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: abdominal pain major surgical or invasive procedure: ercp with placement of 2 biliary stents history of present illness: this is a 42 year old male with pmh of cholecystectomy, autoimmune pancreatitis, ercp x 3 for recurrent cholangitis who is transferring from medical center for abdominal pain and vomiting. patient states that begining on friday he has generalized epigastric pain that was increasing in severity and described as sharp and worse in the ruq. he has had this same pain several times in the past for which he was diagnosed with cholangitis and recurrent stones even post cholecystectomy. he also endorses non-bloody, non-billious vomiting x1 day and his ros is (+) for constipation and hematochezia one time, two days ago. he denies f/c/cp/sob/diarrhea. . patient labs from transfer sig for: wbc:9.9 w/ 12%bands, no gap, tuberculosis:2.4,db:1.3, ast:916, alt735, ap:190,lipase23 . in the ed the patients vitals were 99.6, 116, 149/95, 18 sating 98% on ra. he was given dilaudid and zofran for symptom management as well as started on ampicillin-sulbactam. a ruq ultrasound was performed and showed mild intra and extra hepatic duct dilation with a cbd of 11 mm (7 mm on mrcp from ). the patient was given iv fluids and transferred to the for further management. he was never on pressors nor intubated. . on arrival to the micu, patient's vs 102.3, 131, 132/88, 100% 2l patient appeared fatigued and was in no distress. . review of systems: (+) per hpi (-) denies chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies shortness of breath, cough, or wheezing. denies chest pain, chest pressure, palpitations. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: # hypertension # gerd # s/p ccy () # s/p ercp x3 (, , ) # autoimmune pancreatitis, dx by serology and improved on steroids. dx in , has not used steroids since early in # osa with intermittent cpap use (not currently using) # : cbd stricture and cholangitis. s/p ercp, where pt was found to have a 15 mm long stricture at distal cbd with mild post obstuctive ductal dilatation. social history: pt works at a nursing home and lives with his wife. denies smoking, etoh or illicits. born in , moved to us in . family history: denies family hx of autoimmune disease, no cancers. family healthy, no reported medical issues physical exam: admission exam: vs: 102.3, 131, 132/88, 100% 2l general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. pertinent results: admission labs: 06:30am blood wbc-13.5*# rbc-5.20 hgb-14.1 hct-43.5 mcv-84 mch-27.2 mchc-32.5 rdw-13.8 plt ct-186 06:30am blood neuts-94.8* lymphs-2.1* monos-2.6 eos-0.2 baso-0.3 06:30am blood glucose-123* urean-9 creat-0.9 na-138 k-3.9 cl-101 hco3-29 angap-12 06:30am blood alt-797* ast-808* ld(ldh)-800* alkphos-220* totbili-2.6* 06:30am blood lipase-25 06:34am blood lactate-1.5 lft trend: 06:30am blood alt-797* ast-808* ld(ldh)-800* alkphos-220* totbili-2.6* 04:49am blood alt-397* ast-194* alkphos-139* totbili-3.9* 05:01am blood alt-263* ast-83* alkphos-128 totbili-1.2 dirbili-0.7* indbili-0.5 other pertinent labs: 05:01am blood pt-15.5* ptt-34.0 inr(pt)-1.5* 04:49am blood calcium-7.4* phos-2.8 mg-1.6 04:49am blood -positive * titer-1:40 04:49am blood igg-1238 microbiology: blood cultures : klebsiella pneumoniae | ampicillin/sulbactam-- 8 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- 0.5 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s urine culture : negative blood cultures : pending blood culture : pending imaging: ruq ultrasound : 1. intra- and extra-hepatic bile duct dilation, similar to prior mrcp. if further evaluation is required, mrcp may be helpful. 2. biliary stent is not visualized on this study. correlate with history of removal. ercp : s/p sphincterotomy - this was widely patent. a single smooth stricture that was 20 mm long was seen at the lower third of the common bile duct. given cholangitis, only minimal injection of contrast was performed. a 5cm by 10fr double pig-tail biliary stent was placed. a 7cm by 10fr biliary stent was placed. pus and sludge were extracted successfully using a balloon. (stent placement, stent placement, stone/sludge extraction) otherwise normal ercp to third part of the duodenum. mrcp impression: 1. new right anterior portal vein thrombosis with secondary perfusion-related arterial hyperenhancement in the right lobe of the liver. 2. mild central peribiliary and extrahepatic bile duct wall enhancement, consistent with cholangitis. cbd/chd stent in situ. persistent intrahepatic duct dilatation which has improved slightly since the previous mri. 4. small bilateral pleural effusions. brief hospital course: 42m with history of biliary strictures and autoimmune pancreatitis presenting with abdominal pain, found to have elevated lfts and klebsiella bacteremia in setting of acute cholangitis, s/p ercp with 2 biliary stents placed. # acute cholangitis # biliary obstruction # klebsiella bacteremia patient presented with fevers, leukocytosis, tachycardia, abdominal pain, elevated transaminases, tbili and alkphos, concerning for acute cholangitis. he was normotensive and did not require pressor support, but was admitted to icu given his tachycardia. ruq ultrasound showed intra- and extra-hepatic bile duct dilation. he was started empirically on zosyn, and ercp team consulted. patient underwent ercp on , and was found to have a single smooth stricture 20 mm long at the lower third of the cbd. pus and sludge were extracted, and 2 biliary stents were placed. he tolerated the procedure well, but remained febrile and tachycardic to the 130s following the procedure, requiring multiple fluid boluses. pain was controlled with dilaudid as needed, and nausea controlled with zofran as needed. blood cultures from positive for pan-sensitive klebsiella, and patient's antibiotics switched to ciprofloxacin on with plan to complete 14-day total course of antibiotics. his diet was advanced as tolerated, to full liquids on . per ercp team, mrcp ordered to evaluate for autoimmune cholangitis/pancreatitis. also checked igg (normal), (positive with 1:40 titer), and igg4 levels (still pending) per ercp. #autoimmune pancreatitis, newly discovered portal vein thrombosis - seen by liver consult (dr. who recommended anticoagulation. he was started on lovenox 80 mg sq and received one dose of coumadin 5 mg on the day of discharge. on further discussion with liver, they recommended actually holding off on starting coumadin until at least 48 hrs after lovenox initiation. pt was called on his cell phone within an hour of discharge, and he expressed understanding of this plan. he will follow-up with his pcp's office for inr checks. we have tried to reach his pcp's office today but pcp is . details of this d/c summary have been faxed to pcp . he will f/u with liver clinic in approximately 1 month, as well as anticipated repeat mrcp in 12 weeks to re-evaluate the portal v. thrombosis # sinus tachycardia: was likely multifactorial in etiology in setting of sepsis, fever, pain, and volume depletion. improved with ivf, antibiotics, and pain control. patient continuing on ivf until adequate po intake. # htn: held lisinopril given sepsis physiology on presentation to icu. resumed on regular floor # osa: patient does not use cpap at home. medications on admission: -lisinopril 20 mg -cholecalciferol (vitamin d3) 400 unit -omeprazole 20 mg -multivitamin discharge medications: 1. lisinopril 20 mg po daily 2. omeprazole 20 mg po daily 3. ciprofloxacin hcl 500 mg po q12h day 1 = (day 1 of overall antibiotics ), needs 2 week course rx *ciprofloxacin 500 mg 1 tablet(s) by mouth twice a day disp #*22 tablet refills:*0 4. multivitamins 1 tab po daily 5. vitamin d 400 unit po daily 6. enoxaparin sodium 80 mg sc q12h rx *enoxaparin 80 mg/0.8 ml 80 mg sq twice a day disp #*14 syringe refills:*0 7. warfarin 4 mg po daily rx *warfarin 2 mg 2 tablet(s) by mouth at bedtime disp #*60 tablet refills:*0 note: on further discussion with liver, they recommended actually holding off on starting coumadin until at least 48 hrs after lovenox initiation. pt was called on his cell phone within an hour of discharge, and he expressed understanding of this plan. he will start warfarin on evening. 8. outpatient lab work (icd 9 code: 452 portal vein thrombosis) draw inr on , results to dr phone: , fax: discharge disposition: home discharge diagnosis: cholangitis biliary stricture and obstruction klebsiella bacteremia portal vein thrombosis autoimmune pancreatitis discharge condition: condition: stable mental status: lucid ambulatory status: independent discharge instructions: you were admitted with another episode of cholangitis and underwent ercp which showed biliary stricture in the common bile duct. two stents were placed. you will need another ercp in 6 weeks for removal of the stents. we also obtained an mri which showed a clot in the portal vein, which is a liver vein. you were seen by the liver service and have been started on blood thinner medication. one is an injection medication (lovenox/enoxaparin) which is temporary until your blood reaches the right level. the other medication(warfarin/coumadin) will be ongoing. it is important that you have several more lab checks in the coming week to determine the right coumadin dose. please contact your pcp office tomorrow to discuss with dr. and to determine which lab you should have this drawn at. you have been given a prescription for this lab draw for tomorrow. please keep your follow-up appointments as below. you will need to be seen in the liver clinic in approximately one month, with a repeat mri in 3 months. you will be contact with an appointment in the liver clinic. please complete your antibiotics as directed. if you develop severe diarrhea or nausea/vomiting please seek medical attention. it is important that you not miss of antibiotics. followup instructions: name: , v. location: steward physicians address: , , , phone: ****we have left a message with the office to arrange a follow up appt for you and call you at home with the appt. if you don't hear from the office by tomorrow, please contact them directly to book. please also call the office to discuss having your lab (inr) drawn. department: gastroenterology when: wednesday at 10:00 am with: , md building: ra (/ complex) campus: east best parking: main garage we are working on a follow up appointment in the liver center in the next month. you will be called at home with the appointment.if you have not heard or have questions, please call . md procedure: endoscopic insertion of stent (tube) into bile duct diagnoses: thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) anemia, unspecified esophageal reflux unspecified essential hypertension sepsis other specified cardiac dysrhythmias other septicemia due to gram-negative organisms cholangitis obstruction of bile duct acute pancreatitis portal vein thrombosis 

Answer: The patient is high likely exposed to