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: sulfa (sulfonamide antibiotics) attending: chief complaint: chief complaint: fever reason for micu transfer: hypotension major surgical or invasive procedure: none history of present illness: a 71 year old male with pmh cholelithiasis and biliary colic s/p unsuccessful open cholecystectomy is called out of the micu after a one day hospitalization for hypotension following ercp. . according to the patient, he had an episode of abdominal pain in and presented to where he underwent an attempted laparoscopic cholecystectomy which was converted to an open proceedure due to fibrosis. he reports that the surgeon was able to remove some stones and closed leaving a bile drain in place. he was then sent to for ercp on with biliary stent placement which was successful. following the procedure, the patient noted decreased output from the external biliary drain and had resolution of abdominal pain. on the day of admission () the patient presented for an repeat ercp to place a larger biliary stent which was performed successfully. he returned home where he noted chills and an oral temperature of 100.7. he called his pcp who recommended referral to the ed. in the ed, initial vs were: 98.3 78 91/52 18 94%, labs were remarkable for wbc 5.0 73%pmn 3% bands, he was given amp/sulbactam and 2l ivns and admitted to the micu. . while in the micu, antibiotics were changed to vancomycin and zosyn. biliary drain fluid was cultured with initial gram stain showing gram neg rods and gram positive cocci and culture showing polymicrobial growth. ercp fellow was who noted that the fluid in a cholecystomy bag is rarely cultured and is likely to be colonized with non-pathogenic bacteria. the patient was given a total of 5 liters of fluid in the ed and micu. bp has now been stable without requring fluid for over 24 hrs and therefore patient was able to leave the micu. . on arrival to the floor, patient denies any current complaints and states that he feels as well as he normally does at home. . review of systems on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: htn hyperlipidemia type ii dm status post carotid endarterectomy thrombocytopenia fibrotic lung disease: likely due to asbestosis bladder ca status post turbt social history: lives in with his wife and son. significant 30+ pack year history, quit 3 months ago. no alcohol use. emigrated to the u.s. in the , worked in shipyards for 30 years. family history: denies family history of coronary artery disease, congestive heart failure. physical exam: admission physical exam vitals: 98.9 hr 75 bp 105/51 rr 16 97% 2 liters n/c general: alert, oriented, no acute distress, slightly agitated heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: bibasilar crackles that clear somewhat with ventilation, rare wheeze lul abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly. biliary drain in place gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation pertinent results: admission labs ============== 10:00am blood wbc-5.0 rbc-3.20* hgb-9.8* hct-30.9* mcv-96 mch-30.7 mchc-31.8 rdw-16.8* plt ct-76* 11:25pm blood neuts-73* bands-3 lymphs-10* monos-8 eos-5* baso-0 atyps-1* metas-0 myelos-0 10:00am blood pt-13.9* ptt-28.2 inr(pt)-1.2* 10:00am blood glucose-121* urean-21* creat-1.1 na-136 k-4.4 cl-100 hco3-27 angap-13 10:00am blood alt-28 ast-39 alkphos-207* amylase-31 totbili-0.6 dirbili-0.3 indbili-0.3 10:00am blood lipase-11 06:15am blood albumin-2.5* calcium-7.5* phos-3.4 mg-1.5* 11:25pm blood iron-26* 11:25pm blood caltibc-251* vitb12-450 folate-11.8 ferritn-135 trf-193* 11:25pm blood tsh-1.5 06:15am blood cortsol-27.3* 11:30pm blood lactate-1.1 k-4.2 . discharge labs: =============== 06:27am blood wbc-2.8* rbc-3.02* hgb-9.0* hct-28.3* mcv-94 mch-30.0 mchc-31.9 rdw-16.7* plt ct-85* 06:27am blood glucose-111* urean-21* creat-1.3* na-139 k-3.9 cl-100 hco3-31 angap-12 05:56am blood alt-21 ast-40 alkphos-235* totbili-0.6 06:27am blood mg-1.8 . other studies: ============== cxr : 1. diffuse interstitial opacities likely pulmonary fibrosis (evidence of asbestos exposure) with or without interstial pulmonary edema or atypical infection. 2. dilated azygous vein indicates elevated central venous pressure or volume. . cxr : as compared to the previous radiograph, there is no relevant change. borderline diameter of the azygos vein indicating minimal systemic fluid overload. however, there is no other indicator for pulmonary fluid overload, in particular no widening of the mediastinum, no presence of pleural effusions and no interval enlargement of the cardiac silhouette. unchanged extensive bilateral interstitial opacities, in the context of known pulmonary fibrosis. no interval appearance of new focal parenchymal opacities. . tte : the left atrium is mildly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: normal global and regional biventricular systolic function. mild diastolic lv dysfunction. no clinically-significant valvular disease seen. . microbiology: ============= 12:10 am bile gram stain (final ): no polymorphonuclear leukocytes seen. 3+ (5-10 per 1000x field): gram positive cocci. in pairs and clusters. 3+ (5-10 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): gram positive rod(s). smear reviewed; results confirmed. fluid culture (preliminary): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. anaerobic culture (preliminary): no anaerobes isolated. . blood cultures and : ngtd brief hospital course: 71 year old male with history of htn, hyperlipidemia, who presented with fever and relative hypotension after elective ercp. . active issues: ============== # fever, hypotension- this may have been related to transient bacteremia from manipulation of tube during ercp, however could not exclude acending cholangitis therefore patient was started on empiric antibiotics. workup unremarkable for other localizing source of infection. - he will po cipro and metronidazole based on discussion with ercp. will complete a 7 day course of antibiotics as outpatient. . # pancytopenia: appears to be chronic based upon review of records. no evidence of portal hypertension on exam. given diverse differential on cbc, concern for a marrow process. patient is not deficient in b12, folate, or iron. these findings do not appear to be directly related to current admission but warrant further workup possibly including bone marrow biopsy. however patient eager to go home and have any further testing as outpatient with pcp. risk is low based on current values. - pcp informed and will evaluate and refer appropriately at f/u appointment - further workup as outpatient . # hypoxemia- during his stay the patient was noted to have low o2 sats on room air. ambulatory o2 sats dipped as low as 79% transiently. the patient denied any feeling of shortness of breath. he reported that his breathing was at baseline. it was unclear if he is chronically hypoxemic. the patient's pcp did not have any pft records available. osh records indicated a history of fibrotic lung disease and evidence of asbestosis likely due to his career working in a ship-yard. chest x-rays performed here are concordant with this history. the patient's pcp was and he could not recall any history of de-saturations to this degree. it is unclear what component of his hypoxemia is from his chronic lung disease and what is acute. it was initally thought that he had a component of pulmonary edema because patient 5 liters positive in micu and cxr suggestive. therefore he was diuresed with iv lasix and he was clinically euvolemic but there was minimal improvement in oxygenation. tte showed preserved ef with mild diastolic dysfunction. there was nothing obvious on history or physical to suggest another etiology for patient's acute insult to his chronic lung disease. he was low risk for pulmonary embolism therefore cta was not indicated. he has a long smoking history however patient denied any known diagnosis of copd and patient was not on any copd medications. the patient was strongly opposed to any further workup while inpatient and threatened to leave ama on multiple occassions. therefore he will follow-up with his pcp tomorrow and will have further workup including referral to pulmonology with ct and pfts as outpatient. he was unable to maintain ambulatory o2 sats above 88% therefore he will go home with o2. patient, patient's wife, and daughter all state they are committed to maintaining no smoking in the home. they understand the risks including fire and serious injury. patient counseled on smoking cessation. . chronic issues: ================ # htn- continue home lisinopril . # hl- cont home simvastatin . # type ii dm- continue home metformin . transitional issues: ==================== - contact: daughter () - patient's pcp will coordinate further workup of hypoxemia including chest ct and referal to pulmonology - patient's pcp will coordinate further workup of pancytopenia medications on admission: lisinopril 5 mg daily simvastatin 40 mg daily metformin 850 daily discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po at bedtime. 2. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 3. metformin 850 mg tablet sig: one (1) tablet po once a day. 4. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours): last dose in evening on . disp:*5 tablet(s)* refills:*0* 5. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day): last dose in evening on . disp:*7 tablet(s)* refills:*0* 6. home oxygen therapy 2 liters/minute for portability: pulse dose system discharge disposition: home with service facility: homecare discharge diagnosis: primary - sepsis - post ercp fever - hypoxemia - pulmonary fibrosis secondary - pancytopenia - type 2 dm - hypertension - hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , you were admitted to the hospital because you had fever and low blood pressure after your ercp procedure. there was concern that you could have a serious infection. therefore you were admitted to the intensive care unit and given antibiotics and fluid to help maintain your blood pressure. you did well and were able to leave the icu. you will take 2 more days of antibiotics when you get home as described below. an additional reason that you needed to stay in the hospital was that your oxygen levels were low. although you may not always have symptoms, it is very dangerous to have low oxygen levels for a long period. part of the explanation for your low oxygen levels may have been extra fluid in your lungs, therefore that was removed with medication. however you still had low oxygen levels afterwards. most likely this is from lung disease that you have had for some time. as we discussed, it is very important that you and everyone else in your household quit smoking. oxygen is very flammable and can cause a fire. you will need the following additions were made to your medications: start: ciprofloxacin 500 mg tablet twice daily. last dose in evening on . start: metronidazole 500 mg tablet three times daily. last dose in evening on you should continue taking all of your other medications as you were previously. you will need to see your primary care doctor soon for further evaluation of your lung disease. you also will need further evaluation for your low blood counts. followup instructions: name: vlagopoulos,triphon p. address: , , phone: appointment: wednesday 2:00pm your primary care doctor should refer you to see a pulmonologist (lung specialist) for further evaluation. md, procedure: endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct diagnoses: thrombocytopenia, unspecified tobacco use disorder unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other and unspecified hyperlipidemia postinflammatory pulmonary fibrosis personal history of malignant neoplasm of bladder cholangitis personal history of contact with and (suspected) exposure to asbestos postprocedural fever other pancytopenia other specified counseling 

Answer: The patient is high likely exposed to