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: hypotension, shaking chills, abdominal pain major surgical or invasive procedure: ercp with new (additional) stent placed. history of present illness: 70 year old man with known dmii, htn, and pancreatic ca metastatic to the liver on gemcitabine (last dose 2 days prior to admission, wbc count is currently 2.6, his primary oncologist at is dr. .) the patient presented with explosive diarrhea, fever, chills, and right sided chest pain. the evening prior to admission, the patient complained of constipation x4days to his niece, who gave him laxitive pills. gemcitabine is also known to cause diarrhea. that night he experienced copious explosive diarrhea, "all over the bathroom," non-bloody. denies nausea/vomiting/abd pain. he also slipped and fell in the bathroom that night, but experienced no loc, dizziness, or reported injury. on the day of admission he was brought in for fever (temp 100.8 recorded at home), chills, and right sided chest pain. the pain was constant and "light" in nature, non-radiating, and hurt when he pressed on the area. no sob or palpitations. ed course: initial vitals: 97.6 90 125/75 20 100% on examination the patient was actively rigoring. he became hypotensive with bp 87/48 and pulse of 92. lactate was 11.4, corrected to 4.3 following 2l of fluid, bp now 95 following 4l, cta-negative, abd/pelvis -no abcess. head and c-spine. guiac negative. ed meds: 3l ns, asa, tylenol, vancomycin 1000 mg, cefepime 2 g he was admitted to the icu for sepsis picture. : vitals stable on admission. diarrhea and right sided chest pain resolved without further treatment. following stabilization in the medical icu () the patient was transferred to the hospital medicine service for ongoing management of cholangitis, resolving volume overload, abdominal pain and pancreatic cancer. past medical history: advanced pancreatic cancer diagnosed on when he presented with weight loss, jaundice, pale stools and ruq pain. ercp brushing demonstrated adenocarcinoma. lap chole , gb with metaplastic changes/hydrops of the gb along with edema and inflammation seen in or egd with bx- erythematous gastritis seen s/p ampullary bx that were negative first episode of pancreatitis type ii dm= diet controlled, only requires ss insulin w/ chemo hypertension hypercholesterolemia social history: taken from recent d/c summary which dr performed during his recent admission. he is a priest in . he is currently living with his niece since being discharged. niece- lives in - hcp - cp . his niece is a nurse. cigarettes: never ex-smoker current pack-yrs: 10 quit: ______ etoh: no yes once per 6 months drugs: none occupation: priest marital status: married single lives: alone w/ family other: received influenza vaccination in the past 12 months y n received pneumococcal vaccinationin the past 12 months y n - refused. independent of adls and iadls. family history: mother died of ad at age 84. she also had b/l breast cancer. father died of a cva at age 85. sister died of vulvar cancer at age 61. his first cousin died of pancreatic cancer in at the age of 75. brother died of osteomyelitis at age 55. his aunt died of lung cancer in her 70s/80s. she was a heavy smoker. physical exam: admission exam: vitals: temp 98.9, hr 73, bp 102/53, rr 23, o2 sat 98% general: alert, oriented, no acute distress heent: mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: chest pain resolved, no tenderness to palpation of anterior chest. regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding gu: no foley ext: 1+ pitting edema, patient says this has been going on for a few months. warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, reflexes difficult to elicit but b/l symmetric discharge exam: patient afebrile, well-appearing abdomen benign, soft, normal bowel sounds trace pitting edema bilateral les and upper arms. pertinent results: 02:10pm blood lactate-11.4* 04:43pm blood lactate-4.3* 01:55pm blood albumin-3.6 01:55pm blood lipase-20 01:55pm blood glucose-190* urean-15 creat-1.1 na-138 k-5.3* cl-100 hco3-17* angap-26* 04:40pm blood na-135 k-3.6 cl-105 01:55pm blood pt-13.2* ptt-34.1 inr(pt)-1.2* 01:55pm blood plt ct-537* 01:55pm blood neuts-83.7* lymphs-14.6* monos-0.3* eos-1.0 baso-0.4 01:55pm blood wbc-2.6*# rbc-3.45* hgb-10.9* hct-34.8* mcv-101* mch-31.6 mchc-31.3 rdw-18.3* plt ct-537* portable cxr: no acute cardiopulmonary process. ct c spine w/o contrast: degenerative changes without visualized acute fracture. mild anterolisthesis of c4 on c5 which could be accounted for by facet joint hypertrophic changes. ct head w/o contrast: no acute intracranial abnormality or hemorrhage. ct abd/pelvis w/ contrast and cta chest w and wo contrast: 1. no evidence of pulmonary embolism or acute aortic syndrome. no findings to explain patient's symptoms. 2. enlarged right paratracheal lymph nodes when compared to previous exam from two weeks prior. given short interval change, this could be reactive or due to inflammation/infection, although metastatic disease is not completely excluded. followup of this node is suggested on future exams. 3. no acute intra-abdominal process. multifocal liver lesions compatible with metastatic pancreatic carcinoma. no change to ill-defined lesion of the pancreatic head. 4. 3 mm right upper lobe pulmonary nodule for which continued followup is suggested. micro blood cx x2: no growth at the time of discharge brief hospital course: 70m w/pmhx dmii, htn, and pancreatic ca metastatic to the liver on gemcitabine (last dose 2 days prior to admission) presents with explosive diarrhea, fever, chills, and right sided chest pain. # hypotension and lactic acidosis: attributed to associated intra-abdominal infection. responded to iv fluids in the ed, clinically improved. given the patient's recent copious diarrhea, no signs of infection (no fever, no tachycardia), and quick response to iv fluids, hypotension likely hypovolemia. the patient recieved 2 l of further maintenace fluids the night after admission. blood cultures did not reveal bacteremia. the acidosis resolved with treatment of his underlying process. # cholangitis: the patient was treated with iv antibiotics throughout his course, and was transitioned to oral antibiotics at the time of discharge. upon review of his recent lfts by the ercp team, there was a question if the biliary obstruction noted at the time of the additional stent placement could have occurred gradually in the recent past. # tranaminitis with jaundice: the patient was noted to have a cholestatic picture in the setting of requiring a new stent in addition to the prior stents. follow-up of the patient's lfts was arranged at discharge. # r sided atypical chest pain: resolved on admission to the floor. ecg showed no ischemic changes. this pain was likely related to his cholangitis and functional biliary obstruction, which improved after stent placement and treatment of his infection. one episode of chest pain later in the admission occurred with a large dose of oral potassium. s/p fall: no loc, no disorientation, no head trauma. imaging work up negative for injury (see above) pancreatic ca: tumor load responding to gemcitabine pallative treatment. patient gets treatments per dr , who assisted in the care of the patient throughout the admission and coordinated efforts with the hospital medicine team. she suggested that she will see the patient several days following discharge to determine when she will administer the next chemotherapy treatment, given the resolving cholangitis. hyperbilirubinemia: likely pancreatic ca and liver mets, but is increased from baseline. -repeat bili and lfts showed gradual improvement over the course of the admission, and slow resolution of his jaundice. the ercp team recommended that the patient have lfts drawn on , which were arranged to be drawn by the vns that the patient has previously established care with. htn: on atenolol at home. dmii: normally diet controlled, mostly needs insulin around chemo treatments. -insulin sliding scale # fen: normal die prophylaxis: sqh code: dnr, but ok to intubate transitional issues -lfts resolving -- follow-up arranged to ensure stability. -chemotherapy treatment deferred during active infection. dr to determine timing of restarting, at scheduled follow-up. imaging: -enlarged r paratracheal lymph nodes were noted on ct exam, increased in size from 2 weeks prior. inflammatory/infectious cause thought to be more likely but metastatic disease is a possibility. outpatient follow up of this node is recommended. -3 mm r upper lobe pulmonary nodule --- continued follow up is recommended -incidental finding on chest ct: there is some atherosclerotic plaque with ulcerative plaque at the inferior margin of the aortic arch laterally which is a stable configuration compared to prior exam from , without surrounding inflammatory changes. medications on admission: atenolol - 25 mg tablet - 1 tablet(s) by mouth daily insulin lispro - (prescribed by other provider) - 100 unit/ml cartridge - 2-6 units per sliding scale lorazepam - 0.5 mg tablet - tablet(s) by mouth at bedtime as needed for sleeplessness ondansetron - 4 mg tablet, rapid dissolve - tablet(s) by mouth every 6-8 hours as needed for nausea oxycodone - 5 mg tablet prn pain prochlorperazine maleate - 10 mg tablet - 1 tablet(s) by mouth q6 hour as needed for nausea/vomiting medications - otc docusate sodium - 100 mg capsule - 1 capsule(s) by mouth q12hour polyethylene glycol 3350 - (otc) - 17 gram/dose powder - 17 g by mouth daily as needed for constipation sennosides - 8.6 mg tablet - 2 tablet(s) by mouth q12hour as needed for constipation discharge medications: 1. outpatient lab work please draw the following blood work on through your visiting nurse: chemistry 7, potassium, bun/creatinine, as, alt, total bilirubin, calcium, magnesium. the results should be faxed to dr at office phone:(, office fax:(. 2. atenolol 25 mg tablet sig: one (1) tablet po once a day. 3. lorazepam 0.5 mg tablet sig: 1-2 tablets po at bedtime as needed for insomnia. 4. ondansetron 4 mg tablet, rapid dissolve sig: tablet, rapid dissolves po every 6-8 hours as needed for nausea. 5. oxycodone 5 mg tablet sig: one (1) tablet po twice a day as needed for pain. 6. cipro 500 mg tablet sig: one (1) tablet po twice a day for 10 days: please continue until , then discontinue. disp:*20 tablet(s)* refills:*0* 7. metronidazole 500 mg tablet sig: one (1) tablet po every eight (8) hours for 10 days: please continue until , then discontinue. disp:*30 tablet(s)* refills:*0* 8. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 9. insulin lispro 100 unit/ml cartridge sig: 2-6 units subcutaneous per your sliding scale: please continue the sliding scale you were on prior to this admission. 10. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 11. miralax 17 gram/dose powder sig: one (1) po once a day as needed for constipation. 12. sennosides 8.6 mg tablet sig: two (2) tablet po every twelve (12) hours as needed for constipation. discharge disposition: home with service facility: health vna discharge diagnosis: cholangitis, or infection of biliary tree pancreatic cancer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure to care for you during your admission. as you know, you were admitted for a fever and shaking chills, and were found to have cholangitis or an infection of your biliary tree. you had a new stent placed, in addition to your old stents, and sludge or infected bile was drained as well. you were on iv antibiotics during your admission and will be going home with pill antibiotics (cipro and flagyl) to complete a total of 2 weeks. you will have blood work checked by the visiting rn on monday with the results sent to dr , to check how your liver is functioning. if your liver function tests are rising, dr may call your ercp team to ask about what to do. you had an episode of chest discomfort after taking several potassium pills, that resolved. you had a heart ultrasound checked which showed that your heart was beating well. you did not have a heart attack. you should make the following changes to your medications: -start taking ciprofloxacin through -start taking metronidazole (flagyl) through followup instructions: your chemotherapy treatment for friday has been moved due to your infection. you should see your outpatient oncology team including dr next week at the following appointments to discuss when your next treatment will be: department: hematology/oncology when: friday at 11:00 am with: , rn building: campus: east best parking: garage department: hematology/oncology when: friday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: friday at 2:00 pm with: , rn building: campus: east best parking: garage procedure: endoscopic insertion of stent (tube) into bile duct diagnoses: acidosis pure hypercholesterolemia malignant neoplasm of liver, secondary unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use mechanical complication due to other implant and internal device, not elsewhere classified surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation diarrhea do not resuscitate status hypovolemia cholangitis obstruction of bile duct jaundice, unspecified, not of newborn duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction malignant neoplasm of pancreas, part unspecified 

Answer: The patient is high likely exposed to