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: erythromycin base attending: chief complaint: abdominal pain major surgical or invasive procedure: : procedure: 1. remnant cholecystectomy. 2. takedown, cholecystoduodenal fistula. 3. gastroscopy. 4. gastrojejunostomy. 5. liver biopsy. history of present illness: 54f with complicated biliary tract disease seen in for gangrenous cholecystitis s/p ptc after an aborted open . post-op course complicated by abdominal wall abscess and intraabd fluid collections s/p reexploration and surgical drainage in . pt presented to osh with severe abdominal pain with n/v. osh ct showed air-fluid level in remnant gb fossa, inflammatory changes in d1/d2 and a developing cholecystoduodenal fistula. no air seen in biliary tree. osh egd notable for abnormal ulcer v. fistula orifice in duodenal bulb. osh kub showed no obstruction/free air. pt was afvss with downtrending wbc from 13.6 during osh admission and was conservatively managed with pain medication and adat, no abx. per report, pt tolerating po intake prior to discharge with + bowel function. she was transferred to for further management. past medical history: pmh: dm2, cva with l hemiplegia, sz d/o, htn, depression psh: partial , ptc, ex-lap and surgical drainage of abd wall abscess, craniotomy, r rotator cuff repair. social history: married family history: noncontributory physical exam: discharge physical exam: gen: axox3, r facial droop cv: rrr no m/r/g pulm: ctab abd: bilateral subcostal incision with small areas opened and packed with dry gauze and covered with dry dressing. ruq jp drain to bulb suction, site covered with dry dressing and c/d/i ext: wwp, no edema, 2+pulses pertinent results: 07:00am blood wbc-13.7* rbc-5.41* hgb-13.7 hct-42.7 mcv-79* mch-25.3* mchc-32.0 rdw-16.0* plt ct-172 07:00am blood glucose-276* urean-8 creat-0.5 na-139 k-3.8 cl-101 hco3-30 angap-12 07:00am blood albumin-3.3* calcium-8.2* phos-3.2 mg-1.9 9:00 am serology/blood **final report ** helicobacter pylori antibody test (final ): negative by eia. (reference range-negative). 11:44 pm urine source: catheter. **final report ** urine culture (final ): no growth. 11:26 pm blood culture source: line-picc. **final report ** blood culture, routine (final ): no growth. 8:47 pm mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. ekg: sinus rhythm. normal tracing. no previous tracing available for comparison. pathology examination name birthdate age sex pathology # , g 54 female report to: dr. description by: dr. , dr. . wenson/mtd specimen submitted: liver nodule, fistula wall. procedure date tissue received report date diagnosed by dr. /ttl diagnosis: liver nodule, wedge biopsy: 1. bile duct hamartoma. 2. scant, subjacent hepatic parenchyma with macrovesicular steatosis, mild inflammation and focal ballooning degeneration; see note. note: the hepatic parenchymal findings are suggestive of a toxic/metabolic injury, but there is insufficient liver tissue for further evaluation. clinical correlation is recommended. clinical: gallbladder fistula. chest cta: impression: 1. substantial bibasilar atelectasis, small left pleural effusion, and earlier pulmonary edema, appreciably cleared now, are sufficient to explain hypoxia. there are no central pulmonary emboli. examination is technically inadequate to exclude segmental and smaller emboli. 2. right lower endotracheal nodule or desiccated secretions. when feasible this region can be examined by repeat, directed ct scanning to see if bronchoscopy is indicated. ct abd: impression: 1. evidence of free air in the abdomen which may relate to recent surgery or presence surgical drain. stranding within and adjacent to the operative bed with small amount of free fluid with peritoneal enhancement but no organized fluid collection. findings are compatible with postoperative changes. there is no definite evidence of leak in the form of contrast extravasation. 2. apparent gastric wall thickening and mucosal enhancement may represent gastritis. 3. thickening of the adjacent colon may represent secondary focal colitis. 4. 12-mm left adrenal nodule is not characterized in this study. 5. intermediate density lesion in the upper pole of the left kidney most likely represents a cyst. 6. bilateral pleural effusion, left greater than right with associated compressive atelectasis. white blood cells 12.8* 4.0 - 11.0 k/ul performed at west stat lab red blood cells 3.47* 4.2 - 5.4 m/ul performed at west stat lab hemoglobin 8.6* 12.0 - 16.0 g/dl performed at west stat lab hematocrit 27.0* 36 - 48 % performed at west stat lab mcv 78* 82 - 98 fl performed at west stat lab mch 24.7* 27 - 32 pg performed at west stat lab mchc 31.7 31 - 35 % performed at west stat lab rdw 15.9* 10.5 - 15.5 % performed at west stat lab basic coagulation (pt, ptt, plt, inr) platelet count 245 150 - 440 k/ul glucose 155* 70 - 100 mg/dl if fasting, 70-100 normal, >125 provisional diabetes performed at west stat lab urea nitrogen 13 6 - 20 mg/dl performed at west stat lab creatinine 0.3* 0.4 - 1.1 mg/dl performed at west stat lab sodium 138 133 - 145 meq/l performed at west stat lab potassium 4.3 3.3 - 5.1 meq/l performed at west stat lab chloride 105 96 - 108 meq/l performed at west stat lab bicarbonate 26 22 - 32 meq/l performed at west stat lab anion gap 11 8 - 20 meq/l chemistry calcium, total 8.4 8.4 - 10.3 mg/dl performed at west stat lab phosphate 3.0 2.7 - 4.5 mg/dl performed at west stat lab magnesium 1.9 1.6 - 2.6 mg/dl performed at west stat lab brief hospital course: the patient s/p subtotal cholecystectomy after a cholecystostomy tube and also subsequent drainage of a subhepatic abscess. now she is present with evidence of a cholecystoduodenal fistula, a chronic cholecystitis picture, and partial gastric outlet obstruction. patient was admitted on general surgery service, she was started on iv antibiotics and tpn s/t po intolerance. on , the patient underwent remnant cholecystectomy, cholecystoduodenal fistula takedown, gastroscopy, gastrojejunostomy and liver biopsy, which went well without complication (reader referred to the operative note for details). after a brief, uneventful stay in the pacu, the patient arrived on the floor npo, on iv fluids and antibiotics, with a foley catheter, and dilaudid pca for pain control. patient was continue on tpn post operatively. the patient was hemodynamically stable. neuro: the patient has a history of cva with left sided hemiplegia and seizure disorder. she was started on keppra iv for seizure control after admission, and she remains neurologically stable throughout hospital stay. for pain control the patient received iv dilaudid. immediately after surgery, patient was started on pca, by shortly failed to operate the pca pump, and was transferred on iv regiment. cv: the patient has had several episodes of sinus tachycardia prior surgery with hr up to 110s, several ekg were obtained and were normal. after surgery patient developed persistent tachycardia with hr up to 140, patient remained asymptomatic with normal urine output. increased metoprolol didn't help to improve patient's hr, patient was transferred in icu for observation. chest cta was negative for pulmonary emboli, blood gases were grossly normal. on patient was transferred back on the floor, she continue to have sinus tachycardia with hr up to 115s without any symptoms of cardiac discomfort. patient was kept on telemetry for close observation. pulmonary: on cta patient was found to have right lower endotracheal nodule or desiccated secretions, patient will follow up with her pcp regarding this finding after her discharge. the patient remained stable from a pulmonary standpoint; vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. gi/gu/fen: on admission patient was started on tpn s/t partial gastric outlet obstruction and unability to tolerate po. post-operatively, the patient was continue on tpn. she may take only sips for comfort po. on pod # 8, jp amylase was sent and result was , patient was started on octreotide 100 mcg q8h. jp was left in place. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. id: the patient's white blood count and fever curves were closely watched for signs of infection. patient was afebrile during hospital stay, and all cultures were negative. after removing surgical staples, patient's wound has several superficial openings which require wet-to-dry packing twice a day. patient was treated empirically, her antibiotics were discontinued prior discharge. endocrine: patient has a history of poor controlled diabetes. on admission she was found to have fs between 170-320. she was started on sliding scale insulin. blood sugar was continue to be high, sliding scale was increased, and patient was started on insulin lantus. after starting tpn for nutrition, fs started to rise again. was called for consult, their recommendations were followed. currently, patient continue on tpn insulin, sliding scale and lantus with fs within normal limits. after discharge patient will follow up with her endocrinologist. hematology: the patient's complete blood count was examined routinely; no transfusions were required. prophylaxis: the patient received subcutaneous heparin and venodyne boots were used during this stay; was encouraged to get up . at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: meds: aggrenox'', klonopin 0.5'', cymbalta 60, keppra 500'', metoprolol 25'', trazadone 100qhs discharge medications: 1. trazodone 50 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for sleep. 2. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). 3. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 4. octreotide acetate 100 mcg/ml solution sig: one (1) injection q8h (every 8 hours). 5. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 6. insulin glargine 100 unit/ml solution sig: twenty five (25) subcutaneous at bedtime. 7. insulin regular human 100 unit/ml (3 ml) insulin pen sig: 6-40 units subcutaneous as directed. 8. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for anxiety. 9. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime). 10. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. metoprolol tartrate 25 mg tablet sig: tablet po bid (2 times a day). 13. hydromorphone 2 mg tablet sig: 1-3 tablets po q3h (every 3 hours) as needed for pain. 14. ondansetron 4 mg iv q8h:prn nausea discharge disposition: extended care facility: - discharge diagnosis: 1. cholecystoduodenal fistula 2. uncontrolled diabetes discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: please call your doctor or nurse practitioner if you experience the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. jp drain care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *maintain suction of the bulb. *note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or nurse if the amount increases significantly or changes in character. *be sure to empty the drain frequently. record the output, if instructed to do so. *you may shower; wash the area gently with warm, soapy water. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. picc line: *please monitor the site regularly, and your md, nurse practitioner, or nurse if you notice redness, swelling, tenderness or pain, drainage or bleeding at the insertion site. * your md to the emergency room immediately if the picc line tubing becomes damaged or punctured, or if the line is pulled out partially or completely. do not use the picc line in these circumstances.please keep the dressing clean and dry. contact your nurse if the dressing comes undone or is significantly soiled for further instructions. followup instructions: provider: , md phone: date/time: 9:45 3, . please call to arrange a follow up appointment with dr. (pcp) in weeks after discharge procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other gastroenterostomy without gastrectomy other lysis of peritoneal adhesions open biopsy of liver other partial cholecystectomy closure of other biliary fistula diagnoses: unspecified essential hypertension depressive disorder, not elsewhere classified pulmonary collapse peritoneal adhesions (postoperative) (postinfection) late effects of cerebrovascular disease, hemiplegia affecting unspecified side epilepsy, unspecified, without mention of intractable epilepsy diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled chronic cholecystitis other specified disorders of gallbladder fistula of gallbladder acquired hypertrophic pyloric stenosis other hamartoses, not elsewhere classified 

Answer: The patient is high likely exposed to