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: hypotension major surgical or invasive procedure: ercp, percutaneous drain placement by ir history of present illness: 78 yo f with h/o dm, htn, and cholecystectomy presented to on with hypotension (sbp 80's) initially improved with ivf's, ruq pain, anorexia, loose stools, and jaundice x3 days. ct abd at revealed a gallstone occluding cbd. they were unable to perform ercp at osh given h/o gastric bypass. she was started on ancef. she was noted to have arf thought to be secondary to prerenal azotemia given decreased po intake. . she was to be transferred to on for ercp, however, she became hypotensive to the 50's on the evening of . she was started on neo 10 mg and vasopressin 0.4 units through piv's and transferred to the icu at . she spiked a temp to 102.5. she was given a dose of zosyn. her finger stick was found to 58; she was given 1 amp of d50. a left femoral central line was placed by the surgical service under sterile conditions. a right fem line was attempted. she received ~ 3 liters of normal saline. . she was transferred emergently by to for ercp and further management of presumed sepsis secondary to cholangitis. she was intubated for airway protection prior to the flight. cxr reported as ett in good position, lung fields clear. abg prior to intubation: 7.35/35/55. . currently she is intubated and sedated. her son is present to answer questions. he reports a gradual decline in her function and a 20 lb wt loss over the last month. she has had increasing confusion, intermittent ruq pain and bowel/bladder incontinence. of note, she presented to an osh in with ruq pain; at that time she was noted to have elevated lft's; u/s revealed fattly liver. her lft's subsequently resolved. past medical history: - niddm - htn - hypercholestreolemia - s/p cholecystectomy yrs ago - oa - osteoporosis - s/p gastric bypass for obesity ~30 yrs ago by dr. - b12 deficiency anemia - s/p total hysterectomy - h/o abnormal lft's with abd u/s sig for fatty liver in ; lft's subsequently improved social history: lives alone, however, son dispenses meds and does shopping, home health aide to assist with bathing and laundry 2x/wk, and meals on wheels daily. has life line. son, , involved in her care (h, c, w). pt does not leave her house often. she has a h/o poor hygiene and leaving food out around the house. denies tob, etoh, or illicit drug use. widowed since . husband was a urologist. family history: mother died at age 86 of colon cancer. father died in his 70's secondary to complications from dm. she has 2 healthy children. physical exam: on admission: tm 102.5 tc 97.8 bp 105/51 hr 58 rr 16 sat 97% i/o (from ) 3585/1490 vent: ac vt 650/rr set 10, breathing at 16/peep 5/50% fio2 neo and vasopressin turned off upon arrival; started levophed 0.075 mcg/min gen: intubated, sedated hennt: icteric, pupils ~2 mm minimally reactive to light cv: rrr, nl s1s2, no m/r/g lungs: ctab abd: soft, nt/nd, +bs, no hsm ext: warm, no edema, strong dp/pt pulses bilaterally skin: no rash, jaundiced, mulitple excoriations over upper and lower extremeties pertinent results: 04:10am blood wbc-43.8* rbc-3.87* hgb-11.3* hct-33.9* mcv-88 mch-29.3 mchc-33.5 rdw-14.5 plt ct-208 06:10am blood wbc-14.3* rbc-3.75* hgb-10.8* hct-33.3* mcv-89 mch-28.6 mchc-32.3 rdw-15.5 plt ct-293 04:10am blood neuts-97.2* lymphs-1.4* monos-1.3* eos-0 baso-0.1 05:50am blood neuts-78.9* lymphs-11.4* monos-3.5 eos-6.0* baso-0.2 04:10am blood pt-16.1* ptt-32.2 inr(pt)-1.5* 04:10am blood plt ct-208 06:10am blood plt ct-293 10:50am blood pt-11.7 ptt-24.7 inr(pt)-1.0 04:10am blood fibrino-626* d-dimer-6412* 05:20am blood fdp-10-40 04:10am blood glucose-246* urean-44* creat-2.2* na-130* k-3.3 cl-101 hco3-17* angap-15 09:30am blood glucose-325* urean-18 creat-0.8 na-135 k-4.4 cl-106 hco3-18* angap-15 01:31pm blood ck(cpk)-396* 04:00am blood alt-47* ast-87* alkphos-417* amylase-93 totbili-2.8* 05:20am blood alt-35 ast-54* ld(ldh)-179 alkphos-399* amylase-110* totbili-2.7* 08:10am blood alt-28 ast-34 ld(ldh)-188 alkphos-439* amylase-103* totbili-3.4* 07:45am blood alt-26 ast-31 alkphos-477* amylase-117* totbili-2.7* 05:55am blood alt-30 ast-32 alkphos-526* amylase-134* totbili-2.4* 05:40am blood alt-50* ast-45* alkphos-586* amylase-128* totbili-2.2* 10:50am blood alt-76* ast-60* alkphos-498* amylase-82 totbili-2.3* 05:50am blood alt-59* ast-37 alkphos-386* amylase-77 totbili-1.6* 06:10am blood alt-51* ast-34 alkphos-440* totbili-1.5 09:30am blood amylase-75 04:10am blood lipase-490* 09:30am blood lipase-101* 04:10am blood ck-mb-4 ctropnt-<0.01 01:31pm blood ck-mb-4 ctropnt-<0.01 05:50am blood lipase-72* 10:50am blood lipase-85* 04:10am blood albumin-2.6* calcium-7.2* phos-3.7 mg-2.0 09:30am blood calcium-9.0 phos-2.4* mg-1.6 04:10am blood hapto-234* 01:31pm blood hapto-246* 01:31pm blood cortsol-88.5* 02:06pm blood cortsol-99.8* 02:48pm blood cortsol-112.8* 06:29am blood type- temp-36.6 rates- tidal v-650 peep-5 fio2-50 po2-42* pco2-36 ph-7.31* calhco3-19* base xs--7 -assist/con intubat-intubated 12:37pm blood glucose-49* lactate-0.9 na-143 k-3.2* cl-113* calhco3-20* 12:37pm blood freeca-1.17 ================== studies: ercp ercp: a single spot fluoroscopic image was obtained without a radiologist present demonstrating surgical clips and suture material in the left upper quadrant. a nasogastric tube is noted within the stomach. there is contrast within the transverse colon from prior study. by report, cannulation of the bile duct was not possible . ptc impression: percutaneous transhepatic cholangiography demonstrates dilated intra- and extra-hepatic bile ducts with findings of a large calculus in the distal common bile duct. a 10-french internal-external biliary drainage catheter was placed via the right-sided bile ducts and has been left to straight bag drainage. further definitive management of the biliary obstruction will be performed once the cholangitis has settled with biliary drainage and antibiotic treatment. . cxr findings: compared with the study at 3:33 a.m. the same day, the ett has been withdrawn slightly and now projects approximately 2 cm above the carina. the lungs appear somewhat clearer than previously, probably due to the lack of respiratory motion artifact on the current study. . cxr impression: 1) tip of an endotracheal tube located 1 cm above the level of the carina. the tube should be retracted approximately 3 cm for optimal positioning. 2) tortuous appearance of the thoracic aorta which could be better evaluated with a pa and lateral chest radiograph. . cxr impression: slight worsening of left lower lobe consolidation. no pneumothorax. . mra impression: no evidence of high-grade stenosis or occlusion in the arteries of anterior or posterior circulation . ct head impression: chronic watershed infarction in the right frontal lobe. no significant associated mass effect. no evidence of acute intracranial hemorrhage. . biliary stone removal impression: 1. pullback cholangiogram demonstrated obstruction at the distal common bile which could be a long area of fibrous stricture or the possibility of a small tumor of the pancreatic head. 2. balloon dilatation of the obstructed common bile duct with 8 mm cutting balloon and 10 mm regular balloons. 3. 10-french external-internal biliary drainage catheter was placed with the pigtail locked in the small bowel loop. the catheter was connected with an external drainage bag. . ct abdomen impression: 1. no evidence of a pancreatic mass. 2. status post percutaneous biliary drainage with a catheter extending into the duodenum. no intrahepatic biliary ductal dilatation. 3. obliteration of the portal vein in segments ii and an adjacent portion of segment iv with increased arterial perfusion of the affected segments. 4. borderline enlarged periportal lymph nodes, which may be reactive. 5. left adrenal gland fullness. 6. small bilateral pleural effusions with bibasilar atelectasis. . ultrasound ruq with doppler impression: no demonstrable flow in left portal vein consistent with thrombus. . brief hospital course: ms is a 78 yo f with dm, htn, s/p cholecystectomy who was transferred by from intubated/sedated for ercp and further management of sepsis secondary to cholangitis. she was treated with levophed for hypotension, and fluid resuscitated. she was also continued on zosyn, with the plan to complete a full course of antibiotics for cholangitis. the following morning she had an attempted ercp which could not be completed secondary to her prior bariatric surgery. therefore she underwent a ptc, with successful placement of an internal/external drain. a large stone was thought to be seen in the cbd which was later determined to be a stricture. the pt quickly stabilized, was weaned off pressors, and extubated without complication over the next 2 days. after extubated and removal of sedation she was quite confused, and was noted to have some asymmetry at her mouth. it was unclear if this was new. an mri was ordered, and it showed chronic right frontal watershed infarct and moderate changes of small vessel disease and brain atrophy. there was no evidence of mass effect or midline shift and no evidence of acute or chronic hemorrhage. the pt's mental status gradually came back to baseline and her facial asymmetry resolved. prior to her discharge from the icu, peripheral lines were placed, and the central femoral line placed under sterile conditions at the outside hospital was removed. during her time in the icu her cultures from also grew pan-sensitive e coli. she was continued on zosyn and her bile cultures grew gram negative rods, enterococcus and viridans streptococci. she was maintained on iv zosyn and was transitioned to oral levofloxacin to complete a 10 day course (to end ). the pt's blood cultures were negative. the pt underwent an interventional radiology guided dilatation of cbd stenosis also had a percutaneous drain placed in the common bile duct (as mentioned above). the drain will stay in place for 4-6 weeks at which point pt will be reevaluated by a cholangoigram (scheduled already) to determine timing for removal of drainage by interventional radiology. the pt was noted to have portal vein thrombosis for which she will need work-up by her primary care physician. . sepsis: the pt was noted to have leukocytosis and fever (on admission) secondary to acute cholangitis. she was treated with iv zosyn and transitioned to po levofloxacin to complete a 10 day course (to end ). her blood cultures (2 sets) were negative. the pt remained afebrile and her percutaneous drain (mentioned above) in the bile duct continued to drain about 1.5 liters daily. the bile drain was plugged prior to the pt's discharge and will need to stay plugged until the pt's appointment with interventional radiology on ; at that time pt will be reevaluated to see if restenosis has occurred. in the event of restenosis, the pt will need another stricture dilatation. the interventional radiology team (dr. or dr. ) at should be notified if the pt has recurrence of abdominal pain, worsening levels of liver enzymes (especially total bilirubin), rising white cell count or fever. the ir team can be reached at phone# . . gi: the pt was noted to have acute cholangitis in the setting of cbd stenosis. the gi team was unable to perform a successful ercp due to a previous gastric bypass procedure. the pt underwent a 10-french internal-external biliary drainage catheter placement for drainage for dilated bile ducts. she underwent a ct abdomen that showed no pancreatic mass or tumor. . left portal vein thrombus: the pt underwent a ct abdomen which showed portal vein obliteration in segment ii and an adjacent portion of segment iv, with associated increased arterial perfusion of these segments. a duplex ultrasound confirmed left portal vein thrombosis. these findings were discussed with the pt's pcp, . , and it was decided that he will initiate an out-patient workup for the thrombosis. . neuro: the pt was noted (in icu) to have facial asymmetry. however, the chronicity of this asymmetry was unknown. the pt's head mri was significant for no acute strokes, however it did indicate a chronic right frontal watershed infarct, moderate changes of small vessel disease and brain atrophy and no evidence of high-grade stenosis or occlusion in the arteries of anterior or posterior circulation. . cv: the pt has a history of hypertension and hypercholesterolemia but no known cad. her ecg on admission showed no acute evidence of ischemia and her cardiac enzymes ruled out an acute mi. pt was maintained on captopril during the hospitalization and was transitioned back to her home regimen of lisinopril on discharge. . anemia: the pt was noted to have a hematocrit drop from 40 to 33 with ivf hydration in the icu. her baseline hematocrit is unknown. the pt was noted to have no evidence of bleeding and her hematocrit remained stable in the low 30s. the pt will likely benefit from an out-patient workup of her anemia and will likely need to be scheduled for a colonoscopy by her pcp. . renal: (baseline unknown). the pt was noted to have acute renal failure on admission (cr 2.2) which resolved with hydration and treatment of acute cholangitis. the pt sustained minor foley trauma when she accidentally pulled out her foley (with bulb inflated) while trying to get back into bed from chair. the foley was replaced and continued to drain normally. the foley should eventually removed prior to discharge from rehab. . endocrine: the pt has a history of diabetes for which she was maintained on a regular insulin sliding scale. . fen: the pt was maintained on a low fat diet and her electrolytes were repleted as needed. . prophylaxis: the pt was maintained on prophylaxis with sc heparin and proton pump inhibitor. . code: full . communication: son, , is power of attorney (h, c, w) medications on admission: home meds (confirmed with son): - 20 daily - lisinopril 40 daily - glyburide 40 daily - fosamax 70 weekly - hctz 25 daily - b12 1000 mcg daily - ca supplements - centrum silver - tylenol prn - asa prn . transfer meds: - ancef x3 doses (start date ) - zosyn x1 dose - ativan prn for sedation - neosynephrine gtt - vasopressin gtt discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed: not to exceed 3 grams daily. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 4. multivitamin capsule sig: one (1) cap po daily (daily). 5. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for wheezing. 6. glyburide 5 mg tablet sig: eight (8) tablet po once a day: home dose: 40mg daily of glyburide. 7. warfarin 5 mg tablet sig: 0.5 tablet po daily (daily). 8. outpatient work pt to have inr checked every 2 days and coumadin uptitrated until therapeutic inr (2 to 3) reached. 9. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 10 doses: start date: end date: . 10. lisinopril 40 mg tablet sig: one (1) tablet po once a day: hold for sbp<100. 11. aspirin ec 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 12. calcium 600 + d 600-125 mg-unit tablet sig: one (1) tablet po tid with meals: do not give at the same time as levofloxacin!. 13. vitamin b-12 1,000 mcg tablet sig: one (1) tablet po once a day. 14. 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: nursing & rehabilitation center - discharge diagnosis: primary: acute cholangitis with placement of (temporary) percutaneous drain left portal vein thrombosis . secondary: - niddm - htn - hypercholestreolemia - s/p cholecystectomy yrs ago - oa - osteoporosis - s/p gastric bypass for obesity ~30 yrs ago by dr. - b12 deficiency anemia - s/p total hysterectomy - h/o abnormal lft's with abd u/s sig for fatty liver in ; lft's subsequently improved discharge condition: stable discharge instructions: please report to the nearest emergency department if you have fever, worsening abdominal pain, nausea, vomiting, diarrhea, lightheadedness, loss of consciousness and increased itching. . there has been a change in your medications. . your will need to follow-up with the appointments arranged for your. your tube draining the bile will need to stay in place for 4-6 weeks at which point you will need to be re-evaluated to see if the tube can come out. . you were noted to have a clot in one of your liver veins. your pcp will do further workup of this clotting. . you were noted to have anemia for which you will need to ask your pcp to schedule you for a colonoscopy as an out-patient. . you have been started on a 10 day course of levofloxacin (to end ) for your bile infection. if you have fever, chills or abdominal pain you should call # and ask to speak with any of the interventional radiologists. followup instructions: ***rehab will need to arrange for patient to be transported to her appointment in a bls ambulance **** . provider: . . date/time: at 3:00pm location: , , . phone: fax: . . you have been scheduled for a cholangiogram. date/time: at 7:00am. location: report to daycare on building . call the physician's assistant with any questions. phone: . md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours transfusion of other serum other percutaneous procedures on biliary tract other percutaneous procedures on biliary tract other percutaneous procedures on biliary tract percutaneous hepatic cholangiogram percutaneous hepatic cholangiogram endoscopic retrograde cholangiopancreatography [ercp] diagnoses: unspecified essential hypertension intestinal bypass or anastomosis status diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis other persistent mental disorders due to conditions classified elsewhere acute respiratory failure personal history of other diseases of circulatory system septic shock other vitamin b12 deficiency anemia unspecified accident streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] injury to bladder and urethra, without mention of open wound into cavity cholangitis disorders of magnesium metabolism volume depletion, unspecified unspecified disease of pancreas portal vein thrombosis neoplasm of unspecified nature of digestive system 

Answer: The patient is high likely exposed to