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: penicillins / benadryl / zidovudine / enalaprilat attending: chief complaint: ruq pain major surgical or invasive procedure: endoscopic retrograde cholangiopancreatoscopy fiducial placement cyberknife history of present illness: 61m w/ hiv, hcv cirrhosis, hcc, cad, cholelithiasis and small gallbladder polyps p/w ruq pain. he has had worsening ruq pain w/o radiation since sunday. oxycodone with es tylenol helps somewhat but will only bring the pain from 8 to . he any f/c/n/v/night sweats. he believes he has lost some weight. he has not seen his bowel movements but does not know if they are acholic, or with blood/melena. he any jaundice. the pain is a "gripping" type of pain, occasionally sharp, and is constant. it is not related to po intake or bowel movements. sitting up and putting pressure on his abdomen exacerbates the pain. he any chest pain or dizziness. his sob is at baseline. of note, he recently completed a course of abx for hcap and is currently being treated for cdif. er: 98.3, 106, 125/76, 20, 94% 3l. ros:otherwise negative past medical history: - hcv cirrhosis c/b hcc, s/p tace , rfa - hiv diagnosed 20 years ago, on haart - hld - htn - cad, s/p cath at without intervention, mild cad noted - 3 years ago, no caths since - inclusion body myositis, diagnosed in , on chronic prednisone - cholelithiasis - small gallbladder polyps - s/p cataract surgery - recent cdif - recent pins place in hip @ osh social history: lives with , who is his hcp uses electric wheelchair no tobacco social etoh no illicits family history: mother died of colon cancer age 42 father died at age 86 from suicide physical exam: admission exam vs: tm 98.5, bp 120-132/87, hr 78-95, rr 18-20, o2 sat: 98% 2l/bipap overnight i/o: 0/2300 + 3 bm gen: nad, chronically ill appearing, emaciated male, hunched over in bed. heent: ncat, sclera anicteric, op clear cv: rrr, no m/r/g appreciated lungs: anterior exam, mild crackles. no wheezes appreciated; air movement throughout. ab:+bs, soft, no ttp in ruq, no rebound/guarding, no mass/hsm ext:no c/c/e skin:atrophic le neuro:a&o x 3, strength in ue is , cn ii-xii intact. strength in le: knee extension 0/5; hip abduction/adduction and hip extension . and plantarflexion . equal bilaterally. sensation intact. unable to ambulate. finger to nose intact. speech normal. discharge exam vitals - t:98.5 bp:110/78 hr:105 rr:20 02 sat:100% 2l general: middle aged male appearing comfortable cardiac: rrr, s1/s2, no mrg lung: decreased air entry on the left base, right sided scattered wheezes. abdomen: nondistended, +bs, non tender to palpation, no rebound/guarding chest: tenderness along left costal margion and left sternal border improving. pertinent results: admission labs 03:30pm glucose-122* urea n-8 creat-0.7 sodium-131* potassium-5.1 chloride-95* total co2-25 anion gap-16 03:30pm estgfr-using this 03:30pm alt(sgpt)-171* ast(sgot)-149* alk phos-643* tot bili-1.2 03:30pm albumin-3.5 03:30pm albumin-3.5 03:30pm lactate-2.1* 03:30pm wbc-13.7*# rbc-4.43* hgb-11.3* hct-38.8* mcv-88 mch-25.6*# mchc-29.2* rdw-14.8 03:30pm neuts-89* bands-0 lymphs-7* monos-1* eos-1 basos-0 atyps-2* metas-0 myelos-0 03:30pm plt smr-high plt count-434# 03:30pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 03:30pm urine rbc-1 wbc-0 bacteria-none yeast-none epi-0 discharge labs: 06:15am blood wbc-8.1 rbc-3.35* hgb-8.1* hct-27.6* mcv-82 mch-24.3* mchc-29.5* rdw-18.5* plt ct-356 06:15am blood glucose-81 urean-11 creat-0.7 na-134 k-3.3 cl-99 hco3-26 angap-12 06:15am blood alt-24 ast-30 alkphos-235* totbili-1.0 06:15am blood calcium-8.8 phos-2.7 mg-2.3 micro: stool c. difficile dna amplification assay- negative; fecal culture-no enteric gram negative rods found, no salmonella or shigella found; campylobacter culture- negative blood culture - no growth blood culture - no growth stool c. difficile dna amplification assay- negative; fecal culture-no enteric gram negative rods found, no salmonella or shigella found; campylobacter culture-negative; cryptosporidium/giardia (dfa)-no cryptosporidium or giardia seen. blood culture - no growth blood culture - no growth blood culture - no growth blood culture - enterococcus faecium blood culture - no growth blood culture - enterococcus faecium blood culture - enterococcus faecium, staphylococcus epidermidis blood culture enterococcus faecium, staphylococcus epidermidis sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus faecium | staphylococcus epidermidis | | ampicillin------------ =>32 r clindamycin----------- =>8 r daptomycin------------ s s erythromycin---------- =>8 r gentamicin------------ 4 s levofloxacin---------- =>8 r linezolid------------- 2 s oxacillin------------- =>4 r penicillin g---------- =>64 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s vancomycin------------ =>32 r 2 s immunology hiv-1 viral load/ultrasensitive--1 viral load/ultrasensitive (final ): hiv-1 rna is not detected. blood culture - no growth blood culture - no growth blood culture - no growth blood culture - no growth urine culture- no growth pathology: common bile duct stent pathology positive for malignant cells, consistent with poorly differentiated carcinoma pertinent studies # cxr : no significant interval change from prior with continued chronic elevation of left hemidiaphragm and associated left basilar opacity likely reflective of atelectasis. right picc tip terminates in the mid svc. # ruq u/s : 1. limited study. gallbladder could not be visualized. 2. cirrhosis with ill-defined 15-mm nodule in the left lobe, without a clear correlate on the prior mr. 3. stent in the cbd without intrahepatic biliary dilatation. ct or mri is recommended for further evaluation of the gallbladder, as well as the left lobe hepatic nodule. # mri abdomen with contrast 1. interval increase in the size of the hepatic mass in the left lobe of the liver which causes more extensive obstruction of the left lateral segment bile ducts and has increased intraductal extent into the primary bifurcation of the biliary system. 2. stable right-sided renal cysts, hepatic cyst in the left lateral segment, and gallstones. 3. rounded, expanded lesion in the right 9th rib at the level of the costochondral junction that demonstrates heterogeneous signal on t2 weighted images and post contrast enhancement. dedicated ct examination is recommended to rule out metastasis. 4. slight increase in size of satellite lesion (9 x11mm) in the border of segment v/viii that shows increased signal on t2 weighted images, arterial hyperenhancement and washout pattern. # fiducial placement 1. two gold fiducial markers placed within liver mass as described above. 2. bilateral atelectasis in the lung lower lobes. 3. soft tissue density surrounding the right 8th rib, favor nondisplaced fracture with callus formation (please refer to the body of the report). # cxr mediastinal silhouette with left mediastinal shift, most likely due to left lower lung atelectasis/volume loss, is unchanged. lung volumes remain very low. small amount of pleural effusion is most likely present bilaterally. catheter projecting over the right upper abdomen is redemonstrated. elevation of left hemidiaphragm is unchanged. there is no pneumothorax. # ercp findings: esophagus: limited exam of the esophagus was normal stomach: limited exam of the stomach was normal duodenum: limited exam of the duodenum was normal major papilla: 2 previously placed plastic stents placed in the biliary duct were found in the major papilla. the cotton stent was removed using a snare. a double pigtail stent was removed using a rat tooth forceps. evidence of a previous sphincterotomy was noted in the major papilla. cannulation: cannulation of the biliary duct was successful and deep with a sphincterotome using a free-hand technique. contrast medium was injected resulting in complete opacification. biliary tree fluoroscopic interpretation: a moderate diffuse dilation was seen at the right main hepatic duct and left main hepatic duct. the dilation was greater on the left than right intra-hepatic ductal system. there was a large filling defect in the common hepatic duct c/w known hcc invading and causing bleeding within the biliary tree. impression: previously placed plastic stents were removed evidence of a previous sphincterotomy was noted in the major papilla. there was a large filling defect in the common hepatic duct c/w known hcc invading and causing bleeding within the biliary tree. multiple balloon sweeps were performed and large amount of blood clots and blood was extracted. given tumor in the common hepatic duct and a double pig tail biliary stent was placed # cta chest 1. progressive left lung and right lower lobe collapse. this is likely related to chronic mucoid impaction, and possible underlying tracheobronchomalacia. 2. no pulmonary embolism. # tte there is mild symmetric left ventricular hypertrophy. there is mild global left ventricular hypokinesis (lvef = 45 %). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: suboptimal image quality. no obvious vegetations seen # chest (pa & lat) study date of impression: complete left upper and lower lobe collapse. bronchoscopy is suggested. # rib bilat, w/ap chest study date of impression: 1. near-complete whiteout of the left lung with areas of cystic changes in the left upper lobe which are better evaluated on prior chest ct. 2. there are subacute fractures of several of the left lower ribs, which demonstrate some bridging callus. # chest (portable ap) study date of findings: whereas the left hemithorax was previously completely opacified, there is now marked improved aeration of the left upper lobe, with residual atelectasis involving the left lower lobe. small-to-moderate pleural effusion on the left is difficult to compare to the previous study for change due to the presence of complete lung collapse on the prior exam. partial atelectasis of the right lower lobe is present, manifested by a right retrocardiac opacity and inferior displacement of the right hilum. small right pleural effusion is not appreciably changed. brief hospital course: 61m w/ hiv, hep c cirrhosis, hcc with recent admission for cap, presented with ruq pain and increasing bilirubin with progression of hcc on imaging, s/p ercp with stent placement on resulting improvement in tbili. pt had placement of fiducial and completed rounds of cyberknife treatment. his hospital course was complicated by vre bacteremia and complete left lung collapse, requiring brief icu stay. pt has opted to transition to home hospice. active issues: # complete left lung collapse: pt has poor baseline lung capacity secondary to inclusion body myositis and diaphragmatic weakness. during his hospitalization, he had increasing difficulty clearing his secretions, due to his myositis, immobility and pain from subacute rib fractures. on two occasions, he developed increasing respiratory distress, initially requiring icu admission, where he was placed on bipap. the etiology of his respiratory decompensation was thought to be secondary to mucous plugging. his respiratory status improved with chest pt, suctioning, standing nebs, acapella device and incentive spirometry. pt was also encouraged to get out of bed and his rib pain was well controlled with medications. at time of discharge, he was stable on 2 liters of supplemental oxygen via nasal canula with oxygen saturation maintaining in the mid 90s. he continues to require bipap at night secondary to his myositis. # vre and staph epidermidis bacteremia: pt was found to be bacteremic with multiple blood cultures positive for vre and s. epidermidis on . the etiology was likely a biliary source, possibly secondary to fiducial placement, or pneumonia given chest ct findings of complete left lung collapse. surveillance cultures cleared on . he was initially on vancomycin and then transitioned to daptomycin. he completed a 14 day course of treatment. # left lower chest pain: pt developed left lower rib pain during his hospitalization. his rib xray revealed multiple subacute fractures, likely responsible for his pain. he was treated with pain medications and his pain improved. # ruq pain: he was admitted with worsening ruq pain. on mrcp, the patient's hcc lesion was enlarged and causing mass effect on his biliary system (the likely the etiology of his pain) so he underwent ercp and is s/p stenting with resulting improvement in his lfts and tbili, despite lack of improvement in pain because the lesion was still large. thus, he underwent cyberknife , which provided dramatic improvement in his pain. # diarrhea: pt continue to have diarrhea throughout his hospitalization. his c diff assay was negative on multiple occasions, as were stool studies. his diarrhea was thought to be secondary to his antibiotics. he was ultimately started on imodium with improvement in his symptoms. chronic care # hiv: currently, hiv is undetectable in his blood. cd4 count is 1000. for his haart, his dosing was confirmed with pharmacy given liver failure, thus, he was continued on leviva, zetia and truvada # hep c cirrhosis c/b hcc: slight elevation in lfts, which were normal in . after discussion with the patient and his hcp, he decided to transition to dnr/dni and ultimately would like to go home with hospice. # cdiff: pt had recent c diff infection and was on po vanc at time of admission. his course was continued and repeat pcr showed no evidence of c diff. # inclusion body myositis: pt has limited mobility at baseline and requires bipap nightly. he was continued on prednisone with bactrim prophylaxis. transitions in care # code status: dnr/dni # contact: , hcp and partner, # issues to discuss at follow up: during this hospitalization, pt expressed a desire to change code status to dnr/dni and transition to hospice. ultimately, he would like to receive home hospice but does not have the necessary support at this time. his plan is to be discharged to rehab for 2 weeks. at that time, a friend will be moving to and will be able to provide home health care for the patient. he should be discharged from rehab to home with hospice. he would like to continue all medications at this time, but is aware that he has the option of discontinuing any or all of them. he would like to forgo any further treatment for his hcc, but should he change his mind, he should have a repeat ercp in 6 to 8 weeks with dr. . medications on admission: fexofenadine 60 mg po bid prednisone 15 mg po daily heparin sq tid pseudoephedrine 30 mg po bid sertraline 50 mg po daily bactrim ds daily lansoprazole 30 mg daily fosamprenavir 1400 mg po bid truvada 200-300 daily vitamin d daily calcium daily multivitamin vancomycin 250 mg po qid (until ) oxycodone 5 mg po q6h prn pain tylenol es 500 mg po q6h prn pain xanax 0.25 mg po tid prn anxiety ambien 5 mg po qhs prn insomnia alb/atrovent inh q6h prn ntg 0.4 mg sl q5 mins x 3 prn pain anusol prn discharge medications: 1. fexofenadine 60 mg tablet : one (1) tablet po bid (2 times a day). 2. prednisone 5 mg tablet : three (3) tablet po daily (daily). 3. pseudoephedrine hcl 30 mg tablet : one (1) tablet po bid (2 times a day). 4. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 5. sertraline 50 mg tablet : one (1) tablet po daily (daily). 6. sulfamethoxazole-trimethoprim 800-160 mg tablet : one (1) tablet po daily (daily). 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 8. fosamprenavir 700 mg tablet : two (2) tablet po q12h (every 12 hours). 9. truvada 200-300 mg tablet : one (1) tablet po once a day. 10. cholecalciferol (vitamin d3) 400 unit tablet : one (1) tablet po daily (daily). 11. calcium carbonate 200 mg calcium (500 mg) tablet, chewable : one (1) tablet, chewable po tid (3 times a day). 12. multivitamin tablet : one (1) tablet po daily (daily). 13. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours). 14. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q6h (every 6 hours). 15. oxycodone 5 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for moderate pain. disp:*1 tablet(s)* refills:*0* 16. sodium chloride 3 % solution for nebulization : one (1) neb inhalation q 8h (every 8 hours). 17. tylenol 325 mg tablet : 1-2 tablets po every six (6) hours as needed for fever or pain: do not take more than 2 grams/24 hours. 18. lorazepam 0.5 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for anxiety/nausea. 19. ambien 5 mg tablet : one (1) tablet po at bedtime as needed for insomnia. 20. anusol-hc 2.5 % cream : one (1) application rectal three times a day as needed for hemorrhoids. 21. imodium a-d 2 mg tablet : one (1) tablet po twice a day as needed for diarrhea. 22. docusate sodium 100 mg capsule : one (1) capsule po twice a day as needed for constipation. 23. senna 8.6 mg capsule : one (1) capsule po once a day as needed for constipation. discharge disposition: extended care facility: - discharge diagnosis: primary hepatocellular carcinoma hospital acquired pneumonia bacteremia secondary: inclusion body myositis hiv hepatitis c discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: dear mr. , it was a pleasure taking care of you at . you were admitted for right sided abdominal pain, which was likely from progression of your cancer. you did receive cyberknife radiation treatment to your tumor, which helped improve your pain. during your hospitalization, you were also treated for a pneumonia and an infection in your blood stream, for which you received antibiotics. you had several episodes of difficulty breathing, which we treated with breathing treatments and chest physical therapy. it is important that you continue these treatments at home please note the following changes to your medications: # use sodium chloride 3% nebulizers every 8 hours # start ativan 0.5 mg every 6-8 hours as needed for anxiety; stop taking xanax # start imodium 2-4 times daily as needed for diarrhea # use your incentive spirometer and acapella device every hour while you are awake followup instructions: department: radiology when: thursday at 11:55 am with: radiology mri building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: monday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: removal of t-tube, other bile duct tube, or liver tube other immobilization, pressure, and attention to wound endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct stereotactic radiosurgery, not elsewhere classified diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery unspecified essential hypertension long-term (current) use of steroids cirrhosis of liver without mention of alcohol unspecified viral hepatitis c without hepatic coma secondary malignant neoplasm of other specified sites other and unspecified hyperlipidemia iatrogenic pneumothorax bacteremia other specified disorders of biliary tract calculus of gallbladder without mention of cholecystitis, without mention of obstruction other chest pain diarrhea streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] malignant neoplasm of liver, primary do not resuscitate status cholangitis obstruction of bile duct secondary malignant neoplasm of bone and bone marrow asymptomatic human immunodeficiency virus [hiv] infection status other respiratory abnormalities secondary malignant neoplasm of other digestive organs and spleen neoplasm related pain (acute) (chronic) pathologic fracture of other specified site nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] foreign body in respiratory tree, unspecified abdominal pain, right upper quadrant inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation aftercare for healing traumatic fracture of hip cholesterolosis of gallbladder inclusion body myositis 

Answer: The patient is high likely exposed to