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: bactrim / penicillins attending: chief complaint: cholangiocarcinoma major surgical or invasive procedure: : 1. exploratory laparoscopy. 2. liver biopsy. 3. exploratory laparotomy. 4. pylorus sparing radical pancreatoduodenectomy with en bloc resection of portal vein. 5. left internal jugular vein harvest, portal vein reconstruction with interposition bypass using left internal jugular vein 6. end-to-side ductal mucosa pancreatojejunostomy with 7-french zimmon stent. 7. end-to-side hepaticojejunostomy after cholecystectomy. 8. antecolic duodenojejunostomy. 9. transgastric feeding jejunostomy. 10.placement of gold fiducials. history of present illness: ms. is a 57-year-old woman who experienced a recent 30-pound weight loss over the last month. she has had no abdominal or back pain, denies diarrhea, diabetes, and notes only reduced appetite. she subsequently developed jaundice and pruritus, and presented for an ercp, which demonstrated a 1.5-cm distal biliary stricture. brushings were performed and negative for malignant cells. a 10 french 7 cm biliary stent has resolved her jaundice. her serum ca -9 is 63. a ct scan of her chest, abdomen and pelvis demonstrates no evidence of pulmonary or hepatic metastasis. she has a replaced left hepatic artery, with a dilated pancreatic and bile duct above what appears to be a heterogeneous and somewhat subtle mass in the uncinate portion of the pancreas immediately adjacent to the portal vein. the lesion measured 1.9 cm in diameter. the superior mesenteric artery is not involved. there is no teardrop malformation of the vein or evidence of encasement. the patient was evaluated by dr. in his clinic for possible surgical resection of this mass. after discussion of all risks, benefits and possible outcomes, the patient was scheduled for elective whipple resection. past medical history: -htn -hld -s/p hysterectomy -s/p 2 ectopic pregnancies (removal of ovaries and fallopian tubes bilaterally) social history: the patient is originally from montserrat in the caribbean and immigrated to the us in . has been married for 4 years, husband is a chef at in ny. had 1 child at age 16, died at 9 months of unknown cause. currently living with sisters and mother in . works as nurse's assistant at newbridge on the rehab. -tobacco - never -etoh - rare -illicits - never family history: mother has htn, diabetes, and multiple myeloma. no other known familiy history of malignancy physical exam: upon discharge: vs: 98.5, 79, 106/75, 12, 100% ra gen: nad, aao x 3 heent: neck incision well healed cv: rrr pulm: ctab abd: subcostal incision with moist-to-dry dressing. rlq jp drain x 2 to bulb suction, site with dsd and c/d/i. luq gj tube capped and site c/d/i. extr: warm, lue picc dressing c/d/i pertinent results: 04:36am blood wbc-7.4 rbc-3.37* hgb-8.6* hct-26.8* mcv-80* mch-25.5* mchc-32.0 rdw-15.3 plt ct-546* 04:36am blood glucose-124* urean-7 creat-0.6 na-139 k-4.5 cl-104 hco3-29 angap-11 04:36am blood alt-23 ast-37 alkphos-102 totbili-0.3 04:36am blood calcium-7.9* phos-3.2 mg-2.3 microbiology: 9:15 pm urine source: catheter. **final report ** urine culture (final ): presumptive gardnerella vaginalis. >100,000 organisms/ml.. anaerobic culture (final ): test performed only on suprapubic and kidney aspirates received in a syringe. specimen unacceptable for anaerobes. test cancelled, patient credited. 8:59 am blood culture source: line-picc. **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | amikacin-------------- <=2 s ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r anaerobic bottle gram stain (final ): reported to and read back by @ 5:10a . gram negative rods. 10:51 pm urine source: cvs. **final report ** urine culture (final ): no growth. 7:30 am blood culture **final report ** blood culture, routine (final ): no growth pathology examination name birthdate age sex pathology # , e 57 female report to: dr. gross description by: dr. . cederroth, dr. . /rate specimen submitted: fs liver biopsy left lobe, pancreatic and bile duct margins, common hepatic artery, gallbladder, whipple specimen. procedure date tissue received report date diagnosed by dr. /mn???????????? previous biopsies: mucosal biopsies, distal esophagus (not on file) (not on file) (not on file) diagnosis: i. left lobe, liver biopsy (a): benign bile ductular proliferation consistent with microhamartoma; no carcinoma seen. ii. gallbladder, cholecystectomy (c-d): a. chronic cholecystitis. b. one unremarkable lymph node. iii. pancreatic margin, pancreatoduodenectomy (e-g): pancreatic parenchyma with no carcinoma seen. incidental low grade pancreatic intraepithelial neoplasia (pan-in1a). iv. bile duct margin, pancreatoduodenectomy (h-l): bile duct segment with acute and chronic inflammation; no carcinoma seen. v. pancreatic head and duodenum, pancreatoduodenectomy (m-ai): a. adenocarcinoma of the pancreas, moderately differentiated, with invasion of the duodenal wall (pt3); see synoptic report. b. two of twenty-six regional lymph nodes with involvement by carcinoma (-pn1). c. lymphovascular and perineural invasion are present. d. bile duct segment with reactive changes commonly seen in association with in situ metal stents. vi. lymph node, common hepatic artery (ai-ak). one lymph node with no carcinoma seen (0/1). abd ct: impression: 1. no new fluid collection or abscess. 2. edematous pancreaticobiliary limb of the jejunum within the region of the porta hepatis with surrounding fluid and edematous efferent gastrojejunostomy are both unchanged. 3. marked attenuation of the left renal vein anterior to the aorta, likely post-surgical edema. this is associated with perirenal collaterals emptying into the splenic vein. 4. stable narrowing of the main portal vein near the portal venous confluence related to post-surgical changes. 5. the previously seen small pocket of air and debris noted posterosuperior to the porta hepatis now just contains air. no evidence of collection. 6. resolved left pleural effusion with bibasilar atelectasis. 7. small foci of air tracking from the left incision site to the peritoneum but not within the abdomen. 8. increased intra-abdominal air surrounding the anterior abdominal drain. brief hospital course: the patient with newly diagnosed pancreatic head mass was admitted to the hpb surgical service for elective whipple procedure. on , the patient underwent exploratory laparotomy with liver biopsy, pylorus sparing radical pancreatoduodenectomy with en bloc resection of portal vein, internal jugular vein interposition graft, transgastric feeding jejunostomy and placement of gold fiducials, which went well without complication (reader referred to the operative note for details). the ebl was ~ 450 cc. post operatively, patient was transferred in sicu intubated for observation. she was extubated on pod # 1 without difficulties and on pod # 3 she was transferred on the floor npo, on iv fluids, with a foley catheter, and epidural catheter for pain control. the patient was hemodynamically stable. neuro: the patient received hydromorphone/bupivacaine via epidural. epidural was split on pod # 3 and dilaudid pca was added for pain control. the epidural catheter was removed on pod # 4, and pca was discontinued on pod # 4. the patient was started on roxicet via with good effect and adequate pain control. when tolerating oral intake, the patient was transitioned to oral pain medications. cv: the patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. pulmonary: the patient remained stable from a pulmonary standpoint; vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. gi: post-operatively, the patient was made npo with iv fluids. the patient was started on tf on pod # 5, and her diet was advanced to clears on pod # 6. the jps amylase was sent on pod # 5 and came back high in jp # 2. the patient started to spike low grade fevers and her diet was changed to npo on pod # 10. the patient was continued on tf via j-tube and her g-tube was capped. g-tube was opened only if patient felt nausea. prior discharge patient's diet was advanced to clears. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. id: the patient spiked fever on pod # 4, her blood and urine cultures were sent. urine cultures were positive for gardnerella vaginalis and she was started on flagyl 500 mg . the blood cultures were negative. the patient was continued to have low grade fevers and on pod # 12, her blood and urine cultures were sent again. blood cultures were positive for e.coli and patient was started on iv vancomycin and cefepime. urine cultures were negative. the patient's temperature and wbc returned within normal limits after initiation of antibiotics. id was consulted to determine duration of antibiotics, and id recommended d/c vancomycin and continue ceftriaxone for 14 days total. her last antibiotics dose would be on . wound care: the patient wound was found to have a leak on pod # 6, her wound was open laterally from both sides and started with moist-to-dry dsd packing. on pod # 9, patient's wound was open and vac was applied. the average daily output from the wound was 100-200 cc. the wound vac was taken down on pod # 12, and moist-to-dry dressing packing resumed. the wound vac was restarted on pod # 14. upon discharge patient's wound vac was taken down and moist-to-dry dressing was applied. the patient will continue on wound vac in rehab until follow up with dr. on . endocrine: post operatively patient was started on sliding scale insulin and finger stick qid. finger stick was slightly elevated and patient required minimal amount of insulin. after starting tf, patient's blood glucose increased and was called for consult. continued to see patient on daily basis and their recommendations were followed. glucometer and insulin teaching were done during admission. hematology: the patient's post op hct was 34.7 and was continued to decrease during recovery. she was transfused with 1 unit of prbc for hct 28.8. her hct remained stable low, and upon discharge was 26.8. prophylaxis: the patient received subcutaneous heparin and venodyne boots were used during this stay; aspirin was started on pod # 3. patient was encouraged to get up and ambulate as early as possible. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a clear liquids diet, ambulating, 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: amlodipine 10 mg once a day, aspirin 81 mg once a day. the patient was on atenolol, but due to normal blood pressure and bradycardia, the atenolol was held during recent hospitalization discharge medications: 1. aspirin 325 mg po daily please give po, not through jtube. thank you. 2. bisacodyl 10 mg po/pr daily:prn constipation 3. ceftriaxone 1 gm iv q24h - last day of antibiotics 4. famotidine 20 mg po q12h 5. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 6. glargine 6 units bedtime insulin sc sliding scale using reg insulin 7. metoclopramide 10 mg po qidachs 8. oxycodone (immediate release) 5-10 mg po q4h:prn pain discharge disposition: extended care facility: newbridge on the - discharge diagnosis: 1. ductal adenocarcinoma g2pt3pn1pmx 2. chronic cholecystitis 3. urinary tract infection 4. sepsis 5. grade b pancreatic fistula discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the surgery service at after elective whipple procedure and portal vein reconstruction. you recovery was compicated by pancreatic fistula and infection. currently you doing well and are now safe to be discharge in rehab to complete your recovery with the following 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 lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. . incision care: you have wound vac applied to your subcostal incision. nurses will change dressing every 72 hrs or prn. . jp drain x 2 care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *maintain suction of the bulb. *note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or nurse if the amount increases significantly or changes in character. *be sure to empty the drain frequently. record the output, if instructed to do so. *you may shower; wash the area gently with warm, soapy water. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. . gj-tube care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *wash the area gently with warm, soapy water or 1/2 strength hydrogen peroxide followed by saline rinse, pat dry, and place a drain sponge. change daily and as needed. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. . picc line: *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: department: surgical specialties when: thursday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: other enterostomy enteral infusion of concentrated nutritional substances radical pancreaticoduodenectomy cholecystectomy repair of blood vessel with tissue patch graft insertion of catheter into spinal canal for infusion of therapeutic or palliative substances systemic to pulmonary artery shunt anastomosis of hepatic duct to gastrointestinal tract laparoscopic liver biopsy central venous catheter placement with guidance diagnoses: urinary tract infection, site not specified unspecified essential hypertension sepsis other and unspecified hyperlipidemia malignant neoplasm of head of pancreas surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation paralytic ileus personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits septicemia due to escherichia coli [e. coli] personal history of malignant neoplasm of other gastrointestinal tract other specified diseases of pancreas secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes persistent postoperative fistula acute and chronic cholecystitis other hamartoses, not elsewhere classified postsurgical hypoinsulinemia acquired total absence of pancreas 

Answer: The patient is high likely exposed to