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: abdominal pain major surgical or invasive procedure: percutaneous cholecystostomy tube placement and removal picc line placement history of present illness: this is a yo russian speaking male with a pmh of cad s/p mi, history of pe, cva, who initially presented with sudden onset of luq pain after using the bathroom. the pt had denied n/v, cp, sob, ha, weakness, sharp pain, per ed report. . in the ed, vs on arrival were: t98.8, hr 72, bp 142/50, r 16, sat 95%ra. per report, the pt was c/o luq pain and had guarding on exam. he was also noted to be occult blood positive (brown stool) and had new twi in v4-v6on his ekg with tpn of 0.05 (rising to 0.07 on second set). initial plan was to admit the pt to for r/o mi. cta of the chest was performed given lle swelling. he was hydrated with 1 l ns prior to the study. cta showed moderate pulmonary edema and no pe. ct abdomen showed findings c/w possible cholecystitis and a retroperitoneal sarcoma. at 2 am the pt was tripoding in distress, and experienced an episode of shortness of breath with rr 35. spo2 was 77% at that time. bnp was 7346. he was also hypertensive and agitated. he was started on bipap and received lasix 40 iv x 3 as well as morphine 4 mg iv x1, morphine 2 mg iv x1, and ativan 0.25 mg iv. . he was then started on a nitro gtt. the pts wbc rose from 11.2 at 5:40 pm to 27.2 at 2:30 am. the pt received flagyl 500 mg iv x 1, and 1 gram of ceftriaxone. past medical history: 1. coronary artery disease, followed by dr. /p multiple mis (3 in ) 2. s/p mis 3. dizziness. 4. h/o deep vein thrombophlebitis with chronic left venous stasis 5. status post pulmonary embolism- while he was in . 6. cerebrovascular disease. 7. gallstones and acute cholecystitis with multiple stones and obstructive jaundice, ercp failed so had papillotomy 8. gait disturbance. 9. gastritis with gi bleeding 10. question of prostate cancer. 11. inguinal hernia on r 12. hearing loss. 13. cataracts. 14. hypothyroidism. 15. status post herpes zoster ophthalmicus. 16. hyperlipidemia. 17. r carotid stenosis: 70-80% stenosis distal r carotid, 90% stenosis of suprabulbar r carotid 18. he had an echocardiogram performed in , which showed moderate ischemic myopathy with an ejection fraction of 45%, mild mitral and aortic regurgitation, and aortic sclerosis. social history: married. daughter who is endocrinologist. lives in senior housing. home health aide twice a day. former orthopedic surgeon. no etoh, no smoking. family history: unknown physical exam: vs: tm 102.8 tc 100.3 bp 137-145/59-79 r 26 sat 100% on simv 400x12, 40% fio2, peep 5 gen: on noninvasive ventilation heent: mmm neck: unable to assess due to bipap machine over pts neck cv: tachycardic, no m/r/g lungs: ctab abd: soft, ?ruq tenderness to palpation ext: no c/c/e neuro: agitated and combative pertinent results: admission labs: 05:40pm blood wbc-11.2* rbc-3.38* hgb-11.0* hct-32.7* mcv-97 mch-32.5* mchc-33.7 rdw-14.5 plt ct-273 05:40pm blood neuts-79* bands-0 lymphs-12* monos-6 eos-1 baso-0 atyps-2* metas-0 myelos-0 05:40pm blood hypochr-normal anisocy-1+ poiklo-normal macrocy-normal microcy-1+ polychr-occasional 05:40pm blood pt-12.9 ptt-30.0 inr(pt)-1.1 05:40pm blood plt smr-normal plt ct-273 04:05am blood fibrino-550* d-dimer-2576* 05:40pm blood glucose-116* urean-21* creat-1.1 na-141 k-4.6 cl-108 hco3-25 angap-13 05:40pm blood alt-15 ast-24 ck(cpk)-101 alkphos-70 amylase-45 totbili-0.6 dirbili-0.2 indbili-0.4 03:54pm blood lipase-9 05:40pm blood ck-mb-6 05:40pm blood ctropnt-0.05* 02:30am blood ck-mb-notdone probnp-7346* 05:40pm blood totprot-6.5 albumin-3.3* globuln-3.2 calcium-8.7 phos-2.8 mg-2.0 03:54pm blood calcium-8.4 phos-4.3 mg-1.9 04:05am blood hapto-249* 05:40am blood vanco-9.9* . discharge labs: 11.2 16.5 >--< 454 34.0 . 143 111 21 ----------< 117 3.9 23 1.2 . inr 1.2 . reports: ct abd/pelvis: 1. large heterogeneous retroperitoneal mass is most likely a retroperitoneal sarcoma. 2. intrahepatic biliary ductal dilation and idstended gallbladder with wall edema, sludge and stones, ndpericholecystic fluid/stradning be from external compression by the mass, although given presence of gallstones, choledocholisthiasis cannot be excluded. ultrasound is ulikely to give significant additional details, consider hida scan to assess for cystic duct patency. 3. pneumobilia. please correlate with recent instrumentation or prior sphincterotomy. 4. 3.6-cm exophytic hypodensity arising off the mid left kidney. nonemergent further evaluation with ultrasound can be performed for additional characterization. 5. small amount of ascites and free fluid in the pelvis. 6. no evidence of pulmonary embolism. 7. mild-to-moderate congestive heart failure with bilateral pleural effusions. . cxr: mild-to-moderate chf. recommend follow up cxr post diuresis to exclude underlying infection . gb us: technically successful placement of 10-french pigtail catheter within a distended gallbladder. however, it appears that the gallbladder is filled with stones and gel-like clot. as such, there is very little drainage emanating from the pigtail catheter. specimen was sent for culture and gram stain. . cxr: moderate-to-severe pulmonary edema has not improved since . heart size is normal. little if any pleural effusion is present. there is no pneumothorax. . cxr: there are continued bilateral alveolar infiltrates, central greater than peripheral right upper lobe and left perihilar with bilateral lower lobe volume loss/infiltrates. the heart size continues to be mildly enlarged. there are questionable small bilateral pleural effusions. compared to the film from the prior day, the infiltrates have worsened. there is a right mid abdomen drainage catheter in place. . cxr: widespread pulmonary opacification which progressed between and 17 is stable, accompanied by slightly larger small right pleural effusion. heart size is normal. the progression of findings suggests that the lung abnormalities are due to edema, though not necessarily cardiogenic. there is no pneumothorax. in the upper abdomen one can see a dilated colon and a percutaneous biliary drainage catheter. brief hospital course: mr. is a yo male with cad s/p mi, history of pe, cva, h/o gallstones and cholecystitis s/p papillotomy who presented on with abdominal pain, found to be hypoxic in congestive heart failure and to have cholecystitis now s/p percutaneous cholecystostomy tube. . # chf exacerbation: on admission, his chest xray showed mild to moderate pulmonary edema however admission vitals were o2 sat 95% ra. cta was done out of concern for pe as patient was noted to have lle swelling. the cta was negative for pe and showed mild-to-moderate congestive heart failure with bilateral pleural effusions. he became short of breath the evening of admission after receiving 1l ns and was started on bipap for suspected flash pulmonary edema. bnp was 7346. he was given prn lasix for diuresis. on transfer to the micu, he was placed on mask ventilation. he responded well to diuresis and was weaned to room air the day following admission. tte was checked on which showed regional lv systolic dysfunction c/w cad (ef 25%), moderate calcific aortic stenosis, moderate pulmonary htn and moderate mr. was seen by his cardiologist dr. while in house. he was maintained on his outpatient regimen of propranolol and isosorbide dinitrate. on per dr. recommendation, he was switched from propranol to carvedilol given worsening of ef on current tte. on the day of discharge, he had appropriate oxygen saturation on ra and appeared euvolemic. . # cad/ami: mr. has an extensive cardiac history including cad s/p multiple mis in , recurrent angina, rca stenosis, and past thrombophlebitis and pe. an echocardiogram in 05/99 showed ef of 45% with mild mr, ar and apical aneurysm. on admission, his ekg showed new twi in v4-v6 with troponin of 0.05>0.07. he had elevated troponin without elevated ck which was felt to be due to demand vs. prior event. his aggrenox and plavix were held as patient was going for perc chole and had been guaiac positive. during the hospitalization, his troponins trended up, peaking at 0.70 on . ck became mildly positive on , mb remained negative. troponins continued to remain elevated. ekg was unchanged, patient did not have chest pain. he was transferred to the floor on telemetry. he was restarted on aggrenox and continued on lipitor, propranolol and isosorbide dinitrate. as troponins have not trended down, concern for ami given elevated troponins and change in ef from 45 to 25% on most recent echo. change propranolol to carvidilol as above on . he tolerated this well. on the day of discharge his troponins had begun trending down appropriately. . # cholecystitis: on admission, mr. chief complaint was luq pain radiating to ruq after using the bathroom. he had a cta done to rule out pe as above, which showed pneumobilia, distended gb with stones and sludge and fluid around fossa. he was febrile and tachycardic with a white count peaking at 27. in the ed, he received ceftriaxone and flagyl. there was significant concern for cholecystitis and hida was done which was also consistent with cholecystitis. he was evaluated by surgery who recommended placement of a percutaneous cholecystostomy tube by ir. he was treated with unasyn iv q8hr and morphine prn for pain. a percutaneous cholecystostomy tube was placed on . he was febrile to 101.4 on and antibiotics were switched to zosyn (day 1 ). he defervesced and was called out to the floor on . the bile cultures grew gnr and enterococcus. he was given doses of vancomycin while the enterococcus sensitivities were pending to treat possible vre. blood cultures and urine cultures remained negative. a picc was placed on . overnight on , the patient pulled out his percutaneous cholecystostomy tube. he was evaluated by surgery and ir was contact and they felt that replacement was not indicated. they recommended clinically following the patient for signs of cholecystitis. on the day of discharge, the patient denies any abdominal pain. he is afebrile with a slightly elevated wbc count. he will require daily abdominal exams and monitoring of his white blood cell count to rule out infection. . # retroperitoneal mass: the mass was presumed to be sarcoma. deferred inpatient biopsy. he will need outpatient follow up for possible biopsy. . # arf: mr. developed acute renal failure likely secondary to overdiuresis. it resolved on improvement of his fluid status. on the day of discharge his creatinine was 1.2 and he was maintaining good urine output. . # htn: he was treated with isosorbide and propranolol per his outpatient regimen. his propranolol was changed to carvedilol on . his blood pressure remained in good control. . # guaiac positive stool in ed: as mr. is on aggrenox and plavix at home with guaiac positive stool, aggrenox and plavix were held on admission. his hematocrit was checked and appeared to be stable. aggrenox was eventually restarted, but plavix was held. . # hypothyroid: he was maintained on synthroid 75 mcg/d as per outpatient regimen. . # delirium: during this admission, the patient has had moments of agitation. he was treated with haldol for these episodes with good response. there was concern for prolonged qt with haldol, so ekgs were checked prior to giving each dose. . # f/e/n: on admission the patient was kept npo for cholecystitis and procedure. once his abdominal pain subsided, he was seen by speech and swallow who recommended pureed solids and nectar thickened liquids. his electrolytes were followed and repleted as needed. . # prophylaxis: he was kept on ppi as per outpatient and given subcutaneous heparin injections for dvt prophylaxis. . # full code: discussed with daughter medications on admission: aggrenox 2/day folic acid 1 mg qday lactobacillus prn isosorbide dinitrate 5 mg tid lipitor 10 mg po qday propanolol 10 mg tid proscar 5 mg qday protonix 40 mg qday synthroid 75 mcg qday nitroglycerin prn plavix 3x/day discharge medications: 1. dipyridamole-aspirin 200-25 mg cap, multiphasic release 12 hr sig: one (1) cap po bid (2 times a day). 2. isosorbide dinitrate 10 mg tablet sig: 0.5 tablet po tid (3 times a day). 3. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 7. heparin (porcine) 5,000 unit/ml solution sig: one (1) inj injection tid (3 times a day). 8. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) gram intravenous q48h (every 48 hours). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. carvedilol 3.125 mg tablet sig: 1.5 tablets po bid (2 times a day). 11. piperacillin-tazobactam 2.25 g recon soln sig: 2.25 recon solns intravenous q6h (every 6 hours). discharge disposition: extended care facility: for the aged - macu discharge diagnosis: acute cholecystitis chf exacerbation cad ami retroperitoneal mass acute renal failure hypertension hypothyroidism delirium discharge condition: stable. the patient is hemodynamically stable discharge instructions: you were admitted with a diagnosis of cholecystitis. you have an infection which needs to be treated with antibiotics. a picc line was placed in your arm to help give antibiotics. you were also treated for heart failure. you are now able to breathe comfortably on your own. you were started on the following new medications: 1. zosyn to treat the infection found in the gallbladder. you should continue the zosyn for 4 weeks or until dr. decides. 2. vancomycin to treat the infection found in the gallbladder. this should be continued until the sensitivities of the organisms in the bile return. 3. carvedilol for improved blood pressure control if you begin to experience any further shortness of breath, chest pain, dizziness, palpitations, fevers, or chills please call your regular doctor or 911 immediately. followup instructions: you will need to follow up with dr. , , once you have been released from the rehab. you have an appointment with ,md on 1:00 in the . you will also need follow up for further evaluation and possible biopsy of the retroperitoneal mass. procedure: venous catheterization, not elsewhere classified percutaneous aspiration of gallbladder diagnoses: subendocardial infarction, initial episode of care unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism mitral valve insufficiency and aortic valve insufficiency rheumatic heart failure (congestive) other and unspecified hyperlipidemia old myocardial infarction occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction calculus of gallbladder with acute cholecystitis, without mention of obstruction malignant neoplasm of retroperitoneum 

Answer: The patient is high likely exposed to