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 / iodine / quinine / sulfa (sulfonamide antibiotics) attending: chief complaint: cholecystitis major surgical or invasive procedure: ercp percutaneous biliary drain placement history of present illness: 65 yo f with pmhx significant for mds, tonsillar ca (last ctx 4yrs ago) and recently diagnosed cholelithiasis who was transferred from osh after presenting with septic shock and found to have labs remarkable for ast 248, alt 63, tbili 5.3, direct 3.3, wbc 11.1. ruq u/s showed gb wall thickening and pericholecystic fluid that could indicate cholecystitis; cholithiasis present, however no intra- or extra-hepatic biliary dilation and no choledocholithiasis identified. patient required pressors and was intubated in anticipation for ercp. ercp was performed which showed only small amount of sludge, no pus; stent was placed. on a percutaneous cholecystostomy was placed by ir. initially good drainage via perc chole however yesterday noted to be draining ascitic fluid. patient had a ct a/p on to r/o rp bleed due to hematocrit drop which was negative for bleed however did show that perc chole drain was in atypical position. ir evaluated imaging and determined that drain has been dislodged. drain pulled on . new drain not placed as would be difficult per ir now that gall bladder decompressed. patient also with abdominal pain attributed to bile leak. bilirubin had improved but then began to increase again over past two days, now 5. given overall concern for persistent cholecystitis plan is for hida in the am. patient has been on empiric broad spectrum antibiotics with vancomycin/cefepime/flagyl. of note, lfts have been elevated ast/alt ratio > 2. hepatology consulted , thought likely alcoholic hepatitis worsened by sepsis (significant heavy etoh history, currently drinks 3x per day). concern for hep b/c given history of multiple blood transfusions and ivig for mds. viral hep serologies, , ama, antism ab pending. also with esophageal stricture as seen on ercp with possible aspiraton pneumonitis. failed bedside swallow, currently npo, awaiting video swallow. currently patient has no complaints. endorses vague ruq discomfort. no nausea, vomiting or diarrhea. denies any sob or cp. mild cough. past medical history: - tonsillar ca s/p xrt and ctx (last rx 4 years ago, in remission) - mds: on procrit and ivig infusions - gerd - hypothyroidism - s/p cva in - htn - autoimmune demyelinating polyneuropathy social history: lives with daughter, retired high school english teacher - tobacco: quit 14 years ago, 20pack year hx - alcohol: social use - illicits: denies family history: mother: depression, dm, htn father: died of aneurysm physical exam: general: alert, oriented, no acute distress heent: sclera icteric, dry oral mucosa, oropharynx clear neck: supple, distension of external jugular vein lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardia, regular s1 s2 no m/r/g abdomen: soft, non-distended, bowel sounds present, pain to deep palpation in ruq ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cn ii- xii intact, strenth grossly normal, intact to light sensation; left upper extremity intention tremor, cerebellar exam intact by fnf pertinent results: labs on admission: 03:55am wbc-12.7* rbc-2.77* hgb-10.2* hct-28.7* mcv-104* mch-36.8* mchc-35.6* rdw-13.8 03:55am neuts-82* bands-13* lymphs-1* monos-2 eos-0 basos-0 atyps-0 metas-2* myelos-0 03:55am pt-17.3* ptt-39.6* inr(pt)-1.5* 03:55am glucose-103* urea n-27* creat-2.2* sodium-133 potassium-3.6 chloride-101 total co2-17* anion gap-19 03:55am alt(sgpt)-70* ast(sgot)-244* alk phos-131* tot bili-4.8* dir bili-4.1* indir bil-0.7 04:02am lactate-2.2* 04:40am urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 11:15am pt-19.8* ptt-43.9* inr(pt)-1.8* 11:15am fibrinoge-298 ruq u/s: 1. gallbladder wall thickening and pericholecystic fluid, in the setting of cholelithiasis, representing acute cholecystitis. 2. no choledocholithiasis, or intra- or extrahepatic biliary ductal dilatation. cxr: no focal opacity to suggest pneumonia is seen. no pleural effusion or pneumothorax is present. vascular congestion in the lungs and mediastinum is mild, and the lungs are on the verge of edema. the heart size is normal. a right-sided port-a-cath is in place with tip reaching the right atrium ct abdomen/ pelvis: 1. bilateral simple pleural effusions with atelectasis. 2. cholecystostomy tube appears in an atypical position; a call to the team confirmed that it was draining large amount of bilious fluid; if clinical concern for it becoming displaced increases (ie, drainage ceases), a tube check should be considered. this finding was discussed with at 19:30 on by over the phone. 3. small-to-moderate intraabdominal fluid is simple in nature and tracks along paracolic gutters and into the pelvis. no retroperitoneal fluid collections. 4. age indeterminate compression deformities of the l2 and l3 vertebral bodies. 5. cholelithiasis. micro: bile cx: enterococcus sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s penicillin g----------<=0.12 s vancomycin------------ <=0.5 s brief hospital course: 65f w/ hx tonsillar ca, last chemo 4 years ago, p/w septic shock secondary to presumed cholangitis. . # septic shock: presented with hypotension requiring pressors. presumptive source cholangitis based on presentation of fever, jaundice and ruq pain with ultrasound showing gallbladder thickening with pericystic fluid. initially, given pcn allergy, covered with vanc/cipro/flagyl. no evidence of other focal infection such as pna, uti initially, though she later had focal infiltrate and was broadened to vanc/cefepime/flagyl. for cholangitis, had ercp, which did not show definitive source; later had ptc placement given diverticulum and possible etiology of infection. ptc drained copious bile following placement, however then dislodged so it was removed. following removal, pt noted to have increasing abdominal pain, increasing white count though did not meet sirs criteria. she was continued on vanc/cefepime/flagyl with stablization in her wbc, though total bilirubin continued to rise. surgery did not feel cholecystectomy was indicated because repeat imaging did not suggest cholecystitis. ercp likewise did not feel repeat ercp was indicated. pt's vanc/cefepime/flagyl were discontinued on due to absence of signs or symptoms of infection. the patient did not have any clinical evidence of cholangitis. at this time the patient continued to have evidence of severe sepsis. she continued to have a leukocytosis and intermittently slight fevers throughout her course. patient was treated with 4 ventilator associated pneumonia. she was also found to have , none over 10 cc, growing in her sputum, urine, bile. the patient was started on iv micafungin. the patient continued to require iv pressors throughout her entire hospital course and medical icu. we were unable to successfully wean the patient off her pressor support. this most likely was a combination of her liver failure as well as continued septic shock. ultimately this was one of the main cause of her death. during her stay with her complex infectious disease course we obtained infectious disease consultation and they felt the patient for her medical icu stay. . # elevated bilirubin/transaminases: initially fit with picture of cholangitis; however, in the setting of rising tbili despite ptc drain, hepatology was consulted. they felt she may have component of alcoholic hepatitis in setting of long term continued alcohol use. viral serologies, , ama, antism ab were checked. positive with titer 1:40, ama negative, antism antibody negative. hcv also negative. hbsag negative, hbsab positive, hbcab positive suggesting previous infection. hepatitis a positive but igm negative. suspect that much of her presentation now is attributable almost entirely to alcoholic hepatitis. several other serological tests are pending for auto-immune or other causes of hepatitis. pt does not have cirrhosis by ultrasound imaging, which shows essentially normal liver structure. after spending some time in the medical icu the hepatology service question whether this could also be a biliary disease process as well. a percutaneous cholecystostomy tube was placed a second time by interventional radiology. the gram stain of the bile was significant for , non-albican species. patient continued to have liver failure with significant elevations in her total bilirubin. she remained encephalopathic throughout her hospital stay. the hepatology service felt that this was a nonreversible end-stage liver disease with a extremely poor prognosis. they did not believe she was a candidate for liver transplantation. this was ultimately listed as her primary cause of death. # elevated creatinine: admitted with cr of 2.2 from unknown baseline (stable from osh): likely representing acute on chronic kidney disease. represent arf from septic shock, resolved to cr 1.0, however elevated again in setting of diuresis to 1.4. pt is total volume positive 14 l for hospital stay, though feurea 19% suggesting intravascularly depleted, likely chf. patient remained in the near throughout her hospital stay and medical icu. she required both hemodialysis and cvvh throughout the stay. the renal service was following the patient and provided recommendations for her dialysis treatments. . # anemia: pt required 1 unit prbc on . ct a/p was done to eval for rp bleed in setting of intra-abdominal procedures above. ct was negative. anemia otherwise stable and felt to be mds. the patient remains somewhat anemic throughout her stay and there was no clear source for her anemia. most likely secondary to either marrow suppression or anemia chronic disease. patient required multiple blood transfusions throughout her stay for a slow down-trending hematocrit. . # thrombocytopenia: stable, likely mds. the patient continued to have thrombocytopenia throughout her stay. there is no significant bleeding episodes. #altered mental status: patient had significant altered mental status most likely was secondary to hepatic encephalopathy. however she was noted to have some seizure-like activity towards the end of her hospital stay. an eeg was performed and showed evidence of some ictal activity. the patient was started on keppra with some minimal improvement in her mental status. #supraventricular tachycardia: the patient had multiple episodes of a superventricular tachycardia most likely av nodal reentrant tachycardia. the patient was sensitive to carotid massage. she required both ivp to blockade and calcium channel blockers for rate control if carotid massage did not lower her heart rate. during most of these episodes she remained hemodynamically stable. #nutrition: the patient was started on tube feeding shortly after arriving in the medical icu. we continued his to be throughout her stay. nutrition was following and provide daily recommendations for nutrition changes as needed. #respiratory failure: the patient had significant respiratory problems her stay. she required a period of intubation. she was eventually extubated but remained somewhat hypoxic and required high oxygen requirements most of the time she was in the medical icu. her respiratory distress and hypoxia was most likely due to episodes of pulmonary edema as well as a suspected ventilator associated pneumonia. the patient's fluid status was maintained by hemodialysis and she received a treatment of antibiotics for ventilator associated pneumonia. #goals of care: the patient's daughter was her health care proxy. multiple family meeting were held with the health care proxy discussing the patient's clinical status. throughout most of the family meetings the daughter maintained that she wanted to continue full treatment of the patient. on the morning of another family meeting was held with the daughter. at that time the daughter agreed that the patient should be made comfort measures only. the patient was weaned from the pressors and given iv analgesia for comfort. the patient expired shortly after making her cmo. medications on admission: propranolol 300mg daily irbesartan 300mg daily omeprazole 20mg daily vitamin d/ calcium folic acid 1mg daily levothyroxine 75mg magnesium 400mg mvi discharge disposition: expired discharge diagnosis: liver failure septic shock discharge condition: expired procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage arterial catheterization endoscopic insertion of stent (tube) into bile duct insertion of totally implantable vascular access device [vad] percutaneous aspiration of gallbladder transjugular liver biopsy central venous catheter placement with guidance diagnoses: acidosis anemia of other chronic disease end stage renal disease acute and subacute necrosis of liver alcoholic cirrhosis of liver acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism myelodysplastic syndrome, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure septic shock accidents occurring in other specified places hypoxemia streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] encounter for palliative care do not resuscitate status ventilator associated pneumonia accidents occurring in residential institution acute cholecystitis obstruction of bile duct alcohol abuse, continuous other candidiasis of other specified sites acute alcoholic hepatitis radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure chronic inflammatory demyelinating polyneuritis personal history of malignant neoplasm of other and unspecified oral cavity and pharynx diverticulosis of small intestine (without mention of hemorrhage) 

Answer: The patient is high likely exposed to