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: penicillin g attending: chief complaint: transfer from outside hospital with acute pancreatitis and acute renal failure. major surgical or invasive procedure: 1. tracheostomy 2. drain placement in ir 3. drain upsizing in ir 4. drain change in ir 5. takedown of end of the enterocutaneous fistula with small-bowel resection and primary anastomosis, extended adhesiolysis, repair of enterotomy, g-tube placement, and j-tube placement . history of present illness: mr. is a 54 year old male, with a history of htn, ulcerative colitis, resection of a non-malignant brain tumor, alcohol abuse, chronic methadone maintenance, and ulcerative colitis s/p colectomy who was transferred from an outside hospital with acute alcoholic pancreatitis evolving into necrotizing pancreatitis complicated by respiratory failure s/p tracheostomy. past medical history: hypertension, ulcerative colitis s/p colectomy, j pouch, removal of nonmalignant brain tumor, alcohol abuse, chronic methadone maintenance social history: lives w/sister. history long-term smoking. chronic alcohol use. denies ivdu. family history: not-contributory physical exam: at discharge: . vs: 99.4 po, 120/80, 107, 20, 96% ra general: thin, well appearing male appearing older than stated age in nad. heent: sclerae anicteric. o-p clear, intact. neck: supple. thyroid nt/non-palp. no lymphadenopathy. lungs: cta(b). heart: rrr; nl s1/s2 w/o m/c/r. no s3/s4. abdomen: (l)abdominal g-tube and j-tube insertion sites patent & c/d/i with drain sponge/dsd. g-tube clamped. j-tube receiving tubefeeds. (l) flank jp tip cut, draining into ostomy bag, which is intact. abdomen soft/nt/nd. extrem: no c/c/e. musculoskelatal: overall cachetic with significant muscle mass wasting during hospitalization. improving conditioning. ambulates with assist. neuro: a+ox3. affect somewhat flat, but pleasant. interacts appropriately. exam non-focal/grossly intact. skin: intact w/o lesion or rash. pertinent results: this is a video oropharyngeal swallow study: . . findings: oropharyngeal swallow video fluoroscopy was performed in conjunction with the speech and swallow division. multiple consistencies of barium were administered. barium passes freely through the oropharynx and esophagus without evidence of obstruction. there was no gross aspiration or penetration. . impression: no gross aspiration or penetration. . chest port. line placement: tip of the left subclavian line projects over the upper svc. tracheostomy tube in standard placement, nasogastric tube ends in the stomach. lung volumes remain quite low, but improved since earlier in the day, small linear areas of atelectasis are seen in both lower lungs and a tiny fissural component of pleural fluid on the right is unchanged. upper lungs clear. normal cardiomediastinal and hilar silhouettes. . abd/pelvic ct w/contrast: 1. peripancreatic inflammatory changes and retroperitoneal collections are little changed since except to note increasing peripancreatic air. this is concerning for persistent sinus tract, fistula or contained perforation. 2. collection of fluid in the anterior abdomen has improved and is no longer evident. 3. asymmetric dilation of small bowel loops raises the possibility of partial small bowel obstruction, however dilated loops and fluid extend to the rectum without transition point. 4. moderate intra- and extra- hepatic biliary dilatation as well as gallbladder sludge is unchanged since . . ekg: sinus tachycardia. st-t wave abnormalities. since the previous tracing of the rate has increased. st-t wave abnormalities are more marked. intervals axes: rate pr qrs qt/qtc p qrs t 144 0 80 288/435 0 56 26 . g/gj/gi tube check: under fluoroscopic guidance, a small amount of water-soluble conray contrast was injected via the patient's g-tube. contrast passed freely without obstruction into the stomach without evidence of extraluminal leak. thereafter, similar injection of water-soluble contrast was done via the patient's j-tube which also passed without obstruction into the small bowel. prior to the study, a scout radiograph of the abdomen was taken which excluded the upper and left abdomen from the field of view, though demonstrated the aforementioned feeding tubes as well as multiple air-filled loops of bowel. degenerative change is also noted in the lumbar spine. . impression: patent g and j tubes without evidence of obstruction. . abd/pelvic ct w/contrast: 1. marked peripancreatic inflammatory changes, with multiple retroperitoneal collections. one collection adjacent to the second/third portion of the duodenum contains air, fluid, and suggestion of enteric contrast, and appears to track to the floor of the stomach, at which point the fascial plane is poorly defined. this raises the concern of a sinus tract, fistula, or contained perforation. no frank extravasation of oral contrast is identified. 2. large pocket of fluid within the anterior abdomen, with surrounding enhancement of the adjacent peritoneum, raises the suspicion for infected fluid and associated peritonitis. 3. intrahepatic biliary ductal dilatation, with dilatation of the cbd. 4. gallbladder stone/sludge. 5. bibasilar atelectasis, with small left pleural effusion. . microbiology: ucx + enterococcus bcx + coag neg staph sputum cx + yeast c-diff neg bcx p : bcx: gpc clusters : sputum enterobacter cloacae, yeast : gram negative rod, budding yeast : bcx: gpc drain cx: 1+ gnr drain: gpr, gnr : drain: (x2) enterobacter -, lactobacillus : bcx x2 ngtd : abscess pseudomonas : drains pseudomonas : sputum with >25pmns and 3+ gnr brief hospital course: the patient with history of ulcerative colitis s/p colectomy was transferred from an outside hospital on intubated for management of acute pancreatitis and ards. he remained intubated, aggressive ivf resucitation started, foley catheter in place, flagyl and ceftriaxone for presumed aspiration pneumonia, sedation prn, methadone continued. : spiked temp 101.2. pan cultured. bladder pressure up to 21. continued difficulty with sedation. tense abdomen. continued ventilatory support, nasojejunal tube placed for tube feeding, continued antibiotics, ivf, vancomycin started. : discontinued flagyl, ceftriaxone and started zosyn, continued vancomycin, ivf, ventilatory support, started propofol, weaned fio2 and peep. : started tube feeds, continued ventilatory support, antbiotics, ivf. : flexiseal placed with >1l output, in/out afib but responsive to betab blockade and predominantly in sinus rhythm, ngt replaced, ngt in early am pulled back and pt potentially aspirated gastric contents (moderate amount contents suctioned from ett), no sign change on cxr, tubefeeds held, maintenance ivf, central line changed and tip sent for cx. : temp spike 101.5. : temp 101.2, opening eyes to voice in am , retaining co2 so placed on vent overnight. : increased insulin in tpn. : weaned vent, started clonidine, increased beta blockers. : started trophic feeds, then held in am. : s/p trach, increased insulin in tpn, increased o2 requirements s/p trach improved throughout day, lasix held as renal functions borderline, propofol infusion increased during evening given mild agitation and tachypnea on vent. : acute decompensation, ct demonstrated hemorrhagic pancreatitis, 5 units prbc. : 2 units prbc, ruq u/s, tpn : insulin reduced in tpn due to low blood sugars, no acute issues. : s/p 1 unit prbc : hct stable, clonidine increased to 0.2mg patch, lasix 20mg iv x2 doses with good response. : cont lasix, tpn, vent wean. urine lytes sent in setting of diuresis. : increase clonidine patch, 1-2l neg, diurese prn, in evening question if patient vasovagal with sbp to 80s (started on neo, 500cc bolus, stable hct), panculture for fever. : increase lopressor; standing ativan. : increase ativan to 1mg q6hrs atc. febrile 100.5. free water 1l given for hypernatremia. briefly on trach mask -> resp acidosis. : acidosis while on trach mask; lasix 20mg iv x 2 given, received 1 l free h20 for hypernatremia, methadone increased to q8, ativan interval increased. : precedex started for better sedation/agitation control, fentanyl infusion weaned off. goal to be on methadone/dex only with prn ativan and slowly wean dex. autodiuresis; net -1l. : trophic tubefeeds, question aspiration event, tubefeeds held. : haldol started, precedex stopped, aggitation slightly improved, tubefeeds retried. : moved to different room with improved neuro status, med list pared down due to polypharmacy; encephalopathy metabolic workup negative, lfts slightly elevated. tolerated tcm overnight with reasonable abgs. : neuro stable. advanced tube feeds. d/c central line. : ct head normal, tubefeeds switched to renal formulation, replaced on vent for increased work of breathing. : (l) pleural tap with 500cc straw appearance fluid, mixed metabolic and respiratory alkalosis, methadone increased back to 20mg for suspected withdrawal, spiked temperature and pancultured, ngt output looks like tubefeed;thus tubefeeds held, hypernatremic 152 water deficit 3liter started on d5w 100 cc/hr : unable to tolerate tcm >2 hrs in am, back on ps. tcm trial again in evening, tolerated overnight. hypernatremic, free water deficit 4l, continue to replete with d5w. also prerenal arf on top of the chronic renal insufficiency, with 2 episodes of sbp 80s, 2 liters lr total given, low rate lr infusion started, to reassess in am. : continue tolerating tcm. : retroperitoneal perforation with collection (air + contrast) found, tubefeeds held, meropenem started, pmv placed, transfused 2 u prbcs. ngt placed to suction, kept strict npo. : new onset atrial flutter. rate in 150s with hypotension on phenylephrine drip, cardioconversion attempted converted to sinus rythm, cardiac enzymes sent. spiked fever 101.6 f; blood cultures sent. left sub clavian placed, tpn started. required fluid bolus overnight. : or plan cancelled due to concern of retroperitoneal collection/cyst in direct connection with small bowel, would hold off unless patient looks septic per dr. . stable overnight with intermittent agitation issues, improved with fentanyl but later impoved with versed. : placement of pmv continuously, subsequently pco2 goes up, he experienced increased work of breathing. us: tumefactive sludge in the gallbaldder,dilated cbd. : c/o abdominal pain in pm relieved with burp/ngt placement but pain on percussion & palpation on exam. : ngt clamp trial for 6hours, residual 0. tolerate the trach, restless overnight. bolus of lasix given with good response for positive fluid balance. : agitated, no acute events. unable to wean vent. a-line out. continued diuresis, pressure support weaned to 8, calcium removed from tpn secondary to hypercalcemia. : ir procedure, 2 drains, tolerated trach mask for 24 hrs, up in chair per pt, clearing own secretions. : vancomycin held. no acute events. vancomycin held, pseudomonas resistant to gentamycin, so amikacin started, pth level <6. to or for retroperitoneal tube exchange x 2, post-operative hypotension improved with 1l ns and 2 units prbcs, no pressors required. hourly drain irrigation and drainage system. no acute events. no acute events. : no acute events. : s/p or with up-size of retroperitoneal drains, retroperitoneal debridement. : no acute events. normal saline and calcitonin for hypercalcemia, more lethargic, not hypercarbic, decreased methadone to 2.5mg q12. : stopped flagyl. no acute events. : no acute events. hypercalcemia being treated with fluids/lasix. : cdif sent, flexiseal placed. : s/p or - changed superior chest tube, discontinued inferior chest tube and placed penrose. : brief self-limited episode of sanguineous ngt output, tpn 30kcal/2.0protein. no acute events. sinogram - no isolated leak. stopped dialysate infusions; transferred to the floor. ngt discontinued on transfer x2, replaced x2. ct done. speech/swallow consult ordered. discontinued amikacin per id, given no contrast in rp. no events - cont tpn, npo, ngt. or for ex lap/loa/fistula takedown/small bowel resection/g-tube/j-tube. in sicu, transiently on pressors. hypernatremia; more purulent output from . with mild purulent outpt. d5w for hypernatremia. transferred back to floor. dilaudid pca for pain. hct 25.0; transfused 1 unit prbc with hct increased to 28.9. pt/ot consulted. still on tpn. oob with pt. overnight started trophic tubefeeds at 10ml/hr. started vancomycin. ct abd/pelvis done: peri-pancreatic stranding, with collection adjacent to 2nd/3rd portion of the duodenum; + 12x7x5cm fluid collection anterior in the abdomen. started zosyn/flagyl. tubefeeds held. ir drainage of abdominal collection. cont tpn with fat. on antibiotics. mom down j-tube. iv to po methadone, iv to po lopressor. started trophic tubefeeds via j-tube. discontinued vancomycin/flagyl, cont zosyn. on tubefeeds at 10ml/hr. was out of bed, standing with pt. on tpn. foley removed, condom catheter placed. tubefeeds increased to 20ml/hr with good tolerability. methadone increased to 15mg tid via j-tube with improved pain control. experienced two epidodes nausea and vomitting 300-400ml emesis; tubefeeds held. kub performed, which revealed multiple air-filled loops of small and large bowel are noted. there is no evidence of obstruction, free air, or pneumatosis. g-tube/j-tube study with contrast was performed; revealed both were patent and placement was appropriate. both g-tube and j-tube placed to gravity drainage. ng tube placed. g-tube with minimal output, decreased from baseline. difficult to flush. g-tube repositioned in radiology with return of output. jp amylase sent. g-tube study with contrast performed; g-tube patent with appropriate placement. opened to gravity drainage. ng tube discontined. trophic tubefeeds restarted at 10ml/hr with good tolerability. allowed 1 cup jello daily. tubefeeds increased to 20ml/hr with good tolerability, continued tpn tube feeds stopped due to abdominal distention continued tpn, j tube to gravity started linezolid/zosyn empirically for hypotension, desaturations, ng tube placed, transferred to the icu for continued monitoring, picc removed and cultured, central line placed zosyn discontinued, meropenem started transfused 2 units rbc for low hematocrit, transferred to the floor for monitoring. continued linezolid and meropenem until 6/18 per id recommendations, continued tpn started tube feeds at 10cc/hr tube feeds advanced to 20 cc/hr video swallow study performed; no aspiration trach downsized to # 6 cuffless with cap trial. diet sips with single jello serving. g-tube clamped. tubefeeds advanced. continued on tpn. continued on tubefeeds, tpn. diet advanced to clears. diet advanced to diabtetic dysphagia regular (thin liquids, pureed solids). continued on tpn. tubefeeds advanced. continued on tpn, tubefeeds advanced toward goal. tubefeeds at goal of 80ml/hr; well tolerated. received one-half bag tpn. new picc placed; cvl discontinued. re-screened for rehabilitation. restarted on mirtazepine qhs. jp drain advanced; new ostomy bag placed. tubefeeds 3/4 strength with 60g beneprotein additive at goal of 80ml/hr via j-tube well tolerated. receiving iv antibiotics and medications via picc. g-tube clamped. tolerating diet with small po intake. weaned off tpn. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a diabetic, soft dysphagia diet with fair po intake and tubefeeds at goal via the j-tube with g-tube clamped. jp drain cut with ostomy bag applied around site; drain being slowly advanced. ambulating with assistance, voiding without assistance, and pain was well controlled. the patient was discharged to a rehabilitation facility. he will complete his current course of iv antibiotics. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: lisinopril 20mg po daily, asa 325mg po daily, atenolol 75mg po bid, methadone 70mg po daily. discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb treatment inhalation q6h (every 6 hours) as needed for wheezing, sob. 2. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 3. methadone 10 mg/5 ml solution sig: 7.5 ml (15mg dose) po tid (3 times a day): per j-tube. 4. ipratropium bromide 0.02 % solution sig: one (1) neb treatment inhalation q6h (every 6 hours) as needed for sob/wheezing. 5. acetaminophen 325 mg tablet sig: 1-2 tablets po every hours as needed for fever or pain. 6. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day) as needed for constipation: per j-tube. 7. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed) as needed for fungus. 8. mirtazapine 7.5 mg tablet sig: one (1) tablet po hs (at bedtime). 9. haloperidol 1-2 mg iv q4h:prn agitation 10. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 11. heparin flush (10 units/ml) 1 ml iv prn line flush temporary central access-floor: flush with 10 ml normal saline followed by heparin as above daily and prn. 12. metoclopramide 10 mg iv q6h 13. ondansetron 4 mg iv q8h:prn nausea 14. hydromorphone (dilaudid) 0.25-0.5 mg iv q3h:prn pain 15. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime): give via j-tube if unable to tolerate po. 16. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily): give via j-tube if unable to take po. 17. meropenem 500 mg recon soln sig: one (1) recon soln intravenous q6h (every 6 hours) for 4 days: last dose 6/19. disp:*16 recon soln(s)* refills:*0* 18. linezolid 600 mg/300 ml parenteral solution sig: one (1) intravenous q12h (every 12 hours) for 4 days: last dose 6/19. disp:*8 doses* refills:*0* 19. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). 20. insulin regular human 100 unit/ml solution sig: 2-10 units injection asdir (as directed): as directed per regular insulin sliding scale. discharge disposition: extended care facility: radius speciality hospital of discharge diagnosis: primary: 1. retroperitoneal sepsis with enterocutaneous fistula. 2. necrotizing pancreatitis. 3. malnutrition and failure to thrive. 4. ards 5. dysphagia secondary: 1. chronic pain 2. ulcerative colitis s/p colectomy at outside hospital 2/. discharge condition: stable discharge instructions: please call your doctor or nurse practitioner or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain in not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon. avoid driving or operating heavy machinery while taking pain medications. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. general drain care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *if jp drain in place, please keep to bulb suction. *if tube to a drainage collection system, note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or nurse if the amount increases significantly or changes in character. be sure to empty the drain frequently. record the output, if instructed to do so. *wash the area gently with warm, soapy water. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. . jp drain care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *jp draining into ostomy bag. *note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or nurse if the amount increases significantly or changes in character. *be sure to empty the ostomy bag frequently. record the output, if instructed to do so. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. *if the drain should become dislodged, or fall out, leave ostomy bag over drain site to collect additional fluid, and call clinic. the drain coming out dose not necessitate the patient to return to the hospital, call the clinic for instructions first, if it is after hours call the hospital number and ask for the surgical resident on-call. picc line: *please monitor the site regularly, and your md, nurse practitioner, or nurse if you notice redness, swelling, tenderness or pain, drainage or bleeding at the insertion site. * your md to the emergency room immediately if the picc line tubing becomes damaged or punctured, or if the line is pulled out partially or completely. do not use the picc line in these circumstances.please keep the dressing clean and dry. contact your nurse if the dressing comes undone or is significantly soiled for further instructions. followup instructions: please call ( to schedule a follow-up appointment with dr. (pcp) in 2-3weeks. provider: , md phone: date/time: 11:00 am ( dr. is covering for dr. ) procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other enterostomy other partial resection of small intestine enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage laparoscopy temporary tracheostomy closed [endoscopic] biopsy of bronchus other lysis of peritoneal adhesions bronchoscopy through artificial stoma closure of fistula of small intestine, except duodenum other gastrostomy other excision or destruction of lesion or tissue of pancreas or pancreatic duct diagnoses: acidosis unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia unspecified protein-calorie malnutrition severe sepsis atrial flutter opioid type dependence, continuous acute respiratory failure pneumonitis due to inhalation of food or vomitus alkalosis peritoneal adhesions (postoperative) (postinfection) paralytic ileus dermatitis due to drugs and medicines taken internally other encephalopathy infection and inflammatory reaction due to other vascular device, implant, and graft ulcerative colitis, unspecified other and unspecified alcohol dependence, unspecified peritoneal abscess acute pancreatitis hemoperitoneum (nontraumatic) fistula of intestine, excluding rectum and anus penicillins causing adverse effects in therapeutic use dysphagia, unspecified 

Answer: The patient is high likely exposed to