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 is a 75-year-old female with a history of gallstone pancreatitis, coronary artery disease, peripheral vascular disease status post subclavian stent, who presented with a one-day history of acute onset right upper quadrant and epigastric pain. she also complained of nausea and dry heaves. she also complained of fever and positive rigors. she denied shortness of breath, chest pain, constipation, diarrhea, bright red blood per rectum, melena, and dysuria. the patient initially presented to the emergency department. her laboratory data at hospital revealed increased lfts, increased amylase and lipase, and increased white blood cell count of 16,000. in addition, her temperature at hospital was 101.2??????. she was given tequin 400 mg iv, flagyl 500 mg iv, and lasix 40 mg iv, morphine sulfate 2 mg iv, and tylenol 650 p.r. blood cultures were drawn. she was then transferred here at for an ercp. in the emergency department, her blood pressure was noted to be 86/78, and she was given 2 l of fluid, and blood pressure subsequently increased to 140/55. her temperature at the emergency room was 101.9??????, pulse 79, and she had an oxygen saturation of 99% on room air. she complained of pain and was given 2 mg morphine sulfate times two. past medical history: 1. gallstone pancreatitis in . 2. hypertension. 3. hypercholesterolemia. 4. coronary artery disease status post non-q-wave myocardial infarction in and . 5. status post right knee surgery. 6. status post appendectomy. 7. status post bilateral subclavian stenoses, status post left subclavian stent. 8. ejection fraction of 60-70% in . 9. status post cataract surgery. allergies: codeine causes gi upset. amoxicillin. medications on admission: aspirin, lipitor 10 mg p.o. q.d., mavik 4 mg p.o. q.d., atenolol 75 mg p.o. b.i.d., isosorbide 30 mg p.o. q.d., lasix 40 mg p.o. q.d., ambien. social history: she lives with son and daughter. she denied ethanol. she denied tobacco use. the patient has a remote history of tobacco use. physical examination: vital signs: temperature 101.9??????, pulse 79, blood pressure 145/53, respirations 20, oxygen saturation 99% on room air. general: there was an older female, obese, who was in no apparent distress. heent: ng tube was in place. oropharynx pink. dry mucous membranes. oropharynx dry. cardiovascular: regular, rate and rhythm. there was a 2/6 systolic ejection murmur at the left upper sternal border. lungs: bilaterally clear to auscultation. no wheezing. no rhonchi. good inspiratory effort. abdomen: obese, soft, nondistended. hypoactive bowel sounds. positive moderate tenderness in the right upper quadrant. no rebound. no guarding. extremities: warm. no edema. laboratory data: at the outside hospital sodium was 137, potassium 4.3, chloride 97, bicarb 25, bun 23, creatinine 1.3, glucose 222, calcium 9.7; white count 16.1, hematocrit 38.3, platelet count 254; pt 13, ptt 22, inr 1.1; total protein 7.3, albumin 4.6, alt 350, ast 340, alkaline phosphatase 247, total bilirubin 2.8, delta bilirubin 1.4, amylase 132, lipase 829; ck 84, mb 1.7, troponin less than 0.3; urinalysis 30 mg protein, positive bilirubin, few bacteria. radiology: chest x-ray at hospital was negative by report. kub at hospital was negative by report. electrocardiogram was normal sinus rhythm at 82, depressions in i, ii, avl, v4-6, pseudonormalization of t-waves in i, ii, avl, v2-6. this electrocardiogram was compared to . ultrasound at showed positive gallstones, no ductal dilatation, pancreas not visualized. assessment: this was a 75-year-old female with a history of gallstone pancreatitis, history of coronary artery disease status post non-q-wave myocardial infarction, history of peripheral vascular disease, who presented with right upper quadrant pain. based on clinical exam, laboratory data, and radiologic findings, with her right upper quadrant tenderness, increased lfts, increased amylase and lipase, and elevated white blood cell count, with fevers and with chills, her presentation was consistent with cholangitis and pancreatitis secondary to gallstones. hospital course: 1. gastrointestinal/cholangeitis and pancreatitis presumed secondary to gallstones: the patient was made npo, and broad-spectrum antibiotics were started for coverage. antibiotics were levaquin and flagyl iv. the patient had an ercp done which showed, 1) pus discharge from the major papilla, 2) biliary dilatation, 3) cystic duct did not fill with contrast, 4) amorphous material seen in the bile duct consistent with sludge, 5) no filling defects to suggest stone present in the bile duct, 6) successful sphincterotomy, and 7) successful sludge extraction. the gastrointestinal recommendations were that the patient be kept npo, and broad-spectrum antibiotic coverage with vancomycin, levofloxacin, and flagyl. in addition, because the cystic duct was unable to fill with contrast, there was concern over the fact that a stone may be located in the cystic duct. general surgery consult was placed for evaluation for cholecystectomy. general surgery evaluated the patient and felt that with numerous gallstones, with right upper quadrant and epigastric pain, fever, increased bilirubin/lfts, that she had gallstone pancreatitis, cholangitis, and occluded cystic duct. the surgery team was concerned about elevated troponin of 10.1. surgery was very hesitant to operate on this patient. they felt that she was not an operative candidate in this setting and recommended insertion of cholecystostomy tube. interventional radiology/general radiology was then consulted for percutaneous drainage with a cholecystostomy tube. the patient was transferred to the sicu to have the percutaneous drains placed in that setting. the patient was then transferred to the sicu, and a percutaneous cystostomy tube was placed without event. the patient was then transferred back to the floor the following day. regarding the patient's bile fluid, the bile fluid culture grew out enterococcus which is resistant to vancomycin, penicillin, levofloxacin, and ampicillin. regarding the patient's laboratory data, after the percutaneous drainage, the patient's liver enzymes, as well as pancreatic enzymes had been trending downward, and on the day of discharge, the alt is 103, ast 23, alkaline phosphatase 222, amylase 13, total bilirubin 1.1, and lipase 23. regarding the length of duration of the patient's biliary drain, general surgery recommended that the percutaneous drain stay in place until cholecystectomy is performed. because there was a likelihood that the cystic duct is occluded with a stone, if the drain is pulled prematurely, then there would be increased pressure within the gallbladder, and the same situation/scenario would occur again. thus, it was decided that the percutaneous drains will remain in place until a cholecystectomy is performed, which will be planned for approximately six months in the future. general surgery typically does not operate on patients who have had any type of coronary/cardiac event until six months post event. given the patient's elevated troponin of 10.1, they will plan for cholecystectomy in approximately six months; however, prior to operation, the patient does need full cardiac work-up including a stress mibi to identify any reversible wall motion defects and possible coronary catheterization after the stress mibi to potentially stent/repair any culprit lesions. this plan has been discussed with the patient, as well as with the patient's primary care physician, are both amenable to the outpatient work-up. the outpatient scheduling and work-up will be deferred to the primary care physician and patient which will need to be done in the next couple of months. given that the patient has just had a gastrointestinal infection and troponin leak, it is not the appropriate time for her to proceed with cardiac work-up; thus, this will be carried out as an outpatient. 2. infectious disease: on the day of admission, the patient was started on levaquin, flagyl, and vancomycin. subsequent bile cultures have grown out vancomycin resistant enterococcus. at the time of discharge, her blood cultures are still pending. a sputum culture was contaminated. urine culture showed no growth. an addendum will be made to the infectious disease section regarding duration and antibiotic types, given that the patient now has vancomycin resistant enterococcus. 3. cardiovascular: the patient has a history of coronary artery disease status post non-q-wave myocardial infarction in and , bilateral subclavian stenosis, status post left subclavian stent, ejection fraction of 65-70%. the patient was continued on medications of captopril 12.5 mg p.o. t.i.d., metoprolol 25 mg p.o. t.i.d. cardiology consult was deferred. due to the patient's troponin leak and negative mb fraction and negative mb index, in the setting of gallstone pancreatitis, there will be no cardiac intervention at this time, given the medical stability with no electrocardiogram changes and no chest pain. the patient will need to pursue an outpatient cardiac work-up prior to cholecystectomy. this has been outlined previously and includes a stress test to identify any reversible defects, as well as possible cardiac catheterization to stent/fix any culprit lesions. this outpatient work-up can take place anytime within the next six months but must be done prior to cholecystectomy. 4. endocrine: the patient has no known history of diabetes mellitus. the patient appeared to have stress hyperglycemia in the sicu. she was placed on fingersticks q.i.d. and covered with regular insulin sliding scale. after the patient was transferred back to the floor, the patient had no more elevated blood glucose (all blood glucoses were less than 180 before and after meals). fingersticks q.i.d., as well as regular insulin sliding scale was discontinued. 5. prophylaxis: the patient was given protonix 40 mg p.o. q.d. and heparin 5000 u subcue q.12 hours for prophylaxis. 6. fen: the patient was given maintenance fluids, and after her percutaneous drainage, she was made npo for one day. the following day she tolerated a clear liquid diet well. the patient was advanced to full liquids and then to full solids without event. at the time of discharge, the patient had tolerated a full solid diet with no nausea, no vomiting, and no gastric pain. the patient's bowels were moving. the patient had no urinary difficulty. 7. access: the patient was noted to have very poor peripheral access. she is not a candidate for internal jugular or subclavian central lines given the patient's bilateral subclavian stenoses. the patient therefore had a picc placed on the left side. this picc line will be used for continuation of her antibiotics. 8. physical therapy: the patient is to have physical therapy evaluation and clearance prior to her discharge. condition on discharge: good. disposition: discharge to rehabilitation. discharge diagnosis: 1. cholangeitis. 2. gallstone pancreatitis. 3. cardiac ischemia, but no myocardial infarction. 4. hypertension. 5. hypercholesterolemia. 6. coronary artery disease. 7. bilateral subclavian stenoses. 8. status post right knee surgery. 9. status post appendectomy. 10. ejection fraction of 60-70% in . 11. status post cataract surgery. discharge medications: morphine sulfate 2-4 mg iv/subcue q.4 hours p.r.n., heparin 5000 u subcue q.12 hours, this is while the patient is not ambulatory, once the patient is ambulating, this can be discontinued, captopril 12.5 mg p.o. t.i.d., metoprolol 25 mg p.o. t.i.d., guaifenesin ml p.o. q.6 hours p.r.n. for cough, pantoprazole 40 mg p.o. q.d., aspirin enteric coated 325 mg p.o. q.d., promethazine 25 mg iv q.6 hours p.r.n. nausea, levofloxacin 250 mg iv q.24 hours x 14 days, vancomycin 1 g iv q.24 hours x 14 days, atorvastatin 10 mg p.o. q.d., tylenol 325-650 mg p.o. q.4-6 hours p.r.n., lasix 40 mg p.o. q.d. which is her home dose. follow-up: the patient is to follow-up with her primary care physician, . . the patient and dr. have been notified of the hospital course, as well as the patient's discharge with rehabilitation, as well as the patient's need for cardiac work-up prior to cholecystectomy. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy percutaneous aspiration of gallbladder injection or infusion of nesiritide diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension old myocardial infarction calculus of gallbladder without mention of cholecystitis, without mention of obstruction cholangitis acute pancreatitis other acute and subacute forms of ischemic heart disease, other 

Answer: The patient is high likely exposed to