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: history of present illness: this is a 57 year-old male with a history of klatskin tumor status post cholecystectomy and biliary drainage on continuous chemotherapy who presented to an outside hospital with shortness of breath described as being unable to get breath in. the patient denies that he had chest pain but this was potentially reported at the outside hospital. ekg at the outside hospital was read as having acute changes. troponin was 0.4 and a concern was raised for acute coronary syndrome. the patient was then transferred to the for further evaluation. past medical history: 1. biliary duct adenocarcinoma with positive lymph nodes, unresectable diagnosis . status post exploratory laparotomy and cholecystectomy in with biliary drainage. 2. diabetes mellitus. 3. hypertension. 4. multiple back surgeries for disc problems. allergies: zestril leads to unknown reaction. versed leads to seizure. medications: 1. protonix 40 mg po q day. 2. oxycodone 5 mg po q day six hours prn. 3. oxycontin 40 mg po q eight hours. 4. nph 12 units. 5. chemotherapy of unknown . 6. augmentin one po bid. physical examination: on presentation at vital signs 98.0 f, blood pressure 124/69, heart rate 112, o2 saturation 96% on nonrebreather, respiratory rate ranged from 27 to 36. general exam - alert and oriented times 3, tachypneic. heent - pupils are equal, round and reactive to light. extraocular muscles are intact. oropharynx mucous membranes moist, neck is supple. cardiovascular - tachycardic with a grade ii/vi slow murmur at the right upper sternal base. respiratory - crackles bilaterally with an increase in right base to half way up. abdomen with biliary drains intact and soft though protuberant with diffuse abdominal pain and no rebound. extremities - 3+ pitting edema to the knees. neurologically - cranial nerves ii through xii are grossly intact. strength is . admission laboratory data: white blood cell count 16.5, hematocrit 27.4, platelet count 74, inr 1.7, sodium 133, potassium 4.8, chloride 97, bicarb 23, bun 25, creatinine 1.0, glucose 103, ck 32, troponin 4.8. ekg revealed normal sinus rhythm at a rate of 105 with a q in iii and flipped t wave in lead iii which was old. there was t wave inversion in lead avf and st elevation in v1 and v2 with t wave flattening in v3 and v6. t wave changes were new since . abg 7.47, pco2 31, po2 77 at 100% nonrebreather mask. echocardiogram revealed no focal wall motion abnormalities with some right heart strain and a pa pressure of 58. head ct scan was negative for hemorrhage or mass affect or masses. assessment: given the ekg changes and echocardiographic changes the patient was felt to have a pulmonary embolus. a ct angiogram was performed which revealed thrombi in the right tree and multiple bilateral thrombi, left basilar atelectasis and a right effusion and ground glass appearance in the upper lobes. chest x-ray revealed a moderate right pleural effusion but no consolidation. given the potential for hemodynamic instability the patient was initially admitted to the medical intensive care unit for close observation. the patient did well in the medical intensive care unit and was called out to the floor the following day. upon presentation to the floor the patient denied chest pain, headache, nausea, vomiting and decreasing shortness of breath. he continued abdominal pain with no black or bloody stools and no dysuria. the patient was received on the following medications: 1. heparin. 2. morphine sulfate. 3. oxycodone. 4. oxycontin. 5. augmentin. 6. levaquin. 7. flagyl. levaquin and flagyl were added for a rising white count and the presence of abdominal pain. course on the general medical service: 1. pulmonary - for multiple bilateral pulmonary emboli the patient was continued on heparin and was started on coumadin therapy. his o2 saturation gradually improved over the course of the hospitalization. he had no further complications of his pulmonary emboli or its treatment. 2. oncologic - the patient's oncologist was contact by the medical intensive care unit team who reported that the patient did not need further chemotherapy at this time. the being used was unable to be determined. the oncologist was contact but unsuccessfully by the floor team. 3. infectious disease - the patient was started on levaquin and flagyl as described above for rising white count and abdominal tenderness. the patient remained afebrile despite a rising white blood cell count blood cultures were negative. the patient was discontinued on levaquin, flagyl and augmentin by the floor team. he was followed clinically with no further increase in temperature though white count continued to rise. to evaluate for this the patient was maintained on continuous biliary drainage and received a cholangiogram at this hospital. the results of which are pending at this time. 4. ascites - the patient was felt to have tense ascites and could benefit from a paracentesis for comfort reasons. this was performed on with the removal of approximately 4.6 liters of fluid. analysis of the fluid reveals white blood cells , red blood cells , 54% polys, 1 lymphocytes, 36 monos and 9 macrophages, amylase 7, total bilirubin 1.9, albumin 0.9. this was felt to be consistent with a transient state and the patient was encouraged to consume a low salt diet. he was started on lasix and aldactone. over the remaining course of the hospitalization the fluid did slowly re-accumulate. 5. cardiovascular - though the troponin was elevated, the patient had no symptoms consistent with acute coronary syndrome. he was watched closely and had no further chest pain and no further work up of this problem ensued. 6. diabetes mellitus - the patient was continued on regular sliding scale insulin. 7. prophylaxis - the patient was continued on protonix and was maintained on heparin as described above. disposition and code status: extensive conversation took place between the house officers and the palliative care team, the patient and his family, the patient expressed in his wishes that he not be placed on any machines and should be dnr / dni. he expressed concerned that dnr / dni status would prohibit further treatment which could be of benefit to him. it was extensively explained to him that dnr / dni status does not preclude treatment of other medical problems such as paracentesis or pulmonary emboli. the patient was relieved to hear this and the family agreed that the patient should be made dnr / dni. the beginnings of hospice care were discussed as well and the patient elected to pursue further management with hospice at the time of his discharge. at this point the patient is deemed prepared for transfer to the hospital if a bed is available. at that hospital upon his discharge he should be referred for hospice care with the hospice upon discharge from hospital. the palliative care team at this hospital spoke with from that hospice institution. additional relevant laboratory tests: there was a culture done on biliary fluid which is pending. gram stain of the peritoneal fluid was negative. blood culture no growth to date at the time of this dictation. the blood culture second bottle also negative to date. there was a culture of biliary fluid which grew enterococci species which were not treated. given the lack of symptoms suggesting a clinical infection. the patient also had a hepatic ultrasound to evaluate for chiari syndrome and this was negative. final diagnosis: 1. pulmonary embolus. 2. klatskin tumor. 3. ascites. 4. diabetes mellitus. 5. anemia. discharge instructions: the patient is deemed prepared for transfer to the hospital for continued management. he should follow up with his primary care physician and his oncologist, dr. . dr. phone number is . discharge medications: 1. lovenox. 2. regular sliding scale insulin. 3. oxycodone sustained released 100 mg po q eight hours. 4. bisacodyl 10 mg po prn . 5. trazodone 50 mg po q hs prn. 6. protonix 40 mg po q day. 7. oxycodone 5 mg po four to six hours prn breakthrough pain. 8. coumadin 5 mg po q hs. 9. lasix 40 mg po q day. 10. spirolactone 100 mg po q day. 11. ampicillin 1 gram iv q six hours times two doses status post cholangiography. 12. gentamycin 80 mg iv q eight hours times two doses status post cholangiography. dr., 12-aak dictated by: medquist36 procedure: other cholangiogram other percutaneous procedures on biliary tract diagnoses: thrombocytopenia, unspecified abnormal coagulation profile unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia obstruction of bile duct other pulmonary embolism and infarction malignant neoplasm of extrahepatic bile ducts 

Answer: The patient is high likely exposed to