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 / ciprofloxacin / roxicet / salicylate / clindamycin attending: chief complaint: worsening gastric reflux symptoms major surgical or invasive procedure: : esophagectomy with j-tube placement history of present illness: the patient is a 62 year old male who presented with worsening reflux symptoms. he had an egd at with biopsy which showed adeno ca at 32cm. eus here on showed t disease without nodal enlargement. past medical history: deep vein thrombosis and dx'd with lupus anticoagulant, gastroesophageal reflux disease, prostate ca and prostatectomy, ri hernia repair, hand surgery, occasional asthma social history: married lives with family. denies smoking. etoh- 4 drinks per week. denies illicit drug use. retired construction supervisor. family history: unknown. pt adopted. physical exam: physical exam: vitals: t: 98.3 bp: 132/76 hr: 78 rr: 18 02 sat: 94%/ra general: pleasant, well appearing man in nad, heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . lungs: cta bilaterally abdomen: nabs. soft, nt, nd extremities: le edema 1+ skin: no rashes/lesions, ecchymoses. neuro: a&ox3. appropriate. pertinent results: 07:15am blood wbc-8.6 rbc-3.60* hgb-9.9* hct-30.6* mcv-85 mch-27.6 mchc-32.5 rdw-14.5 plt ct-299 07:15am blood plt ct-299 07:15am blood pt-12.4 inr(pt)-1.0 07:15am blood glucose-111* urean-18 creat-0.7 na-134 k-4.1 cl-98 hco3-28 angap-12 06:40am blood alt-77* ast-47* operative report , s. signed electronically by , on tue 7:53 pm name: , unit no: service: date: date of birth: sex: m surgeon: , procedure: 1. esophagectomy. 2. laparoscopic feeding jejunostomy. 3. buttressing of esophagogastric anastomosis with thymic fat pad. estimated blood loss: 200 ml. first assistant: , md second assistant: , res operative indications: the patient is a 62-year-old gentleman with a distal esophageal adenocarcinoma. his endoscopic ultrasound stage was t2, n0. he was brought to the operating room today for esophageal resection. preoperatively i reviewed with the patient and his wife the risks of the proposed operation. we specifically discussed the risk of anastomotic leak, bleeding, need for reoperation, respiratory failure, myocardial infarction and death. description of procedure: the patient was brought to the operating room and placed supine on the operating table. after identifying the patient appropriately, he was intubated with a double-lumen endotracheal tube. the position of this tube was confirmed bronchoscopically. we performed a surgical time-out and then inserted the flexible gastroscope transorally. we noted the esophageal tumor at 37 cm. we also noted barrett's esophagus that extended to approximately 35 cm from the incisors. the stomach and remainder of the esophagus appeared normal. we decompressed the stomach and removed the gastroscope. we then prepped and draped the abdomen in usual sterile fashion. we made a cutdown port in the left upper quadrant. we inserted the trocar and established pneumoperitoneum to 15 mmhg. we inserted a laparoscope and evaluated the peritoneal cavity. we observed no evidence of metastatic disease on this laparoscopic survey. we then placed 4 additional ports in the usual configuration for laparoscopic esophageal surgery. the left lobe of the liver was retracted with the 5-mm snake retractor. we began by incising the gastrohepatic ligament overlying the caudate lobe. we carried our dissection to the right crus of the diaphragm. there was a small hernia and we entered the dissection plane between the hernia sac and the peritoneum over the right crus. we entered the mediastinum, taking care to not injure either pleura. we then carried our dissection dividing the phrenoesophageal ligament and identified the medial edge of the left crus of the diaphragm. we then elevated the esophagus anteriorly and identified the bifurcation of the right and left crura posterior to the esophagus. we cleaned the left crus off of the stomach which was adherent to the diaphragm in this area. we then turned our attention to the greater curve of the stomach. we first began by dividing all the short gastric vessels using the harmonic scalpel. we then carried our dissection toward the pylorus. we took care to identify and preserve the right gastroepiploic artery and vein during all phases of this operation. there were some small collaterals within the omentum between the right and left gastroepiploic artery that we also preserved. we carried our dissection toward the base of the right gastroepiploic artery and vein. we also divided some adhesions between the posterior surface of the stomach and the pancreas. once the stomach was completely mobilized we then divided the left gastric artery and vein. this was done using a vascular stapler. we then turned our attention to the pylorus. we elevated the pyloric ring using 2 stay sutures. we then injected the pylorus using 200 units of botulinum toxin. we then turned our attention to insertion of the laparoscopic feeding tube. we identified the ligament of treitz and selected a portion of small bowel 20 cm distal that we felt would be appropriate for insertion of the feeding tube. this portion of the small bowel was tacked up to the anterior abdominal wall. we then inserted the 7-french needle jejunostomy catheter using the large needle and wire assembly. we observed appropriate position of this tube going distally into the small bowel. we also noted good distension of the small bowel when air was insufflated into the jejunostomy catheter, indicating intraluminal positioning of the feeding tube. the feeding tube was then tacked up to the abdominal wall using 3 additional sutures. we placed 1 final suture about 5 cm distal to the insertion site to prevent torsion of the bowel in this area. the external portion of the feeding tube was secured to the abdomen using 3-0 nylon sutures. next, we created the gastric tube. we placed bowel graspers on both the fundus of the stomach as well as the antrum to make sure that the stomach was straight and not twisted. we then used the ligasure device to denude the lesser curve of the stomach. we preserved the right gastric artery in this process. once we approached about 2 cm within the ge junction, we then used multiple fires of the green endo staplers to create a wide gastric tube that was about 6-7 cm in diameter. once the tube was created we then placed a single u stitch between the tube and the specimen to allow the tube to be brought up into the chest. we then divided the right crus of the diaphragm using harmonic scalpel. this was done to prevent obstruction of the gastric conduit at the level of the diaphragm. with this done we then removed the liver retractor. the fascia beneath the cutdown port in the left upper quadrant was closed using 0 vicryl. remaining port sites were closed using 4-0 vicryl and dermabond. the patient was then rotated to the left lateral decubitus position. the right chest was prepped and draped in the usual sterile fashion. before turning the patient we also placed a nasogastric tube into the proximal thoracic esophagus. we made a cutdown port in the eighth intercostal space posterior axillary line. we noted some dense adhesions between the lower lobe of the lung and the chest wall. we placed our 2 anterior ports and took these adhesions down using the harmonic scalpel as well as the electrocautery. we then placed our 2 posterior ports for mobilization of the esophagus. we placed a stay suture in the central tendon of the diaphragm and reflected this inferiorly to expose the inferior pulmonary ligament. we divided the inferior pulmonary ligament and carried our pleural incision up toward the carina. at the level of the pericardium we were able to mobilize the esophagus. we carried our dissection plane up toward the carina sweeping the subcarinal lymph nodes off of the pericardium. there was an extremely large bronchial artery in this area that there was divided between clips. we skeletonized both the right and left mainstem bronchi and swept all of the subcarinal lymph nodes onto the esophagus. there was some bleeding in this area from the large bronchial artery that was controlled with clips. with this done we then incised the pleura posterior to the esophagus. we then divided multiple small aortoesophageal vessels between clips. we took care to ensure that the plane of fat overlying the thoracic duct was maintained during this portion of the dissection. we were therefore able to completely mobilize the esophagus at this level. we then divided the azygos vein using a vascular stapler. we also mobilized an additional 2 cm of esophagus above the azygos vein. at this level, we took care to stay right on the esophageal muscle musculature. we also divided the vagus nerves just below the level of the carina. we then brought the gastric conduit into the chest and divided the sutures between the conduit and the specimen. we took care to ensure that the conduit was appropriately oriented so that the lesser curve staple line was directed toward the patient's right side. we then divided the esophagus at the level of the azygos vein using laparoscopic scissors. we removed the specimen using an endocatch bag. we sent margins for frozen section which returned negative for malignancy. we then inserted the 28 mm anvil into the proximal thoracic esophagus. this was secured using 2 concentric pursestring sutures. we then made a small gastrotomy at the tip of the gastric conduit adjacent to the lesser curve staple line. we then enlarged the posterior incision to about 3 cm to allow access of the stapler into the chest through the small thoracotomy. we then penetrated the greater curve of the gastric conduit with the spike of the stapler. we then mated the stapler to the anvil and fired the stapler. we therefore created a 28-mm circular esophagogastric anastomosis. we noted 2 intact donuts from the stapler that were sent to pathology separately. we then closed the gastrotomy using 2 linear endo- staple fires. we copiously irrigated the chest using warm saline. we noted no evidence of bleeding at this time. we then placed a 10 mm flat jp drain adjacent to the anastomosis. at this point we harvested a thymic fat pad. this was done carefully to avoid any injury to the phrenic nerve. once we had an adequate length of thymic fat, we swung this over the hilum of the right lung. we then passed this circumferentially around the esophagogastric anastomosis and sutured this to itself in this manner. we then placed a 24-french chest tube through the camera incision. both this and the jp were secured using silk suture. we observed the lung to inflate under direct vision. we then closed the small posterior thoracotomy using 3-0 vicryl for the muscle layer and 4-0 vicryl for the skin. remaining ports were closed using 4-0 vicryl. dermabond was applied. , m.d. addendum: this is an addendum to the operative note dictated on . the addendum is as follows: please note that during placement of the pursestring suture in the proximal thoracic esophagus, an endostitch device was used. when the device was withdrawn, it was apparent that a small portion of the 3-mm needle was not found. we explored the thoracic cavity and were not able to locate this very small portion of the needle. we did not obtain an x-ray as this very small needle would not be able to be identified. postoperatively, i did inform the patient of this incident. , m.d. pathology examination () specimen submitted: gastroesophageal resection, level 9 lymph node, level 7 lymph node, gastric donut, fundus of stomach, esophageal donut. specimen type: esophagogastrectomy. tumor site: gastroesophageal junction. tumor size greatest dimension: 1.8 cm. microscopic histologic type: adenocarcinoma. histologic grade: g3: poorly differentiated with focal signet ring cells. extent of invasion primary tumor: pt1b: tumor invades submucosa. regional lymph nodes: pn0: no regional lymph node metastasis. lymph nodes number examined: 19. number involved: 0. distant metastasis: pmx: cannot be assessed. margins proximal margin: uninvolved by invasive carcinoma. distal margin: uninvolved by invasive carcinoma. circumferential (adventitial) margin: uninvolved by invasive carcinoma. vnous (large vessel) invasion: absent. additional pathologic findings: intestinal metaplasia, dysplasia, esophagitis. clinical: esophageal cancer. cxr () the right chest drain has been removed with no new pneumothorax. moderate distention of the neo esophagus has slightly decreased and the right lower lobe atelectasis and small right pleural effusion are unchanged. the left lung consolidation and left lower lobe atelectasis have improved. no new consolidation or pneumothorax. cardiomediastinal silhouette is unchanged and normal. impression: improving left lung consolidation and atelectasis oropharyngeal videofluoroscopic swallowing evaluation summary: mr. presents with mild oropharyngeal dysphagia characterized by tongue pumping, increased oral transit times, prespill with thin liquids, reduced epiglottic deflection, and oral and mild pharyngeal residue. two episodes of penetration occurred during the swallow and cleared spontaneously upon laryngeal valve closure. no aspiration was observed. a barium tablet was noted to pass slowly through the ues and upper esophagus. recommend a po diet of thin liquids and regular solids, with encouragement to select soft foods initially. suggest large pills be crushed with puree while small pills may be taken whole. patient is recommended to follow reflux precautions such as staying upright 30-60 minutes after meals, keeping head of bed above 30 degrees, and eating slowly with smaller meals and snacks as needed. if there are further concerns of aspiration upon patient's d/c home, he may return for a repeat video swallow evaluation as an outpatient as indicated. brief hospital course: mr. is a pleasant 62 year old male who underwent esophagectomy on . in the or urology was consulted due to inability to insert a foley catheter. the operation itself went well. after surgery he stayed over night in the pacu for observation and was transferred to the floor on pod1. his pain was well controlled via a thoracic epidural catheter and i.v. pca. tube feeds were started on pod1 and his chest tube was put to water seal on day two. bilateral basal opacities were seen initially in the postoperative period on cxr. the patient was treated with aggressive pulmonary toilette. he has progressed well in his postoperative recovery. his ngt was removed , epidural catheter and chest tubes were removed on pod6 after the patient passed his swallow exam. his home coumadin was started on . he will be bridged with lovenox as an outpatient until he reaches his therapeutic inr. upon his discharge he is doing well and has been instructed in detail, how to manage his food intake at home. follow up appointments have been made for him. discharge medications: 1. prevacid solutab 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr once a day. disp:*30 tablet,rapid dissolve, dr(s)* refills:*2* 2. docusate sodium 50 mg/5 ml liquid : ten ml po bid (2 times a day) as needed for constipation. disp:*60 * refills:*0* 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : two (2) puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 4. simvastatin 20 mg tablet : one (1) tablet po at bedtime. 5. coumadin 2.5 mg tablet : one (1) tablet po at bedtime: take each evening or as directed by pmd based on inr. 6. ascorbic acid 500 mg tablet : one (1) tablet po once a day. 7. b complex vitamins capsule : one (1) capsule po once a day. 8. calcium carbonate-vitamin d3 500 mg(1,250mg) -200 unit tablet : one (1) tablet po once a day. 9. multivitamin capsule : one (1) capsule po once a day. 10. omega-3 fish oil 1,000-5 mg-unit capsule : one (1) capsule po once a day. 11. enoxaparin 80 mg/0.8 ml syringe : one (1) subcutaneous q12h (every 12 hours) for 10 days: stop when inr 2.0 or greater. disp:*20 syringes* refills:*0* 12. azithromycin 200 mg/5 ml suspension for reconstitution : 12.5 ml po once a day for 4 days. disp:*60 ml* refills:*0* 13. morphine 10 mg/5 ml solution : five (5) ml po q4h (every 4 hours) as needed for pain. disp:*400 ml* refills:*0* discharge disposition: home with service facility: area vna discharge diagnosis: esophageal cancer discharge condition: stable discharge instructions: call dr. office if develops fevers > 101.5 or chills, increased shortness of breath, cough or sputum production. call if nausea, vomiting, diarrhea, abdominal pain, or any problems swallowing followup instructions: follow-up with dr. thursday at 9:30am on the clinical center . 45 minutes prior to this, please report to the for a chest xray. procedure: other enterostomy enteral infusion of concentrated nutritional substances other cystoscopy total esophagectomy insertion of indwelling urinary catheter intrathoracic esophageal anastomosis with other interposition diagnoses: esophageal reflux personal history of malignant neoplasm of prostate asthma, unspecified type, unspecified long-term (current) use of anticoagulants bladder neck obstruction personal history of venous thrombosis and embolism primary hypercoagulable state barrett's esophagus malignant neoplasm of lower third of esophagus 

Answer: The patient is high likely exposed to