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: history of present illness: ms. is an 86-year-old woman who presents to the hospital with a three day history of fever, nausea, vomiting, constipation and right upper quadrant pain. the pain was localized to the right upper quadrant and the epigastrium without any alleviation or worsening type factors. the patient denied hematemesis, hematochezia, bright red blood per rectum or melena. she had received three enemas for constipation with minimal results. the patient denies any previous history of right upper quadrant or epigastric pain. she also denied any urinary symptoms. past medical history: 1. choledocholithiasis with an ercp in 2. temporal arteritis 3. history of pneumonia past surgical history: negative medication: 1. prednisone 2.5 mg po qd for temporal arteritis and calcium allergies: no known drug allergies. physical exam: vital signs: on admission, temperature of 101.2??????, blood pressure 200/93, heart rate 105, respiratory rate 24 on 95% saturation. general: the patient is alert and oriented x3. lungs: clear to auscultation bilaterally. heart: regular rate and rhythm with normal s1 and s2. abdomen: slightly obese, distended abdomen with positive tenderness in the right upper and lower quadrants. there was positive rebound in the right upper quadrant. there was no shaking tenderness, no masses and no hernias. a sign was positive. extremities: no cyanosis, clubbing or edema. pertinent lab values: elevated white count at 27.5. hematocrit was 39.4 and platelets were 422. there was a left shift with a 96% neutrophilia and 0 bands. panel 7 showed sodium of 133, potassium of 4.5, chloride of 94, bicarbonate of 23, bun of 9 and creatinine of 0.7 with a glucose of 204. liver function tests were significantly elevated, showing an ast of 379, alt of 260, alkaline phosphatase of 658 and a total bilirubin of 4.6. the amylase was 46 and lipase was 17. an arterial blood gas done at that time showed ph of 7.5, carbon of 33, oxygen of 54, bicarbonate of 28 and base excess of 3. imaging: an electrocardiogram was performed which showed normal sinus rhythm at 106 beats per minute with no st changes or q waves. an x-ray was taken which showed no free air, but positive air fluid levels in the intestines with no air in colon. chest x-ray showed no infiltrates and no congestive heart failure. a ct was performed as well, which showed 1. intrahepatic dilation of the left lobe of the liver, 2. portal vein occlusion, 3. non dilated gallbladder with positive stones. all of the intestinal and bowel appeared okay. the assessment at the time was that this was a patient with a history of choledocholithiasis that appears to have a cholangitis and she was admitted to the surgical intensive care unit for evaluation and treatment. hospital course: ms. was admitted to the intensive care unit on the 16th and that evening had an ercp performed. the ercp was performed without complication. the findings of that study were that the esophagus, stomach and duodenum had a normal gastric mucosa. the major papilla showed a moderately stenosed prior sphincterotomy. cannulation of the biliary duct was successful with a deep sphincterotome free hand and contrast medium was injected showing complete opacification without difficulty. the biliary tree showed a large amount of purulent material and two small stones were seen to drain from the prior sphincterotomy site on cannulating the bile duct. the biliary tree was moderately dilated to the intrahepatic ducts. a filling defect consistent with a stone was present in the distal common bile duct. a 5 cm x 10 french plastic double pigtail stent was placed successfully in the common bile duct. at this point, the patient was shown to have a suppurative cholangitis and choledocholithiasis, status post stent placement. post ercp, the patient returned to the intensive care unit where she continued to be intubated and ventilated for a probable chronic bronchitis versus chronic obstructive pulmonary disease situation. ms. was difficult to wean from the ventilator, but she was successfully extubated by hospital day #2. ms. remained in the intensive care unit through hospital day #5 for close monitoring, at which point she was transferred to the floor in stable condition. neurologic: ms. has a mild amount of dementia, but is able to answer questions appropriately. her pain significantly decreased after the ercp and continued to improve throughout her hospital course to the point in which now she has no pain in her abdomen at rest and only mild tenderness to palpation. cardiovascular: ms. went into an episode of rapid atrial fibrillation on hospital day #2 while in the intensive care unit. at that point, she was started on lopressor, beta block and prn and also was placed on diltiazem for rate control. with the lopressor qid, she spontaneously converted back into normal sinus and remained normal sinus rhythm after hospital day #3. an echocardiogram was performed on that showed normal ejection volume, no significant valve disease and no obvious thrombosis with slight mitral calcification. the plan, as a result of this echocardiogram, was that it was not necessary to anticoagulate ms. as a result of her isolated episode of atrial fibrillation with no previous history of atrial fibrillation. in addition, ms. has received a nitropaste patch for elevated blood pressure which she can continue to use after discharge. also, cardiac enzymes were sent to rule out myocardial infarction and an electrocardiogram was performed during her episode of atrial fibrillation and all cks were normal and the electrocardiogram showed sinus rhythm with a normal axis, flat t-waves and a single q in lead 3. respiratory: ms. has continued to need elevated oxygen support with 40% face mask following extubation. her saturations have remained in the mid to high 90s with oxygen support and she has been weaned down to just a mild nasal cannula oxygen for support. vigorous pulmonary toilet and respiratory therapy has helped clear mrs. lung function over the past few days and she should continue with this in her rehabilitation center. gastrointestinal: ms. cholangitis was appropriately and successfully treated with ercp and stent placement. following her ercp, her liver function tests improved significantly with ast and alt down to the 177 and 215 with alkaline phosphatase down to 417 and the total bilirubin coming down to 3.8 from 4.6. her liver function tests continued to improve with ast and alt normalizing by hospital day #5 into the 38 and 41 range. her total bilirubin continued to come down to 1.7 and eventually to 1.3. paradoxically, her alkaline phosphatase has remained elevated to 537 and up into the 900s, but this has also been coming down and is below 900 on discharge. she has been able to tolerate solids without complication and is taking sufficient po's at this time. she has passed gas and has had loose bowel movements. a clostridium difficile was sent which was negative. genitourinary: ms. has had a foley since her time of admission which had a significant amount of leaking. she had a urinalysis sent on hospital day #6 which showed 2 white blood cells and some elevated red cells to . she denied dysuria. the foley was discontinued on the evening of and mrs. had some incontinence overnight. she will therefore need dressing or other assistance for proper hygiene and bladder function. hematology: ms. white count has continued to fall post ercp from her admission level of 27.5. it initially went up to 32.7, but then came down to 14 from 32. she stayed in the mid to low teen range throughout her course with serial white counts of 14, 16 and 13.1. after her transfer to the floor, she had a transient elevation up to 21, but subsequent white counts have come down to 18.7 and then 15.1. throughout this time, her hematocrit has remained stable in the 33 to 38 range. it was currently 32.8 before discharge. for her cholangitis, ms. was placed on ampicillin, ceftriaxone and flagyl antibiotics which she received intravenously in the intensive care unit. when she was moved to the floor, she was changed over to intravenous levofloxacin and flagyl and was changed over to po doses of these. she will not be discharged with antibiotics at this time, as she has received a full course for treatment of her cholangitis. blood cultures that were sent on from ms. showed gram negative rods in all blood cultures growing out at klebsiella oxytoca. these were pan sensitive to all antibiotics. fluids, electrolytes and nutrition: throughout ms. course, her electrolyte panels have remained normal with occasional replacing of the magnesium and calcium as needed. she is taking sufficient po's to sustain her nutritionally and will not need any supplementation. overall impression: ms. has recovered from her ascending cholangitis and septicemias versus bacteremia. she is status post successful placement of a stent in the bile duct and a full course of antibiotic therapy. discharge status: stable discharge condition: discharged to a rehabilitation facility for close monitoring and care of her pulmonary toilet and hygiene conditions, as well as following her nutrition and physical therapy evaluation and treatment. discharge medications: 1. albuterol inhaler 2 puffs q4 prn 2. desitin topical prn 3. colace 100 mg po bid 4. lopressor 25 mg po q6h withhold parameters 5. nitropaste 0.5 inch q4h topical 6. zantac 150 mg po bid 7. percocet 1 to 2 tablets po q 4 to 6 prn 8. prednisone 2.5 mg po qd follow up: ms. should follow up with dr. in approximately one week. discharge diagnosis: 1. cholangitis with bacteremia, status post ercp and stent placement , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube endoscopic removal of stone(s) from biliary tract endoscopic insertion of stent (tube) into bile duct diagnoses: unspecified essential hypertension atrial fibrillation other septicemia due to gram-negative organisms cholangitis urinary incontinence, unspecified calculus of bile duct without mention of cholecystitis, with obstruction portal vein thrombosis giant cell arteritis unspecified chronic bronchitis 

Answer: The patient is high likely exposed to