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: one week of nausea, vomiting, anorexia, one day of acute dyspnea major surgical or invasive procedure: paracentesis history of present illness: pt is a 59 y/o man with h/o pancreatic ca diagnosed in at , with metastases to liver, s/p attempted percutaneous transhepatic drainage, s/p open t tube placement with interval attempted whipple procedure in , s/p cisplatin 10 days prior to admission, who presented to ed on with 1 week h/o n/v, anorexia, and acute dyspnea. pt had returned from 3 d pta. on the morning of admission, the pt awoke with dyspnea, weakness and disorientation, was found wandering around his bathroom opening windows to "get some air." no fever or chills. no nausea/vomiting today. no chest pain/palpitations. no abdominal pain, melena, dysuria, hematochezia. on arrival to ed, the patient's blood pressure was 130s/70s and he was tachycardic to 130. bp trended down over 4 hours, at nadir, vs: bp: 89/61 hr 99 rr: 18 satting 95% 2l nc. (91% ra). had cta showing a subsegmental pulmonary embolism in the right lower lobe. labs demonstrated a wbc ct of 22, 93% neutrophils, no bands. lactate 2.2. abd ct showed large amount of ascitic fluid. paracentesis done revealed 10,325 wbc (94 poly, 1l, 5m), 450 rbc, 3 protein, 182 glucose, 228 ldh, with peritoneal fluid gram stain 4+pmh, no microorganisms, fluid cx positive for few enterococcus from broth ( to amp, levo, pcn w/ vanco pending), anaerobic bottle: gnr, beta lactamase pos. blood cx with ngtd. in the ed, he got 6l ns, vancomycin iv 1gm, levofloxacin 500mg, flagyl 500mg, and heparin infusion before micu called. in micu, he was continued on zosyn, levoflox, and vanco was added, then d/c'd . he was aggressively fluid resuscitated. during his stay in the micu, he continued to improve, tolerating po, afebrile, wbc ct trending down. iv heparin drip was continued for his pe, transitioned to lovenox on transfer to floor. . also of note, cxr and cta chest showing small left pleural effusion, with rul consolidation w/ cavitation. past medical history: 1. pancreatic ca: diagnosed 3 months ago, with mets in liver, s/p whipple 1 month ago, s/p cisplatin 10 days ago 2. s/p whipple procedure 3. htn 4. dm2: controlled w/ insulin social history: lives w/ wife in , works as a contractor (currently on leave of abscence), has a son who is a resident in and another son who plays the violin professionally. he has smoked 120 pack-years but quit 5 years ago, no alcohol or ivdu. family history: no h/o ca or cad. two sons are healthy. physical exam: pe: temp: 98.0 bp: 98/53 p: 81 rr: 11 oxygen sat: 100% 3l nc i/o: 742/610 +132 gen: cachectic russian-speaking only man lying flat in bed, speaking in full sentences in nad. heent: anicteric, eomi, perrl, op clear w/ dry mm, no lad cv: reg s1/s2, +1/6 systolic murmur loudest at lusb, no s3/s4/r pulm: cta b, no wheezes or crackles abd: distended, tympanitic to percussion, 10cm vertical surgical incision in midline is well healed, several small scars lateral to central scar, +bs, soft, tender ruq, no rebound tenderness, no sign. small subcutaneous nodules felt luq, and rlq (? lovenox injections) ext: warm, faint dp b, trace edema bilaterally neuro: a/o, moving all extremities, able to follow commands, no focal deficits. pertinent results: admission ekg: sinus tach @ 130 bpm, nl axis, nl intervals, no st changes, no prior tracing for comparison . cxr(): left sided pleural effusion, rounded opacity in rul zone w/ suggestion of cavitation. no pulm edema. . ct(): probable isolated subsegmental pulmonary embolus in the right lower lobe. moderate amount of free air and large amount of ascites in the abdomen. large pancreatic mass measuring 4.6 x 4.5 cm, which compresses and nearly occludes the portal vein and the distal splenic vein. the smv is patent. large left adrenal mass is suspicious for metastatic disease, but the appeareance is nonspecific. right upper lobe of the lung consolidation with cavitation. small left pleural effusion. per surgical note/read: also with intraabd subphrenic abscess after recent laparotomy. did not rec. drainage. . cxr (): new small right pleural effusion and unchanged right upper lobe opacity, left basilar opacity and left pleural effusion . cxr : rul cavitary lesion between 2.5 and 3.0 cm, unchanged in size, however, new four peribronchial consolidations suspicious for progressive infection. . kub: : partial sbo vs. ileus, ngt in stomach . : liver doppler us: several areas of focal heterogeneity, with echotexture c/w metastatic lesions. several hypoechoic focal linear lesions seen throughout liver that likely represent pneumobilia. lesion seen in falciform ligament, likely peritoneal mets. significant ascites. irregular slow flow through portal vein. . : portable cxr showing no significant change. moderate bilateral pleural effusions present. ngt in place. subclavian line in place, no ptx. . : ct of the abdomen with iv contrast: impression: 1. a 5.0 x 4.7 cm mass in the pancreatic head, corresponding to the patient's known pancreatic cancer. there is extension of this into the adjacent duodenum, and extensive hepatic, mesenteric, and left adrenal metastases. the main venous and arterial vasculature appears to be widely patent. the patient is status post whipple for this, and changes relating to surgery can be identified. 2. extensive ascites. additionally, there are two small foci of air adjacent to the liver, which may be from recent intervention such as paracentesis. no other foci of air or oral contrast extravasation can be identified. there is no evidence of small or large bowel obstruction. 3. focal hypodensities within the kidneys which are too small to characterize. 4. bilateral moderate sized pleural effusions with associated atelectasis. 5. there are wedge-shaped areas of different attenuation within the liver which may represent focal fatty infiltration or perfusion abnormalities. . : cxr ap chest compared to and 29. although previous mild edema in the right upper lung has cleared, atelectasis has worsened and now the right middle, right lower and left lower lobes are collapsed. there is also at least a moderate amount of pleural effusion on both sides of the chest and unchanged. cardiac silhouette is obscured. there is probably mediastinal venous engorgement. tip of the left pic catheter projects over the left brachiocephalic vein. no pneumothorax. nasogastric tube ends in the stomach. right upper lobe nodules are noted. . ***cultures**** blood neg x4 peritoneal fluid pansens enterococcus, anaerobic bottle: bfragilis neg vre rectal swab neg mrsa blood neg x4 yeast >100k perionteal fluid no growth urine 10-100k yeast, fungal: yeast not c. albicans, afb pending blood cx neg x4 crypto neg in blood 11/30 peritoneal fluid: no growth, no fungus, no mycobacteria . **pathology** peritoneal fluid: blood and inflammatory cells, cytology negative for malignant cells brief hospital course: impression: 59-yo russian speaking man w/ pancreatic ca s/p failed whipple and cisplatin therapy, htn, dm2 admitted initially to micu fpr pulmonary embolism and spontaneous bacterial peritonitis, s/p iv heparin drip transitioned to lovenox subcutaneously, with sbp being treated with zosyn. the pt also demonstrates portal htn secondary to a pancreatic mass compressing the portal vein and splenic vein, with evidence of peritoneal mets on abdominal ultrasound. he is status post 3 paracenteses this admission (first , 2nd , 3rd ) with first growing enterococcus and bacteroides fragilis. the 2nd and 3rd show no growth. despite multiple consultations with liver, infectious disease, renal and surgery specialists, the patient's prognosis remained poor, and despite agressive treatment with paracenteses, intravenous antibiotics, ivf, intravenous heparin, the patient expired on . he remained full code until the morning of his death, wherein he desaturated in the setting of volume overload and bilateral pleural effusions. plans were instituted for icu transfer, thoracentesis, possible intubation, however, the patient stated he did not want further agressive measures taken. multiple meetings were held with family members throughout his course to discuss his prognosis and options. on the morning of his death, he and his wife (his health care proxy), along with his sons, determined that he did not want further measures taken, and he wanted to be comfortable. he was made comfortable on a morphine drip and expired in the afternoon, surrounded by his family. . 1. infectious disease: thought to have sbp on admission, pt met criteria for sepsis given tachycardia, elevated wbc count, with evidence of sbp on fluid studies. s/p 9l ivf for fluid resuscitation over 24 hours. pt did not require pressors and he made gradual improvement in micu. wbc ct was trending down, pt remained afebrile x 3 days, tolerating po, and was transferred from micu to medical floor. iv zosyn was continued. vanco was d/c'd . wbc elevated on to 19.7. concern for sepsis to bacterial peritonitis from recent surgical procedure/instrumentation vs. questionable abscess on ct abd according to surgical opinion (again likely to recent failed surgical attempt at removal off mass, ct showing free air/bubbles/septations/loculated ascites) vs. partial sbo/intermittent sbo causing translocation of enteric organisms across bowel wall. other potential sources included the cavitary lesion seen on cxr therefore there was a questions of a possible necrotizing pna with his b/l pleural effusions (at the time felt to be less likely, most reasonable explanation is old tuberculosis infection but cannot r/out reactivation, especially given the new pt was transfered to isolation room, 3 sputum cx sent, and were much later found to be positive for tuberculosis, infection control notified, as were the health care workers exposed). it was decided, after consultation with infectious disease team, to not start ambisome (for fungal necrotizing pna coverage) because the pt had stable oxygen sats in the setting of no treatment for ? fungal pna and we felt he was most likely volume overloaded from repeated fluid boluses on micu and the medical floor. he was diuresed for volume overload with iv lasix. the patient remained on vanco/zosyn for broad coverage including coverage of enterococcus and bacteroids growing from pleural fluid. iv vancomycin and zosyn were continued until the patient was made cmo on . . 2. portal vein compression- the patient had evidence on abd ct of pancreatic mass nearly occluding portal vein. it was thought that there was accumulation of ascites secondary to portal htn/decline liver portal vein compression. liver was consulted to comment on whether there would be a benefit to placing a portal vein ir-guided stent through the area of compression. after consultation with the liver team, it was agreed there would be little utility in this procedure. a liver ultrasound completed with dopplers showed slow flow through portal vein, w/ significant ascites. the liver team felt the pt would need palliative paracenteses periodically as he reaccumulates ascites. the pt received a total of three paracenteses during his admission. he underwent his third and final therapeutic/diagnostic tap on with cytology negative, fluid cx negative, neg for mycobacteria or fungus as well. . 3. oliguria, resolved: the patient developed oliguria after transfer to the medical floor from the micu. his oliguria was most likely intravascular volume depletion prerenal etiology from poor po intake. early hepatorenal syndrome vs. cisplatin nephrotoxicity was also considered, and a renal consult was initiated. he was initially started on octreotide and mitodrine, however, this was tapered off over 3 days, as hepatorenal syndrome was felt to be less likely after noting the pt's uop responded to ivf boluses and ivf hydration. his fena was <0.05%, consistent with prerenal etiology. his ins and outs were strictly monitored during this admission. all nephrotoxic medications were held and contrast was held in the setting of his oliguia. his uop returned to , and the renal consultants signed off. . 4. liver failure. the patient demonstrated low liver function tests, likely secondary to diseased liver without synthetic function at this stage, with his pt increasing slowly over time, albumin decreasing 1.5->1.2 prior to initiation of albumin. his platelets, albumin, and glucose was closely followed this admission. the pt demonstrated liver mets from his primary pancreatic malignancy. he had multiple hypoattenuating areas seen on abd ct, which corresponded to metastatic foci. additionally, there are large wedge-shaped areas of difference in attenuation involving portions of the left and right lobes which suggest a perfusion difference or areas of fatty infiltration on abd ct. . 5. hypoxia: throughout the patient's admission, he required 3l oxygen by nasal cannula to maintain sats above 95%. his oxygen requirement was this likely to his small pulmonary embolism vs. massive ascites accumulating and pushing up on the diaphragm limiting respiration. his oxygen saturation was monitored closely. he desatted two times during this admission, most likely secondary to volume overload from repeated fluid boluses, and was given nebs, iv lasix with improvement in respiratory status. on the morning of his death, the patient desatted to upper 70s, was given nebs, iv lasix, with cxr showing volume overload (and prior rul cavitary lesion), abg concerning, thus micu consult was initiated. pt refused the micu consult and stated he did not want to be intubated, and did not want further measures taken regarding his medical care. he requested to be made cmo. he was started on morphine, and his breathing was made comfortable. he expired later in the afternoon. posthumously, the patient's tuberculosis sputum cultures came back positive for mycobacteria tuberculosis. indeed, the pt's cxr demonstrated a concerning rul cavitary lesion. after transfer to medical floor, he was put in an isolation room, and tuberculosis precautions were taken. infection control was notified. his son brought in prior from 10 years ago, and these demonstrated rul discrete lesions, likely granulomas, no cavitation. appropriate health care personnel and occupational health were notified. . 6. pulmonary embolism, small subsegmental pe in rll. he was initially started on an iv heparin drip with goal ptt 60-80, then transitioned to lovenox prior to transfer to the medical floor from the micu. he remained on lovenox until he was made cmo/dnr/dni. . 7. pancreatic ca: s/p failed whipple in now c/b ?abscess, bacterial peritonitis. also with mets on ct to adrenals and liver. patient initially seen at where dx was made with liver bx, and elevated tumor markers. also s/p 10 days of cisplatin in , although records were not available from . the family was informed of the pt's poor prognosis (his son is a third year medical resident). the pt was told by the surgical service, as well as the primary team that he was a poor surgical candidate. hematology/oncology at was called, and stated that gemcitabine would be a possible option (as an outpatient), with 30% response rate, impossible to predict responders. also, this tx could potentially only incr life span by a few months. no role for palliative chemo to decr size of mass compressing the portal vein. . 8. type ii dm: his glucose levels were well controlled with an insulin sliding scale, and fingersticks were checked four times daily. . 9. constipation, most likely pain medications. he was given a bowel regimen and milk of magnesia. he responded well to fleet enemas prn. . 10. pain: well controlled. the pt's pain was controlled on fentanyl and dilaudid, with no pain complaints. . medications on admission: 1. ms contin 30mg 2. fentanyl patch 100mcg q 72 hours 3. dilaudid 4mg po q 4 hours prn 4. zofran 4mg po q 8 hours prn 5. reglan 10mg po tid 6. marinol 5mg tid 7. paxil 20mg daily discharge medications: none, pt expired . discharge disposition: expired discharge diagnosis: 1. pulmonary embolism 2. spontaneous bacterial peritonitis 3. metastatic pancreatic cancer status post failed whipple procedure, chemotherapy 4. oliguria secondary to prerenal azotemia 5. pulmonary tuberculosis with right upper lobe cavitary lesion 6. portal hypertension secondary to compression of portal vein by tumor 7. hypertension 8. type ii diabetes mellitus 9. anemia of chronic disease 10. constipation 11. chronic pain discharge condition: expired .. post mortem the state lab confirmed he was infected with m. tuberculosis. discharge instructions: none, pt expired . followup instructions: not applicable md procedure: venous catheterization, not elsewhere classified percutaneous abdominal drainage diagnoses: anemia, unspecified malignant neoplasm of liver, secondary unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled severe sepsis long-term (current) use of insulin septic shock streptococcal septicemia other pulmonary embolism and infarction unspecified intestinal obstruction volume depletion, unspecified secondary malignant neoplasm of retroperitoneum and peritoneum spontaneous bacterial peritonitis portal vein thrombosis malignant neoplasm of other specified sites of pancreas 

Answer: The patient is high likely exposed to