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: phenergan attending: chief complaint: transfer for ercp major surgical or invasive procedure: ercp with sphincterotomy and common bile duct temporary stent placement. history of present illness: 73 yo man with copd on 3l home o2, cad s/p cabg ~12 yrs ago, atrial fibrillation on coumadin, htn, hl, osa on cpap who presented to on with abdominal pain that started earlier that day. the pain was not associated with food and not releived by otc antiacids. at the osh he was found to have a fever to 100.5, elevated lft's concerning for cholecystitis. ruq u/s revealed distended gallbladder with stones but no evidence of cholecystitis and dilated common bile and intrahepatic ducts. mrcp revealed 4 large stones (up to 1 cm) in the common bile duct, no ductal dilation and periportal edema consistent with ascending cholangitis. he remained hemodynamically stable, he received one dose of gentamycin and was subsequently started on zosyn/flagyl, given 2 units of ffp and transfered to for ercp. of note, he was found to have a new rbbb at osh and was romi. . on admssion he was found to have wbc 12.1, bun/cr 41/2.0, alt 340, ast 238, ap 253, tbili 5.5 and amylase 564 and was taken directly to ercp. patient received ampicillin/gentamycin prior to procedure and was intubated. ercp revealed two 1 cm stones, multiple smaller stones, cbd dilation to 12 mm, a stent was placed and a sphynteromy done. he was succesfully extubated after the procedure. . in the , patient denied any pain and stated that he was feeling well. past medical history: cad s/p cabg afib on coumadin copd on home o2 at 3l osa on cpap dm ii htn hl melanoma s/p resection asthma gerd ? dementia depression social history: patient is retired. he has a 60 pk/yr smoking history, quit in the . denies etoh family history: non-contributory physical exam: general: alert, oriented, no acute distress heent: sclera anicteric, dmm, oropharynx clear neck: supple lungs: pursed lip breathing, clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs: 05:58pm wbc-12.1* rbc-4.43* hgb-11.8* hct-36.9* mcv-83 mch-26.7* mchc-32.0 rdw-20.7* 05:58pm pt-22.7* ptt-30.0 inr(pt)-2.1* 05:58pm glucose-223* urea n-41* creat-2.0* sodium-138 potassium-5.1 chloride-103 total co2-19* anion gap-21* alt(sgpt)-340* ast(sgot)-238* alk phos-253* amylase-564* tot bili-5.5* calcium-8.6 phosphate-5.3* magnesium-2.0 05:43am blood wbc-8.3 rbc-4.04* hgb-10.7* hct-33.9* mcv-84 mch-26.5* mchc-31.6 rdw-21.1* plt ct-144* 05:43am blood pt-19.2* inr(pt)-1.8* 05:43am blood glucose-200* urean-45* creat-1.9* na-141 k-4.3 cl-106 hco3-21* angap-18 alt-281* ast-187* alkphos-240* amylase-312* totbili-3.9* ercp report: date: saturday, endoscopist(s): , m.d. (attending) , md (fellow) patient: ref.phys.: , md anesthesiologists: , md assisting nurse(s)/ other personnel: , rn birth date: (73 years) instrument: tjf-160vf () indications: a level 4 consult was performed fever, ruq abdominal pain, jaundice, and an abnormal mrcp with dilated bile ducts and choledocholithiasis all consistent with cholangitis medications: general anesthesia ampicillin 2 gm iv gentamycin 60 mg iv procedure: the procedure, indications, preparation and potential complications were explained to the patient, who indicated his understanding and signed the corresponding consent forms. a physical exam was performed. the patient was administered general anesthesia. the patient was placed in the supine position and an endoscope was introduced through the mouth and advanced under direct visualization until the third part of the duodenum was reached. careful visualization was performed. the procedure was not difficult. the quality of the preparation was good. the patient tolerated the procedure well. there were no complications. findings: esophagus: limited exam of the esophagus was normal stomach: limited exam of the stomach was normal duodenum: limited exam of the duodenum was normal major papilla: a single periampullary diverticulum with a medium opening was found at the major papilla. there was also a medium-sized peri-ampullary lipoma. cannulation: on the first attempt, cannulation of the biliary duct was successful and deep with a sphincterotome after a guidewire was placed. contrast medium was injected resulting in complete opacification. the procedure was not difficult. the pancreatic duct was not cannulated. biliary tree: two 10 mm piston-like stones that were causing partial obstruction were seen at the lower third of the common bile duct. there was post-obstructive dilation of the mid and distal cbd to 12 mm with a mild dilation of the upper cbd and chd to 8-9 mm. a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. two large 1 cm stones and a copious amount of small stones, stone fragments, and thick sludge were extracted successfully using a 9-12mm rx balloon catheter. a 9cm by 10fr plastic biliary stent was placed successfully in the cbd using a microvasive 10fr stent introducer kit. multiple stones were seen in the gallbladder. the cystic duct did opacify with contrast and did not appear to be obstructed. impression: a single periampullary diverticulum with a medium opening was found at the major papilla. there was also a medium-sized peri-ampullary lipoma. on the first attempt, cannulation of the biliary duct was successful and deep with a sphincterotome after a guidewire was placed. contrast medium was injected resulting in complete opacification. the procedure was not difficult. the pancreatic duct was not cannulated. two 10 mm piston-like stones that were causing partial obstruction were seen at the lower third of the common bile duct. there was post-obstructive dilation of the mid and distal cbd to 12 mm with a mild dilation of the upper cbd and chd to 8-9 mm. a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. two large 1 cm stones and a copious amount of small stones, stone fragments, and thick sludge were extracted successfully using a 9-12mm rx balloon catheter. a 9cm by 10fr plastic biliary stent was placed successfully in the cbd using a microvasive 10fr stent introducer kit. multiple stones were seen in the gallbladder. the cystic duct did opacify with contrast and did not appear to be obstructed. recommendations: return to icu overnight. npo overnight with aggressive iv hydration. he will need several liters of ns upfront and then a high infusion rate of 250-300cc/hr for cholangitis and gallstone pancreatitis. continue iv antibiotics for cholangitis. transfuse 2 units of ffp and please give 2.5 mg of vitamin k. no coumadin, asa, plavix, or nsaids for 5-7 days. repeat ercp with dr. ( in 4 weeks for stent removal. he will need to hold coumadin for 5 days prior to this procedure. additional notes: the procedure was performed by the ercp fellow and dr. . brief hospital course: 73 yo m with multiple medical problems who was transfered from osh for ercp after developing acute ascending cholangitis with obstructing stones. on admission to found to have acute renal failure. . #. ascending cholangitis: patient presented to osh with acute onset abdominal pain. found to have acute ascending cholangitis and transfered to for ercp. patient underwent procedure w/o complications, found to have two 1 cm stones, multiple small ones, a dilated cbd. sphincterotomy was performed and a temporary stent was placed. his lft's improved after procedure and zosyn iv was continued. his pain was well controlled with morphine. he remained afebrile and hemodynamically stable throughout admission . #. acute renal failure: patient's bun/cr was wnl at the osh. on admission labs found to have bun/cr 41/2.0. this was thought to be due to pre-renal azotemia due to dehydration as patient was npo and fena was found to be 0.2%. he received ivf hydration and his renal function improved slightly. his lisinopril, lasix and digoxin were held due to arf. patient received gentamycin at the osh and at prior to ercp which could cause renal toxicity. due to this renal function needs to be closely monitored. . #. cad s/p cabg: patient was found to have new rbbb at osh and was romi. on admission ekg rbbb had resolved, but it did show atrial fibrillation and low voltage. atenolol and verapamil were continued. other meds held as above. . #. atrial fibrillation: patient currently in rate controlled atrial fibrillation in the 60's. atenolol and verapamil were continued. he received 2 units of ffp and 5 mg of vitamin k for reversal of inr post-procedure as there was a risk for bleeding. coumadin was held. . #. copd/osa: patient with known copd and was able to be extubated post-ercp w/o complications. home meds were continued. he has sats in the mid 90's on 5 l nc. he was on cpap overnight for osa. . #. gerd: he received iv pantoprazole while npo and transitioned to po pantoprazole one a diet was resumed. . #. dm ii: metformin and lantus were held due to arf and npo status respectively. patient continued on humalog ss. . #. htn: patient was normotensive. meds continued or held as above. . #. hl: simvastatin was held due to liver injury. . #. depression: home meds continued. . #. ?dementia: home meds continued. . #. code status: full code medications on admission: home meds: malatonin 5/lorazepam 0.5mg qhs advair 500/50 spiriva 1 inhalation daily proair ih prn atenolol 50 mg daily digoxin 0.25 mg daily lisinopril 10 mg daily metformin 1000 mg verapamil 240 mg qam, 120 mg qpm paroxetine 20 mg daily omeprazole 20 mg daily furosemide 80 mg daily simvastatin 80 mg daily coumadin 5 mg daily aricept 10 mg daily lantus unknown dose humalog ss .... discharge medications: 1. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 2. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). 4. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 5. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). 6. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for sob. 8. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 9. verapamil 120 mg tablet sig: two (2) tablet po qam (once a day (in the morning)). 10. verapamil 120 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 11. piperacillin-tazobactam 2.25 gram recon soln sig: one (1) recon soln intravenous q6h (every 6 hours) for 7 days. 12. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 13. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 14. lantus 100 unit/ml cartridge sig: unknown subcutaneous once a day. 15. humalog 100 unit/ml cartridge sig: 2-10 units subcutaneous four times a day: per sliding scale. discharge disposition: extended care discharge diagnosis: primary diagnosis: choledocholithiasis ascending cholangitis secondary diagnosis: coronary artery disease atrial fibrillation copd osa hypertension hyperlipidemia dementia discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - requires assistance or aid (walker or cane) discharge instructions: you were transfered from to for ercp. you underwent this procedure and a temporary stent was placed in your bile duct. you stayed in the icu overnight for monitoring and you did well. do not take coumadin (warfarin), aspirin, plavix (clopidogrel), or non steroidal anti inflammatory drugs (such as ibuprofen or naproxen) for the next 5-7 days. you will need to schedule another ercp in 4 weeks to remove the stent that was placed. you will need to hold your coumadin 5 days before this procedure. you were noted to be in renal failure, so your lasix, digoxin, and lisinopril were held. these can be resumed when your renal function returns to normal. due to your elevated liver function tests, simvastatin and metformin were stopped. you may resume these when your liver function returns to normal. no other changes were made in your medications. followup instructions: please schedule a follow up appointment with your primary care doctor within a week of discharge from the hospital. please schedule a repeat ercp with dr. ( in 4 weeks for stent removal. you will need to stop taking coumadin for 5 days prior to this procedure. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial fibrillation aortocoronary bypass status personal history of tobacco use depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere other and unspecified hyperlipidemia long-term (current) use of insulin long-term (current) use of anticoagulants chronic obstructive asthma with (acute) exacerbation dehydration cholangitis personal history of malignant melanoma of skin acute pancreatitis calculus of gallbladder and bile duct without cholecystitis, with obstruction other dependence on machines, supplemental oxygen lipoma of intra-abdominal organs 

Answer: The patient is high likely exposed to