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: "increased parkinsonian symptoms", dyspnea on exertion major surgical or invasive procedure: ercp with stent placed in common bile duct history of present illness: 78yo m with parkinson's disease, af on warfarin, and ? sleep disorder, sent into the ed by pcp for concern that patient is failing at home. he reports worsening of his parkinson's symptoms over the last month, including rigidity, instability, more frequent falls, and memory difficulties. denies difficulty speaking or swallowing, or new weakness in extremities. he administers his own medications, and his wife and pcp are concerned that he is no longer able to do so accurately. he has had 2 falls over the last 2 weeks, both with no head injury and no loc, resulting from balance difficulties while walking. he has also had increasing dyspnea on exertion recently, over last 2-4 weeks, with associated worsening lower extremity edema. . he currently feels well. he has some mild hip pain which he has had since his fall earlier this week. he denies sob at rest, he has not been walking around in the ed so is unable to assess doe. denies cp, headache, n/v, diarrhea. past medical history: 1. atrial fibrillation- on coumadin, followed by dr. , planning for dccv 2. parkinson's disease- on sinemet and mirapex, followed by dr. of neurology 3. prostate cancer- s/p xrt 4. l hip replacement 5. ?sleep disorder 6. le edema 7. cervical myelopathy- to wear c-collar 8. myasthenia - diplopia, on pyridostigmine social history: lives with his wife at home with wife. no etoh, drugs. no tobacco. family history: father died of esophageal ca (cigar smoker), mother with , brother died of cva physical exam: 95.7 75 122/66 18 98% ra general- elderly man sitting up in bed, appears somnolent but easily arousable, ox3, pleasant, nad heent- eyes closed for most of the exam and interview, sclerae anicteric, moist mm neck- supple, no bruits lungs- ctab, ? decreased breath sounds at l base heart- irregularly irregular, no murmur abd- soft, nt, nd, nabs ext- + pitting le edema b/l, abrasions on knees b/l, +tremor in hands b/l pertinent results: labs on admission: 12:40pm pt-17.9* inr(pt)-1.7* 03:40pm blood wbc-6.8 rbc-3.99* hgb-11.9* hct-35.7* mcv-90 mch-29.8 mchc-33.3 rdw-16.9* plt ct-167 03:40pm blood neuts-82.1* lymphs-10.7* monos-4.8 eos-1.7 baso-0.8 12:40pm blood pt-17.9* inr(pt)-1.7* 03:40pm blood glucose-131* urean-31* creat-1.1 na-142 k-4.2 cl-107 hco3-25 angap-14 12:40am blood ck(cpk)-74 01:28am blood lipase-17 03:40pm blood ck-mb-7 ctropnt-0.03* probnp-3834* 03:40pm blood calcium-9.4 phos-3.0 mg-2.1 06:04am blood type-art po2-69* pco2-32* ph-7.48* calhco3-25 base xs-0 01:38am blood lactate-2.1* 11:14pm blood lactate-1.3 . pertinent labs during hospital course (lfts, etc): 01:28am blood alt-151* ast-799* ld(ldh)-733* alkphos-361* totbili-3.5* 09:00am blood alt-186* ast-879* ld(ldh)-626* alkphos-294* totbili-5.0* dirbili-4.3* indbili-0.7 04:50pm blood alt-88* ast-629* alkphos-262* totbili-4.9* 09:10pm blood alt-165* ast-468* alkphos-234* amylase-35 totbili-4.5* 06:28am blood alt-140* ast-362* alkphos-238* totbili-5.1* dirbili-4.6* indbili-0.5 04:03am blood alt-191* ast-166* alkphos-167* totbili-4.4* 05:05am blood alt-140* ast-106* ld(ldh)-215 alkphos-161* totbili-3.3* 05:27am blood alt-72* ast-60* alkphos-165* totbili-2.2* 09:00am blood ggt-486* 09:00am blood hbsag-negative hbsab-negative hbcab-negative hav ab-positive 04:50pm blood igm hav-negative 09:00am blood acetmnp-neg 09:00am blood hcv ab-negative . labs on discharge: 05:27am blood wbc-6.8 rbc-3.85* hgb-10.9* hct-34.0* mcv-88 mch-28.2 mchc-32.0 rdw-16.8* plt ct-107* 05:27am blood pt-17.2* ptt-28.3 inr(pt)-1.6* 05:27am blood glucose-104 urean-21* creat-0.9 na-141 k-3.5 cl-107 hco3-24 angap-14 05:27am blood calcium-8.9 phos-2.2* mg-1.9 . microbiology: blood culture : 4/4 bottles e. coli, 3/4 bottles klebsiella oxytoca, pan sensitive urine culture : negative hcv viral load : negative blood culture : ngtd blood culture : ngtd . cxr : increased pulmonary markings c/w chf . ct head : no acute ich, no mass effect . hip films : impression: no evidence of acute fracture. . ruq u/s : impression: status post cholecystectomy without evidence for intrahepatic or extrahepatic biliary ductal dilatation. . cta chest : impression: 1. no evidence for pulmonary embolus. 2. large bilateral pleural effusions with bilateral air space opacities at the lung bases representing atelectasis versus consolidation. 3. small pericardial effusion. . cxr : impression: 1. persistent congestive heart failure with interstitial edema. 2. new retrocardiac opacities, which may relate to dependent edema. aspiration pneumonia should also be considered. 3. small left pleural effusion. . kub : there is a nonobstructive bowel gas pattern visualized, with air and stool within nondistended colon and air within nondistended loops of small bowel. if there is clinical suspicion for free intraperitoneal air, dedicated upright or left lateral decubitus view would be recommended. . ercp : report pending . cxr : impression: improving mild pulmonary edema and small bilateral effusions. . echo : conclusions: ef 35-40%. the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is top normal/borderline dilated. overall left ventricular systolic function is moderately depressed. resting regional wall motion abnormalities include inferior akinesis/hypokinesis and inferolateral hypokinesis and mild to moderate global hypokinesis. the aortic valve leaflets are mildly thickened. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is a small pericardial effusion. brief hospital course: patient is a 78 year old man with parkinson's disease, atrial fibrillation on anticoagulation (coumadin), with recent worsening in parkinson's symptoms suspected due to improper administration of his own meds, and recent dyspnea on exersion. . # parkinson's disease: he was maintained on his outpatient sinemet and mirapex. his presentation included worsening rigidity and gait difficulties resulting in falls. his pcp and wife were suspicious that he is no longer able to administer his own medications accurately. a neurology consult was obtained to comment on the possible etiologies of his gait difficulties, and whether they could be explained by medication nonadherence. they felt his gait difficulties were likely multifactorial, with parkinson's disease, cervical myelopathy, and possible body dementia contributing, as well as improper administration of his parkinson's medications. he has a history of significant worsening of his symptoms with nonadherence to medications and his cervical collar. therefore he was maintained on his outpatient parkinson's medications and discharged on these medications. he was discharged to rehab for improved administration of these medications, and if patient returns home, his wife will likely need to take over administration of his medications. . # cholangitis: patient was noted to have abdominal pain and fever on , work up included lfts which were noted to be elevated in a hepatitis/obstructive pattern. blood cultures were sent which ended up growing 4/4 bottles pan sensitive e. coli and klebsiella. he was initially empirically started on zosyn. ruq u/s demonstrated no dilation of the common bile duct, but given clinical picture, there was suspicion of obstruction. therefore patient underwent ercp on that noted partial obstruction of common bile duct with 3 stones, stones unable to be removed, but stent placed for pus drainage noticed. immediately following ercp, patient went to the icu for closer monitering, but came back to the regular floor the following day without complication. his fevers resolved, he became more hemodynamically stable, his symptoms improved. his diet was advanced to regular without complication. he was maintained on zosyn throughout hospital course, but given the pan-sensitive bacteria, he was switched to levofloxacin on discharge to complete a 14 day course of antibiotics. he will need follow up with ercp in 1- 2 months time for likely repeat ercp. they will contact him for scheduling. . # doe: he presented with increasing dyspnea on exertion over the last month, most notably on the day of admission when he was trying to put on his compression stockings. while his pulmonary exam was initially without rales, he had chf on cxr, le edema greater than baseline, and he had a markedly elevated bnp. his last tte was in and showed an ef of 45-50%. he had no infiltrates or clinical history for pneumonia. he had excellent o2 saturations on room air, so he was maintained on his outpatient dose of furosemide. he then had some tenuos respiratory issues around the same time as his noted cholangitis, requiring nasal cannula oxygen for a short time period. this was thought secondary to trans-abdominal fluid movement from his abdominal process. as the cholangitis was treated as above, his respiratory issues and oxygen requirement resolved and the patient no longer required supplemental oxygen. his outpatient lasix of 20mg po qd was held during the above infectious period of his hospital course, but was restarted prior to discharge, and the patient had continued (but improved) lower extremity edema. he also had a repeat echo prior to discharge, which demonstrated ef=35-40%. medication adjustments on discharge included restarting the patient's cozaar at 25mg qd, continuing lasix 20mg qd, adding spironolactone 25mg qd, discontinuing the patient's beta blocker (metoprolol 25mg ) and continuing his amiodarone 200mg qd. he was kept on his aspirin dose 325mg qd. . # atrial fibrillation: the patient is on amiodarone and coumadin as an outpatient. he and his cardiologist (dr. were planning for dccv but his inr has been difficult to manage, and he has consistently been subtherapeutic on his coumadin. the patient reached therapeutic values of his coumadin during hospital course, but then had his coumadin held and received ffp prior to his ercp. coumadin remained held following the ercp and discussions ensued regarding risk vs benefit of this patient being on coumadin for his atrial fibrillation given his fall risk. dr. wanted an echo to assess heart function prior to making a decision of patient remaining on coumadin or not. given echo results above, it was decided to continue coumadin 4mg qhs, as patient will be in a controlled environment at rehab. long term coumadin administration will be addressed at a later time. he otherwise had his amiodarone held during his acute lft elevation, but this was restarted upon resolution of his cholangitis. per dr. , there is continued consideration of cardioversion in the future, once patient has a documented therapeutic inr for 1 month's time. . # left shoulder pain: noted following ercp. per patient, positional, and worse with deep breathing. likely musculoskeletal from lying in bed, ?positioning during ercp. therefore patient discharged with oxycodone prn, with thoughts that shoulder pain will improve with time and physical therapy. . # cervical myelopathy: his myelopathy results in left leg weakness, contributing to his gait disturbances. his cervical collar improves his symptoms. . # prostate ca: patient is status-post radiation therapy. he was maintained on his outpatient oxybutynin and tamsulosin . # code status: full medications on admission: sinemet 25/100 tid mirapex 0.5 tid zoloft 100 qd asa 81 qd lasix 20 qd warfarin 2.5 qtwfsasu, 1.25 qmth tamsulosin 0.4 qhs oxybutynin 5 tid amiodarone 200mg qd pyridostigmine discharge medications: 1. sertraline 100 mg tablet sig: one (1) tablet po daily (daily). 2. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po tid (3 times a day). 3. pramipexole 0.25 mg tablet sig: two (2) tablet po tid (3 times a day). 4. oxybutynin chloride 5 mg tablet sig: one (1) tablet po tid (3 times a day). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs (at bedtime). 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 8. multivitamin capsule sig: one (1) cap po daily (daily). 9. pyridostigmine bromide 60 mg tablet sig: one (1) tablet po q8h (every 8 hours). 10. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 12. lactulose 10 g/15 ml syrup sig: 30-60 mls po q6h (every 6 hours) as needed. 13. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 15. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 16. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 17. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 9 days. 18. cozaar 25 mg tablet sig: one (1) tablet po once a day. 19. spironolactone 25 mg tablet sig: one (1) tablet po once a day. 20. oxycodone 5 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain. 21. coumadin 4 mg tablet sig: one (1) tablet po at bedtime: please moniter inr for goal of . discharge disposition: extended care facility: & retirement home - discharge diagnosis: cholangitis parkinson's disease cervical myelopathy myasthenia atrial fibrillation hypertension discharge condition: stable. patient afebrile, stable blood pressure and heart rate, good oxygen saturation, feeling better. discharge instructions: please take all of your medications as prescribed. . if you experience falls, worsening instability, worsening abdominal pain, fevers/chills, or other concerning symptoms, please call your doctor or go to the er. . please follow up with appointments as directed. followup instructions: - please call your pcp, . (, to schedule a follow up appointment within the next 7-10 days. - cardiology: dr. ( - please follow up in weeks - you will need to return in months for follow up ercp. the office will notify you with an appointment time. - neurology: dr. provider: , .d. phone: date/time: 12:00 procedure: endoscopic insertion of stent (tube) into bile duct diagnoses: congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation paralysis agitans cholangitis calculus of bile duct without mention of cholecystitis, with obstruction cervical spondylosis with myelopathy myasthenia gravis without (acute) exacerbation 

Answer: The patient is high likely exposed to