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: obstructive jaundice reason for micu transfer: af with rvr major surgical or invasive procedure: ercp history of present illness: ms. is a 73 year old woman with history of htn and recurrent utis was brought in to osh ed by ems with confusion and jaundice. at the osh she was found to have a ua suggestive of uti with wbc "too numerous to count". ruq us and ct were performed showing bile duct dilation to over 2 cm with the presence of stones, sludge and debris. labs were significant for wbc 17, t bili 16.7, alk phos 234, ast/alt 112/150, cr 0.7. she was given zosyn 4.5 g iv empirically for her uti and concern for biliary infection. she remained afebrile and hemodynamically stable throughout. she was then transferred to for definitive treatment with ercp. en route to patient developed an irregular tachycardia with rates to 150s. she was asymptomatic and denied chest pain or shortness of breath. 73-year-old female who was being transferred from outside hospital here for ercp, en route developed tachycardia to 170s, by ems found to be in atrial fibrillation. she states she was at another hospital yesterday the 2 abdominal pain and jaundice, was supposed to have ercp done today. currently she says she feels chills, no pain. in the ed initial vital signs were, t 98.9 bp 120/86 hr 170 rr 20 spo2 98%. she was found to be in atrial fibrillation with rates reaching 180s. she was given diltiazem 15 mg iv x 2 with minimal response. she was started on a diltiazem gtt which was titrated up to 15mg/hr. with addition of small metoprolol boluses of 5 mg iv x 3 her heart rate was in 120s to 130s. she had no documented episodes of hypotension and did not report chest pain or shortness of breath. she received 4 l ns, zosyn 4.5 g iv, and magnesium 2 g iv prior to transfer to the icu. . on arrival to the icu, patient was drowsy but able to speak in full sentences. on questioning she denied any localizing complaints. she reported that she had abdominal pain for almost a week. she was uncertain when she started to become jaundiced. she was confused and unable to give reliable history regarding associated symptoms. past medical history: htn spinal stenosis osteoarthritis s/p r hip replacement recurrent utis anxiety fluid retention hyponatremia in the setting of hctz use social history: patient lives alone and is independent of all adls. she denies any history of tobacco use. she reports a history of social alcohol use but denies any alcohol use in months. she denies use of illicit drugs and herbal medications. family history: unable to obtain as patient confused. physical exam: physical exam on arrival to : temp: 99.4 bp: 119/65 hr: 140 rr: 21 o2sat 95% ra gen: pleasant, jaundiced, drowsy comfortable, nad heent: perrl, disconjugate gaze, icteric, very dry mm, op without lesions, no supraclavicular or cervical lymphadenopathy, jvd difficult to assess resp: poor inspiratory effort, good air movement throughout cv: distant heart sounds, tachycardic, irregular, no m/r/g abd: obese, no ascites, nd, +b/s, soft, nt ext: no c/c/e , 2+ distal pulses skin: diffusely juandiced, no rashes neuro: awake but drowsy, oriented to person x 2. cn ii-xii intact. strength difficult to assess given inattentiveness, and drowsiness. moving all four extremities, + tremor with exertion vs asterixis, no sensory deficits to light touch appreciated. pertinent results: 12:19pm blood wbc-14.7* rbc-4.18* hgb-13.0 hct-36.3 mcv-87 mch-31.0 mchc-35.8* rdw-14.0 plt ct-177 12:19pm blood neuts-84* bands-0 lymphs-11* monos-4 eos-0 baso-0 atyps-0 metas-1* myelos-0 12:19pm blood pt-13.2 ptt-19.5* inr(pt)-1.1 12:19pm blood glucose-137* urean-24* creat-0.8 na-151* k-3.7 cl-118* hco3-24 angap-13 12:19pm blood alt-137* ast-105* alkphos-233* totbili-17.4* dirbili-15.0* indbili-2.4 12:19pm blood lipase-40 12:19pm blood calcium-9.2 phos-1.5* mg-2.3 12:19pm blood tsh-2.3 09:36pm urine color-brown appear-clear sp -1.019 09:36pm urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirub-lg urobiln-neg ph-5.5 leuks-sm 09:36pm urine rbc-2 wbc-11* bacteri-few yeast-none epi-<1 09:36pm urine mucous-rare ================= microbiology ================= - mrsa screen:------ - urine cx: negative ================= imaging ================= - cxr: a single semi-upright portable view of the chest was obtained. low lung volumes result in bronchovascular crowding. no focal consolidation, effusion, or pneumothorax is seen. right hilar prominence is noted without other findings of overt edema, which may represent vascular crowding versus central vascular congestion. no osseous abnormality is identified. . ercp impression: right hilar prominence may represent crowding versus central vascular congestion. if clinically feasible, consider pa and lateral views for more sensitive evaluation. procedure: the procedure, indications, preparation and potential complications were explained to the patient, who indicated her understanding and signed the corresponding consent forms. a physical exam was performed. the patient was administered moderate sedation. the patient was placed in the prone position and an endoscope was introduced through the mouth and advanced under direct visualization until the third part of the duodenum was reached. careful visualization was performed. the procedure was not difficult. the quality of the preparation was good. the patient tolerated the procedure well. there were no complications. findings: esophagus: limited exam of the esophagus was normal stomach: limited exam of the stomach was normal duodenum: limited exam of the duodenum was normal major papilla: there was pus discharge at the major papilla. cannulation: cannulation of the biliary duct was successful and deep with a sphincterotome using a free-hand technique. contrast medium was injected resulting in partial opacification. biliary tree: on partial opacification of the cbd, several stones were seen in the distal cbd with associated biliary dilation. full contrast opacification was not undertaken because of evidence of cholangitis. procedures: a 8cm by 10fr biliary stent was placed successfully in the cbd. impression: pus was seen at the major papilla. successful biliary cannulation was achieved with a sphincterotome on partial opacification of the cbd, several stones were seen in the distal cbd with associated biliary dilation. full cholangiogram was not undertaken because of the evidence of cholangitis a 8cm x 10fr biliary stent was placed successfully for decompression otherwise normal ercp to 3rd portion of duodenum recommendations: juices when awake and alert, then advance diet astolerated continue iv antibiotics during hospitalization, then po antibiotics (augmentin, or cipro/flagyl) for total 14 day course. repeat ercp in weeks for stent removal and sphincterotomy/sphincteroplasty with stone extraction. discharge labs: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 03:01 9.7 3.37* 10.1* 30.5* 90 29.9 33.1 15.0 149* renal & glucose glucose urean creat na k cl hco3 angap 03:01 * 3.4 116* 25 9 enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili indbili 03:01 85* 56* 199* 9.2* brief hospital course: a/p: 73 year old woman with h/o htn presents to osh with ams and jaundice found to have choledocholithiasis and uti. . # obstructive jaundice: ruq ultrasound and ct confirm choledocholithiasis. pain was well controlled, and patient was afebrile throughout her hospital stay, and she was hemodynamically stable. she underwent ercp in which a stent was placed but no sphincterotomy was preformed. she was kept on iv zosyn with a plan to convert to po augmentin as an outpatient with empiric coverage for her uti. she will need a repeat ercp for sphincterotomy and stent removal - please continue iv zosyn - please convert oral regiment to augmentin or cipro/metronidazole (depending on uti) . # atrial fibrillation: patient presented in new afib with rvr. heart rate initially poorly controlled by diltiazem. no documented episodes of hypotension with elevated heart rates. patient converted to sinus rhythm shortly after arrival to the icu. her diltiazem was weaned, and she had two transient brief episodes of svt. she was not empirically started on any additional rate control. she had conversion within 24 hours and no anti-coagulation was started. . # uti: patient with history of recurrent utis. ua from osh with elevated wbc count. a urine culture was taken which shows no growth. - continue zosyn empirically - check sensitivities since patient has history of multiple uti's . # hypernatremia: initial hypernatremia was thought to be secondary to hypovolemia. she was given 1/2 ns, and later d5w. after her procedure she was given free water and a diet. - check serum na this evening (prior to discharge 147 down from 152). . # confusion: patient's mental status is consistent delirium experienced during prior utis and current choledocholithiasis. her delirium improved with continued antibiotics and hydration. post procedure she was alert and oriented x 3 with occasional inapprioriate statements. . # htn: upon arrival her hypertensive medications were held. medications on admission: (per osh records): lasix 20 mg daily prempro 0.45/1.5 one tablet daily potassium 10 meq trazodone 12.5 mg qhs atorvastatin 20 mg daily ibuprofen 600 mg tid polyethylene glycol 17 g daily docusate 100 mg po bid cozaar 100 mg daily nexium 40 mg daily zyrtec 10 mg daily omega 3 1200 mg vitamin e 400 iu daily calcium carbonate 600 vitamin d one daily mv daily cymbalta 60 mg daily discharge medications: 1. piperacillin-tazobactam 4.5 g iv q8h 2. morphine sulfate 2 mg iv q6h:prn pain or sob please hold if sedated or rr < 14 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). discharge disposition: extended care discharge diagnosis: primary diagnosis: choledocholithiasis secondary diagnosis: uti discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. - thank you for receiving your care at . you were admitted for an ercp for a gallstone. you also had a urinary tract infection in addition to an abnormal heart rhythm (afib) that subsequently resolved. you were discharged to another hospital for continued care. you will need iv antibiotics while in the hospital, and po antibiotics after you are discharged for an additional 2 weeks. you were discharged from hospital with a stable heart rhythm. you will be accepted by dr. : , . the following medications were added to your regiment: zosyn the following medicaitons were stopped (during your hospital stay): lasix 20 mg daily prempro 0.45/1.5 one tablet daily potassium 10 meq trazodone 12.5 mg qhs atorvastatin 20 mg daily ibuprofen 600 mg tid polyethylene glycol 17 g daily docusate 100 mg po bid cozaar 100 mg daily nexium 40 mg daily zyrtec 10 mg daily omega 3 1200 mg vitamin e 400 iu daily calcium carbonate 600 vitamin d one daily mv daily cymbalta 60 mg daily the following medications were changed: none followup instructions: please follow up with your pcp as recommended by your new team. you will need to call the clinic at hospital to schedule another ercp to remove the stent in your bile duct and have a sphincterotomy. procedure: endoscopic insertion of stent (tube) into bile duct diagnoses: acidosis urinary tract infection, site not specified unspecified essential hypertension atrial fibrillation hyperosmolality and/or hypernatremia cholangitis calculus of bile duct without mention of cholecystitis, with obstruction 

Answer: The patient is high likely exposed to