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: food extracts attending: chief complaint: distal cholangiocarcinoma versus pancreatic adenocarcinoma obstructive jaundice. major surgical or invasive procedure: ercp with pancreatic stent interventional radiology biliary drain placement. interventional radiology for internal external drain placement history of present illness: 78 y.o. m presenting with 3 wks of painless jaundice, loss of appetite and weight loss. mrcp shows dilation of biliary tree down to ampulla, normal pd. ercp on showed stricture of distal cbd, unable to cannulate cbd. a pancreatic duct stent was placed as well as a ptbd. past medical history: hcv, dislipidemia, copd, arthritis/gout, type 2 dm, gastritis, pernicious anemia social history: married family history: noncontributory physical exam: on admission: vitals-98.3 70 130/70 15 1004lnc gen-axox3, nad, jaundiced rrr, no mrg ctabl abdomen-soft, mildly tender to epigastric palpation, ptbd in place draining dark green fluid. ext-no c/c/e pertinent results: 09:31am blood wbc-7.4 rbc-3.45* hgb-11.4* hct-32.9* mcv-95 mch-33.0* mchc-34.6 rdw-14.9 plt ct-283 09:08pm blood glucose-85 urean-17 creat-0.6 na-141 k-4.1 cl-104 hco3-26 angap-15 09:08pm blood lipase-672* 09:08pm blood calcium-9.3 phos-3.3 mg-2.2 11:45am blood caltibc-202* ferritn-603* trf-155* 12:56pm blood wbc-14.3* rbc-2.55* hgb-7.9* hct-21.5* mcv-84 mch-31.1 mchc-37.0* rdw-15.8* plt ct-159 05:51pm blood pt-15.2* ptt-42.5* inr(pt)-1.3* 12:56pm blood glucose-129* urean-39* creat-1.3* na-139 k-4.7 cl-109* hco3-22 angap-13 12:56pm blood alt-158* ast-108* ld(ldh)-178 alkphos-222* totbili-6.1* 07:38pm blood lipase-41 12:55pm blood ck-mb-2 ctropnt-<0.01 12:56pm blood calcium-7.9* phos-4.2 mg-1.8 ercp: a bulging of the major papilla was noted. the pancreatic duct was filled partially with contrast and appeared normal the distal most part of the cbd was filled with contrast and there was a tight 1cm malignant appearing stricture cannulation of the cbd was not successful using a sphincterotome a small pre-cut sphincterotomy was performed in the 12 o'clock position using a needle-knife to aid in accessing the cbd cannulation of the pancreatic duct was performed with a sphincterotome using a free-hand technique a 6cm by 5fr plastic single pigtail pancreatic stent was placed successfully to aid in cbd cannulation and decrease risk of acute pancreatitis. despite extensive maneuvering and use of different catheters and guidewires, the cbd was not able to be cannulated. ptbd placement: impression: 1. percutaneous transhepatic cholangiogram demonstrating dilated right and left intrahepatic biliary ducts and dilated common bile duct. a complete obstruction of the distal cbd was noted and attempts to cross into the bowel were unsuccessful at this stage. 2. a modified 6 french external biliary catheter was placed with the pigtail formed and locked in the distal cbd and connected to an external drainage bag. abd ct: impression: 1. 24 mm mass in the pancreatic head/ampullary region which appears to be confined to the pancreas except possible extension in to the duodenal wall and slightly into the pancreaticoduodenal groove. this most likely represents a pancreatic adenocarcinoma, but amopullary carcinoma and cholangiocarcinoma are possible. 2. replaced right hepatic artery otherwise conventional hepatic arterial and venous anatomy with widely patent sma, smv, and portal veins, without evidence of vascular involvement. no definite lymphadenopathy. pancreatic stent in expected position without pancreatic duct dilation snd percutaneous transhepatic biliary catheter with tip in the chd with no bile duct dilation. 3. 4.8-cm slightly complex cyst in the left kidney. attention on follow up recommended. ecg: sinus rhythm. tracing is within normal limits. no previous tracing available for comparison. egd: no evidence of active bleeding and no evidence of hemobilia. small pigmented area over ulcer at ampulla, which is a possible site of intermittent bleeding. successful bipolar cautery treatment. ptbd replacement: impression: 1. removal of the external 6.3 french biliary drain over the wire. 2. check cholangiogram demonstrating decompression of the biliary ductal system as compared to the prior study dated . however, there is high grade stenosis noted in the terminal cbd with trickle of contrast flowing into the distal bowel. 3. successful negotiation of the stricture and placement of internal-external drain, 8 french in size with pigtail formed in the jejunal loop. ecg: sinus tachycardia, rate 114. low voltage in the limb leads. otherwise, tracing is within normal limits. compared to the previous tracing of the low voltage is new. t waves are also more prominent throughout the tracing. these changes are non-specific but myocardial ischemia is not excluded as an etiology. consider electrolyte changes. 11:29 pm bile gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): gram positive cocci. in pairs in short chains. 1+ (<1 per 1000x field): budding yeast. fluid culture (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. pseudomonas aeruginosa. heavy growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 4 s ceftazidime----------- 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem------------- 0.5 s piperacillin/tazo----- 16 s tobramycin------------ <=1 s anaerobic culture (preliminary): no anaerobes isolated. 9:40 pm blood culture source: line-arterial . blood culture, routine (preliminary): pseudomonas aeruginosa. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 2 s ceftazidime----------- 4 s ciprofloxacin---------<=0.25 s gentamicin------------ 2 s meropenem------------- 0.5 s piperacillin/tazo----- 16 s tobramycin------------ <=1 s aerobic bottle gram stain (final ): gram negative rod(s). brief hospital course: the patient with history of painless jaundice x 3 weeks was admitted to the general surgical service for evaluation and treatment. on , the patient underwent ercp, which was unsuccessful for cbd stent placement and only pancreatic stent was placed ( please refer to the operative note for details). on same day, patient underwent placement of ptbd. after procedure, the patient arrived on the floor and was started on regular diet, on iv fluids and antibiotics, with a foley catheter (placed by urology), and iv dilaudid for pain control. on patient underwent cta, which demonstrated 24 mm mass in the pancreatic head/ampullary region with possible extent ion into duodenal wall. patient was evaluated for possible whipple/bypass resection. neuro/delirium: patient was completely independent with adl prior admission. pain was controlled with iv dilaudid with good result. patient was on baseline mental status until , where overnight patient became extremely agitated, required haldol and four point restraints. patient's mental status improved during day time, but overnight patient's mental status changed again. patient received iv haldol and 4 points restraints were applied again. next day geriatric consult was called and recommendations were followed. patient was ordered to have 1:1 sitter and started on olanzapine. pain medication was reduced, patient was encouraged to take more po nutrition. mental status was slightly improving day by day. on , sitter was discontinued, patient did fairly well with 15 min safety checks. patient was ao x 2, more interactive, he followed all commands. patient was screened to be discharge in long term facility and was accepted for transfer on . on patient was triggered for tachycardia, became unresponsive and was transferred in icu. on , patient was made dnr/dni and started on protocol. patient expired on . cv: during admission patient had several episodes of sinus tachycardia. his cardiac status was monitored via telemetry unit. the patient remained stable from a cardiovascular standpoint until his death. pulmonary: the patient remained stable from a pulmonary standpoint until his death. gi/gu/fen: patient was on regular diet after ercp and ptbd placement. when mental status declined, nutritional consult was obtained and patient was started on tpn. patient continue to have good po, and he was only on starter tpn. tpn was discontinued on . picc line was removed. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. id: patient was started on empiric abx treatment on admission. on , ptbd was capped and patient was tolerated well. patient's cultures were sent and came back positive for pseudomonas aeruginosa in bile and blood. patient was continued on abx until protocol initiated. wbc and fever curve were closely monitored during hospitalization, patient had wbc of 29 on transfer in the icu. endocrine: the patient's blood sugar was monitored throughout his stay; insulin dosing was adjusted accordingly. hematology: patient was found to have bloody diarrhea on x 2 and small hematemesis. hct dropped to 20.2 from 31.5. patient was given 5 units of rbc total, hct improved to 29.6. egd was performed and found no active bleeding. gi was consulted for colonoscopy, no colonoscopy was performed due to patient's status improved and hct was stable. patient's hct was monitored throughout hospitalization and was stable until . patient was in icu for acute mental status change, his hct dropped from 31.4 to 18. 3 units of rbc was transferred, hct up to 29. egd was performed and found brisk bleed in ampullary region, suspecting hemobilia. angio was recommended, hcp decided to make patient . no further interventions were made, patient was started on protocol and expired on . prophylaxis: the patient received subcutaneous heparin and venodyne boots were used during this stay. medications on admission: glipizide xl 5', avodart 0.5', b12, zantac 300' discharge medications: none discharge disposition: expired discharge diagnosis: 1. cholangiocarcinoma versus pancreatic adenocarcinoma 2. delirium 3. melena 4. tachycardia discharge condition: expired discharge instructions: no instructions followup instructions: none procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube endoscopic sphincterotomy and papillotomy arterial catheterization endoscopic control of gastric or duodenal bleeding other cystoscopy other percutaneous procedures on biliary tract insertion of indwelling urinary catheter percutaneous hepatic cholangiogram replacement of stent (tube) in biliary or pancreatic duct endoscopic insertion of stent (tube) into pancreatic duct diagnoses: chronic hepatitis c without mention of hepatic coma acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia chronic airway obstruction, not elsewhere classified gout, unspecified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) sepsis constipation, unspecified acute respiratory failure other specified cardiac dysrhythmias malignant neoplasm of head of pancreas other specified disorders of biliary tract encounter for palliative care hemorrhage of gastrointestinal tract, unspecified obstruction of bile duct delirium due to conditions classified elsewhere unspecified gastritis and gastroduodenitis, without mention of hemorrhage pseudomonas infection in conditions classified elsewhere and of unspecified site malignant neoplasm of intrahepatic bile ducts arthropathy, unspecified, site unspecified pernicious anemia other symptoms involving urinary system 

Answer: The patient is high likely exposed to