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 analogues / codeine attending: chief complaint: shortness of breath major surgical or invasive procedure: ercp with stenting history of present illness: the pt is a 60y/o f with pmh of copd (o2 dependent) who was admitted to osh on with dyspnea and chest discomfort. she has a recent admission for resp distress and was treated w/ ceftazidime for pseudomonas uri. she was then admitted on with sob, cp and abdominal pain. she was treated for a copd exacerbation and is currently on a steroid taper. additionally, she developed c. diff and was started on iv flagyl and po vancomycin on the day of admission. during this hospitalization, she also underwent a laproscopic ccy given her abdominal pain. her abdominal pain did not resolve, so she the thought was she had a bile leak. therefore, a hida scan was performed which per reports suggested a bile leak, and she was sent to for an ercp. on ercp was performed and did not show eveidence of bile leak but a stent was placed. the procedure was uncomplicated and she received a total of 2 l ivf during this time. she was tachypneic before the procedure by nursing reports, but after the procedure was increasingly tachypneic with increasing o2 requirement with sats eventually in high 90s on 6l fm at the time of evaluation. she repots that she feel more sob than her baseline, denies cp, abdominal pain, fevers, chills. she does complain of some nause which was improved with zofran in the ercp holding area. . ros: denies fevers, chills. does have diarrhea and occasional abdominal and back pain. past medical history: copd on 2 l home o2 htn pulmonary htn gout pna social history: lives with husband. former , quit 13 years ago 30 pack year smoking history. no etoh, no drugs. 1 son. family history: mother with cancer. father with "lung problems" physical exam: vitals: t 97.6 bp114/65 hr 108 rr 19 o2 sats 88% on 5 l general: elderly female using accessory muscles to breath, able to speak 2 words at a time heent:mmm, op clear neck: no jvd cv: distant heart sounds pulm:distant breath sounds, few end expiratory wheezes abd: multiple ecchymoses, +bs, 2 small incisions intact with sutures, soft, nt/nd, palpable hematoma llq ext:no edema, no calf tenderness neuro: aaox3, moves all 4 extremities pertinent results: 04:56am blood wbc-35.1* rbc-3.68* hgb-10.5* hct-32.4* mcv-88 mch-28.6 mchc-32.5 rdw-15.0 plt ct-347 10:18pm blood wbc-46.3* rbc-4.27 hgb-12.2 hct-37.2 mcv-87 mch-28.5 mchc-32.7 rdw-14.8 plt ct-410 10:18pm blood neuts-90* bands-5 lymphs-1* monos-2 eos-0 baso-0 atyps-0 metas-1* myelos-1* 10:18pm blood hypochr-occasional anisocy-1+ poiklo-occasional macrocy-normal microcy-1+ polychr-occasional schisto-occasional burr-2+ tear dr 04:56am blood plt ct-347 10:18pm blood plt smr-high plt ct-410 10:18pm blood pt-13.2 ptt-25.9 inr(pt)-1.1 04:56am blood glucose-97 urean-13 creat-0.4 na-135 k-3.5 cl-108 hco3-15* angap-16 10:18pm blood glucose-102 urean-12 creat-0.4 na-132* k-3.7 cl-101 hco3-16* angap-19 04:56am blood albumin-2.0* calcium-6.6* phos-3.5 mg-1.4* 10:18pm blood calcium-7.7* phos-4.2 mg-1.6 10:20pm blood type-art po2-55* pco2-40 ph-7.36 caltco2-24 base xs--2 intubat-not intuba cxr: bilateral flattening of diaphragms with ? anterior bleb. no pna or pulmonary edema brief hospital course: 60 yo female with copd on home o2, pulmonary htn, recent lap ccy and recently diagnosed c. diff transferred from hospital for ercp with worseing sob and tachypnea # sob/tachypnea: most likely copd exacerbation given recent steroid taper, poor air movement, and relatively unremarkable cxr. also, consider aspiration peri-procedure, but less likely as no overt signs on cxr. this could be pulmonary edema as well given she received fluids during the procedure, but she does not appear to be volume overloaded on exam. also, consider pe, but has been on dvt prophylaxis and no evidence of dvt. she was given albuterol and atrovent nebulizers, prednisone 60 mg pox1 and her o2 was weaned to 3 l nc with o2 sats in the low 90s and rr in mid 20s. she was continued on prednisone 60 mg po qday x3 days on transfer back to hospital. # abdominal pain s/p ercp: recent ccy. sent here for ercp. uncomplicated procedure. stent was placed. was kept npo overnight, diet advanced at tolerated in am. she was strted on ciprofloxacin in addition to flagyl for a 7 day course. she should have stent removal in 1 month. # nausea/vomiting: per her report this has been going on for some time. could be secondary to pain meds, c. diff. she was continued on antiemetics. # elevated wbc: most likley secondary to c. diff. currently afebrile and hd stable. other possible sources are uti or pna, but cxr is unremarkable and ua only with pyuria. she did have an abdominal procedure, but abdominal exam is benign. also, consider steroids, but unlikely to raise wbc this high. she was continued on po vancomycin, iv flagyl, ciprofloxacin given instrumentation of biliary tree. urine culture and final radiology read of cxr is pending at discharge. # c. diff: her wbc were extremely elevated to 46 on admission, then down to 35 the following day woth a hco3 of 15. she was continued on po vanco and iv flagyl given a 500 cc bolus plus ns at 150 cc/hr with uop of 40-60 cc/hr. # htn: her antihypertensives were held overnight and can be restarted pending clnical stability. # fen: she was npo overnight. now adat # ppx: ppi, sc heparin . # code: full # access: piv # contact: medications on admission: prednisone 10 mg po qday (on taper) multivitamin vicodin 2 tabs prn pain vancomycin 125 mg po q6h (day 1 ) flagyl 500 mg iv qday (day 1 ) albuterol nebs norvasc 5 mg po qday atenolol 25 mg po qday colchicine 0.6 mg po bid colace 100 mg po bid nexium 40 mg po qday flovent 4 puffs heparin 500 units sc tid spiriva once daily discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours). 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 4. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 5. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 6. fluticasone 110 mcg/actuation aerosol sig: four (4) puff inhalation (2 times a day). 7. hexavitamin tablet sig: one (1) cap po daily (daily). 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q2h (every 2 hours) as needed for shortness of breath or wheezing. 9. prednisone 20 mg tablet sig: three (3) tablet po daily (daily) for 3 days. 10. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 6 days. 12. hydrocodone-acetaminophen 5-500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 13. vancomycin 250 mg capsule sig: one (1) capsule po q6h (every 6 hours). 14. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: five hundred (500) mg intravenous q8h (every 8 hours). 15. ondansetron 4 mg iv q8h:prn nausea discharge disposition: extended care discharge diagnosis: 1. copd exacerbation 2. ercp for ? bile leak 3. c. difficile discharge condition: hd stable, o2 sats 91-93% on 3 l nc discharge instructions: patient is being transferred back to hospital after observation overnight for tachypnea and hypoxia. you were transferred to for an ercp to visualize your bile ducts. no leak was identified. you will continue on prophylactic antibiotics for the next 7 days. after your procedure, you became short of breath. it was thought that you had a copd exacerbation. you were treated with steroids and nebulizers, and your respiratory status improved. you are being transferred back to hospital now that your respiratory status has stabilized. followup instructions: you should have a repeat ercp in 1 month for removal of your stent. you are being transferred back to hospital for further management. procedure: endoscopic insertion of stent (tube) into bile duct diagnoses: unspecified essential hypertension gout, unspecified obstructive chronic bronchitis with (acute) exacerbation other chronic pulmonary heart diseases personal history of tobacco use other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure intestinal infection due to clostridium difficile other specified disorders of biliary tract accidents occurring in residential institution 

Answer: The patient is high likely exposed to