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: elevated lft's; transferred for ercp/biliary stent. major surgical or invasive procedure: ercp with sphincterotomy history of present illness: 68-year old woman 2 weeks s/p total abdominal colectomy for gangrenous cecum c/b post colonoscopic decompression for sigmoid volvulus and respiratory failure requiring intubation, acute renal failure in the setting of hypovolemic shock and rhabdo as well as multisystem organ failure with dic requiring multiple transfusions who is now being transferred from an osh for ercp in the setting of acute onset cholestatic pattern of lfts with alk phos reaching 1200. . admitted to hospital with progressive abdominal distention, fevers and chills after not seeing a physician since the age of 5. imaging showed very dilated large bowel and presumptive sigmoid volvulus and an initial lactate was 14.4. labs also showed rhabdo with cpks reaching ~20,000. she underwent colonic decompression with good short-term results but her abdominal distention returned shortly thereafter. she was subsequently taken to the or where exploration showed patches of ischemic bowel and cecum and a total abdominal colectomy was performed with a hartmann pouch and stabled terminal ileum. post-operative course was complicated by multisystem organ failure requiring multiple pressors, dic requiring extensive blood product transfusions, and requiring initiation of hd in the setting of cpks to ~20,000. . she returned to the or for multiple abdominal washouts. in the days leading up to her transfer she developed a worsening leukocytosis to ~15k and low-grade fevers. ultrasound on showed a distal cbd of 11mm but no intrahepatic duct dilatation. she was extubated on without significant complications although required bipap. she was reintubated prior to transfer to given the 1.5 hour ambulance ride. no mrcp performed prior to transfer. per report patient had a new hd catheter placed within a day or transfer. she was hemodynamically stable at the time of transfer and not requiring pressors. . on arrival she was sedated but hemodynamically stable and in nad. . ros: unable to obtain. past medical history: she has not seen a doctor since she was 5 years old, so none known. social history: she lives with her sister. there is no history of alcohol or drug use. retired. per osh records, question of being a recluse and hoarder. family history: no family history of colon cancer. physical exam: upon admission: vitals: t: 97.8 bp: 130/66 hr: 90 rr: 20 o2sat: 98%/fio260% gen: ill-appearing, intubated heent: eomi, perrl, sclera mildly icteric neck: no jvd appreciated cor: rrr, no m/g/r, normal s1 s2, radial pulses +2 pulm: coarse bilaterally but without wheeze or focal crackles abd: obese, soft, nontender, mildly distended, large midline scar with c/d/i dressing, +bowel sounds ext: 2+ edema bilaterally, no cyanosis or clubbing neuro: responsive to commands at discharge: vs: t 98.9, bp 135/89, hr 113, rr 32, spo2 98% on ra gen: nad. alert and oriented x3. mood and affect brighter. heent: ncat. perrl, eomi, anicteric sclera. mmm, op benign. neck: supple. jvp not elevated. no cervical lymphadenopathy. cv: regular with moderate tachycardia. normal s1, s2. no m/r/g appreciated. chest: increased rr. ctab. no wheezes, rhonchi, or rales. abd: bs present. soft, nd, nt. no hsm detected. ostomy with semi-solid stool. ext: wwp. le edema 1+ bilaterally. distal pulses radial 2+, dp 2+, pt 2+. skin: no rashes, ecchymoses, or other lesions noted. neuro: cn ii-xii grossly intact. moving all four limbs. pertinent results: admission labs: 03:39pm blood wbc-11.1* rbc-3.65* hgb-10.9* hct-32.4* mcv-89 mch-29.9 mchc-33.6 rdw-16.7* plt ct-229 03:39pm blood neuts-75* bands-6* lymphs-10* monos-6 eos-0 baso-0 atyps-2* metas-1* myelos-0 03:39pm blood hypochr-1+ anisocy-1+ poiklo-1+ macrocy-normal microcy-normal polychr-occasional ovalocy-occasional target-occasional envelop-occasional 03:39pm blood pt-15.1* ptt-26.8 inr(pt)-1.3* 03:39pm blood glucose-91 urean-92* creat-4.7* na-138 k-4.8 cl-101 hco3-24 angap-18 03:39pm blood alt-65* ast-46* ld(ldh)-346* ck(cpk)-28* alkphos-847* amylase-160* totbili-3.8* 03:39pm blood lipase-110* 03:39pm blood albumin-2.6* calcium-8.4 phos-4.7* mg-2.7* iron-26* . other labs: 03:18am blood %hba1c-5.6 eag-114 03:18am blood triglyc-142 hdl-31 chol/hd-3.5 ldlcalc-48 01:22pm blood tsh-12* 03:30am blood t3-56* free t4-0.62* 03:18am blood cortsol-53.0* . discharge labs: 07:00am blood wbc-10.0 rbc-3.50* hgb-10.4* hct-31.0* mcv-89 mch-29.8 mchc-33.6 rdw-15.5 plt ct-401 07:00am blood glucose-95 urean-32* creat-1.7* na-140 k-3.8 cl-105 hco3-24 angap-15 07:00am blood calcium-8.8 phos-3.7 mg-2.0 . radiology # portable cxr (): the ng tube ends within the stomach. there is mild cardiomegaly. the mediastinal contours are normal. the hila are hazy, consistent with possible mild pulmonary edema. there is a left moderate pleural effusion. no right effusion is seen. there is hazy opacification of the right lower lung with air bronchograms, possibly due to pneumonia or aspiration. there is retrocardiac atelectasis. round opacities project over the seventh and eighth posterior ribs; these opacities may be callus formation from prior rib fractures or could be pulmonary nodules. no pneumothorax is identified. impression: 1. right lower lung opacities are likely pneumonia versus aspiration. 2. left moderate pleural effusion. 3. possible mild pulmonary edema. 4. retrocardiac atelectasis. 5. opacities overlying the seventh and eighth anterior ribs. correlate to prior rib fractures or prior imaging. 6. mild cardiomegaly. . # ercp (): 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 biliary tree: a mild diffuse dilation was seen at the main duct with the cbd measuring 10 mm. two small, 3 mm round stones that were non-obstructing were seen at the cystic duct. the cystic duct filled with contrast and was completely opacified. there were no stone identifed in the main duct or intrahepatic ducts. procedures: a sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. the sphincterotomy was performed due to suspicion for stone disease as the cause of intraheptic cholestasis and stones noted in the cystic duct. an 11.5mm biliary balloon was used to sweep the main bile duct (twice) . a small amount of sludge was revealed. there were no stones seen exiting the duct. impression: successful bilary cannulation. a mild diffuse dilation was seen at the main duct with the cbd measuring 10 mm. two small, 3 mm round stones that were non-obstructing were seen at the cystic duct. the cystic duct filled with contrast and was completely opacified. there were no stone identifed in the main duct or intrahepatic ducts. successful biliary sphincterotomy. the sphincterotomy was performed due to suspicion for stone disease as the cause of intraheptic cholestasis and stones noted in the cystic duct. an 11.5mm biliary balloon was used to sweep the main bile duct several times. a small amount of sludge was revealed. there were no stones seen exiting the duct. balloon sweep of the bile duct revealed sludge. otherwise normal ercp to third part of the duodenum. . # ct abdomen/pelvis (): the imaged lung bases demonstrate small bilateral simple pleural effusions, with associated basal opacities likely representing atelectasis. there is no pericardial effusion. the nasogastric tube ends in the distal portion of the stomach. within the limitations of a non-contrast study, the liver, spleen, pancreas, adrenal glands are unremarkable. there are hyperdense foci within the gallbladder neck, suggestive of gallstones. there is no intrahepatic biliary dilatation. the kidneys are unremarkable, without evidence of hydronephrosis or nephrolithiasis. there is a moderate amount of ascites, which is simple in nature. there is no intra-abdominal free air. the patient is status post total colectomy, right lower quadrant ileostomy and hartmann's pouch. there is no evidence of small-bowel obstruction, with the administered contrast reaching the ileostomy bag. the abdominal aorta has scattered calcification, without aneurysmal dilation. there is diffuse mesenteric stranding and edema, which may be related to volume overload and recent surgery. the urinary bladder is empty with a foley catheter in place. the uterus is bulky, with multiple areas of calcification, which may represent calcified fibroids. the hartmann's pouch is fluid filled. no significant pelvic lymphadenopathy is detected. no bone lesions suspicious for infection or malignancy are detected. there is extensive anasarca involving the subcutaneous tissues. surgical clips are seen along the anterior abdominal wall, with foci of subcutaneous air, secondary to the recent surgery. impression: 1. no retroperitoneal hemorrhage. 2. bilateral small pleural effusions and associated bibasilar atelectasis. 3. moderate amount of simple ascites. 4. no evidence of bowel obstruction. stable appearance of total colectomy, right lower quadrant ileostomy, with unremarkable appearance of the same. the hartmann's pouch is fluid filled. 5. cholelithiasis. . # portable tte ( at 11:13:16 am): the left atrium is elongated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). 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. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: normal global and regional biventricular systolic function. no pulmonary hypertension or clinically-significant valvular disease seen. . brief hospital course: 68 year old woman s/p colectomy for sigmoid volvulus, rhabdomyolysis, renal failure, and multisystem organ failure with rising lfts, leukocytosis, and intrahepatic cholestasis transferred from osh for decompression via ercp. ercp was performed with successful biliary cannulation with sphincterotomy. her course was complicated by anemia, respiratory failure due to volume overload and pna, and demand ischemia. . # elevated lfts. etiology thought to be secondary to cholestasis secondary to choledocolithiasis. she was transferred to due to concern for intrahepatic cholestasis. per reports gallbaldder wall thickening c/w cholecystitis was seen at the osh but there was no evidence of cholangitis. patient underwent ercp with successful biliary cannulation with sphincterotomy given suspicion for stone disease as the cause of intrahepatic cholestasis and stones noted in the cystic duct. two small 3mm round non-obstructing stones seen in the cystic duct and the balloon sweep only revealed sludge. no stones were seen exiting the duct. post-procedure gentle iv fluid continued. zosyn and flagyl continued for antibiotic coverage. the lack of an obstructing stone makes resolving shock liver a more likely etiology for this cholestatic picture. her lft elevations had resolved prior to discharge. . # respiratory failure: patient was electively intubated prior to transfer from osh to . she was maintained on cmv on arrival. she successfully went underwent ercp. extubation was delayed due to hypervolemic status. she underwent hd x2 with removal of excess fluid to optimize respiratory status pre-extubation. she was extubated on without complication. . # ventilator associated pneumonia: per osh report there was a question of consolidation on cxr. she arrived on vanc/zosyn/flagyl providing appropriate coverage for both hcap and aspiration pna. she was afebrile and hd stable on this regimen and completed a 10 day course of treatment. . # s/p total abdominal colectomy: at osh patient she underwent procedure due to gangrenous bowel secondary to sigmoid volvulus. on arrival, midline incision was examined; dressing clean dry and intact. dressings changed daily and had wound care per protocol. osh surgeon contact. removed by surgey on . . # dic: post procedural dic noted at osh. at , all blood counts stable upon admission without any lab indicators or signs of continued dic. we checked serial hcts, coags, fibrinogen and patient had an active type and screen throughout admission. . # rhabdomyolysis: post procedural rhabdomyolysis causing renal failure at the osh with cpks to 20,000. ck was 28 on admission to . resolved by discharge. . # vre uti: pt was treated for vre uti with 7 days of linezolid. last urine culture was negative. . # concern for fungal infection: unclear history but per report she was started on diflucan for a beta-glucan > 500. iv fluconazole was discontinued given the lack of positive culture and lack of risk factors for fungal disease. . # nutrition: renal formula tube feeds were started on . the patient was trasitioned to po's and maintained on a 1 gram phos diet while on dialysis. diet was advanced as tolerated. . # : the patient developed oliguric kidney failure of multifactorial etiology including sepsis induced hypovolemia with subsequent rhabdomyolysis. she had been undergoing hd at the osh prior to arrival, but the line had to be removed at the osh given fevers. labs on admission here notable for creatinine 4.7. labs on demonstrated bun 100 cr 5.2 and k 5.3; on repeat k found to be 5.8. decision made to place r-ij hd line on and start hd. she underwent hd nearly every other day in house. she had her temporary line removed and a tunneled hd line placed. she was continued on a m/w/f schedule for hd and received epo during her sessions. with time, her renal funtion improved and was her last session of dialysis. her hd line was removed several days prior to discharge, and her creatinine had decreased to 1.7 by discharge. please monitor prior hd site for infection. . # anemia: she had an episode of anemia s/p ercp with sphincterotomy. she was transitioned to ppi gtt from ppi iv for 24 hours. rp bleed ruled out. two units of prbcs transfused with subsequent stable hct. she also had a hct drop with melenotic output when temporarily placed on a heparin drip for empiric treatment of ?pe while awaiting a v/q scan that was ultimately negative. she received 3 units of prbcs. she was placed on ppi po bid and her hct stabilized off the heparin drip. . #. hypotension: the patient became hypotensive to sbp of 80 on while at dialysis after ~1500 cc was removed. her bp increased to the mid 90s with 1.5 l of ns prior to transfer to the micu, and she remained asymptommatic throughout. on physical exam, the patient appeared hypovolemic and had new-onset tachypnea. her troponin was elevated to 0.8, but this was decreased from her peak of 3.21, and her lactate was normal at 1.3. she remained afebrile and her white count did not increase significantly. her hypotension was initially treated with iv boluses and neosynephrine. upon discharge her blood pressure had improved, stabilizing in the 130s, and she did not require any further fluid boluses. . # supraventricular tachycardia: pt had persistent tachycardia with intermittent runs of svt to 150-160. ecg was c/w sinus tach vs. atrial tach. less likely avnrt. she was treated with metoprolol tartrate (titrated to 75 mg) po tid and diltiazem xr (titrated to 240 mg) po daily. the metoprolol and diltiazem were held as needed due to hypotension. she continued to be tachycardic to 130s even after fluid bolus and once her bp was stable she was restarted on metoprolol 25 mg po bid, which was titrated up to 75 mg po tid today. her hr is better controlled in the low 100s, and metoprolol can continued to be titrated up as tolerated and as needed. medications on admission: zosyn 2.25 mg q8h metronidazole m g q8h esmolol iv fluid 2500 mg gtt prn pantoprazole iv 40 mg daily diflucan 400mg/200ml daily at 1800 iron sucrose complex 100 mg hd paricalcitol/zemplar vial 2 mcg hd ondansetron 4 mg magnesium sulfate iv 2 gm prn epoetin 10k units hd albuterol 0.083% mnebs 2.5mg q2h prn acetaminophen cup 640 mg q6h prn dextrose pre-filled syringes heparin 5000 units hd albumin 225% 25 gm prn neosporin tube 1 application prn d70w ivf dextrose 12.5g prn discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q2h (every 2 hours) as needed for wheeze. 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 4. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 5. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q4h (every 4 hours) as needed for sob, wheezing. 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 8. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po tid (3 times a day). 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 10. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. discharge disposition: extended care facility: - ( hospital of and islands) discharge diagnosis: primary diagnoses: cholestasis respiratory failure acute renal failure ventilator associated pneumonia supraventricular tachycardia hypotension secondary diagnoses: s/p total abdominal colectomy rhabdomyolysis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were transferred to this hospital for an ercp procedure. you had become very sick after your colon had twisted on itself, cutting off its own blood supply and requiring a colectomy. your hospital stay was complicated by multi-organ failure and several infections. you were treated with antibiotics which you finished while inside the hospital. you were started on hemodialysis while in the hospital, but your renal function improved significantly by the time of your discharge, and your dialysis catheter was removed. . you were started on the following medications during your stay at the hospital. these include aspirin to help protect you from heart attacks, metoprolol to keep your heart rate from going too fast, nephrocaps and calcium acetate because of your reduced kidney function, ipratropium and albuterol inhalers to help you breath more easily, and pantoprazole to reduce the acid in your stomach. the exact doses of these medications are indicated on your discharge medication sheet. on discharge, you will be going to a rehab facility in order to have intensive physical therapy and help build your strength back up. while at the rehab facility, doctors be available to help manage your ongoing medical issues. once you are discharged from the rehab facility, it is important that you choose a primary care doctor. your primary care doctor will be able to refer you to any specialists that you require. an appointment has been scheduled next week with nephrology to discuss your kidney function. followup instructions: after discharge from rehab, you will need to choose a primary care provider (pcp) and schedule a followup appointment to help manage your ongoing medical issues. you are welcome to choose a provider at the clinic, which can be reached at . please discuss with your pcp referral to cardiologist. you have an appointment scheduled with nephrology next week to discuss your kidney function. department: west clinic when: wednesday at 3:00 pm with: , md building: de building ( complex) campus: west best parking: garage procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis endoscopic sphincterotomy and papillotomy insertion of totally implantable vascular access device [vad] diagnoses: hyperpotassemia other iatrogenic hypotension unspecified pleural effusion urinary tract infection, site not specified acute posthemorrhagic anemia acute and subacute necrosis of liver acute respiratory failure other specified cardiac dysrhythmias other shock without mention of trauma blood in stool other specified disorders of biliary tract streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] anticoagulants causing adverse effects in therapeutic use ventilator associated pneumonia rhabdomyolysis oliguria and anuria nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] attention to colostomy other fluid overload acute kidney failure with other specified pathological lesion in kidney 

Answer: The patient is high likely exposed to