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: demerol attending: chief complaint: sepsis major surgical or invasive procedure: none history of present illness: this is a 68 year-old female with a history of crohn's disease with ileostomy and abdominal fistula, who is status post enterocutaneous fistula repair at on . on whe was admitted to hosptial after a fall at home where she sustained a left clavicular fracture. while hospitalized she experienced fevers, nausea, and vomiting. her hickman catheter was removed with suspicion for line sepsis, and an abdominal ct was obtained which reportedly showed fluid collections. she was transferred to on for sepsis. past medical history: 1.crohn's disease s/p proctocolectomy and s/p total abdominal colectomy, proctectomy, and end ileostomy in . 2.incarcerated parastomal hernia s/p repair with mesh in . 3.stenosis of an ileostomy in s/p multiple operations 4.multiple enterocutaneous fistulas 5.diabetes mellitus ii 6.hypertension 7.depression social history: she takes no ethanol, prior tobacco use, quit 20 years ago. family history: non-contributory physical exam: initial physical exam - 98.3 108 104/54 16 93%ra somnolent but arousable, axox2 right chest s/p removal hickman, no drainage, no erythema rrr, b cta, no tenderness over b clavicles, tender sternum on palpation, no bruises abd soft, mildly tender, lower midline hernia, g-tube, ostomy vital and working, bs+ perineum without rectum, 2 small abrasions bilateral le wnp, no edema discharge pe - gen: nad card: rrr lungs: ctab abd: +bs, soft, nontender, nondistended - ostomy/fistulae/g-jtube intact/no leaks neuro: axox3 pertinent results: admission labs: 01:06am blood wbc-24.8*# rbc-2.77* hgb-8.3* hct-24.0* mcv-87 mch-29.8 mchc-34.3 rdw-14.9 plt ct-144*# 01:06am blood neuts-89* bands-3 lymphs-4* monos-2 eos-0 baso-0 atyps-0 metas-2* myelos-0 01:06am blood pt-15.9* ptt-34.1 inr(pt)-1.5* 01:06am blood glucose-92 urean-25* creat-2.4*# na-128* k-5.6* cl-96 hco3-18* angap-20 01:06am blood alt-21 ast-27 ld(ldh)-293* ck(cpk)-137 alkphos-360* amylase-21 totbili-0.5 01:06am blood albumin-2.5* calcium-7.7* phos-4.1 mg-1.2* ----------nutrition labs---------- date-----fe-----tibc----------trf-----alb -----47----------2.2 -----52----------3.3 -----29----------3.1 -----69----------2.7 -----76-----209--------------161-----3.0 -----90----------3.0 -----88----------2.4 -----52----------2.7 -----49----------3.1 -----18----------2.7 recent labs prior to discharge: 05:04am blood wbc-11.7* rbc-3.24* hgb-9.9* hct-28.6* mcv-88 mch-30.6 mchc-34.6 rdw-16.9* plt ct-248 04:23am blood wbc-12.6* rbc-2.60* hgb-8.1* hct-23.2* mcv-89 mch-31.2 mchc-35.0 rdw-17.8* plt ct-255 04:05am blood wbc-11.2* rbc-3.20* hgb-9.8* hct-29.1*# mcv-91 mch-30.6 mchc-33.6 rdw-18.1* plt ct-398# 04:22am blood glucose-148* urean-19 creat-0.5 na-132* k-4.3 cl-102 hco3-23 angap-11 08:04am blood glucose-179* urean-21* creat-0.5 na-131* k-5.1 cl-99 hco3-26 angap-11 07:59am blood glucose-149* urean-21* creat-0.5 na-127* k-5.6* cl-98 hco3-24 angap-11 12:52pm blood glucose-102 urean-20 creat-0.5 na-127* k-5.4* cl-96 hco3-25 angap-11 04:49am blood glucose-112* urean-20 creat-0.5 na-131* k-5.7* cl-100 hco3-27 angap-10 04:53am blood glucose-116* urean-22* creat-0.6 na-128* k-6.1* cl-96 hco3-26 angap-12 10:44am blood glucose-85 urean-23* creat-0.6 na-128* k-6.3* cl-96 hco3-26 angap-12 04:40pm blood glucose-150* urean-23* creat-0.7 na-129* k-5.0 cl-94* hco3-26 angap-14 07:17am blood glucose-151* urean-23* creat-0.6 na-132* k-4.1 cl-95* hco3-31 angap-10 05:01am blood glucose-151* urean-19 creat-0.5 na-133 k-4.1 cl-98 hco3-29 angap-10 04:32am blood glucose-163* urean-16 creat-0.5 na-130* k-3.9 cl-95* hco3-27 angap-12 03:52am blood glucose-158* urean-13 creat-0.5 na-134 k-3.5 cl-97 hco3-28 angap-13 04:53am blood albumin-2.7* calcium-8.3* phos-3.1 mg-1.7 iron-18* 10:44am blood calcium-8.2* phos-3.6 mg-1.7 04:40pm blood calcium-8.8 phos-3.9 mg-1.8 07:17am blood calcium-8.2* phos-3.9 mg-1.7 05:01am blood phos-2.6* mg-1.5* 04:32am blood calcium-7.9* phos-2.3* mg-1.5* 03:52am blood phos-2.7 mg-2.2 02:58pm blood %hba1c-5.6 -done -done 02:58pm blood tsh-3.3 ----------cultures---------- * abdominal wound- yeast, rare growth (f) * urine: consistent w/ fecal contimination (f) * blood: neg x2 (f) * c.diff: neg (f) * urine: vre (f) * blood: vre (f) * blood: neg (f) * mrsa screen: pos (f) * picc tip: neg (f) * urine: citrobacter (imipenem) (f) * urine: <10,000 colonies ct abdomen w/o contrast; ct pelvis w/o contrast reason: r/o fluid collection - infectious source field of view: 36 medical condition: 68 year old woman with h/o crohn's s/p enterocutaneous fistula takedown who came with sepsis and arf s/p fall, now with enterocutaneous fistula and leukocytosis. r/o fluid collection reason for this examination: r/o fluid collection - infectious source contraindications for iv contrast: none. history: 68-year-old woman with history of crohn's disease status post enterocutaneous fistula takedown with sepsis and acute renal failure. comparison: . technique: multidetector contiguous axial images of the abdomen were obtained following oral contrast administration. no iv contrast was used. reformatted images in the coronal and sagittal planes were obtained. findings: few images through the lung bases demonstrate no pleural effusions. the study is slightly limited by patient breathing and motion artifact. percutaneous gastrojejunostomy tube tip is in the proximal-to-mid jejunum. the patient is status post cholecystectomy. the previously seen anterior abdominal wall collection has been decompressed in the interval. there are multiple oral-contrast filled cutaneous fistulae of the anterior abdominal wall that appear to be contiguous to a small amount of free oral contrast and air in the region of the right anterior abdomen extrinsic to bowel loops (images 47-59). this collection has decreased in size compared to the prior study. no dilated bowel loops are seen. ct pelvis without iv contrast: there is a foley catheter in bladder. however, there is an unusually large amount of air in the bladder and within the inferior dependent portion there is contrast material (image 69), (also confirmed on the associated reformatted coronal and sagittal images). please note that the patient did not have intravenous contrast on today's exam and the patient's prior study with intravenous contrast was nine days ago. as such, the small amount of contrast seen in the bladder on today's exam is suggestive of an enterovesical fistula. there are enlarged inguinal nodes bilaterally. a small amount of fluid is seen adjacent to the uterus in the deep pelvis. patient is status post colectomy. impression: 1. decrease in size of small abdominal collection containing contrast which is in communication with multiple cutaneous fistulas. 2. air and contrast in the bladder is suggestive of an enterovesical fistula. t-spine xray reason: eval for fx medical condition: 68 year old woman c/o back pain reason for this examination: eval for fx indication: 68-year-old woman with back pain. t-spine, ap and lateral views: a moderate compression deformity of the t6 vertebra and a mild compression deformity of the fifth thoracic vertebra are seen. these findings are new since , . a right-sided picc line is present with its tip at the brachiocephalic/svc junction. aortic arch calcification is noted. impression: compression fractures at t5 and t6, new compared to 7/. the precise chronicity of these findings is uncertain and could be assessed with mr necessary. brief hospital course: mrs. was admitted to the surgery service on in care of dr. after being transferred from for sepsis. she had a hickman catheter during admission at , which was removed for suspicion of line sepsis and was reported to be positive for mrsa. she presented to with leukocytosis at 23, and acute renal failure with creatinine at 2.3. upon admission she was started on fluconazole and linezolid. an ophthalmology consult was obtained to rule out retinitis, secondary to suspect bacteremia/fungemia, which was negative. an echo was completed to rule out endocarditis, which was negative. two units of blood were transfused for low hematocrit. urinalysis and urine culture were collected and were negative for infection. on hd3 she experienced decreased urine output which was treated with intravenous hydration. her gastrostomy tube was rewired to a gastrojejunostomy by interventional radiology. she was then started on tube feeds. on hd4 blood cultures were sent and these were negative for infection. on hd 5 a central line was placed. tpn with nephramine was initiated. on hd6 she experienced nausea and vomiting;her abdomen was distended. she was placed npo and abdominal films were obtained which were negative for obstruction. her ostomy output was decreased, and for this, her ostomy was dilated and a catheter placed to maintain patency. because her central line was found to be initially positioned in an accessory vein, rewire attempts were made, however it was found that her left brachial cephalic vein was occluded and therefore the catheter could only be placed in an accessory hemiazygos vein. on hd 7 there was a small area of fluid collection with erythema at her midline abdomen above the ostomy site. this was incised and drained of purulent fluid and sent for culture which showed rare growth of yeast, presumptively not c. albicans. at this point in her hospital stay she was moderately depressed. physical therapy was consulted to begin rehabilitation and improve mobility, but she was not motivated to participate. psychiatry was consulted to evaluate her depressed mood. it was recommended that she continue her wellbutrin in order to allow for affect and start on dexedrine to increase her energy levels. these recommendations were followed. by hd 10 her linezolid was stopped and she was taking zosyn to treat her cellulitic areas at the midline of her abdomen. her tpn was advanced and she was getting out of bed to chair for short periods of time. she remained afebrile and her creatinine and urine output were normalizing. she continued to complain of pain at her left arm and sternum for which she was receiving iv pain medication. for this, a pca was provided. in addition to pain, she also complained of left arm weakness for which neurology was consulted to evaluate. from this consult there was some concern for cervical spine pathology; a mri was recommended. however, due to her recent history of acute renal failure, this was not completed. by hd15 her cultures were negative and she remained afebrile. hence, her antibiotics were discontinued. at hd 20 she was more participative and her mood was improved. an abdominal ct scan was performed after renal protection with hydration, mucomyst and bicarbonate. the scan showed an interval increase in the size of the anterior abdominal wall collection, which appeared to communicate with the bowel. there was an adjacent intraperitoneal collection. on hd 22 a fistula gram was performed through the patient's end ileostomy. no opacification of a fistulous tract was identified. whistle-tip catheter was placed into the ostomy and sutured into place. on hd 23 a chest ct without contrast was performed to evaluate for sternal fracture, as she continued to have reproducible chest pain and her chest xrays were negative. this showed a mildly displaced and angulated inferior manubrial fracture. on hd 24 she manifested low grade temperatures. blood and urine cultures were obtained and she was set up to have her picc line changed for possible line sepsis. ceftriaxone and fluconazole were started. at hd 27 she was found to have two enterocutaneous fistula sites adjacent to her ileostomy which were integrated into her ostomy pouch by the wound care nurse. on hd 30 her wbc count was elevated at >30 and she did not appear well. her tube feedings were stopped and zosyn was started. a ct scan of the abdomen was performed to evaluate for septic source which showed air and contrast in the bladder, suggestive of an enterovesical fistula. no significant fluid collections were noted. at this point her blood cultures drawn from the onset of her low grade temperatures were negative and her urine culture was found to have fecal contamination. she was transferred to the icu for further care. on admission to the icu she was started on vancomycin and caspofungin, in addition to her zosyn. her wellbutrin, paxil, and dexedrine were discontinued per psychiatry recommendation during this acute period. her tube feedings and tpn were continued. at this point the original picc line that was supposed to be rewired at hd 25 was still in place, as there was difficulty scheduling her for interventional radiology. this was also delayed due to her acute illness and transfer to icu. previous cultures drawn from the picc site were negative and due to her highly elevated wbc at >30, line sepsis was low on the differential for infectious source. the enterovescicular fistula supported a more likely diagnosis of urosepsis. on hd 34 repeat blood cultures were negative, mrsa and vre screens came back positive. she was doing better, was afebrile, and her leukocytosis was trending downward. her vancomycin was changed to linezolid for vre and her caspofungin was discontinued. on hd 36 she was transferred back to the floor and her picc line was exchanged over wire, with the tip sent for culture. after the picc line was changed she had an episode of hypoglycemia, with a bs of 47. she was difficult to arouse and hypotensive. her bs and pressure came back to baseline after 1 amp of d50, her cardiac enzymes were negative x 3. on hd 37 her tpn was stopped. was consulted to evaluate and treat her labile blood glucose. she was started on lantus with sliding scale coverage. at this point she continued to cry regarding pain medication. we started her on fentanyl patch, dr. talked with her regarding dependency issues with narcotics, and her diluadid was weaned. at hd 40 her sodium was consistently low and she was started on maintenance iv normal saline. when there was no response, 3% hypertonic saline was started daily. at hd 49 she continued with low sodium. her potassium was elevated to 5.7. in suspecting adrenal suppression, a cortisol stem test was completed which was within normal parameters. she was also experiencing intermittent episodes of nausea and emesis. a kub was performed and was negative for obstruction. at hd 50 psychiatry continued to evaluate. they felt that she showed some improvement since discharge from the icu, but found her to exhibit catatonic properties on physical exam. they recommended discontinuing reglan and paxil which was followed. although the cortisol stem test was normal, hydrocortisone was ordered to see if her electrolytes would normalize. fludrocortisone was started on a daily basis. her zosyn and linezolid courses were completed and bactrim was started to treat her urinary infection r/t her enterovescicular fistula. at hd 56 she was doing better from a psychosocial standpoint. she was doing better with pain and rarely asked for pain medication. she was agreeable to work with physical therapy and was walking via walker and assistance. her mood had improved and her catatonia was resolving. however, she was experiencing more nausea and vomiting and it was felt that it would be best to start back her reglan so that she could tolerate tube feeds. at hd 58 the hypertonic saline was discontinued, as it was not improving her sodium level. the reglan appeared to improve her nausea and vomiting. her tube feeds were advanced. at hd 60 it was unclear if the was improving her electrolyte imbalance and so it was stopped. at hd 62 she complained of back pain. there was an area of questionable deformity and tenderness at her thoracic spine. no ecchymosis noted. a thoracic spine film was done which showed compression fractures at t5 and t6 new from 7/. there was no history or report of injury. it was this day that her insurance company visited her in the hospital. they did not want her to stay in the hospital any longer. however they would not approve acute rehabilitation and we did not feel that it was safe to send her to a related to her need for frequent electrolyte replacement and monitoring. on hd 64 her g-tube was clamped and a soft diet was started which she tolerated well. she continued to work with physical therapy and was walking with walker. her diet was advanced to regular and she seemed to tolerate this for a couple of days until she began to have frequent emesis. her hob was elevated > 30 degrees and we limited food after 5pm however this did not decrease her vomiting. hence we un clamped her g-tube and placed her npo with allowance of ~60ml ice chips or water per hour. a kub was negative for obstruction. her reglan was increased to 10mg q6 hours. it was difficult to keep her magnesium and phosphate repleted and so we started her on magnesium injections every other day and neutra-phos twice daily. at hd69 her sodium was low and her potassium was elevated to 6.3. ekg showed peaked t-waves and cardiac enzymes were negative for acute event. she was monitored closely. she was treated with insulin/d50 and lasix. her tube feeds were changed from impact to nepro 1/2 strength. fludorocortisone was restarted. a repeat urine culture showed citrobacter sensitive to imipenem. her bactrim was stopped and imipenem started. at hd 73 she was doing better. her sodium and potassium had improved and a repeat urine culture showed <10,000 organisms. on she was discharged to acute rehabilitation in stable condition. her tube feeds were nepro 1/2 strength at 65 with 26g bene protein. her g-tube remained un clamped and she was taking ~ 60ml/hr po without problems. she was to have 5 more days of iv imipenem. she was to follow up with dr. in 3 weeks. medications on admission: trazadone neutraphos wellbutrin metclopramide sodium bicarbonate metoprolol lovenox levaquin vancomycin toradol zofran discharge medications: 1. calcium 500+d 500-125 mg-unit tablet sig: one (1) tablet po once a day. 2. sulfasalazine 500 mg tablet sig: four (4) tablets po daily (daily): please crush 2 grams and place in tube feeds daily for total of 2 grams per day. 3. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 4. insulin glargine 100 unit/ml solution sig: eight (8) units subcutaneous once a day: please give 8 units at breakfast. 5. humulin r 100 unit/ml solution sig: per sliding scale injection per sliding scale: insulin sc sliding scale q6h regular glucose insulin dose 0-60 mg/dl amp d50 61-160 mg/dl 0 units 161-200 mg/dl 3 units 201-240 mg/dl 6 units 241-280 mg/dl 9 units 281-320 mg/dl 12 units > 320 mg/dl notify m.d. . 6. fentanyl 50 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours). 7. enoxaparin 40 mg/0.4 ml syringe sig: one (1) subcutaneous qd (). 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 9. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed: 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. . 10. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po daily (daily): lansoprazole oral suspension 30 mg j tube daily . 11. acetaminophen 325 mg tablet sig: two (2) tablet po tid (3 times a day). 12. metoclopramide 5 mg/5 ml solution sig: ten (10) ml po qidachs (4 times a day (before meals and at bedtime)). 13. magnesium sulfate 50 % (4 meq/ml) solution sig: one (1) gm injection every other day (every other day): 1 gram im every other day. 14. imipenem-cilastatin 500 mg recon soln sig: five hundred (500) mg intravenous q6h (every 6 hours) for 5 days. 15. fludrocortisone 0.1 mg tablet sig: one (1) tablet po daily (daily). 16. hydromorphone 2 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for pain. 17. neutra-phos mg packet sig: one (1) packet po twice a day. discharge disposition: extended care facility: hospital - discharge diagnosis: crohn's disease enterocutaneous fistulae colovescicular fistula discharge condition: stable discharge instructions: please contact or return if you experience: * persistent nausea or vomiting * fever 101 f or greater * abdominal pain * removal or misplacement of tubes * any other concerns followup instructions: please follow up with dr. in weeks. please call for an appointment. the number is (. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances other incision with drainage of skin and subcutaneous tissue transfusion of packed cells percutaneous (endoscopic) jejunostomy [pej] injection or infusion of oxazolidinone class of antibiotics diagnoses: hypocalcemia cellulitis and abscess of trunk unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia severe sepsis unspecified fall depressive disorder, not elsewhere classified regional enteritis of unspecified site closed fracture of sternum closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury other and unspecified postsurgical nonabsorption delirium due to conditions classified elsewhere disorders of magnesium metabolism fistula of intestine, excluding rectum and anus attention to ileostomy combinations of opioid type drug with any other drug dependence, unspecified intestinovesical fistula persistent vomiting other symptoms involving nervous and musculoskeletal systems 

Answer: The patient is high likely exposed to