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: latex / penicillins / sulfa (sulfonamide antibiotics) attending: chief complaint: abdominal pain; brbpr major surgical or invasive procedure: hartmann's resection of the sigmoid colon, end colostomy with hartmann's pouch history of present illness: 72f with history of rheumatoid arthritis on steroids presents with severe abdominal pain of one day duration. patient reports long standing trouble with gastric ulcers due to her immunosuppressive therapy, however her medication was stopped due to intolerance. she had not had episodes of abdominal pain in the past. her current pain is not accompanied by nausea, vomiting, or diarrhea. she has not been passing flatus since her pain started. she has normal bowel movements and reports a normal recent colonoscopy. she denies fevers, chills, and malaise. her main health problems at this time are related to her ra which is severe and has recently required citoxan therapy for which a tunneled l scv line was placed about 6 weeks ago. her last dose of citoxan was 5 weeks ago. she was recently admitted at for management of mrsa cellulitis from her chronic vasculitic le leg wounds. at outside hospital, received meropenem and flagyl. of note, her plavix has been held for the last 4 days. past medical history: pmh: le vasculitis, mrsa from leg wound, htn, r stroke with minor weakness of lue, diabetes, rhematoid arthritis, vasculitis, cad, bronchiectasis with pigeon chest, diastolic chf, corpus calosum, osteoperosis, anemia, anxiety psh: cervical fusion, r shoulder, b/l wrist, b/l thr, b/l knee replacement, b/l ankle social history: sh: accompanied by her sons, came from rehab facility. denies tobacco use, occasional alcohol use. family history: fh: no known gi cancers physical exam: on exam: vs:97.6 100 140/85 18 98% gen: appears comfortable, nad cv: rrr resp: ctab, anterior protrusion of chest wall abd: distended, tympanitic, very tender to percussion and palption, + guarding, no rebound ext: 2 deep wounds (1.5 cm area) over lateral surface of rle and posterior calf of her lle, chronic from vasculitis. multiple healing ulcers. palpable pulses b/l. warm, no edema. pertinent results: 10:30pm blood wbc-25.4* rbc-3.88* hgb-11.1* hct-34.0* mcv-88 mch-28.7 mchc-32.8 rdw-18.3* plt ct-249 neuts-96.0* lymphs-2.2* monos-1.4* eos-0.2 baso-0.1 pt-12.8 ptt-23.5 inr(pt)-1.1 glucose-98 urean-20 creat-0.7 na-138 k-4.1 cl-106 hco3-20* angap-16 11:17pm blood lactate-1.7 02:47am blood freeca-1.23 04:56am blood wbc-10.0 rbc-3.73* hgb-10.0* hct-33.1* mcv-89 mch-26.7* mchc-30.1* rdw-18.2* plt ct-282 calcium-8.3* phos-3.0 mg-2.0 glucose-108* urean-20 creat-0.4 na-142 k-4.2 cl-114* hco3-19* angap-13 : rapid irregularly irregular narrow complex rhythm is present consistent with atrial fibrillation. a single monomorphic ventricular premature beat is present. non-specific st-t wave changes are present. the development of atrial fibrillation is new compared with the previous tracing of echo at : lvef 65%, 3+ mr, 1+ tr, mild phtn, mild , lvid 5.2 diastolic, 3.5 systolic brief hospital course: the patient was transferred from an osh after an abd ct scan revealed free air and fluid within her pelvis without a clear source of perforation. she was initially admitted to the trauma icu, but was taken emergently to the operating room on , where she underwent a hartmann's resection of the sigmoid colon and end colostomy with hartmann's pouch; please see operative report for further details. postoperatively, the patient was transferred to the icu. she was extubated and transitionted to iv dilaudid for pain control with continued intravenous metronidazole and meropenem. her ngt was discontinued and po medications were initiated. given hemodynamic stability, she was transferred to the general surgical on pod2 for further management. neuro: the patient was alert and oriented throughout her hospitalization; post-extubation, pain was initially managed with intravenous hydromorphone. this was transitioned to oral oxycodone and acetaminophen on pod5 with well controlled pain. of note, the patient did occasionally require intravenous morphine for breakthrough pain control. cv: upon transfer from the osh, the patient was noted to be in a fib with intermittent rvr. oral metoprolol was resumed on pod1 and a cardiology consult was obtained on pod4 with recommendations for anticoagulation with either heparin gtt or lovenox bridged to oral warfarin or to begin anticoagulation with dabigatran. , possible cardioversion either as an in/outpatient was suggested; anticoagulation not resumed at this time as per surgeon due to very high risk for falls. the patient remained asymptomatic and hemodynamically stable, therefore, inpatient cardioversion was not attempted. she will follow-up with her primary care provider upon discharge for ongoing management of these issues. she was not started on anticoagulation, outside of subcutaneous heparin, because of fall risk and the thought that her irregular heart rate was a post-surgical response. this will be reassessed when she follows up in clinic and with her pcp. , the patient presented with a tunneled line in place for outpatient citoxan, which was noted to be out of position on pod2, requiring ir removal and replacement. pulmonary: the patient remained intubated post-operatively due to difficulty with initial intubation for surgery. given respiratory stability she was extubated on pod1. she remained stable until pod6 when she developed acute sob. a cxr was obtained and suggested 'unchanged left lower lung collapse and improved bilateral pleural effusions'. the event did not recur and the patient remained stable throughout the remainder of her hospitalization; vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirometry were encouraged throughout hospitalization. patient has history of diastolic heart failure, chronic, that was monitored throughout this hospitalization and she ahd no acute issues realted to her heart failure. gi/gu/fen: bowel function returned by pod3 as noted by gas/ stool within the ostomy appliance. the patient received teaching regarding ostomy care including emptying pouch and changing the appliance from the ostomy rn. however, her ability to perform these tasks was limited by her hand deformities. occupational therapy was consulted for further assistance and will continue at the rehab facility. she was initially npo, but was advanced sequentially following return of bowel function to diabetic diet, which was well tolerated. nutrition was consulted due to multiple bilateral chronic lower extremity ulcerations; recommendations included high protein supplements and food choices. patient's intake and output were closely monitored with electrolyte repletion prn. she was taking adequate food and had gppd output through her ostomy. id: intravenous metronidazole and meropenem were initiated and continued through pod2 & pod7, respectively. on pod 7, the patient's wbc began trending upward, therefore, blood cultures were sent and an ct torso was obtained and her antibiotics were switched to vancomycin, zosyn, and fluconazole; results from ct scan showed small amount of free fluid in the pelvis but no signs of abscess and otherwise normal ct. on pod 8, the wbc began trending downward and on pod 9 patient was kept on only diflucan with a planned 5 day course for what appeared per derm and rheum to be a yeast infection on her back. she was discharged on no antibioics as she had finished her course of diflucan and her back rash was much improved. at time of discharge her blood cultures had no growth to date. she has a jp drain on her left side that has been draining minimal amout of serous fluid but will be left in until follow-up appointment. she also has staples in her abdominal wound that will be left in until her follow-up appointment with clinic. rheum: no acute change in managment of ra while inpatient, patient will follow up with her outpatient rheumatologist dr . daily predinsone, at home dosage, was continued while in-house. , on pod8, a large rash was noted on the patients back. rheumatology felt this was fungal in nature and recommended topical antifungal treatment with derm consultation who also agreed with antifungal treatment. prophylaxis: the patient received subcutaneous heparin during this stay; she was encouraged to get out of bed as ealry as possible. rehab: the patient was seen by physical therapy for in-patient evaluation and treatment. pt recommended transfer to rehab upon discharge due to the level of assistance required in addition to pt living at home alone; see evaluation for details. at the time of discharge to rehab, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a diabetic diet, ambulating with assistance and use of a rolling walker. she was voiding without assistance, and pain was well controlled. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: folic acid 1g daily plavix 75 mg daily vitamin b12 1000 mcg daily lasix 20 mg daily metoprolol 50 mg daily spironolactone 125 mg daily neurontin 100 mg prednisone 10 mg daily iron 325 mg daily mvi 1 tablet daily maalox 30 mg prn discharge medications: 1. gabapentin 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for pain. 2. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 3. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 4. oxycodone 5 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain. disp:*30 tablet(s)* refills:*0* 5. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 8. spironolactone 25 mg tablet sig: five (5) tablet po once a day. 9. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days. 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 11. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 12. plavix 75 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: of discharge diagnosis: sigmoid diverticulitis with ruptured pelvic abscess and peritonitis atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were transferred to from an outside hospital after experiencing abdominal pain associated with bright red blood per rectum. an abdominal ct scan revealed free air within the abdominal cavity due to perforation. therefore, you underwent an emergent operation to repair a ruptured pelvic abscess. you have recovered from surgery in the hospital and have also worked with occupational therapy, physical therapy and the ostomy care rn and are now preparing for discharge to a rehab facility for ongoing recovery. followup instructions: please call for an acute care service appointment at . you should schedule this appointment for days from discharge with dr. . at this appointment you will possibly have your drain removed and your staples taken out. please follow-up with dr. , your pcp, in the next 2 weeks. this would be regarding this hospitalization if cardiology referral is needed for further follow-up of the mitral regurgitation found on your echo. you should also discusss the possibility of a repeat echo. procedure: temporary colostomy nonexcisional debridement of wound, infection or burn open and other sigmoidectomy diagnoses: unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation candidiasis of mouth anxiety state, unspecified long-term (current) use of other medications osteoporosis, unspecified other ascites knee joint replacement diverticulosis of colon (without mention of hemorrhage) chronic diastolic heart failure hip joint replacement peritonitis (acute) generalized candidiasis of skin and nails arthrodesis status arteritis, unspecified ulcer of ankle ulcer of calf other rheumatoid arthritis with visceral or systemic involvement 

Answer: The patient is high likely exposed to