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: ms contin attending: chief complaint: recurrent cholangitis major surgical or invasive procedure: with stent placement, with stent removal and re-placement history of present illness: 61 yo woman w/hx of recently diagnosed inoperable pancreatic cancer metastatic to the liver s/p recent and placement of metal stent for enterococcal cholangitis complicated by septic shock, intubation, and icu stay re-presenting with abdominal pain and persistent jaundice. she was discharged home on with zosyn. she had been on vancomycin during her previous hospital stay but this was discontinued. . she reports feeling well until the day of presentation when she started getting sharp epigastric pain which was not relieved by her po dilaudid. she also started feeling chills and had a temp of 100.7. . in the ed she was febrile to 102.7 p106, bp139/69, rr20, 97% on ra. lactate 1.6, wbc 24.8 with 96.5 neutrophils, tbili 7.3 (increased from 2.8), lipase 14, alt 48, ast 86, inr 1.5. ct abd/pelvis with contrast showed persistent enlargement of cbd and intrahepatic tree. surgery saw the patient in ed and felt there was nothing to do from a surgical standpoint. the fellow on call demonstrated concern for incompletely treated cholangitis in need of drainage. the patient received vanc/zosyn, dilaudid 2mg iv total, and tylenol. her pain went from a 10 total 6 with the dilaudid. she was never hypotensive in ed. on transfer vitals were t100, hr 109, 118/48, 16, 96% on ra. . on arrival to icu, vitals were 97.7 93 98/58 13 96%. she stated her pain was still at a . she was otherwise feeling well. she denied fevers, chills, nausea, vomiting, diarrhea, or cough. she endorsed continued jaundice since last leaving the hospital. . on ros she denied changes in vision, cough, chest pain, jaw pain, arm pain, shorness of breath, cough, blood in the stool, constipation, joint pains, muscle aches. past medical history: past oncologic history: ====================== initially presented with abdominal pain to , had t. bili of 24. abdominal ct and ultraound demonstarted a pancreatic mass obstructing the bile duct. she underwent with stent placement at osh and then due to rising total bilirubin had a repeat at on during which her initial stent was removed and a new stent was placed. she underwent an eus guided biopsy of her pancreatic mass on showing adenocarcinoma. . past medical history: ================== gerd social history: lives at home with her husband and daughter. smokes 1 pack/day. denies iv drug use, etoh. family history: mother with copd. brother with cirrhosis (due to etoh). 2 aunts with breast cancer, 1 of them also had uterine cancer. grandmother with dm. uncle had mi. physical exam: on arrival to the icu: general - nad, comfortable heent - jaundiced w scleral icterus, nc/at, perrla, somewhat dry mm, op clear neck - supple, no lad, no jvd, no carotid bruits lungs - cta bilat, no w/r/c, good air movement, resp unlabored, no accessory muscle use heart - rrr, no mrg, nl s1-s2 abdomen - +bs, + epigastric tenderness/ruq tenderness, + guarding, no rebound, no masses or hsm extremities - wwp, no c/c/e, 2+ radials 1+ dps skin - no rashes or lesions neuro - awake, a&ox3, ue reflexes +2, patellar +2, achilles unable to elicit pertinent results: 07:08pm urine color-amber appear-clear sp -1.013 blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-sm urobilngn-neg ph-7.0 leuk-neg 06:52pm type- ph-7.51* glucose-123* lactate-1.6 na+-133* glucose-128* urea n-8 creat-0.9 sodium-131* potassium-4.4 chloride-95* total co2-24 anion gap-16 06:45pm alt(sgpt)-48* ast(sgot)-86* alk phos-257* tot bili-7.3* lipase-14 06:45pm wbc-24.8*# rbc-3.80* hgb-11.9* hct-35.3* mcv-93 mch-31.3 mchc-33.6 rdw-17.9* neuts-96.5* lymphs-2.1* monos-0.9* eos-0.3 basos-0.2 plt count-317 pt-16.7* ptt-26.6 inr(pt)-1.5* : the metal stent placed in the biliary duct had migrated distally and was impacted against the duodenal wall thus impairing the biliary drainage. cholangitis - frank pus in bile duct. the stent was removed with a snare and frank pus drrained from the ampulla. cannulation of the biliary duct was successful and deep with a balloon catheter and contrast medium was injected resulting in partial opacification. a distal cbd stricture was noted with severe post-obstructive dilation. the duct was swept with a balloon and frank pus and debris was cleared. a 8cm by 10mm covered wall stent biliary stent was placed successfully across the stricture into the proximal cbd over the guidewire. . : minimal contrast was injected secondary to clinical presence of cholangitis. however, post-obstructive dilatation of the intrahepatic bile ducts was appreciated. two plastic biliary stents were placed within the metallic biliary stent. . : initial images demonstrate a large caliber metallic stent within the cbd, and two plastic stents within the metal stent. subsequent images demonstrate removal of both plastic and metal stents, and opacification of the biliary tree demonstrates narrowing of the cbd at its mid portion, with mild to moderate dilatation just above the area of stricture. there is mild intrahepatic biliary ductal dilatation as well. final images demonstrate two new plastic stents spanning the area of narrowing, within the cbd. . biliary drainage from (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. brief hospital course: 61 yo woman w recently diagnosed inoperable pancreatic cancer thought to be metastatic to the liver s/p recent and placement of metal stent for enterococcal cholangitis complicated by septic shock who presented with fevers, increased wbc, ruq pain, and jaundice along with a ct of the abdomen showing significant enlargement of cbd and intrahepatic biliary tree. . # cholangitis. throughout her stay, the patient experienced repeated episodes of cholangitis stemming from stent migration and compression from her known pancreatic mass. a specific organism was not isolated on culture so she was treated with vancomycin and zosyn. she eventually defervesced on this regimen and remained afebrile for 2 days on an oral regimen of levofloxacin, flagyl and fluconazole prior to discharge. while afebrile and pain-free, her bili continued to again trend upward. /gi and interventional radiology were contact and, given the patient's complicated biliary anatomy with multiple strictures, it was not felt that repeated or pct would be helpful. after multiple thoughtful discussions between the inpatient oncology team, gi oncology, and the patient, the patient decided that she would not want to undergo further procedures that were not likely to significantly lengthen the amount of quality time she would be able to spend at home. as she was afebrile and pain free, she was discharged on levo, flagyl and fluconazole to be continued indefinately. . #. pancreatic cancer. the patient was noted to have multiple liver lesions which were thought to be either abscesses or metastatic disease. these lesions were further discussed with radiology who reviewed multiple recent abdominal imaging studies. after review, it was thought that the lesions were almost certainly metastatic in nature. the patient was presented with the option of aspirating one of these lesions for diagnostic purposes but, as she expressed the desire to avoid any further discomfort for procedures that had a low likelihood of altering her disease course, she declined aspiration. consistent with the belief that these lesions were metastatic, the patient began to develop worsening liver function with inr refractory to vitamin k repletion. given her elevated bili and worsening liver function, she was not a candidate for gemcitabine or alternative chemotherapy regimens. this was discussed with the patient at length. she clearly related a desire to spend time at home with a goal of being comfortable and being with her family as much as possible. she was therefore discharged to home with hospice care. she was instructed to continue vitamin k supplementation at home. . # pain control. the patient's pain was well controlled while in the hospital. at discharge, she was instructed to continue fentanyl patch with po dilaudid for breakthrough. she was also given a script for morphine oral solution and anti-emetics should she develop worsening pain, the inability to take pos or nausea. . # acute renal failure. bland urine sediment. thought most likely to be a result of contrast-induced nephropathy. peaked at 1.7 and trending back to normal (1.4) at time of discharge. . # siadh. the patient was hyponatremic with relatively elevated urine osms and urine sodium. she was fluid restricted and placed on salt tabs with some improvement in her sodium. she was asked to continue to take salt tabs at her time of discharge. . # gerd. ranitidine and omeprazole were continued . # nicotine abuse. nicotine patch was continued. . on , the patient was hemodynamically stable and without pain. she was therefore discharged to home with a plan for home hospice care in place. medications on admission: 1. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) piggyback intravenous q8h. 2. docusate sodium 100 mg capsule sig: two (2) capsule po bid 3. senna 8.6 mg tablet sig: one (1) tablet po bid 4. polyethylene glycol 3350 100 % powder sig: one (1) packet po daily 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet daily 6. ursodiol 300 mg capsule sig: one (1) capsule po bid 7. nicotine 21 mg/24 hr patch 24 hr daily 8. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule po daily 10. fentanyl 25 mcg/hr patch 72 hr 11. miconazole nitrate 2 % powder sig: one (1) appl topical 12. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed. 13. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. discharge medications: 1. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 3. fentanyl 25 mcg/hr patch 72 hr sig: patch 72 hrs transdermal q72h (every 72 hours). 4. hydromorphone 4 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 5. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day) as needed. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 7. polyethylene glycol 3350 100 % powder sig: one (1) po daily (daily) as needed. 8. flagyl 500 mg tablet sig: one (1) tablet po every eight (8) hours. :*90 tablet(s)* refills:*2* 9. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours). :*30 tablet(s)* refills:*2* 10. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 11. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for dyspepsia. 12. ursodiol 300 mg capsule sig: one (1) capsule po twice a day. 13. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours). :*30 tablet(s)* refills:*2* 14. sodium chloride 1 gram tablet sig: one (1) tablet po tid (3 times a day). :*90 tablet(s)* refills:*2* 15. phytonadione 5 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 17. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 18. morphine concentrate 5 mg/0.25 ml solution sig: asdir po every four (4) hours as needed for pain: this medication should be used in the event that you have worsening pain and are unable to take pills. please discuss with your hospice nurse. :*100 ml* refills:*0* 19. phenergan 25 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. :*30 tablet(s)* refills:*2* discharge disposition: home with service facility: hospice discharge diagnosis: primary: pancreatic cancer cholangitis acute renal failure syndrome of inappropriate antidiuretic hormone discharge condition: hemodynamically stable, fair condition. discharge instructions: you came to the hospital because of fever and abdominal pain. you had multiple ercps to relieve the obstruction in the ducts that drain your liver. despite this, your labs remained abnormal and suggested ongoing, worsening liver disease. there was concern that continuing to try to reverse this process would be largely unsuccessful and result in more pain and suffering for you. given your hope to spend time with your family and maximize your comfort, you are being sent home with hospice care. the hospice services will focus on maximizing the quality of your time at home. . you should continue to take antibiotics when you go home. you should take these indefinately to try to keep your infection controlled. you are also being given a prescription for pain medication which you may need in the future. you should take stool softeners to prevent constipation while on pain medications. you should continue to take salt tabs and limit your fluid intake if you are able to prevent your sodium from dropping too low. (low sodium can cause altered mental status and seizures.) you should continue to take vitamin k (if you are able) to prevent your blood from becoming too thin. . please call your hospice nurse should you have any concerning symptoms. followup instructions: please follow up with dr. at your convenience. please also follow up with dr. : provider: , md phone: date/time: 11:10 procedure: endoscopic insertion of stent (tube) into bile duct endoscopic retrograde cholangiopancreatography [ercp] endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct replacement of stent (tube) in biliary or pancreatic duct diagnoses: esophageal reflux tobacco use disorder malignant neoplasm of liver, secondary acute kidney failure, unspecified unspecified septicemia sepsis malignant neoplasm of head of pancreas diarrhea other disorders of neurohypophysis cholangitis obstruction of bile duct 

Answer: The patient is high likely exposed to