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: no known allergies / adverse drug reactions attending: chief complaint: 1. increased abdominal pain 2. fevers 3. rigors. major surgical or invasive procedure: : : uncomplicated exchange of an occluded biliary catheter for a 8.5 french cook biliary catheter : cardiac cath : uncomplicated upsizing of a pre-existing 8.5 french biliary catheter for a 10.2 french multipurpose drainage catheter. : ugd : colonoscopy history of present illness: mr. is a 66 year-old gentleman with duodenal carcinoma causing biliary obstruction who underwent placement of a percutaneous biliary drain for decompression on . pathology revealed a poorly differentiated carcinoma, consistent with pancreatic or biliary origin.) he was seen in dr. clinic today for scheduled consulation for possible tumor resection. he reported a day history of increasing abdominal pain, fevers, and rigors. due to a concern for developing cholangitis, he was directly admitted from clinic for resuscitation and further management. upon interviewing mr. he reports feeling overall unwell. his abdominal pain, fevers, and chills continue past medical history: coronary artery disease and remote history of myocardial infarction hyperlipidemia tobacco use anxiety social history: married and lives with wife in . retired 18 years ago from a granite quarry. smokes 4 packs of cigarettes/week x 40-50 years. no etoh. family history: father with duodenal ulcer, died of renal ca metastatic to lungs. mother with disease. uncles with bleeding ulcers. one sister with cardiac disease; no other siblings. 2 sons alive and well. physical exam: on discharge: vs: 98.1, 93, 133/76, 18, 100 % ra gen: anxious, pleasant cv: rrr, no m/r/g lungs: ctab. no wheezes, rales, or rhonchi. abd: soft, luq with ptb drain, insertion site with dry dressing and c/d/i extr: wwp, no c/c/e neuro: a&ox3. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. pertinent results: cardiac cath: 1. selective coronary angiography demonstrated 2 vessel coronary artery disease. the lmca was free of angiogrphically significant disease. the lad was occluded in its mid segment. there were left to right and right to right collaterals to the lad. the lcx gave rise to a large obtuse marginal proximally that was free of significant disease. the av groove lcx collateralized the right giving rise to an rpl and r-pda. the rca was occluded proximally with right to right collaterals. 2. limited resting hemodynamics revealed normal central aortic pressure. final diagnosis: 1. two vessel coronary artery disease. 2. normal central aortic pressures. echo the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. there is moderate to severe global left ventricular hypokinesis with relative preservation of function of the inferolateral and anterolateral walls (lvef = 30-35 %). no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is high normal. there is no pericardial effusion. impression: mild left ventricular cavity dilation with global systolic dysfunction. mild-moderate mitral regurgitation. increased pcwp. clinical implications: the left ventricular ejection fraction is <40%, a threshold for which the patient may benefit from a beta blocker and an ace inhibitor or . based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. replacement ptbd: 1. obstruction of the distal portion of the pre-existing 8.5 french cook catheter. no flow was seen into the duodenum. 2. post-procedure cholangiogram demonstrates flow into the duodenum and opacification of the intrahepatic ducts. impression: uncomplicated exchange of an occluded biliary catheter for a 8.5 french cook biliary catheter : replacement ptbd: impression: uncomplicated upsizing of a pre-existing 8.5 french biliary catheter for a 10.2 french multipurpose drainage catheter. the catheter was attached to a bag. ugd: impression: a tiny clot was noted at the pylorus and suctioned. no other blood or stigmata of recent bleeding noted otherwise in the stomach. there was again a compressing mass at the duodenal sweep and the gastroscope could not be passed through. no active bleeding noted in the visualized duodenum. colonoscopy: impression: no blood or bleeding was seen. a tiny raised area was seen and thought to be a small polyp, however upon further examination could not be found. this could represent and fold or a small polyp. otherwise normal colonoscopy to cecum. brief hospital course: the patient with biliary obstruction secondary to duodenal mass was admitted to the general surgical service on with symptoms of cholangitis. the patient currently scheduled for elective whipple resection on . the patient had ptbd placed on and drain was found occluded during his outpatient office follow up with dr. . on , the patient underwent drain replacement. after the procedure, patient was noted to have hypotension/tachycardia, chest pain, and elevated cardiac enzymes. the patient was transferred in icu and cardiology was consulted. cv: initial ekg demonstrated sinus tachycardia with st segment depressions in high lateral leads concerning for possible myocardial ischemia. blood test was positive for troponin leak. the patient was treated as nstemi per cardiology recommendations, although this ekg may represent stable angina/demand ischemia in the setting of sirs response. the patient was given asa, b-blockers, and one unit of prbc. patient was hypodynamically stable. on hd # 2, the patient was transfused with 2 unit of rbc for hct = 22.9, hct improved to 30.4 post transfusion. on hd # 3, patient was transferred on the floor. on (hd # 5), the patient underwent echocardiography, which demonstrated global systolic dysfunction with lvef = 30-35%. on hd # 7, the patient underwent cardiac catheterization, with demonstrated two vessel disease (lad and rca) with good collaterals. cardiology did not support coronary artery intervention with stent or cabg prior scheduled surgery. an echo or stress test can be done prior the whipple procedure. patient will required to have cardiac anesthesist during planned surgery. after cardiac catheterization, patient was continued on asa, metoprolol and statin, asa was discontinued on hd # 12 secondary to active rectal bleeding. the patient's cardiac status was monitored with telemetry, the patient continue to have asymptomatic runs of svts, cardiac enzymes continue to go downward, repeat ekg was stable. cholangitis/id: on admission the patient was found to have leukocytosis with wbc max 19.4. blood cultures were positive for e-coli and bile culture was positive for multiple organisms. infectious disease was consulted, the patient was started on vancomycin, zosyn and fluconazole as id recommendations. finally, antibiotics regiment was simplified to zosyn only, wbc trended down, repeat blood/urine cultures were negative. abx was stopped on . the patient remained afebrile with wbc wnl. ptbd drain was exchanged on hd # 1, and drained well with t-bili down from 3.5 to 1.2 on hd # 7. the patient's ptbd was capped. on hd # 9, the patient's t-bili went up to 2.8 and was continued to rise. the patient was taken back to ir on hd # 11 and ptbd was upsized to 10, t-bili trending down to normal. ptbd was capped prior discharge, patient tolerated well, he will continue on ursodiol po bid. anemia/gi bleeding/hematology: the patient has hct 23.7 on admission, he received one unit of rbc on hd # 1, and two units on hd # 2. hct went up to 30 on hd # 4 and was grossly stable. on hd # 11, the patient's hct fell to 19.6, he received 2 units of rbc, post transfusion hct was 28.5. at the same day, the patient underwent ptbd exchange. on hd # 12, hct fell to 23.9, he had brbpr x2 and ptbd output was bloody. the patient was transfused with 5 units total of rbc and underwent egd, which was grossly normal down to duodenal mass. the patient also received vitamin k for inr 1.6. on hd # 13, the patient continued to have bloody stools (850 cc total), ptbd drainage was bilious, the patient received 2 units of rbc for hct = 26.4. on pod # 14, the patient had one tarry stool, he underwent colonoscopy, which was negative for any bleeding, and patient's hct was stable > 30. on hd # 15, the patient' hct remained stable, no transfusions were required. the patient's gi bleed was thought to be caused by his duodenal mass secondary to ptbd manipulation. the patient's hct was 33.1 prior discharge. acute renal failure/gu: on hd # 9, patient's cr was elevated to 2.3, and fena was 3%. the patient was started on iv fluids, all medications were adjusted to renal doses. the patient's cr improved daily and downwarded to normal on hd # 14. the patient continued to have normal renal output throughout hospitalization. gi: on admission the patient was made npo with iv fluids, diet was advanced to regular cardiac healthy diet with supplements qac. the patient complained about poor appetite and his po intake was noticed to be inadequate. he was made npo for procedures and secondary to acute gi bleed. on hd # 12, the patient was started on tpn per nutritionist recommendation. diet was advanced on hd # 15 to clears and on hd # 17 to regular cardiac healthy diet. the patient reported poor appetite and tpn was continued. tpn was cycled prior discharge. the patient was discharged on regular diet with cycled tpn. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. endocrine: the patient's blood sugar was monitored throughout his stay; insulin in patient's tpn was adjusted accordingly. prophylaxis: the patient received subcutaneous heparin and venodyne boots were used during this stay; sc heparin was discontinued since gi bleeding was noticed. the patient was encouraged to ambulate, physical therapy followed the patient daily. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a small amount of regular food and tpn, ambulating with assist, voiding without assistance, and pain was well controlled. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: xanax 0.5 qam, toprol 50', fish oil (he recently stopped aspirin and simvastatin 80') discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. alprazolam 0.25 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for anxiety. 3. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed): see sliding scale. 4. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 5. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 6. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 7. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 8. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 10. colace 100 mg capsule sig: one (1) capsule po twice a day. discharge disposition: extended care facility: life care center of discharge diagnosis: poorly differentiated duodenal carcinoma cholangitis ptbd occlusion angina/demand ischemia chf two vessel cad anemia rectal bleeding acute renal failure (resolved) discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory -with assistance. discharge instructions: please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. ptbd care: * capped *dry dressing apply daily *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the drain site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash with a mild soap and warm water. gently pat the area dry. picc line care: *please monitor the site regularly, and your md, nurse practitioner, or nurse if you notice redness, swelling, tenderness or pain, drainage or bleeding at the insertion site. * your md to the emergency room immediately if the picc line tubing becomes damaged or punctured, or if the line is pulled out partially or completely. do not use the picc line in these circumstances.please keep the dressing clean and dry. contact your nurse if the dressing comes undone or is significantly soiled for further instructions. followup instructions: provider: scan phone: date/time: 9:45 radiology, 3 rd floor provider: , md phone: date/time: 10:45 3, procedure: coronary arteriography using two catheters parenteral infusion of concentrated nutritional substances other endoscopy of small intestine left heart cardiac catheterization colonoscopy other cholangiogram other cholangiogram replacement of stent (tube) in biliary or pancreatic duct replacement of stent (tube) in biliary or pancreatic duct diagnoses: hyperpotassemia subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery tobacco use disorder acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) severe sepsis paroxysmal ventricular tachycardia other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure old myocardial infarction mechanical complication due to other implant and internal device, not elsewhere classified hemorrhage of gastrointestinal tract, unspecified septicemia due to escherichia coli [e. coli] cholangitis obstruction of bile duct malignant neoplasm of duodenum chronic total occlusion of coronary artery 

Answer: The patient is high likely exposed to