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: duodenal perforation after ercp. major surgical or invasive procedure: - ercp complicated by duodenal perforation - external biliary drain placement by interventional radiology history of present illness: 84f w/ possible duodenal perforation during ercp today. pt w/ complicated medical history including a-fib requiring coumadin, hypertension and chf initially presented to hospital ed three days ago w/ fatigue, diarrhea & hypotension. noted to be guiac positive with hct down to 14 from her baseline 36. her inr was supratherapeutic at 16. anticoagulation was reversed w/ vit k, she had a central line placed and was admitted to the icu where she received several units of prbcs and ffp. after stabilization of her bleeding and blood pressure, she underwent ct abdomen which demonstrated a mass in the head of her pancreas. she was seen by dr. of heme-onc at that time. she was sent to for ercp and possible stent placement. during the procedure a 2cm perforation was noted in the duodenum. the procedure was terminated without sphincterotomy, an ngt was placed, and surgery urgently consulted. past medical history: pmh: - atrial fibrillation, on coumadin - chf - htn - depression - hard of hearing . psh: - appendectomy - cholecystectomy physical exam: physical exam on admission: 97.9 110af 115/80 18 100%ra somnolent, somewhat confused (a&o to self) icteric skin, scleral icertus no cervical, supraclavicular or axial lymphadenopathy irreg irreg cta bilat abd w/ well healed midline surgical scar. soft. nontender throughout. no guarding. no tympanny. no shake tenderness. lower extremities edematous w/ brawny skin changes . physical exam on discharge: all vital signs stable irreg irreg, no m/r/g cta bilaterally abd soft, non-tender, mildly distended, +bs all 4 quadrants, ruq biliary drain in place with bilious output pertinent results: 04:26pm blood wbc-6.9 rbc-3.67* hgb-11.8* hct-34.1* mcv-93 mch-32.0 mchc-34.5 rdw-18.1* plt ct-193 01:07am blood wbc-7.1 rbc-3.32* hgb-10.6* hct-31.0* mcv-93 mch-32.0 mchc-34.4 rdw-17.7* plt ct-219 04:26pm blood neuts-86.1* lymphs-7.1* monos-5.5 eos-0.9 baso-0.4 04:26pm blood pt-14.0* ptt-32.2 inr(pt)-1.3* 01:07am blood glucose-64* urean-15 creat-0.5 na-136 k-4.1 cl-100 hco3-25 angap-15 04:26pm blood alt-62* ast-91* alkphos-480* totbili-10.1* dirbili-6.3* indbili-3.8 01:39am blood alt-56* ast-65* alkphos-465* totbili-12.1* 02:04am blood alt-39 ast-42* ld(ldh)-145 alkphos-374* totbili-6.8* 01:07am blood alt-27 ast-22 ld(ldh)-160 alkphos-286* totbili-4.9* 02:25pm blood type-art temp-37 tidal v-600 fio2-50 po2-261* pco2-35 ph-7.51* caltco2-29 base xs-5 intubat-intubated vent-controlled comment-ett 03:55pm blood glucose-73 lactate-1.3 na-133 k-3.4 cl-101 . ct a/p with po/iv contrast: 1. significant amount of retroperitoneal free air with discontinuity of the wall of the 2nd part of the duodenum. the tip of the ng tube lies adjacent to this area of discontinuation. findings are consistent with duodenal perforation. 2. moderate amount of intra-abdominal ascites. 3. small bilateral pleural effusions. 4. 4.8 cm pancreatic head mass consistent with neoplasm. 5. enhancing liver lesion suspicious for metastasis. 6. intra- and extra-hepatic biliary duct dilation due to pancreatic neoplasm. . external biliary drain placement: 1. obstruction of the distal common bile duct on the basis of extrinsic compression by extraluminal mass. obstruction was unable to be crossed by the guidewire. 2. moderate diffuse intrahepatic biliary ductal dilatation. 3. incidental demonstration of pneumoretroperitoneum. 4. successful placement of 8.0 french external biliary drainage catheter into the common bile duct via the right anterior intrahepatic segmental duct. . ct a/p with po and iv contrast: impression: 1. persistent extensive retroperitoneal free air predominantly within the right hemiabdomen; however, with interval decrease to prior. no extraluminal oral contrast or retroperitoneal collection here. 2. similar anasarca, ascites and third spacing. 3. interval increase in bilateral non-hemorrhagic pleural effusions with bibasilar atelectasis at the lung bases. 4. known large pancreatic head mass consistent with neoplasm. 5. similar enhancing liver lesion concerning for metastasis. 6. no intrahepatic biliary duct dilation; status post external biliary drainage catheter into the common bile duct. 7. similar prominent retroperitoneal lymph nodes. brief hospital course: post her ercp for pancreatic head mass the patient was transferred to the tsicu with ngt in place given concern for duodenal perforation. she was initially emperically begun on unasyn/fluconazole, subsequently narrowed to unasyn alone. she was kept npo with ivf and the ngt in place, with hr control with iv lopressor and digoxin. ct a/p with ngt and iv contrast demonstrated massive pneumoperitoneum/rp free air consistent with duodenal perforation. her abdomen remained soft during this time with very mild epigastric discomfort, and she did not display septic signs. she underwent external biliary drain (in common bile duct) placement by ir on . the drain was not able to be internalized at that time secondary to peri-ampullary swelling. she returned to ir on for attempt at internalization of her biliary drain. however, shortly after anesthesia induction/intubation, pt's bp decreased along w/ rvr, treated accordingly by anesthesia. they noted possible inferior st wave depressions despite normalization of bp after hr control. the decision to abort the procedure was made and patient was reversed and extubated. formal cardiac rule-out back in tsicu was negative by clinical exam, ekg and cardiac enzymes. the family decided not to pursue attempt to internalize drain the next day. instead, they requested repeat ct scan, which showed no active extravasation of contrast from the duodenum. her diet was advanced, and on the day of discharge, hd8, she was tolerating a regular diet. cdiff returned positive and she was begun on iv flagyl (in addition to her iv unasyn). on discharge external biliary catheter was in place, and the family was instructed to follow up with dr. . future discussion regarding internalization of the drain may be undertaken at that time. her home coumadin was restarted (2.5 mg) on hd8, , and she should have her inr checked on at rehab. she was discharged to rehab on , hd8, tolerating a regular diet with external biliary drain in place, to complete a course of augmentin given her duodenal perforation, and po flagyl given her cdiff + stool. in addition to follow-up with dr. , follow up appointment was also arranged with dr. (hematology-oncology) of hospital on discharge (who had seen her while at after her pancreatic mass head was seen on imaging), and discharge summary was sent to dr. office. medications on admission: - metoprolol 100mg - lisinopril 5mg - amlodipine 5mg daily - digoxin 0.125mg daily - coumadin 2.5mg daily - lasix 80mg every other day - kcl 20meq po daily - sertraline 100mg daily discharge medications: 1. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 2. sertraline 50 mg tablet sig: two (2) tablet po daily (daily). 3. lisinopril 5 mg tablet sig: one (1) tablet po bid (2 times a day). 4. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). 5. warfarin 2.5 mg tablet sig: one (1) tablet po once a day. 6. furosemide 80 mg tablet sig: one (1) tablet po every other day (every other day). 7. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 8. augmentin 500-125 mg tablet sig: one (1) tablet po twice a day for 6 days. disp:*12 tablet(s)* refills:*0* 9. flagyl 500 mg tablet sig: one (1) tablet po twice a day for 14 days. disp:*28 tablet(s)* refills:*0* discharge disposition: extended care facility: nursing home - discharge diagnosis: ercp complicated by duodenal perforation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted for an ercp procedure to evaluate a mass at the head of your pancreas. the procedure was complicated by a perforation of your duodenum, and you were started on iv antibiotics and underwent a bile-duct drain placement by the interventional radiologists. the drain was not able to be internalized because you did not tolerate the anesthesia for this procedure, and your family elected to hold off on having it internalized for now. you are being discharged with an external drain in place, which visiting nurses will help you empty and care for. you are being discharged on oral antibiotics which you should continue to take (both for your duodenal perforation and for a colon infection called "c diff" which you developed while in the hospital). please return to the ed or call dr. office if you experience fevers/chills/nausea/vomiting, have uncontrollable abdominal pain, notice a change in color in your drain output, or if the drain becomes dislodged. if you would like to have the drain internalized in the future you will need to schedule an appointment through dr. office to have this done (re-attempted) by interventional radiology. followup instructions: please follow up with dr. at hospital of hematology-oncology to discuss the best next steps going forward for your pancreatic mass (possibly chemotherapy). his office number is . an appointment has been scheduled for you on at 1:30pm (level b, hospital) . you are scheduled to follow up with dr. of hepatobiliary surgery on monday at 3:15 pm. the office is located in the of the at (, , ). please call the office at if you need to reschedule this appointment. procedure: other endoscopy of small intestine other percutaneous procedures on biliary tract percutaneous hepatic cholangiogram diagnoses: malignant neoplasm of liver, secondary congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia atrial fibrillation depressive disorder, not elsewhere classified accidental puncture or laceration during a procedure, not elsewhere classified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypotension, unspecified malignant neoplasm of head of pancreas intestinal infection due to clostridium difficile other acquired absence of organ unspecified hearing loss long-term (current) use of anticoagulants obstruction of bile duct chronic diastolic heart failure oliguria and anuria 

Answer: The patient is high likely exposed to