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: cymbalta / morphine / nortriptyline attending: chief complaint: increased output from midline incissional wound/vac. major surgical or invasive procedure: revision colostomy/colectomy and abdominal wound closure. history of present illness: 50m with history of anal squamous ca treated w/ chemoradiation and subsequent anal stricture requiring sigmoid colectomy, end colostomy, non-healing mucous fistula. pt underwent resiting of his ostomy and closure of a parastomal/midline incisional hernia in 5/. shortly after pt was readmitted () for fevers and was found to have a perforated ostomy with midline wound dehis and tracking fistula to ostomy. pt underwent subsequent abdominal washout and was discharged () on a methadone taper. mr. was readmitted on for reduced ostomy output and was treated with q48hr wound vac changes followed by discharge in stable condition to rehabilitation. 24 hours later mr. returned to the general surgery service for closer monitoring of the abdominal wound and evalutation of management options. of note, since initial colostomy placement, pt has had chronic abdominal pain treated with many medications. this pain has been exceedingly difficult to manage throughout numerous hospitalizations and postoperative courses requiring very large doses of narcotics on several occasions. at time of admission, pt is on methadone taper (currently 30mg tid. past medical history: anal scc anal atricture large abdominal hernia chronic abdominal pain coronary artery disease peripheral disease obstructive sleep apnea hypertension hypercholesterolemia vitamin d deficiency social history: originally from and lives with wife, no children quit tobacco 2 months ago, previously 1 ppd x 2 years. no etoh in 14 years family history: non-contributory physical exam: t- 98.2 hr 85 bp 133/68 rr 18 sat% 98% ra gen-axox3, nad, pt ambulating >tid and tolerating regular diet cv-rrr, no mrg pulm- ctabl abd- soft, mildy distended, non-tender, midline incision c/d/i with staples in place. ostomy pink, functioning with soft/semisoft content. ext- no c/c/e pertinent results: 05:45am blood wbc-10.1 rbc-3.35* hgb-8.6* hct-26.1* mcv-78* mch-25.7* mchc-33.0 rdw-16.5* plt ct-463* 06:14pm blood hct-28.2*# 03:54am blood wbc-15.4* rbc-2.89* hgb-7.3* hct-23.1* mcv-80* mch-25.3* mchc-31.6 rdw-17.1* plt ct-485* 05:50pm blood wbc-16.7* rbc-3.50* hgb-8.6* hct-27.9* mcv-80* mch-24.5* mchc-30.7* rdw-16.5* plt ct-577* 07:03am blood wbc-14.8* rbc-3.90* hgb-9.6* hct-30.8* mcv-79* mch-24.6* mchc-31.1 rdw-16.8* plt ct-593* 02:24am blood neuts-76.6* lymphs-17.6* monos-5.3 eos-0.4 baso-0.1 05:45am blood plt ct-463* 05:45am blood pt-14.8* ptt-23.6 inr(pt)-1.3* 02:24am blood plt ct-472* 02:24am blood pt-14.7* ptt-23.4 inr(pt)-1.3* 03:54am blood plt ct-485* 03:54am blood pt-16.1* ptt-28.2 inr(pt)-1.4* 05:50pm blood plt ct-577* 05:45am blood glucose-100 urean-8 creat-0.6 na-138 k-3.6 cl-101 hco3-28 angap-13 09:11am blood na-140 k-3.6 cl-100 02:24am blood glucose-90 urean-9 creat-0.8 na-138 k-3.8 cl-102 hco3-28 angap-12 03:54am blood glucose-100 urean-9 creat-0.7 na-137 k-4.2 cl-103 hco3-26 angap-12 05:50pm blood glucose-125* urean-9 creat-0.8 na-140 k-4.7 cl-102 hco3-29 angap-14 07:03am blood glucose-198* urean-8 creat-0.8 na-137 k-4.9 cl-101 hco3-25 angap-16 09:10am blood glucose-112* urean-8 creat-0.7 na-137 k-4.4 cl-98 hco3-27 angap-16 08:45pm blood glucose-131* urean-8 creat-0.8 na-137 k-4.5 cl-98 hco3-30 angap-14 05:45am blood calcium-8.5 phos-4.8* mg-1.7 09:11am blood mg-1.7 02:24am blood calcium-8.6 phos-3.9 mg-1.8 03:54am blood calcium-8.2* phos-3.3 mg-1.9 05:50pm blood calcium-8.9 phos-3.9 mg-2.2 07:03am blood calcium-8.8 phos-5.2* mg-2.3 09:20pm blood calcium-8.6 phos-5.2* mg-1.8 09:10am blood calcium-9.1 phos-5.8*# mg-2.1 brief hospital course: the patient was readmitted () to the inpatient unit from a rehabilitation hospital as it was felt that there was a greater amount of in the patient's abdominal wound and was therefore no longer appropriate for the facility. on admission the patient was noted to have a wet to dry saline dressing placed in the midline abdominal wound which was accumulateing a moderate amount brown liquid . a new vac dressing was placed with a white sponge dressing to the base of the wound with a black sponge dressing to suction. it was decided that the patient wound remain in house for close monitoring. on hospital day four () the patient accumulated liquid in the vac dressing. the vac was subsequently changed on a roughly q2day cycle (, , , , , ). 30-60 minutes prior to each vac change the patient was medicated with 1-1.5mg ativan and morning methadone done given high degree of anxiety and pain the patient felt with wound examination. gabapentin therapy was also increased to 600mg three times daily to help with pts anxiety/pain. on hospital day 11 () the vac dressing became compromised by more solid/pasty and required changing twice in the same day. on , patient was taken to the or for an ostomy revision and fistual take down. post-operatively he was transferred to the for pain management. chronic pain service was consulted preoperatively to help establish a plan for the patient's post-operative pain control. post-op, mr. pain was managed on scheduled methadone (25mg iv q3h), bupivicane epidural, and ketamine drip but was changed (pod#1) to: methadone pca (1 mg bolus q10min, 1 mg basal rate), bupivicane epidural, gabapentin 600 mg tid, ativan 0.5-1 mg q4h. pt's pain remained very well controlled for remainder of hospitalization. pt was weaned off the pca and epirdural and transitioned to oral narcotic pain medication on and was transferred to the floor on . pt continued to do well on 900 mg gabapentin tid, ativan 1mg q6h, methadone 20/25mg qam/qpm, with methadone 2.5mg q4h prn for breakthrough pain. he was tolerating a regular diet and his ostomy was functioning well. pt was able to get out of bed to chair and ambulate for short periods. - pt was transfered to general surgery floor where he continued to ambulate tid, was advanced to a regular diet, and tolerate lower dose/frequency pain medications. - pt's ativan was decreased to 0.5 q6h prn anxiety the patient remained stable on the prescribed pain regimen and had no acute issue the weekend prior to discharge. a physical therapy consult was ordered and the patient was cleared for home. after much reluctance from from the patient, and collaboration between the surgical team, nursing, physical therapy, case managment, and patient relatons, the patient was discharged to home with visiting nursing for a home safety evaluation. medications on admission: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. gabapentin 300 mg capsule sig: two (2) capsule po tid (3 times a day). 5. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po every six (6) hours as needed for constipation. 6. methadone 10 mg tablet sig: two (2) tablet po tid (3 times a day): methadone to be tapered to 15mg tid on and to be tapered by 5mg per dose every 3-4 days. 7. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qsat (every saturday). 8. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for bp. 10. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 11. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 12. lorazepam 1 mg tablet sig: one (1) tablet po once (once) as needed for dressing change for 1 doses. discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for bp. 3. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety: do not drink alcohol or drive a car while taking this medication. do not take if having increased sedation. . disp:*30 tablet(s)* refills:*0* 4. gabapentin 300 mg capsule sig: three (3) capsule po tid (3 times a day). disp:*270 capsule(s)* refills:*0* 5. magnesium hydroxide 400 mg/5 ml suspension sig: five (5) ml po twice a day as needed for constipation. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 8. acetaminophen 325 mg tablet sig: 1-2 tablets po every hours as needed for pain: do not exceed 4000mg per day. 9. methadone 5 mg tablet sig: four (4) tablet po once a day in the morning: do not consume alcohol or drive a car while taking this medication. decrease the dose by 2.5 mg every 3 days. disp:*44 tablet(s)* refills:*0* 10. methadone 5 mg tablet sig: five (5) tablet po qhs (once a day (at bedtime)): do not consume alcohol or drive a car while taking this medication. decrease your dose by 2.5 mg every 3 days until you follow-up with chronic pain. . disp:*65 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: perforated ostomy with dehiscence of midline abdominal wound and fistula between ostomy and wound. discharge condition: stable mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the general surgery service from rehabilitation center for increased output from your ostomy-wound fistula eventually requiring revision colostomy and midline wound closure. please call your doctor or go to the emergency department if: *you experience new chest pain, pressure, squeezing or tightness. *you develop new or worsening cough, shortness of breath, or wheeze. *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 an unusual discharge. *your pain is not improving within 12 hours or is not under control within 24 hours. *your pain worsens or changes location. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *you develop any concerning symptoms. general discharge instructions: please resume all regular home medications, unless specifically advised not to take a particular medication. please take any new medications as prescribed. please take the prescribed analgesic medications as needed. you may not drive or heavy machinery while taking narcotic analgesic medications. you may also take acetaminophen (tylenol) as directed, but do not exceed 4000 mg in one day. please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. avoid strenuous physical activity and refrain from heavy lifting greater than 10 lbs., until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. please also follow-up with your primary care physician. incision care: *please call your surgeon or go to the emergency department if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until cleared by your surgeon. *you may shower and wash incisions with a mild soap and warm water. gently pat the area dry. *staples will be removed at your follow-up appointment. bulb suction drain care: *please look at the drain site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warmth, and fever). *maintain the bulb on suction. *record the color, consistency, and amount of fluid in the drain. call the surgeon, nurse practitioner, or vna nurse if the amount increases significantly or changes in character. *empty the drain frequently. *you may shower and wash the drain site gently with warm, soapy water. you may also wash with half strength hydrogen peroxide followed by saline rinse. *keep the insertion site clean and dry otherwise. place a drain sponge for cleanliness. *avoid swimming, baths, and hot tubs. do not submerge yourself in water. *attach the drain securely to your body to prevent pulling or dislocation. monitoring ostomy output: *keep well hydrated. *replace fluid loss from ostomy daily. *avoid drinking only plain water. include gatorade and/or other vitamin drinks to replace fluid. *try to maintain ostomy output between 500ml to 1500ml per day. *if ostomy output exceeds 1 liter, take 4mg of imodium, repeat 2mg with each episode of loose . do not exceed 16 mg in one day. call dr. office with any issues. continue to care for your ostomy as instructed by the ostomy nurses. you will see , dr. in the office for staple/drain removal monday of next week. you will be sent home with prescriptions for our methadone. an appointment has been made for you with the chronic pain clinic, you will have enough medication to get you through to this time. at your clinic appointment the will write you a new prescription for methadone. you will be on a methadone taper as follows. morning dose evening dose 7/19: 20 mg 25 mg : 20 mg 25 mg : 20 mg 25 mg : 17.5 mg 22.5 mg : 17.5 mg 22.5 mg : 17.5 mg 22.5 mg : 15 mg 20 mg : 15 mg 20 mg : 15 mg 20 mg : 12.5 mg 17.5 mg : 12.5 mg 17.5 mg : 12.5 mg 17.5 mg : 10 mg 15 mg : 10 mg 15 mg : 10 mg 15 mg : 7.5 mg 12.5 mg : 7.5 mg 12.5 mg you will be given a prescription for the medication ativan which is helping you with pain and anxiety. please take only when needed. followup instructions: please follow up with dr. office next monday at 1330, call with questions. you have been scheduled an appointment with chronic pain service: provider: , md phone: date/time: 2:10 primary care provider , . , phone: call to make an appointment to be seen. ** primary care provider would like call from the vna when you make your first home visit for an update** you have been scheduled an appointment with pain psychology: provider: phone: date/time: 10:00 procedure: other partial resection of small intestine small-to-small intestinal anastomosis other revision of stoma of large intestine diagnoses: other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) other chronic pain anemia, unspecified unspecified essential hypertension peripheral vascular disease, unspecified accidental puncture or laceration during a procedure, not elsewhere classified pulmonary collapse disruption of external operation (surgical) wound unspecified vitamin d deficiency persistent postoperative fistula personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus other colostomy and enterostomy complication surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other acute postoperative pain 

Answer: The patient is high likely exposed to