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: shellfish derived attending: chief complaint: right upper quadrant abdominal pain major surgical or invasive procedure: ercp with sphincterotomy laparoscopic converted to open cholecystectomy history of present illness: the patient is a 49 year old male with history of long standing alcohol abuse with resultant alcoholic cirrhosis who presented initially to on with symptoms of 2 days of epigastric and right upper quadrant pain. the patient reports his ain is sharp, stabbing, at it's worst, and radiates to his back. he reports associated symptoms of nausea and vomiting of non-bloody, non-bilious fluid with associated chills. the patient denies hematemsis, brbpr, melena, chest pain. he does report some shortness of breath which he attributes to difficulty taking deep breaths because of his abdominal pain. at the patient had labs pertinent for cr 1.4, alb 3,9, tuberculosis 4.1, db 1.2, alk phos 102, alt 68 and ast 77, wbc 15.2 (2% bands), hct 44.2, and platelet 129. per d/c summary, the patient had an abdominal ultrasound which revealed gallstones and cbd of 6mm, no ascites. a ct abd/pelvis was subsequently performed which is reported to have revealed cholelithiases with a 7mm stone in the distal cbd as well as gallstones in the neck of the gallbladder (ct report not accompanying). no intrahepatic lesions of dilated intrahepatic ducts were noted. the liver was with irregular contour suggestive of cirrhosis. given report of stone present in the cbd, the patient is now being transferred to with plan for ercp. in anticipation of the need for eventual cholecystectomy, a surgical consult is requested by the hospitalist today. on arrival to the medical floor patient confirms history as above. the patient reports he has history of relapsiing alcoholism, however, he reports his alst drink was now 3 weeks ago. he reports history of tremors and has undergone detox, denies history of seizures or dts. the patient reports ongoing abdominal pain. on review of systems he reports some difficulty taking deep breaths secondary to his abdominal pain, mild sensation of associated air hunger. remainder of ros negative. past medical history: #. history of alcohol abuse - history of tremors and blackouts. has been in detox - no dts, no seizures #. alcholic cirrhosis - denies history of variceal bleed although history of gi bleed nos previously - denies history of ascites - history of encephalopathy documented #. thrombocytopenia #. history of gi bleeding #. gastritis/duodenitis #. cholelithiasis #. pancreatitis #. hypothyroidism social history: the patient lives in with his sister. was previously employed insecurity at a hotel, now going to start new job as security in a hotel. etoh: no use x 3 weeks, previous 18 beers daily or 2 pints of vodka daily tobacco: none illicits: none family history: noncontributory physical exam: vitals on admission: 100.4, 112/80, 118, 16, 95% ra general: patient is a middle aged male, appears to be in pain, no acute distress. appropriate, oriented x 3. no asterixis heent: ncat, eomi, sclera mildly icteric, conjunctiva wnl op: mmm, no lesions neck: supple, no lad, no jvd chest: generally clear anterior. small crackles at both bases, poor air movement in general, + splinting. + spider angioma cor: tachycardic, regular, no m/r/g abdomen: mildly distended, hypoactive bs. mod tenderness throughout, severe tenderness in ruq and epigastrium with voluntary guarding, no rebound. rectal: empty rectal vault, guaiac negative fluid ext: no edema skin/nails: + spider angioma neuro: oriented x3, no asterixis, appropriate vitals on discharge: 100.2, 99.8, 98, 110/80, 20, 96ra gen: nads, aao x 3 lungs: cta cardio: tachy, normal sinus rhythm abd: soft, distended, non-tender, act bowel sounds wound: staples to subcostal area, mildly erythematous. areas packed with wtd to midline and right lateral edge. no purulent drainage ext: no c,c,e pertinent results: . cxr : bibasilar atelectasis, small r pleural effusion, low lung volumes . ercp : 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: normal major papilla cannulation: cannulation of the biliary duct was successful and deep with a sphincterotome. contrast medium was injected resulting in complete opacification. a 0.035in in diameter and 260cm in length straight tip glidewire was placed. the existing guidewire was replaced with a jagwire. . biliary tree: a mild diffuse dilation was seen at the main duct with the cbd measuring 9mm. there were filling defects that appeared like sludge in the lower third of the common bile duct. a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. post sphincterotomy, pus could be seen coming out from the major papilla. some sludge was extracted successfully using a 8 mm balloon. impression: a mild diffuse dilation was seen at the main duct with the cbd measuring 9mm. there were filling defects that appeared like sludge in the lower third of the common bile duct. successful sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. post sphincterotomy, pus could be seen coming out from the major papilla. successful extraction of sludge using a 8 mm balloon. cholangiogram: no evidence of biliary leak. 05:30pm blood wbc-8.1 rbc-2.85* hgb-9.6* hct-27.5* mcv-97 mch-33.9* mchc-35.0 rdw-14.6 plt ct-118* 07:21pm blood wbc-8.4 rbc-2.93* hgb-9.9* hct-28.5* mcv-97 mch-33.8* mchc-34.8 rdw-14.8 plt ct-99* 02:48am blood wbc-6.4 rbc-2.90* hgb-9.8* hct-27.4* mcv-95 mch-34.0* mchc-35.9* rdw-15.8* plt ct-97* 06:35am blood wbc-8.9 rbc-3.13* hgb-10.3* hct-29.8* mcv-95 mch-33.0* mchc-34.6 rdw-15.2 plt ct-126* 03:15am blood wbc-8.3 rbc-2.91* hgb-9.7* hct-27.9* mcv-96 mch-33.2* mchc-34.7 rdw-15.1 plt ct-139* 06:00am blood wbc-6.7 rbc-2.69* hgb-8.9* hct-24.9* mcv-93 mch-32.9* mchc-35.5* rdw-14.8 plt ct-124* 01:30am blood glucose-107* urean-22* creat-1.6* na-128* k-4.5 cl-93* hco3-25 angap-15 07:05am blood glucose-97 urean-21* creat-1.5* na-131* k-3.3 cl-96 hco3-27 angap-11 07:10am blood glucose-88 urean-14 creat-1.2 na-135 k-3.5 cl-100 hco3-25 angap-14 02:48am blood glucose-119* urean-11 creat-0.9 na-140 k-4.1 cl-109* hco3-24 angap-11 01:30am blood alt-55* ast-74* ld(ldh)-480* alkphos-74 amylase-34 totbili-4.7* dirbili-1.8* indbili-2.9 07:10am blood alt-38 ast-35 alkphos-121* totbili-5.0* 07:30am blood alt-27 ast-25 alkphos-106 totbili-3.2* 03:15am blood alt-22 ast-44* alkphos-78 totbili-2.3* dirbili-1.3* indbili-1.0 06:00am blood alt-16 ast-34 alkphos-69 totbili-1.5 dirbili-0.9* indbili-0.6 brief hospital course: the patient is a 49 year old male with medical history of alcoholic cirrhosis who presented with epigastric and ruq pain with concern for impacted stone on ct seen at osh. he was transferred from . he was found to have cholangitis. #. biliary obstruction/cholangitis/fever/cholecystitis: at the patient had labs pertinent for cr 1.4, tuberculosis 4.1, db 1.2, alk phos 102, alt 68 and ast 77, wbc 15.2 (2% bands). at the outside hospital, the patient had an abdominal ultrasound which revealed gallstones and cbd of 6mm, no ascites. a ct abd/pelvis was subsequently performed which is reported to have revealed cholelithiases with a 7mm stone in the distal cbd as well as gallstones in the neck of the gallbladder (ct report not accompanying). no intrahepatic lesions of dilated intrahepatic ducts were noted. the liver was with irregular contour suggestive of cirrhosis. given report of stone present in the cbd, the patient was transferred to with plan for ercp. the patient here was treated with ivf, dilaudid for pain, and iv levo/flagyl given his bandemia at the osh. he was febrile here to 102 prior to his ercp. he underwent ercp on which showed a mild diffuse dilation at the main duct with the cbd measuring 9mm. there were filling defects that appeared like sludge in the lower third of the common bile duct. successful sphincterotomy was performed. post sphincterotomy, pus could be seen coming out from the major papilla. successful extraction of sludge using a 8 mm balloon. he was treated with iv levo/flagyl for 2 additional days.surgery was consulted for consideration of cholecystectomy. patient was then admitted to general surgical service and was taken to the operating room on for a laparoscopic cholecystectomy. with low platelets of 71,000, platelets were placed on call to the operating room. during procedure, there was extensive bleeding and because of the difficult dissection, surgery converted to open cholecystectomy. overall fluid balances were - received 3400ml crystalloid, 3 units prbc, 2 units ffp, 1 six-pack platelets for ebl 1600cc, uop 250cc. patient was kept intubated and transferred to sicu for o/n observation. he maintained hemodynamically stable and postoperative hct of 28.5. on pod1-2, patient was weaned from ventilation and extubated. he was kept on iv levaquin and flagyl. his ngt, arterial line and foley were removed. patient was transferred to the general surgical floor for further post-operative recovery. he remained tachycardic but completely asymptomatic. patient's diet was advanced from sips to clears. on pod3-4, patient developed a fever of 102.3. he was pan-cultured. bile cultures returned to have sparse enterococcus. he was started on augmentin in which he will be kept on for 2 weeks. medial aspect of his abdominal staple incision was opened and swabbed. gram stain result showed gram positive coccus and sensitivities are still pending on day of discharge. incisional areas were packed wet to dry and will be changed twice a day. there appeared to be a darker colored output from the jp drain from a serosanguinous color. on pod5, hida scan was ordered to assess for any intra-biliary leaks. results from imaging showed patent ducts with no extravasation of material. he was discharged home on pod6 with a two week course of augmentin and vna to teach patient to pack wound with wet to dry dressings twice a day. he is tolerating a regular diet, ambulating and voiding without difficulty. he is to call dr. to schedule an appointment for follow up clinic visit. #. acute renal failure: patient's baseline unknown (1.2 in ), cr was 1.4 at outside hospital the day prior to admission, and was 1.6 on admission here. differential was pre-renal vs. contrast-nephropathy from his ct scan. fena was 0.2%, and creatinine trended down with ivf, consistent with pre-renal/dehydration. after ivf, his creatinine was back down to 1.2. . #. anemia: hct at osh 44, repeat on arrival here 35.0 patient guaiac negative on exam, prior baseline in appears to be near 36. elevated hct at osh likely reflective of hemoconcentration -trend . #. hyponatremia: sodium was 128 on admission, and patient appeared hypovolemic with urine chemistries consistent with prerenal etiology of arf. he was hydrated with ivf with resolution of his hyponatremia. . #. dyspnea: symptoms seemed related to splinting and hypoventilation from pain. cxr showed bibasilar atelectasis and small r pleural effusion. bnp only 400s. he was treated with pain control and incentive spirometry. . #. coagulopathy: likely related to underlying cirrhosis, no active evidence of bleeding. vit k 10mg once on admission as well as 2 units of ffp prior to ercp. . #. alcoholic cirrhosis: currently without bleeding, appears to be without encephalopathy. abdominal exam limited by pain, no obvious ascites (none on us at osh per report) -eval for varices on ercp; would likely benefit from nadolol given varices seen on ct at osh -would obviously benefit from long term alcohol abstinence -outpatient management for ongoing cirrhosis management: hcc screening, variceal bleed ppx, etc medications on admission: levothyroxine - dose unknown iron tab daily potassium chloride daily prilosec 20mg daily discharge medications: 1. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 12 days. disp:*36 tablet(s)* refills:*0* 2. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain: do not operate heavy machinery or consume alcohol. cause drowsiness. disp:*40 tablet(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day: take while using narcotics for pain control to help prevent constipation. disp:*60 capsule(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: cholelithiasis and choledocholithiasis gangrenous cholecystitis alcoholic cirrhosis acute blood loss anemia wound infection gastritis hypothyroidism thrombocytopenia discharge condition: tolerating regular diet ambulating and voiding without difficulty incisional area with staples, 2 areas packed with gauze normal bowel movements discharge instructions: general: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. * signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. *avoid lifting objects > 5lbs until your follow-up appointment with the surgeon. *avoid driving or operating heavy machinery while taking pain medications. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. * continue to ambulate several times per day. please pack wound with wet to dry dressings twice a day. followup instructions: follow up with dr. in weeks; please call ( to schedule an appointment follow up with pcp 1 week procedure: endoscopic sphincterotomy and papillotomy cholecystectomy transfusion of packed cells transfusion of other serum transfusion of platelets diagnoses: thrombocytopenia, unspecified other postoperative infection acute posthemorrhagic anemia alcoholic cirrhosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia portal hypertension unspecified acquired hypothyroidism hemorrhage complicating a procedure streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cholangitis unspecified gastritis and gastroduodenitis, without mention of hemorrhage laparoscopic surgical procedure converted to open procedure other and unspecified alcohol dependence, episodic calculus of bile duct with acute cholecystitis, with obstruction 

Answer: The patient is high likely exposed to