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: malaise, abdominal pain major surgical or invasive procedure: ultrasound-guided drainage of gall bladder abscess history of present illness: mr. is a 65 year old man with a history of pancreatic cancer s/p cbd stent placement in with subsequent revisions in and who presents from osh with malaise and mild abdominal pain. he was diagnosed with pancreatic cancer in early and underwent an attempted whipple in that was aborted when metastatic disease to the liver was discovered at laparotomy. he started chemotherapy shortly thereafter, and reports feeling malaise shortly after his chemotherapy sessions, the most recent of which was on friday . he has also been feeling increasingly weak since , sometimes tiring after 10 minutes of walking. he denies accompanying chest pain, dizziness, lightheadedness, orthopea, or pnd. the weekend prior to admission, the patient had poor appetite and did not eat or drink very much. he syncopized twice, and each episode was preceded by presyncope. he reports brief loc but no head strike or abnormal movements. he also reports measuring a low blood pressure at home to 85/61 (baseline in the 110s systolic) though was asymptomatic. his wife grew worried given apparently increasing weakness and took him to ed. at , he received 5l ns, 2u prbcs, and vanc/cefepime. he was in afib with rvr and was started on a ditliazem drip at 10mg/hr. he was given vancomycin and cefepime and transferred to . in the ed, initial vs were: t:100.2 hr:150 bp:113/73 rr:18 o2:97%. a cta was negative for pe and showed numerous lung and liver lesion and an air-filled strucutre at the anterior border of the liver that could represent gallbladder with pneumobilia, bowel, or a necrotic lesion. a ruq u/s showed a cbd dilated to 8-11mm and the same incompletely characterized air-filled structure at the anterior border of the liver. his afib with rvr broke with the diltiazem gtt and he was given tylenol 1g for pain. on arrival to the micu, patient's vs were 99.4 134 109/85 22 96%/ra. he denied dizziness, lightheadedness, cheset pain, or sob. past medical history: - type ii diabetes mellitus - atrial fibrillation: per patient report, developed 12 years ago, resolved 8 years ago after switching jobs social history: war veteran, worked as chemical and mechanical engineer. now retired. denies tobacco, etoh, drugs. family history: no cancer. otherwise, nonncontributory. physical exam: vitals: 99.4 134 109/85 22 96%/ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, no lad cv: irregular, tachycardic, normal s1 + s2, no murmurs, rubs, gallops. jvp 7-8cm. lungs: decreased breath sounds at bases and bibasilar rales, l > r. otherwise clear to auscultation bilaterally, no wheezes, ronchi abdomen: soft, non-distended, ttp in ruq w/o rebound or guarding, hypoactive bowel sounds, liver edge palpable 4cm below costal margin gu: no foley ext: warm, well perfused, 2+ pulses, trace pitting edema to shins bilaterally, no clubbing, cyanosis neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, gait deferred. pertinent results: admission labs: 07:30pm pt-11.8 ptt-23.6* inr(pt)-1.1 07:30pm plt count-354 07:30pm neuts-94.0* lymphs-3.1* monos-0.9* eos-1.8 basos-0.1 07:30pm wbc-9.2 rbc-4.26* hgb-11.2* hct-35.0* mcv-82 mch-26.3* mchc-32.0 rdw-15.9* 07:30pm albumin-2.7* 07:30pm lipase-175* 07:30pm alt(sgpt)-49* ast(sgot)-40 alk phos-374* tot bili-2.1* 07:30pm estgfr-using this 07:30pm glucose-326* urea n-29* creat-0.9 sodium-133 potassium-4.6 chloride-100 total co2-21* anion gap-17 07:51pm lactate-2.1* 08:30pm urine mucous-rare 08:30pm urine rbc-3* wbc-3 bacteria-few yeast-none epi-<1 trans epi-<1 08:30pm urine blood-neg nitrite-neg protein-30 glucose-1000 ketone-40 bilirubin-neg urobilngn-2* ph-6.0 leuk-neg 08:30pm urine color-yellow appear-clear sp -1.030 08:30pm urine gr hold-hold 08:30pm urine hours-random discharge labs : wbc 10.4 (n:89.1 l:5.5 m:4.2 e:0.9 bas:0.4) hgb 9.5 hct 29.6 plt 253 na 133 cl 102 bicarb 22 k 3.8 bun 22 cr 0.7 glucose 135 ca: 7.8 mg: 1.7 alt: 32 ap: 312 tbili: 0.7 ast: 25 ldh: 184 imaging: ct abdomen/pelvis with contrast abdomen: few small pulmonary nodules are seen in the imaged portion of the left lower lobe, the largest measuring 7 mm (2a:4). there is a small right pleural effusion with compressive atelectasis of the right lower lobe. multiple hypoenhancing lesions are seen throughout the liver, with the largest in segment v measuring 4.2 x 4.1 cm (2ae:28). the portal vein is patent. small amount of pneumobilia, relates to the presence of a cbd stent. inflammatory changes are seen around the gallbladder, consistent with acute cholecystitis. there is disruption of the gallbladder wall at the level of the fundus, with a 9.6 x 2.7 cm hepatic subcapsular fluid collection which communicates freely with the gallbladder. this collection contains a small amount of air which may be due to superinfection or due to the presence of a biliary stent. an adjacent rim enhancing fluid collection is seen in the right lateral abdominal wall musculature measuring 4.0 x 2.0 cm (300b:16). the adrenal glands are normal. both kidneys enhance and excrete contrast symmetrically, without evidence of hydronephrosis. the spleen is mildly enlarged measuring 13.8 cm. there is an ill-defined hypodense mass centered in the region of the pancreatic head/uncinate process, measuring approximately 3.1 x 2.7 cm. there is encasement of the common hepatic artery by the mass. an additional hypoechoic lesion measuring 3.7 x 2.5 cm (2a:32) in the portocaval region may represent a lymph node or posterior extension of the known pancreatic tumor. reactive inflammation seen in the distal portion of the stomach. a duodenal stent is in place. the administered oral contrast passes freely through the stent into the proximal small bowel. there is no evidence of bowel obstruction. the abdominal aorta has mild atherosclerotic calcification without aneurysmal dilation. small retroperitoneal lymph nodes are seen, with the largest in the aortocaval region measuring 10 mm (2a:46). there is mild stranding of the mesenteric fat along the right paracolic gutter. a mesenteric nodule in the right lower quadrant of the abdomen measuring 15 x 12 mm (2a:54), concerning for metastatic disease. there is a small amount of simple pelvic ascites. pelvis: the urinary bladder and prostate are unremarkable. there is a small amount of pelvic free fluid. the rectum and sigmoid colon are unremarkable. no significant pelvic lymphadenopathy or free fluid is seen. incidental note of a small fat-containing right inguinal hernia is made. bones and soft tissues: few small lucent lesions are seen in the lumbar spine, the largest in l2 vertebral body measuring 7 mm (2a:44). and a lucent lesion in the right iliac bone (300b:43), are concerning metastatic disease. impression: 1. presumed gangrenous cholecystitis with perforation. subcapsular hepatic fluid collection communicating with the gallbladder. these findings have not significantly changed since the earlier study of but are better characterized on this study given the abdominal coverage today. a rim enhancing fluid collection in the right lateral abdominal wall musculature, concerning for abscess, likely communicating with the larger collection. 2. multiple hypoenhancing liver lesions, in the setting of known pancreatic cancer may represent metastatic disease or multiple abscesses. comparison to prior imaging might provide assistance in evaluating temporal change for assistance in differentiating the two. 3. poorly defined hypoenhancing mass in the pancreatic head/uncinate process, represents known pancreatic cancer. additional hypoechoic lesion in the portacaval region may represent posterior tumor extension versus a lymph node. 4. patent duodenal stent. 5. peritoneal metastasis and possible osseous metastasis. single frontal view of the chest reason for exam: assess line. comparison is made with prior study, . right picc tip is difficult to visualize can be followed to the mid to lower svc. there are low lung volumes with persistent elevation of the right hemidiaphragm. right lower lobe atelectasis has increased. cardiomegaly and widened mediastinum are stable. small right pleural effusion is unchanged. multiple lung nodules described in prior ct are not clearly visualized in this examination and are below the resolution of this exam. rib fractures are again noted. cta chest w&w/o c&recons, non-coronary impression: 1. no evidence of pulmonary embolism although with suboptimal opacification of distal vessels. 2. multiple lung parenchymal nodules which, given history, are concerning for metastatic disease though the appearance is not typical and infectious or inflammatory etiologies may also be considered. 3. small right-sided pleural effusion and associated opacity, in the setting of right hemidiaphragm elevation, likely due to atelectasis although it is difficult to completely exclude an infectious process. 4. partially imaged upper abdomen demonstrating hypodense lesions within the liver concerning for metastatic disease. low density areas with air along the anterior margin of the liver are incompletely imaged and could represent gallbladder with pneumobilia, bowel or possibly even necrotic lesions. if further evaluation is needed, a ct of the abdomen may be obtained if clinically indicated, noting that the anatomy of the area is not well delineated by this study, or an accompanying ultrasound performed around the same time. correlation to prior outside imaging, if any prior abdominal ct is available, may also be helpful. ruq ultrasound 1. predominantly hypoechoic structure with internal echoes and containing air. this cannot be connected to bowel and may represent distended gallbladder with sludge and pneumobilia; however noting limited assessment, stomach or bowel, or potentially a necrosis lesion are difficult to exclude. if more definitive characterization is needed clinically, ct abdomen may be obtained, preferably with intravenous contrast is possible. 2. the cbd measures up to 11 mm shortly above the stent, but there is no intrahepatic biliary dilatation. 3. heterogeneous liver with several hypoechoic foci concerning for metastatic disease. brief hospital course: # fever/malaise: the patient presented with ruq tenderness, elevated transaminases, and elevated tbili. he was started on cipro 400mg iv q12h and flagyl 500mg iv q8h for empiric coverage for potential intra-abdominal infection. his transaminases, alk phos, and tbili were downtrending during his admission. gi/ercp evaluated the patient and felt that his symptoms were unlikley to be due to cholangitis or biliary obstruction and felt that an ercp was unnecessary. early imaging in the ed suggested the presence of a possible liver abscess. a ct abdomen/pelvis showed perforated cholecystitis with an adjacent fluid collection that was concerning for abscess. a gram stain of the fluid showed polymicrobial infection and cultures were pending. he was discharged on cipro 400mg iv q12h and flagyl 500mg iv q8h with a planned 4 week course (). day 1 of antibiotics was . pending culture results, the proposed antibiotic plan was to obtain repeat imaging upon discharge from to ensure that the fluid collection was being drained adequately, to continue iv antibiotics for 2 weeks (last day of iv abx ), to reimage the abdomen, and then to potentially transition to po antibiotics for the last two weeks of his 4 week course (ending ). # afib with rvr: the patient presented from in afib with rvr to the 150s on a diltiazem gtt at 10mg/hr. he returned to sinus rhythm in the ed and his diltiazem gtt was stopped. he returned to afib with rvr on the floor that reverted to nsr with diltiazem gtt at 15mg/hr. he was transitioned to diltiazem po 90mg q6h with good rate control, though remained in and out of afib. # hyperglycemia: the patient presented with a glucose level of 326, glucosuria, and ketonuria. he was given his home lantus 25 units qhs and placed on an insulin sliding scale. his blood sugars were better controlled with this regimen. medications on admission: insulin glargine 25u qhs actos 15mg po daily glipizide 5mg po daily omeprazole 20mg po daily aspirin 81mg po daily zenpep 10,000 tid prescribed diltiazem, metoprolol, and lisinopril, but not taking discharge medications: 1. ciprofloxacin 400 mg iv q12h day 1 = 2. aspirin 81 mg po daily 3. diltiazem 90 mg po q6h please hold for hr<60, sbp<100 4. glargine 25 units bedtime 5. metronidazole (flagyl) 500 mg iv q8h d1 6. mirtazapine 7.5 mg po hs 7. omeprazole 20 mg po daily discharge disposition: extended care discharge diagnosis: perforated cholecystitis with abscess atrial fibrillation with rapid ventricular response discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you at . you were admitted because you were feeling unwell. we initially felt your symptoms might have been due to a bile duct obstruction or a bile duct infection (cholangitis), but your labs normalized and we did not feel an ercp was necessary. we did a ct scan that showed you had a perforated gall bladder that was infected. we took a sample of the infected fluid and the culture results are pending in the microbiology lab. you were given ciprofloxacin and flagyl (metronidazole) for antibiotics, which were started on . your antibiotics may change depending on the final culture results. you will need iv antibiotics for at least two weeks (last day of iv antibiotics: ). you were given a picc line for getting iv antibiotics at home. you should have another imaging study to see if the fluid collection is improving. if it looks better, you should switch to oral antibiotics for two more weeks (last dose on , for a total 4 week course). you were also in rapid atrial fibrillation while in the hospital. you were given diltiazem 90mg by mouth every 6 hours to control your heart rate. you should continue to take this medication at home. your blood sugars were elevated during your hospitalization. in addition to your usual evening long-acting insulin dose, you were placed on a short-acting insulin sliding scale. you should check with your doctors about continuing this at home. change the dressing around the biliary drain daily. wash the skin with 1/2 strength hydrogen peroxide, rinse with a saline-moistened qtip, and apply a new sterile dressing. the percutaneous drain should be flushed daily according to the following instructions: flush with 10cc sterile saline and aspirate back. repeat this until aspirate is clear. do not continue to flush if the volume out is significantly less than the volume in. if there is pain with flushing this may mean that the abscess cavity has collapsed. in this case, please call operator () and ask for with the radiology nurse practitioner's office for further instructions. troubleshooting: if catheter stops draining suddenly: 1) check that the stopcock is open. 2) remove dressing carefully and inspect to make sure that there is no kink in the catheter. 3) inspect to be sure that there is no debris blocking the catheter. if there is, then firmly flush 5 cc of sterile saline into the catheter. followup instructions: pcp: , md oncologist: , md you should follow up with your pcp and oncologist in the next 1-2 days. you should have your gall bladder reimaged in days, and again in 2 weeks. procedure: percutaneous aspiration of gallbladder computerized axial tomography of thorax central venous catheter placement with guidance diagnoses: acidosis malignant neoplasm of liver, secondary unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation constipation, unspecified malignant neoplasm of head of pancreas other postprocedural status acute cholecystitis secondary malignant neoplasm of bone and bone marrow personal history of antineoplastic chemotherapy insomnia, unspecified secondary malignant neoplasm of retroperitoneum and peritoneum nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] perforation of gallbladder 

Answer: The patient is high likely exposed to