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: desipramine hcl attending: chief complaint: pancreatic cancer major surgical or invasive procedure: whipple procedure with j tube placement, exploratory laparotomy for wound dehisence. s/p closure with rentention sutures , s/p trach , s/p open drainage of splenic abscess history of present illness: this 60-year-old man has copd and coronary artery disease as well as bipolar depression and he originally presented with two weeks of nausea, diarrhea, dark colored urine and jaundice. he has been suffering from upper respiratory symptoms for the last three weeks and saw his pulmonologist who started on antibiotics for the steroid taper. he reported diarrhea at this time and he actually had c. diff colitis identified. he reports no change in appetite, recent weight loss or other particular symptoms. he underwent an ercp/stent placement on which showed a distal cbd stricture and atypical cells. cta abdomen showed a 3.6 cm head of pancreas mass. he had a whipple and j-tube on past medical history: copd (chronic bronchitis, emphysema), cad, osa (thumbs, right shoulder and neck), melanoma, bipolar/manic depression, sleep apnea, hx c.diff psh: cardiac stent x4 (), melanoma excision (abdomen) social history: lives alone in . quit tobacco . no etoh. works part-time in sales. family history: mother with breast ca physical exam: gen: looks a bit disheveled, but is awake and oriented x3 and fully conversant. heent: no evidence of scleral icterus at this point. chest: clear to auscultation. cv: cardiac exam shows a regular rate and rhythm. abd: soft, nontender, and nondistended with positive bowel sounds and is quite protuberant and rotund. ext: show no cyanosis, clubbing, or edema. pertinent results: on admission: 10:44pm blood wbc-25.0*# rbc-4.04* hgb-12.1* hct-36.0* mcv-89 mch-30.1 mchc-33.7 rdw-15.5 plt ct-195 10:44pm blood pt-15.0* ptt-43.8* inr(pt)-1.3* 10:44pm blood glucose-186* urean-14 creat-1.0 na-140 k-5.0 cl-107 hco3-22 angap-16 10:44pm blood alt-1015* ast-818* alkphos-96 amylase-24 totbili-2.1* 10:44pm blood lipase-15 10:44pm blood calcium-8.8 phos-5.6*# mg-1.7 12:18pm blood type-art po2-93 pco2-49* ph-7.28* caltco2-24 base xs--3 intubat-intubated . cxr impression: ap chest compared to : lung volumes remain quite low. mild pulmonary edema is new, accompanied by increased caliber to mediastinal and hilar vessels. small left pleural effusion is presumed. tip of the swan-ganz catheter projects over the right descending pulmonary artery. et tube tip ends at the thoracic inlet, partially withdrawn since the prior study. nasogastric tube passes below the diaphragm and out of view. small left pleural effusion is presumed. no pneumothorax. . duplex doppler abd/pelvis history: 60-year-old male status post whipple's procedure. impression: replaced common hepatic artery posterior to the portal vein was not visualized; however, normal arterial waveforms were obtained in the right and left hepatic arteries. . cxr reason for exam: increased o2 requirement. findings: there are low lung volumes. increased diffuse density of the left hemithorax is most likely due to layering pleural effusion. cardiac silhouette is accentuated by the low lung volumes, appears to be mildly enlarged. there is engorgement of the mediastinal and pulmonary vasculature with no overt pulmonary edema. right lower lobe atelectasis is new. ng tube tip is out of view, below the diaphragm. impression: increased left pleural effusion with increased adjacent atelectasis. 05:05am blood wbc-23.9* rbc-3.93* hgb-11.1* hct-34.6* mcv-88 mch-28.3 mchc-32.2 rdw-17.5* plt ct-988* 05:10am blood wbc-19.5* rbc-3.81* hgb-10.8* hct-33.7* mcv-88 mch-28.3 mchc-32.0 rdw-17.5* plt ct-940* 05:10am blood caltibc-186* ferritn-561* trf-143* 02:49pm blood caltibc-120* ferritn-610* trf-92* 02:49pm blood triglyc-140 02:21am blood lithium-0.8 . chest (pa & lat) 10:18 pm impression: persistent but slightly improved retrocardiac opacity which may be secondary to aspiration, pneumonia, or atelectasis. left pleural effusion is unchanged. subsegmental right lower lobe atelectasis. . video oropharyngeal swallow 1:23 pm impression: penetration and intermittent aspiration with thin and nectar consistency barium. . chest (portable ap) 4:47 am findings: the left chest tube is unchanged. there continued to be bilateral pleural effusions moderate in size that layer posteriorly, given positioning it is unclear but these are likely increased compared to prior. there is pulmonary vascular re-distribution, perihilar haze consistent with fluid overload. there is obscuration of both hemidiaphragms due to the effusions and an underlying infiltrate cannot be excluded. . echo conclusions the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. . ct abdomen w/contrast 11:16 am impression: 1. overall, no significant change. infarcted spleen and subsequent hematoma is unchanged in size, with indwelling large-bore catheter. heterogeneity within the hepatic parenchyma, left lobe, likely due to retractor injury, no definite evidence for infection at this time. 2. loculated left pleural effusion with near-complete collapse of the left lower lobe. small right effusion and atelectasis. . ct peritineal drain excluding appendiceal 2:39 pm impression: successful ct-guided percutaneous drainage of splenic collection. . ct pelvis w/contrast 3:33 pm impression: 1. splenic vein thrombosis with extensive splenic infarction. interval development of gas within the infarcted splenic parenchyma concerning for infection. 2. multiple poorly defined hypoenhancing areas in the left hepatic lobe that may be related to retractor injury. however, superimposed infection cannot be excluded. 3. small left pleural effusion and near complete collapse of the left lower lobe. 4. emphysema. 5. no definite evidence of enterocutaneous fistula. however, please note that the small bowel was not well opacified with oral contrast at the time of the examination which limits the sensitivity of this exam. . brief hospital course: patient was admitted after a pylorus-preserving whipple w/ j-tube placement and placement of gold fiducial seeds for cyberknife therapy (please see full operative note for details). because of the pt's baseline cardiopulmonary issues, he remained intubated and was transferred directly to the icu. neuro: he was awake and alert after extubation and was successfully transitioned to a pca for pain control. . cardiac: he initially had a swan-ganz catheter, which was removed with stable cardiac function. he was maintained on asa. . pulmonary: pt was extubated on pod 2 and eventually transitioned to o2 by nasal canula. however, he was electively re-intubated on after his wound dehiscence and emergent return to or. he required ventilatory support post-op was he had a percutaneous tracheostomy placed on . . fen: pt was on a lasix drip initially for diuresis and was eventually transitioned to intermittent doses. he responded well to the treatment. trophic j tube feeds were started on pod#4 and were slowly advanced towards goal. he tolerated them well. they were held briefly during his evisceration but was eventually restarted and advanced to goal. nutrition was following for tube feed recommendations. he was evaluated by speech and swallow and he was cleared for ground solids and nectar thick liquids. . gi: immediately post-op, he had elevated lfts but ultrasound of the hepatic vasculature was negative for pathology. he developed a wound infection that required re-opening of his wound. with the infection and his concurrent steroids, he eviscerated through his wound after a violent cough. he was brought back to the or emergently on and his wound was irrigated/debrided and primary closed with retention sutures. he required large amounts of peep up to 15 to maintain his oxygenation. he continued to be hypotensive requiring vasopressors for several post-operative days. his cortisol stim test showed a marginal response (34 to 41) and steroids were not restarted. an echo was obtained which showed intact lv function with no thrombi. on he developed an low-output colocutaneous fistula through his abdominal wound. it's output was bilious and did not appear to have any tube feeds or methylene blue when placed via the ngt. a vacuum dressing was applied after initially using wet to dry dressings. his wound continued to improved and he will need continued wound care. . id: he spike fevers intermittently and cultures were positive for: enterococcus faecium on in blood x2 bottles, sputum culture for sparse yeast ; sputum cultures from , , revealed enterobacter cloacae and he was treated with appropriate abx. on (pod 13 and 7) he developed a fever to 102 and leukocytosis to 34k. ct showed infarction of the spleen with thrombosis identified within the splenic vein and colitis. he was treated non-operatively with bowel rest for the colitis and an aspirin for the splenic vein thrombus. . heme: pt had consistently decreasing platelet count while on heparin. all heparin products were d/c'd and he was maintained on pneumoboots for prophylaxis throughout his icu stay. ct abd showed infarction of the spleen with thrombosis. ct abd showed splenic abscess, which was drained on via ir. approximately 800cc blood/foul-smelling fluid was drained and a drain was left in place. . endo: pt was adrenally deficient on pod#1 and started on a steroid taper, which was appropriately weaned and then stopped after he eviscerated from his incision. his blood sugars continued to be elevated and diabetes was seeing him and adjusting his sliding scales. . psych: lamictal and lithium were restarted on pod#4 through the j tube. psych continued to see him and he was discharged with diazepam prn. medications on admission: asa, plavix 75', toprol 25', lipitor 80', atacand 4', prilosec', lamictal 200', lithium 900', valium 5-10mg'' prn, advair 500/50'', celebrex 200', colace prn discharge medications: 1. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 2. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po qid (4 times a day) as needed. 3. aspirin 325 mg tablet : one (1) tablet po daily (daily). 4. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed. 5. ascorbic acid 90 mg/ml drops : five hundred four (504) mg po daily (daily). 6. ferrous sulfate 300 mg/5 ml liquid : one (1) po daily (daily). 7. albuterol sulfate 2.5 mg/3 ml solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed for wheeze. 8. therapeutic multivitamin liquid : one (1) cap po daily (daily). 9. papain-urea 830,000-10 unit/g-% ointment : one (1) appl topical (2 times a day). 10. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 11. metoprolol tartrate 25 mg tablet : three (3) tablet po tid (3 times a day). 12. albuterol 90 mcg/actuation aerosol : six (6) puff inhalation q6h (every 6 hours) as needed. 13. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 14. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q4h (every 4 hours). 15. fluticasone 110 mcg/actuation aerosol : four (4) puff inhalation (2 times a day). 16. amylase-lipase-protease 33,200-10,000- 37,500 unit capsule, delayed release(e.c.) : caps po qidwmhs (4 times a day (with meals and at bedtime)). 17. oxycodone-acetaminophen 5-325 mg/5 ml solution : 5-10 mls po q6h (every 6 hours) as needed. 18. cholestyramine-sucrose 4 gram packet : one (1) packet po qid (4 times a day). 19. insulin nph human recomb 100 unit/ml suspension : twenty five (25) units subcutaneous twice a day. 20. lithium carbonate 300 mg capsule : three (3) capsule po qhs (once a day (at bedtime)). 21. lamotrigine 100 mg tablet : two (2) tablet po qhs (once a day (at bedtime)). 22. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed. 23. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 24. zolpidem 5 mg tablet : one (1) tablet po hs (at bedtime) as needed. 25. vancomycin 250 mg capsule : two (2) capsule po q6h (every 6 hours) for 1 weeks. 26. metronidazole 500 mg tablet : one (1) tablet po tid (3 times a day) for 1 weeks. 27. diazepam 5 mg tablet : one (1) tablet po tid (3 times a day) as needed. discharge disposition: extended care facility: northeast - discharge diagnosis: whipple, j-tube wound dehiscence s/p closure with rentention sutures , s/p trach , s/p open drainage of splenic abscess adrenal insufficiency, enterococcal bacteremia, mrse line sepsis, wound infection, splenic vein thrombosis, splenic infarct respiratory failure, enterocutaneous fistula discharge condition: good tolerating tubefeedings wound healing discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in 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. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. . * please resume all regular home medications and take any new meds as ordered. * do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * continue to increase activity daily * no heavy lifting (> lbs) for 6 weeks. * monitor your incision for signs of infection * keep your incision clean and dry. followup instructions: please follow-up with dr. on at 10:30am. call with questions or concerns. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more other enterostomy radical pancreaticoduodenectomy insertion of other (naso-)gastric tube other intubation of respiratory tract cholecystectomy temporary tracheostomy nonexcisional debridement of wound, infection or burn bronchoscopy through artificial stoma transfusion of packed cells other laparotomy reclosure of postoperative disruption of abdominal wall diagnoses: other and unspecified noninfectious gastroenteritis and colitis obstructive sleep apnea (adult)(pediatric) anemia, unspecified coronary atherosclerosis of native coronary artery other postoperative infection unspecified pleural effusion chronic airway obstruction, not elsewhere classified personal history of tobacco use percutaneous transluminal coronary angioplasty status sepsis pulmonary collapse acute respiratory failure personal history of other malignant neoplasm of skin malignant neoplasm of head of pancreas embolism and thrombosis of other specified artery glucocorticoid deficiency streptococcal septicemia chronic pancreatitis bipolar i disorder, most recent episode (or current) unspecified unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure leukocytosis, unspecified secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes fistula of intestine, excluding rectum and anus disruption of external operation (surgical) wound dependence on respirator, status chronic cholecystitis 

Answer: The patient is high likely exposed to