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: penicillins / sulfur / erythromycin base / levofloxacin / vancomycin attending: chief complaint: nausea and vomiting major surgical or invasive procedure: superior mesenteric artery stent placement biliary tube placement history of present illness: 78 yo woman presented with abdominal pain since for 12 hours. patient has had a recent history of abdominal pain and extensive workup by gastroenterology. was recently hospitalized and discharged (- ) for same type of pain, however, the most recent pain is far more intense and has been unremitting since it began. on her previous admission she had an egd which showed gastritis and a ct scan that showed complete atherosclerotic occlusion of the celiac axis with retrograde flow, and severe sma narrowing. however there has never been any evidence of acute ischemia of the bowel on imaging or exam. in the ed she was in distress, at times bundled over with ruq pain. this newest ruq pain is distinct form the pain that brought her into the ed, which had been described as upper abdominal, and bandlike in nature. she is afebrile. no extremity pain or limited motion. no vision changes, headaches or symptoms of ischemia elsewhere. bowel movements have been loose for several weeks. patietn has been urinating, but has a diaper as she is incontinent. the patient reports a 5 month history of vague abdominal discomfort, nausea, nonbloody diarrhea, and occasional vomiting. she reports anorexia and a 30lb weight loss since . she also has significant weakness and lethargy. past medical history: cva in graves' disease/ apethetic thyrotoxicosis copd hypertension hypercholestrolemia chronic uti h/o kidney stones h/o gastritis severe peripheral vascular disease s/p bypass grafts psh: right , left , -> stent placed in aortobifemoral bypass, c/b psuedoaneursym reparied in ventral hernia repair with mesh, - for urinary stress incontinence, discectomy social history: lives by herself with daughter and son nearby. currently smokes 1ppd (60 pack-year history), rare etoh, denies recreational drugs. family history: no gi or abdominal illnesses. father with lung cancer and cad. mother died of unknown causes at 89 yo. physical exam: pe: (by general surgery at admit) vs: 98.3 80 126/60 16 100%/ra gen: in distress, writhing in pain cv: rrr, nl s1 and s2, ii/vi sem resp: ctab abd: soft, mild epigastric tenderness, nondistended, no rebound or guarding back: no cvat ext: no edema pertinent results: 05:43pm urine color-yellow appear-clear sp -1.036* 05:43pm urine blood-tr nitrite-neg protein-30 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 05:41pm glucose-118* urea n-24* creat-1.0 sodium-137 potassium-3.7 chloride-103 total co2-22 anion gap-16 05:41pm alt(sgpt)-10 ast(sgot)-22 ld(ldh)-209 alk phos-104 tot bili-0.3 05:41pm albumin-3.0* calcium-8.6 phosphate-3.4 magnesium-1.4* 05:41pm wbc-35.6* rbc-3.97* hgb-10.3* hct-30.9* mcv-78* mch-25.9* mchc-33.3 rdw-15.5 05:41pm neuts-70 bands-23* lymphs-0 monos-7 eos-0 basos-0 atyps-0 metas-0 myelos-0 05:41pm hypochrom-normal anisocyt-1+ poikilocy-3+ macrocyt-normal microcyt-2+ polychrom-normal ovalocyt-1+ burr-3+ pencil-1+ acanthocy-3+ 06:17am lactate-1.4 06:00am alt(sgpt)-13 ast(sgot)-32 ld(ldh)-201 ck(cpk)-30 alk phos-123* amylase-99 tot bili-0.4 06:00am lipase-18 brief hospital course: # on arrival on a ct scan showed no evidence of bowel ischemia, persistently mildly dilated gallbladder, and severe mesenteric atherosclerotic disease. given that it was known that she had occlusion of her celiac artery with severe stenosis of superior mesenteric artery, and no other explanation for her abdominal pain patient underwent an uncomplicated superior mesenteric artery stent on day of arrival. postoperatively she had persistent right upper quadrant pain. she remained alert and oriented and afebrile. a follow-up ct scan was completed on . the ct showed marked distention and mural thickening of the gallbladder with free fluid in the pericholecystic area. the findings were consistent with acute cholecystitis, with probable areas of mural necrosis and perforation. the patient underwent percutaneous cholecystectomy by interventional radiology for drainage of pericolic fluid in the setting of gallbladder perforation secondary to acute acalculous cholecystitis. after the drain was placed she was transferred to the medicine service for further management on . the drain continued to drain non-purulent bilious material. she remained afebrile. her diet was advanced and on day of discharge she tolerated a regular diet without nausea or vomiting. she had mild, intermittent right upper quadrant abdominal pain, which responded to po pain meds. it is unclear whether the etiology of her abdominal pain on initial presentation was secondary to the mesenteric ischemia, cholecystitis or both. of note, her gastrin was 300 on a prior admission. if she continues to have gastritis-like abdominal pain we recommend an outpatient work up for zollinger syndrome. . # cholecystitis: the percutaneous cholecystostomy tube remained in place. it continued to drain 200-300 cc's of bilious non-purulent drainage. she was initially started on iv flagyl and cipro. the final cultures were positive for klebsiella which was sensitive to cipro and flagyl and she was transitioned to oral cipro and flagyl. the infectious disease consultants recommended a 14 day course of po cipro/flagyl which began on and will end on unless the perc-chole tube is still in place. she should be continued on these antibiotics as long as the perc-chol tube is in place. on day of discharge she was tolerating a regular diet without pain and she was afebrile. . #pleuritic pain: throughout the hospital course she had some mild bilateral pain which she described as "rib" pain. it improved throughout her hospitalization. it was likely msk in the setting of chronic cough- worse with movement and better with heat and tylenol. no pna on was seen on repeated cxrs. . # leukocytosis: acute on subacute/chronic leukocytosis. her baseline wbc has been 17-19. in the setting of this hospitalization it trended up and nadired at 47.6. on day of discharge it was 20. she has been seen by outpatient oncology regarding her baseline leukocytosis which may be related to a malignancy and will get a bone marrow biopsy as an outpatient. ruq u/s negative for abscess on day prior to discharge. u/a neg. cxr with b/l effusions but no consolidation. bcx negative. c diff negative x 3. hiv negative - hep serologies pending, quantaferon gold pending on day of discharge . # mild hypoxia: she has known copd and decompensated from a pulmonary standpoint post-operatively. she required oxygen by nasal canula for comfort and to maintain oxygenation. her oxygen requirement improved each day. by day of discharge her oxygen saturations were 90%-92% on ra and 95% on 2lnc. steroids were not given because of her biliary infection but she was given albuterol inhaler as needed and ipratropium bromide mdi three times daily. she was discharged on fluticasone-salmeterol diskus. in addition to copd post-operative atelectasis as seen on cxr and left lower lobe collapse (which was documented to improve on repeat cxrs) were likely contributing. . # severe peripheral vascular disease s/p bypass grafts: she was continued on plavix which she will take for life. she was continued on aspirin 81 mg each day. . # graves' disease/ apathetic thyrotoxicosis: she was continued on her home methimazole . # hypertension: she was continued on her home antihypertensives with holding parameters. on day of discharge her potassium was 5.6 so her triamterene-hctz was held and hctz was continued. her potassium should be checked on or and, if normalized, she should be resumed on her triamterene-hctz 1 po qday and the hctz should be discontinued. . # hypercholesterolemia: she was continued on her home statin . # incidental findings requiring follow-up: on a previous hospitalizations ct scans noted incidental findings which will require follow-up. these include: -right adenxal mass -3 mm right upper lobe pulmonary nodule - bilateral adrenal nodules - 1.5 cm thyroid nodule - ground glass opacities in lungs bilaterally - liver cysts medications on admission: 1. rosuvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 3. methimazole 5 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 5. sucralfate 1 gram tablet sig: one (1) tablet po tid (3 times a day). 6. polysaccharide iron complex 150 mg capsule sig: one (1) capsule po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 8. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever. 9. famotidine 20 mg tablet sig: two (2) tablet po daily (daily). 10. triamterene-hydrochlorothiazid 37.5-25 mg capsule sig: one (1) cap po daily (daily). 11. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 12. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 13. irbesartan 300 mg tablet sig: one (1) tablet po once a day. discharge medications: 1. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day: hold for sbp<100. 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. rosuvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 5. methimazole 5 mg tablet sig: one (1) tablet po daily (daily). 6. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 9. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 10. miconazole nitrate 2 % powder sig: one (1) teaspoon topical (2 times a day) for 7 days: apply to groin and vulva. 11. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation qid (4 times a day). 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q4h (every 4 hours) as needed for wheezing. 13. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime). 14. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: not to exceed 4 g in 24 hrs. 15. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 16. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day): continue for 10 more days or as long as if perc-chole drain is still in place. disp:*90 tablet(s)* refills:*2* 17. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 10 days: continue for 10 days or as long as perc-chole drain is in place. disp:*30 tablet(s)* refills:*2* 18. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain: not to exceed 4g of tylenol in 24 hrs. disp:*30 tablet(s)* refills:*0* 19. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: acalculous cholecystitis chronic obstructive pulmonary disease exacerbation superior mesenteric artery occlusion hyperkalemia leukocytosis discharge condition: alert and oriented x3 ambulating with assist oxygen saturations 90%-92% on ra discharge instructions: you were admitted for nausea, vomiting, and abdominal pain. you were found to have a blockage in the superior mesenteric artery of the abdomen and required a stent placement. after that procedure you were found to have an infection in your gallbladder requiring iv antibiotics and tube placement for drainage. during your stay, your copd aslo worsened requiring the use of oxygen and nebulizer treatments. you will continue to need to taper off the oxygen as you tolerate. the following medications changes were made: - your triameterene was held due to elevated potassium, this may be resumed once your potassium level returns to normal - you were started on plaix, you will need to continue on this indefinitely - you were started on cipro and flagyl to treat the infection in your gallbladder, please complete this course of oral antibiotics as outlined followup instructions: you will need to arrange follow up with your outpatient oncologist to further evaluate your elevated white blood cell count. you have appointments scheduled next week. please cancel these if you aren't going to be able to make the appointments. you should follow up with dr. of vascular surgery after you get discharged from rehab. you have been scheduled the appointment below. department: vascular surgery with: dr. location: , ma phone number: appointment: 10:15am you need to follow up with dr. to discuss removal of your biliary tube and plan for future gallbladder surgery. dr. phone: ( fax: ( procedure: angioplasty of other non-coronary vessel(s) aortography arteriography of other intra-abdominal arteries insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) percutaneous aspiration of gallbladder transposition of cranial and peripheral nerves insertion of two vascular stents procedure on single vessel diagnoses: acidosis hyperpotassemia tobacco use disorder unspecified essential hypertension acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation other opiates and related narcotics causing adverse effects in therapeutic use pulmonary collapse iron deficiency anemia, unspecified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits dehydration toxic diffuse goiter without mention of thyrotoxic crisis or storm acute cholecystitis chronic vascular insufficiency of intestine urinary incontinence, unspecified leukocytosis, unspecified other specified disorders of liver other specified pruritic conditions perforation of gallbladder 

Answer: The patient is high likely exposed to