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: morphine / compazine / penicillins / codeine attending: chief complaint: abdominal pain. major surgical or invasive procedure: l subclavian line placement. history of present illness: briefly, this is a 40 yo m with a hx of ulcerative colitis with ileoanal pouch then diverting ileostomy with multiple hospital admissions for abdominal pain, diarrhea, and brbpr which have been dx'ed as uc flares, chronic pouchitis, small bowel obstructions, c. difficile colitis. the pt now presents with his usual sx of abd pain, brbpr and n/v. he was recently treated at admitted to for 8 days for similar symptoms including nausea, large stool output, and brbpr, he was treated with supportive care and pain control, and then discharged home. the pt returned to on the following day for recurrent symptoms. in the past, the pt has recieved large doses of iv dilaudid, up to 6mg iv q4, as per records in poe to treat his abd pain, the pt remains very insistent that 6 mg of iv dilaudid is the only treatment that really works to treat his pain. . in ed, central line placed. given dilaudid 4mg, flagyl 500mg, and promethazine. continued to complain of pain. pt was transferred to with tachycardia to 170's, hypertension, and hypoxia. abg revealed 7.38/54/57/lactate 3.8 on 10l face mask. he was given narcan for somulence without a change in his vitals. he was a&ox3; answering questions appropriately. he denies cp, change in baseline abdominal pain, n/v, cough, weakness, or numbness. he notes chills and mild dyspnea. he had received a dose of iv dilaudid for pain in addition to his standing regimen of oxycontin 80 tid and sc dilaudid 6 mg q 3 prn. past medical history: 1. proctocolectomy with ileal pouch - anal anastamosis: 10/03 : loa for small bowel obstruction. at this time the ileostomy was closed, with end to end anastomosis of small intestine to resume flow through intestines through to the ileal pouch and rectum. : ileostomy replaced because of recurrent symtoms which "quite frankly were never clearly delineated" per op note. symtoms were thought to be possibly relating to flow through ileoanal pouch. 3. inflammatory bowel disease - dx 22 years ago 4. grand mal seizure disorder s/p motorcycle accident in 5. chronic back pain with c-spine fx s/p mva 4. iron deficiency anemia 5. narcotic dependence 6. recurrent c. difficile enteritis 7. anxiety 8. gerd 9. postoperative multifocal aspiration pneumonia with parapneumonic effusion 10. lysis of adhesions and ileostomy take-down: social history: married x 25 years. lives with his wife and children on the water in . used to work in law enforcement. + marijuana about 3 times per week, no ivdu. no tob or etoh in last 20 yrs family history: his mother had "crohn's disease" and died at the age of 63 from colon cancer. his father is still alive, at age 79, without any known health problems. his 5 brothers and one sister are all alive and healthy. physical exam: physical exam: t 97.7 bp 144/80 hr 94 rr 20 sat 98% ra gen: appears uncomfortable, nad hennt: mmm, anicteric, mmm neck: no lad, jvd cv: rrr, no m/r/g lungs: ctab abd: soft, tender to palpation diffusely, no rebound/guarding. bs+. ileostomy site without surrounding erythema, c/d/i. ileostomy bag with tan-colored stool. ext: no edema, strong dp/pt pulses bilaterally pertinent results: cxr : impression: improving multilobar pneumonia and resolution of right pleural effusion. . upper ext us : impression: no evidence of dvt. . chest ct : impression: 1. limited study for evaluation of pulmonary embolism due to suboptimal opacification of the pulmonary arteries. however, no central pulmonary embolus identified. 2. coronary artery calcification. 3. progression of multifocal consolidation in bilateral lungs, associated with lymphadenopathy, probably representing worsening multifocal pneumonia. . ct abd : impression: 1no evidence for bowel obstruction, bowel wall ischemia or surrounding inflammatory fat stranding to explain the patient's symptoms. no interval change in the appearance of the bowel and anastamosis since the prior exam. . 11:09am glucose-54* urea n-12 creat-0.6 sodium-144 potassium-3.6 chloride-105 total co2-28 anion gap-15 11:09am alt(sgpt)-115* ast(sgot)-43* alk phos-84 tot bili-0.2 11:09am hbsag-negative hbs ab-negative hbc ab-negative igm hav-negative 11:09am hcv ab-negative 11:09am wbc-15.7* rbc-3.78* hgb-11.0* hct-33.8* mcv-89 mch-29.1 mchc-32.5 rdw-14.0 11:09am plt count-249 02:30am glucose-105 urea n-16 creat-0.7 sodium-138 potassium-4.1 chloride-100 total co2-28 anion gap-14 02:30am alt(sgpt)-144* ast(sgot)-68* ld(ldh)-203 alk phos-121* amylase-40 tot bili-0.2 02:30am lipase-15 02:30am albumin-3.7 calcium-9.1 phosphate-3.5 magnesium-1.9 02:29am lactate-2.4* k+-4.1 12:05am wbc-15.1*# rbc-3.84* hgb-11.9* hct-34.3* mcv-90 mch-31.1 mchc-34.7 rdw-14.0 12:05am neuts-84* bands-0 lymphs-6* monos-4 eos-0 basos-0 atyps-6* metas-0 myelos-0 12:05am plt count-262 12:05am urine color-straw appear-clear sp -1.025 12:05am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-7.0 leuk-neg brief hospital course: a/p: 41 yo m uc s/p colectomy, ileoanal pouch, ileostomy, multiple procedures, multiple admissions, narcotic seeking behavior, with recurrent uc flares, p/w n/v and diarrhea, brbpr, elevated transaminases. . 1. abd pain: the pt initially presented with symptoms of abdominal pain which the pt described as very severe as well as an elevated wbc and mildly elevated lfts. the inital ct scan of the abdomen was negative. the initial impression was that the pt had uc flare vs gastroenteritis. stool cx and c. diff were found to be negative. there was a high suspicion that there was a component of narcotic seeking as well as described below. the pt's symptoms of pain improved over the subsequent days, with increasing levels of narcotic pain regimen, avoiding iv dilaudid, using po oxycontin and sc dilaudid for breakthrough pain relief. the pt stated that mesalamine or rectal anusol or mesalamine was not helpful for the pain relief. the pt has a long history of chronic flares of abdominal pain which have involved recurrent colonoscopies/egd(6 over the past 1-2 years) as well as multiple surgical operations which have included total colectomy, ileostomy diversion, reveral of ileostomy, replacement of the previously reversed ileostomy. these procedures and studies have been unable to obtain a definitive diagnosis or treatment for this unfortunate patient's refractory pain and inflammatory symptoms. the gi consultants agreed that a crohn's was a likely diagnosis given the symptoms although none of the pathology specimens or scoping procedures definitively demonstated the dx. the initial total colectomy specimen in showed no active colitis. given this history, a plan for conservative treatment was favored, with the idea to reserve the pt from further risks of procedures or surgeries only if there would be a clear benefit to the patient. the gi as well as surgery consultants were called to evaluate whether there may be such options to provide the patient a benefit for his symptoms. the gi consultants initially considered a diagnostic scope procedure, although later decided against the procedure after the pt required icu transfer for sepsis. the surgery consultants on dr. team evaluated the pt and recommended that surgery to staple off the efferent limb of the ostomy to cut off the flow of stool to the ileal pouch. the goal was to decrease the symtoms of inflammation and also of dribbling of stool. . 2 sepsis/pneumonia: on hd#3, the pt developed respiratory distress and oxygen desaturation. his situtaion deteriorated despite increasing oxygen, and he was transferred to with tachycardia to 170's, hypertension, and hypoxia. abg revealed 7.38/54/57/ lactate 3.8 on 10l face mask. he had received a dose of iv dilaudid for pain in addition to his standing regimen of oxycontin 80 tid and sc dilaudid 6 mg q 3 prn. there was a concern that he may have aspirated. the chest ct showed multi-focal consolidation c/w pneumonia. the pt developed wbc to 20 as well as fever to 104. the pt was given levo/flagyl, with coverage later expanded to add vanc and aztrenam given the allergy to penicillin. the pt gradually improved clinically over the subsequent days. f/u cxr pa/lat showed resolving of the infiltrates. the vital signs as well as the wbc count stabilized. the pt was able to be discharged to home in stable condition on with a prescription to continue abx treatment for the pna with metronidazole and cefpodoxime to continue for 8 days to complete a 14 day course of abx. . 3. narcotic dependence: the has been difficulty with coordination of the pt's narcotic prescribing in the past. the pt has a history of missing most of his outpatient appointments. he presents as an inpatient and has received the narcotics. mr has mutliple admissions over the past year at as well as . he refuses to see the pain clinic at since he states that he had a negative experience with the physicians. the pt agreed to an appointment at the pain clinic. this clinic was called to establish an appoinment for the pt. the receptionist stated that the pt has missed several scheduled appointment's there in the past and has not attended any of his appointments. the staff there is familiar with mr. however from being consulted to see him as an inpatient at . an attempt was made to help acheive better coordination in the pt's narcotic medicines. the primary care physician was . the pt was explained that he would have to go through his pcp to have narcotic pain medicines in the future. . 4. anemia: the pt has a chronic anemia. laboratory work-up was consistent with multi-factorial cause, low iron and chronic disease. given the h/o chronic gi irritation and brbpr, the pt was directed to take supplemental iron. . 5. h/o seizure: anti-epileptics were continued. 6. chronic back pain: cont oxycontin. 7. fen: npo, ivfs. follow lytes. 8. ppx. ppi medications on admission: pantoprazole40 mg po q24h levetiracetam 1000 mg po bid oxcarbazepine 300 mg po bid mesalamine 400mg dr alprazolam 2 mg po oxycodone 80 mg sustained release po q8h clonazepam 2 mg po bid phenergan prn canasa 500 mg suppository twice a day discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 3. oxcarbazepine 300 mg tablet sig: one (1) tablet po bid (2 times a day). 4. mesalamine 250 mg capsule, sustained release sig: four (4) capsule, sustained release po (4 times a day). 5. acetaminophen 325 mg tablet sig: one (1) tablet po q4h (every 4 hours). 6. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 7. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension sig: 15-30 mls po (4 times a day) as needed. 8. polysaccharide iron complex 150 mg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*2* 9. cefpodoxime 200 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 8 days. disp:*16 tablet(s)* refills:*0* 10. metronidazole 500 mg tablet sig: one (1) tablet po every eight (8) hours for 8 days. disp:*qs tablet(s)* refills:*0* 11. clonazepam 2 mg tablet sig: one (1) tablet po twice a day. disp:*30 tablet(s)* refills:*0* 12. alprazolam 2 mg tablet sig: one (1) tablet po four times a day as needed for anxiety. disp:*40 tablet(s)* refills:*0* 13. oxycodone 80 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po q8h (every 8 hours). disp:*90 tablet sustained release 12hr(s)* refills:*0* 14. oxycodone-acetaminophen 10-325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain for 10 days. disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: pneumonia abdominal pain ulcerative colitis flare narcotic dependence anxiety discharge condition: stable. discharge instructions: you must follow up as described below. if you have worsening shortness of breath, chest pain, fevers, or chills, please return to the ed or call dr. . followup instructions: please follow up with dr. for gi surgery by . they would like to schedule you for surgery as soon as possible. you must attend your appointment with dr. , your pcp on at 3:00 p.m. in the building. if you do not attend this appointment you must call and cancel and reschedule at . you will not be able to get refills on your prescriptions unless you see dr. . procedure: venous catheterization, not elsewhere classified transfusion of packed cells diagnoses: unspecified septicemia severe sepsis other convulsions opioid type dependence, continuous acute respiratory failure pneumonitis due to inhalation of food or vomitus iron deficiency anemia, unspecified ulcerative colitis, unspecified lumbago ileostomy status 

Answer: The patient is high likely exposed to