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: sulfa (sulfonamide antibiotics) / shellfish derived attending: chief complaint: acute cholecystitis in the setting of atrial fibrillation with rvr major surgical or invasive procedure: none history of present illness: ms. is a y/o lady with a-fib on coumadin, and diastolic hf, who is admitted to the micu with acute cholecystitis in the setting of rapid atrial fibrillation. she initially presented to an osh () on due to elevated inr of 12 on labs drawn at home, and upon arrival was found to have abdominal pain, rr 22, and o2 sat of 95% on ra in the setting of an inr of 9.8, wbc 13.1, and t bili 2.2. abd ct revealed cholelithiasis with external biliary duct dilatation (unchanged from ct on ). hida scan was positive for acute cholecystitis. she was in atrial fibrillation with rvr, and due to her age/comorbidities, she was considered to not be a surgical candidate so she was transferred to today for ercp and percutaneous cholecystostomy. . in the ed, initial vs were: t 98, p 104, bp 98/60, r 18, o2 sat 96% 4l nc. she was in a-fib with rvr. her wbc were 21.5, and her lfts were significant for elevated t bili and alk phos. she was given 500cc ns. she was evaluated with us (which showed acute cholecystitis) and abdomen ct to rule out gangrenous cholecysttis. she was given unasyn and vancomycin and was sent to the icu. . review of systems: (+) per hpi. is chronically constipated. (-) denies recent fever, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - tias (transient speech deficit) - afib - diastolic heart failure, ef reportedly 65%. patient has dyspnea on exertion at baseline - pacemaker placement - dm2 controlled with diet - severe constipation - mild dementia - knee replacement x3 - appendectomy social history: - tobacco: none - alcohol: none - illicits: none lives with her daughters, and one is her hcp. with a walker and only occasionally uses wheelchair. is dependent on daughters for most of her adls. has vna. family history: nobody with dm2, liver disease, or mi. no family history of any malignancies. physical exam: vitals: t: 96.2 bp: 97/51 p: 100 r: 18 o2: 92% 4l nc general: alert, oriented to person/city/date/year, no acute distress heent: sclera anicteric, dry mm, oropharynx clear neck: supple, no lad lungs: crackles at bilateral bases cv: s1 and s2, irregularly irregular, sem heard at lsb abdomen: obese but nondistended, (+)bs, tender to palpation of medial ruq; negative sign; no rebound tenderness or guarding, no organomegaly gu: foley with a small amount of bloody urine ext: extremely edematous (2+ throughout); warm, well perfused, 2+ dp pulses pertinent results: 02:35pm wbc-21.5* rbc-5.22 hgb-15.8 hct-47.9 mcv-92 mch-30.2 mchc-32.9 rdw-17.6* 02:35pm neuts-93* bands-0 lymphs-5* monos-2 eos-0 basos-0 atyps-0 metas-0 myelos-0 02:35pm pt-18.9* ptt-37.2* inr(pt)-1.7* 02:35pm albumin-2.0* 02:35pm alt(sgpt)-20 ast(sgot)-36 ld(ldh)-278* alk phos-157* tot bili-3.4* dir bili-1.3* indir bil-2.1 02:35pm lipase-13 02:35pm glucose-58* urea n-14 creat-0.8 sodium-134 potassium-3.8 chloride-100 total co2-23 anion gap-15 micro: blood cultures - pending . images: ruq us wet read: acute cholecystitis with cholelithiasis. gangrenous cholecystitis cannot be excluded in this study. if continued clinical concern, a ct can be considered for better characterization. . ct abdomen wet read: moderate b/l pleural effusions and compressive atelectasis. moderate intra-abdominal ascites and diffuse body wall edema. large calcified gallstone in gallbladder. gb wall not well evaluated on the current study but no evidence of gas within the gallbadder wall or lumen. mild biliary dilitation. cardiomegaly. multiple compression fractures in lumbar and lower thoracic spine of unclear chronicity. grade i retrolisthesis of t12 on l1 with severe and anterior wedging of t12 vb. . tte the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. the right ventricular cavity is moderately dilated with normal free wall contractility. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. there is moderate aortic valve stenosis (valve area 1.0-1.2cm2). the mitral valve leaflets are mildly thickened. there is severe mitral annular calcification. there is a minimally increased gradient consistent with trivial mitral stenosis. the tricuspid valve leaflets are mildly thickened. severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: ms. is a y/o lady who was admitted to the icu with acute cholecystitis and a-fib with rvr. . #. large gallstone and ruq pain: likely chronic cholecystitis. her exam was concerning for acute cholecystitis, and her leukocytosis and osh hida scan was suggestive of this as well. upon imaging here, her gallbadder lumen appeared to be entirely occupied with the stone, which could also explain the positive hida scan at osh. the gall bladder was not distended, and there appeared to be no duct obsruction. after discussion with surgery/i.r./ercp attendings, it was determined that the risks of interventions outweighed the benefits. she is a poor candidate for surgery given her age and comorbidities; there was no lumen to drain percutaneously by i.r.; there was no obstructing stone to be cleared by ercp. she was managed conservatively with pain management (iv dilaudid and tid acetaminophen). the patient and her family elected for dnr/dni, cmo status and efforts were focused on pain control. her pain subsided throughout the hospital stay, and by the time of discharge she had some ruq pain to deep palpation, which was relieved by dilaudid. her wbc started to trend down and was 26 at the time of d/c. though clinically and radiographically she does not appear to have cholangitis, she was kept on antibiotics to cover for any infection. she has been on zosyn, and was sent to a with a picc line to complete a 10 day course of antibiotics (last day will be ). . #. diastolic chf: with as, severe tr, la/ra dilatation. at baseline she has dyspnea on exertion and she has been hospitalized multiple times for chf exacerbations. diltiazem was continued. she had been off her home dose of lasix since admission to osh; she was started on a lasix drip and was diuresed. her urine output did not seem to respond and she remained extremely edematous. discussions with family centered around the irreversible nature of her chf, and her seemingly refractory edema was another reason that they decided to make her cmo. efforts were still made to diurese the patient for her own comfort, and she is being discharged on diuretics (lasix 60mg po tid). she will need daily basic metabolic panels to monitor her renal function and electrolytes. . #. atrial fibrillation: since arriving in the icu, she was not in rvr. her digoxin was continued, as was her diltiazem (as her bps tolerated). her coumadin was held during her stay because of supratherapeutic inr, and at the time of discharge her inr was 2.0, so the coumadin was still held. . #. new o2 requirement since reaching osh: likely due to pulmonary volume overload. patient was satting well, but on 4l nc with no o2 requirement at home. her cxr showed bilateral pleural effusions, so she likely had an element of volume overload. she was dyspneic with activity and after talking for long periods of time, but per daughter this is her baseline. also, pna was considered given her leukocytosis, but she had no cough. she was diuresed as described above and was still satting in the 90's on 4l nc. . #. decreased urine output: fena was <1%; her decreased output is likely due to decreased intravascular volume as described above, from cardiac cause. her cr remained near her baseline despite diuresis; it was 1.1 at the time of discharge. . #. dm2, diet-controlled: she was placed on diabetic diet and fs were checked qachs - they ranged from 90-140 and she required no insulin coverage. . #. coagulopathy: due to coumadin. inr trended down while off coumadin and at the time of discharge was 2.0 - her coumadin was held at discharge. her ct abdomen showed ascites; she likely has an element of liver disease contributing to her coagulopathy. . #. yeast uti: here, as well as based on osh cultures. given that her diabetes seems under control, this was not treated. medications on admission: - ferrous sulfate 325mg po bid - coumadin 2mg po daily - kdur 40meq po bid - omeprazole 20mg po daily - oscal 500mg po bid - mvi 1tab po daily - miralax 17g po daily - lasix 40mg po bid - asa 81mg po daily - aricept 5mg po qhs - digoxin 0.125mg po daily - diltiazem 120mg sustained release daily discharge medications: 1. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 3. os-cal 500 + d 500 mg(1,250mg) -500 unit tablet sig: one (1) tablet po twice a day. 4. multivitamin capsule sig: one (1) capsule po once a day. 5. miralax 17 gram powder in packet sig: seventeen (17) grams po once a day. 6. lasix 40 mg tablet sig: 1 and a half tablet po three times a day: (60mg po tid). 7. aspirin 81 mg tablet sig: one (1) tablet po once a day. 8. aricept 5 mg tablet sig: one (1) tablet po at bedtime. 9. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 10. dilt-xr 120 mg capsule,degradable cnt release sig: one (1) capsule,degradable cnt release po once a day. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. heparin (porcine) 5,000 unit/ml solution sig: 5,000 units injection tid (3 times a day). 13. acetaminophen 325 mg tablet sig: two (2) tablet po q 8h (every 8 hours). 14. piperacillin-tazobactam 2.25 gram recon soln sig: 2.25 grams intravenous q6h (every 6 hours) for 10 days: day 1 was , last day is . 15. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 16. dilaudid 2 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. discharge disposition: extended care facility: alliance discharge diagnosis: gallstone congestive heart failure discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted with a large stone in your gall bladder, which was causing your abdominal pain. in addition, you have been found to have fluid overload due to your chf. the risks of surgery or an interventional radiology procedure or an endoscopic procedure outweighed the benefits, and so you are being discharged with plans for antibiotics to treat any infection that might exist in your gallbladder, as well as plans for pain control. . changes to your medications: -please stop coumadin for now -start tylenol three times daily -start oral dilaudid as needed for pain -zosyn (iv antibiotic) for a total of 10-day course -increased dose of diuretic (lasix) followup instructions: you will be seen by a physicial after admission to the skilled nursing facility md procedure: venous catheterization, not elsewhere classified diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled candidiasis of other urogenital sites atrial fibrillation other persistent mental disorders due to conditions classified elsewhere long-term (current) use of anticoagulants cardiac pacemaker in situ diastolic heart failure, unspecified knee joint replacement calculus of gallbladder with acute cholecystitis, without mention of obstruction 

Answer: The patient is high likely exposed to