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: no known allergies / adverse drug reactions attending: chief complaint: abdominal pain major surgical or invasive procedure: ercp with common bile duct stone removal and sphincterotomy history of present illness: mrs. is an 83 year-old female with unknown past medical who comes with abdominal pain. she was in her prior state of health, until earier today when a neighbor found her with abdominal pain and brought her to emergency room. she had some nausea and vomiting and altered mental status. in the ed she had stable vs (per report) and labs significant for wbc 5, hct 13, plt 237, inr 1.1, ast 483, alt 349, tuberculosis 6.8, bun 15, cr 0.9, na 137, k 4, cl 100, co2 25, trop t <0.01, negative ua. she underwent a ruq us, which showed biliary duct dilation. she was admitted to the surgery team and received iv unasyn and gentamycin. she was stable and transfered to for ercp. past medical history: unknown. social history: she lives by herself with a friend checking on her in ri. she has history of smoking, but denies any current smoking. denies any alcohol or illegal substance use. normally independent with adls. family history: non-contributory. physical exam: vs: t: 96.5, bp: 125/61, hr: 83, rr: 16, spo2: 98%ra general: well-appearing woman in nad, comfortable, appropriate heent: nc/at, perrl, eomi, sclerae anicteric, mmm, op clear, poor dentition neck: supple, no thyromegaly, no jvd, no carotid bruits lungs: ctab, no wheezes, rales or rhonchi, good air movement, resp unlabored, no accessory muscle use heart: rrr, no mrg, nl s1, s2 abdomen: soft/nt/nd, +bs, no masses or hsm, no rebound/guarding. extremities: wwp, no c/c/e, 2+ peripheral pulses (radials, dps), l hallux with ingrown toenail s/p trimming by podiatry, resolved erythema skin: no rashes or lesions lymph: no cervical or supraclavicular lad neuro: awake, a&ox1 (person), cns ii-xii grossly intact, muscle strength 5/5 throughout, sensation grossly intact throughout, dtrs 2+ and symmetric, gait not evaluated pertinent results: admission labs -------------- 03:08am blood wbc-7.5 rbc-3.68* hgb-12.0 hct-35.4* mcv-96 mch-32.6* mchc-33.8 rdw-13.4 plt ct-261 03:08am blood neuts-77.6* lymphs-13.9* monos-7.6 eos-0.4 baso-0.5 03:08am blood pt-13.6* ptt-26.2 inr(pt)-1.2* 03:08am blood alt-369* ast-379* alkphos-126* amylase-174* totbili-2.3* 03:08am blood lipase-349* 03:08am blood albumin-3.7 calcium-8.9 phos-2.6* mg-2.1 imaging ------- ercp impression: - severe iv esophagitis and moderate stricture was noted at the gej. - the duodenoscope was not able to traverse the lesion. - a gastroscope was used to balloon dilate the gej stricture to 12mm, 13.5mm and 15mm with positive heme noted. - the duodenoscope was then able to traverse the stricture with minimal resistance. - no mass was noted at cardia/gej. - normal major papilla - cannulation of the biliary duct was performed with a sphincterotome using a free-hand technique - a moderate diffuse dilation was seen at the biliary tree with the cbd measuring 14 mm. - an approximately 5mm filling defect suggestive of a stone was noted in the distal cbd. - an approximately 3-4mm stone was noted in the cystic duct. - gallbladder was not visualized. - a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. - a balloon sphincteroplasty was performed to 10mm successfully to extend the sphincterotomy. - the 5mm stone and some sludge was extracted with a balloon catheter. - excellent drainage of bile and contrast was noted chest x-ray (portable ap): heart size is top normal. mediastinal contours are grossly unremarkable. questionable left hilar enlargement is present that might be further evaluated with bilateral ap shallow obliques to exclude the possibility of left hilar mass. lungs are essentially clear. there is no pleural effusion or pneumothorax. microbiology ------------ urine culture (final ): escherichia coli. 10,000-100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s blood culture : no growth blood culture : no growth mrsa screen (final ): no mrsa isolated. rapid plasma reagin test (final ): nonreactive. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. brief hospital course: # gallstone pancreatitis: patient had an unremarkable exam, with 2 criteria giving a 1% mortality. it is unclear if she has had episodes of pancreatitis before. she was given morphine for pain control and liberal iv fluids. she was made npo, and taken for ercp soon after admission, upon which a 3-4 mm common bile duct stone was noted. her lfts and amylase elevation resolved. her diet was advanced steadily and she was tolerating a soft mechanical diet on discharge. # cholangitis: patient had dilated common bile duct on ultrasound, and ruq pain, with labs suggestive of biliary obstruction. had choledocholithiasis on ercp. she was afebrile and with stable vital signs, but was placed on ampicillin/sulbactam for presumptive cholangitis for planned 7-day course. however, on work-up of her delirium she was found to have a uti that had intermediate resistance to unasyn, so her antibiotics were changed to ceftriaxone and metronidazole and later cefpodoxime and metronidazole. she received a total of 10 days of antibiotics. # toxic-metabolic encephalopathy: patient was noted to have hyperactive delirium following her ercp, most likely in the setting of infection. she was treated with ampicillin/sulbactam for presumed cholangitis. she was given intravenous fluids for hydration, re-oriented frequently, and sensory environment was optimized. patient required intermittent doses of haloperidol for agitation. she continued to have delirium and was transferred to the medicine service for further management. work up was positive for uti, constipation and vitamin b12 deficiency. she was treated for all 3, but her symptoms did not improve. initially she was not responsive to zyprexa during periods of agitation, so seroquel and trazadone were started qhs. she had two episodes of unresponsiveness after the first night (details described below), so these medications were discontinued. her mental status continued to wax and wane during admission, however, patient became more calm and less hyperactive overall and was not on any psychoactive medications at discharge. it is unclear what her baseline was prior to admission, however, it is likely that she had baseline dementia given her current mental status. # unresponsiveness: patient had an episode of unresponsiveness on . she was doing well early during pre-rounds and then around 10:30am she became more somnolent and was not responsive to sternal rub; only responded to nail bed pressure. fsbg was 121, ekg was unchanged, o2 sat was 97-99% on room air. she was sensitive to movements and retracted when her legs were flexed. she developed some rhythmic movements of her lower extremities. there was no bowel or bladder incontinence. it was thought that maybe this was a delayed reaction to the seroquel 12.5mg and trazadone 25mg po that she had received the previous night. there was also concern for a seizure. she recovered from this episode after 1.5 hours and then was back in her baseline delirious state. this occurred again later that afternoon. stat eeg was ordered and neurology was consulted. after the second event, there was increased concern for siezure, however, eeg did not reveal seizure activity and neurology did not think that this was consistent with seizure. all psychotropic medications were discontinued. these episodes did not recur. # urinary tract infection: patient was found to have a urinary tract infection, which likely contributed to her delirium. she was treated with a 7-day course of cefpodoxime. # ingrown toenail: patient had ingrown left hallux that was trimmed by podiatry. no evidence of infection. # guardianship: during this admission, patient's granddaughter, , was named her temporary guardian. # dvt prophylaxis: patient received heparin products during this admission. # code status: full code. this was discussed with her granddaughter. medications on admission: none. discharge medications: 1. b-12 dots 500 mcg tablet : two (2) tablet po once a day. 2. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 3. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 4. acetaminophen 325 mg tablet : two (2) tablet po every four (4) hours as needed for fever or pain. 5. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 6. senna 8.6 mg tablet : two (2) tablet po bid (2 times a day) as needed for constipation. 7. polyethylene glycol 3350 17 gram/dose powder : one (1) dose po daily (daily) as needed for constipation. discharge disposition: extended care facility: at discharge diagnosis: primary diagnoses: # choledocholithiasis # cholangitis # gallstone pancreatitis # urinary tract infection # acute toxic metabolic encephalopathy secondary diagnosis: # dementia discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: # you were admitted to the hospital for abdominal pain and found to have a stone obstructing your common bile duct. you had a procedure known as an ercp and the stone was removed. you will likely need to have surgery to remove your gallbladder. # you were also found to have a urinary tract infection, which was treated with a 7-day course of cefpodoxime. # you had an ingrown toenail (left, 1st toe) that was trimmed by podiatry. you should see a podiatrist if you have recurrent pain. # we made the following changes to your medications: - started vitamin b12, thiamine & lansoprazole - started acetaminophen as needed for pain - started colace, senna & miralax as needed for constipation # it is important that you take all of your medications as prescribed and keep all of your follow up appointments. followup instructions: **please call dr. office (surgeon) to schedule an appointment in the next 7-10 days (tel: ).** procedure: other gastroscopy endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy dilation of esophagus diagnoses: urinary tract infection, site not specified toxic encephalopathy other persistent mental disorders due to conditions classified elsewhere other b-complex deficiencies constipation, unspecified esophagitis, unspecified antidepressants causing adverse effects in therapeutic use cholangitis acute pancreatitis stricture and stenosis of esophagus other alteration of consciousness calculus of bile duct without mention of cholecystitis, with obstruction other antipsychotics, neuroleptics, and major tranquilizers causing adverse effects in therapeutic use ingrowing nail 

Answer: The patient is high likely exposed to