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: ciprofloxacin / codeine attending: chief complaint: epigastric / luq pain with localized peritonitis and arf (cr 5.9), hypotension major surgical or invasive procedure: percutaneous cholecystostomy tube history of present illness: 71 year old woman, h/o multiple abdominal surgeries for peptic ulcer disease with recurrent stenosis, gastrectomy in for pud (s/p multiple revisions), cad s/p cabg x 5, chf with ef=25%, who presented to with sudden onset of abdominal and back pain associated with hypotension. pt states that she woke up 2 nights prior, went to bathroom, and fell (wasn't using her walker); does not know if she syncopized. denies loss of bowel or bladder function; denies prodromal cp/sob/seizure/palpitations. was not confused afterwards and denies trauma to head. the next day she felt fine, but the following morning, she woke up with severe, sharp, lower abdominal pain (, constant, rlq/rmq) with pain in her mid back. denies nausea/vomiting/diarrhea. states her legs felt weak but denied any loss of bowel/bladder function. states she also felt dizzy but denies lightheadedness or syncope. also reports some sob/wheezing. denies any change in weight (b/l wt about 134 lb) or increase in le edema. no new rashes. states that for a few weeks, she has been taking qid celebrex (1 tab) plus ibuprofen (2 tabs) as per her pcp for joint pain. denies any new medications. she reports decrement in uo starting today. . she presented to the ed with this abdominal pain, leg weakness. vs were initially stable (97.4 84/38 73 18 98% ra) with some low sbp. bedside us was negative for aaa, and non-contrast abdominal ct did not show significant abnormalities (?gallstones, diverticulitis of sigmoid). labs were notable for creatinine of 5.8 (new), potassium of 7.6 (treated with hco3, insulin, d50, kayexalate). she was also noted to have a non-anion gap acidosis with a hco3 of 8. wbc was 10.5 with 8% bands, and she was given 1 dose of imipenem. her mental status remained within normal limits, and she was started on dopamine and levophed for hypotension (sbps 70-80s). abg showed severe acidosis -- 7.01/32/63. she was transferred to for further management. past medical history: 1. pud s/p gastrectomy in , with numerous revisions, converted to roux en y. most recent revision at in . has had several balloon dilations 2. ?crohn's disease 3. cabg x 5 in (?) 4. htn 5. copd 6. mdd 7. oa 8. chf, ef=25% (most recent tte in , cardiologist in -dr. 9. eczema physical exam: vs: 95.9 120/59 83 21 96% 2l nc gen: pleasant female, lying in bed, nad heent: perrl, op with dry mm, no jvd neck: no bruits, no jvd lungs: scattered crackles, no w/r cv: 3/6 sem llsb but heard throughout, no r/g abd: soft, multiple surgical scars, with ttp rmq/rlq, some voluntary guarding, no rebound; soft abdominal bruit extr: no c/c/e, dp 2+ bilat; rectal was guaiac neg as per osh neuro: moving all 4 extremities, cn ii-xii intact pertinent results: renal u.s. 9:41 pm impression: no hydronephrosis. normal arterial waveform is seen within both kidneys. cholelithiasis without evidence of cholecystitis. . ct abdomen w/o contrast 5:53 am impression: 1. incompletely visualized right-sided pneumothorax. this was discussed with dr. immediately upon completion of the study. 2. stone seen in distal common duct, with intrahepatic biliary dilatation. distended gallbladder with mutiple gallstones. discussed with dr. . 3. status post esophagojejunostomy, mild wall thickening of efferent limb. 4. no evidence of contrast extravasation from the bowel. no free air seen within the abdomen. 5. small amount of perihepatic ascites. 6. nonobstructing right renal stone. 7. small bilateral pleural effusions. . gb drainage,intro perc tranhep bil us 4:49 pm impression: technically difficult, but successful ultrasound-guided percutaneous cholecystostomy . chest (portable ap) 3:11 am history: multiple abdominal surgeries, pain, and hypotension. right pneumothorax. impression: ap chest compared to and 11: right apical pleural catheter unchanged in position. no appreciable pneumothorax or right pleural effusion. left lung grossly clear. heart size normal. nasogastric tube passes below the diaphragm and out of view. right jugular line tip projects over the superior cavoatrial junction. . chest (portable ap) 3:23 pm reason: s/p removal of pigtail catheter. eval for resolution of ptx impression: no evidence of pneumothorax on this semi-upright film. . 05:31am blood wbc-7.2 rbc-3.21* hgb-9.6* hct-28.4* mcv-89 mch-29.9 mchc-33.8 rdw-15.3 plt ct-297 05:31am blood glucose-82 urean-25* creat-1.7* na-142 k-4.2 cl-111* hco3-22 angap-13 05:31am blood alt-24 ast-32 alkphos-199* totbili-0.3 08:54pm blood lipase-137* 05:31am blood calcium-7.4* phos-4.2 mg-1.7 02:00am blood caltibc-146* ferritn-195* trf-112* 11:54am blood pth-664* 01:53pm blood freeca-0.90* brief hospital course: a/p: 71 yo female, h/o multiple abdominal surgeries, cad s/p cabg, chf, p/w abdominal and back pain, hypotension, transferred for further management. . 1. renal failure and hyperkalemia: new renal failure (last cr here in was wnl). she has been taking large doses of nsaids as an , ain is a possibility. in addition, if she has been hypotensive at home, atn is a possibility as well. currently oliguric (had 100 cc uo at osh when foley placed). no other new medications or exposures. be prerenal/dehydrated if has systemic infection. labs, bun, cr, and lytes were monitored daily. her meds were renally doseed. her k was treated appropriate (hold home k supplements). she received 1 l hco3. her acidosis and hyperkalemia likely in setting of this arf; may need hd if can't manage these metabolic derangements. initial cr 5.8, k 8.1. oliguric. k better with hco3 (was acidemic on admit). bun/cr peaked at 80/7.1, now coming down with increased uop. resp status good. also hypoca on admit, suspect vit d defic and sepsis. repleting with iv cagluc, po ca, calcitriol. . 2. non-gap acidosis: no diarrhea; ?renal failure or rta. very low serum bicarbonate (may be consistent with distal rta). most likely in setting of renal failure . 3. abdominal pain: surgery was consulted for the pain. an us showed cholelithiasis without evidence of cholecystitis. stone in distal cbd, with intrahepatic biliary dilatation. distended gb w/ mult gallstones. on , she went to ir: perc. gb drainage. the bile grew out gpr and gnr. she was started on zosyn amd then switched to augmentin when cultures grew out enterococcus. she will go home with the cholecystostomy tube in place and return in a couple weeks for a laparoscopic cholecystectomy. . 4. hypotension: ?setting of infection /sepsis. has received 2 l at osh. on dopa/levophed. ef=25%. she received 1l with hco3 (hyperchloremic acidosis). she was on pressors and theses were weaned (dopa first). on she was hypotensive to 80/60 with ambulation. she was encouraged to maintain hydration, especially in the presence of diarrhea. she received a 1l fluid bolus for hypovolemia. she then received 1 unit of prbc on for symptomatic anemia and hypotension. her pre-transfusion hct was 26.9, and post-hct was 28.4. she ambulated with pt and was assymptomatic. . 5. cad: hold bb, spironolactone, nitrate for now; can continue asa, ekg without acute changes (some peaked t-waves). asa for now . 6. resp: she had a small right pneumothorax on cxr and ct. ip placed a pigtail drain and had adequate drainage. the drain was clamped and subsequently pulled. a repeat cxr showed no pneumothorax. copd: advair, albuterol nebs as needed . 7. fen: npo for now, ivf as above. she had a ngt placed for nausea and ileus. the ngt was removed on and she was started on a regular diet. she tolerated a diet. . 8. stool: she reported loose stool on hd . stool was sent for c.diff and was negative. . 9. hypernatremia: on hd6 pt was noted to be nypernatremic, likely secondary to her post-atn diuresis. she was treated with d5w, and her sodium was w/in normal limits by hd8. . 10. +uti: a urine culture was + for yeast and she was started on fluconazole on medications on admission: celexa 40mg, aldactone 25mg, isosorbital 30mg, asa 81mg, remeron 30mg, lipitor 20mg, amitryptillline 25mg, hydroxyzine 25 mg qhs, klonopin 5 mg tid, folic acid 1 mg qd, risperdal 0.5 mg , advair , vitamin e, celebrex 200 mg qd, k-dur 20 meq qd, florastor 250 mg , fe gluconate 325 mg , tylenol trazodone 50 mg qhs, coreg 6.25 mg , 60 mg , wellbutrin 200 mg discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. calcium carbonate 500 mg tablet, chewable sig: four (4) tablet, chewable po qid (4 times a day). disp:*480 tablet, chewable(s)* refills:*2* 3. calcitriol 0.25 mcg capsule sig: two (2) capsule po daily (daily). disp:*60 capsule(s)* refills:*2* 4. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for 2 weeks. disp:*25 tablet(s)* refills:*0* 5. ampicillin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 2 days. disp:*8 capsule(s)* refills:*0* 6. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 1 days. disp:*1 tablet(s)* refills:*0* 7. ferrous gluconate 300 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) as needed. disp:*60 capsule(s)* refills:*2* 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: vna of -east & visiting nurse hospice discharge diagnosis: choledocholithiasis, cholangitis sepsis acute renal failure +uti hypocalcemia vit d deficiency hypotension anemia discharge condition: good discharge instructions: * increasing pain * fever (>101.5 f) * persistent vomiting * inability to pass gas or stool * increasing shortness of breath * chest pain . please resume all of your regular medications and take any new meds as ordered. . continue to ambulate several times per day. followup instructions: please follow-up with dr. in weeks. call ( to schedule an appointment. provider: . phone: date/time: 1:00 this is a renal follow-up. re-check a pth at this appointment. call ( with questions. procedure: percutaneous aspiration of gallbladder diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis candidiasis of other urogenital sites chronic airway obstruction, not elsewhere classified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status hyperosmolality and/or hypernatremia cholangitis calculus of bile duct without mention of cholecystitis, without mention of obstruction 

Answer: The patient is high likely exposed to