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 / bactrim ds attending: chief complaint: necrotizing pancreatitis major surgical or invasive procedure: feeding tube placement history of present illness: mrs. is a 54-year old spanish-speaking ecuadorian lady who was transferred from hospital for necrotizing pancreatitis. she initially presented there on with severe mid-abdominal pain, associated with vomiting and one epiosde of diarrhea. in the , abdominal ct showed gallstones and an ill-defined pancreas with peripancreatic fluid. amylase was 4916 and lipase was >. she was kept npo with ivf with iv pain control with dilaudid, but it was never fully controlled. wbc peaked at 18, but she was never febrile. no antibiotics were given as the osh. repeat ct scan 2 days later showed pancreatic necrosis in the pancreatic head as well as a pv and smv thrombus. at that point imipenem, levofloxacin, and flagyl were started and gi was consulted and recommended transfer for surgical consultation. however, she needed to be transferred into the icu for oversedation from dilaudid, responded to narcan. overnight had several episodes of desaturation requiring bipap. came off of bipap at 1am the morning of transfer to the floor. currently, she feels worse with increased back pain, but otherwise states her breathing is stable. has abdominal pain, but controlled on medication. is frustrated with her feeding tube that is in place. has some mild shortness of breath, but feels better with supplemental oxygen. past medical history: anxiety gerd social history: denies alcohol, tobacco or ivdu. currently unemployed she lives at home in with her daughter family history: no family history of diabetes but positive family history for gallstones and pancreatic cancer. she has an aunt who died from liver cancer. physical exam: general: pleasant, ill-appearing hispanic female in moderate distress from abdominal and back pain. heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, tachycardic rate. normal s1, s2. no murmurs apprecaited. lungs: ctab, good air movement biaterally. abdomen: hyperactive bowel sounds, soft, distended, tympanic to percussion, pain over epigastric area, radiating to back, voluntary guarding no rebound. extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. skin: no rashes/lesions, ecchymoses. neuro: a&ox3 en . appropriate. 5/5 strength throughout. + reflexes, equal bl. gait assessment deferred psych: listens and responds to questions appropriately, pleasant but in obvious pain pertinent results: wbc 17.8 ()--> 16.3 ()-->14.2 () hct 31.7 plts 211 u/a negative 139| 99| 10 --------------< 256 3.1| 32| 0.8 ca 7.3 mg 0.8 ast 18 alt 21 studies: ruq: u/s 9mm nonmobile caclulous in bg, no wall thichening. numerous stones, cbd 3.1mm, pancreas edematous and enlarged. repeat ct extensive necrotizing pancreatitis and smv, pv thrombus. more prominent peripancreatic fluid adn induration. spleen and kidneys nl large right and moderate left pleural effusions. ct chest/abd with contrast : 1. no pulmonary embolus, aortic dissection, or aortic aneurysm. 2. extensive pancreatitis with now only trace residual pancreatic enhancement, consistent with diffuse necrosis. also noted is thrombus in the portal vein, splenic vein and superior mesenteric vein. there is no pseudocyst or aortic pseudoaneurysm. 3. enlarged endometrial hypodensity. these findings should be correlated to the patient's menstrual history as it is atypical in a postmenopausal patient. would recommend correlation to pelvic ultrasound. 4. bibasilar consolidations, likely atelectatic, with adjacent pleural effusions. 5. diffuse fatty infiltration of the liver. cxr : minimal interval improvement in bilateral pleural effusions and associated bibasilar atelectasis. microbiology: () mrsa and vre screen negative bcx ngtd ucx: <5000 gpcs, presumed contaminant labs on discharge () cbc: 07:40am blood wbc-11.9* rbc-3.11* hgb-9.4* hct-28.6* mcv-92 mch-30.2 mchc-32.8 rdw-13.7 plt ct-680* coags: 07:40am blood pt-48.4* ptt-47.8* inr(pt)-5.3* 03:22am blood pt-22.7* ptt-38.4* inr(pt)-2.1* 03:26am blood pt-13.8* ptt-65.0* inr(pt)-1.2* 03:21am blood pt-12.2 ptt-32.3 inr(pt)-1.0 chemistry panel 07:40am blood glucose-150* urean-7 creat-0.6 na-138 k-3.9 cl-101 hco3-30 angap-11 07:40am blood calcium-8.6 phos-4.1 mg-2.3 iron studies: 03:22am blood caltibc-189* ferritn-662* trf-145* brief hospital course: ms. is a 54 year-old spanish speaking female with history of gerd and asthma, who was transferred to the icu for necrotizing gallstone pancreatitis. * necrotizing pancreatitis - etiology is gallstone pancreatitis as stones were clearly visualized on osh ct and abd u/s. she developed necrotizing pancreatitis as a complication of gallstone pancreatitis, as evidenced on repeat ct scan. necrotizing pancreatitis must be closely monitored as it can lead to pancreatic infection, retroperitoneal hemorrhage and sepsis with multi-organ system failure. surgery and gi were consulted upon admission who recommended conservative medical management and contination of meropenem. she was kept npo and interventional radiology was consulted for nj tube placement for parenteral nutrition since below-the-gut nutrition has shown to be beneficial in necrotizing pancreatitis. she was transferred to the floor and continued to improve. her pain continued to decrease and was slowly able to tolerate a diet. unfortunately, one morning she became more nauseous and her feeding tube dislodged and was finally pulled. at this point, she was able to tolerate a regular diet and so the feeding tube was not reinserted. nutrition was reconsulted given that she was no longer on tube feeds and felt that she would be able to continue on her current diet without additional tube feeds. she will need follow up with dr. as an outpatient. per the inpatient gi team, she will also need liver clinic follow up in the future. * smv/portal vein/splenic vein thrombosis - nonocclusive thrombosis found on abd ct. most likely this is provoked in the setting of her pancreatitis, given that she also does not have a history of dvt. she was started on a heparin gtt and closely monitored given the chance of developing hemorraghic pancreatitis in the setting of her necrosis. heme onc was consulted to help determine the length of anticoagulation. they recommended to continue anticoagulation for 6 months and to be seen in their clinic in follow up to determine if the patient should have a hypercoagulable work up. to help transition her home, she was changed from heparin gtt to lovenox. on the day of discharge her inr was 5.3 and her coumadin will be held on evening. she will need daily inr checks until her inr is stable x 2 days. she should receive 2 mg of coumadin daily once her inr is back in the normal range. her hct is stable, but should be followed on am. * sinus tachycardia - on arrival to the floor, her hr was stable in the 120s. given her thromboses above, this was concerning for pe. she had a ct pe protocol which was negative, but revealed moderate bilateral pleural effusions. over the course of her hospitalization, her hr decreased to 90s on discharge. * pleural effusions - this is likely a result of the volume resuscitation at the osh and icu for her pancreatitis. this is likely to the inflammation associated from the pancreatitis. over the course of her hospitalization, her pleural effsuions decreased in size and she was able to be weaned to room air from 4l nasal cannula. she will need a follow cxr in 2 weeks to ensure resolution of her effusions. * anemia - hct is stable between 28-30 throughout her time on the floor. iron studies are consistent with anemia of chronic disease, but elevated ferritin is likely the result of acute pancreatitis. will need f/u with pmd. * endometrial lesions - ct abd revelaed enlarged endometrial hypodensity that will need f/u with pelvic ultrasound as outpatient. * pt has hx depression w/ suicidal ideation. she had no suicidal ideations on this admission. outpatient medications were continued which include paxil 20mg daily. * asthma- was stable on exam, without wheezing. she initially was on albuterol, but this was changed to xopenex given her tachycardia. medications on admission: 1. tylenol 650mg q4h prn 2. asa 81mg daily 3. colace 100 mg prn 4. nexium 40 mg daily 5. dilaudid 1 mg q4h prn pain 6. timentin q8 h 7. riss 8. xopenex 2qh prn 9. ativan 0.5mg iv q4 prn 10. lopressor 5mg q6h iv 11. singulair 10mg qhs 12. phenergan 12.5 mh q6h prn discharge disposition: extended care facility: rehabilitation and nursing center - discharge diagnosis: necrotizing pancreatitis diabetes mellitus gerd anxiety discharge condition: stable. tolerating regular diet. discharge instructions: you were transferred to with pancreatitis. you were initially in the intensive care unit and needed antibiotics and fluids. you were later transferred to the floor. you slowly improved and your antibiotics were discontinued and you were able to tolerate a regular diet. because your pancreas was damaged, you were started on insulin to control your blood sugars. you will need to monitor your sugars closely at home. please return to the hospital if you experience worsening fevers, chills, nausea, vomiting, abdominal pain, blood in your stool or other concerning symptoms. followup instructions: you will need to follow up with your primary care doctor dr. on at 6:15 pm provider: post clinic phone: date/time: 1:10 provider: , phone: date/time: 8:40 provider: , md phone: date/time: 1:00 (surgery) provider: , md at 2:00 pm (gastroenterology) provider: , md phone: date/time: 10:30 procedure: insertion of (naso-)intestinal tube diagnoses: anemia of other chronic disease esophageal reflux unspecified pleural effusion asthma, unspecified type, unspecified pulmonary collapse dysthymic disorder other specified cardiac dysrhythmias calculus of gallbladder without mention of cholecystitis, without mention of obstruction acute pancreatitis other chronic nonalcoholic liver disease portal vein thrombosis secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified 

Answer: The patient is high likely exposed to