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: fever major surgical or invasive procedure: none history of present illness: 79m with metastatic cholangiocarcinoma s/p metal biliary stent placement , who presents with fever x 1 day following repeat ercp. pt is a very poor historian, so most of the history is obtained through chart review and ed providers. the patient stated that he had the ercp done, returned home, felt really fatigued and unable to walk ( leg pain and weakness). his wife called 911 and he was taken to ed. denied any chest pain, abd pain, nausea, vomiting. +fevers to 104 at home, + chills. no headaches. no loc, no h/o syncope. . patient had second, outpatient ercp by dr. the day prior to admission due to increasing pruritis and a ct at that suggesting tumor ingrowth into the stent. he was pretreated with ampicillin 2gm iv, and gentamicin 80mg iv. ercp demonstrated a malignant-appearing biliary stricture affecting the hilumand right and left ducts. there was debris visible with in the stent at early cholangiogram. occulsion cholangiograqm revealed extensive stricturing of both left and right intrahepatic ducts. although a small left intrahepatic radical opacified, it was not possible to advance the balloon catheter in this direction. for this reason, no stent could be introduced. balloon sweeps were performed from just above the stent and down through the stent, and a moderate amount of debris was removed. even after multiple sweeps, there was some filling defect left in the upperprotion of the stent, consistent with a degree of tumor ingrowth. sticture not amenable to ercp, and suggested ptca as next intervention if futher obstructive symptoms occur. he was not discharged on any anti-biotic ppx. . today pt presents with fever to 103.8, no pain. no nausea/no vomiting. c/o fatigue, with reported fevers at home of 103.8--pt took tylenol. in ed, hemodynamically stable. clinically appears well. wcc is 20. pt was pancultured and started on levo and flagyl per ercp fellow who review pt in am for consideration of ir guided drainage if abscess present. ct in er was equivocal regards to this. pt was therefore admitted for iv rehydration, iv abx and possible ir procedure. apparently had an episode of unresponsiveness in the ed + incontinence. stat head ct ordered--negative. dr. requested a neuro consult on the floor. . in the ed, initial vs were t98.8; hr 63; bp 107/57; rr 16, o2 sat 96%. no nausea/vomting reported. no abdominal pain. blood cx sent. ivf given, levo, flagyl given as well. pt was schdeduled to go to the regular floor but at 2305; pt was found to be unresponsive, diaphoretic and incontinent of stool. t 102.0(r); hr 57; bp 104/45; rr 21 o2 sat 97%2l. bs 246 at the time. per nsg report, got up to go to the bathroom, felt off, ? syncopal event; got back into bed, was found by nurse to be unresponsive and was incontinent of stool. pt woke up after sternal rub, alert and oriented x 3. ct scan was ordered in the ed--negative. of note, but had a recent 40-50lbs weight loss over last year. . upon arrival to the , the patient's complaint was fatigue and leg pain. vital signs were stable. no abdominal pain, no nausea, no vomiting. past medical history: 1) metastatic cholangiocarcinoma, diagnosed , s/p metal stent placement. 2) glucose intolerance 3) cad, s/p old inferior mi, s/p cath demonstrating 60% lcx lesion, no intervention . ef 45%. 4) pvd 5) hyperlipidemia 6) s/p pacemaker placement for bradycardia 4 yrs ago-- sigma 300 sdr. placed for sx bradycardia. programmed ddd with max rate 80. psh: 7) intussusception repair as a child 8) herniorraphy social history: the patient has been married for 47 years, has four children and 11 grandchildren. he does not smoke though he did in the remote past having quit 20 years ago. family history: father died of heart disease at age 88. mother had disease, and apparently died of complications of that in her late 60's. two of the patient's children are physicians. . physical exam: pe: temp: 99.5; hr 100; bp 106/63; rr 17; o2 sat 98%ra heent: very dry mucus membranes. no thyromegaly. no scleral icterus appreciated. cv: regular s1 and s2. no murmurs, rubs or gallops appreciated. lung: ctab. no wheezes, rales, rhonchi abd: scar from previous surgery. +bs. soft, non-tender, non-distended, no organomegaly appreciated. no ruq tenderness ext: wwp, good palpable pulses. neur: a and o x 3. responds to questions appropriately, but at times tangential and a poor historian skin: no rashes pertinent results: 10:00am wbc-8.4 rbc-4.43* hgb-13.6* hct-41.6 mcv-94 mch-30.7 mchc-32.7 rdw-14.2 10:00am neuts-78.9* lymphs-13.8* monos-5.1 eos-0.8 basos-1.3 10:00am plt count-224 10:00am pt-15.2* inr(pt)-1.4* 10:00am albumin-3.8 10:00am alt(sgpt)-99* ast(sgot)-101* alk phos-516* tot bili-1.8* dir bili-0.4* indir bil-1.4 10:00am urea n-18 creat-1.1 sodium-138 potassium-6.0* chloride-102 total co2-25 anion gap-17 11:00am urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 11:00am urine rbc-2 wbc-0 bacteria-none yeast-none epi-0 troponin 0.04->0.02 ck-mb 7->3 . aerobic bottle (final ): reported by phone to 11am. enterobacter cloacae. final sensitivities. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. trimethoprim/sulfa sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s imipenem-------------- <=1 s meropenem-------------<=0.25 s piperacillin---------- <=4 s tobramycin------------ <=1 s anaerobic bottle (final ): enterobacter cloacae. identification and sensitivities performed from aerobic bottle. . surveillance blood cx from and : no growth to date . ekg: sinus rhythm with atrial sensing and ventricular pacing. no previous tracing available for comparison. . ct of the abdomen with iv contrast: there are mild dependent changes at the lung bases. a biliary stent is noted in the common duct. moderate intrahepatic biliary ductal dilatation is noted. near the porta hepatis and adjacent to the proximal end of the biliary stent is an approximately 5.7 x 3.7-cm area of hypodensity of the hepatic parenchyma with ill-defined borders. multiple smaller satellite low-attenuation hepatic foci with similar ill- defined appearance are noted. there is associated moderate intrahepatic biliary ductal dilatation. there is no defined fluid collection and no subcapsular or perihepatic fluid. there is no ascites or intraperitoneal focal fluid collection or abscess. the pancreas, spleen, adrenal glands, stomach and bowel are unremarkable. at the upper pole of the right kidney is a 3.1-cm exophytic lesion which measures 28 hounsfield units, higher than expected for a simple cyst. smaller bilateral parapelvic cysts are noted. there are bilateral extrarenal pelves. there is no pathologic mesenteric or retroperitoneal lymphadenopathy. ct of the pelvis with iv contrast: the rectum, urinary bladder and pelvic loops of bowel are unremarkable. the prostate is mildly enlarged. there is no free pelvic fluid or lymphadenopathy. bone windows: no suspicious osteoblastic or osteolytic lesions are identified. impression: 1. 5.7 x 3.7 cm region of low attenuation of the hepatic parenchyma near the porta hepatis with ill-defined borders and multiple smaller satellite hypodense foci. these findings are thought more likely to represent primary cholangiocarcinoma with intrahepatic metastases. the possibility of superinfection cannot be definitively excluded. evaluation with ultrasound could be helpful to determine if there is a fluid component. if so, this could be aspirated for diagnostic purposes. 2. bilateral parapelvic renal cysts. 3. 3.1-cm exophytic lesion of the right kidney measures greater density than expected for a simple cyst. ultrasound is suggested to determine if this is a cyst or possibly a solid lesion. . ruq ultrasound: findings: there is mild edema within the gallbladder wall which may be seen with liver disease. the gallbladder is relaxed and no pericholecystic fluid is identified to suggest cholecystitis. as noted on prior ct, there is intrahepatic biliary ductal dilatation. upper pole cyst is identified on the right kidney measuring 3.1 cm x 3 cm x 2.1 cm. no fluid collections around the liver or gallbladder are identified. impression: 1. no fluid collections identified in or around the liver or gallbladder. 2. intrahepatic biliary ductal dilatation also noted on ct one day previous. 3. edema within the gallbladder wall which may be seen with liver disease. no evidence of acute cholecystitis identified. . ap cxr: heart size top normal. lungs clear. no edema or pleural effusion. fullness in the mediastinum at the thoracic inlet to the right of midline could be due to goiter or tortuous head and neck vessels. transvenous right atrial and right ventricular pacer leads in standard placements. no pneumothorax or pleural effusion. . head ct w/o contrast: findings: no definite evidence of acute intracranial hemorrhage. there is no shift of normally midline structures or hydrocephalus. -white matter differentiation appears grossly preserved. several areas of relative is seen within vessels, including the mcas and vertebrals, possibly secondary to recent contrast administration. visualized paranasal sinuses appear normally aerated. impression: no evidence of acute intracranial hemorrhage. mri with diffusion-weighted images is more sensitive in the evaluation for acute ischemia/infarct and for vascular detail. brief hospital course: 1) gram negative septicemia due to cholangitis: bacteremia may have been secondary to manipulation during ercp. ruq ultrasound showed no evidence of cholecystitis. culture grew enterobacter. patient received ampicillin and gentamicin while in house and was discharged on po cipro. surveillance blood cultures remain negative. plan for total of 14 days of antibiotics. patient is hemodynamically stable. lfts are steadily improving. percutaneous biliary drain was discussed but was not necessary given bili trending down with the cleaning of the stent done on initial ercp. . 2) cholangiocarcinoma/locally metastatic, growing into the stent, obstructing bile ducts: patient is currently under hospice care. . 3) syncope: pacer was interrogated. episode of ? vt noted but did not temporally correlate with patient's episode. more likely this was due to transient hypotension in the setting of his sepsis. however, could certainly consider aicd once bacteremia completely treated given concurrent low ef (ef 20-30%). however, patient is in hospice and likely would refuse. this was not discussed during his inhospital course. neuro exam was normal and head ct was negative. orthostatics were negative. no significant arrhythmias on tele other than a transient tachycardia ep believes was possibly afib/flutter, ventricularly paced. . 4) renal cyst: incidental finding on ct. consider follow-up ultrasound to better characterize, as recommended, if patient agreeable. . 5) h/o cad: patient is on an aspirin and a beta blocker. he denied any chest pain. his statin was held due to bump in lfts. could consider restarting at follow-up but likely little benefit given overall prognosis and patient will continue to be at risk of recurrent transaminitis. . 6) h/o colitis: patient was continued on his home asacol, anaspaz . 7) arf: resolved with ivf. likely prerenal. please resume diovan at follow-up visit if creatinine and blood pressure remain stable. . 8) coagulopathy: resolved with vitamin k. inr 1.9 on admit, now 1.4. . 9) dispo: discharged home with prior hospice services . 10) code status: dnr/dni medications on admission: meds from records--need to confirm with wife in am asacol 400mg--2 tabs three times a day per dr aspirin 81mg--one tablet twice a day diovan 80mg--one tablet by mouth every day hyoscyamine sulfate 0.375mg--one tablet twice a day metoprolol tartrate 25mg--one tablet twice a day pravachol 20mg--one tablet at bedtime timolol 0.25%--one gtt twice a day discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 2. mesalamine 400 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po tid (3 times a day). 3. hyoscyamine sulfate 0.125 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual qid (4 times a day). disp:*120 tablet, sublingual(s)* refills:*0* 4. ciprofloxacin 750 mg tablet sig: one (1) tablet po twice a day for 11 days. disp:*22 tablet(s)* refills:*0* discharge disposition: home with service facility: old hospice discharge diagnosis: primary: enterobacter septicemia due to cholangitis secondary: cholangiocarcinoma syncope discharge condition: good: hemodynamically stable, afebrile, lfts improved discharge instructions: please call your doctor or go to the emergency room for temperature > 100.5, worsening abdominal pain or fullness, or other concerning symptoms. please take the antibiotics, as prescribed, until they are gone. please note you have been started on a new blood pressure medication, which also helps with controlling the rate of your heart. please take, as prescribed. followup instructions: please follow-up with your primary care doctor, dr. , on monday, at 4:30 pm to follow-up this hospital admission. phone: you can call to schedule follow-up with dr. , only as needed. phone: ( procedure: endoscopic retrograde cholangiopancreatography [ercp] diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension acute kidney failure, unspecified peripheral vascular disease, unspecified personal history of tobacco use unspecified glaucoma sepsis other and unspecified hyperlipidemia old myocardial infarction cardiac pacemaker in situ other septicemia due to gram-negative organisms accidents occurring in residential institution urinary complications, not elsewhere classified cholangitis other and unspecified coagulation defects secondary malignant neoplasm of other digestive organs and spleen long-term (current) use of aspirin other drugs and medicinal substances causing adverse effects in therapeutic use malignant neoplasm of intrahepatic bile ducts cystic kidney disease, unspecified 

Answer: The patient is high likely exposed to