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: abdominal pain major surgical or invasive procedure: ercp history of present illness: ms. is a 65 yo female who presented to a on with five days of generalized weakness with associated ruq pain, fevers, chills, nausea, vomiting, dyspnea and was found to have hypotension, leukocytosis and choledocholithiasis on ultrasound consistent with ascending cholangitis. she was transfered to for ercp. on presentation at the osh her platelet count was 22k at outside. she received two six packs of plateletes prior to ercp that showed stone and sludge in the cbd. no sphincterotomy was performed secondary to thrombocytopenia and her risk of bleeding. they were unable to retreive the stone and therefore a stent was placed. past medical history: crohn's disease htn vitamin b12 deficiency social history: born in . lives in . single. no children. enjoys mystery. 75 pyh. no etoh. denies hiv risk factors, ivdu. family history: 8 siblings. physical exam: vitals: t:97.6 bp: 103/42 hr: 88 rr: 15 o2sat: 100% ra gen: well-appearing, well-nourished, no acute distress heent: eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, mmm, op clear neck: no jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: rrr, no m/g/r, normal s1 s2, radial pulses +2 pulm: lungs ctab, no w/r/r abd: soft, nt, nd, +bs, no hsm, no masses ext: no c/c/e, no palpable cords neuro: alert, oriented to person, place, and time. cn ii ?????? xii grossly intact. moves all 4 extremities. strength 5/5 in upper and lower extremities. patellar dtr +1. plantar reflex downgoing. no gait disturbance. no cerebellar dysfunction. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: 02:54pm blood wbc-14.4*# rbc-2.97* hgb-9.9* hct-27.8* mcv-93 mch-33.2* mchc-35.6* rdw-13.6 plt ct-31* 06:15am blood wbc-8.7 rbc-2.89* hgb-9.3* hct-27.4* mcv-95 mch-32.3* mchc-34.0 rdw-14.1 plt ct-49*# 06:15am blood glucose-92 urean-62* creat-1.6* na-145 k-4.0 cl-111* hco3-21* angap-17 08:56pm blood alt-187* ast-67* ld(ldh)-253* alkphos-342* totbili-13.6* 06:15am blood alt-44* ast-28 alkphos-131* amylase-179* totbili-3.6* 08:56pm blood lipase-195* 01:36am blood lipase-1239* 06:15am blood lipase-408* 06:15am blood calcium-8.4 phos-4.0 mg-1.9 . liver or gallbladder us (single organ) 8:42 pm impression: choledocholithiasis with intra and extrahepatic ductal dilatation. further evaluation with ercp is recommended. . ercp biliary&pancreas by gi unit 4:42 pm 11 fluoroscopic images were acquired. the common bile duct was cannulated. there is moderate diffuse dilatation of the common bile duct. filling defects noted within the lower third of cbd corresponded to the stone and sludge on ercp note. based on the ercp notes full cholangiogram was not performed due to cholangitis suspicion. biliary stent is noted within the cbd. dilated cystic duct with stones was also visualized. impression: dilated cbd and cystic duct with multiple filling defects which based on the ercp note were consistent with sludge and stones. . chest (portable ap) 4:31 am findings: persistent mild cardiomegaly is again noted. unilateral opacification of the right hemithorax is again seen, not significantly changed. the left lung is clear. no pleural effusion is detected. feeding tube has been removed while a right internal jugular line persists terminating in the proximal svc. impression:stable pneumonia or aspiration in the right lung. . 05:12am blood wbc-6.5 rbc-2.41* hgb-7.6* hct-22.9* mcv-95 mch-31.6 mchc-33.3 rdw-14.3 plt ct-178 05:12am blood glucose-88 urean-16 creat-1.0 na-139 k-3.5 cl-109* hco3-25 angap-9 05:12am blood calcium-8.1* phos-3.7 mg-1.6 brief hospital course: this is a 65 yo female transferred from osh with fever, jaundice, ruq pain with hypotension on transport, mental status changes. given 8l ivf, levophed transiently, zosyn before arrival. cholangitis: septic shock requiring levophed and ivf bolus. she was admitted to the icu and continued on zosyn. she went urgently for ercp ercp: pus in the major papilla. biliary dilation with stones in the bile duct were found. given suspicion for cholangitis, full cholangiogram was not obtained. a biliary stent was inserted. dilated cystic duct with stones. otherwise normal ercp to third part of the duodenum. no sphincterotomy performed. extubated post ercp then required reintubation for respiratory distress secondary to high volume given pre-procedure. fluid volume overload: she received lasix for volume overload on hd 4 with good effect. she received several doses of lasix over the next few days for diuresis. she was able to extubate on hd 5 and was transferred out to the floor in stable condition. she did well once on the floor and was discharged in good condition and will complete a 14 day course of antibiotics. fen: he was started on sips on hd 6. her diet was advanced slowly over the next few days and she was tolerating a regular diet and reported +flatus. hemeatology: a consult was called for thrombocytopenia. her platelet count was 22k at outside. she received two six packs of plateletes prior to ercp. no sphincterotomy was performed secondary to thrombocytopenia and her risk of bleeding. they were unable to retrieve the stone and therefore a stent was placed. holding heparin. ms. reports a four year history of easy bruising which has worsened more recently. she denies epistaxis, gum bleeding, dark black tarry stools or melana. she denied headache. she denies hiv risk factors, recent viral illness or a history of thrombocytopenia. per her outpatient pcp her platelet count was 195 in , 187 in and 145 in . she has a history of macrocytosis 102 with a low to normal b12 count, elevated mma and homocystine, but her hgb as an outpatient was stable around 14.4 blood count wbc hgb hct mcv plt ct 6.7 8.7 25.2 94 28 8.8 9.5 26.9 93 24 16.2 10.3 30.4 95 27 16.0 10.2 28.4 93 24 19.1 10.3 28.9 93 29 14.4 9.9 27.8 93 31 9.0 11.3 31.4 92 47 12.4* 12.7 35.2 91 24 most likely etiology of her thrombocytopenia is transient marrow suppression from septic shock. she may have an underlying myelodysplastic syndrome which compromises her marrow reserve, but that would be difficult to sort out at this time. it is unlikely that this is being caused by an underlying viral process (hcv). hiv is within the differential, but the patient has no risk factors. mesalamin (pentasa) is associated with thrombocytopenia in very rare instances (<1%). there is no evidence to support ttp or heparin induced thrombocytopenia (hit). we believe that this will resolve as her underlying infection improves. we would not transfuse her unless her platelets are less than 10k or 50k if she requires an invasive procedure. additionally, we recommend checking hcv and hiv ab in a few days if her counts do not recover. finally, she should follow up as an outpatient with her internist for a repeat cbc to ensure that her counts are normal at baseline. medications on admission: lisinopril, pentasa discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 2. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 3. mesalamine 250 mg capsule, sustained release sig: four (4) capsule, sustained release po qid (4 times a day). 4. ciprofloxacin 500 mg tablet sig: 1.5 tablets po q12h (every 12 hours) for 5 days. disp:*15 tablet(s)* refills:*0* 5. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 5 days. disp:*15 tablet(s)* refills:*0* 6. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: cholangitis fever jaundice ruq pain hypotension thrombocytopenia discharge condition: good discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. * signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. . * please resume all regular home medications and take any new meds as ordered. * do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * continue to increase activity daily * no heavy lifting (> lbs) for 6 weeks. followup instructions: please follow-up with dr. for an ercp in weeks. call ( with questions. please follow-up with dr. in 3 weeks. call to schedule an appointment. please follow-up with your pcp regarding your blood sugars and thrombocytopenia. call to schedule. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization endoscopic insertion of stent (tube) into bile duct transfusion of platelets diagnoses: acidosis thrombocytopenia, unspecified anemia, unspecified unspecified essential hypertension unspecified septicemia severe sepsis other b-complex deficiencies septic shock dehydration cholangitis other respiratory abnormalities calculus of bile duct without mention of cholecystitis, with obstruction 

Answer: The patient is high likely exposed to