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: the patient is an 81 year old female with a past medical history significant for hypertension, coronary artery disease status post cardiac catheterization and stenting, status post ventricular fibrillation at rest with anterior wall myocardial infarction () and congestive heart failure with an ejection fraction of 20 to 25% who presents from an outside hospital with cholecystitis status post cholecystotomy tube placement. the patient is status post a recent prolonged hospitalization at from to for ventricular fibrillation at rest with anterior wall myocardial infarction requiring two cardiac catheterizations with evidence of multivessel disease. the patient's hospitalization was completed by complete heartblock requiring transcutaneous pacer placement, nonsustained ventricular tachycardia requiring implantable cardioverter defibrillator placement and congestive heart failure with ischemic cardiomyopathy and ejection fraction of 20 to 25%. the patient was discharged to a nursing home on . while at the nursing home, the patient reportedly complained of diffuse abdominal pain worsened with eating and associated with persistent nausea, vomiting, and fever. the patient was admitted to an outside hospital on , where she was found to have acute cholecystitis. the patient was made nothing by mouth and was started on total parenteral nutrition. an abdominal computerized axial tomography scan and right upper quadrant ultrasound evidenced distended gallbladder with edema, stones, and sludge. the patient was started on empiric antibiotics and underwent an ultrasound-guided placement of a cholecystotomy tube on . the patient continued with persistent abdominal pain and follow up abdominal computerized axial tomography scan demonstrated a subcapsular hematoma/bile collection. the hospital course was complicated by congestive heart failure, acute hematocrit drop to 21 requiring blood transfusion and acute progressive renal failure. the patient was reportedly ruled out for a myocardial infarction, however, developed, per report, a supraventricular tachycardia requiring the initiation of an esmolol drip prior to transfer. the patient was transferred for further management to on . past medical history: 1. hypertension; 2. diverticulitis; 3. coronary artery disease, status post catheterization 15 years ago, status post cardiac catheterization in with stenting of the left anterior descending artery and left circumflex artery; 4. ventricular fibrillation at rest, status post anterior wall myocardial infarction; 5. nonsustained ventricular tachycardia status post implantable cardioverter defibrillator placement; 6. ischemic cardiomyopathy with echocardiogram in demonstrating left atrial enlargement, aneurysmal apex, akinetic inferior, lateral and anterior wall with an ejection fraction of 20 to 25%; 7. esophageal stricture status post dilatation; 8. hypercholesterolemia; 9. depression. allergies: no known drug allergies. medications on admission: medications on transfer, 1. zofran 2 gm intravenously q. 6 hours prn; 2. ativan 0.5 mg intravenously q. 4 hours prn; 3. subcutaneous heparin 5000 units subcutaneously b.i.d.; 4. zoloft 25 mg p.o. q. day; 5. imdur 60 mg p.o. q. day; 6. protonix 40 mg p.o. q. day; 7. unasyn 3 gm intravenously q. 24 hours; 8. esmolol drip; 9. plavix 75 mg p.o. q. day; 10. aspirin 81 mg p.o. q. day; 11. total parenteral nutrition social history: the patient lives with her four year old son who has cerebral palsy. the patient cares for her son independently and has five other children with him she is very closely involved with. the patient has no previous current use of tobacco, alcohol or intravenous drug use. physical examination: examination on admission revealed temperature 99.5, blood pressure 134/74, heartrate 90, oxygen saturation 97% on room air with a respiratory rate of 22. in general the patient is a well developed, well nourished elderly female, spanish-speaking in mild distress, resting in bed. head, eyes, ears, nose and throat examination, normocephalic, atraumatic, anicteric sclera, pupils equally round and reactive to light and accommodation, extraocular movements intact bilaterally. clear oropharynx, moist mucous membranes. neck examination, no jugulovenous distension, supple with no lymphadenopathy. cardiovascular examination, regular rate and rhythm, normal s1 and s2 with a ii/vi holosystolic murmur at the left lower sternal border with no s3 or s4 appreciated. pulmonary examination, clear to auscultation bilaterally, anteriorly with no wheezes, rales or rhonchi. abdominal examination, normoactive bowel sounds, distended, soft, diffusely tender to percussion and palpation with rebound, no masses appreciated. cholecystotomy tube in place. extremities, no cyanosis, clubbing or edema, warm and well perfused, 2+ distal pulses. neurological examination is grossly intact. laboratory data/studies: on transfer complete blood count with a white blood cell count of 11.6, hematocrit 28, platelets 200. chem-7 with sodium 137, potassium 3.0, chloride 101, bicarbonate 23, bun 74, creatinine 1.7, glucose 103, calcium 7.3 with an albumin of 2.7, phosphate 4.1, magnesium 2.1, coagulation screen with pt of 13.1, inr 1.1, and ptt 25.8. urinalysis was notable for small blood, negative nitrites, 25 to 50 white blood cells, moderate bacteria, many yeast, 3 to 5 squamous epithelial cells. liver function tests with an alt of 53, ast 32, alkaline phosphatase 186 and total bilirubin of 0.9. ldh 319, amylase and lipase within normal limits. chest x-ray on admission was notable for cardiomegaly, bilateral pleural effusions, with increased vascular distribution in the upper lung fields consistent with congestive heart failure. bile cultures from the cholecystotomy tube without organisms on gram stain and cultures no growth to date. blood cultures from admission with no growth to date. abdominal and pelvic computerized axial tomography scan notable for normal liver with no ductal dilatation, moderate quantity of free fluid in the abdomen and pelvis with hyperdense subcapsular fluid adjacent to the right lobe of the liver consistent with bile and blood. hospital course: the patient was transferred from the outside hospital and admitted directly to the medical intensive care unit. the patient remained hemodynamically stable on telemetry without evidence of supraventricular tachycardia, previously reported at the outside hospital. the esmolol drip was subsequently discontinued and the patient was started on her outpatient dose of beta blocker with adequate rate control. the patient was continued off of coumadin, given the question of blood loss with the subcapsular hematoma. the patient's hematocrit remained stable without transfusion. the surgical service was consulted with the recommendation to continue the patient on total parenteral nutrition with nothing by mouth. the patient is not considered a surgical candidate at this time given her recent myocardial infarction. remainder of hospital course by systems: 1. gastrointestinal - the patient was transferred with a cholecystotomy tube for decompression of acute cholecystitis in the setting of an elevated white blood cell count, fever, gallbladder distention, gallstones, and pericholecystic fluid. the decompression was used as a temporizing measure without surgical options given the patient's recent myocardial infarction. the patient was continued on empiric antibiotics to complete a ten day course for acute cholecystitis. the patient's abdominal examination was significant for abdominal distention with rebound and diffuse abdominal tenderness. the patient was maintained on total parenteral nutrition with nothing by mouth and pain management. a follow up abdominal computerized tomography scan demonstrated perihepatic fluid collection secondary to a bile leak. the patient's liver function test stabilized and trended down with no further surgical intervention. the patient's cholecystotomy tube inadvertently was removed by the patient on hospital day #3 with a follow up right upper quadrant ultrasound demonstrating cholelithiasis without evidence of cholecystitis and stable perihepatic hematoma. the cholecystotomy tube was not replaced at this time. over the next several days the patient's abdominal pain persisted without evidence of rebound or guarding. a follow up abdominal x-ray revealed fecal impaction, however, the pain persisted despite evacuation. a lactate level was checked on several occasions and remained within normal limits. the patient's liver function tests continued to remain elevated, however, remained stable with no further evidence of recurrent cholecystitis. the abdominal pain was felt likely secondary to biliary colic, and the patient was treated symptomatically until the time of dictation. 2. infectious disease - the patient was treated with a ten day course of empiric antibiotics for acute cholecystitis. the patient remained afebrile without signs of acute infection until hospital day #7 when the patient spiked a temperature to 101.1 with subsequent intermittent low grade fevers. blood cultures and urine cultures were without growth, however, given the patient's abdominal pain and a xylocaine demonstrating persistent bilateral lower lobe opacities, the patient was started on empiric levofloxacin and flagyl. the patient continues on antibiotics at the time of this dictation without recurrent fever and no obvious source. 3. renal - the patient developed acute and chronic renal insufficiency while at the outside hospital, likely secondary to prerenal/congestive heart failure. the patient's creatinine progressively improved following transfer with diuresis and stabilized with a creatinine of 1.5. however, the patient's bun remained persistently elevated in the range of 95 to 115. the etiology of the elevated bun was felt likely secondary to excess protein load from the total parenteral nutrition/peripheral parenteral nutrition. the elevated bun was complicated by uremia with symptoms of nausea, vomiting, somnolence and an anion gap metabolic acidosis. a renal consult as well as nutrition consults were obtained. the recommendations are pending at the time of dictation. 4. hematology - the patient had a rapid drop in her hematocrit at the outside hospital from an initial hematocrit of 29 to 30 to a nadir of 21. the patient required transfusion at the outside hospital, however, since the time of transfer the patient's hematocrit has remained stable, greater than 30 without further transfusion requirement. 5. pulmonary - on transfer from the outside hospital the patient was found with congestive heart failure and bilateral pulmonary lower lobe opacities consistent with contrast aspiration versus atelectasis. the patient's oxygen requirements decreased with diuresis, however, the patient continues with a persistent oxygen requirement of 2 liters by nasal cannula with an oxygen saturation of 88 to 90% on room air. 6. fluids, electrolytes and nutrition - the patient has remained nothing by mouth on total parenteral nutrition and/or peripheral parenteral nutrition for the duration of the hospitalization. the above dictation includes hospital course from to . the dictation summary is to be continued at a later date. , m.d. dictated by: medquist36 procedure: parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrojejunostomy diagnoses: acidosis mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia percutaneous transluminal coronary angioplasty status other specified forms of chronic ischemic heart disease calculus of gallbladder with acute cholecystitis, without mention of obstruction acute myocardial infarction of other anterior wall, subsequent episode of care 

Answer: The patient is high likely exposed to