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 / iv dye, iodine containing attending: chief complaint: nausea, vomiting, abdominal pain major surgical or invasive procedure: history of present illness: 53 y.o. female w/ h.o. bipolar d.o., s/p recent hospitalization for jaundice and found to have pancreatic mass causing obstruction, s/p stent placement p/w recurrent nausea, vomiting, abdominal pain. pt states she noted the onset of nausea, vomiting as well as new onset of jaundice 1 day pta. noted temp of 100.3 at home. pt reports also diarrhea and periumbilical pain this am to the ed, but on the floor denies diarrhea and denies pain. she does report tea colored urine since yesterday. pt was noted to have jaundice during psych hospitalization several weeks ago at osh and had ct abd/pelvis and mr at osh notable for ? pancreatic head mass and biliary dilation and was transferred to on for . showed a chain of lakes with a beaded pattern in the main pancreatic duct c/w chronic pancreatitis versus auto immune disease or malignancy. pt also found to have distal high grade stricture of the cbd and dilated intra-hepatic ducts. sphincterotomy was performed and cytology samples sent from cbd which showed atypical cells. a biliary stent was placed in cbd c plans to remove it the following week. stent was removed on and sent for path which also showed atypical cells. pt also underwent abdominal cta given question of pancreatic head mass which showed "diffuse hypoenhancement of pancreatic head and neck with upstream dilation of pancreatic duct. no definite discrete mass identified; findings may represent focal pancreatitis, however, an underlying mass cannot be excluded." past medical history: bipolar disorder htn asthma social history: no smoking. remote drinking. family history: father - leukemia mother - cad physical exam: at admission: general: tachypneic, cachectic, dyspneic heent: sclera anicteric, dry mucous membranes neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic, no m/g/r abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: no clubbing, cyanosis or edema msk: tenderness to palpation over lateral hip and anterior hip. tenderness with passive extension, passive internal and external rotation. patient cannot atively move his hip joint. skin: multiple scars and excoriations on arms. pertinent results: labs on admission 08:20pm blood wbc-17.7* rbc-4.16*# hgb-13.7# hct-40.2# mcv-97 mch-32.8* mchc-34.0 rdw-16.1* plt ct-212 08:20pm blood neuts-95.0* lymphs-1.4* monos-2.5 eos-0.5 baso-0.6 08:20pm blood pt-14.7* ptt-29.6 inr(pt)-1.3* 08:20pm blood glucose-109* urean-16 creat-1.1 na-141 k-3.0* cl-102 hco3-23 angap-19 08:20pm blood albumin-4.3 calcium-8.9 phos-1.3* mg-1.6 06:55am blood alt-85* ast-36 alkphos-122* 08:20pm blood lipase-15 08:20pm blood ctropnt-<0.01 03:03am blood ck-mb-notdone ctropnt-<0.01 08:20pm blood lithium-0.4* 08:29pm blood glucose-105 lactate-3.6* na-138 k-2.9* 04:26am blood freeca-0.91* labs on discharge: wbc13.4* rbc3.90* hgb12.7 hct38.2 glc103 bun14 cr0.7 na139 k+5.8 (hemolyzed) cl103 bicarb23 alt52 ast37 ldh444 ap115 amy19 tbili1.2 liver or gallbladder u/s findings: no previous ultrasound scan is available for comparison. there is marked dilatation of the common hepatic duct proximal to the biliary stent, with maximal transverse diameter of 14 mm. intrahepatic biliary duct dilatation is also seen, most prominent in the left hepatic duct. no obvious focal parenchymal lesion is identified in the liver. the gallbladder is surgically removed. the body and tail of pancreas are not fully visualized. no pancreatic duct dilatation is identified at the head of the pancreas. patent flow is identified in the portal vein. impression: prominent dilatation of the common hepatic duct and intrahepatic ducts proximal to biliary stent. findings are suggestive of obstruction of biliary stent. report : scout images demonstrate cholecystectomy clips and a plastic biliary stent in the right upper quadrant. subsequent images demonstrate cannulation of the pancreatic duct with a beaded appearance. cannulation of the common bile duct reveals smooth tapering of the distal cbd and post- obstructive dilatation of the proximal cbd and intrahepatic bile ducts. a new plastic biliary stent was placed. please refer to the operative note for further details. impression: 1. beaded pancreatic duct, suggestive of chronic pancreatitis. 2. smooth distal cbd tapering, consistent with pancreatitis. portable cxr findings: in comparison with the study of , there has been the development of patchy opacification at the left base consistent with pneumonia. no vascular congestion or pleural effusion. impression: left lower lung pneumonia. chest pa and lateral history: cholangitis. increasing hypoxia and shortness of breath. impression: pa and lateral chest compared to : the lung base is elevated at least by a moderate right pleural effusion. although heart size is normal and unchanged, mediastinal and pulmonary vasculature is more pronounced and there is new septal opacification in both lungs. the simplest explanation is volume or cardiac related pulmonary edema. chest pa and lateral findings: frontal and lateral radiographs of the chest demonstrate increased patchy opacity in the right upper lobe which may represent infection. mild pulmonary vascular congestion and small, right greater than left pleural effusions with compressive atelectasis at the right lung base is unchanged. the cardiomediastinal silhouette is within normal limits. there has been placement of a right picc with the tip at the cavoatrial junction. echo the left atrium is dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal regional and global biventricular systolic function. no pathologic valvular abnormality seen. moderate pulmonary artery systolic hypertension ct chest without contrast ct chest without contrast: there are multifocal infiltrate involving all major segments of the lungs, but predominantly in the right upper lobe. the findings are compatible with multifocal pneumonia. there is a partially consolidation versus collapse at the base of the right lung. there is no discrete pulmonary nodule, allowing the obscuration of the underlying infectious process. there is no pneumothorax. small bilateral pleural effusions are noted, but no evidence of organized abscess. the heart is within normal limit in size. there is no pericardial effusion. a right subclavian central venous catheter is seen with the tip at the cavoatrial junction. the great mediastinal vessels are grossly intact, within the limits of non-contrast study. the tracheobronchial tree is patent to the subsegmental levels. assessment of lymphadenopathy in the thorax is limited. two subcentimeter pericardial lymph nodes are noted, likely reactive to the underlying infectious process. there is no gross hilar, mediastinal or axillary lymphadenopathy by ct criteria. the study is suboptimal to assess intraabdominal parenchymal organs. again noted is moderate pneumobilia. two biliary stents are noted in the cbd, unchanged. surgical clips are seen at the empty gallbladder fossa, compatible with prior cholecystectomy. there is probably a pancreatic head mass, incompletely evaluated in this study, grossly unchanged in appearance. bone window: there is no acute fracture or dislocation. no suspicious lytic lesions are noted concerning for metastasis. impression: 1. multifocal pneumonia, predominantly in the right upper lobe. partially collapsed or consolidation right lung base. 2. bilateral small pleural effusions. 3. no evidence of fluid collection to suggest abscess. 4. unchanged pneumobilia, incompletely assessed. brief hospital course: patient was admitted to the micu on with nausea, vomiting, and abdominal pain and was found to have cholangitis, sepsis, ? pna, and pleural effusion. obstructive jaundice/cholangitis patient initially presented with fevers, nausea, vomiting, jaundice, leukocytosis and elevated lft's and was admitted to the icu. initial differential diagnosis included cholangitis, cholecystitis or an auto-immune process. pancreatitis was also considered given history of pancreatitis in the past and x 2. she was started on vancomycin and zosyn. a ruq-us was performed which showed prominent dilatation of the common hepatic duct and intrahepatic ducts proximal to biliary stent, suggestive of biliary stent obstruction. was consulted and an was performed revealing cbd obstruction with cbd dilitation. pancreatic and biliary stents were placed. blood cultures returned positive were positive for klebsiella and enterococcus. the jaundice, fevers, nausea, vomiting and leukocytosis all continued to resolve upon transfer to the floor. bacteremia patient's blood cultures were positive for klebsiella and enterrococcus faecalis. patient was started on daptomycin, flagyl and cefepime which was narrowed to vancomycin (patient allergic to ampicillin) and ciprofloxacin which was then changed to vancomycin and levofloxacin for better lung penetration as there was some suspicion that the patient might have a coexistent pneumonia. last dose of levofloxacin and vancomycin are . vanco dose increased to 1250mg po q8hrs on for the mid-day dose. tte was negative for vegetation given enterococcal bacteremia. multifocal pneumonia when the patient was transferred to the floor, she had an oxygen requirement of 2-3l with an oxygen saturation of >90%. her exam and chest x ray suggested fluid overload. she was diuresed with good effect and was weaned off of oxygen completely without feeling short of breath. a picc was placed for her iv antibiotics and the x ray was concerning for a right multifocal pneumonia as well as a right-sided effusion. a chest ct was done which revealed bilateral effusions which were too small to tap and multifocal pna. she should complete an 8 day course of hospital acquired pna. pancreatic mass: in process of being worked up by dr as outpt. her path results were positive for atypical cells and ca -9 was elevated. on further discussion with , this could be consistent with inflammation. she has follow up with gi on at . bipolar disorder: the patient has a history of bp d/o with recent psychiatric hospitalization. lithium, wellbutrin, and celexa were continued. her next dose of risperidone is due on per the patient. an ekg was checked and her qtc was 432. this should be rechecked at the rehab facility after her riperidone is given. hypertension the patient was remained normotensive and home bp medications were held. code: full code. the patient expressed her preference to be dnr/dni but we later found out that her cousins were in the middle of getting guardianship. thus the decision was made that the patient should remain full code for the time being. medications on admission: lisinopril 10 mg daily bupropion hcl 300 mg daily citalopram 80 mg daily lithium carbonate 600 mg qhs risperidone 37.5 mg im q2 weeks discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. lithium carbonate 300 mg capsule sig: two (2) capsule po qhs (once a day (at bedtime)). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 5. citalopram 20 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 6. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 7. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours): last dose on . 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for sob, wheezing. 9. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 10. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 11. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 12. vancomycin 500 mg recon soln sig: one (1) recon soln intravenous q 12h (every 12 hours). 13. vancomycin 1,000 mg recon soln sig: 1.25 (total 1250mg) intravenous q8hrs for 8 days: last dose evening of . 14. check vanco trough on goal 15-20, check alt, ldh, wbc 15. risperidone microspheres 37.5 mg/2 ml syringe sig: one (1) intramuscular q 2 weeks. discharge disposition: extended care facility: nursing & rehabilitation center - discharge diagnosis: primary diagnosis: -cholangitis -? pancreatic head mass -sepsis -bacteremia with klebsiella and enterococcus faecalis -pneumonia . secondary diagnosis: -bipolar d/o -htn -asthma discharge condition: stable. no abdominal pain. satting well on room air. non icteric. discharge instructions: you were hospitalized because you presented to the ed with concern for cholangitis. you were admitted to the intensive care unit. an was done and a stent was placed resulting in resolution of your jaundice. they also found a lot of bacteria in your blood. you were started on iv antibiotics and your jaundice improved. one of your antibiotics was switched to an oral antibiotic. you were also short of breath and required oxygen but after fluid was taken off you were able breath much more easily. there was a fluid collection seen on chest x-ray but your ct scan showed it was too small to drain. it is very important that you follow up with gastroenterology in regards to the stents you've needed and the findings of your pancreas biopsy. . you were started on the following new medications: - vancomycin 1250mg po q 8hrs (check next trough tomorrow afternoon, goal 15-20) last dose on - levofloxacin 500 mg po q24h last dose on -albuterol 0.083% neb soln 1 neb inhaled every 6 hours as needed for shortness of breath or wheeze -colace and senna prn -heparin sc 5000 units sc tid . you were continued on all your home psych medications. . please seek immediate medical attention if you develop fevers, chills, cough, abdominal pain, dizziness, inability to tolerate food, yellow eyes, yellow skin, blood in the stool, diarrhea, or any new concerning symptoms. followup instructions: provider: , md phone: date/time: 1:20 provider: phone: date/time: 1:40 provider: 2 (st-4) gi rooms date/time: 10:00 procedure: venous catheterization, not elsewhere classified endoscopic dilation of ampulla and biliary duct replacement of stent (tube) in biliary or pancreatic duct diagnoses: pneumonia, organism unspecified unspecified pleural effusion unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site pulmonary collapse bacteremia other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation chronic pancreatitis cholangitis obstruction of bile duct bipolar disorder, unspecified other complications due to other internal prosthetic device, implant, and graft 

Answer: The patient is high likely exposed to