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: patient recorded as having no known allergies to drugs attending: chief complaint: infected pancreatic necrosis/pseudocyst major surgical or invasive procedure: pancreatic necrosectomy cholecystostomy tube g-tube j-tube drains x 4 s/p ex-lap, modified patch approach, debridement of necrotic abdominal wall s/p washout and reapproximation of temporary bag closure exploration of abdomen and washout of upper abdomen. repair of ventral hernia with biological mesh. tracheosotomy . decannulated history of present illness: this is a 57 year old male recently admitted to dr. service with gallstone pancreatitis s/p ercp/papillotomy/stent on complicated by pancreatic necrosis & pseudocyst replacement presents with infected pancreatic necrosis/pseudocyst. he has had absolutely no change since discharge in his level of abdominal pain, degree of nausea or presence of fevers, chills, rigors or steatorrhea. his sole concern leading to a visit to his pcp was progressive hyperglycemia since discharge, requiring escalating doses of insulin. on his pcp 't "like the way (he) looked", so he sent him to where he has found to have a leukocytosis with 54% band neutrophils. subsequent abdominal ct demonstrated slightly larger area of pancreatic necrosis and cyst, but with diffuse gas throught the collection. he was hemodynamically normal transferred to for management. past medical history: diabetes, non-insulin dependent hypertension lumbar disk bulge (l4) gallstone pancreatitis as above social history: married, non-drinker physical exam: pe: 98.9 81 101/58 22 95%/2l gen: nad, mmdry, (-)jaundice pul: ctab cor: rrr abd: soft/nd(+)periumbilical tenderness (-)tympani (-)guarding ext: warm, well perfused pertinent results: 03:00am blood wbc-12.3* rbc-3.73* hgb-12.0* hct-33.0* mcv-89 mch-32.2* mchc-36.3* rdw-15.5 plt ct-451*# 04:19am blood wbc-28.7*# rbc-3.58* hgb-11.1* hct-33.5* mcv-94 mch-31.0 mchc-33.1 rdw-15.7* plt ct-773* 07:12pm blood wbc-18.8* rbc-3.08* hgb-9.6* hct-27.8* mcv-90 mch-31.2 mchc-34.6 rdw-16.3* plt ct-428 02:30am blood wbc-8.9 rbc-3.20* hgb-9.9* hct-29.3* mcv-92 mch-30.9 mchc-33.8 rdw-17.1* plt ct-236 10:53am blood glucose-268* urean-12 creat-0.7 na-129* k-3.8 cl-95* hco3-24 angap-14 08:51am blood glucose-96 urean-16 creat-0.8 na-128* k-3.8 cl-98 hco3-26 angap-8 02:30am blood glucose-139* urean-18 creat-0.7 na-138 k-4.7 cl-102 hco3-31 angap-10 03:00am blood alt-13 ast-15 alkphos-83 amylase-43 totbili-0.7 02:54am blood alt-152* ast-286* alkphos-63 amylase-16 totbili-0.5 02:05am blood alt-55* ast-45* alkphos-89 amylase-18 totbili-1.3 03:00am blood lipase-23 02:05am blood lipase-14 . chest (portable ap) 12:07 pm medical condition: 57 year old man with necrotizing pancreatitis, now septic, recieving massive fluid resuscitation indication: sepsis. a single ap view of the chest is obtained semi-upright at 1215 hours and compared with the prior radiograph performed . the patient remains intubated with the tip of the et tube approximately 3 cm above the carina. right-sided ij line is unchanged in position. diffuse haziness is seen over both lung fields consistent with layering pleural effusion tracking posteriorly. increased retrocardiac density is seen on the left side consistent with airspace disease/atelectasis of the left base. impression: findings are consistent with pleural effusions layering posteriorly, more marked on the left side than on the right and apparently increasing since the prior examination. . echocardiography report , portable tte (complete) done at 11:55:01 am final findings intravenous administration of echo contrast was used due to poor native endocardial border definition. left atrium: mild la enlargement. right atrium/interatrial septum: mildly dilated ra. left ventricle: normal lv cavity size. overall normal lvef (>55%). no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. aortic valve: aortic valve not well seen. no as. no ar. mitral valve: normal mitral valve leaflets with trivial mr. lv inflow pattern c/w impaired relaxation. tricuspid valve: normal tricuspid valve leaflets with trivial tr. indeterminate pa systolic pressure. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor echo windows. suboptimal image quality - ventilator. conclusions the left atrium is mildly dilated. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the left ventricular inflow pattern suggests impaired relaxation. there is no pericardial effusion. . ct abdomen w/o contrast 1:09 pm impression: 1. interval decrease in the size of a peripancreatic tissue and air collection, with three drains in appropriate position. 2. additional small right rectus sheath fluid collection, with a small hemorrhagic component. 3. 5.2 cm fluid collection in the left pelvis is new when compared to the prior study. . unilat lower ext veins left 3:20 pm impression: no evidence of left lower extremity deep venous thrombosis. . ct abdomen w/o contrast 11:35 am impression: 1. decrease in size of pancreatic fluid collection due to necrotizing pancreatitis with air and surrounding fat stranding and small fluid, with multiple drains. open wound in the mid upper abdomen, with significant amount of oral contrast leakage, suggestive of direct fistulous communication between the wound and stomach, possibly from the g tube site, or less likely loop of bowel, fluid collection with additional connection to the bowel loops. 2. decreased pleural effusion with atelectasis. 3. foley catheter with balloon in the prostatic urethra, which needs repositioning. 4. limited study due to lack of intravenous contrast . . ct head w/o contrast 1:16 pm impression: 1. partial opacification of both mastoid air cells. otherwise unremarkable examination. . mrcp w/secretin (abd w&w/o c) 3:16 pm impression: 1. no appreciable increase in peripancreatic fluid following the administration of secretin to suggest leak in the pancreatic bed. 2. small fluid collection adjacent to the pancreatic head about a tip is unchanged. this is the site that on the ct abdomen and pelvis on had extraluminal oral contrast that was not reported. this may be from a duodenal injury. 3. unchanged 19 x 18 mm peripancreatic fluid collection adjacent to the portal vein. 4. minimal residual pancreatic tissue within the lateral tail, dorsal head, and pancreatic uncinate process. 5. hemosiderosis. 6. left pleural effusion. . cta chest w&w/o c&recons, non-coronary 8:55 pm conclusion: 1. no pulmonary embolism or aortic dissection. atherosclerosis is present in the proximal left anterior descending coronary artery. 2. large left basal effusion with passive atelectasis of the left lower lobe. 3. 6-mm low-attenuation focus in the left lobe of the thyroid gland should be further evaluated with a thyroid ultrasound. . . stool clostridium difficile toxin assay-final inpatient stool clostridium difficile toxin assay-final inpatient stool clostridium difficile toxin assay-final inpatient catheter tip-iv wound culture-final inpatient swab r/o vancomycin resistant enterococcus-final inpatient mrsa screen mrsa screen-final inpatient mrsa screen mrsa screen-final inpatient urine urine culture-final inpatient abscess gram stain-final; wound culture-final {pseudomonas aeruginosa, lactobacillus species}; anaerobic culture-final; fungal culture-final inpatient urine urine culture-final inpatient swab not processed inpatient swab gram stain-final; wound culture-final {pseudomonas aeruginosa}; anaerobic culture-final; fungal culture-final inpatient mrsa screen mrsa screen-final inpatient swab r/o vancomycin resistant enterococcus-final inpatient mrsa screen mrsa screen-final inpatient stool clostridium difficile toxin assay-final inpatient stool clostridium difficile toxin assay-final inpatient stool clostridium difficile toxin assay-final inpatient swab r/o vancomycin resistant enterococcus-final inpatient mrsa screen mrsa screen-final inpatient mrsa screen mrsa screen-final inpatient swab gram stain-final; wound culture-final {probable enterococcus, lactobacillus species, gram negative rod(s), staphylococcus, coagulase negative}; anaerobic culture-final inpatient stool clostridium difficile toxin assay-final inpatient peritoneal fluid gram stain-final; fluid culture-final {klebsiella pneumoniae, viridans streptococci, staphylococcus, coagulase negative}; anaerobic culture-final inpatient blood culture aerobic bottle-final; anaerobic bottle-final inpatient urine urine culture-final {gram positive coccus(cocci)} inpatient sputum gram stain-final; respiratory culture-final inpatient catheter tip-iv wound culture-final inpatient mrsa screen mrsa screen-final inpatient swab r/o vancomycin resistant enterococcus-final inpatient mrsa screen mrsa screen-final inpatient mrsa screen mrsa screen-final inpatient swab r/o vancomycin resistant enterococcus-final inpatient mrsa screen mrsa screen-final inpatient blood culture aerobic bottle-final; anaerobic bottle-final inpatient swab gram stain-final; wound culture-final {klebsiella pneumoniae, viridans streptococci}; anaerobic culture-final; fungal culture-final . ascites chemistry amylase 11:15am 1 verified by dilution 09:02pm . brief hospital course: this is a 57 year old male with copious amounts of extraluminal gas in his pancreatic pseudocyst. amazingly, he is not toxic appearing, but this could change rapidly. the source of the air is likely the bowel gas transmitted across the biliary stent placed in ercp ten days ago and may not be from gas-forming bacteria presently. regardless, even if it is not currently infected, it would only be a matter of time before communication with the gut flora would result in just such an infection. he was admitted for aggressive ivf, npo, ftg and iv abx (meropenem/fluconazole). he went to the or for pancreatic necrosectomy on (1 liter of purulent fluid), cholecystostomy tube, g tube, j tube, x 4 (#1-gallbladder area, #2-pancreatic head, #3-body, #4-tail) he remained intubated in the icu with drains in place significant events: -, underwent debridement of his pancreas with 1.5l of pus drained - his wound culture started growing pan-sensitive klebsiella and viridans strep. - washout: peritoneal fluid grew klebsiella, viridans strep and rare coagulase negative staph. - ex lap, washout and debridement; wound grew enterococcus(mod), lactobacillus(mod), gram negative rods(sparse) and coag negative staph(sparse). tracheostomy - and washouts with attempt at ventral hernia closure with mesh (disintegration of graft). gent, amikacin and ceftaz, on and changed to ceftazidime and colistin on . - abd swab: pseudomonas (s to ceftaz) - ct showed a gastic fistula, and decreased pancreatic fluid collection - head ct wnl. (s/p fall when attempting to get oob while confused) - ct abd: open wound in the mid upper abdomen, with significant amount of oral contrast leakage, suggestive of direct fistulous communication between the wound and stomach, possibly from the g tube site, or less likely loop of bowel, fluid collection with additional connection to the bowel loops. : transfused 2u prbc, 2u ffp - mrcp with secretin: no increase in peripanc fluid with secretin, stable 19x18mm fluid adj to pv, stable fluid adj to panc uncinate with , panc tissue in splenic hilum & uncinate, herosiderosis - tracheostomy decannulated - cta: no pe . culture: pancreatic abscess: klebsiella (pan s), s. viridans peritoneal fluid: klebsiella (pan s) blood: neg abd swab: prob enterococcus, lactobacillus, gnrs sparse growth, coag neg staph c. diff: neg abd swab: pseudomonas (s to ceftaz) ucx: neg wound cx: pseudomonas (s to ceftaz), lactobacillus mrsa & vre screen: neg cath tip: neg c.diff: neg c.diff: neg id was following along. prior abx: flagyl meropenem - vanco(, gentamicin(- abx: ceftazidime 2 gm iv q8h (-) colistin 120 mg iv q12h (-) fluconazole 400 mg iv q24h () vancomycin 1000 mg iv q 12h () micro: 10/5 blood no growth swab: klebsiella pneumoniae pan sensitive blood no growth peritoneal fluid: :klebsiella pneumoniae-pan sensitive. viridans streptococci. staphylococcus, coagulase negative. swab: probable enterococcus. lactobacillus species. gram negative rod(s). staphylococcus, coagulase negative. swab: pseudomonas aeruginosa resistant to all but ceftaz, colistin sensi pend c.diff toxin negative , , , 10/28 : renal function slightly worse today cont cef/colisitin day sensi return intermediate to amikacin await sensi to colistin : creat up to 1.7 (baseline 0.6). d/c colistin, change ceftaz to q12h dosing. check urine eos. colistin sensitivities are , take 10 days to get back. creat stable at 2.4, renal now following, think it is related to colistin. ct showed oral contrast extravasating into pancreatic area, concerning for enteric fistula. plan to follow one more day until know surgical plan for enteric fistula, etc. will set final course of abx tomorrow. watching one more day, if afebrile will set abx course tomorrow and probably sign off. id said to continue vancomycin, fluconazole, and ceftaz. the vancomycin and fluconazole were stopped on after 30 and 41 days respectively. the ceftaz was stopped on after completing a 4 week course. acute renal failure: has had long sicu course complicated by wound dehiscence requiring multiple "wash-outs" and mesh placements. current issue is mesh disintegration secondary to pseudomonas infection for which the patient was initially placed on gent+amikacin, and then colistin, all of which caused nephrotoxic atn. creatinine stable and expect tubules to heal over time. : creatinine=2.3 (plateaued), supportive atn care and renally-dosing meds : cr plateaued and uop excellent, tubules expected to heal over 10-14 days. gastric fistula: he remained npo due to the fistula. he was physically able to eat and swallow, but due to the fistula, was prevented from doing so. he had a +grape juice test at the bedside, with extravasation of juice. he continued on j-tube feeding for nutrition. his abdomen remained open with a vac dressing being changed q3d. we were using the white foam vac sponge due to the exposed bowel. there was also a malecott tube helping to the open abdomen that was to wall suction. his drains are as follows: cholecystostomy tube, g tube, j tube, x 4 (#1-gallbladder area, #2-pancreatic head, #3-body, #4-tail). the drains have sequentuially been worked out, 2-cm at a time, and resutured in. only 2 drains now remain. the cholecystostomy biliary tube must remain in place and is currently capped. the g-tube was to gravity drainage in order to fascilitate fistula healing. the malecott was removed on and the white sponge vac remains in place. post-op orthostasis: when attempting to get oob with assistance, he was having issue of orthostasis. this was probably due to prolonged icu course and due to fluid loss from his abdominal wound. pt and ot continued to work with him and we attempted to stay up with his fluid loss, but providing fluid resuscitation. he improved gradually, and was able to maintain his blood pressure with transfers and sitting. we held all hypertensive medications in order to help his his symptomatic orthostasis. post-op hyperglycemia: currently on lantus and ss regular which seems to have helped smooth out his highs and lows. be careful not to increase lantus too much as he is on high rate tf's and will be in trouble if they are interrupted. he was followed by for continued blood glucose control. neuro: he had confusion in the icu and at times was difficult to reorient. once out on the floor, his mental status continued to improve. he is now aa+o x 3, with no apparent deficits. medications on admission: toprolxl 100, lisinopril 20, asa discharge medications: 1. acetaminophen 160 mg/5 ml solution : ml po q6h (every 6 hours) as needed for fever. 2. amylase-lipase-protease 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) : two (2) cap po tid w/meals (3 times a day with meals). 3. docusate sodium 50 mg/5 ml liquid : two (2) po bid (2 times a day). 4. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily) as needed for constipation. 5. paroxetine hcl 10 mg tablet : two (2) tablet po daily (daily). 6. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 7. atorvastatin 10 mg tablet : one (1) tablet po daily (daily). 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. morphine 10 mg/5 ml solution : 1-5 mg po q4h (every 4 hours) as needed. 10. insulin glargine 100 unit/ml solution : see scale subcutaneous twice a day: 34 units qam. 38 units qpm. 11. insulin regular human 100 unit/ml solution : see sliding scale injection every six (6) hours. 12. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). discharge disposition: extended care facility: st. hospital rehabilitation discharge diagnosis: pancreatic pseudocyst pancreatic necrosis hyperglycemia gastic fistula acute renal failure infected mesh with pseudomonas infection respiratory distress prolong intubation requiring tracheostomy orthostasis malnutrition discharge condition: good tolerating tubefeedings vac in place discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. . * continue to amubulate several times per day. * no heavy lifting >10 lbs. followup instructions: provider: , md phone: date/time: 9:00 provider: suite gi rooms date/time: 4:00 provider: , md phone: date/time: 4:00 please follow-up with clinic. call ( to schedule an appointment. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other enterostomy enteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances temporary tracheostomy gastric lavage other repair of abdominal wall other open incisional hernia repair with graft or prosthesis other cholecystostomy other gastrostomy transfusion of other serum excision or destruction of lesion or tissue of abdominal wall or umbilicus other immobilization, pressure, and attention to wound other excision or destruction of lesion or tissue of pancreas or pancreatic duct diagnoses: acute kidney failure with lesion of tubular necrosis other postoperative infection unspecified pleural effusion unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis disruption of internal operation (surgical) wound acute respiratory failure calculus of gallbladder with other cholecystitis, without mention of obstruction incisional hernia without mention of obstruction or gangrene septic shock other septicemia due to gram-negative organisms other and unspecified coagulation defects acute pancreatitis cyst and pseudocyst of pancreas necrotizing fasciitis fistula of stomach or duodenum 

Answer: The patient is high likely exposed to