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: metformin / oxycodone attending: chief complaint: hypotension major surgical or invasive procedure: ercp with metal stent placement history of present illness: ms. is a 57 year old woman with recently diagnosed pancreatic head adenoca, s/p ercp with plastic stent insertion , admitted to osh on with fever, rising lfts, septic shock and transferred to for repeat ercp. . she was admitted to hospital with fevers, chills, sweats, back pain, n/v, andlightheadedness. at the osh, her sbp dropped to 60s-70s, thought to be due to septic shock from cholangitis. bcx grew gnrs. a l subclavian was placed, and she was resucitated wtih ivfs and started on levophed and zosyn. she was transferred to on levophed for another ercp. . in the icu, she was easily weaned off pressors. she went to ercp and had her stent removed. frank pus was seen exiting from the ampulla after biliary stent removal, and a wallflex stent was successfully placed. again, large amounts of frank pus drained following placement of the metal stent. after return from her procedure, she developed chest pain, was treated with nitro x 2, iv morphine 6 mg. ekg x 2 had no changes. her pain improved with morphine. she is also growing aerobic gnrs in blood from and is on vanc, zosyn, and cipro. . currently, she has no abdominal pain, nausea, vomiting, fevers, chills. she had a normal bm this morning. she denies any chest pain, sob, cough, dysuria. she reports urinary frequency. she occ. has mild headaches. no further lightheadedness. past medical history: dm pancreatic adenoca, diagnosed . surgical history: s/p appendectomy s/p c-section social history: lives with husband. in housekeeping. - tobacco: none - etoh: none - illicits: none family history: parents died in , no known medical problems. physical exam: gen: well appearing, nad, aox3 vs: t 98.6 (tm 99.6), 93, 133/69, 32, 97ra heent: mmm, mild scleral icterus, no op lesions cv: rrr, nl s1s2, no murmurs appreciated pulm: bibasilar crackles, l > r, no wheezes abd: bs+, soft, ntnd limbs: no le edema, 2+ distal pulses skin: no rashes or skin breakdown pertinent results: 11:17am blood wbc-22.1* rbc-3.33* hgb-9.2* hct-26.6* mcv-80* mch-27.7 mchc-34.7 rdw-15.6* plt ct-242 06:35am blood wbc-12.3* rbc-3.60* hgb-9.6* hct-28.4* mcv-79* mch-26.6* mchc-33.7 rdw-16.2* plt ct-298 05:50am blood pt-11.5 ptt-27.6 inr(pt)-1.0 06:35am blood glucose-214* urean-7 creat-0.6 na-135 k-3.8 cl-105 hco3-24 angap-10 06:35am blood calcium-8.4 phos-3.1 mg-1.9 liver functions: 11:17am blood alt-151* ast-151* ld(ldh)-278* alkphos-222* totbili-4.3* dirbili-3.6* indbili-0.7 03:12am blood alt-133* ast-145* alkphos-266* totbili-4.5* 01:40pm blood alt-90* ast-71* alkphos-485* totbili-3.0* 06:35am blood alt-53* ast-30 alkphos-430* totbili-1.5 03:12am blood lipase-39 tumor markers: 03:12am blood cea-1.7 pending: 03:12am blood ca -9 -pnd radiology: cta abd w&w/o c & recons (full report): comparison: ercp . ct abdomen: bilateral pleural effusions are seen with associated compressive atelectasis. the partially imaged heart and pericardium are unremarkable. a few hypodensities are seen within the left lobe of the liver (3b 137-139) that are too small to characterize. pneumobilia is in the biliary tree is consistent with common bile duct stent patency. the stent has a small amount of debris. there is enhancement of the gallbladder wall with surrounding pericholecystic fluid. no stones are seen. a history of cholangitis is noted. air within the gallbladder is likely due to stent patency. the pancreatic duct is dilated over its entire length up to the junction with the stent in the common bile duct. the proximal pancreatic duct measures 8 mm (3a:65). no definite hypodensity or mass is identified in the pancreatic head. the superior mesenteric vein is 50% effaced. the splenic and portal veins are patent. there is a replaced left hepatic artery off the left gastric artery. small subcentimeter portacaval lymph nodes measuring 7-8 mm (3a:56) are noted. the spleen, adrenal glands and intra-abdominal portions of the small bowel are within normal limits. the kidneys enhance and excrete contrast symmetrically. scattered diverticula are seen in the visualized portions of the large bowel without inflammatory changes. calcifications are noted in the aorta, which is normal in caliber. bone windows: no sclerotic or lytic lesion suspicious for malignancy. pancreatic tumor table: i: pancreatic tumor present: no definite hypodensity or mass identified a) location: not applicable b) size: not applicable c) enhancement relative to pancreas: not applicable d) confined to pancreas with clear fat planes (duodenum and ivc do not apply): not applicable e) remaining pancreas: not applicable ii. adenopathy present: subcentimeter portacaval lymph nodes a) size and location of largest lymph node: portahepatis, 8 mm (3a:56) b) necrosis in lymph nodes: no c) size of gastroduodenal artery node, "node of importance": no iii. metastatic disease, definitely present: no iv: ascites/peripancreatic fluid: no pancreatic vascular table i: vascular tumor involvement: yes a) celiac involvement: no b) sma involvement: no c) smv involvement and percent encasement: smv effaced greater than 50% d) less than 1 cm smv between tumor and first major smv branch: not applicable e) portal vein involvement: no g) splenic vein involvement: no h) splenic artery involvement and distance from tumor to celiac artery bifurcation: no i) vascular involvement, other: no ii: thrombosis, any vessel: no iii: aberrant anatomy: yes. replaced left hepatic artery of left gastric artery. impression: 1. no definite hypodensity or mass in the pancreatic head identified. 2. stent in the common bile duct. intrahepatic pneumobilia consistent with stent patency. 3. enhancement of gallbladder wall and pericholecystic fluid. no stones identified. air in the gallbladder likely due to stent patency, although a history of cholangitis is noted. 4. bilateral pleural effusions with associated compressive atelectasis. ercp impression: * a previously placed plastic biliary stent was found in the major papilla. * the plastic stent appeared to be in good position. * frank pus was seen exiting from the ampulla after biliary stent removal. * a wallflex stent was successfully placed.large amounts of frank pus drained following placement of the metal stent. * otherwise normal ercp to third part of the duodenum brief hospital course: ms. is a 57 year old woman with recently diagnosed pancreatic head adenoca, s/p ercp with plastic stent insertion , admitted to osh on with fever, rising lfts, septic shock and transferred to for repeat ercp. . she was admitted to hospital with fevers, chills, sweats, back pain, n/v, and lightheadedness. at the osh, her sbp dropped to 60s-70s, thought to be due to septic shock from cholangitis. bcx grew gnrs. a l subclavian was placed, and she was resucitated with ivfs and started on levophed and zosyn. she was transferred to on levophed for another ercp. . in the icu, she was easily weaned off pressors. she went to ercp and had her stent removed. frank pus was seen exiting from the ampulla after biliary stent removal, and a wallflex stent (metal) was successfully placed. again, large amounts of frank pus drained following placement of the metal stent. after return from her procedure, she developed chest pain, was treated with nitro x 2, iv morphine 6 mg. ekg x 2 had no changes. her pain improved with morphine. she is also growing aerobic gnrs in blood from and was on vanc, zosyn, and cipro in icu. she remained hemodynamically stable off of pressors, and she was transferred to the floor for further care. microbiology reports were obtained from hospital, with the findings of klebsiella bacteremia, sensitive to cipro (pan-sensitive except ampicillin, tetracycline. see outside records section of chart). her antibiotics were tapered to cipro/flagyl, with ongoing improvement in her wbc. . . #. pancreatic adenoca: she was seen by dr. for evaluation of a pancreatic head mass. after discussion with the patient's primary care doctor the plan was made to proceed with a whipple procedure as an outpatient. this was scheduled for and dr. office will be in contact with the patient to make specific arrangements. she was seen by anesthesia while in the hospital. her ca is still pending at this time. she was given a short course of ms contin and immediate release morphine to help with pain. this seemed to help her and will hopefully bridge her to when she has her surgery. #. dm: her glucotrol was held while she was in the hospital because she was n.p.o. after she started her diet she was managed with insulin sliding scale. at discharge we did restart her glucotrol though at a lower dose because her appetite was not the same as prior to admission. she will need to have her blood sugar checked in the outpatient setting. #. hypertension: her lisinopril was held while she was in the intensive care unit because of concerns of hypotension. while on the medical floor her blood pressure was normal and so it was not restarted. she should have her blood pressure rechecked as an outpatient. # prophylaxis: - dvt ppx: heparin sq was continued while in the hospital. - gi ppx: ppi was continued while in the hospital. - bowel regimen: standing colace and senna prn were continued while in the hospital and continued at discharge. # communication: with patient medications on admission: medications on transfer: piperacillin-tazobactam 4.5 g iv q8h vancomycin 1000 mg iv q 12h ciprofloxacin 400 mg iv q12h pantoprazole 40 mg po q24h insulin sc phytonadione 5 mg po/ng daily duration: 3 days heparin 5000 unit sc tid docusate sodium 100 mg po bid senna 1 tab po/ng :prn constipation nitroglycerin sl 0.3 mg sl prn chest pain ondansetron 4 mg iv q8h:prn nausea . medications at home: glucotrol ca/vit d discharge medications: 1. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation: take this medication while you are on pain mediciations. it will prevent you from becoming constipated. disp:*30 tablet(s)* refills:*1* 2. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 8 days. disp:*16 tablet(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day: take this medication while you are on pain mediciations. it will prevent you from becoming constipated. . disp:*60 capsule(s)* refills:*2* 4. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 8 days. disp:*24 tablet(s)* refills:*0* 5. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po q12h (every 12 hours): take everyday twice a day for pain. do not drive while on this medication. disp:*30 tablet sustained release(s)* refills:*0* 6. morphine 15 mg tablet sig: one (1) tablet po every 6-8 hours as needed for pain: for extra pain take this immediate dose. do not drive while on this medication. disp:*30 tablet(s)* refills:*0* 7. glucotrol xl 10 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day: for diabetes. disp:*30 tablet extended rel 24 hr(s)* refills:*0* discharge disposition: home discharge diagnosis: # septic shock from cholangitis with klebsiella bacteremia # pancreatic adenocarcinoma # anemia, nos # coagulopathy, malnutritional etiology # t2dm discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted in transfer from an outside hospital with fever, rising liver tests, and septic shock from an infection in your bile ducts. you underwent ercp with stenting of your bile duct, and you were treated with antibiotics. your diet was gradually advanced as you healed, and you are continuing a course of antibiotics. the testing showed that you have a tumor in your pancreas and per the discussion with your surgeon dr. you have agreed to have surgery done on . followup instructions: you will need to have a surgical procedure for your pancreatic cancer (whipple) in the near future. this may be performed at hospital, and you would need to follow up with your surgeon there regarding timing. you indicated that you would prefer to have the procedure performed here (at ), and we arranged to have anesthesia see you in the hospital. your surgeon dr. office will call you before surgery to give you more information. you can reach them at (. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct diagnoses: acidosis anemia, unspecified other postoperative infection unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified protein-calorie malnutrition severe sepsis other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure malignant neoplasm of head of pancreas septic shock other septicemia due to gram-negative organisms hyperosmolality and/or hypernatremia cholangitis other and unspecified coagulation defects electrolyte and fluid disorders not elsewhere classified jaundice, unspecified, not of newborn 

Answer: The patient is high likely exposed to