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: dyspnea, nausea, vomiting major surgical or invasive procedure: intubation/extubation rij central venous line placement, removal picc placement history of present illness: this is an 85yo f with a h/o choledocholithiasis, htn, renal ca, and dementia who presented to today with dyspnea and vomiting. history is mainly taken from that visit note. the patient had onset of n/v yesterday after eating fried shrimp the prior day. she took "nausea relief" from cvs with improvement, although had anorexia. in addition, the patient has had dyspnea with minimal exertion associated with nonproductive cough and chronic orthopnea. she has also experienced weakness and 2 mild falls (no trauma or loc). she has had diarrhea four to five times a day, although may have chronic diarrhea. per family report, patient also had chest pain, although patient could not confirm. she had a fever of 100.9 at home that improved to 97.6. she was sent to the ed for eval. . in the ed, labs showed tbili 9.9 with transaminitis, anion gap acidosis, lactate 4.5, bandemia 18% of 4.8 and creat 2.6 from 1.3 baseline. cxr was clear. due to report of copd history, she initially received combivent and methylprednisolone, as well as asa and ceftriaxone. once labs revealed a septic picture, she received vanc and pip-tazo. sbp was upper 80s to low 90s and a rij was placed and the patient received 3l ivf. while undergoing ruq u/s, she became acutely dyspneic with new opacities on cxr. she was tiring on , was intubated and sedated. the u/s showed cbd 25mm and sludge/sludge ball and gi plans to take for in the am. prior to transfer, vitals were: 101.3 119 118/103 25 99%. however, after signout, she was started on norepinephrine. . on the floor, the patient is intubated and sedated. she is unable to answer questions. past medical history: primary kidney ca s/p cyberknife choledocholithiasis s/p with sphincterotomy in dementia b12 deficiency hypertension osteoporosis ckd disease, s/p rai follicular lymphoma of the small intestine, in remission ?chronic diarrhea social history: the patient is married and is accompanied to this visit today by her husband as well as by one of her three children (). she lives in and remains quite active around the house. she has a distant trivial smoking history, having quit more than 30 years ago. she does not consume alcohol. family history: there is no family history of malignancies or inflammatory bowel disease. physical exam: (admission physical exam) vitals: bp: 94/53 p: 90 r: 26 o2: 98% on fio2 40% general: intubated, sedated, not responsive heent: perrl, mmm, ett in place neck: rij in place lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: 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 ext: warm, well perfused, 2+ pulses, no edema (discharge summary) vitals: bp: 139/57 p: 80 r: 22 o2: 94% on room air general: sitting up in bed, eating breakfast, no acute distress heent: perrl, mmm lungs: clear to auscultation bilaterally, no wheezes, rales; occasional rhonchi cv: 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 ext: warm, well perfused, 2+ pulses, no edema pertinent results: admit labs: 08:47pm plt smr-low plt count-140* 08:47pm wbc-4.8 rbc-3.97* hgb-12.7 hct-37.3 mcv-94 mch-31.8 mchc-33.9 rdw-14.3 08:47pm neuts-71* bands-18* lymphs-7* monos-0 eos-0 basos-0 atyps-1* metas-3* myelos-0 08:47pm albumin-3.9 08:47pm ck-mb-5 ctropnt-0.02* probnp-5614* 08:47pm lipase-20 08:47pm alt(sgpt)-206* ast(sgot)-163* ck(cpk)-182* alk phos-183* tot bili-9.9* dir bili-6.8* indir bil-3.1 08:57pm lactate-4.5* 07:35am fibrinoge-515* 10:07am d-dimer-* 11:00am fdp-10-40* echo this study was compared to the prior study of . left atrium: mild la enlargement. right atrium/interatrial septum: the patient is mechanically ventilated. cannot assess ra pressure. left ventricle: normal lv wall thickness, cavity size and regional/global systolic function (lvef >55%). estimated cardiac index is normal (>=2.5l/min/m2). no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aortic valve: mildly thickened aortic valve leaflets (3). no as. trace ar. mitral valve: normal mitral valve leaflets. mild mitral annular calcification. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. normal pa systolic pressure. pericardium: trivial/physiologic pericardial effusion. cxr : upright ap view of the chest: study is slightly limited due to patient motion. the cardiac, mediastinal, and hilar contours are stable, with unchanged enlargement of the pulmonary arteries, compatible with underlying hypertension. prominent epicardial fat pad is again noted. the lungs are grossly clear without focal consolidation, pleural effusion or pneumothorax. there appears to be hyperinflation of the lungs, stable from prior. degenerative changes are seen within the right shoulder. new surgical clips are also noted within the epigastric region. multilevel degenerative changes are present in the thoracic spine. impression: study is slightly limited due to patient motion. no gross evidence of pneumonia or congestive heart failure. ruq ultrasound : dilatation of bile ducts, similar to that seen on recent mri study performed 2 weeks ago. again with sludge/stones seen in cbd, but distal most cbd and pancreatic head not well visualized. in this patient with clinical concern for ascending cholangitis,there are no imaging studies sensitive for this. : the major papilla was intra-diverticular. pus was seen extruding from the major papilla. an opening draining bile and pus consistent with a choledochoduodenal fistula was seen at the superior portion of the major papilla. cannulation of the biliary duct was successful and deep with a sphincterotome using a free-hand technique. contrast medium was injected resulting in complete opacification. a single 2.5-3cm filling defect consistent witha stone or sludge ball that was causing partial obstruction was seen at the mid cbd. a 10fr by 5cm double pigtail biliary stent was placed successfully using a oasis 10fr stent introducer kit. partial pancreatogram was normal. ekg : sinus rhythm. since the previous tracing of the single beat showing a more leftward axis and right bundle-branch block morphology is no longer present. ekg : sinus rhythm. leftward axis. since the previous tracing no significant change. ekg : baseline artifact. sinus rhythm. since the previous tracing probably no significant change. ekg : atrial fibrillation with rapid ventricular response. low qrs voltage in the precordial leads. diffuse non-specific t wave flattening. compared to the previous tracing of atrial fibrillation is new. decreased qrs voltage is now evident. cxr : left picc ends in the upper superior vena cava. the patient remains intubated, with the endotracheal tube terminating 3.2 cm above the carina. the right internal jugular line ends in the mid superior vena cava. left pleural effusion with atelectasis have not changed. pulmonary arteries are markedly enlarged, consistent with pulmonary arterial hypertension. the right lung is clear. there is no pulmonary edema. blood culture x 2. blood culture, routine (final ): anaerobic gram positive rod(s). not resembling clostridium species. unable to further identify. clostridium species not c. perfringens or c. septicum. beta lactamase incorrectly reported . test not routinely performed for this organism. reported by phone to # at 2:15pm. anaerobic bottle gram stain (final ): reported by phone to dr. on at 0705. gram positive rod(s). brief hospital course: assessment and plan: 85yo f with a h/o choledocholithiasis, htn, renal ca, and dementia who presents with dyspnea and vomiting complicated by acute respiratory failure and septic shock. . # dyspnea/respiratory failure: admitted with worsening dyspnea on exertion, stable orthopnea. became acutely sob requiring intubation in the ed, likely due to metabolic acidosis with respiratory compensation leading to fatigue. repeat cxr showed increased bilateral opacities suggesting pulmonary edema. heart failure was considered her bnp elevation and history of orthopnea, although she has no known heart failure and echo was not particularly concerning for chf ( dilated, lvef > 55%). viral dfa was negative, pneumonia was less likely in the absence of sputum and change in cxr. she has smoking history, but no wheezing or co2 retention to suggest copd. ischemia was considered given report of chest pain, although ekg negative and cardiac markers negative. abg showed good oxygenation and patient was switched to psv 10/5 with fio2 40%. pt was stable on pressure support on the vent and sedation was weaned. sbts starting with intention to extubate were unsuccesful (rr into the 40s, tachycardic), likely secondary to volume overload. she was diuresed with lasix and repeated almost daily sbts continued to show elevated rr and tachycardia. rsbi was 156 on , but given that she is an elderly female with baseline tachypnea and small tvs, extubation was attempted on and was successful. she was quickly weaned down to 2l nc with o2 sats 95-100%. of note, rsbi is not likely a good indication of this patients suitability for extubation given her baseline tachypnea and small tv and as she did very well s/p extubation with a pre-extubation rsbi of 156. . # septic shock: initial wbc with bandemia, elevated lactate, fever, tachycardia, and pressor requirement. most likely biliary source given cbd dilation with sludge and obstructive lfts in setting on known choledocholithiasis. was done on and showed large amounts of sludge and a sludge ball obstructing flow in the cbd. sludge ball/stone in cbd is approx 3 cm long, so a 5 cm 10 fr pigtail stent was placed around the sludge ball to facilitate drainage until a definitive procedure can be attempted, now scheduled for . blood cultures showed g positive rods and clostridium species (not perfringens) in anaerobic culture bottles, but have not yet been speciated. she was started on broad spectrum antibiotics including vanc and zosyn on , then narrowed to zosyn with g negative organisms in blood with plan for 14 day course. a picc was placed on . pressors were weaned starting and she has maintained her bp off pressors. metoprolol was started on and uptitrated. . # atrial fibrillation with rvr. she developed atrial fibrillation on . she was initially started on iv amiodarone with no good response. her rate remained in 100-120's, and rate control was initiated with metoprolol and diltiazem on . on , diltiazem was discontinued and metoprolol was uptitrated. on , she spontaneously converted back to normal sinus rhythm. . # arf: likely related to sepsis (atn), as well as hypovolemia from vomiting and diarrhea. baseline creatinine 1.2-1.4. urine lytes: fena: 0.2, feurea: 14.9%. she was rescuscitated with d5 1/2 ns with 3 amps of bicarb followed by ns prn to maintain cvp > 10. cr returned to baseline by . . # anion gap acidosis: most likely related to elevated lactate, initially 4.5 improved consistently with ivf, now 1.7. no history of ingestion and no clear offenders on med list. glucose not c/w dka, bun not c/w uremia. . fen: pt was initially kept npo then provided with full fibersource tube feeds at 30 ml/hr. in anticipation of extubation and question of whether she would be able to pass speech and swallow immediately, her og tube was changed to an ng tube on . she was evaluated by speech and swallow and her diet changed to regular full, which she tolerated well. . she was called out of the icu on . floor course: on the floor, she continued to do well. she spontaneously converted from atrial fibrillation back to nsr on . her oxygen was weaned, and she was seen by physical therapy, who recommended rehab. the remainder of her blood pressure medications from home were held and should be re-added as an outpatient. she was discharged to rehab on in stable condition, not on oxygen, and tolerating po. . on the floor, she was noted to have frequent stools (3-4 per day). per her daughter, this is chronic and has been going on for months. a c. difficile study on was negative, and her abdominal exam is benign. this warrants further workup as an outpatient, and she was instructed to make an appointment to see her primary care doctor as an outpatient once discharged from rehab. medications on admission: (per omr) alendronate - 70 mg weekly amlodipine - 10 mg once a day chlorthalidone - 25 mg qam citalopram - 20 mg at bedtime ergocalciferol (vitamin d2) - 50,000 unit monthly lisinopril - 40 mg once a day memantine - 10 mg twice daily metoprolol succinate - 100 mg once a day potassium chloride - 20 meq twice a day ascorbic acid - (otc) - 500 mg once a day cyanocobalamin - 1,000 mcg once a day multivitamins with minerals - 1 capsule once a day discharge medications: 1. piperacillin-tazobactam 2.25 gram recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 4 days. 2. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 3. alendronate 70 mg tablet sig: one (1) tablet po qfri (every friday). 4. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 5. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po once a month. 6. memantine 5 mg tablet sig: two (2) tablet po bid (). 7. ascorbic acid 250 mg tablet, chewable sig: two (2) tablet, chewable po daily (daily). 8. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). 9. multivitamin tablet sig: one (1) tablet po daily (daily). 10. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush: picc care per protocol. 11. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 12. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for rash. 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day): discontinue if ambulatory. 14. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). discharge disposition: extended care facility: discharge diagnosis: septic shock cholangitis s/p acute renal failure respiratory failure discharge condition: stable, on room air, normal vital signs, tolerating po diet. discharge instructions: you were admitted to the hospital because you were having difficulty breathing and vomiting; you were found to have a fever and abnormal labs. you were intubated and placed on a mechanical ventilator, and you underwent an on . you slowly got better, and you will need to complete a 14 day course of intravenous antibiotics. . if you develop worsening fevers, chills, abdominal pain, breathing difficulty, bleeding, chest pain, shortness of breath, or other concerning symptoms, please seek medical attention immediately. please keep all of your follow up appointments and take all of your medications as prescribed. followup instructions: you have follow up on with the team for removal of your biliary stent: provider: 2 (st-4) gi rooms date/time: 9:00 provider: , md phone: date/time: 9:00 . please make a follow up appointment with your primary care doctor, dr. , within 1 week of discharge from rehab. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances endoscopic insertion of stent (tube) into bile duct diagnoses: acidosis thrombocytopenia, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation malignant neoplasm of kidney, except pelvis other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified acute respiratory failure osteoporosis, unspecified septic shock toxic diffuse goiter without mention of thyrotoxic crisis or storm hypovolemia cholangitis hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified calculus of gallbladder and bile duct without cholecystitis, with obstruction nodular lymphoma, unspecified site, extranodal and solid organ sites 

Answer: The patient is high likely exposed to