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: history of present illness: the patient was in his usual state of health but began to experience intermittent middle abdominal pain. a ct was performed and showed common bile duct stones, as well as biliary dilatation. on the , the patient underwent uncomplicated endoscopic retrograde cholangiopancreatography with spincterotomy producing eight pigmented stones. the patient tolerated the procedure well and was discharged in stable condition. however, the patient began to experience diarrhea that was melenic in character and noted bright red blood times two. the patient denies any abdominal pain, nausea, vomiting. the patient was transferred back to the emergency department where an nasogastric lavage was performed and it was negative. review of systems: notable for no fevers, chills, nausea, vomiting, jaundice, dark urine, dysuria, urgency, chest pain, shortness of breath, palpitations, cough, or upper respiratory infection symptoms. the patient does complain of dizziness and lightheadedness however. past medical history: 1. choledocholithiasis. 2. porcelain gallbladder. 3. spinal stenosis. 4. near paraplegia secondary to the spinal stenosis. 5. parkinson's disease. 6. question coronary artery disease. 7. autonomic dysfunction. 8. anxiety disorder. 9. chronic constipation. 10. chronic renal insufficiency. 11. benign prostatic hypertrophy. allergies: patient has no known drug allergies. medications on admission: 1. zoloft 100. 2. klonopin 1 b.i.d. 3. sinemet 25/250 b.i.d. 4. lasix 20 q.d. 5. sublingual nitroglycerin prn. 6. oxycodone prn. 7. proscar 5 q.d. 8. prevacid 15 q.d. 9. prinivil 40 mg q.d. 10. adalat 30 mg q.d. 11. zocor 40 mg h.s. 12. multivitamin capsule. 13. enteric coated aspirin. social history: the patient is a resident of the . he has a remote smoking history. he quit tobacco 40 years ago. he rarely drinks ethanol. physical exam on admission: temperature 100. heart rate 60. blood pressure 173/64. oxygen saturation 97% on room air. in general, this is a pleasant elderly man in no acute distress. head, eyes, ears, nose and throat: there is no scleral icterus. conjunctivae are not injected. pupils equal, round and reactive to light. extraocular movements intact. neck: no jugular venous distention. cardiovascular: distant heart sounds. pulmonary: clear to auscultation bilaterally. abdomen soft, nontender, nondistended. patient is guaiac positive. extremities: no edema. neurological: awake, alert, oriented times three, weak diffusely, and unable to stand with assistance. labs on admission: his sodium is 139, potassium 5.0, chloride 105, bicarbonate 25, bun 63, creatinine 1.6, glucose 148, white blood cell count 12.4 with 72 neutrophils, no bands, hematocrit is 32.5 which is down from 41 previously and 232 is his platelet count. alt is 107, ast 80. his t bilirubin is 0.7. albumin is 3.3. his lipase is 45. hospital course: the patient was initially admitted to the general medicine floor for observation. however, the patient was noted to have further decline in his hematocrit from the 32 on admission to 26.5 at which point the patient was transferred to medical intensive care unit. the patient was given four units of packed red blood cells and was taken for emergent endoscopic retrograde cholangiopancreatography/egd. fresh oozing blood was revealed in the duodenal bulb, the second part of the duodenum. the major papilla was covered with large clot. epinephrine injection was performed and hemostasis was believed to be achieved. however, the patient's hematocrit was noted to drop subsequently on the from 31.5 where he was after receiving an additional three units of packed red blood cells to 27.3 accompanied by a new episode of bright red blood per rectum. the patient was, again, taken for emergent endoscopic retrograde cholangiopancreatography/egd at which point the patient was noted to have clotted blood in the stomach body, as well as an acute crater nonbleeding 5 mm ulcer in the distal stomach body. red blood was noted in the anterior bulb in the second portion of the duodenum and a clot was unroofed over the major papilla which exposed further bleeding at the site of the left spincterotomy, at the site of the major papilla, as well as a visible vessel. the epinephrine injection was, again, performed and two hemoclips were placed at the visible vessel. in addition, there was mild diffuse dilatation of the biliary tree with a single 8 mm round stone causing the partial obstruction at the cystic duct. a 10 x 15 double pigtail biliary stent was placed. of note, biliary pus was suggestive of cholangitis was seen draining at the major papilla and the patient was begun on levaquin. the patient subsequently seemed to have low grade fevers with a temperature maximum of 100.6 on the during which point he was noted to continue having maroon liquid stool with a hematocrit that dropped from 30 down to 27. the patient was again transfused with one unit of blood on the . again, the patient was noted to have a low grade temperature elevation to a maximum of 100.7 on the 20th. the patient was transferred from the medical intensive care unit back to the general medicine floor for further observation. the patient's hematocrit was closely followed and he was noted to have a stable hematocrit as follows: his hematocrit was 30.2 post transfusion on the morning of the 20th at 4 a.m. and subsequent hematocrits revealed levels of 30.9, 31.1, 29, 28.9 and then 30.8 on the at 7:50 a.m. thus, the patient's hematocrit has been stable for greater than 24 hours prior to his discharge. it is believed that the site of post spincterotomy bleeding was identified and that adequate hemostasis was achieved on the . patient has had no further episodes of bright red blood per rectum since being transferred from the medical intensive care unit. he denies any abdominal pain, nausea, vomiting, fevers, chills, chest pain, shortness of breath, or palpitations. the patient has not had signs of cholangitis on physical examination, however, given the drainage noted operatively on the , the patient was continued on a ten day course of 500 mg po q.d. of levofloxacin. the patient has tolerated the antibiotic course well and has had a decreasing white blood cell count as follows: the patient's white blood cell count reached a maximum of 13.9 on the 19th and subsequently has declined to a nadir of 10.7 on the day of discharge. the patient has not developed further signs concerning for worsening cholangitis, and in particular, does not have, over the 24 hours prior to discharge, fever, right upper quadrant pain or jaundice. he has a clear mental status and has remained hemodynamically stable. his alt was noted to be 9 on the morning of with an ast of 22, alkaline phosphatase 60, amylase of 93, total bilirubin of 1.1., lipase was 56, ldh 155. the patient's aspirin has been held out of concern for provoking further gastrointestinal bleed and the patient has been maintained on 40 mg of intravenous protonix b.i.d. 2. question of coronary artery disease: the patient is thought to have a history of coronary artery disease, although, the patient is not aware of any prior exercise tolerance tests, abnormal electrocardiograms, cardiac catheterizations, or even any echocardiograms. the patient's aspirin was held given his gastrointestinal bleed as detailed above. the patient was maintained on some of his antihypertensive regimen including nifedipine 30 mg q.d. and was transitioned to captopril 75 mg t.i.d. the patient was also continued on his simvastatin at 40 mg q.d. the patient did not develop any chest pain or shortness of breath over the course of this admission. 3. parkinson's: the patient was maintained on his outpatient dose of sinemet which is 25/250 b.i.d. 4. patient was noted to have hyperglycemia on several occasions during this admission. in particular, patient was noted to have elevated glucose and was fasting on the at a level of 187, as well as slightly elevated a.m. fasting glucoses on the at 122 and 121 respectively. the patient is not aware of any history of diabetes mellitus. the patient was maintained on a regular insulin sliding scale though had minimal insulin requirements over the course of this admission. 5. spinal stenosis pain: the patient was maintained on a regimen of oxycodone prn. 6. anxiety: the patient was continued on clonazepam and zoloft. 7. fluid, electrolytes and nutrition: the patient was intermittently npo and during those times was given rehydration with intravenous saline. patient's diet was advanced and on the day of discharge, the patient is tolerating a po diet. 8. benign prostatic hypertrophy: the patient was continued on finasteride 5 mg q.d. discharge condition: the patient is discharged in stable condition. primary diagnosis: primary diagnosis of portal pyemia. secondary diagnoses: 1. anemia secondary to blood loss. 2. melena. 3. hypertension. 4. spinal stenosis with neurological deficit. 5. hyperglycemia. medications on discharge: 1. sinemet 25/250 mg b.i.d. 2. clonazepam .5-1 mg po b.i.d. 3. finasteride 5 mg po q.d. 4. simvastatin 40 gm po q.h.s. 5. vitamin g capsules 2 po q.d. 6. sertraline 100 mg po q.d. 7. oxycodone 5 mg po q. 6 prn. 8. pantoprazole 40 mg po q.a.m. 9. colace 100 mg po b.i.d. 10. levofloxacin 500 mg po q. 24 hours to complete a ten day course. patient will have six days of levofloxacin following discharge. 11. acetaminophen 325 mg 1-2 tablets po q. prn. 12. prinivil 40 mg po q.d. 13. lasix 20 mg po q.d. 14. atenolol 25 mg po q.d. 15. potassium chloride 10 mg po q.o.d. 16. adalat 30 mg po q.d. follow-up: patient will follow-up with his primary care physician. addition, the patient will follow-up with dr. of the surgical division for cholecystectomy. patient will also follow-up with dr. of the gastroenterology division for repeat endoscopic retrograde cholangiopancreatography after removal of his bile drainage stent in approximately eight weeks. patient also has a follow-up appointment with dr. of the renal division on the at 2:30. , dictated by: medquist36 procedure: other endoscopy of small intestine endoscopic insertion of stent (tube) into bile duct transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery acute posthemorrhagic anemia paralysis agitans hemorrhage complicating a procedure other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation unspecified disorder of kidney and ureter cholangitis calculus of gallbladder without mention of cholecystitis, with obstruction portal pyemia 

Answer: The patient is high likely exposed to