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: zosyn attending: chief complaint: fever of 103 on hd, abd pain, n/v major surgical or invasive procedure: ercp on with stent placement et intubation on ercp on with stent placement extubation on hemodialysis central venous catheter - rij arterial line echocardiogram history of present illness: this is a 43 yo man transferred from micu for ercp in the setting of presumed biliary sepsis. patient was transferred on from ed with fever found at hd to 103. he reports symptoms started the evening of with sharp abdominal pain, nausea, vomitting, and diarrhea. at hd he was febrile with rigors to temp of 103. he had blood cultures and was given vanco/ceftazidime and sent to . at he was given benedryl 25mg iv, reglan 10mg iv, morphine 6mg iv, zosyn 2.25gm iv. he had an abdomen/pelvis ct that preliminarily showed gall bladder hypodensity without signs of acute cholecysitis. he was transferred here for ercp given elevated amylase, lipase and transaminases. at ed he was given 3l ivf for sbp 77-111 with hr 100's with tm 101.5. he was given tylenol 1gm. he was admitted to micu overnight where a right ij central line was placed and he received 2l ns, iv vancomycin and zosyn. patient was transferred to the for planned ercp intervention on the . past medical history: cad s/p stent at in the setting of pna htn gout: no active symptoms for several years, does not take ppx esrd on hd x9 years, ? post-strep infection as a child?, on m/w/f schedule, last hd , at forsinius in where he reportedly normally gets 5kg removed osa on cpap, pressure 17mmhg?, but is unable to tolerate at home social history: lives with children (age 19, 22), denies past or current tobacco, drinks etoh only on special occaisions (less than once/month) but drank more heavily prior to hd, occaisional mj but no ivdu or cocaine. family history: father with hypertension, mother with dm, sibs healthy, children healthy. physical exam: vs: t 99.5 hr 101 bp 117/75 rr 28 sat 93% on 4l nc gen: nad, obese man, speaking in full sentances, mild labored breathing, drowsy but arousable, witnessed apnic episodes while sleeping heent: perrl, op clear, mm dry, mild scleral icterus neck: supple, right ij in place, no lad cv: reg, tachy, iii/vi sem best at rusb, heard throughout, no r/g resp: decreased bs at both bases with scattered rales r base abdomen: obese, distended but soft, nt, no obvious masses but very protuberant, white striae, no fluid wave, tympanic to percussion throughout, unable to palpate liver or spleen; no periumbilical ecchymosis ext: 1+ pe to thigh bilaterally; 2+ dp's b, left ue fistula +palpable thrill neuro: a&ox3, cn ii-xii intact, strength 5/5 b ue/le, sensation intact to light touch skin: no rashes, lesions or ecchymoses . pertinent results: 10:22pm type-art temp-38.2 rates-20/1 tidal vol-700 peep-5 o2-60 po2-79* pco2-41 ph-7.42 total co2-28 base xs-1 intubated-intubated vent-controlled 10:22pm lactate-1.2 10:22pm o2 sat-95 08:56pm type-art temp-38.2 rates- tidal vol-700 peep-5 o2-60 po2-86 pco2-63* ph-7.28* total co2-31* base xs-0 intubated-intubated vent-controlled 08:56pm lactate-0.9 08:56pm freeca-1.03* 08:49pm glucose-101 urea n-45* creat-10.1* sodium-140 potassium-4.6 chloride-98 total co2-27 anion gap-20 08:49pm ck(cpk)-534* 08:49pm ck-mb-5 ctropnt-0.29* 08:49pm calcium-7.6* phosphate-5.9* magnesium-2.1 02:22pm type-mix po2-44* pco2-54* ph-7.39 total co2-34* base xs-5 02:22pm lactate-1.4 01:55pm glucose-125* urea n-38* creat-9.1* sodium-139 potassium-4.4 chloride-96 total co2-30 anion gap-17 01:55pm alt(sgpt)-70* ast(sgot)-50* ld(ldh)-198 alk phos-200* amylase-241* tot bili-4.5* 01:55pm lipase-236* 01:55pm albumin-3.5 calcium-7.8* phosphate-5.1* magnesium-2.1 01:55pm wbc-6.9 rbc-3.60* hgb-11.2* hct-33.2* mcv-92 mch-31.2 mchc-33.8 rdw-14.2 01:55pm neuts-92.5* lymphs-3.1* monos-4.0 eos-0.2 basos-0.2 01:55pm plt count-179 01:21pm lactate-1.7 04:10am glucose-127* urea n-32* creat-8.8* sodium-140 potassium-4.8 chloride-92* total co2-32 anion gap-21* 04:10am alt(sgpt)-87* ast(sgot)-66* ck(cpk)-80 alk phos-213* amylase-376* tot bili-3.7* dir bili-2.3* indir bil-1.4 04:10am lipase-459* 04:10am ck-mb-notdone ctropnt-0.21* 04:10am albumin-3.9 calcium-7.6* phosphate-4.4 magnesium-1.2* 04:10am triglycer-236* 04:10am cortisol-34.3* 04:10am vanco-10.4 04:10am asa-neg acetmnphn-7.0 bnzodzpn-neg barbitrt-neg tricyclic-neg 04:10am wbc-10.3 rbc-3.63* hgb-11.2* hct-32.5* mcv-90 mch-30.9 mchc-34.4 rdw-14.7 04:10am neuts-94* bands-4 lymphs-1* monos-1* eos-0 basos-0 atyps-0 metas-0 myelos-0 04:10am hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 04:10am plt count-240 04:10am pt-15.5* ptt-28.7 inr(pt)-1.4* ercp findings: the common bile duct was adequately opacified with contrast medium after the cannulation of the biliary duct. no apparent extrahepatic or intrahepatic biliary duct dilatation or irregularity is seen. no filling defects consistent with stones were noted. as per report, in subsequent images, biliary stent was successfully placed. impression: successful placement of biliary stent. transthoracic echo: the left atrium is moderately dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 70%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). transmitral doppler and tissue velocity imaging are consistent with grade ii (moderate) lv diastolic dysfunction. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is moderately dilated. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. ercp findings: comparison is made with ct from , and prior ercp from . there is removal of a plastic stent. a retrograde cholangiogram shows multiple filling defects, some of which likely represent stones, within otherwise normal- appearing biliary tree. a biliary stent was then placed. brief hospital course: #hypotension/sepsis: on admission, patient met sirs criteria with fever, tachypnea, tachycardia and lactate of 2.5 consistent with sepsis. infectious source was likely biliary tract vs. hd line infection, however also considered was pulmonary source w/ new o2 requirements although more likely from capillary leak/chf. patient has remained fluid responsive intially without need for pressors. the underlying infection was treated with iv vancomycin/unasyn/gentamycin for synergy until cultures at osh grew enterobacter at which point only zosyn was continued with appropriate coverage. the patients lactate level, fevers and wbc were trended and returned to . zosyn was switched to ciprofloxacin after the patient developed a drug rash. . #mechanical ventilation: patient came to the icu intubated s/p ercp, on a propofol drip. initially he was hypotensive which was treated with iv fluids and discontinued propofol, switching to fentanyl/versed for sedation. shortly thereafter the patient became restless, agitated and continued to be hypotensive. he was given 10mg vecuronium and paralyzed for arterial line placement and foley placement. his labile blood pressures also exacerbated his already fluid-overloaded state, making it difficult to wean off the vent. the initiation of hemodialysis effectively controlled his bp and fluid status, and on day 7, after his second ercp, he was extubated and started on cpap overnight. . # gallstone pancreatitis: on admission the patient had elevated lfts, pancreatic enzymes, bilirubin and alk phos. his levels slowly trended down post-ercp except bilirubin and ap, which continued to rise. the patient experienced intermittent epigastric discomfort which prompted a ruq us, which showed a fatty liver but the common bile duct non-well visualised. ct scan of abdomen showed no intrahepatic biliary dilatation, cholelithiasis, and a subtle hypodensity in pancreatic head. hepatology and ercp were consulted prompting a second-look ercp, which showed sludge drainage in the major papilla, stent migrated to major papilla and several stones in the cystic duct. the stent was replaced, antibiotics were continued, and the patient's enzymes and bilirubin were trended. . # esrd: initially the nephrology service felt hd was not appropriate early during admission, in setting of patient becoming hypertensive to 200s with volume resusitation for pancreatitis. beta-blockers were started however the patient did not respond and o2 sats started trending down with worsening acidemia and low pao2. the following day hd was initiated with good response in blood pressure. the patient received hd throughout his course, with the day before d/c the final time. . # hypoxia: suspected capillary leak in the setting of sepsis vs. chf as pt with known cad. the patient was weaned off his o2 requirement prior to discharge. . # drug rash: patient developed a diffuse petticheal/macular rash on his chest and legs which was pruritic. dermatology was consulted who felt consistent with a drug rash. offending was felt to be zosyn. was discontinued and rash improved. he will continue hydoxyzine, sarna and fluocinonide. . # cad: an echo was performed to rule out endocarditis as a cause of fever. this showed extensive calcification of cardiac skeleton, mild calcific aortic stenosis, and no definite vegetations . his ecg had some ischemic changes of unclear duration, and the patient had no active symptoms. cardiac enzymes were stably elevated on admission and, in the setting of esrd, this was unlikely to be acute event. his aspirin and plavix were continued and the patient remained on telemetry for the duration of his stay. . # osa: witnessed apneic episodes while asleep. known history of osa on cpap as outpatient but has not been tolerating of recent. once patient was extubated he was started on cpap overnight. . # anemia: normocytic with normal rdw. unclear baseline. be low related to esrd (not on epo as outpatient that we know of). d. bili not consistent with hemolysis. hematocrit was trended and continued to improve with hd and management. renal recs: use epo during hd. . medications on admission: fish oil daily sensipar 120mg daily ativan 0.5mg prn (rare) percocet prn (rare) nifedipineer 90 daily (last ) minoxidil-dose unable to verify but pt states rx for 2 tabs and only takes 1 renagel 2400mg tid ac phoslo 1334mg (?) tid ac simvastatin 20mg daily plavix 75mg daily aspirin 325mg daily toprolxl 50mg daily discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 4. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 5. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical (2 times a day) as needed. disp:*1 tube* refills:*0* 6. ciprofloxacin 750 mg tablet sig: one (1) tablet po once a day for 5 days: take this at least one hour before you take renagel. disp:*5 tablet(s)* refills:*0* 7. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for itching: only take this as long as your rash is itching. disp:*21 tablet(s)* refills:*0* 8. fluocinonide 0.05 % cream sig: one (1) appl topical (2 times a day) as needed for rash for 12 days: only use while you have the rash. disp:*1 tube* refills:*0* 9. cinacalcet 30 mg tablet sig: four (4) tablet po daily (daily). 10. nifedipine 90 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 11. minoxidil 2.5 mg tablet sig: two (2) tablet po daily (daily). 12. sevelamer hcl 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 13. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). discharge disposition: home discharge diagnosis: primary diagnoses: biliary sepsis gallstone pancreatitis secondary diagnoses: esrd with hemodialysis cad drug rash osa htn anemia discharge condition: good, tolerating regular diet, ambulating with walker for deconditioning, able to climb a flight of stairs, no oxygen requirement, vss discharge instructions: you were seen and treated at the hopital for a blockage in the area of your gallbladder, which caused you to become infected. you were treated with intravenous fluids, antibiotics and ercp (endoscopic retrograde cholangiopancreatography) twice. a small tube called a stent was placed near your gallbladder so that it will drain bile into your intestine. please take the antibiotics (ciprofloxacin) until it is finished. you may also use the skin cream for your rash as long as you need it. you may take all of your home medications, and none of the dosages were changed. call your doctor or come to the emergency department right away if any of the following problems develop: * if you are vomitting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomitting, 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 skin, or the whites of your eyes become yellow again. * 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. * you have shaking chills, or a fever greater than 100.4 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. followup instructions: please make an appointment to follow up with your pcp: , in the next week or two to further evaluate your response to treatment. you will also need to follow-up with the gastroenterology team to have a repeat ercp 6 weeks with dr. . please call his office at ( m-f 8:30am-4:30pm. the dermatologists would also like you to make an appointment for some areas of skin that require follow-up. you may call their office at ( to schedule the appointment. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube hemodialysis arterial catheterization endoscopic insertion of stent (tube) into bile duct endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct replacement of stent (tube) in biliary or pancreatic duct diagnoses: anemia in chronic kidney disease end stage renal disease obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified severe sepsis gout, unspecified percutaneous transluminal coronary angioplasty status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure septic shock dermatitis due to drugs and medicines taken internally other septicemia due to gram-negative organisms acute diastolic heart failure cholangitis acute pancreatitis calculus of gallbladder and bile duct without cholecystitis, with obstruction penicillins causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to