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 / sulfa (sulfonamide antibiotics) / nsaids / beta-blockers (beta-adrenergic blocking agts) attending: chief complaint: common bile duct transection major surgical or invasive procedure: roux en y hepaticojejunostomy () aortic valvuloplasty on () open tracheostomy with j tube and g tube () history of present illness: mrs. is a 78 woman s/p lap ccy on for gangrenous cholecystitis, complicated by cbd transection. she was discharged from on after satisfactory placement of a 6.3 french biliary drain through her right biliary system through the transected proximal cbd and into the subhepatic space. she was discharged with her ptc open and on ciprofloxacin and micafungin to care and rehabilitation center. the plan was to let the inflammation around her gallbladder fossa and transected cbdsubside and then proceed with surgery to re-establish biliary continuity (likely a rny hepaticojejunostomy). on blood cultures obtained as part of a fever workup returned positive for gram positive cocci in clusters. the patient was started on vancomycin 500mg q12hrs. she presented to clinic today with dr. and admitted for further treatment of her bacteremia. at admission, mrs. reported that she felt tired. she complained of right shoulder pain and non-focal abdominal tenderness. she had some back pain which seemed to be an old issue for her. her last fever of 100.9 was onenight ago per the patient. she denied fevers, chills, nausea, vomiting, diarrhea, anorexia, or abdominal distention. past medical history: htn - dmii - gerd - multiple sclerosis since age 29 - rheumatic heart disease w/ aortic stenosis (moderate aortic stenosis & diastolic dysfunction noted on echo ) with an aortic valve area of 0.8cm2 - arthritis of the cervical and lumbar spine social history: retired homemaker/housewife, lives at home with husband, no children. smoked briefly when she was in her 20s. denies alcohol or recreation/illicit drug use. family history: strong family history of dm, cad and htn physical exam: vitals:t max: 99.7,t curr=97,hr=83,bp= 132/54,rr=17,sat=100%,cmv fio2 .40,tv=340,rr=12,psv=15,peep=10 gen:alert,responds to voice heent:perrl,extrenal occular muscles intact. neck:tracheostomy tube in place chest:decreased breath sounds at the lung bases,no crackles or ronchi cvs:n s1,s2,no m/r/g abdomen:soft, nt, nd. no hsm. feeding tube in place. no abdominal bruits.wound present on r upper quadrant c/d/i. ext:edema present in b/l feet,b/l pt and at palpable pertinent results: echocardiography : there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild global left ventricular hypokinesis (lvef = 45-50 %).the aortic valve leaflets are moderately thickened.there is severe aortic valve stenosis (valve area 0.8-1.0cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened.there is no pericardial effusion. . echocardiography : there is mild symmetric left ventricular hypertrophy. overall left ventricular systolic function is moderately depressed (lvef= 35-40 % secondary to hypokinesis of the septum, anterior free wall, and apex. contractile function of the inferior, posterior, and lateral walls appears relatively well-preserved). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size is normal. with focal hypokinesis of the apical free wall. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is "critical" aortic valve stenosis (valve orifice area approximately 0.7 cm2) (may have low flow/low gradient component). the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the left ventricular ejection fraction and the aortic valve orifice area are further reduced. . chest x ray: et tube tip is in standard position 4.8 cm above the carina. ng tube tip is in the stomach. right ij catheter tip is in the lower svc. cardiac size is top normal. there is no pneumothorax. small bilateral pleural effusions are unchanged. there is no pneumothorax. mild pulmonary edema is unchanged. new right upper lobe opacity could be due to asymmetric pulmonary edema but aspiration is also a possibility . . usg: no portal vein occlusion. right pleural effusion . chest x ray:: mild pulmonary edema in the left lung is unchanged. greater opacification in the right perihilar lung could represent concurrent development of pneumonia. moderate bilateral pleural effusion, right greater than left, is stable. heart size is normal, but mediastinal veins are more engorged indicating greater volume overload. et tube and right internal jugular line are in standard placements and a nasogastric tube passes into the stomach and out of view. no pneumothorax. . chest x ray: in comparison with the study of , the monitoring and support devices remain in place. continued evidence of elevation of pulmonary venous pressure with bilateral pleural effusions. it is difficult to determine whether the opacification in the right perihilar region reflects elevation of venous pressure or possibly a supervening focus of pneumonia. . tube cholangiogram and dobbhoff placement : 1. patent right-sided biliary system without evidence for leak or stenosis. 2. successful placement of dobbhoff feeding tube with post-pyloric position of tip. the tube is ready for use. . echocardiography : there is trace aortic regurgitation. the aortic valve gradient was not assessed. left ventricular systolic function is depressed with apical, mid to distal anteroseptal, anterior and inferior hypokinesis (although regional wall motion was not fully assessed). lv systolic function appears similar to that on the study. . echocardiography : compared with the prior study (images reviewed) of , the aortic valve orifice area is minimally increased. left ventricular contractile function is significantly improved. the increment in aortic valve orifice area is most likely explained by improved left ventricular contractile function (low flow/low gradient aortic stenosis) . chest x ray: impression: worsening pulmonary edema with increasing perihilar opacities and moderate-to-large bilateral pleural effusions. . abdominal fluoro: impression: interval placement of a surgical gastrostomy tube with the tip seen along the right lateral margin of the thoracolumbar spine. . mr head small layering of old blood in the posterior of both lateral ventricles with findings suggestive of communicating hydrocephalus. no mass effect or midline shift. mra brain demonstrates non-visualization of distal right vertebral artery which may be due to this artery ending in pica or due to occlusion in neck. . mra brain the major intracranial vessels are visualized except the right distal vertebral artery. there is subtle flow signal narrowing at right mca bifurcation which may be artifactual or due to mild atherosclerotic disease. the posterior communicating arteries and anterior communicating arteries are visualized. no evidence of aneurysms or vessel occlusions. aica is not visualized. the left pica is visualized. there appears to be a right aica and pica configuration. . chest xray: moderate pulmonary edema has worsened since , accompanied by moderate to large bilateral pleural effusion, increased on the right, stable on the left. heart is borderline enlarged, but the improvement in previous mediastinal vascular engorgement suggests a decrease in intravascular volume or pressure. left internal jugular line tip projects over mid brachiocephalic vein. tracheostomy tube in standard placement. no pneumothorax. drainage catheter in the left upper abdomen is presumably a gastrostomy but cannot be evaluated by this view alone. no pneumothorax. . upper extremity usg: no evidence of deep vein thrombosis in the right arm. . fluoro guid plct: uncomplicated ultrasound and fluoroscopically guided double lumen picc line placement via the right brachial venous approach. final internal length is 41 cm, with the tip positioned in svc. the line is ready to use. . echocardiography : the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is mild to moderate global left ventricular hypokinesis (lvef = 40-45%). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the aortic valve leaflets are mildly thickened. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the right ventricle is seen reasonably well on the current study and appears mildly dilated/hypokinetic. the degree of aortic stenosis and mitral regurgitation are similar. the other findings are similar. fluoro guid plct: uncomplicated ultrasound and fluoroscopically guided 5 french double-lumen picc line placement via the left brachial venous approach. final internal length is 45 cm, with the tip positioned in svc. the line is ready to use. chest xray: tracheostomy tube is in place. a left subclavian picc line is present, tip over distal svc. there is diffuse hazy opacity throughout both lungs which likely represents chf with interstitial and alveolar edema, as well as bilateral layering effusions with underlying collapse and/or consolidation. the cardiomediastinal silhouette is grossly unchanged. tubing noted over upper abdomen, not fully evaluated on this exam. microbiology: bile:enterococcus sp:vre,staphylococcus, coagulase negative:mr blood culture:enterococcus faecium,daptomycin sensitive :feces positive for c. difficile toxin by eia :urine: (torulopsis) glabrata :picc line:staphylococcus, coagulase negative labs: :wbc:8.01 hb: 9.0* hct:28.5* platelets: 388 :wbc:10.4 hb: 8.5* hct:27.4* platelets: 324 :wbc:23.1 hb: 9.2* hct: 29.2*platelets: 292 :wbc:12.3 hb: 9.2* hct: 30.3*platelets: 171 :wbc14.3* hb:7.6 hct: 23.8*platelets: 266 :wbc:4.6 hb:9.6* hct: 31.5*platelets: 347 :wbc:8.8 hb:9.9* hct:31.0*platelets: 324 :wbc7.9 hb:10.1* hct:30.6* platelets: 182 :wbc9.4 hb:9.6* hct:29.8* platelets: 229 :wbc8.2 hb: 9.2* hct:28.4* platelets: 257 :gl:61bun:19 cr:1.5* na:137 k:4.7 cl:99 co2:28 :gl:127bun:23*cr:1.4* na:137 k: 4.4*cl: 102*co2: 26 :gl:167bun:167*cr:1.3* na:137 k: 4.4*cl: 105*co2: 20 :gl:159bun:24*cr:3.0* na:136 k:4.2 cl:101 co2:22 :gl:215 bun:85*cr:1.9*na: 137 k: 3.9 cl:98 co2:27 :gl:247 bun:69*cr: 1.3*na: 150*k: 3.6cl:116*co2: 23 :gl:205 bun: 30*cr: 1.2*na: 143k: 4.0 cl: 114*co2: 20* :gl:239 bun: 32*cr: 0.7 na:139 k:4.4 cl:112* co2:21* :gl:103 bun: 56*cr: 1.3*na: 150k: 3.9 cl:113* co2:26 :gl:158 bun:75*cr: 1.4* na:139 k:4.3 cl:108 co2:22 :gl:158 bun:75*cr: 1.4* na:139 k:4.3 cl:108 co2:22 alt:128* ast:70* alk phos:475* tuberculosis:1.1 alt:63* ast:132* alk phos:772* tuberculosis: 1.1 alt: 367*ast:1475* alk phos:217* tuberculosis: 4.2* alt:57* ast:74* alk phos:348* tuberculosis:6.1* alt: 29 ast:32 alk phos:221* tuberculosis: 1.8* alt:22 ast:28 193 alk phos:395* tuberculosis: 2.0* alt:48* ast:36 162 alk phos:305* tuberculosis: 1.3 alt:69* ast:39 alk phos:384* tuberculosis: 0.8 alt:72* ast:42* 197 alk phos:431*tuberculosis: 0.7 16:09 art po2251* pco234* ph7.42 caltco2 23 base xs -1 05:25 art po2109* pco250* ph7.24*1 caltco2 22 base xs -6 03:07 art po2115* pco244 ph7.45 caltco2 32*base xs 6 04:09 art po2127* pco241 ph7.37 caltco2 25 base xs-1 11:42 art po2112* pco238 ph7.39 caltco2 24 base xs-1 03:01 art po2144* pco234* ph7.40 caltco2 22 base xs-2 16:32 art po2134* pco234* ph7.36 caltco2 20* base xs-5 03:11 art po2116* pco241 ph7.38 caltco2 25 base xs0 14:59 art po2159* pco236 ph7.37 caltco2 22 base xs-3 brief hospital course: the patient was admitted to the on the . neuro:the patient had an episode of pupillary asymmetry, reactive bilaterally, and decreased r arm movementon . the pupillary asymmetry had resolved spontaneously. she had intermittent spontaneous limb movements, l>r, fluctuations in alertness and ability to follow commands. mri showed evidence of communicating hydrocephalus without midline shift, intraventricular fluid collections; lp did not show evidence of anyacute sah or infection.as per neurology, it is not possible todelineate the time course of this patient's hydrocephalus, which could be chronic or subsequent to resolved sah or infection over the course of her multiple hospitalizations. her mental status has been stable,she is alert and responds to opens eyes to voice. respiratory:after her operation on ,she was briefly extubated but had to be reintubated because of desaturation.the patient failed repeated tries of extubation.she underwent open tracheostomy on . however she failed to improve even after her tracheostomy.her chest xray over the last 2 months showed increasing pulmonary edema.she also developed repeated pleural effusions that were drained thrice during her hospital stay.her pleural fluid were negative on culture.on the day of discharge she was on a regimen with cpap during the day and cmv during the night. cvs: the patient was started on pressors (phenyleperine,vasopressin and milrinone) postoperatively for hypotension which were subsequently weaned off.her echo on showed lvef= 35-40 % secondary to hypokinesis of the septum, anterior free wall, and apex.she underwent a aortic valvuloplasty on for a as w/ of 0.6 cm2 pre valvuoplasty and 0.7 cm2 post valvuoplasty.her ef remained low to 40% on her most recent echo on . gi:the patient underwent a roux-en-y hepaticojejunostomy performed .however she went to septic shock post op and was started on tubefeeds via dobhoff.she underwent a cholangiogram on which showed no leak. she underwent a gtube and j tube placement on and is being fed on through the j tube since then. gu:the patient went into acute renal failure.however over the course the patient recovered spontanously with ivf resuciataion. id:the patient has been on ciproflocacin prophylaxis for her biliary drain.she was treated with vancomycin for 5 days after admission for positive blood cultures.post op the patient recieved meropennem for 15 days. the patient also had c diff infection for which she recieved flagyl for 12 days.the patient also recieved fluconazole for positive fungal cultures from urine.the patient also had positive coag. negative staph. cultures on from her picc line and was restarted on vancomycin. hematology: the patient recieved multiple blood transfusions postoperatively after her gastrojujenostomy.her hct has been largely stable since then. ` medications on admission: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 2. clotrimazole 1 % cream sig: one (1) appl vaginal hs (at bedtime) for 1 days. 3. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 4. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 6. humulin 70/30 100 unit/ml (70-30) suspension sig: thirty (30) units subcutaneous twice a day. 7. insulin regular human 100 unit/ml solution sig: per sliding scale injection four times a day: follow sliding scale. 8. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours): continue while drains are in place. 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 10. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush: picc care. 11. morphine 5 mg/ml solution sig: one (1) mg injection q4h (every 4 hours) as needed for pain. 12. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) mg injection every eight (8) hours as needed for nausea. 13. micafungin 100 mg recon soln sig: one hundred (100) mg intravenous q24h (every 24 hours): via picc line. discharge medications: 1. maalox advanced 200-200-20 mg/5 ml suspension sig: five (5) ml po qid (4 times a day) as needed for rbuccal lesion pain: swish and spit. disp:*100 ml(s)* refills:*2* 2. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). disp:*2 bottles* refills:*2* 3. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). disp:*900 ml(s)* refills:*2* 4. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for mouth. disp:*500 ml(s)* refills:*0* 5. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 4-6 puffs inhalation q4h (every 4 hours) as needed for wheezing. disp:*2 inhalers* refills:*0* 6. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal prn (as needed) as needed for hemorrhoids. disp:*2 tubes* refills:*0* 7. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed) as needed for dry eyes. disp:*2 bottles* refills:*0* 8. pantoprazole 40 mg recon soln sig: forty (40) recon soln intravenous q24h (every 24 hours). disp:*1200 recon soln(s)* refills:*2* 9. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) iu injection three times a day. 10. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush: picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 11. insulin regular human 100 unit/ml (3 ml) insulin pen sig: sliding scale subcutaneous four times a day: please follow sliding scale. 12. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours). discharge disposition: extended care facility: discharge diagnosis: cbd transection on ventillator discharge condition: mental status: on ventillator. level of consciousness:lethargic but arousable. activity status: bedbound. discharge instructions: please call dr. office if you have any of the warning signs listed below:fever greater than 101,redness that is spreading,pain not adequately relieved with medication,drainage from wound,opening of incision,tachypnoea,wheezing,blood in stool,black stool. wound care:change abdominal wound dressings with wet to dry dressing twice a day. blood sugar:finger sticks qid ventillation settings:the patient is ventillator dependant.keep the patient on cpap during day and cmv during night. cpap settings:mechanical ventilation: cpap w/ & w/o ps consult respiratory therapy pressure support level: 18 cm/h2o peep: 10 cm/h2o fio2: 40 % cmv settings:mechanical ventilation: cpap w/ & w/o ps pressure support level: 18 cm/h2o peep: 10 cm/h2o fio2: 40 % ac 40% 350x16+10 @ 2000h followup instructions: -follow up appointment in1 weeks time would be set up by (ph:,coordinator for dr . md, procedure: spinal tap incision of lung parenteral infusion of concentrated nutritional substances other enterostomy enteral infusion of concentrated nutritional substances hemodialysis thoracentesis thoracentesis thoracentesis temporary tracheostomy other gastrostomy other cholangiogram other cholangiogram anastomosis of hepatic duct to gastrointestinal tract percutaneous balloon valvuloplasty replacement of stent (tube) in biliary or pancreatic duct central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux acute kidney failure with lesion of tubular necrosis other postoperative infection diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other chronic pulmonary heart diseases sepsis chronic kidney disease, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure bacteremia surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of insulin septic shock intestinal infection due to clostridium difficile other specified disorders of biliary tract disseminated candidiasis multiple sclerosis hyperosmolality and/or hypernatremia other and unspecified infection due to central venous catheter streptococcal septicemia cholangitis rheumatic aortic stenosis communicating hydrocephalus perforation of bile duct 

Answer: The patient is high likely exposed to