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: sulfa (sulfonamides) attending: chief complaint: hypotension major surgical or invasive procedure: tibeocalcaneal fusion history of present illness: this is a 75 yo m with charcot deformity of the left lower extremity admitted for left tibeocalcaneal fusion social history: from nh in . no tob or ivdu. unclear history of alcohol use. family history: n/c physical exam: from icu admit: bp 132/62 hr 108 rr 18 (intubated) o2 100% on vent genrl: in distress, appears in pain, uncomfortable with tube heent: ncat, perrla, mmm neck: no jvd, neck supple cv: irreg, irreg, slightly tachycardic, no m/r/g pulm: cta (anteriorly) abd: nabs, soft, nt/nd extr: left leg in cast, left foot cold, right foot with diminished pulses pertinent results: 04:00pm glucose-161* urea n-16 creat-0.9 sodium-139 potassium-4.7 chloride-107 total co2-24 anion gap-13 04:00pm calcium-9.3 phosphate-3.3 magnesium-1.9 04:00pm digoxin-1.3 04:00pm wbc-2.8* rbc-3.36* hgb-9.4* hct-27.3* mcv-81* mch-27.9 mchc-34.3 rdw-17.5* 04:00pm plt count-115* 04:00pm pt-13.3* ptt-27.6 inr(pt)-1.2* 07:37pm urine blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 07:37pm urine rbc-22* wbc-0 bacteria-rare yeast-none epi-0 . c diff negative x 3 blood cx : no growth urine cx : contaminated. . colon bx pathology: pending . cxr : pa and lateral chest: compared to . heart size is normal. mediastinal and hilar contours are unremarkable. there is a left-sided subclavian line with its tip in the region of the left brachiocephalic vein just short of midline. no focal consolidation or other acute cardiopulmonary process. stable appearing calcified pleural plaques. impression: no acute cardiopulmonary process. . ten radiographs of the left foot are submitted. the external fixator seen on has been removed. previously seen antibiotic beads are no longer present. patient is now seen to be status post arthrodesis of the first tarsal-metatarsal joint. a bone stimulator is present with the electrodes seen along the junction of the tibia and hindfoot. vascular calcifications are noted. limited assessment of the knee joint is grossly unremarkable. fine osseous and soft tissue detail is obscured by overlying casting material. postoperative change involving the second through fifth metatarsals remains similar in appearance. proximal phalanx of the third toe is again noted to be surgically absent. with the exception of the first ray arthrodesis, the forefoot findings remain similar in appearance. . fluor guided picc placement: impression: successful placement of 4 french single lumen picc line placement via left brachial vein approach. final catheter length is 47 cm. tip position is in the high right atrium. the catheter is ready to employ. post- procedural orders written. . port assessment by fluoro: description of procedure: timeout was performed to identify the patient, the procedure to be performed, the site of the procedure, appropriate requisition, and appropriate informed consent. once the above were verified, the patient was positioned in supine fashion on a special procedures table. the left- sided single lumen chest port was noted to have an access needle in place underneath the transparent dressing. utilizing usual aseptic precautions, the hub of the access needle was accessed and contrast administered by hand injection under fluoroscopy. images demonstrate the proximal limb of the port catheter to be retained in the distal left brachiocephalic vein, just distal to the confluence of both the right and left brachiocephalic veins in close apposition to the vein wall inferiorly. infusion of the port and the port catheter was then possible, however, aspiration was not possible. no superior vena cava obstruction is seen. the contrast column was seen in continuity to the level of the right atrium. (a dsa venogram was performed and recorded.) impression: suboptimal tip positioning of port catheter in left brachiocephalic vein as described above. no evidence of svc stenosis. unable to aspirate from the catheter. . ct chest with iv contrast: airway patent to the segmental level. there are no pathologically enlarged lymph nodes in the axilla, mediastinum, or hilum. scattered shotty mediastinal lymph nodes, all less than a centimeter in short axis. there is prominent coronary artery and diffuse vascular calcification. central venous line in place with its tip in the distal svc. heart, pericardium, and great vessels are otherwise unremarkable. mild emphysema. there are several tiny pulmonary nodules less than 5 mm in diameter. the most prominent is in the right upper lobe (series 9, image 21) measuring 4 mm. tiny (2-mm) pulmonary nodules in the right lower lobe (9, 37), and left lower lobe (9, 40). tiny nonspecific subpleural nodular opacity in the right upper lobe (9, 25). extensive calcified pleural plaques, likely the sequela of prior asbestos exposure. dependent posterior pleural thickening/small effusions. ct abdomen with and without iv contrast: non-contrast portion of the scan demonstrates diffuse dense vascular calcification, gallstones, and large right-sided renal calculi, one within the pelvis at the mid pole and the other within the proximal ureter. there are some surrounding inflammatory changes, but no evidence of significant hydronephrosis from these calculi. small non- obstructing left-sided calculi are also present. mild-to-moderate splenomegaly is noted. contrast-enhanced portion through the abdomen demonstrates a nodular liver with volume redistrubution with patchy perfusion of the peripheral aspect of the right lobe, and it is difficult to exclude an infiltrating lesion, especially in segment v/vi. additionally, there are several small hypoattenuating lesions within segment , , iii, and vi, which are too small to characterize. while these lesions may represent small cysts or hemangiomas, metastases are not excluded. portal venous system appears patent. no thrombus is visualized within the hepatic veins. minimal fullness of the anterior limb of the left adrenal gland without distinct nodularity. there are several tiny shotty mesenteric and retroperitoneal lymph nodes, most prominent around the celiac axis, however, none are pathologically enlarged by ct criteria. ct pelvis with iv contrast: there is circumferential mural thickening around the proximal sigmoid, concerning for primary colon cancer. there are diffuse diverticuli in this region, but no surrounding stranding to suggest acute diverticulitis. however, more superiorly along the lateral aspect of the descending colon, there are mild inflammatory changes and fluid, nonspecific in nature. within the pelvis, there are small subcentimeter, but borderline left retroperitoneal nodes, measuring up to 8 mm in diameter. additionally, in the left deep pelvis just medial to the lower pole of the left kidney and at the level of the aortic bifurcation, there is a 3.3 x 3.3 well- circumscribed cystic lesion demonstrating a dense fluid level dependently, which could represent a necrotic lymph node. this node displaces, but does not appear to obstruct the left ureter. remainder of the colon demonstrates no evidence of other areas of lesions or mural thickening. there are vascular borderline enlarged bilateral inguinal lymph nodes. bone windows: there are diffuse degenerative changes and evidence of diffuse idiopathic skeletal hyperostosis involving the thoracic levels anteriorly, but no suspicious lytic or blastic lesions. isolated hyperdense focus in the right femur is likely a bone island. multiplanar reformats: coronal and sagittal reformatted images confirm the above findings. impression: 1) 4-cm segment of circumferential wall thickening involving the proximal sigmoid colon, presumably corresponding to the concerning mass seen on colonoscopy. 2) nodular liver with volume redistribution suggestive of cirrhosis. trace ascites and splenomegaly. 3) heterogeneous perfusion of the peripheral right lobe of the liver, most prominent in segment vi; difficult to exclude an infiltrating lesion; additionally there are several small hypoattenuating lesions in both lobes, too small to characterize; mri is recommended for further characterization. 4) approximately 3-cm well-circumscribed cystic lesion medial to the lower pole the left kidney, of uncertainty etiology; possibly a duplication cyst or necrotic lymph node. 4) borderline enlarged, hyperperfusing inguinal lymphadenopathy and subcentimeter, nonspecific left retroperitoneal lymph nodes. 5) several small (<5mm) pulmonary nodules bilaterally; short term follow-up is recommended. 6) right renal parenchymal and proximal collecting system calculi. brief hospital course: # chronic left foot osteomyelitis with charcot foot deformity: patient was admitted for left tibeocalcaneal fusion for treatment. his surgery was complicated by 2 l estimated blood loss intraoperatively with subsequent hypotension requiring icu admission. patient quickly stabilized and surgery was completed on . this second, less invasive surgery went will with an estimated 75 cc blood loss. patient remained hemodynamically stable postop. patient has been on vancomycin/levofloxacin/flagyl in house and will continue on vancomycin and flagyl x 2 weeks more, with possible extended course based on follow-up with dr. . patient has picc in place for iv antibiotics. he has been afebrile and wbc stable. his pain is controlled with prn oxycodone. he will need continued pt but is non-weight bearing on the left lower extremity. no bandage dressings are needed. these will be done by dr. in follow-up. . # acute blood loss anemia / hypotension / colon mass: patient had an estimated 2 liter blood loss intraoperatively. he had been transfused preop for hct 27, given history of bleeding with surgery but postop hct 26. patient was hypotensive to sbp 70s-80s requiring icu admission for levophed to maintain map > 60. suspect component of anesthesia, pain med, and blood loss were all contributors. he was bolused (total approx 15 liters) in the icu and quickly weaned off pressors. he has received a total of 13 units of prbc in house. his hematocrit slowly trended down on the floor with guaic positive stool and minimal bleeding on the bandage. gi was consulted and did a colonoscopy in house which showed an erythematous, friable, protruding, malignant appearing circumferential mass with ulceration and contact bleeding in the mid sigmoid at 30 cm. surgery was consulted and recommended a cea and ct scan. ct torso shows no clear mets but possible liver lesions which will be assessed intraoperatively by biopsy or ultrasound if the patient wishes to pursue operative treatment. cea was normal (< 1.0). patient will need follow-up scheduled with dr. to discuss possible surgical options. currently, pathology is pending. patient declined offer to discuss these findings with his family. hematocrit will need to be rechecked in 2 days (29.2 prior to discharge). egd showed erythema, granularity, and congestion in the stomach body compatible with gastritis and gastric erosion with active oozing of blood. -cap was successfully applied for hemostasis. patient is to continue on ppi and avoid nsaids. he is currently off asa. . # port failure: port placed at outside facility 1 year ago. we were unable to aspirate off the port but it does flush. ir study shows port is not in proper position and in a low flow vessel. outpatient follow-up will need to be arranged for removal. . # thrombocytopenia - platelets decreased from 261 to 67 postop. hit antibody was negative and dic panel unremarkable. suspect this was dilutional due to ivf and prbc. platelets improved to 198 prior to discharge. he had no further bleeding in the setting of his low platelets and thus did not require a platelet transfusion. . # coagulopathy: inr also slightly elevated preop, as well as ptt. again, suspect this was dilutional. however, inr improving with sq vitamin k. . # paf: patient is not on anticoagulation, but will follow-up with his pcp as an outpatient to consider starting this. he is on digoxin for rate control. . # diastolic chf: patient is preload dependent. he is on standing lasix at home, which has been restarted. . # h/o etoh abuse: patient had no requirement for benzos on his ciwa scale. he is on thiamine, folate, and a multivitamin. . # hyperglycemia: patient was started on metformin last admission. this can be restarted if his creatinine is stable in 2 days. he was taking metformin 500 mg po bid. he is on a regular sliding scale insulin scale currently for blood sugar control. consider restarting asa once gi issues resolve. . # ppx - lovenox for dvt ppx until ambulating. mrsa precautions. . # access - picc in place . # dispo: patient discharged back to rehab and nursing center medications on admission: percocet, iron 325 mg po tid, protonix 40 mg po qd, thiamine 100 mg po qd folate 1 mg po qd, digoxin 250 mcg po qmon,wed,fri and 125 mcg qtues,thurs,sat; lasix 20 mg po qd discharge medications: 1. lovenox 40 mg/0.4 ml syringe sig: one (1) injection subcutaneous once a day: until ambulating. 2. lasix 20 mg tablet sig: one (1) tablet po once a day. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po once a day. 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. digoxin 250 mcg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 8. digoxin 125 mcg tablet sig: one (1) tablet po 3x/week (tu,th,sa). 9. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 weeks: patient to follow-up with dr. regarding possibly extending antibiotic duration. 10. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 2 weeks: patient to follow-up with dr. regarding possibly extending antibiotic duration. 11. insulin regular human 100 unit/ml solution sig: one (1) injection injection four times a day: per sliding scale. 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 14. oxycodone 5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain: hold for rr < 8 or oversedation. discharge disposition: extended care facility: rehab discharge diagnosis: colon mass, probable malignancy left foot chronic osteomyelitis s/p tibeocalcaneal fusion acute blood loss anemia port-a-cath failure history of type 2 diabetes history of paroxysmal atrial fibrillation history of diastolic heart failure discharge condition: good: pain controlled, afebrile, hematocrit stable discharge instructions: please monitor for temperature > 101, decreased mental status, bright red blood in the stool, diarrhea, or other concerning symptoms. please avoid taking your aspirin for now. please follow-up with dr. to discuss when it is safe for you to restart this medication. followup instructions: please call to schedule follow-up with dr. for this week. phone: ( please call to schedule follow-up with dr. on the same day to discuss possible surgical options for your colon mass, which is likely cancer. phone: ( please follow-up with the surgeon that placed your port, to schedule a surgery to have that removed as it is not working and puts you at risk of developing a clot in your blood vessel. this should be done within the next 1-2 weeks. please follow-up with dr. in weeks for a routine check-up. phone: procedure: venous catheterization, not elsewhere classified endoscopic control of gastric or duodenal bleeding closed [endoscopic] biopsy of large intestine application of external fixator device, tibia and fibula transfusion of packed cells application of external fixator device, tarsals and metatarsals ankle fusion infusion of vasopressor agent application of external fixator device, ring system excision of bone for graft, tarsals and metatarsals diagnoses: other iatrogenic hypotension unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled hemorrhage complicating a procedure diastolic heart failure, unspecified asbestosis mechanical complication of other vascular device, implant, and graft acute gastritis, with hemorrhage chronic osteomyelitis, ankle and foot arthropathy associated with neurological disorders malignant neoplasm of sigmoid colon 

Answer: The patient is high likely exposed to