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: cefepime attending: chief complaint: biliary colic major surgical or invasive procedure: ercp w/ sphincterotomy open cholecystectomy history of present illness: 46m with history of biliary colic, morbid obesity, htn, lower extremity edema , who presents directly from ercp where he underwent ercp and sphincterotomy. pt tolerated the procedure well. prior to the ercp pt was admitted to hospital for severe recurrent epigastric pain after eating, lasting hours, in the setting of elevated transaminases (ast:alt 370:447 ap 166, tuberculosis 4, lipase 22 ). pt does have history of similar pain just a few days prior as well as approx one year ago which resolved on its own. on and again on pt underwent ruq u/s which showed cholelithiasis but no evidence of cholecystitis. pt denies fever at any point, but does admit to recent nausea and vomiting. past medical history: obesity, depression, hypothyroidism, lower extremity edema, biliary colic social history: lives alone in , unemployed. denies cigs or drugs, +etoh (1-2 drinks a night) family history: noncontributory physical exam: upon presentation: vs: 97.6, 128/85, 68, 18, 93% ra gen: a&o, nad heent: no scleral icterus, mucus membranes dry cv: rrr, no m/g/r pulm: clear to auscultation b/l, abd: soft, obese, nontender, no rebound or guarding, normoactive bowel sounds, no palpable masses ext: severe le edema. psych: flat affect. pertinent results: renal & glucose glucose 78 urea nitrogen 9 6 - 20 mg/dl creatinine 0.6 0.5 - 1.2 mg/dl sodium 136 133 - 145 meq/l potassium 3.8 3.3 - 5.1 meq/l chloride 100 96 - 108 meq/l bicarbonate 27 22 - 32 meq/l enzymes & bilirubin alanine aminotransferase (alt) 206* 0 - 40 iu/l asparate aminotransferase (ast) 98* 0 - 40 iu/l alkaline phosphatase 121 40 - 130 iu/l bilirubin, total 0.6 0 - 1.5 mg/dl other enzymes & bilirubins lipase 24 0 - 60 iu/l chemistry calcium, total 8.4 phosphate 3.3 magnesium 2.0 imaging: ercp: a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire.cbd was sweeped with balloon catheter and sludge was extracted. impression: normal major papilla cannulation of the biliary duct was successful and deep with a sphincterotome using a free-hand technique. contrast medium was injected resulting in complete opacification. cbd and intrahepatic biliary tree was normal in calibre. there was a filling defect that appeared like sludge in the distal cbd. a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. cbd was sweeped with balloon catheter and sludge was extracted. ble duplex u/s: no evidence of dvt in bilateral lower extremities. ct torso (non-con): impression: 1. bilateral heterogeneous opacification in the lungs, worst in the left lower , represent atelectasis; however, underlying infectious process such as pneumonia or aspiration cannot be completely excluded and should be considered in the correct clinical setting. 2. status post cholecystectomy with percutaneous biliary drain. 3. fat-containing ventral periumbilical hernia and a fluid filled right inguinal hernia. ct torso (w/ con): impression: 1. nondiagnostic examination in the evaluation of pulmonary embolism secondary to respiratory motion artifact. 2. no evidence of venous clot in the iliac veins or veins of the pelvis. 3. increasing size and number of lymph nodes both in the mediastinum and right inguinal area. clinical correlation recommended to exclude low grade hematologic malignancy. 4. areas of consolidation in bilateral lung bases and in the right upper may be on the basis of atelectasis, although superimposed infection or central obstructing lesion cannot be excluded based on this examination. echo: technically suboptimal study despite the use of definity. no clinically useful information was derived. if clinically indicated, a radionuclide ventriculogram may be better able to assess biventricular systolic function. brief hospital course: he was admitted to the acute care surgery service as a direct admission following ercp. he was given iv hydration and made npo. his lft's and bilirubin were followed closely and slowly trended downward. early discussions took place with patient for operative management with cholecystectomy for which patient wanted to discuss further with team and his family before definitively consenting for this. on the he underwent a laparoscopic converted to an open cholecystectomy. pod #1 his urinary output dropped and he received fluid along with 1 unit prbc with adequate urinary response. on pod #2 he was advanced to a regular diet. he continued to do well. however, overnight he began to drop his o2 sats and became tachycardic. in addition, his cr rose to 1.6 from 0.9 the day before. a cxr was performed which showed mild pulmonary vascular congestion. he was given a dose of lasix with no response. an abg revealed hypoxemia with po2 of 65. given the concern for pe and his ongoing hypoxia, he was transferred to the icu for close monitoring. a cta chest with pe protocol was unable to be performed because the patient's cr had bumped to 1.9. therefore, a ct torso without contrast was performed which showed a bilateral lower opacification (l>r) but was otherwise unremarkable. ble duplex u/s was negative for dvt. while in the unit, he became hypotensive with systolic blood pressures ranging between 70s-80s. he was empirically started on vanc/zosyn. the next day (), his antibiotics were changed to vanc/cipro/cefepime to cover hospital acquired pneumonia. an ngt was placed with immediate return of 500 cc of coffee ground fluid; his hct was found to be 22.8. he was transfused 2 units of prbc's. gi team was consulted regarding a potential upper endoscopy. however, they felt egd would require elective intubation and therefore the procedure was deferred. the patient was aggressively fluid resuscitated and his urine output remained adequate. the following day his cr dropped to 1.3 and he was sent for a cta with pe protocol which was indeterminate for pe due to motion artifact but did not show thrombus in the aortoiliac or pelvic veins. serial hct were trended and remained stable. an echo was attempted but the quality was suboptimal secondary to the patient's large body habitus. he still had a significant supplemental oxygen requirement. over the next few days in the icu his respiratory status remained tenuous. he was started on intermittent lasix boluses which resulted in large diuresis and he was able to be weaned to nasal cannula. on , he was started on 20mg po lasix daily and was given 40mg iv lasix as well as a dose of diamox. he again responded with a brisk diuresis but then became hypotensive overnight requiring 2.5l of fluid boluses. his hct in the am was 21 and he was transfused one unit prbc's. the patient also developed an urticarial rash on and this was attributed to having switched his cipro from iv to po. the cipro was therefore discontinued and he was started on levofloxacin. his rash has virtually resolved at time of this dictation. he remained on the vancomycin and levofloxacin for the pneumonia for a total of 7 day course, stop date . he is also receiving flagyl for a presumed c. difficile colitis given his stool volume. it should be noted that he has had 2 negative stool for c. diff cultures. his treatment with flagyl will continue for a total of 7 day course. a flexi seal system was placed rectally for stool containment and protection of patient's skin given his large body habitus. cholestyramine was started as well. he was also seen by psychiatry for his anxiety and depression and it was recommended to increase his celexa to 40 mg daily from 30 mg and to avoid benzodiazepines as this would put him at risk for delirium. he was evaluated by physical therapy and is being recommended for rehab after his acute hospital stay. medications on admission: lisinopril 10mg po daily levothyroxine 137 mcg po daily lasix 20 mg po daily celexa 30 mg po daily discharge medications: 1. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 137 mcg tablet sig: one (1) tablet po daily (daily). 3. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 4. citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 6. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation every six (6) hours. 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 9. levothyroxine 75 mcg tablet sig: two (2) tablet po daily (daily). 10. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for pruritis. 11. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 12. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 13. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 14. miconazole nitrate 2 % powder sig: one (1) appl topical three times a day: apply to skin folds. 15. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 16. cholestyramine-sucrose 4 gram packet sig: two (2) packet po bid (2 times a day). 17. vancomycin 1500 mg iv q 12h start: stop date 18. levofloxacin in d5w 750 mg/150 ml piggyback sig: seven y (750) mg intravenous q24h (every 24 hours): stop date . 19. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: five hundred (500) mg intravenous q8h (every 8 hours): stop date . 20. insulin regular human 100 unit/ml solution sig: one (1) dose injection four times a day as needed for per sliding scale. discharge disposition: extended care facility: hospital - discharge diagnosis: choledocholithiasis upper gastrointestinal bleed acute blood loss anemia pneumonia anxiety depression discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hopsital with gallstones and underwent a procedure called an ercp which looks inside of your biliary system. you then had your galbladder removed. you did well in the post operative period and your diet was advanced. you should avoid fried and/or greasey foods; food choices should include those that are low in fat. you may resume your home medications as prescribed. if you have been prescribed an anitibiotic please continue the course as directed. return to the emergency room if your symptoms come back. followup instructions: follow up in weeks in acute care surgery clinic. please call for an appointment. follow up with your primary care providers as directed. procedure: arterial catheterization cholecystectomy endoscopic retrograde cholangiopancreatography [ercp] central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified acute posthemorrhagic anemia pulmonary collapse dysthymic disorder hemorrhage complicating a procedure morbid obesity dermatitis due to drugs and medicines taken internally hypoxemia hemorrhage of gastrointestinal tract, unspecified accidents occurring in residential institution removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation laparoscopic surgical procedure converted to open procedure other drugs and medicinal substances causing adverse effects in therapeutic use adjustment disorder with anxiety calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction other specified pervasive developmental disorders, current or active state unspecified delay in development body mass index 60.0-69.9, adult 

Answer: The patient is high likely exposed to