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: no known allergies / adverse drug reactions attending: chief complaint: altered mental status major surgical or invasive procedure: ercp with biliary stent placement peg placement on history of present illness: ms. is an 83 year-old woman with a history of severe dementia (baseline oriented to name, minimally verbal, has to be fed, non-ambulatory), depression, hypertension and hypothyroidism who was sent in from her nursing home due to worsening mental status. according to the nursing home, she has had decreased po intake over the past 3 days as well as fevers. she has had increased somnolence as well with her spending a lot of time sleeping. she was noted to have a positive u/a and was started on levaquin. she also had labs on which showed bun 81, cr. 2.6, sodium 150. due to her decline she was sent to the ed for further evaluation. in the ed inital vitals were, t102.6 hr 92 113/62 rr30s 99% on nrm. she was started on vancomycin, ceftriaxone and given a dose of tylenol for her fever. her sodium was noted to be 157, creatinine of 2.9 and alt of 164/ast of 147. she was given 1.5l of normal saline. she had a ruq ultrasound which showed biliary stone but no evidence of cholangitis. she was admitted to the icu for management of sepsis. she was unresponsive and was unable to answer questions. she was tachypneic. according to her nursing home, she did not have any cough, chest pain, vomiting, rashes or skin changes. past medical history: - advanced dementia - hypertension - hypothyroidism - depression social history: lived in until recently. currently lives in . she does not have close family. her healthcare proxy is , a friend of hers for the last 40+ years. she enjoys going to church services. family history: pt unable to give history. physical exam: exam at time of arrival to medicine floor (from icu) on : vs: t 96.8, bp 94/52, hr 68, rr 18, o2 94% on 2lnc pain: unable to assess. gen: no acute distress, comfortable breathing heent: eomi, mmm, no oral lesions, but poor dentition neck: supple chest: ctab cv: rrr abd: soft, nontender, nondistended, bowel sounds present skin: ecchymoses on arms. ext: 3+ ble pitting edema neuro: awake, eyes open, surgical pupils, hypertonicity in all extremities, mostly non-verbal, does not follow commands. psych: calm pertinent results: 09:00am urine blood-mod nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-lg 09:00am urine rbc-43* wbc->182* bacteri-many yeast-none epi-0 08:37am blood wbc-8.4 rbc-3.51* hgb-10.6* hct-31.1* mcv-89 mch-30.2 mchc-34.1 rdw-14.3 plt ct-132* 08:37am blood plt ct-132* 08:37am blood glucose-142* urean-94* creat-2.9* na-157* k-4.3 cl-117* hco3-27 angap-17 08:37am blood alt-164* ast-147* alkphos-233* totbili-0.3 08:37am blood calcium-8.7 phos-4.0 mg-3.0* 08:37am blood tsh-2.7 08:37am blood t3-39* microbiology: urine culture : e.coli >100,000 ampicillin------------ 4 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s blood culture : coagulase negative staphylococcus in 1 set. all other blood cultures no growth (5 other sets). mrsa screen: negative ecg : sinus rhythm, rate 71, normal axis, nonspecific t-wave changes in anterior precordial leads. cxr : bedside frontal radiograph of the chest: cardiac, mediastinal and hilar contours are normal. subsegmental atelectasis is bilateral. there is no pneumothorax, pleural effusion or focal consolidation. there is no pulmonary edema. ct abdomen : 1. retroperitoneal, pelvic and inguinal lymphadenopathy. possible right axillary lymphadenopathy as well. given these findings, considerations include lymphoma. 2. numerous spinal compression deformities, with the most severe, at l3 new from 3. cholelithiasis 4. fibroids. 5. diverticulosis. 6. diffuse thickening of the left adrenal gland without definite nodularity, possible hyperplasia. 7. bibasilar pulmonary opacities, greater on the left than right, possibly atelectatic or infectious depending on the appropriate clinical context. ct head : no acute intracranial abnormality. ruq ultrasound : cholelithiasis and choledocholithiasis, without specific signs to confirm cholecystitis. lower extremity ultrasound : 1. extensive dvt in the left lower extremity as above. 2. dvt in the right proximal superficial femoral vein. 3. incidental probable cyst on the right. ercp : impression: multiple large stones in the entire biliary tree. given hypotension and over all clinical condition no attempt at stone extraction was made. a double pig-tail stent was placed. otherwise normal ercp to third part of the duodenum. cxr chest radiograph indication: evaluation for fluid overload. comparison: . findings: compared to the previous radiograph, there is a newly appeared opacity at the lung base. in addition, the left lung base also shows a newly appeared parenchymal opacity in the retrocardiac lung areas. the opacities are more likely to represent pneumonia rather than pulmonary edema, given the distribution and the lack of other signs indicative of overhydration. the size of the cardiac silhouette is unchanged. the position of the picc line is also constant. cxr:impression the right picc line tip is at the level of mid low svc. cardiomediastinal silhouette is unchanged, but there is interval progression of pulmonary edema. right hilar prominence is noted, more pronounced than on radiograph and may reflect engorged vasculature as well as hilar lesion. evaluation of the patient preferably with pa and lateral radiographs is recommended or if not possible, chest ct might be an option for evaluating of this area. brief hospital course: 83 year-old woman with advanced dementia presented to the hospital with acute metabolic encephalopathy from urinary tract infection with sepsis complicated by hypovolemic hypernatremia and acute kidney injury. further investigation found cholelithiasis and choledocholithiasis without cholecystitis. she underwent ercp with biliary stent placed. muliple gallstones were observed but none were removed at this time given her clinical condition. she was also found to have dvts in both legs and was started on a heparin gtt. many "family meetings" took place with the patient's hcp. the patient was not able to take po and the decision was made to pursue a temporary feeding tube to give the patient one more chance to recover to a standard of living that she would find acceptable. if no significant improvement is seen or the patient's condition worsens despite these interventions, then transition to comfort oriented care and discontinuation of feeding tube. the patient's pcp agrees with this approach. geriatrics and palliative care services were closely involved. after some delay due to scheduling issues, a peg was placed on . . problem list: # cholelithiasis, choledocholithiasis, and cholangitis: she had an elevated alkaline phosphatase and transaminitis on admission with imaging showing cholelithiasis and choledocholithiasis. ercp showed multiple stones that were causing partial obstruction seen at the biliary tree. given hypotension and over all clinical condition no attempt at stone extraction was made and a stent was placed. if patient's condition is acceptable for undergoing an ercp, repeat ercp in 8 weeks for stent removal and stone extraction/lithotripsy occurs. she was treated for 14-days with unasyn for cholangitis. . # uti with e. coli: this was treated with unasyn as it is being used for cholangitis (see above). . # ble dvt: the patient was started on a heparin gtt and transitioned to coumadin after peg placement by ir. she will be discharged with a lovenox bridge. inr goal is . the day prior to discharge she had a large bowel movement that was guiac positive; there was a question of melena. her hct was followed which remained stable and the patient had no further episodes. please monitor closely. . # hypernatremia hypovolemia: admission na 159. hypernatremia resolved with volume resuscitation. . # acute kidney injury (baseline cr 1.1): admission cr 2.9. was hypovolemia and sepsis. improved gradually with treatment of sepsis and hypovolemia. discharge cr is 0.9. . # hypothyroidism: tsh was normal at admission. she was treated with iv levothyroxine until her peg was placed at which time she was restarted on her oral dose. . # advanced dementia with overlying delirium critical illness and metabolic abnormalities including hypernatremia, hypovolemia, , uti, cholangitis, and dvt. her baseline function is oriented to name, minimally verbal, has to be fed, and non-ambulatory. given the severity of the illness that led her to this hospitalization, she will be unlikely to return to her prior level of (low) function. risperdone was restarted at discharge as a liquid form can be given through the peg. . # tachypnea: during the patient's hospitalization, she was noted to be intermittently tachypnic. her o2 sats were normal on ra but she was placed on a 35% fm for comfort. on she had a transient episode of tachypnea vs agitation and a repeat cxr was obtained. there was some concern for pneumonia vs asymmetric pulmonary edema. the patient's symptoms resolved completely with a nebulizer treatment and given that she remained afebrile without a leukocytosis, antibiotics were not initiated. after her peg was placed, the patient was again more tachypneic but after suctioning, returned to her baseline. cxr at that time showed some worsening of pulmonary edema. she did receive a dose of lasix at at the time of discharge, o2 sats were 96% on ra. pt should have repeat cxr to evaluate for resolution. right hilar prominence was noted and if unresolved, chest ct may be pursued in the future. . # nutrition: the patient had a prolonged period of being npo as there were scheduling challenges with the peg. it was placed on and she was started on fibersource hn at 45cc/hr. the patient did receive vit k x 1 when inr rose to 2. it down trended to 1.2. . #goals of care: i was in close contact with , the hcp; she felt the patient would not want any heroic measures to resuscitate her if she should experience cardiac arrest. she would also not like to be on any long-term life supportive treatments such as mechanical ventilation or long-term tube feeding. intubation for clearly reversible respiratory failure is acceptable. short-term tube feeding is also okay. primary care physician, . , assisted ms. in determining the goals of care for the patient. . # code status: dnr, but ok to intubate for reversible causes of respiratory failure. ms. is aware that there is a difference between dni and ok to intubate for procedure and is in the process of considering this as well as other goals of care. for now, she wishes for the patient to return to with the hopes that with additional nutrition she can build her strength and return to her prior baseline. . medications on admission: 1. acetaminophen 500 mg tablet sig: one (1) tablet po twice a day as needed for fever or pain. 2. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 3. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 4. nystatin 100,000 unit/g powder sig: one (1) app topical twice a day. 5. oyster shell calcium-vit d3 500 mg(1,250mg) -400 unit tablet 6. preservision areds 14, unit-mg-unit capsule 7. risperidone 0.25 mg tablet sig: one (1) tablet po bid (2 times a day). 8. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). discharge medications: 1. acetaminophen 650 mg suppository sig: one (1) suppository rectal q 8h (every 8 hours) as needed for pain. 2. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 3. levothyroxine 200 mcg recon soln sig: one (1) recon soln injection daily (daily). 4. vitamin d-3 400 unit tablet, chewable sig: one (1) tablet, chewable po once a day. 5. therapeutic multivitamin liquid sig: five (5) ml po daily (daily). 6. lovenox 100 mg/ml syringe sig: one (1) 90 units subcutaneous twice a day for until inr is for 2 days days. 7. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 8. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for sob. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for sob. 10. risperdone sig: 0.25 mg 0.25 mg po once a day: liquid form via peg. discharge disposition: extended care facility: - discharge diagnosis: - sepsis - cholangitis - urinary tract infection - acute kidney injury - hypernatremia - deep venous thrombosis, bilateral lower extremities - choledocholithiasis - cholelithiasis - advanced dementia discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: you were admitted to the icu with sepsis from urinary tract infection and cholangitis. complications of your sepsis included hypernatremia and acute kidney injury. you were also found to have blood clots in both legs. an ercp procedure was performed and stent placed in your bile duct. stones were found in your bile ducts that were not removed because your condition was too poor to tolerate stone removal. you also had a peg placed for tube feeds. medication changes: 1. held: preservision areds 12, unit-mg-unit capsule 2. held: amlodipine 5mg tablet daily - may be restarted a bp tolerates 5. stopped: aspirin 81mg tablet daily followup instructions: department: digestive disease center when: thursday at 10:00 am with: , md building: building (/ complex) campus: east best parking: main garage *this appointment is for an ercp procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] endoscopic insertion of stent (tube) into bile duct diagnoses: anemia, unspecified urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere pressure ulcer, buttock do not resuscitate status metabolic encephalopathy hyperosmolality and/or hypernatremia delirium due to conditions classified elsewhere calculus of gallbladder and bile duct without cholecystitis, with obstruction pressure ulcer, stage ii nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] acute venous embolism and thrombosis of deep vessels of distal lower extremity tachypnea 

Answer: The patient is high likely exposed to