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 / keflex / darvon / darvocet / percocet / percodan / strawberry attending: chief complaint: abdominal pain and fever major surgical or invasive procedure: ercp with stone extraction and stent placement history of present illness: the patient is a 61yo f depression presenting with choledocholithiasis with pmh notable for choledocolithiasis 10 years ago s/p ccy. . per patient report and record patient with h/o with choledocolithiasis s/p gallbladder removal in which was complicated by cystic stump leak s/p ercp with sphincterotomy and stent placment with further complication of duodenal perforation. patient has been without instrumentation since that time. . patient had been in usoh when presented to with 5 days of abdominal pan , nausea, vomiting and poor po intake with associated weight loss. she has also noticed "yellow" stools during this time period as well. she has also been having subjective fevers and chills. the patient underwent ct scan that showed a 5x7mm in the cbd with intrahepatic ductal dilation with air concerning for gas-forming organism. her baseline sbp are usually in the 90's per report. she had documented pressures as low as the 60's at the osh. she was given 5l ivf and started on peripheral neo at 50mcg/min. she was covered with levofloxacin/flagyl/zosyn/vanco po. she was transferred to ed for further evaluation. . in the ed, 97.1 93 88/59 18 100% 3l. the patient's labs were significant leukocytosis of 11.7, hct 29.7. lft were remarkable for tbili 7.3, ap 243, alt: 95 and ast 40. the patient was weaned off pressors in the ed. the patient was seen by surgery who will continue to follow along. the patient was also evaluated by ercp with plans to perform the procedure in the am. . on the floor the patient reports feeling better and painis improved to . . ros: the patient denies any nausea, vomiting, abdominal pain, diarrhea, constipation, melena, hematochezia, chest pain, shortness of breath, orthopnea, pnd, lower extremity edema, cough, urinary frequency, urgency, dysuria, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash or skin changes. past medical history: depression fibromyalgia s/p parathyroidectomy for adenoma, s/p cholecystectomy -- biliary sphincterotomy and placement of biliary stent with subsequent removal. ercp complicated by duodenal perforation social history: patient quit smoking 20years ago with a 40 pack year history. occasional etoh. denies ivdu family history: mother died of breast cancer at 54 physical exam: vs: temp: bp: / hr: rr: o2sat gen: pleasant, comfortable, nad, jaundice, tired appearing heent: perrl, eomi, anicteric, dry mm, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: + tenderness over the umbilicus. tenderness to deep palpation over the epigastric and ruq, +b/s, soft ext: no c/c/e skin: no rashes/ jaundice/no splinters neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. no pass-pointing on finger to nose. 2+dtr's-patellar and biceps pertinent results: labs on admission: 10:40pm blood wbc-11.7*# rbc-3.50* hgb-10.6* hct-29.7* mcv-85 mch-30.2 mchc-35.6* rdw-12.9 plt ct-220 10:40pm blood neuts-92.5* lymphs-4.8* monos-2.5 eos-0 baso-0.2 10:40pm blood pt-15.6* ptt-25.6 inr(pt)-1.4* 10:40pm blood fibrino-712* 10:40pm blood glucose-125* urean-14 creat-0.8 na-140 k-3.4 cl-110* hco3-23 angap-10 10:40pm blood alt-95* ast-40 alkphos-243* amylase-9 totbili-7.3* 10:40pm blood lipase-13 ggt-262* 10:40pm blood albumin-3.2* calcium-8.3* phos-2.2* mg-1.9 cholest-122 10:40pm blood triglyc-136 hdl-7 chol/hd-17.4 ldlcalc-88 01:30am urine rbc-0-2 wbc-* bacteri-mod yeast-none epi-0-2 01:30am urine blood-sm nitrite-neg protein-75 glucose-neg ketone-neg bilirub-lg urobiln-neg ph-5.0 leuks-tr 01:30am urine color-amber appear-hazy sp -1.018 cxr: pa & lateral: widened mediastinal contour is unchanged and may be secondary to underlying vascular abnormality/tortuosity or possibly an underlying mass. an 11-mm nodular opacity overlies the right first anterior rib. there is no pneumothorax. there is slight blunting of the costophrenic angles. impression: prominent mediastinal contour and nodular right apical opacity, for which dedicated contrast-enhanced chest ct is recommended for further evaluation. ercp: impression: successful biliary cannulation stones at the main duct successful stone extraction with spiral basket. pus exiting the ampulla there was a suggestion of narrowing at the biliary hilum successful placement of 10cm x 10f biliary stent. otherwise normal ercp to third part of the duodenum recommendations: please call dr. office at with any further questions or concerns. please call the on call ercp fellow at with any immediate concerns such as fever, abdominal pain, bleeding, following your procedure. watch for bleeding, perforation, and pancreatitis. repeat ercp in 3 weeks with dr. for stent removal and reassement of duct for residual stone or stricture. continue antibiotic therapy for 14 days. ct chest: impression: a roughly 11-mm wide right upper lobe nodule corresponding to lesion seen on recent chest radiograph should be considered malignant until proved otherwise. any prior chest radiograph should be obtained to see if the lesion is longstanding. otherwise pet ct scanning or short-term followup in three months would constitute imaging management. the lesion should be accessible to transthoracic ct-guided needle aspiration. brief hospital course: 61f with history of prior chole c/b stump leak in past now admitted with findings c/w acute cholangitis / 5x7mm cbd stone. febrile o/n but hd stable. . # cholangitis: patient presented to osh with symptoms os fevers, ruq tenderness and jaundice. ct scan from osh demonstrated pneumobilia and a stone in the cbd with intrahepatic ductal dilation. initially hypotensive at outside hospital requiring pressors, however on arrival patient fluid responsive (resuscitated with ~6l ivf) and pressors weaned. patient continued on vancomycin and zosyn for antibiotic coverage. ercp was consulted and patient underwent uncomplicated ercp on . ercp demonstrated successful biliary cannulation, stones at the main duct, successful stone extraction with spiral basket, pus exiting the ampulla, and successful placement of 10cm x 10f biliary stent. her diet was advanced the following morning to clears, which resulted in increased nausea and abdominal pain. she then had intermittent abd pain for the next few days. we suspected mild post ercp pancreatitis. after more ivf her pain improved. repeat lfts showed improved t. bili, with mild transaminitis. she was transitioned to cipro/flagyl for which she will need a 14 day total course - she will need repeat ercp in 3 weeks - we recommend repeating lfts on pcp follow up. . # chest ct abnormalities: hilar and right apical abnormalities noted on initial cxr and on repeat pa/lateral. ct scan showed prelim read was 11 x 9mm pulmonary nodule in the right apex, also with right apical and basilar lung acarring/atelectasis. pet/ct can be considered for evaluation of metabolic activity). given patient's 50 pack-year history and recent 30 pound unintentional weight loss, this will require close follow-up to rule-out malignancy. final read: a roughly 11-mm wide right upper lobe nodule corresponding to lesion seen on recent chest radiograph should be considered malignant until proved otherwise. any prior chest radiograph should be obtained to see if the lesion is longstanding. otherwise pet ct scanning or short-term followup in three months would constitute imaging management. the lesion should be accessible to transthoracic ct-guided needle aspiration. --these findings were discussed with the patient and she understands the possibility of maligancy. . # coagulopathy: patient's inr elevated at 1.4 on admission. no evidence of dic, fibrinogen was 712. likely vit k def in the setting of poor nutrition. stable at time of discharge. . # diarrhea: c.difficile sent and was negative. medications on admission: codeine xanax 2-3mg qhs discharge medications: 1. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 9 days. disp:*18 tablet(s)* refills:*0* 2. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 9 days. disp:*27 tablet(s)* refills:*0* 3. hydromorphone 2 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*20 tablet(s)* refills:*0* 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 5. zofran 4 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. disp:*15 tablet(s)* refills:*0* 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation: over the counter. 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation: over the counter. 8. alprazolam 1 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 9. outpatient lab work cbc, ast, alt, alk phos, t. bili at next follow up. discharge disposition: home discharge diagnosis: acute cholangitis pulmonary nodule fibromyalgia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were transferred to the for further evaluation and treatment of your cholangitis. you underwent ercp with stone removal and stent placement and were treated with iv antibiotics. these were transitioned to oral antibiotics, which you will need to continue taking for a total of 14 days. as we discussed, you were found to have a lung nodule of uncertain significance, though it might be a cancer. please follow-up with your primary care physician regarding the pulmonary nodule found on your chest ct as soon as possible. medications started: ciprofloxacin 500mg twice daily flagyl 500mg three times daily (avoid with alcohol) dilaudid as needed for pain. do not use with alcohol or driving, take with stool softeners followup instructions: please follow-up with dr. on thursday, at 1:30. you will also need to follow-up with the ercp for a repeat ercp in three weeks for stent removal. their office will be in contact with you to schedule that procedure. pcp: . location: internal medicine address: ., , , phone: procedure: endoscopic removal of stone(s) from biliary tract endoscopic insertion of stent (tube) into bile duct diagnoses: abnormal coagulation profile polymyalgia rheumatica depressive disorder, not elsewhere classified diarrhea cholangitis myalgia and myositis, unspecified acute pancreatitis calculus of bile duct without mention of cholecystitis, with obstruction 

Answer: The patient is high likely exposed to