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 after ercp major surgical or invasive procedure: ercp picc placement & removal history of present illness: 81 yo man with pmhx cad s/p cabg and recent nstemi last week, htn, chf ef 35% transferred from hospital directly to ercp for ? septic cholangitis then transferred to icu for hypotension after ercp. at hospital, patient had nstemi and was treated medically because of his age, comorbidities including acute on chronic renal failure. he was in their icu for a brief time on heparin gtt, nitro gtt and lasix gtt for diuresis. of note, one of the reports states that he had hematemesis after heparin gtt so it was discontinued. he was started on asa and plavix which have been held because of ercp. his lfts were elevated and there was concern for cholangitis so he was started on gentamycin and unasyn in . in the pacu, initial vs were t 98.1, hr 106, bp was 80/30s on 1 mcg neo. patient had cholangiogram, sphincterotomy and stent placement. he received 100 cc fluid, no blood loss. pt was under general anesthesia. he was extubated in the pacu and complained of sob and epigastric tightness similar to previous mi he had last week. his blood pressure was initially 80/30s on 1 mcg neo. ekg showed lbbb with left anterior fasicular block at rate 105. ekg unchanged from ekg at hosp on . abg was obtained and showed 7.41 pco2 33 po2 66 hco3 22. patient had a lot of secretions that were suctioned. cxr was obtained and showed enlarged heart, pulm vasc engorged, minimal perihilar haziness, mild edema. no focal consolidations. patient denied dizziness, ld, cp, palp, nausea, abd pain, vomiting. initially his breathing was labored and he complained of sob but this improved with some suctioning. patient's blood pressure continued to drop and neo was increased and patient was given 500 cc bolus of lr. on transfer to the icu, patient was mentating well. had no specific complaints. right ij placed. cvo2 was 68 and cvp 12. pt denied cp, sob, abd pain, nausea, vomiting. on transfer to the floor patient was comfortable without complaint. past medical history: cad s/p cabg chf with ef 35% ckd with creatinine baseline high 2s htn macular degeneration cholangitis social history: pt lives at home with his wife . is a retired driver for gm. smoked most of his life and quit in . no etoh or drug use. family history: nc physical exam: discharge physical exam vs t 98.4 p 66-69 bp 120-125/66-70 r 20 o2 sat 96%@ra gen- elderly male in no acute distress heent- cn iii-xii grossly intact cv: s1 & s2 regular without murmur pulm: clear to ausculation bilaterally abd: non-tender, non distended, bowel sounds present ext: no edema, 1+ dp pertinent results: labs osh : . wbc 29.7 hct 32.3 plt 428 . ck 31 mbi 1.9 trop i 0.44 . 135 99 67 -------------< 98 3.3 22 4.11 . bili 8.0, ast 184, alt 215, alb 2.2, ap 1145 . labs today at : 134 95 77 -----------< 108 3.6 20 5.0 estgfr: (click for details) ck: 217 mb: pnd trop-t: pnd ca: 8.0 mg: 2.4 p: 4.0 alt: 237 ap: 1180 tbili: 7.4 alb: 2.9 ast: 227 ldh: 326 dbili: tprot: : 143 lip: 65 . wbc 46.1 hgb 10.5 hct 32.6 plt 470 . abg: ph 7.41 pco2 33 po2 66 hco3 22 discharge labs: 05:00am blood wbc-13.4* rbc-3.65* hgb-10.0* hct-31.4* mcv-86 mch-27.5 mchc-31.9 rdw-15.4 plt ct-452* 05:00am blood pt-14.0* ptt-30.1 inr(pt)-1.2* 05:00am blood glucose-104 urean-62* creat-3.3* na-137 k-4.2 cl-106 hco3-18* angap-17 05:00am blood alt-78* ast-57* ld(ldh)-295* alkphos-541* amylase-341* totbili-2.3* brief hospital course: 81 year old man with cad status post cabg (), recent nstemi at outside hospital, hypertension, and chronic kidney disease admitted for management of cholangitis. admitted to icu due to hypotension following procedure, suspected biliary sepsis. # hypotension/biliary sepsis: in pacu received 500 cc lr and neo gtt. patient persistently hypotensive. transferred to unit. cvl placed. cvp 12-17 so spoke against volume depletion and patient did not lose any blood during procedure per anesthesia. hematocrit stable and no evidnece of active bleeding. possibilities for hypotension included sepsis given white count 46, fever, biliary source. cxr without consolidation. cardiogenic shock also suspected given recent nstemi and known chf with ef 35%. no evidence of tamponade on ekg and patient does not have muffled heart sounds or elevated jvd. tte showed reduced lvef 20-25%, no evidence of tamponade. pressors (neo) discontinued on . improved with treatment for biliary sepsis (vanc and zosyn). blood, sputum cultures with no growth. cycled cardiac enzymes to peak. # hypoxia, resolved: likely due to mucous plugging at presentation as patient had secretions per anesthesia. also likely component of volume overload seen on cxr and pt has known chf. improved with supplemental oxygen, prn nebs. no further intervention necessary. # cholangitis/sepsis: s/p ercp. wbc, lfts still elevated but coming down. on admission, biliary sepsis covered with zosyn; also started vancomycin initially empirically. in icu, has been afebrile and without abdominal discomfort. taking pos well. on , is day 5 on zosyn. vancomycin discontinued. picc was placed for continuing iv therapy, however management was changed to oral metronidazole & ciprofloxacin for 1 week (2 week total antibiotics course). per gi, needs repeat ercp in months, follow up with dr. in 6 weeks. # cad/nstemi: patient with recent nstemi and hypotension. ekg unchanged but difficult to interpret in setting of lbbb which is old. tte results as above. heparin ggt discontinued. beta-blocker restarted after hypotension resolved. continued aspirin and clopidigrel. statin held pending lft resolution. # chronic systolic heart failure: patient with history of ef 35%. tte here showed lvef 20-25%. beta-blocker restarted. given poor renal function, did not start ace inhibitor given acute renal failure. patient discharged on hydralazine & isosorbide dinitrate for afterload reduction. # htn: restarted beta-blocker on as above. # acute renal failure/chronic kidney disease stage iii: creatinine resolving thoughout admission. etiology was likely pre-renal as the administration of oral and iv fluids improved bun & creatinine. # bph: hytrin initially held given hypotension. restarted and foley discontinued on . # macular degeneration: patient not started on any therapy during this admission. medications on admission: atorvastatin 20 mg daily norvasc 5 mg hytrin 2 mg qhs lopressor 50 mg lasix 20 mg qd pletal 50 mg qd asa 81 mg qd discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. terazosin 1 mg capsule sig: two (2) capsule po hs (at bedtime). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 5. metoprolol tartrate 25 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. metronidazole 500 mg tablet sig: one (1) tablet po bid (2 times a day) for 7 days. disp:*14 tablet(s)* refills:*0* 7. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. disp:*7 tablet(s)* refills:*0* 8. cilostazol 50 mg tablet sig: one (1) tablet po once a day. 9. amlodipine 5 mg tablet sig: one (1) tablet po once a day. 10. hydralazine 10 mg tablet sig: one (1) tablet po every eight (8) hours. disp:*90 tablet(s)* refills:*2* 11. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* discharge disposition: home with service facility: area vna discharge diagnosis: primary diagnoses 1) cholangitis 2) nstemi 3) acute renal failure secondary diagnoses 1) coronary artery disease 2) hypertension 3) congestive heart failure 4) chronic kidney disease 5) macular degeneration discharge condition: stable discharge instructions: you have been admitted for cholangitis or an infection of the gall bladder and because of a heart attack. while you were here you had a stent placed in your gallbladder to help clear the infection. it must be removed in approximately 6 weeks. please take all medications as instructed including two antibiotics: metronidazole & ciprofloxacin for 1 week as prescribed. we have added clopidogrel 75mg daily and atorvastatin has been increased to 80mg daily. please call your doctor or the er at 911 for any chest pain, abdominal pain, shortness of breath or any other medical concern. followup instructions: please follow up with dr. on thursday at 2:30pm. please follow up with dr. for a repeat look at your gall bladder in 6 weeks. he can be reached for scheduling at . procedure: venous catheterization, not elsewhere classified endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified septic shock chronic systolic heart failure cholangitis subendocardial infarction, subsequent episode of care calculus of bile duct without mention of cholecystitis, without mention of obstruction septicemia due to gram-negative organism, unspecified 

Answer: The patient is high likely exposed to