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 attending: chief complaint: fevers, altered mental status major surgical or invasive procedure: - ercp - placement of picc line history of present illness: mrs. is a pleasant 83 year old female, followed by biliary service at for biliary obstruction status-post stenting for likely malignancy, though not biopsy proven, as well as a history of cholangitis. she was at home with her husband, who noted on morning of admission she was much less responsive than usual, and that she felt warm to the touch. he describes that she was slightly more somnolent the day prior to admission. he was concerned and called ems. she was brought to . there, she was noted to have a white blood cell count of 26 with bands, a total bilirubin of 2.4, no acute chest process on chest x-ray, and a mildly positive urine analysis with 1+ le. she was given vancomycin, ceftriaxone, and flagyl over concern of cholangitis. her inr was over 8, and she was given 10 mg of intravenous vitamin k. blood and urine cultures were drawn prior to administration of antibiotics. she was then transferred to . . in the , abdominal ultrasound was completed, which demonstrated no change in known intrahepatic dilatation, two common bile duct stents in place, and no obvious abscesses. her vitals at that time were: temperature of 101.4 rectal, stable blood pressure (never hypotensive, lowest 120/40) 160/70, rr 24, sat 98% on nrb. she was noted to be rigoring and was somnolent but somewhat arousable. her laboratories were notable for a transaminitis ast >alt, lactate 2.4, inr 7.7. she received more vitamin k, was seen by surgery and was admitted to for plan to ercp in am. . of note, patient had recent admission to for polymicrobial sepsis in setting of biliary stent obstruction due to tumor. she underwent ercp with successful flushing of stents. her course was complicated by afib with rvr, dvt and liver abscesses not amenable to drainage. . blood cultures at that time grew: enterococcus sensitive to gent and streptomycin; e.coli sensitive to gent, imipenem, and cephalosporins; klebsiella pansensitive except to amp. . upon arrival to the , she would open her eyes to tactile stimuli and would squeeze her hand when ask; she was not otherwise interactive. past medical history: biliary obstruction/malignant stricture s/p ercp x 2 and 2 metal stents--last placed in . thought to be cholangiocarcinoma, no clear pathologic diagnosis made. by report, evaluated by surgical team, thought not to be a surgical candidate. now with peritoneal carcinomatosis. -diabetes mellitus, type 2 -hypertension -coronary artery disease -parkinson's disease -diastolic chf -vaginal carcinoma -s/p cholecystectomy -urosepsis d/t e. coli and proteus -bacteremia due to vre in treated with 2 week course of linezolid -bacteremia due to e. coli in treated with 2 week course of ceftriaxone. -atrial fibrillation -hyperlipidemia social history: she lives with husband in , and has no children. dependent for adls--has vna and husband cares for her, no tobacco or drugs, occassional alcohol. retired tax examiner for the state. at baseline, she eats pureed foods with some assistance from her husband depending on how bad her parkinsons tremor is. her primary care physician describes she has a good baseline quality of life. family history: per records, her mother died of heart disease. physical exam: on admission: t= 101.9 axillary bp=125/59 hr=103 rr=? o2= 100% on 50% shovel mask gen: elderly female, very warm, somnolent but follows with eyes. heent: dry mucous membranes, op clear neck: no jvp car: tachycardic, irregular, no murmurs appreciated resp: course bs bilaterally transmitted from o2. abd: soft, +bs, nd, unclear if tenderness pain in - pt opens eyes wide. ext: strong distal pulses, bilateral edema neuro: somnolent, unable to participate in neuro exam. skin: no rashes or lesions noted pertinent results: ultrasound: impression: 1. no significant interval change in intrahepatic biliary duct dilatation, most severe within the left lobe. 2. echogenic material within both common bile duct stents is nonspecific, and could represent debris, but tumor involvement is not excluded. 3. patent main portal vein, however, the patient's known right posterior portal venous branch occlusion is not visualized on current examination. 4. small amount of perihepatic fluid. 5. 1.1-cm pancreatic mid body lesion, stable from the prior studies. 6. no new hepatic abscess identified. chest x-ray: impression: no acute cardiopulmonary abnormality. patchy opacity within the retrocardiac region is felt to represent atelectasis and/or scarring. brief hospital course: mrs. is an 83 year old female with history of biliary obstruction, polymicrobial bacteremia from cholantitis presenting with fever, altered mental status concerning for ascending cholangitis. #. sepsis: pt presented with altered mental status, fevers, tachycardia and leukocytosis. symptoms were presumed to be due to cholangitis and obstruction of known biliary stent, given elevated white blood cell count, fevers, and elevated liver function tests. there were no other clear sources of infection on admission. a ruq ultrasound showed no change in biliary dilitation but ercp showed sludge and stones obstructing the stent which were successfully cleared out. pt was initially empirically treated linezolid, ceftriaxone and flagyl given prior h/o vre and resistent bacteria, and transitioned to only high dose ceftriaxone once blood cultures grew klebsiella. she was also treated with ivf boluses via picc and did not require a cvl or pressors. the biliary surgery and ercp team followed along during her stay. the infectious disease team helped guide appropriate antibiotic choice: as she did not have evidence of active hepatic abscesses on abdominal ct, a 2 week course was deemed sufficient (last day ). her mental status returned to baseline, and her fevers resolved within a few days of hospitalization. her blood cutlures checked after the initial positive results remained sterile. #. coagulopathy: on presentation pt's inr was 8, likely in setting of poor hepatic clearance of coumadin. she had no signs of active bleeding. she recieved several doses of vitamin k and ffp to reverse her inr for ercp and was not restarted on anticoagulation post procedure, out of concern for needing future procedures. benefits and downsides of anticoagulation can be discussed with pt's pcp given ongoing goals of care. #. pt's home home glyburide was held and pt was monitored and treated with a sliding scale of insulin. this was not restarted after her procedures due to generally good blood sugar control; however, this can be restarted when necessary at rehab depending on her blood sugars. #. coronary artery disease: patient's last echo was in , which demonstrated an ef of >55%, normal systolic function, mild mr. she was continued on her home statin, while her home anti-hypertensives were initially held in the setting of concern of hypotension while septic. her metoprolol was started after her bp recovered. #. atrial fibrillation: pt supratherpeutic on coumadin on arrival. this was not restarted due to ongoing discussions about goals of care. metoprolol was restarted and titrated up to 50mg tid given episodes of afib with rvr in the icu. this was backed down to 25mg after she was noted to be in sinus brady in the 50s on the floor. digoxin was not restarted. #. htn: held home bp regimen on admission. metoprolol was added back as above and lisinopril and hctz were added and titrated up after she became hypertensive on the floor. this can continue to be titrated as needed at rehab. #. parkinsons: continued sinimet and pramipexole #. concern for aspiration/goals of care: the patient failed a video speech and swallow study after being called out of the icu. the speech and swallow team discussed the possibility of a feeding tube with the patient and family in order to be able to provide adequate nutrition, but she and her husband were adamantly against this, as quality of life and being able to have the comfort of eating food were deemed to be more important; thus, speech and swallow recommended nectar thick liquids and pureed solids per her husband's request. the patient and husband acknowledged the risks that she will likely aspirate. goals of care should continue to be discussed at rehab and any concern for aspiration should be discussed with the patient and husband before she is sent to the hospital in the event that she does aspirate, to see if they may decide not to hospitalize her in that situation. ## code status: dnr/dni emergency contact: medications on admission: albuterol sinemet 25-100 tid lasix 40 mg glyburide 5 mg daily lisinopril 5 mg singulair 10 mg daily protonix 40 mg daily pramipexole 0.375 mg tid prazosin 2 mg simvastatin 10 mg daily (although not confirmed with patient at time of admission--per discharge from , was also on digoxin, metoprolol, and coumadin) discharge medications: 1. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 2. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po tid (3 times a day). 3. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 4. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 5. singulair 10 mg tablet sig: one (1) tablet po once a day. 6. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours). 7. pramipexole 0.125 mg tablet sig: three (3) tablet po tid (3 times a day). 8. prazosin 2 mg capsule sig: one (1) capsule po twice a day. 9. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 11. acetaminophen 650 mg suppository sig: one (1) suppository rectal q6h (every 6 hours) as needed for fever. 12. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 13. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 14. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: two (2) g intravenous q24h (every 24 hours) for 5 days. 15. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous asdir (as directed). 16. aspirin 81 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: center discharge diagnosis: primary: biliary obstruction, bacteremia secondary: likely cholangiocarcinoma, hypertension, atrial fibrillation, diabetes mellitus type 2, coronary artery disease, parkinson's disease, chronic diastolic chf discharge condition: good, stable, at baseline mental status, afebrile discharge instructions: you were evaluated for fevers and lethargy and improved after ercp. you are being treated for a bloodstream infection and will continue iv antibiotics for a few more days. you were evaluated by speech and swallow and were found to be at risk for aspiration; however, after discussion you declined a feeding tube and would rather eat despite the risk of aspiration. if you have fevers, chills, chest pain, shortness of breath, confusion, episodes of loss of consciousness, or any other concerning symptoms, have the doctors at rehab you. followup instructions: follow up with your primary care physician 1-2 weeks after discharge from rehab. procedure: venous catheterization, not elsewhere classified endoscopic removal of stone(s) from biliary tract injection or infusion of oxazolidinone class of antibiotics diagnoses: abnormal coagulation profile coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation sepsis paralysis agitans other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure mechanical complication due to other implant and internal device, not elsewhere classified accidents occurring in other specified places septicemia due to escherichia coli [e. coli] cholangitis diastolic heart failure, unspecified oliguria and anuria infection and inflammatory reaction due to other internal prosthetic device, implant, and graft calculus of bile duct without mention of cholecystitis, without mention of obstruction personal history of malignant neoplasm of other female genital organs malignant neoplasm of intrahepatic bile ducts ulcer of thigh diverticulosis of small intestine (without mention of hemorrhage) 

Answer: The patient is high likely exposed to