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: patient recorded as having no known allergies to drugs attending: chief complaint: biliary sepsis major surgical or invasive procedure: ercp with plastic stent placement picc line placement ercp with 8 mm x 80 mm biliary wallflex stent placement into the hilum and left intrahepatic system history of present illness: 48 yo w w pmh of htn, dm who underwent ct-guided biopsy of newly diagnosed liver mass on . pt presented to osh ed on with chills, sweats and reported temp at home of 92 f. in the ed, vs notable for rectal temp of 94, hr 52, bp 87/58, 99%ra. kub was within normal limits. labs were notable for wbc count of 17 with 9% bands, bun/cr of 78/2.8, t bili 40, direct 17, glucose of 43. pt received 2l ns, 1 amp d50, unasyn x 1 dose and underwent ct abdomen prior to transfer to the icu. there she also received vanco x 1 dose and 3rd liter of ivfs. on arrival to the , patient was stable but with bps in the low 90's. otherwise, without complaints. ros unrevealing. denies history of hepatitis or recent travel. past medical history: htn hyperlipidemia type ii dm gerd psh: appy social history: pt quit tobacco 13 years ago; total 15 pk year history. married without children. no hx of etoh abuse family history: no hx of pancreatic hx physical exam: vs: t 97 bp 91/50, hr 61, 99% ra gen: obese female in nad, jaundiced heent: eomi, perrl, anicteric neck: supple chest: ctabl, no w/r/r cv: rrr, s1s2, no m/r/g abd: obese, soft/nd, + bs, ttp in ruq ext: no cyanosis, edema skin: jaundiced, no rashes neuro: cn ii-xii intact; strength/sensation grossly intact; aao x 3; toes downgoing bilaterally pertinent results: 07:49pm neuts-87* bands-1 lymphs-4* monos-6 eos-1 basos-0 atyps-0 metas-0 myelos-1* 07:49pm albumin-2.8* calcium-8.4 phosphate-4.7* magnesium-2.7* 07:49pm wbc-13.7* rbc-5.32 hgb-15.3 hct-44.1 mcv-83 mch-28.7 mchc-34.6 rdw-19.0* 07:49pm alt(sgpt)-31 ast(sgot)-47* ld(ldh)-229 alk phos-242* amylase-42 tot bili-32.8* 07:49pm lipase-55 07:49pm plt smr-normal plt count-388 05:48am blood wbc-16.4* rbc-4.09* hgb-11.7* hct-35.6* mcv-87 mch-28.7 mchc-33.0 rdw-20.5* plt ct-315 05:48am blood pt-15.4* ptt-25.2 inr(pt)-1.4* 05:48am blood glucose-140* urean-11 creat-0.8 na-139 k-3.9 cl-107 hco3-21* angap-15 05:48am blood alt-18 ast-33 ld(ldh)-226 alkphos-117 totbili-11.1* 03:53am blood ca -9 -502 h ct chest: impression: 1. no good evidence for intrathoracic malignancy. a 4 mm left upper lobe nodule is the only candidate for metastasis. small right and tiny left pleural effusions are probably due to volume overload or migration of ascites. 2. subpleural cyst or old abscess or infarct, right lung, do not warrant followup, unless patient is symptomatic. the study and the report were reviewed by the staff radiologist. dr. dr. approved: tue 10:39 am ct abd/pelvis impression: 1. infiltrative hepatic mass which surrounds the ivc and appears to obliterate the right and middle hepatic veins as well as the right posterior portal vein. in addition, innumerable masses are also seen satellite to this lesion at the liver dome, and throughout the right lobe. there is relative preservation of the left lobe of the liver from this mass, although portions of the dominant mass extends contiguously into the left lobe. 2. marked intrahepatic biliary ductal dilatation. 3. moderate ascites. 4. moderate right-sided pleural effusion and atelectasis; trace left-sided pleural effusion and atelectasis. dr. approved: sat 11:00 pm cytology report peritoneal fluid procedure date of peritoneal fluid: negative for malignant cells. reactive mesothelial cells, histiocytes and lymphocytes. cytology report common bile duct brushings procedure date of bile duct stricture: suspicious. scattered clusters of highly atypical cells with increased nuclear:cytoplasmic ratios and irregular nuclear contours, suspicious for adenocarcinoma. brief hospital course: 48 year old female with dm, htn, and recently found liver mass, transferred from osh with hypotension, bandemia, hypoglycemia, arf likely secondary to sepsis after recent liver biopsy. #. hyperbilirubinemia/hepatic failure/liver mass: patient presented with painless jaundice, significant hyperbilirubinemia and was also known to have a liver mass. she had had a liver biopsy done at hospital prior to admission with results reportedly demonstrating fibrosis only. on admission, with above presentation, concern for carcinoma, hepatocellular versus cholangiocarcinoma. on presentation, she underwent ercp with plastic stent placed initially, and brushings done which were sent to cytology and returned "highly suspicious for malignancy". she also underwent a triple phase ct scan of abdomen/pelvis that demonstrated tumor throughout right lobe, extending into left lobe of the liver, as well as infiltrating the vena cava, and some enlarged lymph nodes. . hepatobiliary surgery and oncology teams were consulted, and evaluation was made to determine if the patient was a surgical candidate. evaluation included large volume paracenteses with ascitic fluid sent for cytology which returned negative. however, upon evaluation of extent of liver metastasis, it was determined that the patient was not a surgical candidate for her cancer. social work was consulted for assistance with coping with her new diagnosis of cancer, and the fact that she was not a candidate for surgery. prior to discharge, she underwent repeat ercp with metal stent (more permanent stent) placement and repeat brushings sent to cytology. the results of this are pending at the time of discharge. the patient will follow up with dr. on for the results of this and discussion re: chemotherapy. --> plans for discharge with oncology follow up. they will also follow up on cytology of ercp brushings and if inconclusive will schedule an outpatient liver biopsy. #. sepsis, now resolved: on presentation, patient had elevated wbc count with bandemia, and was hypotensive, consistent with sepsis. infectious source thought to be hepatobiliary given severe jaundice and recent instrumentation of liver biopsy prior to presentation. also concern for mrsa with recent hospitalization and right lower lobe infiltrate versus effusion seen on chest x-ray. she was started on zosyn and vancomycin and completed 9 day course. she initially required ivf boluses to maintain adequate blood pressure. blood pressure and symptoms stabilized and patient was transferred to the floor, and she remained well throughout remainder of hospital course. her antihypertensive medications were held for the duration of her hospitalization and dr. personally advised her to continue to not take these medications (hctz and ace-inhibitor) until further directed by a physician. her wbc was still elevated at discharge, she was discharged on a seven day course of levofloxacin, as recommended by dr. from ercp. # hypoglycemia/diabetes: patient was initially hypoglycemic during her hospital course, off of her home insulin regimen. concern for hepatic failure initially, but then resolved, and therefore was likely to sepsis and oral agents in the setting of acute renal failure. she was otherwise maintained on insulin sliding scale throughout remainder of hospital course. on the day of discharge, she was given 15 units of glargine which is half of her usual dose. she was instructed to continue this (15 units each morning) and take her fs 4 x daily. she will call her endocrinologist on monday to discuss further therapy. she declined to continue her metformin given her hepatic process which seems reasonable. # uti: ua on admission with pyuria. osh urine culture with no growth. urine culture no growth. any potential uti was likely covered by zosyn. # acute renal failure: fena of 1.9 initially suggested atn consistent with hypotension. renal function improved with ivf and was much improved (0.8) at time of discharge. # htn: anti hypertensives held during hospital course # gerd: maintained on ppi medications on admission: protonix flonase (following recently discontinued) hctz benicar tricor amaryl lantus 30 u metformin discharge medications: 1. ursodiol 300 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*2* 2. insulin glargine 100 unit/ml solution sig: 15 units 15 units subcutaneous once a day: take 15 units of glargine every morning. if you are unable to eat, call your doctor and do not take this medication. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. fluticasone 50 mcg/actuation spray, suspension sig: sprays nasal prn as needed for postnasal drip. 5. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 7 days. disp:*7 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: cholangiocarcinoma obstructive jaundice s/p metallic stent placement secondary: htn diabetes type 2 uncontrolled discharge condition: good. patient without pain, tolerating po, ambulating without difficulty. discharge instructions: you were admitted to the hospital with jaundice and liver masses, as well as sepsis (severe infection with low blood pressure). your infection was treated and your jaundice and liver masses were worked up and determined to be cholangiocarcinoma. you are discharged with follow up with oncology services. please follow up with appointments as directed. . please contact physician if develop abdominal pain, fevers/chills, nausea/vomiting, increase in jaundice, any other questions or concerns. . call your endocrinologist on monday to discuss your insulin regimen. you are being discharged on half your usual dose of lantus/glargine. this is because you have lost weight and you are not eating the same amount as before admission. you may ultimately need more long-acting insulin. please continue to take your fingersticks 4 times per day. call dr. ( if your fingersticks are higher than 200 or below 80. as we discussed, you have not been on your metformin since admisson and we agreed for you not to take this medication until further directed. you can discuss this with dr. if you wish. . do not take your hydrochlorothiazide, your benicar, tricor, amaryl or metformin until directed otherwise by a physician. . the ercp team recommended that you start levofloxacin (an antibiotic) on discharge. you are being discharged on a one week course of this medication. you should take it once per day for seven days. followup instructions: please follow up with the clinic, dr. and dr. on tuesday at 3pm. this is located on the of the clinic building at hospital. (this building is on the corner and .) please follow up with your primary care physician, . on tuesday at 11am. procedure: venous catheterization, not elsewhere classified percutaneous abdominal drainage endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct transfusion of other serum diagnoses: esophageal reflux malignant neoplasm of liver, secondary acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified unspecified essential hypertension unspecified septicemia severe sepsis other and unspecified hyperlipidemia other ascites obstruction of bile duct diabetes with other specified manifestations, type ii or unspecified type, uncontrolled malignant neoplasm of intrahepatic bile ducts 

Answer: The patient is high likely exposed to