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: reglan / sorbitol / aspirin / hydrochlorothiazide attending: chief complaint: n/v, abdominal pain major surgical or invasive procedure: none history of present illness: 85f with hx of copd, chf, esophageal ulcer, and significant restless leg syndrome transferred from osh for further management of abdominal pain and fevers concerning for acute cholecytitis c/b sepsis. patient was in her usoh until sunday evening when she developed abdominal pain, non-bloody vomiting, and nausea. she describes the pain as sharp and crampy with severity ranging from pain with inability to take po's since sunday afternoon. she denies sick contacts at her nursing home but does state that there's been a stomach bug going around. she presented to earlier today where her initial vs were 98.2, 92, 179/92, 24, 92%ra. labs notable for wbc of 21.3k, 83 segs, 0 bands, k of 3.3, cr 0.9, dig < 0.04, lactate 2.9, lft's and lipase wnl's, ua with 3+ bacteria, wbc's, rare epis. she rec'd k repletion with 40meq, 1l ns, duoneb x 1, zosyn 3.25g x 1, atarax, and underwent ct abd/pelv (report not in chart) which per report showed massive retrocardiac hernia, markedly distended gb, pericholecystic fluid suggesting calculous cholecystitis. ruq u/s showed thick gb wall but no stones. she was transferred here for further management. ed course: initial vs - 100.6, 110, 166/100, 16, 97%2lnc -labs: 20.9wbc's, no bands, lactate 2.4, inr 1.0, bun/cr 15/1.0, k 3.8, lft's wnl's, lipase 21. -ekg: nsr @ 118, ni, leftward axis, q-waves in ii, avf, poor r-wave progression, no old priors on record -ruq u/s: no stones, extra- and intra-hepatic biliary ducts with the common bile duct measuring up to 10 mm. -cxr: large hiatal hernia, hyperinflated lungs, fibrotic pattern, no clear pleural effusions or infiltrates -evaluated by surgery in the ed who felt given her presentation c/w cholecystitis/possible cholangitis but given comorbidities that she is an overall poor surgical candidate and recommended admission to medical service with percutaneous drainage by ir. -admitted to micu for further management on arrival to the micu, patient's vs 99.2, 112, 162/84, 25, 96%2lnc. she confirms the above history and complains of mild headache. she otherwise denies chest pain, shortness of breath beyond her baseline, sore throat, cough, sinus tenderness, neck or back pain, urinary symptoms, or extremity discomfort other than her restless leg syndrome. review of systems: (+) per hpi, otherwise negative past medical history: - htn - cva - chf - restles leg - fibromyalgia - spinal stenosis - osteoporosis - glaucoma - esophageal uler - hiatal hernia into left hemithorax - copd - dyslipidemia - atrophic gastritis - polymyalgia rheumatica - pulmonary fibrosis - status post myocarditits with pericardial effusion - constipation - anemia - severe hip arthritis - rotator cuff orthopathy - insomnia - anxiety - depression social history: widowed, retired secretary. lives at rehabilitation and nursing care center. no tobacco, alcohol, recreational drug use. family history: not obtained physical exam: admission physical exam: vs: 99.2 ??????f, 117, 147/92, 26, 96% general: restless, reports having trouble getting words out coherently because she is so tired (no sleep in several days) heent: sclera anicteric, tongue appears moist though lips slightly dry, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops lungs: dry crackles at bases bilaterally, l > r, no wheeze. mildly tachypneic with speaking - breaks between sentences. abdomen: soft, non-distended, bowel sounds present, no organomegaly, mild ttp in epigastrum/ruq, no rebound or guarding gu: + foley ext: warm, well perfused, 2+ pulses, 1+ pitting edema b/l neuro: patient has shaking/spasms in her lower extremities which she says is due to restless legs. hands also shaking. discharge physical exam: 97.7(98.6) 147/84(130-160/70-90) 105(70-90) 20 96/ra i/o: 240+/375+ gen: resting in bed, nad heent: dry mm neck: supple. cor: +s1s2, pansystolic murmur heard throughout precordium pulm: faint inspiratory crackles scattered throughout both lung fields : +nabs in 4q. soft, ntnd. ext: wwp, trace le edema. neuro: oriented person, place, time. maee. psychomotor slowed. pertinent results: admission labs: =============== 04:00pm blood wbc-20.9* rbc-4.78 hgb-14.6 hct-46.0 mcv-96 mch-30.5 mchc-31.7 rdw-14.4 plt ct-309 04:00pm blood neuts-82.6* lymphs-12.0* monos-5.0 eos-0 baso-0.4 04:00pm blood pt-11.3 ptt-34.5 inr(pt)-1.0 04:00pm blood glucose-127* urean-15 creat-1.0 na-140 k-3.8 cl-102 hco3-24 angap-18 04:00pm blood alt-21 ast-36 alkphos-92 totbili-1.1 04:00pm blood lipase-21 08:54pm blood calcium-9.0 phos-2.2* mg-2.0 09:03pm blood type-art temp-37.3 po2-138* pco2-38 ph-7.45 caltco2-27 base xs-3 04:13pm blood lactate-2.4* 04:50pm urine rbc-7* wbc-3 bacteri-none yeast-none epi-0 04:50pm urine color-straw appear-clear sp -1.029 04:50pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.5 leuks-tr 04:50pm urine rbc-7* wbc-3 bacteri-none yeast-none epi-0 discharge labs: =============== 06:10am blood wbc-11.0 rbc-4.44 hgb-13.5 hct-43.3 mcv-98 mch-30.4 mchc-31.2 rdw-14.4 plt ct-235 06:10am blood glucose-99 urean-11 creat-0.8 na-138 k-4.2 cl-101 hco3-26 angap-15 micro/path: =========== mrsa screen: negative blood culture x 2: ngtd urine culture: no growth imaging/studies: ================ hida scan: impression: normal hepatobiliary scan. no evidence of cholecystitis. ct head w/o contrast: impression: 1. no acute intracranial process. 2. mild global atrophy with mild chronic microvascular ischemic disease. ct torso with contrast: impression: 1. dilation of the gallbladder is nonspecific without accompanying secondary signs of cholecystitis. 2. no definitive acute infectious process identified. 3. large left hemidiaphragmatic defect without definitive evidence of bowel obstruction or strangulation. equivocal fat stranding is seen here and the contrast column has not cleared this point-delayed plain film might be useful 4. marked demineralization accompanied by severe degenerative changes of the spine and hips. multiple age indeterminate thoracic compression fractures. chest (pa & lat): impression: large retrocardiac left mid-to-lower hemithorax opacity with areas of lucency with appearance of bowel and possibly stomach, likely related to large hernia possibly containing bowel, not well evaluated on this study, no priors for comparison. minimal right base atelectasis. ruq u/s: impression: distended gallbladder without evidence of stones. there is mild prominence of the extra- and intra-hepatic biliary ducts with the common bile duct measuring up to 10 mm. however, the patient has an equivocal sign post-medication as demonstrated by the attending radiologist. acalculous cholecystitis can not be excluded in the appropriate clinical setting. brief hospital course: 85f with a history of chf, copd, pulmonary fibrosis who presents with nausea, vomiting and abdominal pain since sunday. imaging at osh significant for likely cholecystitis. deemed poor surgical candidate so transferred to for consideration of percutaneous drainage by ir. active diagnoses: # cholecystitis: on arrival patient was with high-grade leukocytosis, fever, and significant abdominal pain and nausea. she was admitted to the micu for concern for evolving sepsis. she underwent ruq u/s here with findings that could be consistent with acalculous cholecystitis. she was evaluated in the ed by general surgery who felt she was not an ideal operative candidate and suggested hida scan and evaluation by ir for percutaneous cholecystostomy. egd also evaluated her but deferred to ir given the lack of obstructive findings on her lft's. ct torso and hida scan were negative for cholecystitis but did demonstrate dilated gall bladder. ct torso also demonstrated known large diaphragmatic hernia with stomach and bowel in the left chest with mild stranding and old po contrast from osh possibly c/w recent inflammation of the intrathoracic bowel. ir thus felt there would be little benefit from intervention. patient was started on vanc/zosyn, became abdominal pain free, afebrile, with a downtrending white count and was called out to the floor for further management. the patient did well on the floor. her vancomycin was discontinued. she remained on zosyn and completed a 7-day course in house. symptoms resolved at the time of discharge. # transient somnolence: patient has multiple late morning episodes of transient somnolence with normal finger sticks, normal abg's, and no clear seizure activity. she had a ct head which was negative for acute process. this was thought to be the result of oversedation from meds (iv morphine, klonopin prn, pm amitryptiline, and antiemetics). her level of alertness spontaneously resolved following these episodes. # diarrhea - on the floor the patient had a number of episodes of diarrhea. a c. diff was negative. she was maintained on ivf. her vancomycin was stopped as above. the patient's bowel regimen was stopped. the diarrhea improved. bowel regimen may be resumed as outpatient prn. # depression: the patient endorsed acute on chronic decrease in appetite long with insomnia and anhedonia. this was felt to be due to worsening depression. nutrition evaluated her and felt that she need maximal supplementation of her diet. the psychiatry team evaluated her while she was in the hospital and started mirtazapine 7.5 mg qpm (1 hour before meals). on the last evening of her admission she was able to sleep. her depression should be monitored while on this medication for signs of improvement. she warrants ongoing evaluation of her symptoms and medications. at the moment she appears well nourished, but if her diet and appetite do not improve with treatment of her depression then nutrition felt she might require tube feeds and evaluation for peg tube. this was briefly discussed with her son, . given that she is still recovering from an acute abdominal insult, it was felt that further evaluation could take place on an outpatient basis. # urinary retention: the patient was noted to have problems with urinary retention after having her foley pulled. if she does not produce urine she will need to be bladder scanned and possibly straight cathed if scanned for > 500. at the time of discharge she was incontinent of urine. chronic diagnoses: # copd: treated for exacerbation with rapid steroid taper in early . no active wheezing on exam. continued on nebs in-house. # chronic diastolic chf: lvef >75%. on home furosemide and digoxin which were initially held. pt's digoxin level non-toxic on admission. given poor po intake, her lasix was held at the time of discharge. it can be resumed at her nursing home once deemed appropriate after assessment of her volume status by a physician. # glaucoma: stable. continued on lumigan 0.3% ou qhs # depression/anxiety/restless leg syndrome: chronic issue for her. her home klonopin was dose-reduced prn but she was continued on her home amitryptiline and citalopram. # polymyalgia rheumatica: on chronic prednisone. no evidence of adrenal insufficiency. continued on prednisone 5mg po daily in-house as well as calcium and vitamin d. # htn: restarted on metoprolol after infectious process resolved. transitional issues: code status: dnr/dni, not cmo medications on admission: -miralax prn -calcium -vitamin d3 50,000 iu po monthly -protonix 40mg po daily -klor-con 20meq po bid -metoprolol tart 50mg po bid -fluticasone spray 50mcg twice daily -tylenol 650mg po qid prn -klonopin 1mg po daily qhs -klonopin 0.5mg po tid prn -albuterol neb q4hrs prn -tramadol 50mg po bid prn -milk of magnesia prn -fleet enema prn -robitussin prn -bisacodyl 10mg supp prn -prednisone 5mg alternating with 7.5mg po daily -lumigan 0.03% solution qhs -lactulose 30 ml po every other night at bedtime -amitryptiline 100mg po qhs -lactobacillus tabs po tid -furosemide 60mg po daily -digoxin 0.125mg po daily -citalopram 30mg po daily -bio e with selenium soft gel 1 tab po daily -multivitamin po daily -levaquin 750 mg once daily x 3 days () -prednisone 5 mg po daily -albuterol neb 0.083% inhaled qid x 7 days () discharge medications: 1. calcium 500 500 mg calcium (1,250 mg) tablet sig: one (1) tablet po twice a day. 2. miralax 17 gram powder in packet sig: one (1) po once a day as needed for constipation. 3. klor-con 20 meq packet sig: one (1) po twice a day. 4. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 5. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. fluticasone 50 mcg/actuation spray, suspension sig: one (1) nasal twice a day. 7. tylenol 325 mg tablet sig: two (2) tablet po four times a day as needed for pain. tablet(s) 8. clonazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for anxiety/nausea. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation every four (4) hours as needed for sob/wheeze. 10. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 11. bimatoprost 0.03 % drops sig: one (1) ophthalmic qhs (once a day (at bedtime)). 12. amitriptyline 50 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 13. lactobacillus acidophilus tablet, chewable sig: one (1) tablet, chewable po three times a day. 14. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 15. citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). 16. multivitamin tablet sig: one (1) tablet po once a day. 17. medication bisacodyl 10 mg suppository prn constipation 18. medication robitussin prn cough 19. medication milk of magnesia prn constipation 20. medication fleet enema prn constipation 21. lactulose 20 gram/30 ml solution sig: thirty (30) ml po every other night. 22. lumigan 0.03 % drops sig: one (1) drop ophthalmic at bedtime. 23. medication bio e with selenium soft gel 1 tab po daily 24. lasix 20 mg tablet sig: three (3) tablet po once a day: this medication should not be restarted until the patient is evaluated by a physician at the nursing home. 25. vitamin d2 50,000 unit capsule sig: one (1) capsule po once a month. discharge disposition: extended care facility: house discharge diagnosis: primary diagnosis: - cholecystitis secondary diagnosis: - depression - urinary retention discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: ms. , it was a pleasure taking care of you at ! you were admitted due to abdominal pain and found to have an infection surrounding your gallbladder. in the hospital it was decided that the best course of management would be a course of antibiotics. you were started on intra-venous antibiotics and your infection improved. while you were here, we noticed that your appetite was very poor and that you have been having difficulty sleeping. given your history of depression we had our psychiatry team evaluate you. they started you on a new medication to help with your depression & appetite. medication instructions: - medications added: ---> please take mirtazapine 7.5 mg 1 hour before dinner - medications stopped: ---> please stop taking standing klonopin (you may take a small dose as needed for anxiety) ---> please stop taking furosemide until a physician at your nursing home evaluates you. ---> please do not take tramadol as this can interact with your other medications followup instructions: please call you primary care physician, . , at ( to set up an appointment within the next two weeks. procedure: venous catheterization, not elsewhere classified diagnoses: anemia, unspecified polymyalgia rheumatica esophageal reflux congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids unspecified septicemia chronic airway obstruction, not elsewhere classified unspecified glaucoma sepsis diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia anxiety state, unspecified osteoporosis, unspecified other acquired absence of organ old myocardial infarction postinflammatory pulmonary fibrosis retention of urine, unspecified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diarrhea do not resuscitate status encephalopathy, unspecified acute cholecystitis spinal stenosis, unspecified region other specified antibiotics causing adverse effects in therapeutic use tachycardia, unspecified myalgia and myositis, unspecified chronic diastolic heart failure insomnia, unspecified acquired absence of both cervix and uterus restless legs syndrome (rls) major depressive affective disorder, recurrent episode, moderate 

Answer: The patient is high likely exposed to