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: no known allergies / adverse drug reactions attending: chief complaint: abdominal pain major surgical or invasive procedure: ercp with sphincterotomy and biliary stent placement history of present illness: 82m with pmh chf, t2dm, prostate ca, s/p ccy who presents from ed with concern for cholangitis. pt states that he began to have epigastric pain last night 'steady' pain not associated with food and without radiation. pain eventually went away on its own, but returned this am and didn't go away, leading to presntation to ed. per records, he had nausea and dry heaves and was febrile to 102. upright x-ray showed no free air, large stool. ultrasound showed dilated cbd and intrahepatic ducts, distal and cbd large impacted gallstone 1.8cm, with proximal duct measuring 1.6cm. he had wbc to 15.7. he was given morphine 8mg iv, zofran 4mg iv, 500mg flagyl and 500mg levaquin. . in the ed inital vitals were, 99.9 104 136/59 18 97%. he appeared confused, stating "2nd" "" "11" for year, initially states "" for location. he is aware that he is confused. abdomen was distended with +bs, ttp ruq, epigastrium, and luq without rebound or guarding. labs were notable for wbc of 18.6, tbili of 3.1, dbili of 2.3, ast and alt 609 and 265 and ap of 167. lactate was 2.4. gi was consulted who recommended urgent ercp with admission to the . . on the floor, patient is in no current pain. he admits to nausea earlier without emesis. he did note chills yesterday. he denies shortness of breath or dizziness. he has had no bloody bowel movements. he did have his gallbladder removed approximately 8 years ago, associated with similar pain 'but worse' at that time. review of systems is otherwise unremarkable past medical history: -chf (although patient denies) -dm -prostate ca s/p ccy -s/p cholecystectomy approximately 8 years ago -s/p splenectomy for 'low platelets' -s/p two knee replacements -'lung procedure' for a 'virus around the lung' approximately 3 years ago at hospital social history: retired propane truck driver. lives in with his wife of 52 years. 2 daughters and 1 son. - tobacco: quit 45 years ago - alcohol: occasional - illicits: denies family history: nc physical exam: admission: vitals: t:98.4 bp:107/55 p:77 r:16 o2:95% 2lnc general: alert, oriented to person, hosptital, year and president. no acute distress, watching football. heent: sclera mildly icteric, dry mm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: soft breath sounds. mild crackles at bases bilaterally. nonlabored. cv: soft heart sounds. regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. no sign. scars c/w prior splenectomy and cholecysctectomy. ext: warm, well perfused, 2+ pulses. rt chronic venous stasis changes. 1+pitting edema to mid shins, prominently over ankles. 2 scars over knees c/w prior surgery. discharge exam: vss gen: patient lying comfortably in bed nad a+ox3 heent: mmm oropharynx clear neck: supple no thyromegaly cv: rrr no m/r/g resp: ctab no w/r/r abd: soft nt nd bs+ no rebound or guarding extr: no le edema good pedal pulses bilaterally derm: no rashes, ulcers or petechiae neuro: cn 2-12 grossly intact non-focal psych: normal affect and mood pertinent results: admission labs: 04:19pm blood wbc-18.6* rbc-4.52* hgb-14.3 hct-41.5 mcv-92 mch-31.7 mchc-34.6 rdw-13.7 plt ct-209 04:19pm blood neuts-90.5* lymphs-6.0* monos-2.7 eos-0.5 baso-0.4 04:19pm blood pt-14.4* ptt-22.5 inr(pt)-1.2* 04:19pm blood glucose-199* urean-15 creat-0.8 na-138 k-3.6 cl-103 hco3-23 angap-16 04:19pm blood alt-465* ast-609* alkphos-167* totbili-3.1* dirbili-2.3* indbili-0.8 04:19pm blood lipase-16 10:40pm blood albumin-3.5 calcium-8.3* phos-3.4 mg-1.9 04:19pm blood digoxin-0.9 04:21pm blood lactate-2.4* 04:19pm urine color-yellow appear-clear sp -1.014 04:19pm urine blood-neg nitrite-neg protein-neg glucose-tr ketone-neg bilirub-sm urobiln-4* ph-5.5 leuks-neg urine site: clean catch **final report ** urine culture (final ): no growth. ercp: a large periampullary diverticulum was noted. there was pus drainage from the ampulla successful biliary cannulation was achieved with the sphincterotome. partial opacification of the biliary tree was performed because of the clinical evidence of cholangitis there was significant dilation of the cbd up to approximately 18 mm in the mid cbd with evidence of at least two large stones, measuring up to 18mm in size successful placement of a 7cm x 10fr biliary stent for drainage otherwise normal ercp to 3rd part of duodenum. ruq u/s: findings: the liver demonstrates a normal-appearing echotexture, with minimal prominence of the intrahepatic biliary ducts. the portal vein is patent with directionally appropriate flow. the distal cbd is markedly distended up to 1.8 cm. a 2.3-cm echogenic shadowing stone is demonstrated within the distal cbd. limited views of the pancreatic head and body show no pancreatic duct dilatation. impression: 2.3-cm stone in the distal cbd with marked extrahepatic and mild intrahepatic biliary dilatation. cxr: hyperinflation of the lungs and the configuration of the diaphragm suggest copd. thickening of the lower lateral and posterior costal pleural margins could be due to thickening or small effusions. there is pleural parenchymal scarring at both lung apices, right greater than left. heart size is normal and there is no evidence of central adenopathy. any prior chest radiograph should be obtained to see if there are new findings warranting further investigation. discharge labs: 06:45am blood wbc-10.8 rbc-4.09* hgb-13.0* hct-39.0* mcv-95 mch-31.7 mchc-33.3 rdw-13.7 plt ct-179 06:45am blood pt-14.8* ptt-28.2 inr(pt)-1.3* 06:45am blood glucose-172* urean-13 creat-0.8 na-139 k-3.9 cl-105 hco3-28 angap-10 06:45am blood alt-227* ast-103* alkphos-155* totbili-2.1* brief hospital course: # cholangitis: ercp evaluated pt in ed and recommended icu admission with plan for ercp on night of admission. he underwent sphincterotomy with purulent drainage and cbd stones were seen. no extraction was performed and biliary stent was placed with improvement in symptoms. his diet was advanced and he should have repeat ercp for stent removal, sphincteroplasty and stone extraction in weeks(plan for ). he was started on unasyn post-procedure. cultures from osh were sensitive to cipro and he was discharged to complete a 2 week course(complete on ). he will follow up with his pcp, that visit please check lft's(which were downtrending on discharge) and cbc(leukocytosis had normalized on discharge). gi will be calling the patient to give a time for the procedure on . . # gnr bacteremia: osh blood cultures grew e.coli in 2 bottles which were sensitive to cipro. unasyn was d/c and he was started on po cipro. he will complete his course on . . # dm: insulin dependent. metformin held and lantus initially held, started on iss. patient discharged to restart his home lantus and metformin. . # chf? vs afib: patient stated he was on digoxin for an arrhythmia not chf as previous notes stated. dig level 0.9. lasix was initially held and restarted post ercp. digoxin and lasix were continued on discharge. . . transitional issues: -repeat ercp 3-4 weeks -cipro po until medications on admission: kcl er 750mg daily furosemide 20mg daily digoxin 25mcg daily metformin 500 asa 81 insulin (unsure type, suspect lantus) 28 units qhs discharge medications: 1. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 4. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 5. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*24 tablet(s)* refills:*0* 6. metformin 500 mg tablet sig: one (1) tablet po twice a day. 7. insulin glargine 100 unit/ml solution sig: twenty eight (28) units subcutaneous at bedtime. 8. potassium chloride oral discharge disposition: home discharge diagnosis: 1. acute cholangitis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you presented with abdominal pain and fevers and were found to have cholangitis-this is an obstruction/infection of the bile ducts. you were treated with antibiotics and an ercp to relieve the obstruction. when discharged you will be on antibiotics for a total of 2 weeks and will follow up with the gastroenterologists for a repeat ercp. followup instructions: 1) primary care physician follow up: name: , w. address: , , phone: appt: at 3:15pm 2) you will have a follow up ercp on . the gastroenterology clinic will call you with a time in weeks. procedure: endoscopic insertion of stent (tube) into bile duct diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation personal history of malignant neoplasm of prostate bacteremia cholangitis calculus of bile duct without mention of cholecystitis, without mention of obstruction other and unspecified escherichia coli [e. coli] 

Answer: The patient is high likely exposed to