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: sulfonamides attending: chief complaint: abdominal pain. major surgical or invasive procedure: ercp history of present illness: this is an 89 year-old female with multiple medical problems including metastatic breast cancer and history of gallstones and diverticulitis, now with ruq abdominal pain x 2-3 days, getting progressively worse. pain was described as dull and generalized. patient also with decreased po intake over that time. patient and daughter deny fevers/chills, nausea/vomiting; no other systemic symptoms. last bowel movement in the ed; denies diarrhea, melena, hematochezia. patient also complains of dysuria and urinary frequency over ths time frame. . in the ed, vs 96.1 78 106/70 16 100%ra. patient given levofloxacin 500 mg iv, flagyl 500 mg iv. . admitted to icu for progressively worsening abd pain and anorexia. ros negative for fevers/chills, n/v/d, no melena or brbpr. +dysuria and frequency. patient initially given levofloxacin 500 mg iv, flagyl 500 mg iv. patient admitted to 3, continued to have abdominal pain, ruq u/s c/w cholecystitis however no lft abnormalities on admission. plan was to get a hida scan to better evaluate gallbladder. on , patient noted to be more sedated, difficult to arouse, only responding to painful stimuli. given narcan since was getting morphine for pain, however no response. head ct was ordered which showed a possibly thrombus however cta was negative. patient then spiked a temp to 101.4 and vanco added. sbp dropped to 80's, started peripheral fluid boluses. patient evaluated by both surgery and gi, taken for ercp which showed gallstones and sludge. of note, micro growing e coli and coag neg staph in blood. . upon arrival to the icu vs: 112/ 67 14 92-100% fm. patient sedated, extubated, eyes open but does not follow commands. past medical history: 1. metastatic breast cancer, left breast, status post lumpectomy, now on faslodex; no chemotherapy or radiation per patient's wishes 2. vascular dementia 3. endoscopic removal of gallstones 4. copd with frequent pneumonias 5. rbbb, history of wenkebach, 2:1 av block 6. history of diverticulitis 7. chronic constipation 8. arthritis 9. brain aneurysm 10. status post compression fracture of spine 11. history of bleeding gastric ulcer 12. thyroid irradiation , not on thyroid replacement 13. pacemaker placement ( prodigy 7865u pacer placement) 14. orif, right hip, 15. orif, left hip, 16. right rotator cuff repair in 's social history: she lives in a nursing home. she does not walk and is wheelchair bound. she quit smoking 17 years ago, having been a prior one pack per day for approximately 50 years. no alcohol use. family history: non-contributory. physical exam: vs: 100.9 88 136/70 20 gen: elderly women lying in bed, breathing comfortably, in no acute distress. heent: perrl, eomi, mm dry. neck: no bruits. heart: distant heart sounds. rrr. lungs: ctab. abd: diffusely tender. nabs. soft, nondistended. negative sign. no hsm. no rebound, guarding. no cvat. ext: no c/c/e. neuro: alert, oriented x 0. strength 5/5 bue/le. pertinent results: labwork on admission: 01:18pm wbc-6.1 rbc-4.51 hgb-12.4 hct-36.3 mcv-81* mch-27.5 mchc-34.1 rdw-14.0 01:18pm plt smr-normal plt count-192 01:18pm neuts-86.8* bands-0 lymphs-7.7* monos-4.2 eos-0.8 basos-0.6 01:18pm alt(sgpt)-22 ast(sgot)-58* alk phos-161* amylase-76 tot bili-0.6 01:18pm lipase-24 01:44pm urine color-yellow appear-hazy sp -1.018 01:44pm urine blood-neg nitrite-pos protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-8* ph-7.0 leuk-neg 01:44pm urine rbc-0 wbc-* bacteria-many yeast-none epi-0 . blood culture: aerobic bottle (final ): reported by phone to 1120. escherichia coli. final sensitivities. trimethoprim/sulfa sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i imipenem-------------- <=1 s levofloxacin---------- =>8 r meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ 4 s anaerobic bottle (final ): escherichia coli. identification and sensitivities performed from aerobic bottle. escherichia coli. second morphology. trimethoprim/sulfa sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i imipenem-------------- <=1 s levofloxacin---------- =>8 r meropenem-------------<=0.25 s piperacillin---------- 64 i piperacillin/tazo----- <=4 s tobramycin------------ 8 i . urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. trimethoprim/sulfa sensitivity testing confirmed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 8 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin---------- =>8 r meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . blood cultures 10/17, : no growth to date . liver or gallbladder us impression: 1. distended gallbladder containing gallstones with gallbladder wall edema. 2. borderline/dilated common duct at the porta hepatis, for a patient of this age. sludge and possibly small stones are seen within the common duct. the caliber of the common duct appears minimally increased from , when the duct measured 7 mm, though sludge within the duct is new from this time. 3. pneumobilia in the left lobe of the liver, possibly related to prior ercp. 4. intrahepatic biliary ductal dilatation within the right lobe. in the appropriate clinical setting, the findings would raise concern for cholecystitis/cholangitis. however, it is noted that patient does not have an elevated white blood cell count or profound lft abnormalities. edema of the gallbladder wall could be related to third spacing of fluid, particularly given the pleural effusion. the findings merit further evaluation, both clinically and/or with ercp/mrcp. . cxr : no free air. . ekg : ventricularly paced rhythm at 68. appropiate discordance. . ct head w/o contrast : findings: there is no evidence of hemorrhage, mass effect, shift of normally midline structures, or hydrocephalus. the density values of the brain show periventricular white matter hypodensity consistent with chronic microvascular ischemic changes. the -white matter differentiation is preserved. there is prominence of the sulci and ventricles consistent with age-related involutional change. the basilar artery is slightly dense and more prominent than typically seen. the surrounding osseous and soft tissue structures are unremarkable. the visualized paranasal sinuses are well aerated. impression: no evidence of hemorrhage. possible dense basilar artery, which may represent basilar artery thrombosis. an mri/mra is recommended for further evaluation of this patient's mental status changes. note added at attending review: there is sclerosis of the margins of the left sphenoid sinus with a small air fluid level. there are some high density contents within this fluid. these findings are consistent with chronic sphenoid sinusitis with inspissated secretions. . ct scan of the brain with ct angiography findings: the noncontrast head ct scan shows no new intracranial hemorrhage, mass effect, or shift of normally midline structures. there is redemonstration of biparietal bony thinning, a congenital finding, as well as generalized brain atrophy. ct angiography: findings: the tributaries of the circle of , including the basilar artery are patent. however, visualized is a 3 x 7 mm partially calcified aneurysm arising from the origin of the supraclinoid portion of the left internal carotid artery, and projecting medially towards the sella turcica. a much smaller aneurysm (2 mm) is seen arising from the lateral aspect of the same left internal carotid artery segment. a questionable punctate aneurysm arises off the superior margin of the origin of the left middle cerebral artery. no other vascular abnormalities are detected. conclusion: no thrombosis of the basilar artery. multiple left internal carotid and middle cerebral artery aneurysms seen. this report is in complete concordance with the "wet " provided by dr. on . addendum: all studies show what appears to be an irregularly sclerotic appearance of the greater and lesser sphenoid wings in addition to the previously noted sclerosis involving the margins of the sphenoid sinus. the more diffuse sclerosis potentially could represent fibrous dysplasia. . left upper extremity ultrasound: -scale and doppler son were performed of the left internal jugular, subclavian, axillary, brachial, basilic, and cephalic veins. normal flow, compression, augmentation, and waveforms are demonstrated. there is no evidence of left upper extremity deep venous thrombosis. again seen in the left supraclavicular region, appearing to arise from the region of the thyroid is a 2.6 x 3.6 x 2.9 cm heterogeneous mass, which continues to demonstrate mass effect upon the left subclavian vessels. doppler flow is demonstrated within the subclavian vessels despite this mass effect. impression: 1. no evidence of left upper extremity dvt. 2. continued evidence of left supraclavicular mass, appearing to arise from the left lobe of the thyroid, demonstrating mass effect on the left subclavian vessels, which remain patent with doppler flow. . brief hospital course: 89 year-old female with multiple medical problems including metastatic breast cancer and history of gallstones and diverticulitis, presenting with ruq abdominal pain x 2-3 days, found to have elevated alkaline phosphatase with dilated common bile duct and urinary tract infection. . #. ascending cholangitis complicated by e coli septicemia: patient s/p ercp () with removal of sludge/gallstones. she initially required icu management with pressors and broad spectrum antibiotics, but has been hemodynamically stable since transfer to the floor . blood cultures grew e coli sensitive to zosyn. she will continue on these antibiotics for a total of 14 days s/p intervention. surgery was consulted and offered elective cholecystectomy but given patient's worsened mental status following ercp, family decided to defer operative management at this time. currently afebrile with stable bp. lft's trending down since ercp. mild persistent tenderness to palpation but much improved. . #. e. coli urinary tract infection. treated with zosyn. #. thrombocytopenia. platelets trended down to 81 on . concern for hit, but hit antibody was negative. no evidence of dic (fdp 0-10, fibrinogen 557, normal coags). ppi was changed to famotidine. platelets have recovered to 160. . # altered mental status/dementia: onset s/p ercp. likely due to infection, meds, hypernatremia. sodium corrected with free water. head ct with question of basilar artery occlusion but follow-up cta head not supportive. tfts, remaining lytes, folate, b12 were all normal. patient is currently at her baseline, per the family. . # hypokalemia: patient required iv repletion in house. urine lytes suggest type 1 rta (? due to nephrosclerosis) but low urine ph. potassium has since stabilized without further repletion. . # left upper extremity swelling: u/s negative for dvt. . # anemia: hematocrit stable at 34. iron, folate, b12 wnl. low reticulocyte count likely due to comorbidities (metastatic breast cancer). . # metastatic breast cancer: patient will need to follow-up as an outpatient with dr. to receive her faslodex injection. . # thyroid mass: seen on prior ultrasound/ct. history of thyroid radiation. hcp, , notified and wishes to defer work-up at this time. can be discussed further as an outpatient with her pcp after resolution of cholangitis. . # copd: on 2 l at baseline. currently only needing 0.5 l nc to maintain o2 > 93%. . # access: left midline in place . # code status: patient was dnr/dni in house but family wishes to return to full code on return to nursing home. . # dispo: patient d/c back to eastpoint nh in . medications on admission: patient has refused all oral medications for the past six months. was on bisacodyl, colace, aricept, prednisone, namenda, percocet. discharge medications: 1. acetaminophen 325 mg tablet sig: 325-650 mg po q4-6h (every 4 to 6 hours): max = 2 g per day. 2. regular insulin per sliding scale 3. piperacillin-tazobactam 2.25 g recon soln sig: 2.25 grams intravenous q6h (every 6 hours) for 9 days. 4. famotidine 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary: 1. e coli sepsis 2. cholangitis 3. urinary tract infection 4. thrombocytopenia 5. hypokalemia 6. thyroid mass, consider follow-up 7. left upper extremity swelling . secondary: 1. metastatic breast cancer, left breast, status post lumpectomy, now on faslodex; no chemotherapy or radiation per patient's wishes 2. vascular dementia 3. endoscopic removal of gallstones 4. copd with frequent pneumonias 5. rbbb, history of wenkebach, 2:1 av block 6. history of diverticulitis 7. chronic constipation 8. arthritis 9. brain aneurysm 10. status post compression fracture of spine 11. history of bleeding gastric ulcer 12. thyroid irradiation , not on thyroid replacement 13. pacemaker placement ( prodigy 7865u pacer placement) 14. orif, right hip, 15. orif, left hip, 16. right rotator cuff repair in 's discharge condition: afebrile, vital signs stable. discharge instructions: please monitor for temperature > 101, worsening abdominal pain, diarrhea, worsening mental status, or other concerning symptoms. followup instructions: provider: , rn phone: date/time: 11:00 . provider: 6 date/time: 11:00 . provider: , m.d. date/time: 11:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube endoscopic removal of stone(s) from biliary tract non-invasive mechanical ventilation infusion of vasopressor agent diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified severe sepsis chronic airway obstruction, not elsewhere classified personal history of malignant neoplasm of breast hypopotassemia constipation, unspecified acute respiratory failure iron deficiency anemia, unspecified hyperosmolality and/or hypernatremia septicemia due to escherichia coli [e. coli] cholangitis secondary malignant neoplasm of bone and bone marrow vascular dementia, uncomplicated cerebral atherosclerosis unspecified disorder of thyroid calculus of gallbladder and bile duct with acute cholecystitis, with obstruction secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb swelling of limb 

Answer: The patient is high likely exposed to