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: patient recorded as having no known allergies to drugs attending: chief complaint: 53m with h/o htn presents after neighbor called ems because they had not seen patient come out of the house for 1 week. when ems arrived, he was in bed, from which he had not moved, even to eat or drink, for several days due to severe l knee pain. he was disheveled and covered in his own stool. major surgical or invasive procedure: l knee arthocentesis cvl - laparoscopically assisted right colectomy history of present illness: 53m with h/o htn presents after neighbor called ems because they had not seen patient come out of the house for 1 week. when ems arrived, he was in bed, from which he had not moved, even to eat or drink, for several days due to severe l knee pain. he was disheveled and covered in his own stool. he is very tangential as a historian and repeatedly brings up a planned trip to that he cancelled this past week, almost to the point of perseverating. in the ed, a large l knee effusion was tapped and copious, "milky" material aspirated. central line placed for access. labs notable for arf, with bun 153 and cr 6.3; leukemoid wbc of 46.8; anion gap acidosis (gap 29). bld cx sent and pt received ctx 1 gram. received banana bag + 4l ns and cr down to 4.6. ed spoke to pcp , who reported that he has 3-drug htn; sometimes c/o nonspecific leg pain; last seen 2wks ago for reg visit, no specific complaints at that time. . ros: constitutional: fatigue, no(t) fever eyes: no(t) blurry vision, no(t) conjunctival edema ear, nose, throat: dry mouth, no(t) epistaxis cardiovascular: no(t) chest pain, no(t) palpitations, no(t) edema, no(t) tachycardia, no(t) orthopnea respiratory: no(t) cough, no(t) dyspnea, no(t) tachypnea, no(t) wheeze gastrointestinal: no(t) abdominal pain, no(t) nausea, no(t) emesis, no(t) diarrhea, no(t) constipation genitourinary: no(t) dysuria, foley musculoskeletal: joint pain, no(t) myalgias integumentary (skin): no(t) jaundice, no(t) rash heme / lymph: no(t) lymphadenopathy, anemia, no(t) coagulopathy neurologic: no(t) numbness / tingling, no(t) headache, no(t) seizure psychiatric / sleep: no(t) agitated, very tangential historian pain: minimal . past medical history: htn djd of r hip gout cirrhosis social history: divorced in , has lived alone since. drinks 5 drinks/day, usually rum and coke; remote tobacco use, "back when he was a kid." denies illicit/ivda. works as a taxi driver. family history: pt unsure. physical exam: tmax: 35.5 ??????c (95.9 ??????f) tcurrent: 35.5 ??????c (95.9 ??????f) hr: 78 (78 - 93) bpm bp: 106/69(79) {88/65(70) - 106/69(79)} mmhg rr: 17 (13 - 17) insp/min spo2: 100% heart rhythm: sr (sinus rhythm) wgt (current): 64.3 kg (admission): 64.5 kg height: 65 inch . general appearance: thin cardiovascular: (pmi normal), (s1: normal), (s2: normal), no(t) s3, no(t) s4, (murmur: no(t) systolic, no(t) diastolic) peripheral vascular: (right radial pulse: diminished), (left radial pulse: diminished), (right dp pulse: diminished), (left dp pulse: diminished) respiratory / chest: (expansion: symmetric), (percussion: resonant : ), (breath sounds: clear : ) abdominal: soft, non-tender, bowel sounds present, distended, scaphoid extremities: right: absent, left: absent, no(t) cyanosis, no(t) clubbing musculoskeletal: unable to stand, cannot weight bear pain in l knee skin: warm, no(t) rash: , painless nodules in flexor tendon both wrists, achilles tendons, and elbows neurologic: attentive, responds to: not assessed, oriented (to): hospital, person, movement: not assessed, no(t) sedated, tone: not assessed, tangential, borders on confabulatory . at discharge: vitals: t-98.3, hr-71, bp-134/80, rr-16, o2 sat-98% gen: nad, a/ox3 cv: rrr resp: ctab abd: +bs, nd, appropriately tender incision: midline, abdominal, portion packed with gauze extrem: no c/c/e pertinent results: 06:35am blood wbc-14.2* rbc-2.96* hgb-9.0* hct-26.3* mcv-89 mch-30.5 mchc-34.3 rdw-15.6* plt ct-198 08:50am blood wbc-46.8* rbc-2.05* hgb-7.7* hct-22.0* mcv-107* mch-37.5* mchc-34.9 rdw-18.0* plt ct-658* 06:20am blood pt-15.2* ptt-28.3 inr(pt)-1.3* 06:35am blood glucose-108* urean-15 creat-0.9 na-137 k-3.9 cl-101 hco3-30 angap-10 08:50am blood glucose-146* urean-153* creat-6.3*# na-123* k-4.8 cl-84* hco3-10* angap-34* 02:55pm blood alt-37 ast-43* ld(ldh)-281* alkphos-119* amylase-36 totbili-0.6 08:50am blood alt-15 ast-70* ld(ldh)-233 ck(cpk)-752* alkphos-230* totbili-1.3 06:35am blood calcium-7.7* phos-3.0 mg-1.5* 02:52am blood albumin-2.8* calcium-8.0* phos-4.8* mg-1.9 08:50am blood calcium-9.7 phos-10.6* mg-2.8* uricacd-16.9* iron-25* 04:00pm blood folate-8.0 06:26pm blood vitb12-840 08:50am blood caltibc-242* hapto-583* ferritn-936* trf-186* 06:26pm blood tsh-1.2 04:00pm blood hbsag-negative hbsab-negative hbcab-negative igm hav-negative 08:50am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 04:00pm blood hcv ab-negative . 7:10 am swab site: not specified source: wound 1 charcoal swab sent. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. smear reviewed; results confirmed. wound culture (preliminary): pseudomonas aeruginosa. moderate growth. . rads: kub - ileus - abd u/s - no ascites, possible cirrhosis - ct abd - small bowel dilatation up to 4.2 cm with relatively decompressed distal loops of small bowel and colon - psbo vs. ileus, cholelithiasis - kub/cxr - free air under l hemidiaphragm and dilated sb up to 5 cm with decompressed loops distally. . pathology examination procedure date diagnosis: ascending colon, segmented resection: 1. cecal perforation, 6.0 cm, with associated transmural inflammation and serositis. 2. remainder of specimen, including colonic and ileal margins is viable. 3. diverticulosis, focal. 4. partial fibrous obliteration of appendix. clinical: free air viscus perforation, perforated typhlitis. brief hospital course: 53m with acute polyarticular arthritis and acute renal failure, also 3-drug hypertension and alcoholism . acute polyarticular arthritis: although joint distribution is not classic, polys and needle shaped crystals and negative gram stain on microscopy of joint fluid is c/w gout. due to arf, nsaids and colchicine avoided early in admission. pt not complaining of pain at time and says he wants to avoid medications; rheumatology consulted, as presentation is atypical. - rheum recommended iv solumedrol 24mg iv x1 and reassessing daily. gout symptoms persisted, and worsened. continued on iv methylprednisolone 10mg iv bid post-op . gout symptoms improved, decreased swelling and pain. transitioned to po prednisone taper on . . leukemoid reaction: suspect stress response from several days of acute inflammatory illness. liquid tumor is less likely, but must be considered, especially if wbc not responding to managements directed at inflammation. patient's wbc count initially trended down. infectious work-up non-revealing. had some loose stool so sent for c. diff although abdominal exam benign, and no known recent antibiotic exposure prior to presentation. more concerning possibility was for underlying malignancy. differential notable for left shift without significant predominance of abnormal forms. leukocyte alkaline phosphatase was elevated - not c/w cml. spep/upep sent given arf and anemia and were... . acute renal failure: bun:cr ratio > 20:1 and pt has not been taking adequate po x5 days, highly suggestive of prerenal azotemia. cr decreased with aggressive fluid hydration. metabolic acidosis and hyperphosphatemia likely secondary to renal failure with inadequate acid secretion also resolved with hydration. continued to improve with iv fluids. fluid ajusted according to labwork. hyponatremia: hypovolemic, improved with ivf's. . anemia: hct low despite significant volume contraction. macrocytic, no signs of active/obvious bleeding. stools all guaiac negative. suspect alcohol bone marrow suppression + iron deficiency. transfused for hct <21 with appropriate increase to 25%. will need outpt colonoscopy--concern for underlying malignancy given anemia, and leukocytosis. . alcoholism: 5 drinks per day, last drink was 5 days prior to admission. pt with odd affect and seems confabulatory, so will empirically replete thiamine, folate. check ed tsh, b12. monitored per ciwa scale protocol- no signs of withdrawal noted during admission. scale discontinued after 11 days. . htn: antihypertensives held durign early admission due to hemodynamic instability. restarted once full volume resuscitation achieved and stable. . on general surgery consulted for complaints of abdominal distension and emesis - treated as an ileus with an ngt and had dark bilious output from the ngt - put out 1-2 liters per day. today with free air under the diaphragm per ct scan. abdomen was benign at the time, but steroid managment makes abdominal exam unreliable. also had elevated wbc, which was trended down from 40. heme-onc attributed elevated wbc as reactive leukocytosis. he was pre-op consented for exploratory laparoscopy/laparotomy with dr. . . his operative course was uncomplicated. he was routinely observed in the pacu, and transferred to 12 . pod1-he continued with ngt, npo, iv fluid hydration, and pca for pain control. iv steroids continued for managment of gout. his abdominal dressing remained cdi. attempt per nursing staff to assist patient oob to chair. due to gout flare and associated pain, patient had difficultly mobilizing. both physical and occupation therapy were consulted, and recommended short term rehab. foley remained in place for an extra day due to compromised mobility of upper extremities. foley removed pod3, patient failed to urinate, scanned bladder for >500cc of urine. he was catheterized, and was able to urinate thereafter using urinal. he continued with ngt in place for days due to increased ngt output, and prolonged ileus. ngt was removed once bowel function improved, and output decreased. he reported flatus, and tolerated a regular diet. ensure supplements were added with each meal. his abdominal incision developed some mild erythema, and serous drainage. incision was opened at bedside on , packed with moist gauze. erythema decreased. there was no increase in wbc or development of fever. on , patient reports gout pain to have resolved. he was started on po prednisone, and colchicine. he was screened for rehab placement, and was transferred for continue rehabilitation. he was advised to follow-up with pcp for colonoscopy in the future, and with rheumatology in weeks for continued management of gout. medications on admission: amlodipine 5mg daily atenolol 50mg daily triamterene/hctz 37.5/25 discharge medications: 1. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 3. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 4. triamterene-hydrochlorothiazid 37.5-25 mg capsule sig: one (1) cap po bid (2 times a day). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain for 2 weeks. 7. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 8. prednisone 10 mg tablet sig: 2.5 tablets po qd () for 3 doses: /08. 9. prednisone 20 mg tablet sig: one (1) tablet po qd () for 3 doses: /08. 10. prednisone 10 mg tablet sig: one (1) tablet po qd () for 3 doses: /08. 11. prednisone 5 mg tablet sig: one (1) tablet po qd () for 5 doses: . discharge disposition: extended care facility: healthcare discharge diagnosis: primary: typhlitis with perforation. post-op ileus gout flare post-op urine retention post-op surgical wound cellulitis . secondary: htn, djd of right hip, gout, cirrhosis discharge condition: stable tolerating a regular diet adequate pain control with oral medication discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * 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 skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or becoming progressively worse, or inadequately controlled with the prescribed pain medication. * 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. . incision care: *pack open area of incision with moist gauze in normal saline. changed twice a day, and as needed. *you may shower. pat incision dry. *avoid swimming and baths until further instruction at your follow-up appointment. *please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. followup instructions: 1. please call the office of dr. to make a follow up appointment in weeks . . 2. please make a follow-up appointment with rheumatology in weeks for further management of gout. . 3. follow-up with your pcp, . as needed. you will require a colonoscopy in the near future for routine screening and to assess all possible causes of anemia. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances arthrocentesis transfusion of packed cells open and other cecectomy laparoscopic appendectomy diagnoses: anemia, unspecified other postoperative infection cellulitis and abscess of trunk alcoholic cirrhosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia paralytic ileus retention of urine, unspecified hypovolemia removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other and unspecified alcohol dependence, continuous acute appendicitis with generalized peritonitis leukemoid reaction 

Answer: The patient is high likely exposed to