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: iodine / penicillins / iodine; iodine containing attending: chief complaint: 69m w/ hx pancreatic ca dx s/p multiple cbd stent placements was admitted on with acute cholangitis. major surgical or invasive procedure: ercp 7 cm 10 french stent placement history of present illness: mr. is a 69 year old italian speaking gentleman diagnosed with pancreatic ca in , s/p multiple cbd stent placements, who presented to an osh on with severe abdominal pain and jaundice. he had been feeling well since removal of his last stent in until , when he told his family that he wasn't feeling well, with decreased appetite and malaise that progressed during the next several days. on he experienced onset of severe abdominal pain in the ruq and epigastric region with radiation to his back, and was admitted to hospital. at the time of admission, mr. complained of abdominal pain, anorexia, malaise, weakness, and nausea. he denied fevers or chills. he was afebrile, hemodynamically stable, with no leukocytosis, so was given iv hydration and analgesia. during the first 24 hours of admission, however, he began to look more toxic and spike low-grade fevers. he was transferred to the icu and started on gentamycin and imipenem, and given one dose of levofloxacin. he required oxygen (50% on venting mask) to maintain sats of 90-94%, but required neither intubation nor pressors. per his niece, the gsh did not have ercp capabilities available and he was transferred to the micu for ercp on the evening of . at the time of transfer, his labs were notable for na 134, mg 1.6, tbili 19.8, dbili 15.4, and alk phos of 411, wbc 10.3, and hct 36.9. blood cultures were negative at the time of transfer. on his arrival in the micu, mr. was febrile to 100.6, satting 90-93% on 50% o2 face mask. he complained of severe abdominal pain radiating to his back. he was noted to be jaundiced and disoriented. he was started on meropenam and vancomycin, administered 1 mg ativan and 5 mg zydis for anxiety, and given a total of 6 mg dilaudid for pain. his dbili increased to 27.9, with dbili 20.0 and alk 354. ast was 72, alt 40, 16, lip 7, albumin 3.1. digoxin, initiated in following an episode of pulmonary edema, was discontinued as thought to be contributing to 1st degree heart block noted on ekg. ercp was performed on , and the patient was noted to have a 10 mm long irregular stricture of the lower cbd. a 7 cm 10 french stent was placed successfully. the patient noted resolution of pain following ercp. he was transferred to the floor on the morning of for monitoring and evaluation. the history of mr. pancreatic cancer is as follows. he had been in his usual state of good health until of , when he began experiencing abdominal pain and anorexia. he was treated with antibiotics with initial resolution of symptoms, but through and noted increasing anorexia. in the last week of he was admitted to good hospital with malaise, ruq and luq post-prandial pain, and 10 lbs weight loss. non-contrast ct at that time showed an abnormal pancreatic duct with ductal dilation, a cystic lesion measuring 8 mm in the pancreatic body and a cystic structure in the tail measuring 1.3 cm. his common bile duct and his liver function tests were normal. ercp showed stricture of both the pancreatic duct and intra-pancreatic portion of the cbd, and a plastic stent was placed in the cbd. cytology was negative for malignant cells. the patient continued to experience nausea, vomiting, and abdominal pain, without fever or jaundice. his weight had at this time decreased from 120 lbs to 80 lbs. eus with fna of the pancreatic cystic lesions (head and body) on revealed atypical cells and cea of 416. his stent was replaced on . based on cytology, the patient was thought to have either ipmt or mucinous ductal ectasia, and a whipple procedure was contemplated for . tpn was initiated in preparation for surgery, and the patient gained back 42 lbs. an echo showed ef of 65% and an exercise stress test showed no evidence of ischemia. however, just before the procedure, the patient was hospitalized for sob and was found to be in pulmonary edema. per his niece, plans for surgery in the immediate future were discontinued secondary to concerns for his perioperative pulmonary status. the patient was begun on home o2 when vna noted sats in the 80s on room air, asymptomatic from the patient's perspective. on repeat ercp, the cbd stent was removed on and not replaced when it was found that a 12 mm balloon could be passed through the stricture. he did well at home on solid pos and 3l o2, with good mobility and mental function, until the symptoms prompting the current admission. the patient's translator and health-care proxy is his niece, , who can be reached at (. past medical history: 1. pancreatic ca, as above 2. pud 3. ventricular ectopy, possibly secondary to small mi at age 40 4. osteoarthritis 5. emphysmea 6. anxiety psh: - s/p laminectomy in 30s, for back pain following a car accident. - appendectomy in youth - vein ligation for vericosities social history: italian-speaking. history of heavy smoking, currently several cigarettes per day. glasses wine per day, no hx heavy etoh. lives with sister and her husband in . single, without children. retired shoe-factory worker. family history: cad in mother, father, and sister. cerebral aneurysms in sister. negative for pancreatic, colorectal, or any other cad. physical exam: vs: tmax 99.5, tcurr 98.9, pulse 93, bp 110/72, rr 22, sats 95% 6l. gen: the patient is a cachectic, jaundiced gentleman in nad, appearing older than his stated age. heent: icterus noted in eyes and buccal mucosa. oropharynx non-injected. upper teeth, lower molars missing. neck: supple, no lad. no virchow's node appreciated. pulm: reduced breath sounds bilaterally. tympanitic. very light crackles at bases. end expiratory wheezes throughout. cv: nsr, no mrg. abd: soft, non-distended, tender to palpation in ruq, no rebound or guarding. no masses appreciated. liver span 9 cm in mid-clavicular line. no periumbilical nodes appreciated. ext: warm, 2+ pulses b at radius and dp. varicosity noted on anterior aspect of r crus. neuro: via translation, patient appeared alert. oriented to self and year, but not to which hospital he was in. could not recall why he is in hospital. answered questions appropriately. cn ii-xii intact. sensation intact to distal extremities. strength 5/5 in upper and lower limbs. patellar reflexes 2+. no clonus; babinski downgoing. pertinent results: : na 131 k 3.9 cl 98 bicarb 19 bun 6 cr <0.3 glu 174 wbc 10.4 (62% polys) crit 33.6 platelets 531 alt 40 ast 30 ldh 151 alk phos 290 (from peak 396 on ) tbili 23.8 (from peak 27.9 on ) dbili 17.4 (from peak 20.0 on ) cxr : portable ap chest x-ray: comparison is made to studies from 1/--/02. an area of lucency representing a bulla is seen in the right lower lobe, and a smaller than was seen on the previous exam. diffuse linear opacities are noted, likely representing parenchymal scarring and fibrosis are seen diffusely bilaterally. no pneumothorax is seen. no infiltrate is identified. heart size is normal. mediastinal and hilar contours are within normal limits. no osseous abnormalities are identified. impression: no evidence of pneumonia. right lower lobe bulla is smaller in comparison to previous exam. diffuse interstitial scar is seen. ercp : - a single irregular stricture that was 10 mm long was seen at the lower third of the common bile duct and it could represent malignant versus inflammatory stricture. - cytology samples were obtained for histology using a brush in the lower third of the common bile duct. - a 7 cm by 10 fr tannenbaun stent biliary stent was placed successfully in the common bile duct. echo : the left atrium is normal in size. left ventricular wall thickness, cavity size, and systolic function are normal (lvef 70%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. brief hospital course: a/p: 69m with hx pancreatic cancer since , s/p multiple cbd stents, presents to osh with abdominal pain and jaundice. transferred to the , ercp performed, and stent placed , with resolution of pain and disorientation. patient transferred from micu for monitoring and evaluation. 1. gi history and labs consistent with ascending cholangitis cbd stricture. s/p ercp with stent placement on , with resolution of pain and disorientation. tbili (today 15.4 from peak 27.9 on ). pain free since . -will have lfts checked qwk at rehab. if increases, may need change of stent. will f/u with ercp in months for metallic stent. 2. pancreatic ca whipple procedure considered in but aborted due to episode of pulmonary edema and concern for pulmonary status. cytology from biliary washing now suggestive of adenoca. will likely require metal stent eventually. - follow up as outpatient with surgery and gi. will need f/u with heme-onc per pcp. 3. pulmonary etiology of oxygen requirement uncertain. per niece, patient had not needed oxygen prior to episode of pulmonary edema; has been on 3l home o2 requirement since to maintain sats in low 90s. cts have shown emphysema, consistent with heavy smoking history. pulmonary edema episode may have been caused by volume overload tpn, transient cardiac ischemia, or less likely pe. - satting 95% on 3l this am (at baseline from home). - lenis negative, no right heart strain per tte. - continue pulmonary regimen: advair diskus 250/50 2 puffs ; ipratropium bromide 1 neb q6; albuterol 1 neb q4 4. id begun on merepenam and vancomycin (due to pcn allergy) on . - wbc stable. afebrile. has not spiked fever since . follow. - continue abx for 10 day course. - c. diff antigen from negative. 5. cardiac: - pump: bp stable. no evidence of volume overload by lung, neck, or extremities exam. digitoxin started during pulmonary edema episode d/ced in micu due to suggestion of first degree heart block. with ef of 70% and no evidence of failure, no current indication to resume digitoxin. - ischemia: no evidence of current ischemia. - rhythm: borderline first degree heart block noted on ekg, dig discontinued. - consider asa for outpatient regimen. however, benefits may be outweighed by risk of exacerbating pud. 6. renal: bun, cr reassuring. no active issues. - continued good urine output following foley removal . 7. heme: stable hct. 8. fen: -pancrease and megace added. tolerating diet. 9. endocrine: - improved sugars with increased ss insulin. requirement may increase as acute episode resolves. alternatively, could be new onset diabetes pancreatic process. 10. pain: well controlled. has not requested pain meds since . po morphine ir for breakthrough pain. 11: prophylaxis: - heparin sc - ppi - vit d, ca. 12. anxiety and depression - however, patient is still sad and periodically anxious. reassurance seems to help; continue checking in on patient frequently. - continue home xanax, remeron regimens. 13. code: full 14. dispo: to rehab, will f/u with ercp, gi, and pcp medications on admission: home meds: combivent mdi 2 puffs qid advair mdi 250/50 2 puffs megace 400 mg qd pancrease 900 units tid remeron 15 mg qhs xanex 0.25 mg qid carafate 1 gram qid protonix 40 mg qd digoxin 0.25 mg qd morphine sulfate 60 mg , 5 mg q2 hrs prn breakthrough pain. meds on transfer to micu: dilaudid 1.2 mg iv q6 prn pain digoxin 0.25 mg po qd xanex 0.25 mg po qd remeron 15 mg po qhs vancomycin 1000 mg iv q12 meropenam 1000 mg iv q8 advair diskus 250/50 2 puffs ipratropium bromide 1 neb q6 albuterol 1 neb q4 protonix 40 mg iv qd carafate 1 gm po qid heparin 5000 units sq tid discharge medications: 1. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 2. alprazolam 0.25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 3. albuterol sulfate 0.083 % solution sig: one (1) nebulizer neb inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 4. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 5. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. amylase-lipase-protease 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) sig: two (2) cap po tid w/meals (3 times a day with meals). 9. morphine sulfate 15 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). 11. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po qd (once a day). 12. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po qd (once a day). 13. multivitamin capsule sig: one (1) cap po qd (once a day). 14. megestrol acetate 40 mg/ml suspension sig: four hundred (400) mg po qd (once a day). 15. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for gerd. 16. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 17. zolpidem tartrate 5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed for insomnia. 18. meropenem 1 g recon soln sig: one (1) gram intravenous three times a day for 4 days. 19. vancomycin hcl 1,000 mg recon soln sig: one (1) gram intravenous twice a day for 4 days. 20. insulin regular human 300 unit/3 ml syringe sig: per sliding scale units subcutaneous four times a day. discharge disposition: extended care facility: life care center of discharge diagnosis: cholangitis s/p ercp and stent placement discharge condition: stable discharge instructions: please call your primary care physician if you are having temperatures > 101.5, severe chest pain, shortness of breath, or abdominal pain. followup instructions: follow up with ercp in months for metallic stent. the ercp fellow will call you to set up an appointment. follow up with dr. , your pcp weeks. please call his office for an appointment. follow up with dr. in weeks. procedure: parenteral infusion of concentrated nutritional substances endoscopic sphincterotomy and papillotomy other closed [endoscopic] biopsy of biliary duct or sphincter of oddi diagnoses: dysthymic disorder other emphysema cholangitis obstruction of bile duct first degree atrioventricular block nutritional marasmus malignant neoplasm of other specified sites of pancreas 

Answer: The patient is high likely exposed to