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: tylenol / ibuprofen / percodan / capsaicin/peppermint oil/anise attending: chief complaint: bile duct obstruction major surgical or invasive procedure: ercp history of present illness: mrs. is a yo f with history of cad, dchf ef 60%, af on coumadin, ckd, copd and htn who is being transfered to for ercp. patient was in her usual state of health until yesterday when she began feeling unwell, was having chills, abdominal pain and nausea, and decided to go to hospital. at agh a ruq u/s revealed intrahepatic biliary duct dilation and ct abd/pel revealed an obstructing mass in the head of the pancreas. on admission she was found to have ast 569, alt 255 and normal wbc. on hd 2 this increased to 27 and 4/4 bottles of blood cultures became positive for gnr's. she had been started on unasyn on admission but this was changed to zosyn after the cultured came back (+) and she was transfered to for ercp. on the floor, patient is feeling better after. review of systems: (+) per hpi. low appetite since feburary, loss appetite and weightloss, l>r, back adn l hip pain. (-) denies cough, shortness of breath. denies chest pain, chest pressure, palpitations. denies dirrhea, changes in bowel habits. past medical history: 1. coronary artery disease 2. congestive heart failure, diastolic (ef 60%) 3. atrial fibrillation 4. chronic kidney disease 5. left hip arthrititis 6. hypertension 7. copd 8. shingles social history: lives by herself and does adl's without problem. - tobacco: ~100 pk/yr history, quit at 45 yo - alcohol: denies - illicits: denies family history: father: disease mother: cva physical exam: vitals: t: 96.7 bp: 114/55 hr: 85 r: 23 o2: 93% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, perrl, eomi neck: supple, jvp not elevated, no lad lungs: crackles ~ way up cv: irregularly irregular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, ttp throughout (mostly epigastric and ruq), non-distended, bowel sounds present, no rebound tenderness or guarding gu: no foley ext: warm, well perfused, 2+ pulses, 2+ edema up to knees l>r on discharge: decreased breath sounds at left base assymetric lower extremity edema (left > right) pertinent results: discharge labs: wbc-8.6 rbc-4.18* hgb-11.4* hct-35.8* mcv-86 mch-27.2 mchc-31.8 rdw-16.2* plt ct-653* pt-16.1* inr(pt)-1.4* glucose-92 urean-14 creat-1.1 na-135 k-3.8 cl-92* hco3-35* angap-12 alt-73* ast-35 ld(ldh)-202 alkphos-537* totbili-1.4 peak lft values (): alt-223* ast-418* alkphos-943* totbili-3.3* please creatinine (): 1.7 ercp (): surgical clips are noted in the gallbladder fossa. dilated common bile duct with evidence of either distal narrowing or extrinsic compression. biliary stent was placed. minimal opacification of the remainder of the biliary tree was performed given concern for cholangitis. ercp (): a plastic stent previously placed in the biliary duct was found in the major papilla. a small sphincterotomy was performed in the 12 o'clock position using a needle-knife over previously placed plastic biliary stent. the plastic stent was then removed with a snare and sent for cytology. cannulation of the biliary duct was successful and deep with a sphincterotome using a free-hand technique. a single stricture that was approximately 1cm long was seen contained in the intra-ampullary portion of the cbd. two round stones ranging in size from 5 mm to 6 mm were seen at the biliary tree. an extension sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. the two stones and some sludge were extracted successfully using a balloon catheter. excellent drainage of bile and contrast was noted. extensive cold forceps biopsies were performed of the ampulla for histology. it is possible that the stricture may be due to inflammation and scarring related to stone passage, however, this will not explain the mass seen on ct scan. since the intra-ampullary stenosis was completely opened with the sphincterotomy with excellent drainage, there was no need to place another stent. brief hospital course: 1. e. coli sepsis: pansensitive e coli, cultures grown from outside hospital. the patient was on antibiotics but had low grade temperatures even following initial ercp with plastic stent placement in an area of stenosis related to a pancreatic head mass. she underwent a second ercp on which revealed new gallstones in the common bile duct. she underwent a sphincterotomy which relived this obstruction. following this procedure her lfts increased and slowly trended downward. a course of ciprofloxacin was completed. 2. pancreatic mass: initial brushings with atypical cells. repeat brushings and biopsy from showed inflammation but no evidence of malignancy. given that the patient and family would likely not pursue any further work-up should this be a cancer, further evaluation (e.g. ct abdomen) was deferred. 3. chronic diastolic chf: given sepsis lasix and lisinopril initially were held. following reintroduction of these medications at her home doses she became hypotensive to an sbp of 80 and had acute renal failure with a cr of 1.7. she was treated with ivf. eventually after holding diuretics and with 2 units of ffp on she became dyspneic and had pulmonary edema, she was given 40mg iv lasix on and transitioned to her home dose of lasix 40mg po daily on . her lisinopril was not reintroduced given hypotension. she also experienced morning dyspnea on and for which qhs ms contin was introduced; this decreased the symptomatic dyspnea. 4. atrial fibrillation: patient with af on coumadin. inr 2.2 on admission, coumadin held for ercp and restarted post ercp. at discharge, inr was 1.4. 5. lower extremity joint pains: likely secondary to osteoarthritis, worsened secondary to immobility as well as to infection / fevers. this improved with physical therapy and with treatment of infection but the patient will require further physical therapy upon discharge to improve mobility to the point at which she can become independent again. gabapentin, lidocaine patch and tramadol were started (allergy to tylenol and ibuprofen) with improvement in her symptoms, in addition she had low dose morphine for breakthrough pain. medications on admission: atenolol 50 mg qam, 25 mg qpm diltiazem cd 180 mg daily lasix 40 mg daily colace 100 mg kcl 10 meq daily spiriva ih daily coumadin 1 mg smwtf, 1 mg ts lisinopril 10 mg daily gabapentin 200 mg qhs oxycodone prn miralax discharge medications: 1. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 2. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for shoulder pain. 3. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for heartburn. 4. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily). 5. warfarin 1 mg tablet sig: two (2) tablet po once daily at 4 pm. 6. gabapentin 100 mg capsule sig: two (2) capsule po hs (at bedtime). 7. ondansetron 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 8. morphine 10 mg/5 ml solution sig: 5-10 mg po q6h (every 6 hours) as needed for pain. disp:*1 bottle* refills:*0* 9. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 10. diltiazem hcl 120 mg capsule, sustained release sig: one (1) capsule, sustained release po once a day. 11. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 13. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itching. 14. hydrocortisone acetate 1 % ointment sig: one (1) appl rectal prn () as needed for anal itch. 15. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas. 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 17. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 18. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 19. tramadol 50 mg tablet sig: 0.5 tablet po bid prn () as needed for pain. 20. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po qhs (once a day (at bedtime)). disp:*30 tablet sustained release(s)* refills:*0* discharge disposition: extended care facility: lifecare center of discharge diagnosis: pancreatic mass with biliary obstruction e coli sepsis congestive heart failure, diastolic 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 an infection of your blood stream and an obstruction of your biliary tract. you also experienced congestive heart failure during your hospitalization. followup instructions: please be sure to follow-up with dr. within 2-3 weeks after discharge. procedure: endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct removal of t-tube, other bile duct tube, or liver tube other closed [endoscopic] biopsy of biliary duct or sphincter of oddi other closed [endoscopic] biopsy of biliary duct or sphincter of oddi diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure chronic kidney disease, stage iii (moderate) long-term (current) use of anticoagulants septicemia due to escherichia coli [e. coli] cholangitis unspecified disease of pancreas restless legs syndrome (rls) calculus of bile duct without mention of cholecystitis, with obstruction 

Answer: The patient is high likely exposed to