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: the patient is a 74-year-old gentleman with a history of type 2 diabetes, coronary artery disease (status post myocardial infarction), and cerebrovascular accident who originally presented on from hospital with painless jaundice and a 55-pounds weight over the past year here for endoscopic retrograde cholangiopancreatography. the patient noticed gradual jaundice since . no abdominal pain, nausea, vomiting, fevers, or chills. positive dark urine, and light stools, pruritus, and fatigue. an abdominal computed tomography on from the outside hospital was reported to have shown moderate ascites, a large liver and spleen, and dilation of the biliary tree, with a question of intrahepatic malignancy. an abdominal ultrasound at the outside hospital on showed splenomegaly, ascites, gallbladder wall thickening, and dilated ducts in the liver. a magnetic resonance imaging on at the outside hospital showed dilation of the biliary tree and a 4-cm lesion in the left lobe of the liver. endoscopic retrograde cholangiopancreatography on performed at showed an intraductal mass, and plastic stent placed. the mass was brushed and cells were sent to cytology which were positive for adenocarcinoma. additionally, the patient was found to have an increased creatinine while admitted. creatinine in was noted to be 0.9. then on , creatinine was noted to be 2 after a computed tomography scan at the outside hospital. on admission to the hospital on , creatinine was noted to be 8.1. the patient was treated multiple times with kayexalate for a high potassium. a paracentesis was performed on which showed no evidence of spontaneous bacterial peritonitis. on , a quinton catheter was placed in the right femoral vein, and the patient underwent hemodialysis. during the course of hemodialysis the patient became hypotensive in the 80s/40s, and was subsequently volume resuscitated with 2.2 liters of fluids. his blood pressure did not increase, and the patient began to experience shortness of breath. the patient was originally saturating 96% on room air but then desaturated to 93% on 2 liters of oxygen and then 95% on 4 liters of oxygen. additionally, the patient was wheezing. thus, the patient was transferred to the medical intensive care unit. an arterial blood gas was taken and showed a ph of 7.41, a pco2 of 28, and a po2 of 72. once the patient was transferred to the medical intensive care unit, his blood pressures dropped to the 60s. a right internal jugular was placed, and the patient was started on levophed. fresh frozen plasma was given prior to line placement as the patient's inr was 1.7. additionally, the patient was started on ampicillin, gentamicin, and flagyl for presume cholangitis. past medical history: (past medical history is significant for) 1. coronary artery disease; status post myocardial infarction. a catheterization performed in showed no significant coronary artery disease. 2. an echocardiogram performed in showed diastolic dysfunction without systolic dysfunction and left atrial enlargement. 3. non-insulin-dependent diabetes mellitus. 4. cerebrovascular accident with a right facial droop. 5. left hydronephrosis; chronic ? 6. mild spinal stenosis at l4-l5. 7. left anterior temporal lobe small arachnoid cyst. medications on admission: spironolactone. allergies: no known drug allergies. social history: alcohol once per month. tobacco times 20 years; quit four years ago. no intravenous drug abuse. one to two cups of coffee once per day. a retired truck driver. family history: family history was not significant for gastrointestinal problems or cancer. physical examination on presentation: physical examination on admission to the medical intensive care unit revealed vital signs of 93/29, heart rate was 83, respiratory rate was 10, and oxygen saturation was 96% oxygen saturation on 4 liters nasal cannula. temperature was 95.8 (hypothermic). in general, the patient was markedly jaundiced and appropriately conversational. head, eyes, ears, nose, and throat examination revealed normocephalic and atraumatic. pupils were equal, round, and reactive to light. scleral icterus. a jaundiced oropharynx. spider angiomas on the face. chest examination revealed crackles at the bases bilaterally/anteriorly. mild expiratory wheezes. cardiovascular examination revealed a regular rate and rhythm. a holosystolic murmur heard at the left fifth intercostal space midclavicular line. the abdomen was soft and nontender. distended. positive fluid wave. unable to assess organ size. a right femoral quinton catheter. extremity examination revealed no edema. dorsalis pedis pulses were 2+ bilaterally. positive asterixis bilaterally. pertinent laboratory values on presentation: laboratories on admission to the medical intensive care unit revealed white blood cell count was 7 (down from 10.2), hematocrit was 28.6, and platelets were 90. prothrombin time was 15.9, partial thromboplastin time was 37.1, and inr was 1.7. urinalysis revealed brown/cloudy. specific gravity was 1.016, large blood, 100 protein, moderate bilirubin, trace leukocytes, greater than 50 red blood cells, 6 to 10 white blood cells, few bacteria, and amorphous crystals. sodium was 137, potassium was 4.5, chloride was 100, bicarbonate was 16, blood urea nitrogen was 86, creatinine was 7.9, and blood glucose was 105. lipase was 72 and amylase was 25. calcium was 7.8, phosphate was 6.9, and magnesium was 2.1. albumin was 3. alt was 47, ast was 82, total bilirubin was 27.2, and alkaline phosphatase was 145. microscopic examination from ascites taken from revealed no growth, no polymorphonuclear leukocytes, no organisms seen on gram stain, 55 white blood cells, and 3045 red blood cells. cytology from ascites taken from was negative for malignant cells. brush on endoscopic retrograde cholangiopancreatography taken from was positive for malignancy cells adenocarcinoma. urine cultures from and revealed no growth. pertinent radiology/imaging performed at : 1. endoscopic retrograde cholangiopancreatography performed on revealed intraductal mass, stent placed. 2. abdominal ultrasound on revealed sludge in the gallbladder, negative sign, liver shrunken with increased echogenicity, enlarged spleen, and portal vein was patent. 3. magnetic resonance imaging of the abdomen performed on (although limited by the patient's claustrophobia), revealed massive ascites, left greater than right small bilateral pleural effusions, liver nodularity (consistent with cirrhosis), 3.6-cm x 4.8-cm mass with increased signal in segment 4a liver, spleen mildly enlarged, varices along the stomach (portal hypertension), gallbladder with no stones and no ductal dilatation. 4. a chest x-ray on revealed right internal jugular in place and pulmonary edema. no infiltrate. no pneumothorax. hospital course by issue/system: in summary, the patient is a 74-year-old gentleman with diabetes, coronary artery disease, and cerebrovascular accident who presented with painless jaundice and a 55-pound weight loss, status post endoscopic retrograde cholangiopancreatography with stent, now with cirrhosis and acute renal failure and probable cholangiocarcinoma. the patient was transferred to the medical intensive care unit with hypotension and shortness of breath. 1. hypotension issues: hypotension was treated with pressors (levophed). the patient was weaned off levophed with gentle fluid boluses. mean arterial pressure remained in the 50s to 60s, and the patient mentated well throughout his hospital course in the medical intensive care unit. hypotension was most likely secondary to sepsis. 2. pulmonary issues: the patient remained stable on 4 liters nasal cannula and was saturating well. the patient's pulmonary status was monitored closely while receiving fluid boluses for blood pressure so as to prevent a flare of pulmonary edema. albuterol nebulizers were given for wheezing. shortness of breath differential diagnoses included cirrhosis, renal failure, ascites (atelectasis), possible congestive heart failure or fluid overload. 3. coronary artery disease/congestive heart failure issues: no aspirin was given at this time as the patient was coagulopathic with an increased inr. no beta blocker were given during this time as the patient was hypotensive. mild congestive heart failure was seen on chest x-ray on . the patient received an echocardiogram on which revealed an ejection fraction of 75% to 80%; although the patient was on levophed at the time of this echocardiogram. findings included left atrium was mildly dilated, left ventricular wall thickness and cavity size were normal, hyperdynamic, right ventricular size and motion were normal, aortic valve leaflets were thickened, no regurgitation, trivial tricuspid regurgitation, and borderline pulmonary artery systolic hypertension. no effusions. 4. gastroenterology issues: intraductal mass was positive for adenocarcinoma by cytology. palliative care for this patient. the patient's treatment options and prognosis were discussed at length with the patient and his family. total bilirubin and liver function tests were checked daily to assess for obstruction. if these values were to increase significantly, could possibly replace stent with a more permanent stent via endoscopic retrograde cholangiopancreatography to relieve obstruction. total bilirubin tended to decrease throughout his hospital stay. the patient also has cirrhosis of unclear etiology. 5. renal issues: acute renal failure; question as to etiology - acute tubular necrosis; status post contrast for computed tomography versus hepatorenal syndrome. the patient received three days of hemodialysis. no fluid was removed in hemodialysis. renal consultation team is following the patient. fractional excretion of sodium was 1%. 6. infectious disease issues: the patient was originally started on ampicillin, gentamicin, and flagyl for presumed cholangitis causing a septic picture with increased white blood cells, hypotension, and hypothermia. this antibiotic regimen was changed to vancomycin, ceftazidime, and flagyl so as to provide more protection for the kidneys. cultures were negative or pending to date. blood cultures from were pending. urine cultures from and showed no growth. ascites from showed no growth. 7. hematologic issues: the patient remained coagulopathic secondary to liver disease. the patient was oozing from intravenous site. thus, the patient was given three days of subcutaneous vitamin k to correct for the increased inr. the patient received two units of packed red blood cells while in the medical intensive care unit for a hematocrit of less than 30. the patient also received one unit of fresh frozen plasma prior to internal jugular central vein line placement on . 8. fluids/electrolytes/nutrition issues: the patient received fluid boluses for a decreased blood pressure; yet remained saturating well on 4 liters nasal cannula oxygen and had no complaints of chest discomfort. electrolytes were repleted as needed. the patient was given a full diet upon his request. 9. access issues: the patient has a right internal jugular central line which was placed on , and a right femoral quinton catheter which was placed on , as well as two peripheral intravenous lines. 10. code status: the patient's code status was changed from full code to do not resuscitate/do not intubate. the patient and the patient's family expressed a wish to not be started on pressors if the patient's blood pressure were to fall. 11. social issues: multiple family meetings were held with the patient and his family. his son is the main contact person. additionally, the patient's brother flew in from and was able to meet with the patient and spend time with him. discharge disposition: currently, the patient is in the medical intensive care unit awaiting a private bed on the floor. the patient will most likely either be discharged to the floor in a private bed or go home soon with some kind of hospice care or visiting nurse assistance; pending social work evaluation and discussions with the family and the patient. condition at discharge: condition on discharge was fair. discharge status: the patient was to be discharged pending a private room on the floor, or the patient and his family wish for care at home. discharge diagnoses: 1. cirrhosis. 2. probably cholangiocarcinoma. 3. acute renal failure. 4. diabetes. 5. coronary artery disease/congestive heart failure. medications on discharge: have yet to be decided. the patient will most likely go home with antibiotics for presumed cholangitis and other comfort medications. discharge instructions/followup: 1. the patient was to follow up with his primary care doctor if needed. 2. the patient was also to follow up with social work for home hospice care if desired. , m.d. dictated by: medquist36 d: 22:36 t: 22:51 job#: procedure: venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage endoscopic insertion of stent (tube) into bile duct other closed [endoscopic] biopsy of biliary duct or sphincter of oddi diagnoses: acidosis hyperpotassemia acute kidney failure with lesion of tubular necrosis cirrhosis of liver without mention of alcohol unspecified septicemia hydronephrosis cholangitis malignant neoplasm of extrahepatic bile ducts 

Answer: The patient is high likely exposed to