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: history of present illness: ms. is a pleasant, 74 year-old woman with multiple medical problems, presenting from an outside hospital with a one week history of 8 out of 10 right upper quadrant pain, fever, nausea and vomiting, diarrhea. at an outside hospital, the patient was noted briefly to be in atrial fibrillation with ventricular rate in the 130s to 150s. at the outside hospital, the patient was also noticed to have guaiac positive, black, tarry stools, hematocrit of 37 and mildly elevated lfts with total bilirubin of 4.2. inr at outside hospital was 4.02. she was given 10 mg of vitamin k subcutaneously. on initial presentation, she denied any reports of chest pain, shortness of breath or back pain. her belly was soft. she has passed flatus. temperature at outside hospital was 99.1, 100.9 by ems. per report of the patient, she has been febrile to 101 for the past 2 days prior to the initial presentation. past medical history: remarkable for history of pulmonary embolism, end stage renal disease, congestive heart failure, diabetes, hypertension and hypothyroidism. physical examination: on initial presentation, she was in mild painful distress. vital signs at were 98.5, heart rate 99, blood pressure 79/44, respiratory rate 17, oxygen saturation 94% on room air. belly was mildly distended with right upper quadrant tenderness. 1 to 2 cm palpable liver edge and hypoactive bowel sounds. rectal examination was stool positive guaiac and black and tarry, with no gross blood visualized. bedside ultrasound showed a positive gallbladder distention with no wall thickening and the common bile duct was not visualized. the patient was taken to the operating room on for laparoscopic cholecystectomy versus open with initial diagnosis of cholangitis/cholelithiasis. procedure was uncomplicated. the patient was extubated in stable condition to the pacu. intraoperatively, a nodular liver was visualized. gallbladder specimen was sent for pathology. physical examination on initial presentation revealed vital signs with temperature of 98.5, heart rate 99, blood pressure 97/50, respiratory rate of 17 and oxygen saturation 94%. the patient was in painful distress. the pupils were equal, round and reactive to light and accommodation. extraocular movements intact. neck was supple with no lymphadenopathy. lungs were clear to auscultation bilaterally without wheezes, rhonchi or rales. cardiovascular rate was in sinus rhythm without murmurs, rubs or gallops, normal s1 and s2. belly was mildly distended with right upper quadrant tenderness. hypoactive bowel sounds and a 1 to 2 cm palpable liver edge. there was no cva tenderness. it was noted that the patient had 1+ bilateral lower extremity edema with some venous stasis changes. there was no calf tenderness and sign was negative. cranial nerves 2 through 12 were intact. motor was throughout and sensation was grossly intact to light touch. laboratory data: cbc dated revealed a white count of 19.2, hematocrit of 31.9, cbc white count was 28.9; hematocrit of 31.5. cbc on revealed a white count of 10.2, hematocrit of 30.5. cbc on revealed a white count of 7.2, hematocrit 27.9. final pathology results of the gallbladder revealed acute and chronic cholecystitis with no calculi. liver needle biopsy showing chronic active cholangitis and cholestasis. tri-chrome stain mild increase of portal fibrosis; iron stain moderate iron deposition and kupffer cells. hepatic features consistent with large bile duct obstruction. hospital course: in short, ms. was transferred to on from an outside hospital complaining of 8 out of 10 right upper quadrant pain. she is admitted for observation. ultrasound showed gallbladder distention, no wall thickening. the common bile duct is not visualized. the patient was taken to the operating room on by dr. and the surgical team for laparoscopic cholecystectomy. the procedure was uncomplicated with minimal blood loss. specimen was sent for pathology. report listed above. the patient was extubated in stable condition to the pacu for monitoring. the patient was hypotensive with systolic pressures in the 70s. postoperatively, the patient was alert and oriented x3, moving all extremities. speech is clear and coherent. her systolic pressures ranged from the 60s to 100s. her left arm with fistula had a positive bruit and a positive thrill. left hand was warm, well perfused, however, occasionally she reported coolness and purpleness in her fingers. she is neurovascularly intact distally. the patient had a brief period of atrial fibrillation. she was observed in the intensive care unit. cardiology was consulted and the patient was treated with intravenous lopressor 2.5 mg. on postoperative day number 3, the patient received 1 unit of packed red blood cells. she was started on coumadin and heparin. on , she was taken to hemodialysis. she was comfortable, eating breakfast and watching tv. her blood pressure continued to be low with systolics in the 70s and 80s. the patient initially had some respiratory difficulty postoperatively requiring bi-pap but had improved by postoperative day number 3 and had been relatively stable since. at that time, the patient appeared to have been fluid over loaded despite her hypotension and presumed intravascular volume depletion. overall, by postoperative day number 3, she had much improved and denied any pain. on postoperative day number 4, the patient was tilt negative. the use of an alpha agonist p.o. was discussed and the use of a concurrent beta blocker was discussed. there was concern for blunting potential responses to her hypotension. this was discussed with the cardiology fellow who stated that the team would review the patient again with the rest of the cardiology team. the patient tolerated solid foods. with regards to ms. atrial fibrillation, she was fairly asymptomatic. rhythm control was attempted with amiodarone per cardiology's recommendation 600 mg p.o. q. day x3 weeks. she was to be sent home on a kingdom heart monitoring for her bradycardia. she also had several 3 second pauses throughout the night. given the conversion pauses since starting amiodarone, one of 3.3 seconds and the other of 4.1 seconds, cardiology recommended discontinuing the use of the amiodarone and convert back to rate control, metoprolol 25 mg twice a day and to cut back on the patient's valsartan dose, which was eventually discontinued. physical therapy and occupational therapy worked with the patient. on , the patient was taken to echocardiography which showed mild left atrial dilatation, mild right ventricular hypokinesis, 1+ mitral regurgitation and left ventricular ejection fraction greater than 65%. chest x-ray on that date showed bilateral moderate pleural effusion. her midodrine dose was increased to 7.5 three times a day. endocrine and clinic were consulted for management of patient's hypothyroidism, levothyroxine dose and blood sugars. on , house officer was called to see the patient for somnolence, low blood pressure, tinnitus, mild confusion, fatigue and blurry vision. these side effects were seen to be consistent with the side effects of neurontin which was discontinued at that time. on , the patient was comfortable, denied headaches, ataxia or any other further visual changes now off of the dilantin. she was able to perform finger to nose and had no disdiadochokinesia. thyroid function tests were checked. a tsh was elevated. this was discussed with endocrine who recommended increasing her levothyroxine dose. this was increased to 200 mcg q. day. blood sugars on were low, 54, 58, 75. her p.o. diabetes medication, glipizide, was discontinued at that time. by , the patient was doing well from a surgical perspective. her incision was clean, dry and intact. her belly was soft. she had no further abdominal pain. she was tolerating a regular diet. she was out of bed with physical therapist. she was receiving dialysis per renal. on , the renal service felt that the patient was steadily improving and from their standpoint, ready for discharge after dialysis on . disposition was planned with case management at that time. condition on discharge: stable. discharge status: home with vna. discharge diagnoses: cholecystitis, cholelithiasis, status post laparoscopic cholecystectomy. discharge medications: aspirin 325 mg p.o. q day. bisacodyl 10 mg p.o./p.r. daily prn. folate 1 mg p.o. daily. insulin dosing. levothyroxine sodium 175 mcg p.o. q. day. metoprolol 12.5 mg p.o. q. day. midodrine hydrochloride 7.5 mg p.o. three times a day. protonix 40 mg p.o. q. 24 hours. warfarin 3 mg p.o. q. day. follow up: follow up will be with the patient's primary care physician for management of her multiple medical problems. in addition, she may call the transplant/access clinic to schedule an appointment. number is . please md of symptoms, fevers, chills, nausea and vomiting, or recurrence of her abdominal pain. , m.d. procedure: venous catheterization, not elsewhere classified hemodialysis closed (percutaneous) [needle] biopsy of liver endoscopic sphincterotomy and papillotomy non-invasive mechanical ventilation arterial catheterization laparoscopic cholecystectomy transfusion of packed cells transfusion of other serum infusion of vasopressor agent diagnoses: congestive heart failure, unspecified other pulmonary insufficiency, not elsewhere classified unspecified acquired hypothyroidism atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hypotension, unspecified cholangitis obstruction of bile duct unspecified gastritis and gastroduodenitis, without mention of hemorrhage diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled acute and chronic cholecystitis 

Answer: The patient is high likely exposed to