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: meperidine attending: chief complaint: fever, cough urinary frequency major surgical or invasive procedure: picc placement r nephrostomy replacement history of present illness: 60 yo woman with endometrial/cervical cancer s/p chemo/xrt c/b severe radiation cystitis/colitis s/p colectomy resulting in short gut syndrome), enterocutaneous fistula, vesiculopelvic fistula s/p bilat nephrostomy tubes, chronic rectal bleeding, here w/ fever and malaise and abdominal pain. admitted to micu for closer monitoring. most recently admitted for hydronephrosis and line bacteremia (cn staph), noted at that time to have high alk phos (3000s) and elevated bili (as high as 5) thought to be tpn induced cholestasis. completed vanco . . usoh since discharge until 4 days prior to admission. developed fever, chills, then developed non-productive cough 2 days prior to admission. one day prior to admission, noted chest pain across lower chest, but predomininantly on l under breast, worse with deep inspiration. also noted increasing urinary frequency. denies nausea, vomiting, increased abdominal pain (has "surface abdominal pain" chronically - "it's the muscles"). . in ed, noted to be mildly hypotensive to 80s. given two liters of fluid with good response. received vancomycin/zosyn. cxr revealed no pneumonia, but some degree of atelectasis. she also spiked temp t o101. kub revealed dilated loops of bowel, but no overt evidence of obstruction. cta chest, abdomen/pelvis was pending at the time of this note. past medical history: 1. endometrial/cervical cancer 2. s/p tah in (due to uterine cancer) 3. chylous ascites 4. colectomy, cholecystectomy, and ileostomy (, likely related to radiation bowel damage.) 5. small bowel removal and ileostomy () 6. s/p ventral hernia w/ repair 7. pe s/p ivc filter 8. anxiety 9. bronchitis () 10. pneumonia () 11. nephrostomy tube replacements, multiple (last on l) 12. hyperbilirubinemia and hyper alkaline phosphatemia thought to be tpn induced chronic cholestasis. 13. anemia of chronic disease 14. vre social history: lives with her husband and has 2. denies current alcohol use. had been banking executive prior to development of health issues. smokes + ppd for 19 years. family history: father 83 (deceased, cva, mi); mother (deceased, 92, cva); brother (79, esophageal cancer); sister (60s, colon cancer, lung mass, afib) physical exam: vs t 98.1 bp 105/52 (105-116/54-66) hr 112 (112-139) rr25 o298% general: nad, mild diaphoretic, tachypneic heent: icteric sclerae, eomi, dry mm neck: jvp ~6cm, supple, no lad cardiovascular: rrr, tachy, s1, s2, reg, no murmurs lungs: mild tachypenia, ctab abdomen: soft, tender diffusely, no rebound, no guarding, suprapubic fistula with dressings dry and intact back: nephrostomy tube and sites intact, no erythema or tenderness, clear urine. extremities: warm, 2+ pitting edema in bilat lower extremities r>l neuro: a/ox3. pertinent results: 10:30am blood wbc-4.5 rbc-3.10*# hgb-10.6*# hct-32.1*# mcv-104* mch-34.2* mchc-33.0 rdw-19.3* plt ct-171 10:30am blood neuts-71.7* lymphs-12.5* monos-14.6* eos-0.8 baso-0.5 10:30am blood glucose-106* urean-33* creat-0.6 na-146* k-3.4 cl-108 hco3-32 angap-9 10:30am blood alt-44* ast-58* ck(cpk)-8* alkphos-* amylase-6 totbili-5.2* dirbili-3.3* indbili-1.9 10:30am blood lipase-7 04:45am blood ggt-312* 10:30am blood totprot-6.0* albumin-2.6* globuln-3.4 calcium-9.0 phos-2.0* mg-2.1 03:07pm blood lactate-2.3* 05:22am blood wbc-6.2 rbc-2.35* hgb-7.8* hct-24.3* mcv-103* mch-33.3* mchc-32.2 rdw-18.4* plt ct-205 05:22am blood glucose-124* urean-39* creat-1.0 na-133 k-5.3* cl-103 hco3-26 angap-9 05:22am blood alt-48* ast-52* ld(ldh)-85* alkphos-2129* totbili-3.6* 04:45am blood ggt-312* 05:22am blood calcium-9.6 phos-4.0 mg-1.9 . . cxr : the left upper extremity approach picc line has been removed. there are stable bilateral pleural effusions, left greater than right. there is marked stability of the retrocardiac opacity previously noted consistent with left lower lobe collapse. impression: aside from the removal of the left upper extremity picc line, there is little interval change again demonstrating left lower lobe collapse and bilateral pleural effusions, left greater than right. . single upright ap abdominal radiograph: in the right lower quadrant, there are two loops of dilated small bowel measuring up to 3.8 cm. no other loops of dilated bowel are seen. there is evidence of numerous prior procedures including bilateral nephrostomy tubes, ivc filter, and clips in the pelvis and scattered throughout the abdomen. no free air is seen under the hemidiaphragms. colostomy bag is noted in the right lower abdomen. . ct chest, abd/pelivs: impression: 1. no evidence of pulmonary embolism. 2. bilateral pleural effusions with compressive atelectasis, unchanged. 3. unchanged appearance of extensive radiation changes in the pelvis. 4. bilateral nephrostomy tubes. 5. no intrahepatic biliary dilatation. 6. generalized soft tissue edema. 7. no evidence of small bowel obstruction. . fistulogram: enterocutaneous fistula with no evidence of abscess. . unilat lower ext veins study date of 11:21 am 1. no evidence of dvt within the visualized portion of the left common femoral, superficial femoral, and popliteal veins. 2. monophasic waveform within the left common femoral, superficial femoral, and popliteal veins, indicating limited transmission of both respiratory variation and change in pressures from valsalva. these findings are most consistent with an occlusion within the left common or external left iliac vein. there is normal waveform demonstrated within the right common femoral vein indicating that the lesion is unlikely to be within the ivc. review of a prior ct torso from shows compression upon the left external iliac vein by an overlying fluid filled presumed loop of bowel, this finding may account for such a monophasic waveform. . foot ap,lat & obl right study date of 6:01 pm no evidence of fracture or dislocation. brief hospital course: 60 yo f h/o endometrial/cervical ca s/p xrt c/b bowel obstruction leading to colectomy and short gut syndrome on tpn, who was admitted to the micu for klebsiella urosepsis, abdominal wound infection with . . * fever: patient continue to spike temperature while on cipro for uti and vanco for wound infection. potential sources of infection included uti, wound infection, c.diff. -picc was pulled and cultured, but without growth. -wound culture from abd grew and streptococcus -blood cultures with no growth -initial urine culture grew klebsiella. subsequent urine culture grew yeast. -initially on ciprofloxacin and vancomycin, but cipro broadened to zosyn given persistent fevers. also started on fluconazole given persistant fevers with funguria. after afebrile x 48 hours therapy was narrowed on narrowed therapy to levofloxacin (to cover klebsiella, ) and fluconazole. remained afebrile for subsequent hospitalization. will complete 2 weeks course of iv levofloxacin and fluconazole. . * hyperbilirubinemia: patient has history of hyperbilirubinemia and elevated alkaline phosphatase felt secondary to cholestasis in setting of tpn. high ggt and minimally elevated ast and alt consistent with this diagnosis. -treated w/ ursodiol. -abd ct did not demonstrate acute hepatic pathology. . * nutrition: short gut syndrome. clears. initially held on tpn while awaited blood culture results and resolution of fever, on ppn instead. -picc line placed after afebrile x 48 hours * tachycardia: hr elevated throughout hospital stay even after fever defervesed. ekg demonstrated sinus tach w/ ectopy. given risk for dvt/pe, u/s lower extremities were obtained and were negative for dvt. likely secondary to dehydration, especially given high ostomy output. . * anemia: likely multifactoral. macrocytic, although b12 and folate levels wnl. iron studies indicate acd. was maintained on epogen; received 1 u prbcs on day of discharge, and tpn contained folate. . -renal/gu: initially klebsiella urosepsis. subsequent urine cultures from nephrostomy tubes grew yeast. will continue antibiotics and antifungal agents as above. r nephrostomy tube replaced for poor output and subsequently drained well. . *orthostatic hypotension: patient was to be discharged but became orthostatic. in conjuction w/ increase in bun and cr over prior days, felt secondary to dehydration. patient received additionsl fluid boluses and 1 l prbcs. . *prophylaxis: given high risk for dvt, prescribed heparin and pneumoboots, but patient repeatedly decline these treatments. . *goals of care: given ms. susceptibility to infections, discussion was initiated in conjunction with regarding goals of care. these discussions will be continued as an outpatient. ms. did confirm that she is dnr/dni. medications on admission: 1. ativan p.r.n. 2. mirtazapine 15 mg 3. epogen five times per week 4. tpn 5. vancomycin (completed ) 6. ursodiol tid discharge medications: 1. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 2. 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* 3. levofloxacin 25 mg/ml solution sig: seven y (750) mg intravenous once a day for 12 days. disp:*qs qs* refills:*0* 4. tpn electrolytes solution sig: one (1) tpn solution intravenous once a day: 2.2 liters; 300g dextrose; 96g amino acids; 175 nacl; 100 naacetate; 20 napo4; 45 kcl; 5 kac; 15 mgso4; 8 cagluc. **50 g fats twice weekly only** cycle over 12 hours. disp:*qs qs* refills:*2* 5. picc sig: line care per protocol once a day. disp:*qs * refills:*2* 6. fluconazole in saline(iso-osm) 200 mg/100 ml piggyback sig: one (1) intravenous once a day for 12 days. disp:*qs qs* refills:*0* 7. ursodiol 300 mg capsule sig: one (1) capsule po tid (3 times a day). 8. lorazepam 1 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 9. octreotide acetate 100 mcg iv q8h 10. iv fluids please administer 1 l ns after each tpn order. thanks 11. outpatient lab work thursday : please draw cbc, chem10, total bilirubin, alkaline phosphatase, ast, alt. 12. outpatient lab work qmonday blood draws: cbc, chem10. please release to nutritionist for tailoring tpn order. 13. epoetin alfa 10,000 unit/ml solution sig: units injection 5 times per week. disp:*qs qs* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: - klebsiella urosepsis - cellulitis - candidal pyelonephritis - hyperbilirubinemia, elevated alkaline phosphatase (likely secondary to cholestatis related to chronic tpn) . secondary diagnoses: -endometrial/cervical cancer s/p tah in (due to uterine cancer) -chylous ascites -colectomy, cholecystectomy, and ileostomy (, likely related to radiation bowel damage.) -small bowel removal and ileostomy () -pe s/p ivc filter -nephrostomy tube replacements, multiple (last on l) -anemia of chronic disease discharge condition: stable discharge instructions: you were hospitalized and treated for a serious infection, and found to have a urinary tract infection and skin infection. the urinary tract infection was serious and caused a dangerously low blood pressure that required admission to the intensive care unit. . you were also found to have elevations in some liver tests; but imaging of your liver was normal. take all medications as directed. you will need to receive antibiotics by vein for several weeks. attend all follow up appointments. if you develop fever, chills, shortness of breath, chest pain, worsening or severe abdominal pain, persistant nausea/vomiting, or any other symptom that concerns, contact your primary doctor or if unavailable, go to the emergency room. followup instructions: please follow-up with dr. at 12:20 pm. . you will need to have blood tests to help your doctor follow your liver function and to help determine your tpn prescription . provider: ,two date/time: 7:00 provider: west phone: date/time: 8:30 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances transfusion of packed cells replacement of nephrostomy tube diagnoses: cellulitis and abscess of trunk friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site candidiasis of other urogenital sites hypopotassemia personal history of malignant neoplasm of other parts of uterus pulmonary collapse dysthymic disorder hypotension, unspecified methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site other specified disorders of biliary tract personal history of venous thrombosis and embolism dehydration other and unspecified postsurgical nonabsorption tachycardia, unspecified fistula of intestine, excluding rectum and anus orthostatic hypotension jaundice, unspecified, not of newborn pyelonephritis, unspecified attention to ileostomy intestinovesical fistula 

Answer: The patient is high likely exposed to