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: diovan attending: chief complaint: abdominal pain . major surgical or invasive procedure: ij central line placement history of present illness: patient is a f with pmh of dementia, a. fib with tachy-brady syndrome who was brought in from rehab with 1 week of abdominal pain, nausea, vomiting, poor po intake on liquid diet. she had an ultrasound at rehab which showed a gallstone or porcelain gallbladder. she was treated with oxycodone for pain and zofran for nausea. she developed acute renal failure with increase in her creatinine to 3.13 on . she was given ivf and her torsemide dose was increased. she initially had a do not hospitalize order but after discussion with the daugher and hcp, this was reversed. . in the ed, initial vs were: t 96.3 p 45 (30-70) 150/98 16 89% on ra. her bp dropped to 56-64 systolic, on recheck was 90/doppler in l arm, 70/doppler in r arm. bp remained 87/60 after 4l ns and she was started on levophed drip. exam showed ruq abdominal pain. her ekg showed afib rvr @ 116, no ischemic change. stools were guaiac positive. she was given ceftriaxone and flagyl. cxr was neg for pna. pelvic films showed no fx. she was seen by surgery who recommended zosyn and ercp eval as hcp does not want surgery. vs prior to transfer were t 95, p: 107, bp: 117/99, rr: 23, 95% on ra . on arrival to the micu, patient was comfortable. she was complaining of mild nausea but no abdominal pain at rest. past medical history: - hypertension - atrial fibrillation - dementia - gerd - h/o frequent falls, ? association w/syncope - depression and anxiety - dm ii - cholelithiasis social history: russian-speaking only, lives at rehab nursing home. has daughter. tobacco, etoh or drugs family history: noncontributory. physical exam: admission physical general: elderly female, smiling, oriented to person, hospital but not time heent: sclera anicteric, mmm, oropharynx clear, neck: supple, jvp not elevated, r ij in place cv: irregular rate and rhythm (tachy-brady), normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, ttp in ruq, hypoactive bowel sounds present, no organomegaly gu: foley in place ext: cool, well perfused, 2+ pulses, 2+ pedal edema neuro: cnii-xii grossly intact, moving all extremities, no focal deficits . discharge physical p-109, 100% ra , 130/80 general: elderly female, smiling, oriented to person, hospital but not time heent: sclera anicteric, mmm, oropharynx clear, neck: supple, jvp not elevated, r ij in place cv: irregular rate and rhythm (tachy-brady), normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, ttp in luq,no ruq tenderness, hypoactive bowel sounds present, no organomegaly gu: foley in place ext: cool, well perfused, 2+ pulses, 2+ pedal edema neuro: cnii-xii grossly intact, moving all extremities, no focal deficits . pertinent results: admission labs 09:07pm ck(cpk)-65 09:07pm ck-mb-6 ctropnt-0.07* 09:07pm wbc-6.0 rbc-2.43* hgb-8.5* hct-26.5* mcv-109* mch-34.9* mchc-32.0 rdw-14.6 09:07pm plt count-234 12:30pm urine osmolal-324 12:30pm urine osmolal-324 12:30pm urine hours-random urea n-483 creat-51 sodium-13 potassium-55 chloride-25 12:30pm urine color-yellow appear-hazy sp -1.008 12:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-2* ph-5.5 leuk-sm 12:30pm urine rbc-0 wbc-7* bacteria-mod yeast-none epi-0 12:30pm urine hyaline-1* 12:28pm comments-green top 12:28pm glucose-93 lactate-1.3 na+-134 k+-4.3 cl--95* tco2-26 12:20pm glucose-101* urea n-69* creat-2.6*# sodium-133 potassium-4.6 chloride-97 total co2-26 anion gap-15 12:20pm alt(sgpt)-29 ast(sgot)-19 alk phos-128* tot bili-0.9 12:20pm alt(sgpt)-29 ast(sgot)-19 alk phos-128* tot bili-0.9 12:20pm ctropnt-0.09* 12:20pm lipase-23 12:20pm wbc-6.5 rbc-2.67* hgb-9.4* hct-28.8* mcv-108* mch-35.1* mchc-32.6 rdw-14.6 12:20pm plt count-272 12:20pm neuts-67.2 lymphs-27.3 monos-2.8 eos-2.5 basos-0.2 12:20pm pt-12.6* ptt-28.2 inr(pt)-1.2* . discharge labs 02:20am blood wbc-4.9 rbc-2.39* hgb-8.7* hct-26.2* mcv-110* mch-36.4* mchc-33.2 rdw-14.8 plt ct-238 03:54am blood wbc-5.3 rbc-2.32* hgb-8.1* hct-25.4* mcv-110* mch-35.1* mchc-32.0 rdw-14.8 plt ct-223 12:20pm blood neuts-67.2 lymphs-27.3 monos-2.8 eos-2.5 baso-0.2 02:20am blood plt ct-238 03:54am blood plt ct-223 02:20am blood glucose-80 urean-47* creat-2.0* na-138 k-3.8 cl-106 hco3-19* angap-17 03:54am blood ret aut-2.1 03:54am blood glucose-78 urean-55* creat-2.0* na-140 k-3.7 cl-108 hco3-23 angap-13 02:20am blood alt-25 ast-23 ld(ldh)-324* alkphos-105 totbili-0.8 03:54am blood alt-22 ast-17 ld(ldh)-234 ck(cpk)-74 alkphos-100 totbili-0.6 03:54am blood ck-mb-6 ctropnt-0.07* 09:07pm blood ck-mb-6 ctropnt-0.07* 12:20pm blood ctropnt-0.09* 02:20am blood calcium-8.4 phos-3.6 mg-1.7 03:54am blood caltibc-199* vitb12-1727* folate-16.8 ferritn-161* trf-153* 12:28pm blood glucose-93 lactate-1.3 na-134 k-4.3 cl-95* calhco3-26 . micro- blood cx pending, negative to date brief hospital course: patient is a f with pmh of dementia, a. fib with tachy-brady syndrome with 1 week of abdominal pain, nausea, vomiting, was found to have ruq pain, gallstones with possible choledocholithiasis. . #hypotension: now resolved. patient presented with ruq pain, findings of choledocholithiasis, hypotension and hypothermia. patient was volume resuscitated in the ed with 4 l ns. her hypotension was likely worsened by her tachy-brady syndrome and her history of baseline relative hypotension/dehydration. suspicion for sepsis was low given the resolved hypotension in less than 12 hours, no fevers, no leukocytosis or infection localized. could also be related to hypovolemia and tachycardia causing hypotension. zosyn for choledocholithiasis has been discontinued given very low clinical suspicion for cholangitis.bcx, ucx ?????? pending and negative to date. . # abdominal pain: likely secondary to chololithiasis given ruq us that showed porcelain gallbladder, intra and extrahepatic biliary dilation, with cbd measuring up to 17 mm along with ruq pain and positive sign. these changes however were felt to be more chronic in nature than acute given normal lft's. would expect her lfts to be more elevated if gallbladder was etiology of septic shock and wbc also remains normal. family is against any surgical intervention at this time but open to ercp. could be more of a chronic biliary process given porcelain gallbladder and normal labs, such as a pancreatic or biliary malignancy. no acute indication for ercp . # acute on chronic renal failure: patient's creatinine peaked at 3.13 on , now sl improved at 2.0 with ivf. arf likely secondary to poor po intake in the setting of sepsis and infection. resolved with fluids to a creatinine of 2.0. . #elevated troponin: also associated with twi which are resolved and ce trending down. patient denies cp currently.per patient has had chest pain intermittently for over 20 years. likely related to demand ischemia in the setting of hypotension and tachycardia when the patient was off beta blockade at the beginning of the admission. repeat ecg revealed no new ischemic changes trop downtrending from 0.09 to 0.07 and negative ck-mb. continued home aspirin 325 mg po daily. restarted metoprolol after hypotension resolved and patient's heart rate stabilized around 100-110. . # macrocytic anemia: hct 28.8 sl lower than prior of 34 in though unclear recent baseline. hct 26.5-> 25.4 after 4 l ns likely from hemodilution.hct stabilized around 26. continue ppi for now, will discontinue on discharge to rehab given low suspicion for gastric ulcer or bleed.vitamin b12 and folate were normal and not iron deficient. . #dementia: patient has dementia at baseline and is not oriented to time. she continues to have agitation and is trying to get out of bed but can reorient. reoriented frequently. haldol prn agitation # communication: daughter # code: dnr/dni confirmed with ludmila dymina # disposition: back to rehab. .------------------ transitional issues -f/u cbc and creatinine in 1 week time -up titrate beta blockade as tolerated to control atrial fibrillation - ensure patient is hydrated medications on admission: protonix 40mg ranitidine 300mg qhs fludrocortisone .1mg topamax 100mg naproxen 375mg klonopin 1mg qhs, .5mg qam symbicort 80mcg 2 puff alb inh and nebs prn singulair 10mg qhs fioricet prn nortriptyline 50mg qhs asacol 2400mg daily nimodipine 60mg . allergies: amoxicillin reglan compazine discharge medications: 1. oxycodone 5 mg tablet sig: one (1) tablet po four times a day as needed for pain. 2. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 3. ativan 0.5 mg tablet sig: one (1) tablet po once a day. tablet(s) 4. aspirin 325 mg tablet sig: one (1) tablet po once a day. 5. torsemide 20 mg tablet sig: two (2) tablet po once a day. 6. hyoscyamine sulfate 0.125 mg tablet sig: two (2) tablet po twice a day. discharge disposition: extended care facility: for the aged - discharge diagnosis: primary diagnosis hypotension dehydration chronic biliary obstruction . secondary diagnosis atrial fibrilliation coronary artery disease dementia discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: it was a pleasure to care for you as your doctor. . you were brought to the hospital because of low blood pressures and high heart rate which we felt was due to dehydration and a underlying arrythmia which you have. your low blood pressure resolved with fluids and your high heart rate improved with the medication named metoprolol. signs of infection was found in your urine or blood. an ultrasound of your liver showed dilated gall bladder which most likely represents a chronic process of unknown etiology. . there was no changes made to your home medication list. . please follow up with your care at rehab. weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: rehab procedure: venous catheterization, not elsewhere classified diagnoses: esophageal reflux diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation depressive disorder, not elsewhere classified chronic kidney disease, unspecified anxiety state, unspecified hypotension, unspecified do not resuscitate status sinoatrial node dysfunction dehydration obstruction of bile duct unspecified deficiency anemia other specified disorders of gallbladder history of fall 

Answer: The patient is high likely exposed to