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: tetracycline / meclizine / demerol / thioridazine / opioids-morphine & related / chlorpromazine attending: chief complaint: sepsis (presumed from a biliary source). major surgical or invasive procedure: ercp with biliary stent placement right internal jugular central venous line placement midline venous line placement history of present illness: patient is a 68 year old female with (per osh records) history of htn, bipolar disorder, ? esrd on hd, cad s/p pci, and copd who was transferred from an osh this morning for management of septic shock, thought secondary to ascending cholangitis. per records, patient, who lives in nursing home, was found to have episodes of nausea and vomiting at her nursing home with associated fever. she was noted to be hypotensive, ems was called, and upon arriving at scene, found patient to be "unconscious" with sbp in the 50s. baseline mental status is unable to be determined at this time. she received 1 liter ns enroute to osh ed. in the ed, patient remained unresponsive with hemodynamic instability, and a right femoral line was placed, and norepi was started. . initial labs showed creatinine of 2.6, t. bil of 5, ast 470, alt 227, alk phs 422. trop t 0.21. bnp > . wbc 17.5, 64% polys, 19% bands. inr 1.4. u/a showed 21-30 wbcs and 1 blood culture grew out gnrs. lipase 42. . following admission, she received vancomycin and zosyn. she was also started on pantoprazole iv. ct scan showed gb distention with pericholecystic fluid, cbd dilated to 10 mm with 8 mm high-density filling defect in distal cbd, with intrahepatic bile ducts were also dilated. there was a question of portal vein thrombosis. gi was consulted, and suggested stablizing patient prior to mrcp or ercp. cardiology was also consulted -> her cath films were reviewed, and she was noted to have ectatic, dilated coronaries; stents were patent (unsure of anatomy). patient was improved hemodynamically, and transfer was arranged directly to micu to facilitate ercp. . upon arrival to the floor, patient was alert to name, not following commands. she was unable to provide any history. attempt was made to contact next of . . past medical history: htn cri: history of hemodialysis over 15 years ago with r av-fistula in place; unclear recent baseline creatinine. cad s/p pci copd mood disorder nos s/p recent psychiatric admission for one month osteoporosis social history: lives in a nursing home. denies history of tobacco, alcohol or illicit drugs. per nursing home she requires help with nearly all adls. has had psych decline over the last few months. recently admitted to psych inpatient facility. family history: noncontributory physical exam: admission exam: vitals: t: 98.8 bp: 125/69 p: 90s r: 16 18 o2: 97% 3.5 liters general: alert, oriented to name, not following commands initially. subsequent assessment showed patient was more interactive, following commands, no distress. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, systolic murmurs, rubs, gallops abdomen: soft, mildly tender to palpation in epigastrium and ruq, no rebound/guarding, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place from osh ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . discharge exam: v t=98.6, bp 104/51, hr 68, rr 18, 98%ra gen: nad, comfortable cardiac: systolic murmur at right sternal border, s1, s2 pulm: ctab, no crackles, no rhonchi, no rhales abd: soft, nt, nd, pos bs skin: erythematous rash on buttocks and medial thights ext: warm, has fistula in right arm. no pedal edema. no anasarca. pertinent results: admission labs: . 06:32pm type-art temp-36.7 o2 flow-6 po2-104 pco2-32* ph-7.38 total co2-20* base xs--4 intubated-not intuba 06:32pm lactate-2.2* 06:32pm freeca-1.09* 06:05pm glucose-102* urea n-50* creat-2.1* sodium-145 potassium-3.5 chloride-114* total co2-21* anion gap-14 06:05pm calcium-7.6* phosphate-2.5* magnesium-2.4 06:05pm wbc-23.9* rbc-4.03* hgb-11.9* hct-35.7* mcv-89 mch-29.6 mchc-33.5 rdw-15.4 06:05pm plt count-65* 06:05pm pt-14.6* ptt-31.5 inr(pt)-1.3* 02:48pm type-mix po2-53* pco2-37 ph-7.36 total co2-22 base xs--3 02:48pm lactate-2.0 02:48pm o2 sat-86 02:30pm glucose-84 urea n-52* creat-2.3* sodium-147* potassium-4.6 chloride-115* total co2-21* anion gap-16 02:30pm alt(sgpt)-103* ast(sgot)-92* alk phos-228* tot bili-1.8* 02:30pm calcium-7.5* phosphate-3.0 magnesium-2.8* 02:30pm wbc-20.5* rbc-4.12* hgb-12.0 hct-37.1 mcv-90 mch-29.2 mchc-32.4 rdw-16.2* 02:30pm plt count-66* 02:30pm pt-14.5* ptt-31.2 inr(pt)-1.3* 06:32am type-mix comments-green top 06:32am lactate-2.7* 06:22am urine rbc-1 wbc-23* bacteria-none yeast-none epi-0 06:21am glucose-75 urea n-53* creat-2.4* sodium-150* potassium-3.5 chloride-116* total co2-19* anion gap-19 06:21am alt(sgpt)-116* ast(sgot)-133* ck(cpk)-146 alk phos-246* tot bili-2.0* dir bili-1.5* indir bil-0.5 06:21am lipase-12 06:21am ck-mb-6 ctropnt-0.11* 06:21am albumin-2.4* calcium-5.9* phosphate-2.7 magnesium-1.5* 06:21am wbc-30.4* rbc-4.59 hgb-13.0 hct-42.1 mcv-92 mch-28.3 mchc-30.9* rdw-16.2* 06:21am neuts-94.9* lymphs-3.9* monos-0.7* eos-0.2 basos-0.4 06:21am plt count-82* 06:21am pt-15.6* ptt-33.1 inr(pt)-1.4* discharge labs: 07:40 complete blood count white blood cells 4.2 4.0 - 11.0 k/ul performed at west stat lab red blood cells 3.19* 4.2 - 5.4 m/ul performed at west stat lab hemoglobin 9.4* 12.0 - 16.0 g/dl performed at west stat lab hematocrit 28.9* 36 - 48 % performed at west stat lab mcv 91 82 - 98 fl performed at west stat lab mch 29.4 27 - 32 pg performed at west stat lab mchc 32.4 31 - 35 % performed at west stat lab rdw 16.4* 10.5 - 15.5 % performed at west stat lab basic coagulation (pt, ptt, plt, inr) platelet count 139* 150 - 440 k/ul performed at west stat lab 07:40 renal & glucose glucose 87 70 - 100 mg/dl if fasting, 70-100 normal, >125 provisional diabetes performed at west stat lab urea nitrogen 10 6 - 20 mg/dl performed at west stat lab creatinine 0.8 0.4 - 1.1 mg/dl performed at west stat lab sodium 139 133 - 145 meq/l performed at west stat lab potassium 4.3 3.3 - 5.1 meq/l performed at west stat lab chloride 106 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 enzymes & bilirubin alkaline phosphatase 121* 35 - 105 iu/l performed at west stat lab chemistry calcium, total 7.9* 8.4 - 10.3 mg/dl performed at west stat lab phosphate 2.1* 2.7 - 4.5 mg/dl performed at west stat lab magnesium 1.7 1.6 - 2.6 mg/dl performed at west stat lab alkaline phosphatase 121* 35 - 105 iu/l performed at west stat lab chemistry calcium, total 7.9* 8.4 - 10.3 mg/dl performed at west stat lab phosphate 2.1* 2.7 - 4.5 mg/dl performed at west stat lab magnesium 1.7 1.6 - 2.6 mg/dl performed at west stat lab . micro: blood cx: ngtd . c. diff toxin: negative c. diff toxin: positive . urine cx: contamination . urine cx: contamination . images: . ekg: ekg: sinus rhythm, rate in 70s, normal axis, intervals, inverted t waves in v2-v5 unchanged from two days ago, no other st-t wave changes. v2-v5 flipped ts are new from last year. . ercp: impression: 1) multiple duodenal erosions 2) partial pancreatogram 3) successful biliary cannulation 4) a moderate diffuse dilation was seen at the main duct with the cbd measuring 12 mm. 5) a single 10 mm round stone that was causing partial obstruction was seen at the middle third of the common bile duct. there were a couple other small filling defects suggestive of stones or stone fragments seen on the cholangiogram. 6) a 7cm by 10fr cotton biliary stent was placed otherwise normal ercp to third part of the duodenum . echo: the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . ct head w/o contrast: no acute intracranial abnormality liver/gallbladder u/s: impression: dilated sludge-filled gallbladder with an irregular wall, which is, in the appropriate clinical setting, consistent with cholecystitis. kub: reason for examination: recent ercp , new emesis, evaluation of ng tube placement. two ap views of the abdomen were reviewed. there is coiled tube in the proximal stomach/lower portion of the known hiatal hernia. small bowel loops are dilated up to 3.4 cm. there is relative paucity of the bowel gas in the abdomen. multiple vertebroplasties findings are present. left lower lung opacity most likely representing area of atelectasis, partially imaged. tortuous aorta as well as the abdominal aortic calcifications are present. brief hospital course: ms. is a 68 year old woman with h/o cad s/p percutaneous intervention, ckd (formerly on hd but no longer), depression and bipolar disorders, admitted with septic shock from ascending cholangitis, cholecystitis, and e. coli bacteremia. #. septic shock/ascending cholangitis/bacteremia - pt admitted from osh initially with septic shock secondary to ascending cholangitis, cholecystitis, and ecoli bacteremia. e. coli from osh sensitive to ceftriaxone and pt completed 10 days, completed on . she had ercp & cbd stenting . large stone was not removed as patient was too unstable during procedure. gi placed temporary stent until infection resolves, and then follow up 4 week stent and stone removal. subsequent bacterial and urine cultures were negative. surgery team was consulted for cholecystitis (no gallbladeder stones visualized) seen on ultrasound, treated patient supportively with antibiotics. pt improved during hosptalization and remained afebrile, normal wbc, normotensive. **plan to follow up with dr. office at on for stent removal, sphincterotomy, and stone extraction. . #. mental status change/catatonia?????? patient had altered mental status in hospital, likely secondary to acute toxic metabolic encephalopathy as well as underlying psych disorder, possibly schizophrenia with catatonic state. ct head negative. she was very withdrawn, refused to eat or talk, had posturing. she was responsive but would not cooperate. psych was constuled and reccomended haldol and ativan prn as well as re-starting abilify that was initially held on admission. pt was unable to take abilify until she started to eat food. until she started to eat, she was given ppn, iv haldol and lorazepam. as she started to eat, abilify dose was increased to 15mg daily and she was contiued on lorazpam 0.5 tid for treatment of catatonic state. pt's fentanyl patch was decreased to 100-->25 every 72 hours. she is wearing her final 25mg patch which should be removed in 2 days. she will not need further fentanyl patches. nursing home and daughter - reported that pt has had significant psych decline over the last month with a recent psych hospital admission. she requires continued psych follow up to help her recover from her catatonic state. . #c. diff: pt developed diarrhea the last few days of hospitalization, tested positive for stool c. diff. started on flagyl 500 tid on . should continue for 14 days. *** -continue flagyl 500 tid for 14 days. -make sure patient drinks enough and matches her output. needs 1:1 assistance to make sure she is drinking and eating. . #ckd: cr 2.4 on admission and cr trended down during hospitalization. it was 0.8 on day of discharge. has history of renal failure with hd and fistula. no longer requiring hd. daughter reports that pt was on hd for alcohol induced renal failure. isopropyl alchohol? unclear exact etiology of prior renal insult. . #. anasarca ?????? pt noted to have edema of hands and feet that improved with aggressive iv lasix. was given furosemide 40mg iv bid. anarsarca secondary to agressive volume resuscitation in the setting of biliary sepsis as well as hypoabluminemia. echo without significant valvular disease or evidence of decompensation. no respiratory or renal compromise from elevated volume status. pt's anarsarca resolved and iv furosemide was no longer needed. . #. htn, benign - pts home bp med initially held when she was acute septic and hypotensive. meds were reintroduced in iv/skin patch form since pt's ams prevented her from swallowing. she was given metoprolol iv, mitropaste, and clonidine patch. clonidine patch was decreaed to 0.2mg/q monday, metoprolol was decreased from 50bid to 25 . and nitropaste was stopped. hydralazine caused pt to have tachycardia and was avoided. lisinopril was reintroduced as she started to eat food. pt did not need her home lasix or imdur at the time of discharge. *** - reconsider adding lasix 40am and 20pm if pt has any edema. she did not require this during the final 2 weeks of her hosptialization - consider adding back her home imdur 30mg daily if her bp increases. she did not need this at the time of discharge. . #. anemia/thrombocytopenia ?????? found to have hct drop on admission, thought to be due to hypoproliferation due to sepsis. hct (range 28-30) and plt (100-200s) stabalized during hospitalization and daughter reported that ms. has a history of chronic anemia and thrombocytopena. . #. cad, native ?????? given home asa and metoprolol medications. . #. nutrition - feeding tube initially placed to provide nutrition since pt's catatonic state prevented her from eating. she eventually pulled out dopoff and feeds were held until pt more alert to eat. she was given ppn until she was able to eat food on her own. she then pulled out all of her lines and refused peripheral line replacement. she gradually started to eat food by the time of discharge. she was eating 1,000-2,000 calories a day by the time of discharge. *** -pt needs 1:1 assistance during mealtime to encourage eating medications on admission: fosamax 70 mg weekly allopurinol 200 mg daily abilify 5 mg daily asa 81 mg daily celexa 10 mg day clonidine 0.2 mg patch, two patches weekly colace 100 mg daily fentanyl patch 100 mcg q72 hours lasix 40 mg qam, 20 mg qpm imdur 30 mg daily lisinopril 40 mg daily ativan 0.5 mg tid metoprolol 50 mg omeprazole 20 mg daily ditropan 10 mg daily miralax 17 gm daily trazadone 50 mg qhs, 12.5 mg at 14:00 daily discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for rash: apply to buttocks, thighs. 3. acetaminophen 650 mg suppository sig: one (1) suppository rectal q6h (every 6 hours) as needed for fever/pain. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 6. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 7. clonidine 0.2 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmon (every monday). 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 9. aripiprazole 15 mg tablet sig: one (1) tablet po daily (daily). 10. lorazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day): please give standing to clear catatonic state. titrate down and off when pt less withdrawn. 11. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 14 days: day 1=. discharge disposition: extended care facility: of discharge diagnosis: primary: 1)ascending cholangitis 2)psychological disorder secondary: 1)hypertension discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it was a pleasure providing care for you during your hospitalization. you were admitted for an infection of your bile duct system. a gallbladder stone was stuck in one of the ducts causing an infection and pain. specialists put a stent in the duct to keep it open. they were unable to remove the stone at the time of the procedure because you were so sick. you were also started on antibiotics that were targeted against the specific bacteria in your duct and blood. the stent and antibiotics helped to clear the infection and your symptoms improved, you stopped having fevers. within a couple of weeks, the stent will be removed along with the stone that caused the initial plug. you will follow up with the specialists outpatient on . you must call them to coordinate a time. as the infection cleared, your psychological state was a little concerning. you did not talk or eat. we had psychiatrists help us in treating your underlying psych disorder. we gave you medicines that helped clear your mind and you gradually improved. for nutrition, we gave you food through your veins (called ppn) until you were able to eat on your own. you developed an infection in your gut called c.diff which was the cause of your diarrhea the last couple of days of your admission. we started you on antibiotics for this. you must continue a 14 day course. the following changes were made to your medications: your home antihypertensive medications (metoprolol, imdur, lisinopril) were briefly held. they were then gradually restarted and titrated to your blood pressure. you will go home on clonipine patch 0.2/monday (you came in on 0.4mg which was changed to 0.2mg), metprolol 25 (you came in on 50bid which was changed to 25 ), lisinopril 40mg. you did not require the imdur at the time of your discharge. your lasix 40mg am and 20mg in pm was held. you did not require it at the time of discharge. your fentanyl patch was titrated down. you came in on 100mcg/hr and it was titrated down, on the day of discharge you were wearing your final patch (25 mcg/hr). it should be removed in 2 days and you no longer require any further fentanyl patches. you completed 10 days of ceftriaxone antibiotics, finished on . your abilify and celexa were held. you will go home on abilify 15mg and celexa 10mg as well as lorazepam 0.5mg for catatonia. your fosamaz 70mg weekly was held throughout admission. your trazadone 50mg qhs was held since you did not require it during hospitalization. your ditropan 10mg daily was held. please resume all of your other home medications when you leave the hospital. please make sure to follow up with the gi doctors to get the stent and stone removed on . followup instructions: you will need to meet with the specialists to get both the stone and the stent removed on , please call to confirm the appointment and time. department: endo suites: call: to confirm the time. when: wednesday at 11:00 am department: digestive disease center when: wednesday at 11:00 am with: , md building: building (/ complex) campus: east best parking: main garage procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances arterial catheterization endoscopic insertion of stent (tube) into bile duct diagnoses: thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery toxic encephalopathy acute kidney failure, unspecified unspecified protein-calorie malnutrition severe sepsis chronic airway obstruction, not elsewhere classified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified osteoporosis, unspecified septic shock intestinal infection due to clostridium difficile other disorders of plasma protein metabolism hyperosmolality and/or hypernatremia septicemia due to escherichia coli [e. coli] cholangitis bipolar disorder, unspecified other candidiasis of other specified sites other specified hypoglycemia unspecified deficiency anemia hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified calculus of gallbladder and bile duct without cholecystitis, with obstruction edema catatonic type schizophrenia, unspecified other disorders of eating 

Answer: The patient is high likely exposed to