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: patient recorded as having no known allergies to drugs attending: chief complaint: transfer for ercp major surgical or invasive procedure: ercp history of present illness: 84 year old male with a history of of coronary artery disease, sick sinus syndrome s/p pacemaker, chronic kidney disease and recent prolonged hospitalization for gangrenous cholecystitis s/p open cholecystectomy complicated by bile leak requiring external drainage in . the initial surgery was performed on . on entering the abdomen he was noted to have gangrenous cholecystitis. he had extensive adhesions and it was difficult to dissect the fascial planes. it was not possible to remove the entire gallbladder and the gallbladder was instead divided 1 cm above the takeoff of the cystic duct. he was ultimately discharged to blueberry nursing home on . per notes his subhepatic drain was removed on . . he represented to hospital on with right upper quadrant pain and chills. on arrival to hospital he was afebrile with a hr of 78, bp of 98/57, o2 saturation 95% on ra. wbc count on presentation was 20.4 with normal transaminases. ct scan done on admission showed a distended gallbladder with irregular contour and thickened wall and pericholecystic inflammatory changes suspicious for acute cholecytsitits with possible track from the gallbladder to the skin. he was started on iv antibiotics initially with unasyn and then zosyn. he underwent drainage of subhepatic fluid collection on with removal of 50ml thicky cloudy bile and a 12 f catheter was placed. he was transferred to this hospital for ercp and internalization of his biliary drain. . he was transferred to the ercp suite. he was intubated periprocedure. the procedure was technically uncomplicated and he had two plastic stents placed. during the procedure his blood pressure was labile ranging from the 60s to 130s systolic. he required treatment with neosynephrine at 0.5 mcg/kg. he received 1.5 l ivf and made 120 cc urine. there was minimal blood loss. he was extubated in the pacu and transferred to the medical icu (). neosynephrine was turned off on arrival to the with blood pressures in the 120s to 130s systolic. in the , he currently had no complaints. he denied fevers, chills, nausea, vomiting, diarrhea, constipation, dysuria, hematuria, leg pain or swelling. he continued to endorse abdominal pain, worst in the right upper quadrant. past medical history: open cholecystectomy for gangrenous cholecystitis coronary artery disease s/p anterior mi in cardiomyopathy with congestive heart failure (ef 45-50% in ) sick sinus syndrome s/p biventriuclar pacemaker in stage iv chronic kidney disease (baseline creatinine 2.0) cervical spinal fracture with cord compression in complicated by three month hospitalization with tracheostomy and peg placement gastroesophageal reflux disease hypogonadism hypopituitarism (on 5 mg hydrocortisone at home) hyperlipidemia hypertension history of orthostatic hypotension bph s/p turp left pulmonary granuloma history of diverticulosis and diverticulitis osteoarthritis history of reflux sympathetic dystrophy of left hand type ii diabetes history of mrsa social history: lives with his son in but now coming from rehab. remote history of smoking (quit 20+ years ago). no current alcohol use but previously drank one per day. no illicit drug use. retired electrician. family history: father died at age 83 of throat cancer. mother died at age 80 of coronary artery disease. 1 sister died of leukemia. 1 living brother and 2 living sisters. physical exam: pe at admission to : vitals: t: 97.6 bp: 123/66 p: 117 r: 18 o2: 97% on 3l general: alert, oriented to person, , not place or season, no acute distress heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: trace crackles at bases, poor inspiratory effort, no wheezes or ronchi cv: tachycardic, regular rhythm, normal s1 and s2, ii/vi hsm at llsb, no rubs or gallops abdomen: soft, tender in ruq, mildly distended, bowel sounds present, positive guarding, no rebound, cholecystecomy scars well healing, drain in place with green bile, previous g-tube site well healed, no organomegaly gu: foley with clear yellow urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . pe at transfer back to : tmax: 99.4 ??????f tc: 99.4 ??????f hr: 106 bp:136/56(75) rr: 17 spo2: 94% nc 4l general: alert, oriented to person, , not place or season, no acute distress lungs: trace crackles at bases, poor inspiratory effort, no wheezes or rhonchi cv: tachycardic, regular rhythm, normal s1 and s2, ii/vi hsm at llsb, no rubs or gallops abdomen: soft, tender in ruq, mildly distended, bowel sounds present, positive guarding, no rebound, cholecystecomy scars well healing, drain in place with green bile, previous g-tube site well healed, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission : urinalysis : negative chemistries : na 141, k 4.8, cl 108, co2: 20, bun: 31, creatinine 1.9, tbili 0.5, lipase 138, ap 54, ast 20, alt 26 inr 1.25 wbc: 14.5 (from 20.4 with 84% pns), hct: 36.2, plts 155 . labs on transfer to : wbc-12.0* rbc-3.73* hgb-11.2* hct-34.4* mcv-92 mch-30.1 mchc-32.6 rdw-16.0* plt ct-191 neuts-79.8* lymphs-16.0* monos-2.5 eos-1.2 baso-0.4 pt-13.9* ptt-31.2 inr(pt)-1.2* glucose-57* urean-22* creat-1.6* na-142 k-4.1 cl-111* hco3-18* angap-17 alt-12 ast-13 alkphos-47 totbili-0.7 calcium-8.4 phos-3.3 mg-2.0 lactate-0.7 . micro bcx - pending at time of transfer . imaging: cxr : extremely low lung volumes may account for much of the prominence of the transverse diameter of the heart. bibasilar atelectatic change without definite acute focal pneumonia. pacemaker device is in place. no evidence of intubation on this study. of incidental note is an apparent tube in the right mid abdomen laterally. . ercp : findings: esophagus: limited exam of the esophagus was normal stomach: limited exam of the stomach was normal duodenum: limited exam of the duodenum was normal major papilla: normal major papilla cannulation: cannulation of the biliary duct was successful and deep with a autotome 44 using a free-hand technique. contrast medium was injected resulting in partial opacification. . biliary tree: extravasation of dye was noted at the gallbladder. no filling defects were seen in the cbd. a biliary sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. two 10fr by 9cm cotton biliary stents were placed in tandem successfully using a microvasive 10fr stent introducer kit. . impression: cannulation of the biliary duct was successful and deep with a autotome 44 using a free-hand technique. extravasation of dye was noted at the gallbladder. no filling defects were seen in the cbd. a biliary sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. two 10fr by 9cm cotton biliary stents were placed in tandem successfully using a microvasive 10fr stent introducer kit. brief hospital course: course : assessment and plan: 84 year old male with a history of of coronary artery disease, sick sinus syndrome s/p pacemaker, chronic kidney disease and gangrenous cholecystitis now presenting with fevers, leukocytosis and right upper quadrant pain transferred for ercp. . biliary sepsis: patient with known bile leak from previous cholecystectomy. on presentation to he was afebrile but with leukocytosis, tachycardia and mild hypotension. he had significant clinical improvement with iv antibiotics and drain placement and is now s/p ercp with stents with ultimate hope to internalize drain. he was mildly tachycardic but with stable blood pressures. pt was npo post procedure, advanced to clears which the patient tolerated well. carvediolol was restarted but other anti-hypertensives were held and not re-initiated before transfer. continued zosyn for broad spectrum coverage of biliary pathogens. pain not adequately controlled with morphine and pt had increased o2 requirement, so changed mediation to dilaudid for better pain management and decreased splinting with improved pain control. . hypoxia: patient with 3-4l oxygen requirement post-procedure. lung exam significant for crackles. patient does have a history of cardiomyopathy with mildly decreased ejection fraction. also may have a component of atelectasis and is an aspiration risk. pt was also splinting due to pain and pain control increased with dilaudid 0.5mg q4h: prn. . coronary artery disease: s/p anterior mi in . no chest pain after procedure. coreg and zestril were initially held. coreg restarted prior to transfer with stable sbp 100s. statin and fibrate were contrinued. aspirin was held peri-procedure and continues to be held for 72 post procedure. . cardiomyopathy: last ejection fraction 45-50% in . currently with new oxygen requirement. no pulmonary edema on cxr although pt had low lung volumes. carvedilol restarted once bp stable. zestril continued to be held. . stage iv chronic kidney disease: baseline creatinine 2.0. at baseline at the time of transfer from osh. cr on transfer back to was 1.6. zestril held and not re-initiated prior to transfer back to osh. . hypopituitarism: per notes, post-traumatic, on hydrocortisone at home, on transfer on both hydrocortisone and fludricortisone. will continue with plans to taper if remains at this facility. continued hydrocortisone 15 mg po daily, 10 mg at 3 pm. continued fludrocortisone 0.1 mg po bid. . gastroesophageal reflux disease: continued ppi . hyperlipidemia: continued statin and fibrate . hypertension: coreg re-initiated prior to transfer. zestril held. . benign prostatic hypertrophy: floxmax held given foley . type ii diabetes: currently diet controlled but was on sliding scale at rehab. insulin sliding scale was held. . prophylaxis: subutaneous heparin . code: dnr not dni (discussed with health care proxy) . communication: patient, son , (cell) . disposition: transfer back to hospital icu medications on admission: medications from rehab: coreg 6.25 mg po bid prenisone 10 mg (taper) flomax 0.5 mg po daily omeprazole 20 mg po daily multivitamin daily vitamin d 800 iu daily aspirin 81 mg po daily megestrol acetate 800 mg po bid oxycodone 5 mg po q4h:prn tylenol prn insulin sliding sale milk of magnesia dulcolax fleets enemas . medications on transfer from hospital : zosyn 3.375 iv q6h coreg 6.25 mg flomax 0.4 mg po hs prilosec 20 mg po daily hydrocortisone 15 mg po daily, 10 mg at 3 pm fludrocortisone 0.1 mg po bid zocor 40 mg po daily tricor 145 mg po daily zestril 5 mg po daily tylenol 650 mg po q6h:prn dilaudid 1 mg sc q2h:prn vicodin 1 mg po q4h:prn discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. hydrocortisone 5 mg tablet sig: three (3) tablet po qam (once a day (in the morning)). 3. hydrocortisone 5 mg tablet sig: two (2) tablet po qpm (once a day (in the evening)). 4. fludrocortisone 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 5. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 6. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 7. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day) as needed for pain, fever. 8. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp<100 or hr<60 . 9. piperacillin-tazobactam 2.25 gram recon soln sig: 2.25 g intravenous q6h (every 6 hours). 10. hydromorphone (pf) 1 mg/ml syringe sig: 0.5 mg injection q4h: prn as needed for pain. 11. insulin sliding scale - per rehab sliding scale discharge disposition: extended care facility: hospital - discharge diagnosis: 1. biliary sepsis . 2. hypoxia . 3. cad, cardiomyopathy, ckd, hypopituitarism discharge condition: stable, to hospital icu for further care. discharge instructions: you were transferred to for endoscopic study of your biliary tract and pancreas (ercp) and internalization of your biliary drain. you were intubated peri-procedure. the ercp was technically uncomplicated and you had two plastic stents placed. during the procedure your blood pressure was labile and you required medicine to maintain an adequte blood pressure to perfuse your organs. you received fluids and there was minimal blood loss. you were extubated after the procedure and transfered to the intensive care unit for further monitoring of your blood pressure. your blood pressures were stable but you did require increased oxygen to maintain oxygen saturation. this was attributed to atelectasis (collapsed lung, often seen after a procedure) and pain. your pain was controlled with dilaudid and incentive spirometry was recommended. you were transferred back to hospital for further care. followup instructions: ercp recommendations: -follow-up with dr. any problems- please call dr. at . -no aspirin, plavix, nsaids, coumadin for 72 hours. -follow for response and complications. if any abdominal pain, fever, jaundice, gastrointestinal bleeding please call ercp fellow on call ( , pager ) -repeat ercp in 6 weeks for evaluation and stent pull. -follow drainage from percutaneous drain and gb fossa. md procedure: endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct endoscopic insertion of stent (tube) into bile duct diagnoses: other primary cardiomyopathies coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified sepsis other and unspecified hyperlipidemia old myocardial infarction osteoarthrosis, unspecified whether generalized or localized, site unspecified cardiac pacemaker in situ cholangitis gastrostomy status tracheostomy status other testicular hypofunction personal history of methicillin resistant staphylococcus aureus panhypopituitarism 

Answer: The patient is high likely exposed to