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: ambien attending: chief complaint: abdominal pain major surgical or invasive procedure: re-opening of laparotomy open cholecystectomy small bowel resection roux-en-y duodeno-jejunosotmy small bowel stricture-plasty x 10 j-tube placement history of present illness: this is a 45 year old male who presented from with a 12 hour history of abdominal pain, nausea and vomitting and diarrhea. a ct revealed free fluid and free air with perforation of the duodenum. he was transfered via med-flight and intubated just prior to departure. hisa o2 sats were in the low 80's. he was started on dopamine for pressure support and received 7.5 liters of crystalloid. past medical history: s/p bilroth ii ', crohn's, anemia, depression, pud physical exam: vs: 99.3, 141 sinus tach, 112/57, 14, 92% intubated gen: intubated, perrl, mucous membrane dry cv: tachy, regular pulm: diffusely coarse bs abd: distended, firm, reducable umbilical and right groin hernia, guaic negative ext: no edema pertinent results: cardiology report echo study date of patient/test information: indication: endocarditis. ? height: (in) 70 weight (lb): 165 bsa (m2): 1.93 m2 bp (mm hg): 128/69 hr (bpm): 88 status: inpatient date/time: at 16:21 test: portable tte (complete) doppler: full doppler and color doppler contrast: none tape number: 2006w031-0:13 test location: west sicu/ctic/vicu technical quality: adequate referring doctor: dr. measurements: left atrium - long axis dimension: 3.6 cm (nl <= 4.0 cm) left atrium - four chamber length: 5.1 cm (nl <= 5.2 cm) right atrium - four chamber length: 4.6 cm (nl <= 5.0 cm) left ventricle - ejection fraction: >= 75% (nl >=55%) aorta - valve level: 3.5 cm (nl <= 3.6 cm) aorta - arch: *3.2 cm (nl <= 3.0 cm) mitral valve - e wave: 0.8 m/sec mitral valve - a wave: 0.4 m/sec mitral valve - e/a ratio: 2.00 interpretation: findings: left atrium: normal la size. right atrium/interatrial septum: normal ra size. left ventricle: normal lv wall thicknesses and cavity size. normal regional lv systolic function. hyperdynamic lvef. tvi e/e' < 8, suggesting normal pcwp (<12mmhg). no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: normal mitral valve leaflets with trivial mr. no mvp. tricuspid valve: normal tricuspid valve leaflets with trivial tr. indeterminate pa systolic pressure. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. general comments: based on aha endocarditis prophylaxis recommendations, the echo findings indicate a low risk (prophylaxis not recommended). clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. conclusions: the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). tissue velocity imaging demonstrates an e/e' <8 suggesting a normal left ventricular filling pressure (<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: no valvular pathology or pathologic flow identified. hyperdynamic left ventricular systolic function. liver or gallbladder us (single organ) 8:47 am us hepatotomy drain abscess/cy; guidance for abscess () reason: please perform an ultrasound guided percutaneous drainage of medical condition: 48 year old man with crohn's s/p bii reconstruction (92) c/b jejunal perforation, enterectomy and now s/p roux-en_y duodenojejunostomy and stricturoplasty x10 with post0operative fevers and leukocytosis reason for this examination: please perform an ultrasound guided percutaneous drainage of the gallbladder fossae abscess and possible drainage of the left paracolic gutter collection on examination: ultrasound-guided abscess drainage, comparison: ct of the abdomen and pelvis dated . indication: history of crohn's disease and multiple surgeries with postoperative fluid collections suspicious for abscess. procedure and findings: ultrasonography of the gallbladder fossa demonstrates a complex fluid collection with echogenic foci within it consistent with fluid collection containing foci of gas as seen on prior ct scan. imaging of the left pericolic gutter demonstrates a complex heterogeneous fluid collection with multiple septations, which also corresponds to the fluid collection seen on ct along the left pericolic gutter. the procedure was explained along with risks and benefits to the patient's wife via telephone consent and informed consent was obtained. throughout the procedure, the patient received 2.5 mg of versed and 50 mcg of fentanyl. in addition, after the patient was prepped and draped in usual sterile fashion. approximately 10 ml of lidocaine was used to provide local anesthesia. the left lower quadrant fluid collection was marked under ultrasound guidance and after the lidocaine was placed skin was made using a scalpel. using ultrasound guidance, an 8-french pigtail drainage catheter was placed into the left lower quadrant fluid collection. a total of 300 ml of serosanguinous fluid was aspirated into a drainage bag and the cavity was flushed with approximately 150 ml of saline which was also aspirated into the drainage bag. the pigtail catheter was left to gravity drainage. the fluid and gas collection within the gallbladder fossa was then approached using ultrasound guidance. using a transhepatic approach after the skin was numb, with lidocaine and a skin was performed, an 8-french pigtail catheter was inserted transhepatically into the complex fluid collection in the gallbladder fossa and the catheter was secured in place. approximately 160 ml of reddish purulent material was aspirated and the cavity was flushed with 80 ml of saline. the pigtail catheter was left to gravity drainage. the patient tolerated the procedure well and there were no immediate post- procedural complications. dr. is present for placement of the pigtail catheter in in the gallbladder fossa collection and dr. and were present for placement of the catheter into the left lower quadrant fluid collection impression:. successful ultraound guided drain placement into the gallbladder fossa fluid collection and left pericolic gutter fluid. a portion of the aspirated fluid from each collection was sent for gram stain and culture and bilirubin levels which are pending. pathology examination name birthdate age sex pathology # , 48 male report to: dr. gross description by: dr. /dif specimen submitted: gallbladder, jejunum afferent portion. ct abdomen w/contrast 4:28 pm ct abdomen w/contrast; ct pelvis w/contrast reason: anastomotic leaks post surgery field of view: 37 contrast: optiray medical condition: 48 year old man with crohns s/p bilroth ii (remotely) c/b recent jejunal perforation (near l.o. trietz), small bowel resection w/ duodenostomy, now s/p roux-en-y duodenojejunostomy and stricturoplasty of different small bowel stritures (due to his crohns) and a feeding j-tube and drain placement near his pancreaticobiliary limb reason for this examination: please give po and iv contrast please use gastrograffin for po contrast and please put contrast via j-tube. we are looking for anastomotic leaks above and below the level of the j-tube contraindications for iv contrast: none. ct abdomen indication: status post billroth ii and extensive surgery for crohn disease. technique: a ct of abdomen was performed with axial images taken from the lung bases to the symphysis pubis. oral and iv contrast was administered. findings there are bilateral pleural effusions with associated compressive atelectasis and consolidation. the effusions have reduced in size when compared with the previous ct from . in the gallbladder fossa, note is made of a fluid collection that measures 6 x 5.7 cm and contains air. the appearances are consistent with an abscess. just inferior to this, note is made of an area of mixed attenuation in the right lower quadrant. no contrast-filled bowel loops are seen in this area, and it may represent some organizing hematoma. the surgical patient is post roux en y duodeno-jejunostomy and the draining duodenal catheter has been removed.the exact site of the anastomosis is difficult to appreciate, but there is a small amount of layering contrast within the third part of the duodenum suggesting communication between this loops and the opacified jejunum. there are several loops of mildly dilated small bowel, but contrast flows freely to the rectum and there is no evidence of obstruction .there is also no evidence of intraabdominal spilage of oral contrast. a feeding tube has been placed in the jejunum. a jp-drain is also noted in the right lower quadrant. in relation to the liver, a collection which measures approximately 6 x 3 cm is seen in the left lobe just deep to the anterior abdominal wall at the site of recent abdominal wall closure. this collection contains air and likely represents an abscess.a tract extending from this collection to the superior extent of the suture line can be seen. in the liver, there is some minimal intrahepatic biliary dilatation which is . the spleen is identified and is normal. the adrenals, kidneys, and pancreas are unremarkable. there is significant free fluid throughout the abdomen, and this has increased since the previous ct. in the left paracolic gutter, fluid is identified which also contains some air. this fluid collection is relatively contained. the air may be postoperative or represent an abscess. in the pelvis, the bladder is normal and a flatus tube is seen in the rectum. conclusion: bilateral pleural effusions with atelectasis and consolidation. probable abscess in the gallbladder fossa. probable abscess in the left lobe of the liver just deep to the recent abdominal wall closure. fluid collection in left paracolic gutter which contains air. probable hematoma in right flank at the site of recent surgery. minimal intrahepatic biliary dilatation. jejunostomy tube. right lower quadrant drain. findings discussed with surgical service procedure date tissue received report date diagnosed by dr. /cma?????? previous biopsies: jejunum and gallstone (1). gi biopsies. gi bx's/da/lp. diagnosis i. gallbladder: chronic cholecystitis; cholelithiasis. ii. jejunum, afferent portion: 1. chronic active enteritis extending to margin resection (on side of stitch); consistent with crohn's disease. 2. organizing fibrinous serositis. ct abdomen w/contrast 1:37 pm ct abdomen w/contrast; ct pelvis w/contrast reason: ct pelvis and abdomen w/ oral contrast through nasogastric t medical condition: 48 year old man with crohns s/p small bowel resection w/ duodostomy reason for this examination: ct pelvis and abdomen w/ oral contrast through nasogastric tube contraindications for iv contrast: none. ct abdomen reason for exam: 48-year-old man with crohn's disease s/p small bowel resection technique: multidetector ct through the abdomen obtained after administration of oral contrast through the nasogastric tube and iv contrast. axial contiguous images were obtained from the bases of the lungs through the symphysis pubis. coronal and sagittal reformations are also provided. comparison is made with prior study dated . findings: small bilateral pleural effusions with adjacent relaxation atelectasis are mildlely larger. the liver, spleen, pancreas, adrenal glands and kidneys are unremarkable. the aorta is normal in caliber. the celiac, sma, are patent as is the portal, splenic and superior mesenteric vein innumerable enlarged lymph nodes present throughout the mesentery are enlarged. the patient has had oral contrast administered via his ng tube and is status post billroth ii procedure. there is extensive thickening of the jejunal bowel loops. oral contrast proceeds through the gastrojejunostomy, but there is then a long segment of bowel which has essentiazlly no oral contrast within its lumen.the bowel can be traced throughout its length, however, and this non-opacified segment apppears to then become contigous with opacified loops of bowel. the appearances are likely due to intermittent administration of oral contrast via the ng tube, but fistulization could also have a similar appearance. there does not appear, on this exam hwever to be evidence of fistula formation. there is no free contrast within the abdomen. tiny pockets of air in the mesentery likely relate to recent surgery. patient is s/p gastrojejunostomy(old) and small bowel resection. two drain catheters are seen in the left flank and one catheter is in the subhepatic region. ng tube with tip is in the stomach. jejunostomy tube in the right lower quadrant is folded within the jejunal loop.also seen on the right side is an intraduodenal drainage catheter:reference to the operative notes describes creation of a duodenal biliary reservoir with external drainage and a blind ending loop of duodenum with drainage catheter-corresponding to the described surgical procedure is seen. no overt evidence of complications are seen in this area. several pockets of fluid are seen within the abdomen, the largest one in the right lower quadrant. there are no organized complicated fluid collections. pelvic ct. the rectum and sigmoid colon are unremarkable. there is free fluid. foley catheter is within the bladder lumen. there is no lymphadenopathy. there is and open wound in the anterior abdominal wall. there are bilateral fat-containing inguinal hernias. bone windows: there are no concerning bone lesions. coronal and sagittal reformations were essential in the interpretation of the bowel findings. impression: 1. status post extensive surgical repair, there is no evidence of significant intrabdominal fluid collection or free contrast within the abdomen 2. 3 surgical drains, one draining duodenal reservoir catheter and a feeding jejunostomy tube appear in good position. the feeding tube is probably coiled within a loop of jejunum 3. moderate amount of fluid within the abdomen without complicated organized collections. 4. reasonably long segment of nonopacified proximal jejunum is though likely to reflect bolus administration of oral contrast. no evidence of jejuno- jejunal/ileal fistula is seen . 5. thickening of bowel loops may reflect underlying crohns versus post- operative edema/change 6.bilateral fat-containing inguinal hernias. chest (portable ap) 1:52 am chest (portable ap) reason: eval infil medical condition: 48 year old man with acute abdomen, s/p intubation by med flight s/p left subclavian swan placement reason for this examination: eval infil ap chest. indication: status post line placement. a single ap view of the chest is obtained at 02:16 hours and is compared with the prior day's radiograph performed at 06:24 hours. tubes and lines appear unchanged. mild increase in density in the right base may represent a small layering pleural effusion as has been previously reported. no acute airspace disease is visualized. impression: stable radiograph. pathology examination name birthdate age sex pathology # , 48 male report to: dr. gross description by: dr. /dif specimen submitted: jejunum and gallstone (1). procedure date tissue received report date diagnosed by dr. . /lo?????? previous biopsies: gi biopsies. gi bx's/da/lp. diagnosis: jejunum and gallstone: 1. gallstone, cholesterol type. 2. acute perforation of jejunum, with marked mural inflammation and acute peritonitis. 3. no tumor. chest (portable ap) 11:21 pm chest (portable ap) reason: eval ett position medical condition: 48 year old man with acute abdomen, s/p intubation by med flight reason for this examination: eval ett position single ap portable view chest. reason for exam: evaluate ett position. comparison: none. findings: et tube tip is located 5 cm above the carina. ng tube with tip in the stomach, side hole projected over the ge junction. mild pulmonary edema. allowing supine position, the cardiac size is normal. widened mediastinum warrants evaluation with ct. bilateral small pleural effusions. brief hospital course: he was med-flighted immediately to us and within an hour, he was taken to the operating room for findings of free air on his outside hospital cat scan. mr. the storm of postoperative sepsis quite well and returned to the operating room for abdominal wash-out and graduated midline closure using the mesh on . then on he presented for a definitive closure of the abdomen, if not a definitive operation to reconstitute his bowel continuity. he had a reopening of a recent laparotomy, open cholecystectomy, small bowel resection, roux-en-y duodenojejunostomy, small-bowel stricturoplasty x10, and j tube placement. cv: post-operatively he was on neo and levophed for pressure support and was getting aggressive volume repletion. on he came off of pressors/inotropes. resp: he was intubated and on protective ventilatory support. once extubated, he did well and was stable. gi: his abdomen was open with multiple jp drains. the plan was to reexplore in a couple days. he had a duodenal drain tube and j-tube. his drains were working appropriately. the right sided drain was d/c'd on . the left sided drain continued to put out thick tan fluid. due to fevers and increased abdominal pain a ct was ordered on . a ct scan showed a 13 cm subhepatic fluid collection is contiguous with the previously identified gallbladder fossa collection. a new drain was placed under ultra sound guidance and drained 600 cc of fluid. he was discharged with drains in place on both sides and given instructions on drain care. renal: increased creatinine likely secondary to pre-renal. with hydration, he had improving creatinine id: ampicillin, gentamycin, flagyl, fluconazole were started empirically. he was pancultured on . blood and sputum cultures and urine cultures were negative from and . a swab culture showed perfringes, aeromonas (pan-s), viridans strep. he was changed to zosyn, vanc, flagyl, and fluc. he had a temperature the morning of . a ct scan was done (see above). heme: he received several units of prbc for drifting hct while in the sicu. on his hct dipped to 19. he received 2 units of rbc and his hct responded appropriately to 25.6. fen: he was on tpn after the or for nutritional support. he was also started on tubefeedings. hd #30 () his tpn was decreased and he was on a regular diet. he continued to increase his po intake and had calorie counts of 1500+ kcal. his tube feedings were stopped and he did not require tube feedings nutrition at home. pertinent microbiology: peritoneal fluid - gram negative rod. c.diff neg; blcx p ucx ng; abscess-ecoli s:levo,; abd fluid-e. coli levo s, blcx- p, line tip- neg, mrsa- neg, vre- neg; ucx: neg; : ucx ng, bcx: p. c.diff neg; tip- neg, mrsa/vre screens neg, bcx p, ucx neg; bcx neg, ucx: neg, bcx neg, ucx neg. 8 pertinent radiology: ct abd: 13 cm subhepatic fluid collection. cxr- picc in ra, no acute dz echo- ef > 75, no abnormalities; pigtails placed in llq and gallbladder fossa; ct a/p showed lg fluid collection in gallbladder fossa and l paracolic gutter cxr: tubes and lines in good position, lll atelectasis; ct abd/pelv: free fluid w/o collections cxr: lll infiltrate. cxr stable retrocardiac opacity/atelectasis; cxr: unchanged; cxr b/l pleural effusions; cxr b/l pleural effusions stable; cxr stable. physical therapy: he was seen by pt and made great progress and was able to walk the halls with assistance. he will receive pt at home. medications on admission: pentasa 750qam, paxil 20', folate 2' discharge disposition: home with service facility: interim home care discharge diagnosis: crohn's disease s/p multiple operations for perforated duodenum, spesis, shock discharge condition: fair discharge instructions: * increasing pain * fever (>101.5 f) * inability to eat or persistent vomiting * inability to pass gas or stool * other symptoms concerning to you you may resume your normal home medications and take all new medications as ordered. you may shower and wash incision with soap and water. pat area dry. leave open to air. the staples ..... will be removed at your follow-up appointment. monitor your incision for redness, swelling, or discharge. no lifting >10 lbs for 4 weeks. walk several times every day and increase activity as tolerated. followup instructions: please follow-up with dr. in 2 weeks. call ( to schedule an appointment. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other enterostomy other enterostomy other partial resection of small intestine other partial resection of small intestine enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage cholecystectomy other lysis of peritoneal adhesions pulmonary artery wedge monitoring reopening of recent laparotomy site transfusion of packed cells small-to-small intestinal anastomosis other repair of intestine other suture of abdominal wall infusion of vasopressor agent diagnoses: anemia, unspecified intestinal bypass or anastomosis status unspecified septicemia perforation of intestine other specified intestinal obstruction calculus of gallbladder with other cholecystitis, without mention of obstruction peritoneal adhesions (postoperative) (postinfection) septic shock peritoneal abscess peritonitis (acute) generalized regional enteritis of small intestine with large intestine 

Answer: The patient is high likely exposed to