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: azithromycin / zosyn / meropenem attending: chief complaint: anemia, abdominal pain. major surgical or invasive procedure: none history of present illness: 69year old male, known very well to dr. , s/p a whipple in with postoperative complications of anastamotic leaks and failure to thrive, as well as a known ec fistula. he was recently discharged from the hospital after a long course of treatment for klebsiella bacteremia from hepatic abscesses and obstructive cholangitis and issues with enteral feedings. he was seen at dr. clinic last friday, at which time his pigtail drains were removed, because the previous abscesses had resolved, although new smaller ones, not amenable to drainage were noted. he was to continue his antibiotics for 2 more weeks after drain removal. . he now returns from with a reported hct of 20. he reports feeling fatigued, more from baseline. he says that he still has poor po appetite, but is tolerating tube feeds at 90cc/hr overnight. he does note that he has up to 3 loose bowel movements. past medical history: pmhx: adenocarcinoma (duodenum), htn, peptic ulcer disease . pshx: s/p gastric resection for pud s/p revision with roux-en-y and partial gastrectomy in s/p whipple s/p . drainage of intra-abdominal abscess through reopening of recent laparotomy; repair of pancreaticojejunostomy through a bridge stent technique; mass closure of the abdominal wall for pancreatic and biliary fistula, and intra-abdominal abscess s/p tracheostomy s/p gj-tube placed on . s/p picc line placed on . s/p hepatic drains placed on -- removed s/p right-sided thoracentesis on . s/p j-tube placement via ec fistula and social history: he used to work as property manager but is now retired. married; wife and grown children very involved. he has 40 pack-year smoking history; quit a while back. no alcohol use. family history: non-contributory. physical exam: on admission: vs: 97.5, hr 100, bp 120/80, rr 18, o2sat 99% genl: nad, gaunt cv: rrr resp: cta-b abd: s/nt/nd; jtube in place via ec fistula; bilious drainage in fistula bag extr: no c/c/e . at discharge: vs: gen: gaunt, thin in nad. heent: mild scleral icterus. o-p clear. neck: supple. lungs: cta(b) cor: rrr abd: scaphoid. multiple well-healed surgical incisions. lower abdominal ec fistula through which j-tube enters. j-tube intact/patent. ec fistula/j-t complex covered with ostomy appliance with bilious drainage. bsx4. soft/nd. extrem: no c/c/e. neuro: a+ox3. flat affect. pertinent results: on admission: 08:20pm glucose-99 urea n-34* creat-1.4* sodium-136 potassium-4.9 chloride-97 total co2-28 anion gap-16 08:20pm wbc-3.8*# rbc-2.42* hgb-7.5* hct-22.7* mcv-94 mch-30.8 mchc-32.9 rdw-15.9* 08:20pm neuts-58.8 lymphs-20.9 monos-7.7 eos-11.5* basos-1.1 08:20pm plt count-370 08:20pm pt-11.7 ptt-24.2 inr(pt)-1.0 . at discharge: 06:45am blood wbc-4.7 rbc-3.07* hgb-8.9* hct-28.5* mcv-93 mch-29.0 mchc-31.2 rdw-17.0* plt ct-233 02:47am blood neuts-91.8* lymphs-4.8* monos-2.6 eos-0.5 baso-0.2 06:45am blood plt ct-233 06:45am blood glucose-110* urean-18 creat-0.9 na-136 k-4.9 cl-102 hco3-29 angap-10 06:45am blood alt-14 ast-21 ld(ldh)-107 alkphos-567* totbili-4.4* 12:56pm blood lipase-61* 12:56pm blood ck-mb-notdone ctropnt-0.02* 02:38am blood ck-mb-notdone ctropnt-0.01 01:04am blood ck-mb-notdone ctropnt-0.02* 06:45am blood albumin-2.2* calcium-8.0* phos-2.7 mg-1.9 . imaging: ct abd/pelvis w/contrast: interval decrease in size of multiple gas containing hepatic fluid collections. there are new ill-defined hypodense lesions within the lateral right hepatic lobe, which are suspicious for new foci of infection given the short interval time course. there is a tiny new fluid collection in the right lateral abdominal wall in the area of prior drain, measuring approximately 1.8cm maximally. otherwise, no new fluid collections are identified. . portable abdominal x-ray: only a supine portable view of the abdomen is submitted for interpretation, precluding assessment for free intraperitoneal air. considering the clinical concern, either a fully upright or left lateral decubitus view would be recommended. a percutaneous feeding tube is present terminating in the expected location of the jejunum. a non-obstructive bowel gas pattern is visualized. . cxr: interval placement of right subclavian catheter terminating in the lower svc with no evidence of pneumothorax. examination is otherwise unchanged since the recent study except for development of linear atelectasis at the left lung base. . ecg: tracing submitted late and out of sequence. rhythm is probably sinus tachycardia but consider also possible atrial tachycardia given the markedly rapid rate. probable left anterior fascicular block. qtc interval may be prolonged but is difficult to measure. modest st-t wave changes. findings are non-specific. clinical correlation is suggested. since the previous tracing of marked tachycardia is now present and modest st-t wave changes are seen. intervals axes: rate pr qrs qt/qtc p qrs t 169 0 80 292/482 0 -53 62 . mrcp (mr abd w&w/oc): correlation is made with prior ct performed on . findings: again noted are multiple peripherally enhancing hepatic fluid collections containing foci of gas consistent with abscesses. allowing for differences in technique, these are not significantly changed in size, and no new collections are identified. for example, the collection within segment vii posteriorly measures 2.9 x 3.3 cm in its entirety, with the central fluid component measuring 1.7 x 1.1 cm. the central fluid component on prior ct measured 1.6 x 1.5 cm. the collection within segment measures 2.7 x 1.9 cm in its entirety, with the anterior central fluid component measuring 0.9 x 0.9 cm. this is difficult to compare to the prior ct, but appears stable to smaller. there are two foci of enhancement within the right lateral abdominal wall in the site of prior drainage catheter tracts. there are no focal fluid collections within the abdominal wall. again noted are postsurgical changes from whipple procedure. there is no intra- or extra-hepatic biliary dilatation. mrcp images are limited, but there is no obvious focal stricture. the remaining pancreas is atrophic and the pancreatic duct is mildly prominent. there are stable retroperitoneal lymph nodes. there are bilateral nonenhancing renal cysts. a cyst within the posterior left renal mid pole is bright on t1 pre-contrast images, consistent with hemorrhagic or proteinaceous fluid. the left kidney is mildly atrophic compared to the right. there is mild diffuse anasarca. susceptibility artifact is noted in the anterior abdominal wall from multiple surgical clips. the spleen and adrenal glands are normal. the visualed abdominal bowel loops are nondilated, and there is no ascites or new focal fluid collection. limited images of the lower chest demonstrate loculated right pleural fluid and atelectasis and minimal left pleural fluid. the visualized bone marrow signal is unremarkable. a percutaneous jejunostomy tube is identified. multiplanar reformations and subtraction images provided multiple perspectives for the dynamic series. impression: 1. multiple hepatic abscesses, not significantly changed in size given differences in technique. no new fluid collections are identified. there is enhancement within the right lateral abdominal wall in the region of prior drainage catheters, without focal fluid collection. 2. stable post-surgical changes from whipple, with no evidence of biliary dilatation. 3. bilateral renal cysts. brief hospital course: the patient was admitted to the general surgical service on for evaluation of the aforementioned problem. was continued on a regular diet with supplements, cycled tubefeeds via the j-tube, which enters the duodenum via a ec fistual, on home medications and oral antibiotics, the latter consisting of ciprofloxacin, clindamycin, and linezolid. these antibiotics were prescribed during his last admission for abdominal abscesses, which grew out pseudomonas, mrsa and beta strep. upon admission, his hgb was 7.5 and hct 22.7, for which he was transfused 2 units of prbcs without adverse event. nutrition, ostomy nurse, physical therapy, and occupational therapy were consulted early during this admission. infectious disease also followed the patient during the admission. overall, the patient was hemodynamically stable. on hd#2, the patient received an additional unit of prbcs responding with a hgb of 10.4 and hct of 31.4. urine and blood cultures were sent. he was given supplemental hydration with lactated ringer's via the j-tube. tolerated tubefeeds at goal, but only fair intake of his diet. early on , the patient became hypotensive, acutely confused and briefly unresponsive. he was transferred to the sicu. a cxr, ecg, labwork, and blood cultures were performed. a foley catheter and a-line were placed. the ekg was unremarkable, and the cxr showed moderate (r) pleural effusion increased, rightward mediastinal shift with opacification in (r) lower lobe most likely representing atelectasis. he was given a 1l lr bolus with good response. he was started on iv flagyl for possible colitis. a abdominal/pelvic ct with contrast demonstrated interval improvement in the hepatic fluid collection and a few small new collection less than 1.8cm in size. trophic tubefeeds were started. the next sicu day, his diet was restarted and trophic tubefeeds continued. he experienced another episode of hypotension on , and was again bolused with a total of 725ml lr with good response. tubefeeds were again held. a cvl was placed, and iv cefepime was added for temperature spikes to cover pseudomonas. on , he remained hemodynamically stable. he was restarted on tubefeeds, this time continuous advancing to goal, which he tolerated. given that he continued stable into , he was transferred back to the inpatient floor. early on , the patient again experienced an episode of confusion. heart rate was tachy between 104-125, other vital signs were stable. no fever or leukocytosis. labwork, blood and urine cultures were sent. later that morning, his mental status returned to baseline. on , the patient underwent mrcp, which revealed multiple hepatic abscesses, but not significantly changed in size given differences in technique, and no new fluid collections. given these finding demonstrating overall improvement and potential risks of interventional biospy, it was ultimately determined in consultation with infectious disease to forego planned ultrasound-guided aspiration and biopsy of one or more of the liver abscesses. infectious disease continued to follow along, updating antibiotic recommendations. on , cefepime, clindamycin, and cipro were discontinued, with the patient continued on flagyl. the lineolid was completed on . the flagyl will be continued until outpatient infectious disease follow-up appointment on . other than that mentioned above, the hospital course back on the floor was unremarkable. he ambulated early and frequently with nursing or physical therapy, was adherent with respiratory toilet and incentive spirrometry, and actively participated in the plan of care. the patient received subcutaneous heparin and venodyne boots were used during this stay. the patient's blood sugar was monitored regularly throughout the stay; sliding scale insulin was administered when indicated. his labwork was monitored regularly; electolytes repleted when needed. after his foley was discontinued, he voided without problem with an adequate urine output. he tolerated cycled tubefeeds via the j-tube and a regular diet. marinol was added on to stimulate his appetite. he was also started on viokase and imodium prn for loose stools with improvement. at the time of discharge on , the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, although with poor intake, ambulating, voiding without assistance, and pain was well controlled. he was tolerating cycled tubefeeds via the j-tube, placed through the ec fistula. the ostomy appliance as ordered remained intact. the patient was discharged to an extended care facility. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: 1. ursodiol 300 mg capsule sig: two (2) capsule po bid (2 times a day). 2. triamcinolone acetonide 0.1 % cream sig: one (1) appl topical (2 times a day) as needed for pruritus. 3. fentanyl 50 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 4. metoprolol tartrate 50 mg tablet sig: one (1) tablet po twice a day. 5. hydromorphone 2 mg tablet sig: 1-4 tablets po q3h (every 3 hours) as needed for pain. 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. 7. zofran 8 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. 8. ammonium lactate 12 % lotion sig: one (1) liberal application topical four times a day as needed for dry skin, pruritus. 9. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 10. metoclopramide 10 mg tablet sig: one (1) tablet po qid 11. clindamycin hcl 150 mg capsule sig: three (3) capsule po q6h 12. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h 13. linezolid 600 mg tablet sig: one (1) tablet po q12h discharge medications: 1. ursodiol 300 mg capsule sig: two (2) capsule po bid (2 times a day). 2. triamcinolone acetonide 0.1 % cream sig: one (1) appl topical (2 times a day) as needed for pruritus. 3. fentanyl 50 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). disp:*10 patch 72 hr(s)* refills:*0* 4. metoprolol tartrate 50 mg tablet sig: one (1) tablet po twice a day. 5. hydromorphone 2 mg tablet sig: 1-3 tablets po q3h (every 3 hours) as needed for pain. disp:*70 tablet(s)* refills:*0* 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. 7. zofran 8 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. 8. ammonium lactate 12 % lotion sig: one (1) liberal application topical four times a day as needed for dry skin, pruritus. 9. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 10. dronabinol 2.5 mg capsule sig: one (1) capsule po bid (2 times a day). 11. amylase-lipase-protease 30,000-8,000- 30,000 unit tablet sig: two (2) tablet po tid with meals (). 12. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for diarrhea. 13. flagyl 500 mg tablet sig: one (1) tablet po every eight (8) hours: d/c date to be determined at infectious disease follow-up. discharge disposition: extended care facility: - discharge diagnosis: 1. recurrent cholangitis 2. refractory intra-hepatic abscesses 3. anemia discharge condition: stable discharge instructions: please call your doctor or nurse practitioner or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down 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. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon. avoid driving or operating heavy machinery while taking pain medications. . general drain care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *if the drain is connected to a collection container, please note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or nurse if the amount increases significantly or changes in character. be sure to empty the drain frequently. record the output, if instructed to do so. *ostomy bag around j-tube as directed by ostomy nurse discharge instructions (see page 2). *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. . ostomy care and appliance changes: 1. cleanse peri tube skin with warm water and pat dry. 2. apply no sting barrier wipe to peritubular tissue 3. cut opening on coloplast urostomy pouch # 5585 1/8th inch larger apply seal on the back of the pouch. press into place. reapply backing onto pouch wafer with slit cut for easier removal. cut small opening into the anterior of the bag for tube attachment device. apply the tube attachment device to the pouch. 4. cut very small slit bilateral tube holder so that the feeding tube will slide thru. this material is stretchy so it does not need to be a large slit. 5. place pouch over the tube and with clamp slide through the tube attachment device and grab the feeding tube (may unscrew end piece to allow for smaller diameter to pass through tube holder.) stabilize the base of the tube and with the clamp pull the tube through the attachment device. 6. place the pouch on the skin and mold into place. 7. secure edges of pouch and holder with pink hy tape. 8. apply a warm pack over the pouching system to mold in place. 9. encourage patient to lie flat for 30 minutes after pouch change. 10. attach pouch to bedside drainage, other wise empty pouch when it is full. followup instructions: please call ( to arrange a follow-up appointment with dr. (pcp) in weeks. . provider: scan phone: date/time: 11:00 provider: , md phone: date/time: 11:45 . provider: , md phone: date/time: 10:10. location: , basement, . procedure: enteral infusion of concentrated nutritional substances injection or infusion of oxazolidinone class of antibiotics diagnoses: anemia of other chronic disease unspecified pleural effusion unspecified essential hypertension unspecified protein-calorie malnutrition paroxysmal ventricular tachycardia hypotension, unspecified surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation abscess of liver diarrhea dehydration cholangitis personal history of malignant neoplasm of other gastrointestinal tract mechanical complication of colostomy and enterostomy persistent postoperative fistula body mass index less than 19, adult 

Answer: The patient is high likely exposed to