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: cholangiocarcinoma major surgical or invasive procedure: exploratory laparotomy, lymph node biopsy, porta hepatis dissection. history of present illness: 73 year old male with klatskin tumor s/p stenting of l hepatic duct and ir placement of internal/external r ptbd who presented for an elective resection of the cholangiocarcinoma. patient is asymptomatic on admission. past medical history: past medical history: klatskin tumor, gerd, barrett's esophagus past surgical history: placement of percutaneous r internal and external biliary drain , stenting of l hepatic duct , segmental right colectomy for polyp , open cholecystectomy current medications: omeprazole 20 mg daily, aspirin 81 mg daily, flomax 0.4mg daily, multivitamin, reglan 10qachs social history: denies tobacco use past/present, etoh and recreational drug use. works as an engineering professor . family history: mother - breast ca; sister - melanoma physical exam: vs: 99.9 96.9 68 92/62 20 98ra gen: comfortable, nad cv: rrr pulm: cta b/l abdomen: thin, soft, nd/nt, + bs, staples removed, steri-strips in place, incision c/d/i, no edema/ no erythema extremities: no edema pertinent results: 11:40am blood wbc-6.3# rbc-3.40* hgb-11.2* hct-32.4* mcv-95 mch-33.0* mchc-34.7 rdw-15.8* plt ct-248 08:40am blood wbc-8.9 rbc-3.25* hgb-10.9* hct-31.2* mcv-96 mch-33.4* mchc-34.8 rdw-15.7* plt ct-223 09:10am blood wbc-17.4*# rbc-3.56* hgb-11.5* hct-33.8* mcv-95 mch-32.2* mchc-33.9 rdw-15.3 plt ct-225 05:45am blood wbc-10.8 rbc-2.97* hgb-9.6* hct-28.3* mcv-95 mch-32.3* mchc-33.9 rdw-15.1 plt ct-196 09:45am blood wbc-10.3 rbc-3.18* hgb-10.2* hct-30.1* mcv-95 mch-32.2* mchc-33.9 rdw-15.2 plt ct-230 06:25am blood wbc-9.5 rbc-3.01* hgb-9.8* hct-27.9* mcv-93 mch-32.5* mchc-35.0 rdw-15.0 plt ct-227 05:45am blood wbc-6.1 rbc-2.90* hgb-9.3* hct-27.2* mcv-94 mch-32.1* mchc-34.2 rdw-15.0 plt ct-266 04:20am blood wbc-5.7 rbc-2.99* hgb-9.9* hct-28.9* mcv-96 mch-33.0* mchc-34.2 rdw-15.0 plt ct-407# 03:43am blood wbc-17.8*# rbc-2.98* hgb-9.7* hct-28.3* mcv-95 mch-32.5* mchc-34.2 rdw-14.8 plt ct-347 05:15am blood wbc-6.3# rbc-3.01* hgb-9.8* hct-29.2* mcv-97 mch-32.5* mchc-33.5 rdw-14.9 plt ct-332 11:40am blood glucose-108* urean-13 creat-0.7 na-139 k-4.2 cl-104 hco3-26 angap-13 08:40am blood glucose-105* urean-13 creat-0.7 na-135 k-4.3 cl-101 hco3-28 angap-10 09:10am blood glucose-113* urean-13 creat-0.7 na-134 k-4.6 cl-101 hco3-28 angap-10 05:45am blood glucose-466* urean-16 creat-0.7 na-127* k-5.9* cl-102 hco3-24 angap-7* 09:45am blood glucose-137* urean-17 creat-0.7 na-134 k-4.4 cl-101 hco3-27 angap-10 06:25am blood glucose-118* urean-20 creat-0.8 na-132* k-4.0 cl-101 hco3-25 angap-10 05:45am blood glucose-111* urean-15 creat-0.7 na-137 k-3.9 cl-105 hco3-26 angap-10 10:50am blood glucose-128* urean-13 creat-0.7 na-137 k-4.0 cl-103 hco3-29 angap-9 04:00pm blood glucose-94 urean-11 creat-0.8 na-139 k-4.0 cl-103 hco3-25 angap-15 03:43am blood glucose-118* urean-11 creat-0.6 na-138 k-4.1 cl-105 hco3-27 angap-10 05:15am blood glucose-117* urean-9 creat-0.8 na-139 k-4.1 cl-106 hco3-27 angap-10 11:40am blood alt-98* ast-140* alkphos-303* totbili-2.5* 08:40am blood alt-143* ast-168* alkphos-283* totbili-2.5* 09:10am blood alt-122* ast-113* alkphos-268* totbili-2.5* 05:45am blood alt-72* ast-58* alkphos-194* totbili-1.8* 06:25am blood alt-61* ast-47* alkphos-206* totbili-2.0* 05:45am blood alt-51* ast-37 alkphos-221* totbili-1.8* 06:55am blood alt-48* ast-43* alkphos-297* totbili-1.9* dirbili-1.3* indbili-0.6 09:00am blood alt-67* ast-75* alkphos-499* totbili-2.5* 10:50am blood alt-59* ast-58* alkphos-499* totbili-2.1* 04:20am blood alt-59* ast-67* alkphos-551* totbili-2.1* 04:00pm blood alt-65* ast-87* alkphos-602* amylase-91 totbili-2.6* 03:43am blood alt-57* ast-63* alkphos-502* totbili-1.9* 05:15am blood alt-41* ast-36 alkphos-434* totbili-1.6* 11:40am blood albumin-3.1* calcium-8.2* phos-3.4 mg-1.8 08:40am blood albumin-3.0* calcium-7.7* phos-3.0 mg-1.8 09:10am blood calcium-7.9* phos-2.0* mg-2.3 05:45am blood albumin-2.1* calcium-6.8* phos-1.2* mg-2.0 09:45am blood calcium-7.6* phos-1.1* mg-2.1 06:25am blood albumin-2.5* calcium-7.7* phos-3.0# mg-2.1 05:45am blood albumin-2.3* calcium-7.7* phos-2.4* mg-2.1 10:50am blood albumin-2.7* calcium-8.0* phos-2.9 mg-2.0 04:00pm blood albumin-2.4* calcium-7.8* phos-2.3* mg-1.6 03:43am blood albumin-2.2* calcium-7.5* phos-2.7 mg-2.2 05:15am blood albumin-2.4* calcium-7.7* phos-2.3* mg-2.1 imaging: cxr in comparison with study of , there has been placement of a right ij sheath that extends to about the junction of the jugular and subclavian veins. no evidence of pneumothorax. no acute focal pneumonia. cxr new bilateral infiltrates. video swallow penetration of thin liquids with residue in the valleculae. video swallow 1. penetration with thin liquid without aspiration. 2. moderate-to-severe residue in the valleculae after puree and cracker-thickened barium. the previously placed cotton- plastic biliary stent and the percutaneous internalized biliary drain placed by ir were found at the major papilla. an 8mm x 100mm wallflex uncovered metal biliary stent was placed successfully in the right hepatic duct with the distal edge just entering the dudenum ref: 7063 lot: . next, an 8mm x 80mm wallflex uncovered metal biliary stent was placed successfully in the left hepatic duct with the distal edge in the distal cbd ref: 7062 lot: . a second 8mm x 60mm wallflex uncovered metal biliary stent was placed successfully within the left duct wallflex stent extending from the proximal cbd and exiting at the major papilla ref: 7061 lot: . excellent drainage of bile was noted. pathology: lymph node, posterior common bile duct: no tumor seen. microbiology: direct influenza a antigen test (final ): reported by phone to on at 11:00am. positive for influenza a viral antigen. blood culture - no growth final urine culture - no growth final blood culture - no growth final urine culture - no growth final blood culture - pending fungal culture - pending brief hospital course: the patient was admitted to the hepatobiliary surgical service for an elective resection of the cholangiocarcinoma. this was unfortunately not feasible. in the pacu, patient experienced a fever up to 104f and infectious work up was performed. the influenza a and b were tested as well as urine and blood cultures. after the recovery in the pacu, the patient arrived on the floor npo, on iv fluids, with a foley catheter, and pca dilaudid for pain control. the patient was hemodynamically stable. neuro: the patient received pca dilaudid with good effect and adequate pain control. when tolerating oral intake, the patient was transitioned to oral pain medications. he had an excellent tolerance to pain and was discharged home without any narcotic pain medications. patient was appropriate throughout hospitalization, did not experience any delirium. cv: the patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. patient reported one episode of chest pain, for which ekg was obtained as well as a set of cardiac markers. they were all negative. pulmonary: patient was diagnosed with influenza a and was given osteamvir for a total of 5 days. he was placed on respiratory isolation for the entire treatment period. he remained stable from a pulmonary standpoint; vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. gi/gu/fen: post-operatively, the patient was made npo with iv fluids. patient had a speech and swallow evaluation which was initially concerning for potential aspiration, thus he was continued npo for a few more day. the following evaluation was improved and patient was placed on soft diet, which he tolerated well. the supplements were provided with each meals as well as an appetite stimulant. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. patient had the cbd stent removed by and at the same time his ptc catheter was removed by ir and internal metal stent was placed. following the procedure patient became transiently bacteremic and septic. he received fluid resuscitation and required short administration of vasopressors. he also received broad spectrum antibiotics. he was monitored in the icu for one night. id: the patient's white blood count and fever curves were closely watched for signs of infection. as mentioned he received treatment for influenza a and for bacteremia post-procedure. he was discharged on 3 additional doses of ciprofloxacin to complete the course. he was afebrile with normal wbc on discharge. endocrine: the patient's blood sugar was monitored throughout his stay. hematology: the patient's complete blood count was examined routinely; no blood product transfusions were required. prophylaxis: the patient received subcutaneous heparin and venodyne boots were used during this stay; he ambulates early. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular soft diet with boosts, ambulating, voiding without assistance, and pain was well controlled on non-narcotic pain medications. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: - omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). - metoclopramide 10 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). - tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 3. metoclopramide 10 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 4. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 5. ciprofloxacin 500 mg tablet sig: one (1) tablet po twice a day for 3 days. disp:*7 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: unresectable cholangiocarcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: please call your doctor or nurse practitioner or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down 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. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. 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. avoid driving or operating heavy machinery while taking pain medications. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. medications: - take ciprofloxacin as prescribed. the last dose will be on wed ( in the evening). - please take all your home medications as you did prior to hospitalization followup instructions: please follow up with your pcp weeks. dr. office will call you to set up an appointment with him in weeks. provider: 2 (st-4) gi rooms date/time: 12:00 provider: , md phone: date/time: 12:00 procedure: endoscopic insertion of stent (tube) into bile duct biopsy of lymphatic structure diagnoses: esophageal reflux other postoperative infection unspecified septicemia sepsis barrett's esophagus influenza with other respiratory manifestations malignant neoplasm of intrahepatic bile ducts 

Answer: The patient is high likely exposed to