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: iodine / iv dye, iodine containing contrast media / penicillins attending: chief complaint: fevers, increased abdominal pain, tachycardia major surgical or invasive procedure: : exploratory laparotomy, washout, splenectomy, gastrotomy repair, transgastric jejunostomy. : paracentesis history of present illness: pt is 49 y/o m with h/o severe necrotizing alcoholic pancreatitis on tpn for chronic pancreatitis who presents from osh with worsening abdominal pain. pt initially presented to osh one week ago with fevers and abdominal pain. blood cxs did grow enterobacter as well as streptococcus and pt was started on broad spectrum abx for this. the source for the bacteremia has remained unclear. pt did have normal hida scan. pt developed acute worsening of his abd pain with tachycardia and hypotension to 90s. pt was subsequently transferred to for further management. past medical history: severe necrotizing alcoholic pancreatitis, chronic alcoholic pancreatitis, possible 1.7 cm ipmn at uncinate process, splenic vein thrombosis, cbd stricture s/p ercp with stent placement , malnutrition, depression, anxiety, gerd, esophagus, dm, spine stenosis social history: history of alcohol abuse, marijuana abuse, cocaine use, benzodiazepine abuse, 50 pack-year smoker family history: denies family history of gastrointestinal disorders and cancers. denies family history of other cancers. physical exam: on admission: t: 95.9 p: 113 bp: 107/73 rr: 18 o2sat: 97% 2l general: cachectic, lethargic heent: ncat, eomi, no scleral icterus heart: rrr, nmrg lungs: clear abdomen: moderate diffuse tenderness with rebound tenderness and guarding, nonrigid extrem: no edema on discharge: vs: gen: cachetic in nad, aao x 3 cv: rrr, no m/r/g lungs: diminished breath sounds bilateraly on bases l > r abd: midline incision open to air with steri strip and c/d/i. luq jp drain to bulb suction, site c/d/i. j-tube - site intact. extr: warm, thin, no c/c/e pertinent results: 04:29am blood wbc-16.0* rbc-3.07* hgb-9.2* hct-27.2* mcv-89 mch-29.9 mchc-33.7 rdw-14.8 plt ct-940* 04:29am blood glucose-154* urean-22* creat-0.7 na-137 k-4.1 cl-96 hco3-33* angap-12 11:46am blood alt-12 ast-13 alkphos-78 totbili-0.2 04:29am blood calcium-8.5 phos-3.3 mg-1.9 04:14am blood prealbumin-test 10:00am other body fluid amylase- 02:00pm ascites amylase-37 6:30 pm tissue site: spleen infected spleen. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. tissue (final ): reported to and read back by 8:35am. due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. enterobacter cloacae. sparse growth. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. piperacillin/tazobactam sensitivity testing performed by . streptococcus anginosus (milleri) group. sparse growth. gram negative rod #2. rare growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic culture (final ): no anaerobes isolated. fungal culture (final ): no fungus isolated. 2:00 pm peritoneal fluid **final report ** gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. anaerobic culture (final ): no growth. 9:25 pm blood culture **final report ** blood culture, routine (final ): no growth : abd: impression: 1. patent portal vasculature. 2. gallbladder sludge and stones with negative son sign. 3. left lower quadrant ascites and possibly complex fluid adjacent to the liver which could be due to hemorrhage or infection. 4. portal venous gas better seen on recent ct. 5. bilateral pleural effusions. 6. multiple splenic infarctions as stated in the provided history, although given elevated white blood cell count, infection is not excluded abd ct: impression: 1. remaining head and body of the pancreas continues to enhance. the tail is not well visualized; however, the pancreatic tail was not well seen the outside hospital mri and ct of , either. calcifications throughout the remaining pancreas are consistent with history of chronic pancreatitis. 2. moderate amount of intraperitoneal free fluid, stable since . thin, curvilinear configuration of fluid in the post-splenectomy site; is unclear whether this is an actual separate fluid collection or in continuity with the free fluid within the abdomen. it measures simple fluid density and could represent a small post-operative seroma versus ascites tracking into the post-splenectomy site. percutaneous abdominal drain ending in the left upper quadrant ends inferiorly to the above described fluid. 3. small amount of retroperitoneal fluid, likely related to diffuse anasarca, without a discrete fluid collection. 4. moderate-sized bilateral pleural effusions with adjacent compressive atelectasis, stable. 5. biliary stent and percutaneous gj tube are in place. 6. cholelithiasis. ct head: impression: normal study. consider mri if there is continued clinical concern and not otherwise contraindicated. eeg: impression: this tracing did not reveal any paroxysmal epileptiform activity. while there were a few bursts of theta activity, it probably represents drowsiness. the patient did appear to be excessively drowsy throughout most of the record. there is also prominent beta activity which may be a normal variant or secondary to medication. no clear focal activity identified. brief hospital course: pt presented from osh . it was evident that the pt had peritonitis and was developing sepsis. given the pt's positive blood cultures at the osh, there was concern for an intra-abdominal infectious etiology for the pt's peritonitis. pt was subsequently taken to the or for an exploratory laparotomy where it was revealed that the pt had a splenic abscess that had ruptured. pt subsequently underwent a splenectomy, repair of gastrotomy, and gj tube placement which the pt did tolerate. , pt remained intubated and required pressors for hypotension and continued to have volume resuscitation in the sicu. on post-op day 1, pt was able to be weaned off pressors and urine output did improve. pt was able to be extubated on post-op day 2 and was started on trophic tube feeds through his gj tube. pt remained in the sicu for further monitoring of his respiratory status and was transferred to the floor on post-op day 5. the patient arrived on the floor npo, on tpn, tube feeds, and antibiotics, with a foley catheter, and dilaudid pca for pain control. the patient was hemodynamically stable. neuro: the patient received dilaudid pca with good effect and adequate pain control. when tolerating oral intake, the patient was transitioned to oral pain medications. delirium: postoperatively the patient has had waxing and periods of lucidity and confusion. he has usually not been oriented and unable to have normal conversation. on pod # 8, patient was found to be more agitated than at baseline, he was given one dose of olanzapine and started on haldol. psychiatry was consulted on pod # 10 and they recommended standing doses of haldol and continue trazodone and sertraline (home meds). the patient's delirium continued to deteriorate. on pod # 13, the patient was found less responsive, with gibberish speech, and able participate in limited neurological exam only. haldol was held and neurology consult was called. the patient underwent head ct, which was grossly normal. haldol and other psych meds were held per neurology recommendation. the patient underwent 24 hrs eeg, which was negative for acute seizure activity. since haldol was stopped, patient's mental status gradually returned to his baseline. he remained stable from neurological standpoint until discharge. cv: the patient was required neo-synephrine drip postoperatively to maintain map > 60. the drip was discontinued on pod # 2, the patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. pulmonary: the patient was extubated on pod # 2, he was found to have bilateral pulmonary effusions on pod # 3, which were secondary to multiple transfusions and aggressive fluid resuscitation. the patient was given lasix iv to diureses and is was encouraged. the patient eventually was weaned form supplemental o2, and his pulmonary function remained stable. good pulmonary toilet, early ambulation and incentive spirrometry were encouraged throughout hospitalization. gi: post-operatively, the patient was continued on tpn, tube feed was started on pod # 2. the tube feed was advanced to goal and tpn was discontinued on pod # 5. the patient's diet was advanced to clear liquids on pod # 5. jp's amylase was sent on pod # 7 and was high (), diet was changed back to npo. diet was advanced to clears on pod # 14 and was well tolerated. diet progressively was advanced to regular on pod # 17, the tube feed was started to cycle. patient's intake and output were closely monitored, electrolytes were routinely followed, and repleted when necessary. gu: the patient's urine output was closely monitored in the immediate post-operative period. the patient was able to successfully void without issue after foley catheter was removed. id: the patient underwent 10 days treatment with iv cipro and flagyl for his peritonitis. surveillance blood and urine cultures were negative. the patient's white blood count and fever curves were closely watched. the wbc downwarded postoperatively from 53 to 16. wound was evaluated daily and no signs or symptoms of infection were noticed. endocrine: the patient's blood glucose was closely monitored with q6 hour glucose checks. blood glucose levels greater than 120 mg/dl were addressed with an insulin sliding scale. the endocrinology service was helping to manage the patient's insulin requirements and their recommendations were followed. hematology: the patient received 6 units of rbc and 3 units of plasma intraoperatively. postop complete blood count was examined routinely; no transfusions were required. prophylaxis: the patient received subcutaneous heparin and venodyne boots were used during this stay; was encouraged to get up and ambulate as early as possible. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diabetic diet and tubefeed, ambulating, voiding without assistance, and pain was well controlled. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. the patient was discharged in long term care facility for convalescent care less than 30 days. medications on admission: 1. sertraline 50 mg daily 2. trazodone 100 mg qhs prn insomnia 3. fentanyl 25 mcg/hr patch q72hr 4. nicotine 21 mg/24 hr patch daily 5. pancrelipase 5000 5,000-17,000 -27,000 unit capsule daily 6. insulin aspart sliding scale 7. omeprazole 20 mg discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. trazodone 100 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for sleep. 3. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 4. acetaminophen 500 mg tablet sig: two (2) tablet po every eight (8) hours as needed for pain. 5. aspirin 325 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. disp:*100 tablet(s)* refills:*0* 7. lipase-protease-amylase 12,000-38,000 -60,000 unit capsule, delayed release(e.c.) sig: one (1) cap po tid w/meals (3 times a day with meals). 8. insulin glargine 100 unit/ml (3 ml) insulin pen sig: eight (8) units subcutaneous at bedtime. 9. insulin lispro 100 unit/ml insulin pen sig: 2-6 units subcutaneous before meals and bedtime: please follow sliding scale instructions. discharge disposition: extended care facility: house nursing & rehabilitation center - discharge diagnosis: 1. peritonitis secondary to ruptured infected spleen. 2. necrotizing pancreatitis 3. delirium 4. diabetes 5. bilateral pleural effusions discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires bystand assistance. discharge instructions: please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. . incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. . jp drain care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *maintain suction of the bulb. *note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or vna nurse if the amount increases significantly or changes in character. *be sure to empty the drain frequently. record the output, if instructed to do so. *you may shower; wash the area gently with warm, soapy water. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. . g-tube care: *please flush with 30 cc of tap water q4h. *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *wash the area gently with warm, soapy water or 1/2 strength hydrogen peroxide followed by saline rinse, pat dry, and place a drain sponge. change daily and as needed. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. followup instructions: provider: , md phone: date/time: 12:45 office, , , . please follow up with dr. (pcp) in weeks after discharge procedure: parenteral infusion of concentrated nutritional substances other enterostomy enteral infusion of concentrated nutritional substances percutaneous abdominal drainage total splenectomy other repair of stomach diagnoses: esophageal reflux unspecified pleural effusion unspecified septicemia sepsis diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled chronic pancreatitis other and unspecified alcohol dependence, unspecified other diseases of spleen portal vein thrombosis unspecified peritonitis essential thrombocythemia 

Answer: The patient is high likely exposed to