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: ampicillin attending: chief complaint: abdominal pain major surgical or invasive procedure: ercp history of present illness: this is an 80 yo f with a history of svt, as s/p avr who presents with 4 weeks of general malaise and 2 weeks of intermittent ruq/epigastric pain, worse with eating. she also notes intermittent shaking chills since friday. she kept putting off having an evaluation because she hoped it would go away or be indigestion. today, she finally called 911 when the pain and chills became more severe today and she noticed her urine had become dark several days prior. she presented to an osh where a ruq u/s showed a dilated cbd to 1.3cm with 2 1cm obstructing stones but no evidence of cholecystitis. initial temp there was 102. she received iv cipro/flagyl and was transferred to ed for ercp eval for ? of cholangitis. . in the ed, initial vitals wer 98.2, 93, 119/63, 14, 97% 2l. she received 2mg iv morphine and 1g iv vancomycin. she was admitted to the for monitoring and ercp in am. . ros: the patient denies any weight change, nausea, vomiting, diarrhea, constipation, melena, hematochezia, chest pain, shortness of breath, orthopnea, pnd, lower extremity oedema, cough, urinary frequency, urgency, dysuria, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash or skin changes. past medical history: aortic stenosis s/p avr w/ st. porcine, hepatitis c psvt varicose veins s/p stripping macular degeneration osteoporosis s/p tonsillectomy s/p total abdominal hysterectomy s/p umbilical hernia repair and abdominoplasty s/p spinal fusion and laminectomy s/p bilateral cataract surgery social history: retired lab tech. denies tobacco use. also denies etoh use in 20 yrs. family history: brother died of chf at age 75. physical exam: vitals: t: 97.2 bp: 116/56 hr: 81 rr:14 o2sat:100% 2l gen: well-appearing, well-nourished, no acute distress heent: eomi, perrl, sclera icteric, 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, nd, +bs, no hsm, no masses, tender in ruq, + 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: ========= labs ========= 03:20am blood wbc-4.7 rbc-3.45* hgb-10.8* hct-31.7* mcv-92 mch-31.5 mchc-34.2 rdw-16.9* plt ct-266 05:43pm blood wbc-8.4# rbc-4.04*# hgb-12.4# hct-35.7* mcv-88# mch-30.6 mchc-34.7 rdw-16.6* plt ct-329# 03:20am blood neuts-71.9* lymphs-17.2* monos-8.4 eos-2.2 baso-0.2 05:43pm blood neuts-81.0* lymphs-12.5* monos-5.9 eos-0.4 baso-0.2 03:20am blood pt-14.1* ptt-30.4 inr(pt)-1.2* 05:43pm blood pt-14.4* ptt-27.2 inr(pt)-1.3* 03:20am blood glucose-83 urean-8 creat-0.4 na-140 k-3.5 cl-110* hco3-19* angap-15 05:43pm blood glucose-91 urean-10 creat-0.5 na-135 k-3.4 cl-103 hco3-21* angap-14 03:20am blood alt-38 ast-75* ld(ldh)-179 alkphos-288* totbili-11.1* dirbili-9.5* indbili-1.6 05:43pm blood alt-52* ast-92* alkphos-370* totbili-12.7* dirbili-10.8* indbili-1.9 03:20am blood albumin-2.4* calcium-7.1* phos-2.2* mg-2.2 05:43pm blood albumin-3.1* calcium-8.0* phos-2.5* mg-2.1 05:45pm blood glucose-85 lactate-1.1 na-135 k-3.4* cl-102 05:45pm blood hgb-12.9 calchct-39 ========== gi ========== ercp - "impression: choledocho-duodenal fistula with pus discharging from the fistula. otherwise normal major papilla. normal pancreatic duct . the common bile duct, common hepatic duct, right and left hepatic ducts, biliary radicles and cystic duct were filled with contrast and well visualized. the common bile duct was dilated to 14mm with multiple stones noted within the distal common bile duct up to 12mm. successful biliary sphincterotomy extended to the choledochoduodenal fistula performed in the 12 o'clock position using a sphincterotome over an existing guidewire. successful extraction of stone fragments and sludge using a 15 mm balloon. successful extraction of stone fragments using a spiral basket. successful placement of a 5cm by 10fr double pig tail biliary stent into the left intrahepatic system because of pus draining from the common bile duct and possible retained stone fragments. free flow of bile noted after stent placement. recommendations: return to . no aspirin/plavix/anticoagulants for 72 hrs. juices today when awake, alert and at baseline remain on antibiotics for a total of 7 days return in 8 weeks for plastic stent removal and re-evaluation for any remaining stone fragments. " 07:05am blood wbc-6.9 rbc-3.87* hgb-11.9* hct-36.3 mcv-94 mch-30.7 mchc-32.8 rdw-17.1* plt ct-449* 06:05am blood wbc-6.5 rbc-3.46* hgb-11.0* hct-32.5* mcv-94 mch-31.7 mchc-33.7 rdw-16.7* plt ct-313 03:20am blood wbc-4.7 rbc-3.45* hgb-10.8* hct-31.7* mcv-92 mch-31.5 mchc-34.2 rdw-16.9* plt ct-266 07:05am blood glucose-82 urean-8 creat-0.6 na-137 k-4.0 cl-106 hco3-26 angap-9 06:05am blood glucose-75 urean-8 creat-0.6 na-137 k-4.7 cl-106 hco3-25 angap-11 05:43pm blood alt-52* ast-92* alkphos-370* totbili-12.7* dirbili-10.8* indbili-1.9 03:20am blood alt-38 ast-75* ld(ldh)-179 alkphos-288* totbili-11.1* dirbili-9.5* indbili-1.6 06:05am blood alt-38 ast-70* ld(ldh)-182 alkphos-285* totbili-10.9* 07:05am blood alt-44* ast-95* alkphos-298* amylase-21 totbili-6.5* dirbili-4.5* indbili-2.0 brief hospital course: patient is an 80 yo female with history of as s/p avr who presents with biliary obstruction complicated by cholangitis, now s/p successful stone extraction and biliary decompression with ercp. . #. cholangitis, bacterial: secondary to biliary obstruction from stones. patient hemodynamically stable, now decompressed. blood cx from hospital neg todate. blood cx here neg so far too. - afebrile, nl wbc, and clinically improved after abx and ercp. - lfts were downtrending at dc - continue cipro/flagyl for a total 10 day course, additional 7days at dc - pt told to resume aspirin on friday - pt's diet was advanced and tolerated it well. day of discharge, pt complained of "gas pain" in lower abdomen, not severe, not significant on exam - lipase/amylase were checked to eval for post-ercp pancreatitis. pt ate meal and tolerated it well. this may be related to antibiotics but pt was able to keep them down and only had a few more days of abx left, so decision was made to continue them. pt was told that if she noticed worsening abdominal pain, diarrhea, fever, she should talk to her pcp or go to local ed -pt will be called for repeat ercp -pt was seen by surgery inpt and they recommended that she fu in clinic for elective cholecystectomy in near future . . #. aortic stenosis s/p porcine avr - patient currently euvolemic, not anti-coagulated as an outpatient - she was on toprol xl as outpt, initially held, then metoprolol was restarted. pt told to resume toprol xl at discharge . #. hepatitis c, chronic - no active issues - outpatient follow up . #. fen - regular diet. #. dispo - pt was ambulating well and discharged home w home pt eval (given hx of foot drop/brace not available in hospital) . medications on admission: aspirin 81 mg once daily, toprol xl 100 mg once daily calcium citrate with vitamin d - 600mg daily vitamin e once daily vitamin c 1000mg daily multivitamin dailyy vitamin b6 100mg daily zinc 50mg daily magnesium oxide 50mg daily every fourth sunday ocuvite lutein daily ibuprofen as needed discharge medications: 1. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days. disp:*14 tablet(s)* refills:*0* 2. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 7 days. disp:*21 tablet(s)* refills:*0* 3. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day: please start this on friday. do not take aspirin or any blood thinners until then. 5. 150 mg tablet sig: one (1) tablet po once a month. 6. calcium citrate + d 315-200 mg-unit tablet sig: one (1) tablet po twice a day. 7. ocuvite lutein capsule sig: one (1) capsule po once a day. 8. magnesium oxide 500 mg tablet sig: one (1) tablet po once a day. 9. vitamin b-6 100 mg tablet sig: one (1) tablet po once a day. 10. zinc 50 mg tablet sig: one (1) tablet po once a day. 11. multivitamin tablet sig: one (1) tablet po once a day. 12. vitamin e 400 unit tablet sig: one (1) tablet po once a day. 13. vitamin c 1,000 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: vna of central & discharge diagnosis: cholangitis obstructed gallstones discharge condition: good discharge instructions: you were admitted to the hospital with fevers and jaundice caused by multiple gallstones causing obstruction of bile. you were placed on antibiotics and an ercp was done which showed many stones in your bile duct, most have been removed and a repeat ercp needs to take place in a few weeks. you were also seen by surgery in the hospital and they want you to call the clinic to set up an appointment as soon as possible. please return to ed for fevers, chills, severe abdominal pain, bleeding followup instructions: 1. dr. , ph: , , thurs, 1:30pm 2. gen surgery, dr. ph: , please call clinic to schedule an appt within next week. 3. ercp scheduling, ph: . you should be getting a call about scheduling ercp.please call this number if you do not hear from them by next week. procedure: endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct diagnoses: chronic hepatitis c without mention of hepatic coma heart valve replaced by other means osteoporosis, unspecified macular degeneration (senile), unspecified cholangitis paroxysmal supraventricular tachycardia arthrodesis status calculus of bile duct without mention of cholecystitis, with obstruction fistula of bile duct 

Answer: The patient is high likely exposed to