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: penicillins attending: chief complaint: abdominal pain, n/v major surgical or invasive procedure: ercp history of present illness: patient is a year old woman with pmh of atrial fibrillation (not on coumadin), chf, htn, and rheumatoid arthritis (on prednisone) who presented to on the morning of the day of transfer with nausea and vomiting. patient was last in her usual state of health two days prior to presentation when she began to feel mild malaise with loss of appetite. on the day early morning hours of the day of admission, the sensation progressed to frank nausea with vomiting. the vomit did not have blood or dark material but patient admits that she would not be able to see this well, owing to her macular degeneration. leading up to this she did not notice a change in her bowel habits. she denies fevers but reports feeling very cold in the two days preceding admission. initial laboratory investigation revealed elevated alt/ast 418/315, tbili 4.0, lactate 1.6. ct abdomen revealed choledocholithiasis. she received 2l of ns, with subsequent hypotension (bp 80/50). another 1l ns was given with improvement of blood pressures bp 130/90s. vancomycin, metronidazole and levofloxacin were given for suspected ascending cholangitis. zofran was given for nausea. she was transferred for further management and likely ercp. vitals prior to transfer: bp 133/92, 96% ra. . on arrival to the icu, vital signs t: bp:136/97 p:107 r:22 o2:92%. she has no pain, no shortness of breath, no nausea, but endorses a feeling of "sour stomach". she feels no fever and has been having diarrhea for the day which she attributes to the antibiotics she is receiving. past medical history: atrial fibrillation - not on coumadin congestive heart failure - normal ef per cardiology note from , no record of echo hypertension rheumatoid arthritis - on prednisone anxiety gout macular degeneration social history: - tobacco: denies - alcohol: denied - illicits: denies family history: noncontributory physical exam: admission exam: vitals: afebrile bp:136/97 p:107 r:22 o2:92% general: alert, oriented, no acute distress heent: sclera very mildly icteric, mmm, oropharynx clear neck: supple, jvp to angle of jaw, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: irregularly irregular rate and rhythm, normal s1 + s2, systolic murmur heard best at the lusb, no rubs, no gallops abdomen: soft, non-tender, mild gaseous distension, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . discharge exam vss gen: patient lying comfortably in bed nad a+ox3 heent: mmm oropharynx clear neck: supple no thyromegaly cv: rrr no m/r/g resp: ctab no w/r/r abd: soft nt nd bs+ extr: no le edema good pedal pulses bilaterally derm: no rashes, ulcers or petechiae neuro: cn 2-12 grossly intact non-focal psych: normal affect and mood pertinent results: admission labs: 01:45pm blood wbc-9.2 rbc-4.28 hgb-13.6 hct-42.1 mcv-98 mch-31.7 mchc-32.2 rdw-13.7 plt ct-319 01:45pm blood neuts-90.6* lymphs-7.0* monos-2.1 eos-0.3 baso-0.1 01:45pm blood pt-12.2 ptt-26.4 inr(pt)-1.1 01:45pm blood glucose-126* urean-14 creat-0.9 na-141 k-3.4 cl-104 hco3-24 angap-16 01:45pm blood alt-338* ast-433* ld(ldh)-332* alkphos-423* totbili-3.4* 01:45pm blood lipase-17 01:45pm blood albumin-3.5 calcium-8.2* phos-2.0* mg-1.6 01:53pm blood lactate-2.1* microbiology: bcx pending ucx pending from osh: ct abdomen/pelvis with contrast: stones in the distal common bile duct and gallbladder with dilatation of the common bile duct and central intahepatic bile ducts ekg: afib with rate to 126, lad, diffuse st-depressions in inferior, lateral, and anterior leads ercp: impression: two large periampullary diverticula were found at the major papilla. cannulation of the biliary duct was successful and deep with a sphincterotome after a guidewire was placed. contrast medium was injected resulting in opacification - a full cholangiogram was not done given cholangitis. the bile duct was severely dilated to 18 mm with multiple large filling defects consistent with cbd stones noted. a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. pus was noted to drain from the biliary orifice. given cholangitis, decision was made to place a stent rather than attempt lithotripsy and stone extraction in the current setting. a 5cm by 10fr double pigtail biliary stent was placed successfully. discharge labs: 06:50am blood wbc-8.5 rbc-3.67* hgb-12.0 hct-37.9 mcv-103* mch-32.6* mchc-31.6 rdw-14.1 plt ct-340 06:50am blood pt-13.2* inr(pt)-1.2* 06:50am blood glucose-93 urean-15 creat-1.0 na-139 k-3.1* cl-101 hco3-29 angap-12 06:50am blood alt-61* ast-29 alkphos-192* totbili-0.9 06:40am blood calcium-8.2* phos-2.4* mg-1.7 brief hospital course: patient is a yo female with pmh of afib with rvr, chf, and ra on prednisone who is transferred here from osh for choledocholithiasis with concerns for ascending cholangitis. she is hemodynamically stable, afebrile on abx, and awaiting ercp for stone removal. # choledochilithiasis/ascending cholangitis: patient presented to osh with two days of malaise culminating in nausea and vomiting of unrelenting nature. concerned for dehydration, her family brought her to the hospital where she was found to have elevated lft's of a cholestatic picture, and hypotension initially not responsive to fluids. ct showed choledocholithiasis with cbd dilation. patient was started on abx (vanc, levofloxacin, flagyl) and was given ivf with stabilization of bp. she was transferred to for ercp and stone removal. currently, bp stable at 130's systolic with hr 120-130 and without fever, pain, and with mild jaundice. her antibiotics was changed to ciprofloxacin and metronidazole for abdominal flora. she was given 500 cc ns bolus for her bp. she was kept npo for ercp. following ercp, she tolerated clear liquids without issue. her diet was tolerated and she had no further abd pain and her lft/bili continued to improve. she was discharge on cipro/flagyl to complete a 7 day course(end ) and had a follow up with dr. on at 245 pm to discuss further intervention. # afib with rvr: patient has a history of afib with rvr for which she is on rate control with metoprolol and diltiazem at home. holding home dose for now in the setting of hypotension related to n/v and infection. she received a dose of digoxin at osh but will hold here. ecg reveals afib with rvr. she is not on anticoagulation at home because of significant vaginal bleeding that she experienced on coumadin. she was given metoprolol 12.5 mg po as one time doses to control her hr and her diltiazem was held. following her ercp, her metoprolol and diltiazem were restarted with improvement in her heart rate. anticoagulation was deferred given expected procedures during the hospital stay. her metoprolol and dilt were continued. she would have episodes of asymptommatic hypotension at night for which her meds were held, but then her hr would increase. she was discharged on metoprolol 50 tid and dilt 30 with good hr control. bp will have to be monitored at rehab. she was restarted on aspirin on discharge(she previously had not been on coumadin) # chf: patient has a known history of chronic chf of unknown type. she is on home lasix and beta blocker. currently she is not showing signs of heart failure, but did receive large amounts of fluids for volume depletion/hypotension at osh. cardiology consultation note obtained from noted that she had "normal ejection fraction," but no report of echo was sent. as patient had evidence of pulmonary congestion on cxr, she was diuresed with home dose of lasix. with episode of hypotension on the floor, her lasix was held and will be held on discharge. please evaluate clinically to decide when to restart lasix. # arthritis: patient has rheumatoid arthritis and gouty arthritis and is currently experiencing pain in her knee. she is on allopurinol and prednisone at home and those medications were continued. medications on admission: medications (home): lasix 40mg po daily potassium 20meq po daily metoprolol 50mg po bid prednisone 3mg po daily aspirin 81mg po daily cardizem 30mg po bid tylenol prn stool softener daily ferrex 150mg po daily claritin 1 daily allopurinol 150mg po daily vitamin d 50,000 units once weekly . medications (upon transfer): allopurinol 150mg po daily aspirin 81mg po daily diltiazem 30mg po bid hydrocortisone 100mg iv q8h levofloxacin 500mg iv daily lopressor 50mg po bid flagyl 500mg iv q8h morphine 2mg iv prn zofran 4mg iv q6h prn protonix 20mg iv bid prednisone 3mg po daily vancomycin 1250mg ivx1 discharge medications: 1. allopurinol 100 mg tablet sig: 1.5 tablets po daily (daily). 2. prednisone 1 mg tablet sig: three (3) tablet po daily (daily). 3. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 4. diltiazem hcl 30 mg tablet sig: one (1) tablet po bid (2 times a day). 5. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 4 days. 6. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 4 days. 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. claritin 10 mg tablet sig: one (1) tablet po once a day as needed for allergy symptoms. discharge disposition: extended care facility: at ponds discharge diagnosis: cholangitis 2nd diagnosis: afib chf htn discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted with increased abd pain and found to have an infection of your bile ducts(cholangitis). an ercp was performed and a stent was placed to drain the bile and antibiotics were given. your infection improved and your symptoms resolved. you were deconditioned after your hospitalization and will need to go to acute discharge for rehab. new medications 1. ciprofloxacin end 2. flagyl end followup instructions: department: div. of gastroenterology when: thursday at 2:45 pm with: , m.d. building: ra (/ complex) campus: east best parking: main garage procedure: endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct diagnoses: congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids atrial fibrillation acute on chronic diastolic heart failure personal history of tobacco use anxiety state, unspecified hypotension, unspecified macular degeneration (senile), unspecified rheumatoid arthritis do not resuscitate status cholangitis calculus of bile duct without mention of cholecystitis, without mention of obstruction gouty arthropathy, unspecified hypertrophy of uterus 

Answer: The patient is high likely exposed to