: stage iii t3n1 rectal cancer completed xrt pre-op treatment of pneumonia post-op dvt-lue post-op stage ii ulcer of coccyx positive for heparin induced thrombocytopenia discharge condition: alert & oriented x3 tolerating a regular diet with supplements pain well controlled with oral ultram and tylenol discharge instructions: rehab instruction: please call the doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. *avoid lifting objects > 5lbs until your follow-up appointment with the surgeon. *avoid driving or operating heavy machinery while taking pain medications. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. * continue to ambulate several times per day. . incision care: 1.abdomen: open to air with dermabond, clean & intact 2.old jp drain site: apply dry gauze dressing until serous drainage stops. change at least twice a day & as needed. 3.perineal: open to air with sutures, -you may shower, and wash surgical incisions. -avoid swimming and baths until your follow-up appointment. -please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. 4. ostomy-stoma protruding, dark red in color with clotted blood at skin level. functioning well. no concerns for ischemia. continue to monitor. call dr. office with any concerns. . monitoring ostomy output/prevention of dehydration: -keep well hydrated. -replace fluid loss from ostomy daily. -avoid only drinking plain water. include gatorade and/or other vitamin drinks to replace fluid. -try to maintain ostomy output between 1000ml to 1500ml per day. -if ostomy output >1 liter, call dr office. . anticoagulation: -continue argatroban drip protocol and adhere to modifications per hematology/oncolgy specialists (see enclosed note & instruction section). followup instructions: 1. please follow-up with dr. 1:30pm in multidisciplinary clinic. . 2. provider: , md phone: date/time: 1:30 . 3. provider: , md phone: date/time: 1:30 . 4. please follow-up with pcp, . , once you are discharged from rehab for long-term management of anticoagulation. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified open abdominoperineal resection of the rectum diagnoses: pneumonia, organism unspecified hypocalcemia acute kidney failure with lesion of tubular necrosis unspecified pleural effusion congestive heart failure, unspecified candidiasis of other urogenital sites other persistent mental disorders due to conditions classified elsewhere dysthymic disorder delirium due to conditions classified elsewhere disorders of magnesium metabolism chronic diastolic heart failure obstructive chronic bronchitis without exacerbation unspecified cataract secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes late effect of radiation heparin-induced thrombocytopenia (hit) laparoscopic surgical procedure converted to open procedure malignant neoplasm of rectum chronic ulcer of other specified sites suicidal ideation acute venous embolism and thrombosis of deep veins of upper extremity gastroenteritis and colitis due to radiation acute venous embolism and thrombosis of subclavian veins 

Answer: The patient is high likely exposed to