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: abdominal pain major surgical or invasive procedure: ir placement of percutaneous cholecystostomy tube history of present illness: ms. is a 77 year old woman with bipolar disorder, dementia, prior cva, who presented to the ed complaining of several days of abdominal pain with fevers. the patient was unable to give the details of her recent symptoms upon admission, presumably due to her dementia, and history was obtained from her son. two weeks pta, she started complaining of abdominal distension. three days pta, she started getting up throughout the night q30 mins to go to the bathroom and was found defecating and urinating on floor. her son noticed her urine was -colored. at , she was febrile to 100.8. an abdominal ultrasound showed evidence of acute cholecystitis. an abdominal ct was performed which showed an enhancing adrenal mass, a hepatic mass (likely a cyst), and a hypodense splenic lesion. she was transferred to out of concern for malignancy and further management of the cholecystitis. she was also given ceftriaxone and metronidazole. of note, she had a potassium of 2.3 on presentation to (she has a long-standing history of hypokalemia). urinalysis was consistent with uti. blood and urine cultures were drawn. at on transfer, she was afebrile with hr 98, bp 146/80, rr 18, sat 98% on 2l nc. past medical history: -bipolar disorder h/o suicide attempt in with hospitaliziation -prior cva in (slurred speech, facial droop, l arm weakness, unsteady gait --> good recovery with some residual l arm weakness) -hypothyroidism -dementia; baseline ms reportedly poor -cad -htn -hypercholesterolemia -hypokalemia (documented since , with baseline k+ 3.0-3.8) -cri -atrial fibrillation social history: lives with her son and daughter who describe her as "an invalid at baseline". she has 5 children, but is estranged from 3 of them. her husband died 8 years ago. she has a history of suicide attempt in with hospitalization at . currently there is no tobacco or alcohol use. family history: non-contributory physical exam: admission physical exam: t 99.8 bp 174/88 hr 89 rr 22 sat 97% on 2 l/min general: obese, sleeping but arousable; inattentive when asked to follow commands heent: no icterus, (+) hirsutism neck: supple, no lad chest: cta b/l, no w/r/r cv: irregular heartrate, no m/r/g abdomen: soft, (+) tenderness to moderate palpation in ruq, no rebound/guarding, (+) extremities: no edema, 2+ pt pulses skin: no jaundice neuro: sleepy, oriented to self only pertinent results: labs admission labs (on transfer from ): 07:40pm blood wbc-15.8* rbc-5.04 hgb-14.4 hct-41.3 mcv-82 mch-28.5 mchc-34.7 rdw-13.9 plt ct-138* 07:40pm blood neuts-90.3* bands-0 lymphs-6.5* monos-2.9 eos-0.2 baso-0.2 07:40pm blood pt-15.6* ptt-27.0 inr(pt)-1.4* 03:04pm blood fibrino-656* 07:40pm blood glucose-165* urean-19 creat-1.0 na-141 k-2.6* cl-101 hco3-29 angap-14 07:40pm blood albumin-3.7 calcium-9.8 phos-2.1* mg-1.2* 07:40pm blood alt-55* ast-40 ld(ldh)-185 alkphos-93 amylase-7 totbili-3.9* dirbili-1.7* indbili-2.2 lipase-10 abg: 11:56am blood type-art po2-169* pco2-31* ph-7.41 caltco2-20* base xs--3 endocrine labs: 01:15am blood cortsol-44.1* 05:16am blood freetes-pnd 12:28pm blood aldosterone-pnd 12:28pm blood renin-pnd 12:28pm blood metanephrines (plasma)-pnd 12:28pm blood methylmalonic acid-pnd 09:55am blood aldosterone-pnd cardiac enzymes: 02:40pm blood ck-mb-notdone ctropnt-0.07* 03:25am blood ck-mb-notdone ctropnt-0.07* ecg (): atrial fibrillation with ventricular rate of 93 bpm. nl axis, nl intervals. no st/t wave changes imaging ct abdomen/pelvis (from , ): the left atrium is enlarged. mild bibasilar dependent atelectasis is noted. within the right middle lobe, air space consolidation with associated air bronchograms are noted. within segment and 4, there is a 1.4 x 4.1 cm low attenuation slightly ill-defined focus visualized (image 17, series 2) with a peripheral calcification . in addition, along the periphery of segment 4, there is a 1.4 x 3.3 cm slightly ill-defined partially peripherally enhancing low attenuation focus and along the periphery of segment , and 4, there is a well-circumscribed 3.0 x 2.5 cm low attenuation focus that likely represents a cyst. the gallbladder is distended associated with adjacent stranding. within the gallbladder, there are dependent ill-defined high density foci. within the spleen, there is a 5.5 mm indeterminate low attenuation focus seen. arising from the left adrenal gland, a 2.7 x 2.1 cm enhancing mass is noted. bilateral peripelvic cysts are seen. multiple nonpathologically enlarged retroperitoneal lymph nodes are seen. there is a foley within the bladder. air is noted within the bladder likely secondary to instrumentation. please note there is an associated peripheral calcification along the low attenuation focus i described in the liver that measures 4.1 x 1.4 cm. a fat containing umbilical hernia is present. the uterus is absent. the bones are diffusely demineralized. degenerative changes are noted. ruq ultrasound (from ): the gallbladder is distended and filled with mobile stones and sludge. a son sign was elicited during the examination. there is questionable focal thickening of the gallbladder in the region of the fundal neck junction. no significant gallbladder wall thickening nor pericholecystic fluid is seen. the common bile duct is within normal limits measuring 4.5 mm. cxr: a single portable image of the chest was obtained. the cardiac silhouette is at the upper limits of normal. there are low lung volumes. there is perihilar fullness, may be exaggerated secondary to underlying mild pulmonary venous congestion. no focal airspace opacity is seen. there is minimal left basilar streaky opacities likely secondary to underlying atelectasis. the bony thorax is grossly intact. cxr: new patchy opacities in the left lower lobe and inferior lingula. although a component of volume loss is present suggesting atelectasis, coexistent pneumonia should be considered in the appropriate clinical setting. echo: the left and right atrium are moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic leaflets are mildly thickened. no aortic stenosis is seen. mild (1+) aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is an anterior space which most likely represents a fat pad. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with preserved global systolic function. mild aortic regurgitation. mri: *** limited study the examination is limited due to inability to cooperate with breath-hold imaging and absence of contrast administration. * there are a number of liver lesions. there is a focal irregularly marginated area of intermediate-to-high signal at the liver hilum measuring 2.3 x 3.8 x 2.9 cm in diameter. this predominantly involves segments and ii. the mass is incompletely characterized. the location raises the possibility of cholangiocarcinoma, but the absence of proximal intrahepatic biliary dilatation makes cholangiocarcinoma less likely. there are a number of additional liver lesions. there is a 1.3-cm segment vii lesion. there is a 1.7 x 2.8 cm segment /b lesion. both these lesions are incompletely characterized but are high signal on t2-weighted sequences and low signal on t1. there is a 3-cm segment liver cyst. * the gallbladder wall is thickened and the gallbladder contains multiple calculi. some free fluid anterior to the liver may relate to previous recent instrumentation. there are a number of low-signal filling defects, compatible with calculi, in the distal common bile duct. the largest of these measures 8 mm in diameter. the common bile duct measures 9 mm in diameter. there is no pancreatic duct dilatation. * there is a 1.5-cm left adrenal mass. the signal characteristics are hypointense to liver on t1-weighted in-phase imaging. there is signal drop-off on the out-of-phase sequence. this is compatible with a left adrenal adenoma. * there are bilateral basal small pleural effusions. there is a 1-cm right epicardiac fat pad lymph node. there is a cholecystostomy catheter in situ. * the spleen is normal in size. there is a small nonspecific high signal on t2-weighted sequence lesion measuring approximately 8 mm in diameter. * there are a number of vertebral body lesions high signal on t1- and t2- weighted sequence, compatible with hemangiomas. impression: 1. gallbladder and distal common duct calculi. 2. cholecystostomy in situ. 3. several incompletely characterized liver lesions the largest of which is at segment /ii. 4. left adrenal adenoma. microbiology bile culture: streptococcus bovis . moderate growth. klebsiella oxytoca. rare growth. presumptive clostridium perfringens. klebsiella oxytoca sensitivities: mic expressed in mcg/ml | ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s blood culture: no growth in four vials blood culture: no growth in two vials blood culture: ngtd in two vials urine culture (from ): greater than 10^5 klebsiella species urine culture: no growth brief hospital course: acute cholecystitis: ms. was noted to have several weeks of abdominal pain and distention prior to presentation with acute cholecystitis. the surgical service was consulted and recommended a percutaneous cholecystostomy tube for drainage, and the tube was placed by interventional radiology on without complication. she was started empirically on iv vacnomycin and zosyn while bile cultures were pending. on , she developed hypoxia and rigors requiring a transfer to the micu. she was never intubated and remained hemodynamically stable, although she did not need all home hypertension medicines while in-house (she was kept on metoprolol, isosorbide dinitrate and amlodipine, hctz was held). lung exam revealed wheezes, and she was started on ipratropium and albuterol nebulizers with good response. bile cultures returned streptococcus bovis, clostridium perfringens and klebsiella oxytoca susceptible to zosyn. on , vancomycin was discontinued; she defervesced and had improvement of her leukocytosis on zosyn (wbc from 25.2 on to 6.6 on discharge). of note, all blood cultures were negative throughout the admission. it was noted that her gallbladder was distended, filled with stones and sludge. presumably, her cholecystitis was secondary to obstruction by stones/sludge as stones were also noted in the cbd (although there was no dilatation of the cbd on imaging). upon discharge, the cholecystostomy tube was left in place for ongoing drainage and will be left in place indefinitely until she has the out-patient surgery follow-up appointment. she is also to remain on iv zosyn (with a picc line in place) until she returns for surgical follow-up, at which point the antibiotics and tube may be discontinued pending clinical improvement. she was discharged on a full diet, with minimal ruq abdominal pain and nausea. hypokalemia: ms. has a history of hypokalemia at baseline. records, k+ has been low as far back as , with a baseline between 3.0 and 3.8. notes, she has taken potassium supplements in the past, but was not on supplements upon admission. she was noted to be persistently hypokalemic thorughout the admission, dependent on 40 - 60 meq po potassium repletion daily. she was also kept on spironolactone 25 mg qd. she was discharged on potassium chloride 40 meq qd, with suggestion to check potassium levels q2 - 3 days initially in rehab. an endocrinology consult was placed to work-up the hypokalemia (and adrenal mass). aldosterone, renin and acth levels were pending at the time of discharge, although it is noted that spironolactone administration may prevent proper interpretation of these results. adrenal mass: records from her prior endocrinologist, dr. , and previous ct scans show that this adrenal mass was known previously. comparison to prior studies seemed to show that the mass was stable in size. cortisol level was 44 on admission, and aldosterone, renin and acth levels were pending at the time of discharge. mri of the abdomen was ordered for further evaluation and showed the adrneal mass was consistent with an adenoma. we have recommended out-patient evaluation and appointment with dr. for further work-up and management. atrial fibrillation: the patient was known to have atrial fibrillation and has had evaluations in the past. she was not admitted on anticoagulation and was kept on subcutaneous heparin for dvt prophylaxis while in the hospital. the decision to begin anticoagulation has been deferred to out-patient pcp . mental status/dementia: the patient was noted to be oriented to person upon admission and also at discharge; she was somnolent at times, but easily arousable and able to carry on a conversation. according to her son, she was at baseline mental status. she was continued on olanzapine while in the hospital. pending issues for follow-up (1) potassium levels should be checked every 2 - 3 days initially upon discharge to ensure that the patient's potassium level remains stable on 40 meq kcl daily supplementation. (2) blood pressure should be followed, as hctz were held in the hospital because of relatively low blood pressures. the need for hctz and increasing doses of current meds should be readdressed at her primay care follow-up appointment. (3) it is noted that she has rate-controlled atrial fibrillation, but is not on anticoagulation. the risks and benefits of long-term anticoagulation should be readdressed in primary care follow-up. no changes were made to her out-patient regimen at this time. (4) the adrenal mass has been followed as an out-patient and does not seem malignant given its slow rate of growth. the need for repeat imaging and further work-up shoud be determined by the pcp and endocrinologist. in addition, the aldosterone, acth, renin, testosterone and dhea-s levels were pending at the time of discharge and should be reviewed as an out-patient to ensure there have been no changes since they were last measured. (5) the need for further zosyn treatment and cholecystostomy tube should be addressed at her sugical follow-up appointment, as well as need for surgical cholecystectomy. medications on admission: olanzapine 5 mg once daily amlodipine 10 mg daily oxybutinin 5 mg simvastatin 20 mg daily hctz 12.5 mg daily levothyroxine 150 mcg metoprolol 50 mg once daily isosorbide (? mono- vs dinitrate) 15 mg daily discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 2. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 3. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 4. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po tid (3 times a day). 5. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 6. piperacillin-tazobactam 2.25 gram recon soln sig: one (1) recon soln intravenous q6h (every 6 hours). 7. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po daily (daily). 8. levothyroxine 150 mcg tablet sig: one (1) tablet po once a day. 9. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po daily (daily). 10. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 11. albuterol 90 mcg/actuation aerosol sig: inhalation every six (6) hours as needed for shortness of breath or wheezing. 12. amlodipine 10 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: of discharge diagnosis: primary diagnoses: acute cholecystitis adrenal mass hypokalemia urinary tract infection secondary diagnoses: hypertension dementia atrial fibrillation discharge condition: stable-- afebrile; breathing comfortably in the mid-90's on room air; oriented to self at baseline; still with occasional abdominal pain, but significnatly improved from admission. discharge instructions: please call your primary care doctor if you have worsening abdominal pain or fevers. if you cannot reach your doctor, or if you feel severely worse or sob, please return to the emergency department. you have been put on antibiotics through the vein for your gallbladder infection. you will need to be on them at least through your surgery appointment on . they will decide whether you need to remain on antibiotics and whether the tube can come out at that visit. you have been started on a potassium supplement. you have been on a supplement in the past and were restarted on this because your potassium levels were low in the hospital. please follow the medication list carefully and take only what is on the list at the doses that are written. several changes have been made to what you used to take, so please follow it closely. followup instructions: you have the following follow-up appointments: (1) you have an appointment with dr. in general surgery on , at 1:45 pm for follow-up on your gall bladdder. the office is on the of the building on the of hospital. their phone number is (. you must call the office before your appointment to register with them over the phone. (2) please see your primary care doctor, dr. , at . you should call to set up an appointment to be seen in the next 2 - 3 weeks. (3) please call dr. in endocrinology to make an appointment for follow-up in the next 3 - 4 weeks. this is to follow-up on your low potassium levels and adrenal mass. the phone number is . dr. called on to try to set up an appointment, but was unable to speak to someone directly. she left a message with the staff at the office to call your home number ot set something up. if you do not hear from them, you will need to call to set something up. procedure: trocar cholecystostomy diagnoses: other postoperative infection urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other persistent mental disorders due to conditions classified elsewhere hypopotassemia chronic kidney disease, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation acute systolic heart failure bipolar disorder, unspecified candidiasis of skin and nails benign neoplasm of adrenal gland calculus of gallbladder and bile duct with acute cholecystitis, with obstruction 

Answer: The patient is high likely exposed to