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 / tylenol/codeine / iodine containing agents classifier attending: chief complaint: failure to thrive, nausea major surgical or invasive procedure: ercp with removal and replacement of biliary stent rbc scan x 2, both unremarkable history of present illness: ms. is an 82 year-old spanish speaking woman with a history of non-resectable cholangiocarcinoma s/p seven cycles of gemcinabine (last ) and cyberknife radiotherapy (). since her most recent chemotherapy, she has felt generally unwell and has been unable to take much po. for the past 3 weeks, she has also been vomiting. her chronic abdominal and back pain have also been gradually worsening. denies fevers or chills, chest pain, dyspnea, abdominal pain, or changes in bowel habits. her urine may be darker than usual. because she was gradually weakening, her son decided to bring her to the today. at baseline the patient is quite functional, lives alone and cares for herself. her sons stop by daily to help her. in the ed, initial vs: t 99, bp 138/48, hr 62, o2 sat 100% ra. cxr showed no significant abnormality. urinalysis was clean. she was admitted to omed for further evaluation and management. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations. denies cough, shortness of breath, or wheezes. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. denies rashes or skin breakdown. no numbness/tingling in extremities. no feelings of depression or anxiety. past medical history: oncologic history: mrs. presented to in with acute onset of abdominal pain, nausea, vomiting and diarrhea. abdominal ct revealed soft tissue attenuation surrounding the superior mesenteric artery and extending to the periportal region; enhancing soft tissue surrounding the common hepatic and bile duct with periportal edema; and an ill-defined low attenuation in the head of the pancreas. abdominal mri revealed abnormal t2 dark soft tissues surrounding the celiac axis extending to the periportal region and abutting the head of the pancreas. on , the patient underwent egd which demonstrated normal esophagus, stomach and duodenum. eus revealed small volume to the pancreatic parenchyma, which was normal in echotexture without changes suggestive of chronic pancreatitis. the pancreatic duct was normal in diameter and texture. the cbd was thickened for the entire course from the porta hepatis to the pancreatic head. the hypoechoic thickness measured from 8-12 mm. fna demonstrated adenocarcinoma suggestive of cholangiocarcinoma. on , dr. performed ercp, which demonstrated normal pancreatic, common hepatic and cystic filling with contrast. a 2-cm stricture was noted along the entire length of the cbd. following cannulation of the pancreatic duct, the cbd was cannulated and stented for the length of the stricture. on , mrs. saw dr. on who deemed the lesion unresectable. on , she underwent repeat ercp and removal of the pancreatic duct stent. treatment history: : c1 gemcitabine 1000 mg/m2; w3 dose reduced by 25% to 750 mg/m2 : c2 gemcitabine 750 mg/m2 : c3 gemcitabine 750 mg/m2 aranesp 200 mcg for hg/hct < 10/30 : c4 gemcitabine 750 mg/m2. d15 held due to thrombocytopenia (plt 96) : c5d1 750 mg/m2. d8 and d15 held due to thrombocytopenia, 53 and 85, respectively. : c6d1 600 mg/m2 on d1/15 schedule *c6 effectively replaced cycle 5. : "c7:" course complicated by constipation requiring er visit for disempaction. mrs. underwent ct scan on and this revealed complete stability. she has generally felt well and reports good appetite and energy. she does some house chores on her own. pt notes one week history of bilateral lower back pain, that is moderate in intensity, sporadic, wakes her up at night, does not radiate down the lower extremities and is not associated with bladder or bowel dysfunction. she has been having normal bowel movements and has been off fentanyl since mid-. she denies fevers, chills, nausea, vomiting, chest pain, abdominal pain, night sweats, melena or hematochezia. . past medical history: -cholangiocarcinoma, as above -osteoporosis -hypertension social history: originally from . spanish speaking. many children. she smoked for a few years and has occasional social alcohol family history: nc physical exam: gen: pleasant woman in nad, cooperative, pleasant vs: 96.8, 157/76, 66, 16, 100% ra heent: eomi, no conjunctival icterus, pallor, or injection. no appreciable jvd or lad cv: rrr, nl s1/s2, no m/g/r pulm: ctab no wheeze or crackles. good inspiratory effort abd: soft, nt/nd, + nabs x4. no pulsatile masses or organomegaly. no rebound tenderness or guarding limbs: warm and well perfused. no cyanosis or edema. 2+ symmetric radial/dp/pt pulses bilaterally. skin: many varicosities over bilateral distal lower extremities neuro: aao x3. spanish-speaking only, interpreter at bedside. 5/5 strength in upper/lower extremities proximally & distally. moving all extremities freely. sensation grossly intact throughout. exam at discharge: comfortable, alert and oriented x 3 pertinent results: 02:45pm blood wbc-6.6 rbc-3.08* hgb-10.3* hct-30.0* mcv-97 mch-33.4* mchc-34.3 rdw-13.6 plt ct-198 06:45am blood wbc-4.0 rbc-2.97* hgb-9.7* hct-29.3* mcv-99* mch-32.6* mchc-33.0 rdw-13.3 plt ct-168 02:45pm blood neuts-75.8* lymphs-16.9* monos-4.8 eos-2.1 baso-0.5 02:45pm blood plt ct-198 02:45pm blood glucose-106* urean-27* creat-1.0 na-134 k-3.8 cl-98 hco3-27 angap-13 02:45pm blood alt-103* ast-125* ld(ldh)-201 alkphos-686* totbili-1.1 06:45am blood alt-79* ast-78* ld(ldh)-165 alkphos-594* totbili-0.7 02:45pm blood albumin-3.3* 06:45am blood albumin-2.9* calcium-8.6 phos-3.4 mg-2.4 chest x-ray ()- findings: as compared to the previous radiograph, there is no relevant change. normal lung volumes. no pleural effusions. no evidence of focal parenchymal opacities suggesting pneumonia. normal size of the cardiac silhouette, no pulmonary edema. mild tortuosity of the thoracic aorta. : interpretation: baseline images were obtained before tracer injection since the patient had a tagged rbc scan the day prior. following intravenous injection of autologous red blood cells labeled with tc-m, blood flow and dynamic images of the abdomen for 90 minutes were obtained. pre-injection images show activity in the bowel compatible with interval bleed since the prior study. flow study shows normal abdominal flow. dynamic blood pool images show no evidence for a active gi bleed. impression: no gi bleed during the course of study. appearance similar to the scan from one day prior. : interpretation: following intravenous injection of autologous red blood cells labeled with tc-m, blood flow and dynamic images of the abdomen at 60 and 90 minutes were obtained. blood flow images show flow into abdominal vasculature. there is no evidence of hyperemia. dynamic blood pool images show no evidence for bleeding. there was no excretion of tracer into the bladder. impression: no active bleeding identified over the course of 90 minutes. absence of activity in the bladder raises a the question of poor renal function. tte: the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef 70-80%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. : indication: cholangiocarcinoma with previous metal stent placement and now rising liver function tests. five fluoroscopic ercp images are included. initial scout film demonstrates preexisting biliary stent. subsequent images demonstrate cannulation of stent with injection of contrast. air and some contrast is seen within the right intrahepatic biliary ducts. left sided ducts are not included on the images provided. the proximal stent is demonstrated to opacify with contrast. for further details, please see the endoscopy report in the online medical record. : comparison: . ercp: 6 spot fluoroscopic images were obtained without a radiologist present and submitted for review. initial scout image demonstrates a metal stent within the biliary tree. there is contrast injection into the duodenum, with a space seen from the duodenum to the lower portion of the stent. subsequently, there is pooling of contrast around the lower portion of the stent, likely reflecting an ulcer as seen on ercp. for further details please refer to ercp note from the same day. the study and the report were reviewed by the staff radiologist. ercp: ten fluoroscopic spot images were obtained by a gastroenterologist during an ercp procedure without a radiologist present. scout image shows a metal stent which was subsequently removed. an irregular stricture of malignant appearance was seen at the lower and middle third of the common bile duct with mild dilatation of the biliary tree proximal to this strictured portion. a metal stent was placed, spanning the strictured portion. impression: single irregular stricture of malignant appearance in the lower and middle third of the common bile duct with subsequent biliary stent placement across the strictured portion. mild to moderate dilatation of the biliary tree proximal to the strictured portion. brief hospital course: assessment and plan: 82 y/o f with unresectable cholangiocarcinoma p/w failure to thrive, poor po intake, nausea and vomiting . # failure to thrive: this was initially concerning for infectious process or progression of cancer. she was afebrile and without leukocytosis, no focal signs of infection. cxr clear, no other localizing signs or symptoms. u/a bland. lfts demonstrated an obstructive picture. ct torso was performed with premedication to evaluate for metastatic and/or locally progressive disease. it showed neither of these but did deonstrate possible biliary ductal dilatation. ercp evaluated her and recommended ercp to evaluate the patency of stent and other ducts. she underwent ercp, during which her previous biliary stent was removed and replaced. after her ercp procedure, she was being prepared for discharge but developed a fever. blood cultures were drawn and were positive for serratia. she was started on cefepime and flagyl. a ct scan was performed and showed abscesses in the liver. this was confirmed with abdominal ultrasound, but it was felt that the abscesses were not amenable to ir drainage. she ultimately underwent a repeat ercp. during the repeat ercp, her biliary stent was seen to be adjacent to the duodenum and eroding into the duodenal wall. out of concern for duodenal perforation, no intervention was performed during this ercp. however, the patient's alkaline phosphatase and bilirubin levels continued to rise during this time. of note, during this time as well, the patient's more recent blood cultures began to grow enterococcus. she was started on vancomycin in addition to the cefepime/flagyl. on , because her alk phos and bilirubin were still rising, the patient underwent a 3rd ercp, during which a defect was created in the distal portion of her previous stent so that bile could drain into the duodenum. on the following evening (), while she was talking to her family, the patient's eyes rolled back in her head, and she suddenly became tired and short of breath. she was also noted to be somewhat hypotensive. while she was being evaluation, she had an episode of bright red bloody stool. stat labs were drawn and revealed a 5-point hematocrit drop. the patient was started on iv fluids as well as blood. she was transferred to the were she was found to have stopped bleeding. a tagged rbc scan was performed which revealed no clear source of bleeding. unfortunately she bled again overnight, and the family and patient were offered a repeat rbc scan. at this time the family and patient got together and decided that they no longer wanted to escalate care. the patient was set-up with hospice care and prepared to go home comfortably with her family. # cholangiocarcinoma: locally advanced and unresectable but stable in appearance by ct , s/p 7 cycles of gemcitabine (most recent ) and cyberknife (). there was no evidence of metastatic disease on ct torso. dr. was made aware of the above events and agreed with the family's decision to send her home with hospice care. . # hypertension: bp elevated on arrival. home atenolol was continued. . # anemia: her hematocrit was consistent with baseline, with expected drop from gi bleeding. she remained hemodynamically stable. medications on admission: alendronate - 70 mg tablet - 1 (one) tablet(s) by mouth qweek once a week atenolol - (prescribed by other provider) - 25 mg tablet - 1 (one) tablet(s) by mouth twice a day latanoprost - (prescribed by other provider) - 0.005 % drops - 1 in each eye qpm acetaminophen - (prescribed by other provider) - 325 mg tablet - 2 (two) tablet(s) by mouth every four (4) hours as needed for pain camphor-menthol - 0.5 %-0.5 % lotion - apply to affected areas twice a day docusate sodium - 100 mg capsule - one capsule(s) by mouth three times a day purchase over the counter if cheaper magnesium hydroxide - 400 mg/5 ml suspension - 5 cc by mouth 1-2 times per day as needed for constipation if no bowel movement sennosides - 8.6 mg tablet - 2 tablet(s) by mouth daily discharge medications: none patient will receive hospice-focused medications following discharge discharge disposition: home with service facility: hospice discharge diagnosis: primary: cholangiocarcinoma gi bleeding discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: you came to the hospital because of difficulty eating and weight loss. blood tests and ct showed that you had blockage in the ducts that drain the liver. you had several procedures to evaluate this, during which your biliary stent was removed and replaced. however the stent has eroded into the soft tissue around the tumor, and is causing bleeding. you received blood transfusions. you also had bacteria growing in your bloodstream, likely from the biliary tract where the tumor is located. you were treated with antibiotics for this. you had another episode of bleeding in your gi tract, and the decision was made by you, your family, and your medical team to discharge you home with hospice care. followup instructions: you have the following upcoming appointment: provider: , md phone: date/time: 3:30 md procedure: venous catheterization, not elsewhere classified endoscopic insertion of stent (tube) into bile duct removal of t-tube, other bile duct tube, or liver tube endoscopic excision or destruction of lesion of biliary ducts or sphincter of oddi endoscopic retrograde cholangiopancreatography [ercp] endoscopic retrograde cholangiopancreatography [ercp] diagnoses: thrombocytopenia, unspecified anemia, unspecified unspecified essential hypertension acute kidney failure, unspecified bacteremia osteoporosis, unspecified abscess of liver mechanical complication due to other implant and internal device, not elsewhere classified chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms malignant neoplasm of intrahepatic bile ducts 

Answer: The patient is high likely exposed to