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: bactrim / aspirin / nsaids attending: chief complaint: ruq pain and hypotension major surgical or invasive procedure: picc line placement history of present illness: 52m w/ hx of psc s/p open cholecystectomy, roux-en-y hepaticojejunostomy (), stage ib pancreatic neuroendocrine tumor, recurrent ruq pain presents w/ 4 to 5 days of worsening ruq pain. today his pain increased and he developed nausea, fever to 102.7f, decreased appetitite, and "feeling septic" in the early afternoon. after contacting his hepatologist (dr. he presented to the ed for evaluation. . he was most recently evaluated by dr. in early where he reported ongoing low-grade temps to 99f, ruq discomfort, pale stools, dark urine, occasional pruritis. he does experience intermittent exacerbation of similar symptoms for which he takes ciprofloxacin, but he was changed to levofloxacin for better gram positive coverage and scheduled for 6 months follow up w/ mrcp at that time to evalute for disease progression. . in the ed, initial vs were: 101.3 120 111/69 20 100%. he was started on vancomycin and unasyn. around 7pm he became hypotensive to sbp upper 80's and felt light-headed. 18g and 16g peripheral ivs were started and he was given 4l ivf w/ bp incrasing to 96/54. throughout his lactate remained unelevated and he quickly felt better. he was admitted to the icu given concern for possible cholangitis w/ hypotension. . on arrival to the micu, his pain had decreased and he was otherwise feeling well. his blood pressure sbp was stable in the low 100's. . review of systems: - negative except as noted in hpi past medical history: 1. primary sclerosing cholangitis s/p open cholecystectomy, common bile duct excision, liver biopsy, and roux-en-y hepaticojejunostomy on , admitted every wks for flairs, usually responsive to abx. 2. s/p ptc placement times two. 3. recurrant utis, with negative urology workup in past. 4. depression. 5. anxiety disorder. 6. hx of hep b, hep a. 7. hx of lyme disease 8. papillary urothelial carcinoma in . social history: patient in monogamous relationship, lives with male partner , currently sexually active. does not use condoms with intercourse. no hx of stds in himself or his partner. history of tobacco or alcohol. no ivdu. family history: no history of utis, kidney stones, or other kidney pathology. physical exam: admission physical exam: vitals: t 99.0, 98/57, 85, 17 98%ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, no jvd cv: regular rate, no m/r/g lungs: no resp distress, very mild crackles at lung bases bilaterally, otherwise ctab abdomen: soft, non-tender, non-distended, bowel sounds present gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: grossly intact pertinent results: admission labs: 05:35pm blood wbc-16.2*# rbc-4.30* hgb-13.4* hct-39.3* mcv-91 mch-31.0 mchc-34.0 rdw-12.6 plt ct-387 05:35pm blood neuts-85.5* lymphs-8.4* monos-5.4 eos-0.5 baso-0.2 05:35pm blood glucose-108* urean-8 creat-0.7 na-135 k-3.9 cl-99 hco3-27 angap-13 05:35pm blood alt-97* ast-82* alkphos-247* totbili-1.2 05:35pm blood lipase-33 05:35pm blood albumin-4.0 05:55am blood calcium-8.3* phos-3.2 mg-2.1 05:48pm blood lactate-1.3 12:33am urine color-straw appear-clear sp -1.003 12:33am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg . micro: blood and urine cultures no growth to date . imaging: liver/gallbladder u/s findings: preliminary reportthe liver demonstrates coarse echotexture without discrete lesions. there is preliminary reportno evidence of intrahepatic or extrahepatic biliary ductal dilatation. cbd is preliminary reportof normal caliber measuring 5 mm. the portal vein is patent demonstrating preliminary reporthepatopetal flow. there is no ascites. gallbladder is surgically absent. preliminary reportpancreas is obscured by overlying bowel gas. preliminary reportimpression: preliminary reportcoarse liver echotexture, which likely represents underlying fibrosis, better preliminary reportcharacterized on mrcp exam of . no discrete hepatic lesion. . cxr: comparison: . pa and lateral views of the chest: the cardiac, mediastinal and hilar contours are normal. the pulmonary vascularity is normal and the lungs are clear. no focal consolidation, pleural effusion or pneumothorax is present. there are mild degenerative changes of the thoracic spine with anterior osteophyte formation. impression: no acute cardiopulmonary abnormality. brief hospital course: mr. is a 52 year old male with a history of primary sclerosing cholangitis (psc) status post open cholecystectomy, roux-en-y hepaticojejunostomy (), stage ib pancreatic neuroendocrine tumor, recurrent right upper quadrant (ruq) abdominal pain who presented with 4 to 5 days of worsening ruq pain. . # ruq pain: given fever, leukocytosis, ruq pain, and liver enzyme elevation suggestive of obstructive biliary pathology, cholangitis was high on the differential, however ultrasound did not show any evidence of common bile duct (cbd) dilation; pt also with normal lactate. hepatology saw patient in ed and it was decided that ercp was not indicated. the patient was started on iv vancomycin/unasyn for cholangitis treatment. he was also continued on his home ursodiol and pain regimen. his pain resolved in one day and he never developed any criteria of sepsis. vancomycin was discontinued and a picc line was placed. he was sent home with vna to receive 6 more days of unasyn and then was to continue with 7 days of augmentin. . # hypotension: the patient had brief episode in ed responsive to ivf bolus, but while in the micu had no recurrent episodes. possibly related to transient bacteremia within biliary system. he was continued on iv antibiotic treatment. . # mild rales bilaterally. patient has no history of heart failure, but he was given 4l of total ivf in the ed prior to admission. he was not diuresed while in the micu. . # depression/anxiety: the patient was continued on his home wellbutrin and citalopram. . transitional issues: mr. was sent home with vna services for assistance with his picc line and iv antibiotic therapy. he has follow up appointments with his pcp and the liver transplant center. medications on admission: - bupropion hcl 100 mg - citalopram 20 mg daily - gabapentin 100 mg - metoclopramide 5 mg tid prn nausea - oxycodone 5 mg q6h prn pain - ursodiol 1500 mg daily - acetaminophen 650 mg tablet extended release, 2 tabs prn - famotidine unknown dosage discharge medications: 1. ampicillin-sulbactam 3 gram recon soln sig: three (3) gram injection q6h (every 6 hours) for 5 days. disp:*60 gram* refills:*0* 2. picc line dressing please change picc line dressing weekly and prn 3. bupropion hcl 100 mg tablet sig: one (1) tablet po bid (2 times a day). 4. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 5. gabapentin 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 7. metoclopramide 5 mg tablet sig: one (1) tablet po three times a day as needed for nausea. 8. ursodiol 300 mg capsule sig: three (3) capsule po qam (once a day (in the morning)). 9. ursodiol 300 mg capsule sig: two (2) capsule po qpm (once a day (in the evening)). 10. famotidine 20 mg tablet sig: two (2) tablet po daily (daily). 11. augmentin 875-125 mg tablet sig: one (1) tablet po twice a day for 7 days: start after iv antibiotics are complete. disp:*14 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: acute cholangitis primary sclerosing cholangitis depression/anxiety discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure taking care of you at . you were admitted to the hospital with abdominal pain and fevers. you have been started on iv antibiotics to treat an infection in your abdomen involving your liver. an iv line was placed in your arm for home antibiotic administration. you will need 5 more days of iv ampicillin-sulbactam every 6 hours. once this is complete you should start taking augmentin 875-125mg twice per day for 7 days. the following changes have been made to your medications: start: ampicillin-sulbactam 3grams via iv every 6 hours for five more days augmentin 875-125mg take one tablet twice per day for 7 days once iv antibiotics are complete followup instructions: name: , d. location: associates of health address: , 2nd fl, , phone: appointment: friday 10:20am department: liver center when: friday at 3:20 pm with: , md building: lm campus: west best parking: garage md procedure: central venous catheter placement with guidance diagnoses: esophageal reflux personal history of other infectious and parasitic diseases dysthymic disorder hypotension, unspecified cholangitis backache, unspecified biliary cirrhosis 

Answer: The patient is high likely exposed to