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: abdominal pain major surgical or invasive procedure: none history of present illness: 81yom htn, chf, stage iii ckd, lung cancer s/p wedge resection, prostate ca, s/p hormonal tx and xrt presented with 4 days rlq pain, admitted to surgery for ruptured appendix which was medically managed, transferred to medicine service on night of transfer after a trigger for tachycardia. pt presented with rlq abd pain. per surgery note, pt reported he was in his usual state of health until 4 days prior to presentation when he purchased a bottle of wine and drank of the bottle, followed by dull pain and tenderness in rlq without radiation. pain persisted over the next four days, relatively unchanged, until the pt presented to his pcp for an urgent care visit on . during this time, he notes decreased appetite and loose stools 2-3x/day. he denies fevers, chills. he notes chronic sob unchanged recently and denies chest pain. pt was admitted to surgery service on , had a ct of abd, which showed a perforated appendix with possible early abscess formation. he was started on hep sq, cipro, and flagyl, and medically managed on surgery service. transferred from 5 at 7pm from surgery service to medicine service. hr upon transfer 100, sbp ~100, 2l oxygen. around 2200, staff noticed pt "not looking good," hr rose to 120-130s, pt diuresed 10mg iv lasix, bp dropped from 110/60 to 96/56 to 92/58, remained on 2l. also received one albuterol neb, ipratropium neb, and po ativan for concern for ethanol withdrawal. ekg showed rapid rate at 130, likely afib, nl axis. past medical history: 1. copd 2. htn 3. chf ef <35% - inferior scar and lvef 43% on mibi 4. paf 5. depression 6. hip fx 7. hyperlipidemia 8. osteoporosis 9. stage iii ckd (baseline cr 1.3-1.5) 10. mild cognitive impairment 11. lung cancer t1 adenocarcinoma - wedge resection 12. s/p rul wedge resection () - unable to perform complete lobar resection poor respiratory reserve. c/b persistent mediastinal lymph node followed by yearly ct 13. prostate ca - high grade, s/p lupron tx, xrt - in 14. s/p left intertrochanteric nail ' 15. pancreatic head mass -- likely ipmt social history: he lives alone in apartment. he was divorced 25 yrs ago. (+) tobacco 69 pack yrs quit 3 yrs ago. has been drinking since his divorce 25 yrs ago 1/2-1 liter wine qd. no hard liquor. he lost his job at because family history: noncontributory physical exam: on transfer to the t=98 bp83/61 hr110 (after 10mg iv lopressor) rr 16 99%2l . physical exam general: pleasant, well appearing ..... in nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . jvp= lungs: ctab, good air movement biaterally. abdomen: nabs. soft, nt, nd. no hsm extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. skin: no rashes/lesions, ecchymoses. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. + reflexes, equal bl. normal coordination. gait assessment deferred psych: listens and responds to questions appropriately, pleasant pertinent results: echo : prior myocardial infarction without inducible ischemia to achieved low workload. blunted heart rate response to physiologic stress. moderate regional left ventricular systolic dysfunction. moderate mitral regurgitation at rest. at least moderate pulmonary artery systolic hypertension. ef 35%. . ct abd : 1. findings are consistent with perforated appendicitis with surrounding phlegmonous or early abscess collection. small locules of extraluminal air are noted within the pelvic cavity with free fluid and air also noted to track into the right inguinal ring. edema of the terminal ileum is presumed to be reactive. 2. known underlying emphysema and extensive atherosclerotic disease. 3. stable hypoattenuating pancreatic head lesions likely representing side branch ipmt. ct abd/pelvis : final report indication: perforated appendicitis being conservatively managed with antibiotics, please evaluate for fluid collections or pseudocyst. comparison: . technique: axial mdct images were obtained from the lung bases to the pubic symphysis with oral contrast only but no intravenous contrast. coronal and sagittal reformatted images are provided. contrast: oral contrast only. ct of the abdomen without intravenous contrast: large bilateral pleural effusions of low density are slightly increased from the ct of . there is adjacent atelectasis in the lower lobes bilaterally, also more marked. focal calcifications along the left hemidiaphragm (2a:11) are unchanged and could represent sequelae of prior asbestos exposure. the aerated portions of the lungs appear unremarkable. heart and pericardium appear unchanged. allowing for non-contrast technique, the liver, spleen, adrenal glands, and pancreas appear unremarkable, although it is noted that hypodense pancreatic lesions were seen on previous contrast examination that are not evident on today's study. bilateral renal calcifications are most likely vascular in nature, and there is no evidence of hydronephrosis. abdominal aorta is normal in caliber with mural calcification consistent with atheromatous disease. since the previous examination of , the degree of distention of the proximal small bowel has decreased somewhat, and there is now passage of contrast into the colon without definite evidence of small bowel obstruction. note is made of a filling defect in the distal esophagus, which is hyperdense and most likely represents a pill. numerous additional similar structures are seen in the ascending colon and cecum, also most likely representing pills. again seen is a distended appendix containing contrast and air at its base with periappendiceal stranding and inflammation as well as extraluminal gas, consistent with the patient's known appendiceal perforation. a couple of very small adjacent organized fluid collections are seen, the largest in the right lower quadrant measuring 1.8 x 2.3 cm (2a:61), probably minimally decreased from the previous examination and no longer containing gas as it had at the time of the prior scan. no new developing fluid collections are identified. hyperdense material again seen within the non-distended gallbladder possibly representing stones or sludge. ct of the pelvis without intravenous contrast: a left-sided fat- and fluid- containing inguinal hernia is again noted, slightly larger than at the time of the previous study. smaller right-sided fat- and fluid-containing inguinal hernia is seen with the fluid component decreased in size and no longer containing gas. a foley catheter is in place within the bladder which appears otherwise unremarkable. prostate and seminal vesicles, and hyperdense prosthetic structures possibly representing brachytherapy seeds, are unchanged. rectum and sigmoid colon appear unremarkable. a small collection in the right upper pelvis is probably slightly decreased as previously described. there is diffuse stranding throughout the subcutaneous tissues. bilateral femoral neck compression screws in unchanged orientation. bone windows: degenerative change of the lumbar spine again noted. impression: 1. slight decrease in size of small fluid collections adjacent to the patient's known perforated appendicitis, without evidence of drainable collections or new collections. 2. decrease in previously present small bowel obstruction with only mild residual small bowel dilation, possibly reflecting ileus. 3. increase in large bilateral pleural effusions and adjacent bilateral lower lobe atelectasis. 4. ct appearance of pills located in distal esophagus and in the colon and cecum. rue u/s: final report history: 81-year-old male with asymmetric right extremity swelling, with picc line. evaluate for dvt. comparison: none available in the pacs. right upper extremity ultrasound: the right arm is erythematous and edematous, with multiple blisters on the medial aspect several centimeters proximal to the elbow. grayscale, color, and pulse wave doppler ultrasound of the right upper extremity were performed to evaluate for deep venous thrombosis. a right picc line enters the basilic vein, and courses beyond the subclavian vein into the superior vena cava. the subclavian vein demonstrates thrombus on grayscale images, with minimal flow distally. except for where instrumented by picc, the right basilic and axillary veins are compressible and demonstrate color flow with appropriate waveforms. no augmentation maneuvers were performed due to thrombus in the subclavian vein, and the patient was unable to perform valsalva maneuvers. however, flow in the basilic, axillary, internal jugular, and brachial veins demonstrate respiratory phasicity. although compression of the brachial veins was somewhat difficult, they were somewhat compressible and demonstrated normal flow with appropriate waveforms and respiratory variation, and likely do not contain thrombus. the left subclavian vein was evaluated for comparison, and demonstrate wall-to-wall flow and collapsibility during the respiratory cycle. impression: thrombus in the right subclavian vein, with minimal if any distal flow. pcxr : final report history: left picc line placement. findings: in comparison with study of , there has been placement of a left subclavian picc line that extends to the upper portion of the svc. persistent prominent bilateral pleural effusions. the pulmonary vascular congestion appears to have substantially reduced. brief hospital course: 81 yo male with pmh of htn, chf, stage iii ckd, lung cancer s/p wedge resection, prostate ca, s/p hormonal tx and xrt presented with 4 days rlq pain, admitted to surgery for ruptured appendix which was medically managed, transferred to medicine service on night of transfer after a trigger for tachycardia, transferred to micu for 5 day course for management of tachycardia, called out to medical floor with stable vital signs. #atrial tachcyardia: patient was initially in 150's-160's with sbp in 80's though denying light-headedness, sob, chest pain, or any other issues. his heart rate was initially controlled with iv lopressor with uptitration to po lopressor. the rhythm transitioned from sinus tachycardia with apbs, with some ekgs which could not rule out atrial fibrillation. cardiac enzymes were checked and were not consistent with an acs. cta ruled out pe. cardiology was consulted (thought tachycardia was sinus tach with apbs and mat) and was due to intra-abdominal appendix rupture and inflammation, recommended watching clinically, with consideration of digoxin therapy, which was not initiated. #anemia, guiac positive stool: on the day of presentation to the the patient had guiac positive stools and a hct drop from 27-24, with no signs of hemodynamic instability; there was no melena or hematochezia. gi was consulted, thought no indication for immediate scope and that this could be dangerous given ruptured appendicitis. over the following days, patient showed no signs of bleed and had a stable hematocrit. his aspirin and heparin sq was held in icu and upon transfer to medical floor. #ruptured appendicitis: the patient was conservatively managed by surgery with antibiotics and this was continued with ciprofloxacin and metronidazole, initiating date was , with continuation until , then changed to vanco/zosyn for broader coverage until , then transitioned back to cipro/flagyl, with plan to complete full course of abx until . bladder pressures and lactates were monitored while in icu, which both remained normal, in addition to stable abdominal exam. the patient's abdominal exam improved and the patient was advanced to a regular diet per surgery on day of discharge. -antibitics can likely be changed to oral if he is tolerating regular diet well (ct scan had demonstarted retained meds in esophagaus and stomach). -patient to have outpatient surgery f/u. #renal failure: pt noted to have rising creatinine from 1.0 to 1.4, 1.8, and 1.9 while in . urine electrolytes suggested pre-renal physiology, but clinical suspicion for contrast-induced nephropathy was high, given dye load on . pt was not diuresed in this setting (o2 requirements at 4l thought chf, copd) and allowed to run positive. the renal failure was non-oliguric throughout this course and remained stable with discharge creatinine of 2.1. #right subclavian vein thrombus: the patient had rue swelling in the arm he initially had a picc line in. rue u/s revealed a thrombus in the right subclavian vein, with minimal if any distal flow. given recent hct drop in icu with concern for gi bleed, the patient was started on a heparin ggt. if patient continues to tolerate heparin ggt well, can transition to lovenox and coumadin for a three month course. medications on admission: 1. alendronate 70 mg weekly 2. atenolol 100 mg daily 3. pravastatin 40 mg daily 4. tiotropium bromide 18 mcg capsule 1 puff inhalation daily 5. trazodone 75 mg qhs 6. aspirin 325 daily 7. calcium carbonate 500 mg tid 8. vit d3 400 u 9. daily mvi discharge medications: 1. alendronate 70 mg tablet sig: one (1) tablet po qthur (every thursday). 2. metoprolol tartrate 25 mg tablet sig: three (3) tablet po q 8h (every 8 hours). 3. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 4. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 5. trazodone 50 mg tablet sig: 1.5 tablets po hs (at bedtime). 6. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 7. calcium carbonate 500 mg (1,250 mg) tablet sig: one (1) tablet po tid (3 times a day). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po q 12h (every 12 hours). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. acetaminophen 325 mg tablet sig: two (2) tablet po every six (6) hours as needed for pain. 11. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) neb inhalation q2h () as needed for sob. 12. heparin, porcine (pf) 10,000 unit/5 ml solution sig: one (1) dose intravenous continuos: heparin ggt per dvt protocol. 13. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 14. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 15. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: five hundred (500) mg intravenous q8h (every 8 hours) for 10 days. 16. ciprofloxacin in d5w 400 mg/200 ml piggyback sig: four hundred (400) mg intravenous q12h (every 12 hours) for 10 days. 17. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: perforated appendicitis ileus/partial sbo anemia from acute gi bleed acute renal failure multi-atrial tachycardia right subclavian dvt copd exacerbation discharge condition: vital signs stable discharge instructions: return to the ed if you are having very high fevers, severe abdominal pain, confusion. you had a perforated appendicitis which was treated conservatively with antibiotics. followup instructions: tuesday. at 10am surgery clinic with dr. provider: , dpm phone: date/time: 1:10 provider: , md phone: date/time: 2:30 provider: , md,phd: date/time: 9:30 provider: , . call to schedule appointment procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified atrial fibrillation personal history of malignant neoplasm of prostate personal history of malignant neoplasm of bronchus and lung obstructive chronic bronchitis with (acute) exacerbation depressive disorder, not elsewhere classified other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) osteoporosis, unspecified other complications due to other vascular device, implant, and graft chronic systolic heart failure hemorrhage of gastrointestinal tract, unspecified unspecified intestinal obstruction paroxysmal supraventricular tachycardia acute appendicitis with peritoneal abscess 

Answer: The patient is high likely exposed to