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: patient recorded as having no known allergies to drugs attending: chief complaint: asystolic cardiac arrest, respiratory failure major surgical or invasive procedure: intubation central line placement, arterial line placement ercp with biliary and pancreatic stents placed biloma pigtail catheter placement and removal ercp for pancreatic stent removal history of present illness: 82 yo f with copd and intestinal malrotation with recent cholecystitis and gallstone pancreatitis s/p cholecystectomy c/b bile leak transferred from the ercp suite after intra-procedural hypoxia and bradycardic vs. asystolic cardiac arrest. . the patient was admitted with cholecystitis and gallstone pancreatitis to center 07.02-23.08. a cholecystostomy tube was placed. post op course was complicated by sepsis (thought due to enterobacter bacteremia though not confirmed in records) complicated by ards requiring icu admission. the pt was then readmitted with fevers/ dysuria on apparent e. coli urosepsis with positive urine and blood cultures. following initiation of imipenem, cultures cleared by (imipenem was continued for an estimated days). her hospital course was c/b volume overload (documentation of this problem is limited), abdominal pain and emesis necessitating re-operation. laparoscopic cholecystectomy was converted to open cholecystectomy with ladd's procedure (fixation of malrotation) on . she developed post-op anemia with a nadir of hct 24.7. her post-op course was complicated by acute on chronic renal failure (cr peaking 3.0) thought oliguric atn that resolved with ivf resuscitation; post-op possible ileus vs. obstruction (documented on plain film on ), and bile leak confirmed by subsequent ct scan and hida scan on 08.15-16.08. an ercp attempted on at osh was aborted due to failure to access and repair the biliary tree. . pt was transferred to for emergent ercp. during the ercp, the pt developed acutely hypoxia, and subsequent bradycardia and hypotension, leading to the calling of a code blue. chest compressions were initiated, and 1mg atropine x2 and 1mg epinephrine were administered leading to return of spontaneous, palpable pulse at a rate of 160 with hypotension to the systolics 70-80's. sbp were maintained with a neosynephrine continuous infusion. an attempt was made during rescucitation for central line placement in the internal jugular vein with return of fluid that was serous possibly consistent with aspiration of a pleural effusion. past medical history: pmh: - recent choledocholithiasis and gallstone pancreatitis s/p open cholecystectomy c/b bile leak - recent multidrug resistent e coli urosepsis (2/2 blood cx, on ; negative as of ) - cri baseline cr 1.5 - diastolic chf ef 65%, mild tr - htn - h/o asthma and copd - intestinal malrotation s/p ladd's procedure . social history: spanish speaking only. 2 daughters are her health care proxy. family history: non-contributory physical exam: pe 98.0 153 119/53 18 99% ac vt 450 rr 16 fio2 100% gen: intubated and sedated. minimally responsive. heent: surgical right pupil. cv: tachycardic. no m/r/g. pulm: poor air exchange. no rhonchi or wheezes. abd: distended. active bowel sounds. ext: 1+ bilateral lower extremity edema. pertinent results: osh labs: ekg (): sinus tachycardia to 125. normal axis and intervals. downgoing t's in v1. no acute st or t wave changes. none more recent for comparison. ua (): 200 wbc, 1 rbc, 2 squams, pos leuk esterase. ascites fluid cx (): few wbc's, no organisms. no growth. blood cx (): e. coli sensitive to amikacin (8), zosyn (<8), imipenem (<4), gentamycin (2), all other resistant. (): no growth.(): no growth. imaging: osh ct abd/pelvis (): large bilateral pleural effusions. consolidation in the rll. unchanged since . fluid surrounding the dome of the liver. 13 cm fluid collection in the gallbladder fossa contiguous with collection extending down the right flank. air within the gallbladder fossa. increased abdominal fluid since which may reflect increased ascites, bile leak or possibly abscess/infection. . u/s guided paracentesis (): 300cc aspiration of dark brown/green fluid sent for culture and sensitivity. residual loculated fluid int he gallbladder fossa noted. . hida scan (): active bile leak with extension into the subhepatic space and right paracolic gutter. . kub and left lateral decubitus (): mild ileus vs. partial small bowel obstruction. . tte (): lvef 65%, mild ar, tr, minimal pericardial effusion. mild rv enlargement with normal biventricular function. abnormal diastolic filling pattern. mild pulmonary hypertension. . chem7: na 147, k 4.1, cl 108, bicarb 30, bun/cr 11/0.6, glucose 82. cbc: wbc 22.9, hct 31.5, platelets 266 lfts: alt 35, ast 43, alk phos 464, t bili 0.7, alb 1.8, t prot 5.1 inr 1.56, pt 15.4 . cxr : 1. right humeral head fracture, only partially imaged. 2. mild fluid overload. 3. right central line in the mid svc, et tube approximately 3 cm above the carina. : 143(147) 106 (108) 16(11) 139 agap=16 4.3 (4.1) 25 (30) 0.8(0.6) ca: 8.6 mg: 3.1 (repleted) p: 5.0 (high) cbc: 36.8 (22.9) /29.6 (31.5) / 224 (266) n:91.2 l:6.6 m:1.7 e:0.2 bas:0.3 lfts: alt: 25 ap: 381 tbili: 0.6 alb: 2.3 ast: 49 ldh: 554 : 113 lip: 126 (: alt 35, ast 43, alk phos 464, t bili 0.7, alb 1.8, t prot 5.1 inr 1.56, pt 15.4) . : 145 (144) 112 (111) 16 (17) 86 agap=11 4.0 (3.7) 22 (22) 0.6 (0.7) ca: 7.5 (7.4) mg: 1.9 (2.1) p: 3.0 (3.9) 25.5 / 27.3 (24.3)/ 201 diff:n:90.6 l:5.8 m:3.3 e:0.2 bas:0.2 (32.4, 36.8, 22.9) / (24.3, 29.6, 31.5) / (226, 224, 266) pt: 17.4 ptt: 40.1 (37,2) inr: 1.6 ( 1.7) alt: 29 ap: 314 tbili: 0.6 alb: 2.2 ast: 56 : 353 (334) lip: 930 (970) . 147 (144) 112 (111) 13 (14) 70 agap=12 3.9 (3.6) 27 (24) 0.6 (0.6) ca: 8.1 (8.3) mg: 1.9 (2.3) p: 2.3 (2.7) 19.3 (20.5) /27.2 (27.7) / 218 (218) n:81.7 l:12.8 m:3.4 e:1.7 bas:0.3 pt: 17.2 (17.4) ptt: 69.4 (40.1) inr: 1.6 (1.6) alt: 23 (27) ap: 322 (304) tbili: 0.7 (0.5) ast: 31 (40) ldh: 415 (464) : 83 (166, 353) lip: 171 (329, 930) ' . 139 102 9 25 ---------< 3.7 31 0.5 ca 8 mg 2.6 p 3.1 alb 2.4 alt 25 ast 29 alkphos 533 tbil 0.5 22/27.8/ 238 ua + leak 125 wbc cdif- pending . : 145 106 9 117 agap=10 -------------< 3.9 33 0.5 ca: 8.0 mg: 2.0 p: 3.3 22.9 / 27.1 / 199 n:73.8 l:17.4 m:6.7 e:1.8 bas:0.3 coags - not pending yet this am lfts- alt 16 ast 22 alkphos 376* ldh 399* tbil 0.6 . : 145 103 11 125 agap=11 -------------< 3.7 35 0.5 ca: 7.8 mg: 1.6 p: 2.4 17.5 (22.9) /25.7/ 167 no diff alt: 17 ap: 365 tbili: 0.6 alb: 2.2 ast: 21 ldh: 361 ua specgr 1.017 leuk mod rbc 7 wbc 79 bactfew ucx- pending . micro:blood (): e. coli sensitive to amikacin (8), zosyn (<8), imipenem (<4), gentamycin (2) (): no growth. (): no growth. micro-picc- no growth micro bile- no growth ucx : yeast ucx - yeast c dif ()- negative sputum cx - yeast minibal - yeast . blood cultures - pending ucx - pending . urine (): 200 wbc, 1 rbc, 2 squams, pos leuk esterase. ascites fluid (): few wbc's, no organisms. no growth. : urean:109 creat:161 na:27 osmolal:320 fena> 9.39; feun 12.4% : u lytes urean:297 creat:44 na:69 osmolal:327 fena 0.6%, feun 36.8% : bnp - serum osms:302 . cardiac enzymes: ck: 139 mb: pnd trop-t: pnd ck: 36 mb: 3 trop-t: 0.03 ck: 45 mb: 4 trop-t: 0.03 . imaging ekg (): sinus tachycardia to 125. normal axis and intervals. downgoing t's in v1. no acute st or t wave changes. none more recent for comparison. ecg (): sinus tachycardia, no ischemic changes kub - no obstruction echo - ef 75% ir - percutaneous biliary drain placed ercp report - difficult cannulation kub : biliary and pancreato-hepatic stents in place. ir : biloma drain removed ercp : pancreatic stent removed brief hospital course: a/p: 82 yo f w/ copd, chf, intestinal malrotation s/p ladd's procedure with cholecystitis and gallstone pancreatitis s/p cholecystectomy c/b ards, atn, ongoing bile leak, and recent urosepsis transferred following intra-ercp hypoxia followed by bradycardic vs. asystolic cardiac arrest. . # cholecystectomy c/b bile leak: ruq ultrasound and ct - contrast demonstrated extensive biloma. biliary drainage was performed on , with retrieval of > 1l. ercp for stenting was attempted x24 hrs after percutaneous drain was placed (on ). surgery/gi were consulted and followed for 24hrs to monitor for reaccumulation and recommend imaging. stenting was performed , and the pancreatic stent was to stay in place for 1 week, and the biliary stent for 8 weeks. vancomycin and meropenem were empirically started, and then vancomycin was discontinued after day 4 given low suspicion of mrsa, and meropenem continued for a 9 day course. once biliary drainage dropped to less than 10 cc/day and ct abdomen showed the biloma was much decreased in size, the biloma drain was removed (on ) by ir. the patient returned for ercp on and had her pancreatic duct stent removed. she will return in to have the biliary stent removal. . # hypoxic respiratory failure during attempted ercp: likely precipitated by aspiration vs mucous plug intra-procedure. also contributing to the primary event is flash pulmonary edema; recent ards, copd flare. lower suscipsion for r/o pe and anaphylaxis. s/p cardiac arrest pt was intubated and placed on ac ventilation with phenylephrine. pt was weaned off phenylephrine by icu day2. stress dose steriods for possible anaphylaxis were discontinued icu day2. pt was placed on ipratropium and albuterol nebs for possible copd exacerbation. pt was started on meropenem 9 day course and vancomycin for 4 day course for broad coverage for both urosepsis and possible aspiration event. repeat echo did not reveal r heart strain. sbts were attempted daily from icu day 6 onwards. pt was switched from ac to cpap but remained hypercarbic and hyperventilation with low tidal volumes by hd9. she was extubated and transferred to the floor. . # cardiac arrest: precipitated by respiratory failure, with end organ renal and possible liver hypoperfusion. other possible precipitants including chf exacerbation, hypovolemia, and pe. unlikely primary arrhythmia given absence of electrolyte derangement, cad, and family hx of arrhythmia. pt was resuscitated by cpr, supported by atropine and epinephrine. induced hypothermia and maintained at 32degc until 24 hours after return of circulation, and rewarmed passively. . # leukocytosis: this was persistent despite being on 9 days of meropenem since admission for urosepsis at osh; sources included urine (ua+) with given her risk factors of indwelling lines/tubes; gi processes, arf, and long term broad spectrum antibiotics. picc from osh was removed and the tip cultured without growth. repeat ua and ucx x2 grew yeast despite being on meropenem and foley changes as well as sputum cx and minibal with + yeast as well. there was concern for fungemia and empiric fluconazole was started for a 1 week course. by day of discharge, her wbc was 14. she had a negative cxr and urinalysis prior to discharge. . # oliguria/acute on chronic kidney failure: pt presented with a prerenal arf picture with cr 3 (from baseline 1.5) with reported atn prior to transfer from osh; with a high likelihood of atn recurrence in the setting of post-op volume loss and hypotension, hypovolemia related to chf exacerbation, and 3rd spacing intraabdominal infection. pt responded slowly to gentle ivf bolus challenge. lasix diuresis was initiated icu day2 after volume repletion. . # acute on chronic diastolic chf exacerbation: likely precipitated intraoperatively by arrhythmia/bradycardia, also possible infection and pe and anemia contributing. finished r/o mi and repeat echo demonstrated hyperdynamic function with ef 75% and bnp elevated from transfer levels (998) to >. lasix diuresis was initiated following percutaneous biliary drainage procedure after volume repletion was achieved. she successfully diuresed and was satting 100% ra by . she was restarted on her home dose of lasix. her magnesium and potassium levels will need to be followed as these did require some repletion. . # copd/asthma: no evidence of exacerbation at this time. she was continued on advair, standing atrovent nebs, albuterol/atrovent as needed. she is not on tiotropium at home, unclear degree of copd, will hold on starting. this can be started in the future. . # tachycardia: may be sinus tachycardia infection (sources see above); also possible atrial tachycardia and was plcaed on verapamil for rate control. some of the episodes did look like small bursts of svt on tele. . # ileus ongoing bile leak and recent cholecystectomy and ladd's procedure with no evidence of continued obstruction. osh kub raised question of sbo vs ileus and showed air fluid levels. pt was made npo, and decompressed by ng tube. repeat kub showed no sign of obstruction. pt was started on tfs and transitioned to po. she is tolerating a regular diet. . #sepsis due to uti: positive blood cultures and ucx dating from , but remained negative here, without growth from osh cx as of and without growth on cultures drawn here. the foley was changed given a positive yeast culture. a repeat ua was positive with a positive yeast culture. she was treated with fluconazole as per above (given yeast also on bal). . # right humeral head fracture observed on x-ray after resuscitation. orthopedic surgery was consulted, and repeat ap/lateral x-ray of right femoral head was performed. ortho recommended a sling for shoulder as needed and non-operative management. she was started on calcium and vitamin d. . # l 10th rib fracture: likely from cpr. again, the patient was treated with tylenol and ibuprofen. she was given oxycodone 2.5 mg as needed for pain. again, nonoperative. she was started on calcium and vitamin d. . # hypernatremia was noted on : na 145; and free water supplied with return to normal levels by . . # anemia of chronic disease: transfused 1 unit for hct 24- bumped to hct on icu day 3. her hematocrit remained stable at 26-30. . # hypertension. initially hypotensive. held home beta-blocker and aspirin pending stabilization and repeat ercp. her asa was held given her stenting and procedures. she was started on verapamil for rate control and her blood pressure was well controlled on this. . # fen: diet was advanced as tolerated to regular. she was maintained on aspiration precautions. . # code: dnr/dni . # failure to thrive. she was noted to be deconditioned during her hospital stay. she was discharged home with physical therapy services. she was started on remeron and a nutrition consult was placed for poor oral intake and this will need to be monitored as an outpatient. . #. urinary tract infection. patient was noted to have a persistent leukocytosis without fever for which an infectious workup was done. cxr was negative. her urinalysis was positive, and she was started on ciprofloxacin on day of discharge. her sensitivities will need to be followed up. medications on admission: meds: inpatient: aspirin 162mg daily -> d/c'd on heparin subq 5000u primaxin 500mg iv q8h -> d/c'd on metoprolol 50mg twice daily reglan 5mg iv prior to meals culturelle 1 tab daily colace 100mg twice daily senna 2 tabs every evening ceftriaxone 1g x1 dose on ferrous sulfate 1 tab . home meds prior to admission: vicodin 1-2 tabs every 4 hours as needed metoprolol 50mg twice daily k-dur 20meq daily lasix 40mg daily ciprofloxacin 500mg daily . discharge medications: 1. oxycodone 5 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain. disp:*20 tablet(s)* refills:*0* 2. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). disp:*1 inhaler* refills:*2* 3. calcium 600 + d 600-400 mg-unit tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*2* 4. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours) as needed. disp:*1 inhaler* refills:*0* 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) inhalation inhalation (2 times a day). disp:*1 device* refills:*2* 6. verapamil 180 mg tablet sustained release sig: two (2) tablet sustained release po once a day. disp:*60 tablet sustained release(s)* refills:*2* 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 8. ibuprofen 600 mg tablet sig: one (1) tablet po q 12h (every 12 hours) as needed for rib pain. disp:*60 tablet(s)* refills:*0* 9. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 10. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 11. ciprofloxacin 250 mg tablet sig: one (1) tablet po twice a day for 7 days. disp:*14 tablet(s)* refills:*0* discharge disposition: home with service facility: of discharge diagnosis: biloma cardiac/respiratory arrest acute tubular necrosis/acute renal failure left 10th rib fracture right humerus fracture copd failure to thrive urinary tract infection discharge condition: stable, satting 98% room air discharge instructions: you were seen for a biliary leak, and experienced cardiac/respiratory arrest while at ercp. you had a drain placed in the biliary leakage area by interventional radiology. you also had 2 stents placed--a biliary stent and a pancreatic stent--by ercp. you had the pancreatic stent removed on . you will need the biliary stent removed in 8 weeks from . you also were in congestive heart failure and received lasix to try and remove fluid. . you were started on many new medications. you were started on albuterol, atrovent, and advair inhalers to help your breathing. you were started on verapamil for your blood pressure. your lopressor (metoprolol) was stopped. you also were given prescription for oxycodone as needed for pain. this is a narcotic and can make you sleepy. you can take aspirin and tylenol as directed to help with your pain. you should also take the calcium and vitamin d supplements to help your bones heal. you should also take remeron to help with your appetite. . please call your doctor or return to the er if you experience any chest pain, shortness of breath, fever, abdominal pain, yellowing of your skin, fainting, or any other concerning symptoms. . weight yourself daily and if you gain greater than 3 pounds, call your doctor. restrict your fluid intake to 1 liter or less a day. eat a low salt diet. . you were started on ciprofloxacin for a urine infection. you should take this for seven days. followup instructions: 1. please come to building for removal of your biliary stent (gastroenterology department). your appointment is at 11:30 am with provider: , md phone:. you should not eat the night prior to the procedure. 2. please follow up with dr. on thursday , at 2pm; please call their office for directions or with any questions at ; fax: 3. please follow up with your primary care doctor, dr. , on tuesday at 1:15 pm. the doctor at in . please call their office at with any questions or if you need to change this appointment time. fax procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances endoscopic insertion of stent (tube) into bile duct cardiopulmonary resuscitation, not otherwise specified other percutaneous procedures on biliary tract removal of pancreatic tube or drain diagnoses: anemia of other chronic disease acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure chronic kidney disease, unspecified acute respiratory failure other specified cardiac dysrhythmias cardiac arrest paralytic ileus other specified disorders of biliary tract closed fracture of one rib hyperosmolality and/or hypernatremia chronic pancreatitis leukocytosis, unspecified adult failure to thrive other closed fracture of upper end of humerus 

Answer: The patient is high likely exposed to