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: sulfa (sulfonamides) attending: chief complaint: lower gi bleed, history of diverticulitis major surgical or invasive procedure: exploratory laporatomy abdomnal colectomy with end ileostomy small bowel resection orogastric tube intubation with ventilatory support tracheostomy nasogastric tube central venous access history of present illness: 85f w hx of recent cva on coumadin, present w/ nausea and large painless bloody bowel movements at home x2 starting today. - f/c/s, more large bloody bms in ed. hct decreased from 32.9 to 29.4 in 1hr, inr 3.2, wbc 18.5 received 2l ivf, levo/flagyl, 4 units ffp, vit k 5units, 2 unit prbc. continued brbpr. cxr from osh concerning for free air. ct scan from demonstrated pockets of free intraperitoneal air, as well as inflammation of the right colon. past medical history: pmh: h/o cva, dm, htn, copd psh: tonsillectomy social history: noncontributory family history: noncontributory physical exam: physical exam: vitals- t 98.3, hr 99, bp 90/55, rr 34, o2sat 100% 5l gen- nad, alert, pale head and neck- at, nc, soft, supple, no masses heart- rrr, no murmurs lungs- ctab, no rhonchi, no crackles abd- soft, minimally tender to deep palpation, nd, no scars, no hernia rectal- blood clots per rectum, no masses ext- warm, well-perfused, no edema pertinent results: pathology specimen submitted: segment of small bowel, total colectomy. 1) small bowel: segment of small intestine: within normal limits. 2) ileocolectomy: 1. multiple diverticula. 2. hemorrhagic necrosis of multiple areas of diverticular mucosa, with focal perforation of the larger diverticula. 3. ileal segment and appendix: within normal limits. portable tte (complete) done . impression: no cardiac source of embolism identified. preserved global and regional biventricular systolic function. diastolic dysfunction. mild aortic regurgitation. lvef>55% radiology report carotid series complete port study date of 9:30 am. impression: mild atherosclerotic changes with less than 40% stenosis of the internal carotid arteries bilaterally. radiology report mra brain w/o contrast study date of impression: 1. multiple small cortical infarctions in both cerebral hemispheres, in the distribution of the anterior and posterior circulation, suggestive of embolic etiology. 2. chronic small vessel ischemic disease. 3. bilateral mastoid air cell opacification. 4. diffuse irregularity in the anterior, middle and posterior cerebral arteries bilaterally, most likely related to atherosclerosis in a patient of this age. vasculitis is less likely. unilat up ext veins us left port study date of 9:48 am. impression: no left upper extremity dvt. radiology report g/gj/gi tube check study date of impression: 1. again seen, free intraperitoneal air. 2. no evidence of extravasation of oral contrast. radiology report bilat lower ext veins port study date of . impression: no evidence of deep vein thrombosis in either leg. liver or gallbladder us (single organ) port study date of impression: 1. no gallstones and no signs of cholecystitis. partially contracted gallbladder. 2. left pleural effusion and complex ascites in the right flank. 3. 2.7 cm simple left renal cyst. brief hospital course: patient was admitted to dr. surgical service on for treatment of her bleeding per rectum and imaging concerns of fre intraperitoneal air. patient continued to pass several large bloody bowel movements, and her hematocrit dropped as low as 18%. she was taken directly to the surgical intensive care unit where she was resuscitated. her coagulopathy was reversed with six units fresh frozen plasma and a total of seven units of packed red blood cells were transfused. her hemodynamics remained stable; however she did develop respiratory distress and required fairly urgent intubation in the icu. given the presence of perforated diverticulitis with free intraperitoneal air, as well as her gastrointestinal bleeding and need for long-term anticoagulation, the decision was made by the team and family for an urgent total abdominal colectomy and end ileostomy in order to remove all of the colon at risk. on , she was taken to the operating room for a total abdominal colectomy, end ileostomy, and small-bowel resection with stapled side-to-side anastomosis. the patient tolerated the procedure well without complications. she was transferred directly to the surgical intensive care unit postoperatively for monitoring. patient remained intubated. neuro: on , sicu staff noticed patient with lue weakness. concerns for stroke given recent history of cva and sudden episode of atrial fibrillation. stroke and neurology consulted for complete workup. tte, mri of head, neck, carotid us were ordered. patient started on statin, aspirin and heparin drip for possibility of embolic event. imaging studies unchanged and did not reveal any new onset acute processes. however, there was a study from osh suggesting pfo, possibly contributing to cva. plan to keep patient anticoagulated with heparin drip. as per neurology, patient was taken off heparin drip on . on coumadin was restarted. with ventilatory status, patient kept on propofol for muscle relaxation and sedative effects. she was weaned off propofol and provided with intermittent versed on which she only tolerated briefly. she remained on propofol to keep sedated while on assist control ventilation. she eventually was taken off propofol while ventilatory status maintained on pressure support via tracheostomy. cardio: on , patient's cardiac rhythm spontaneously changed to atrial fibrillation with rvr, rate 110-130. diltiazem started and rhythm converted back. she developed atrial fibrillation later on during hospital stay but convereted with lopressor dosing. patient remained hemodynamically stable postoperatively. she did receive 2 units of prbc for low hct of 23. hct remained stable throughout remaining of hospital course (hct 29 for ). findings of patent foramen ovale from outside hospital imaging, possibly contributing to etiology of stroke. will keep anticoagulated. diltiazem weaned ventilatror weaned and tube feeds were increased : pt febrile and cultures were sent pt had persistent leukocytosis vanco and zosyn were started empirically propofol weaned off peg performed at bedside : spiked fevers had + blood cultures for gpc in clusters and pairs picc removed pseudomonas in sputum on zosyn; blood cultures coag neg staph on vanco palliattive care inv9olved in patient's care family deciding on cmo but does not want any other "procedure" done ruq u/s nl family wishes to pursue supports with vent tf and antibiotics but no invasive procedures white count significantly down tolerated trach mask; picc replaced resp: patient was first extubated on . however, due to tachypnea and ongoing repiratory distress, she was immediately reintubated. throughout hospital course, patient's vent and pressure support were weaned but she was not able to tolerate trials. patient with increased work of breathing and instant oxygen desaturations with tachycardia. patient does have history of copd and did require home oxygen for ambulating and occasionally at night. with her pulmonary condition and poor ability to tolerate ventilation weans, decision reached for patient to have a percutaneous tracheostomy for long-term ventilator dependence. on , tracheostomy placed without any complications. she will be discharged to vent rehab for further monitoring and treatment. gi: patient placed with nasogastric tube to help with gastric decompression after procedure. her ileostomy was patent, stoma was pink and ostomy started producing outflow. she was started on tube feeds and nutrition was consulted for assessment of nutritional goals given patient status. patient was provided with peg tube for pareneteral feeding pod16. the pt was experiencing ruq abdominal pain on . a abdominal us was done which showed no eveidence for acute cholecystitis. lft's as well as amylase and lipase were cheked and were normal. gu/renal: patient continued to have decent urine output from foley. input and output monitored closely by house staff. id: patient devleoped febrile episode on with persistent increasing leukocytosis. she was pan-cultured and antiobiotics (vancomycin and zosyn) started empirically. patient's central access was also removed to prevent line infections. urine cultures positive for yeast. patient started on diflucan on . the pts wbc remained elevated throughout most of her hospital course, peaking 1t 36.7 on at whcih time antibiotic coverage was expanded to include flagyl. vancomycin was stopped on and the pt remained on zosyn and flagyl with good response as the lukocytosis has continued to resolve with the current antibiotic regimen. a ct abd/pelvis was considered to evaluate for any drainable fluid collections, however, since the family would not consider any invasive procedures such as ct drainage on any collections, a ct was not performed and the lukocytosis was addressed by broadening antibiotic coverage. medications on admission: : ec aspirin 325 mg tab, delayed release oral 1 tablet, delayed release (e.c.)(s) once daily caltrate 600+d plus minerals 600 mg-400 unit tab oral 1 tablet(s) twice daily coumadin -- 2 mg hs 1 tablet(s) once daily metformin 500 mg tab oral tablet(s) twice daily monopril 20 mg tab oral tablet(s) once daily m-vit 27 mg-1 mg tab oral 1 tablet(s) once daily vitamin d 50,000 unit cap oral 1 capsule(s) once daily simvastatin 40 mg tab oral 1 tablet(s) , at bedtime advair diskus -- unknown strength 1puff disk with device(s) twice daily albuterol 90 mcg/actuation aerosol inhaler inhalation 1 puff aerosol(s) four times daily duoneb 0.5 mg-2.5 mg/3 ml neb solution inhalation 1 solution for nebulization(s) three times daily spiriva with handihaler 18 mcg & inhalation caps inhalation 1 puff capsule, w/inhalation device(s) once daily discharge medications: albuterol mdi 4 puff ih q4h:prn @ 2056 view heparin flush (10 units/ml) 2 ml iv prn line flush warfarin 1 mg po qhs @ 0833 view metoprolol tartrate 25 mg po bid @ 0935 view tobramycin inhalation soln 300 mg ih @ 0928 view metronidazole (flagyl) 500 mg iv q8h @ 0858 view metoclopramide 10 mg po q6h @ 0840 view erythromycin 250 mg po q6h @ 0840 view sodium chloride 1 gm po daily hyponatremia start: @ 1508 view acetaminophen 650 mg pr q6h:prn fever @ 1327 view piperacillin-tazobactam na 4.5 g iv q8h @ 0654 view miconazole powder 2% 1 appl tp :prn @ 1523 view hydralazine 10 mg iv q6h prn htn @ 2305 view lorazepam 0.5-1 mg iv q4h:prn @ 1349 view diltiazem 30 mg po tid @ 1525 view insulin sc (per insulin flowsheet) sliding scale 09/03 @ 1524 view potassium chloride iv sliding scale @ 0458 view pyllium pkt po bid @ 1228 view heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. @ 1119 view sertraline 50 mg po daily @ 0754 view metoprolol tartrate 5-10 mg iv q2h:prn hold for sbp<120 or hr<60 @ 1000 view qvar *nf* 1 inh ih start: @ 2125 view nystatin oral suspension 5 ml po qid:prn @ 0451 view acetaminophen (liquid) 650 mg po q6h:prn @ 1819 view aspirin 325 mg po daily @ 2337 view simvastatin 40 mg po qhs @ 2308 view famotidine 20 mg po daily @ 0756 view ipratropium bromide mdi 2 puff ih q4-6h:prn sob, wheeze @ 1142 view fentanyl citrate 12.5-100 mcg iv q2h:prn pain @ 1142 view sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. @ 1142 view chlorhexidine gluconate 0.12% oral rinse 15 ml oral use only if patient is on mechanical ventilation. @ 1142 view magnesium sulfate iv sliding scale @ 1142 view calcium gluconate iv sliding scale @ 1142 view ondansetron 4 mg iv q8h:prn @ 1142 view discharge disposition: extended care facility: - discharge diagnosis: blood per rectum diverticulitis history of cerebrovasculare accident diabetes mellitus hypertension copd respiratory distress requiring ventilation support discharge condition: ostomy with sufficient output tracheostomy for ventilation discharge instructions: general: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in 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. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. *avoid lifting objects > 5lbs until your follow-up appointment with the surgeon. *avoid driving or operating heavy machinery while taking pain medications. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. * continue to ambulate several times per day. . incision care: -your steri-strips will fall off on their own. please remove any remaining strips 7-10 days after surgery. -you may shower, and wash surgical incisions. -avoid swimming and baths until your follow-up appointment. -please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. monitoring ostomy output/prevention of dehydration: -keep well hydrated. -replace fluid loss from ostomy daily. -avoid only drinking plain water. include gatorade and/or other vitamin drinks to replace fluid. -try to maintain ostomy output between 1000ml to 1500ml per day. -if ostomy output >1 liter, take 4mg of imodium, repeat 2mg with each episode of loose stool. do not exceed 16mg/24 hours. - md with increased ostomy output. . followup instructions: follow up with pcp 1 week follow up with dr. in weeks procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other partial resection of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy temporary ileostomy percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy small-to-small intestinal anastomosis diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified cardiac complications, not elsewhere classified atrial fibrillation cerebral embolism with cerebral infarction other and unspecified coagulation defects diverticulitis of colon with hemorrhage iatrogenic cerebrovascular infarction or hemorrhage 

Answer: The patient is high likely exposed to