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: tetracycline / dilaudid (pf) / pravastatin attending: chief complaint: diarrea, nausea, vomiting, blood in ostomy bag major surgical or invasive procedure: - r ij catheter placed history of present illness: 54f w crohn's (on humira) b/c colitis now s/p sigmoidectomy w end colostomy, ventral hernia repair, & abdominal wall reconstruction c/b complete sbo due to adhesive disease & porta1 vein thrombosis, afib on coumadin presents with 1-2 wks of abd pain, emesis, fever to 100.7, diarrhea with small amt of brb (sml amt brb she thinks from irritation of the ostomy itself). . pt states that all the members of her family had a gi illness in the past several weeks; her symptoms were similar to what her family experienced. however, over the past week, she developed crampy abdominal pain that is more consistent with a crohn's flare, as well as bloody diarrhea. she states that this diarrhea is far more watery that her usual ibd flares. she has been unable to keep anything down due to nausea and vomiting. she has felt progressively more weak with dizziness on standing as well as palptitations. today, the patient became so severe that she decided to present to an emergency department for evaluation. . vital signs in the ed: 97.6 88 83/44 16 99 ra . in the , pt's abdomen was noted to be diffusely tender, especially around ostomy site. the patient was noted to be persistently hypotensive in the sbp 80s after 4 l ns resuscitation and she developed brb in her ostomy bag. in total she received 5l ns, a r ij was placed and she was ultimately started on levophed at 10 mcg/min. . ed labs were significant for inr 8.3; the patient received 10 mg iv vitamin k. lactate 3.4 on admission with improved to 1.3 s/p ivf administration. she was also started on zosyn. . - ekg: atrial fibrillation with hr 101, lad, ivcd, std v4-v6 - cxr: no acute process - ct abdomen with po & iv contrast was obtained which showed ? air near colostomy site as well as stranding . the patient was discussed with gi; they felt that no steroids were needed at the moment. . last set of ed vital signs: 114/50, 77, 25, 95% 2l nc . ros: (+): as above (-): chest pain, cough, sputum production, dysuria, urinary frequency/urgency, syncope, myalgias, arthralgias, headache, wheeze, focal numbness or weakness. past medical history: - crohn's disease (diagnosed ) c/b fistulas, sigmoidectomy, sbos - atrial fibrillation since ---> dccv x3 at ---> cardioversion at - nonsustained ventricular tachycardia - benign multinodular goiter (followed by dr. - s/p cervical cancer - gerd - paraspinal cyst (followed by dr. - pulmonary lesions - mediastinal mass (stable on mri) - portal vein clot - arthritis - anxiety social history: - married, living with her family in - previously worked as physical therapist - tobacco: smoked intermittently in college, but no recent use - etoh: denies - illicit drug use: nil. family history: - father: uc, esophageal cancer --- paternal aunt with - mother: basal & squamous cell carcinoma - grandmother developed afib at 80 years of age - maternal grandmother: lung cancer - diagnosed with ibd at age 14 physical exam: on admission: gen: obese, pallid, nad heent: ncat. eomi. neck: r ij in place pulm: diminished bs bilaterally with faint expiratory wheeze at bases. cor: irregular, +s1s2 : hypoactive bs. diffusely ttp, worse surrounding ostomy site. ostomy bag with green liquid stool. slightly more tender in ruq as well, with rebound but no guarding. nontender to percussion & bed shake. ext: wwp, unable to palpate pulses. 1+ le edema neuro: aaox3. maee peripheral vascular: (right radial pulse: not assessed), (left radial pulse: not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) skin: not assessed neurologic: responds to: not assessed, movement: not assessed, tone: not assessed pertinent results: cxr no acute process. frontal and lateral views of the chest are compared to previous exam from . again seen is elevation of the right hemidiaphragm. the lungs remain clear of consolidation or effusion. the cardiac silhouette is within normal limits. osseous and soft tissue structures are unchanged. . abd/pelvis ct impression: 1. diffuse colonic wall thickening of the remaining colon. differential considerations include changes from patients known crohn's disease, infectious or inflammatory causes, or even hemorrhage given elevated inr and possible high density of the wall in certain areas. 2. parastomal hernia with a focus of air within the soft tissues which is not clearly intraluminal and may be may be extraluminal. close clinical followup suggested and repeat can be performed if desired. . cmv viral load: negative 3:36 pm stool consistency: watery source: stool r/o k.oxy & listeria per dr. # . fecal culture (pending): campylobacter culture (final ): no campylobacter found. fecal culture - r/o e.coli 0157:h7 (final ): no e.coli 0157:h7 found. fecal culture - r/o vibrio (final ): no vibrio found. fecal culture - r/o yersinia (final ): no yersinia found. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). brief hospital course: reason for hospital admission: 54 f with crohn's c/b multiple surgeries & prior sbo presents with fever, diarrhea, hypotension, brb per ostomy bag. . hospital course # hypotension/septic shock: pt met multiple sirs criteria (hypotension, fever, tachycardia, leukocytosis) with suspected gi source given her abdominal pain & diarrhea. pulmonary source was considered but no signs or symptoms of pna, clear cxr. low suspicion for urosepsis as pt without dysuria and urinalysis not c/w infection. initially c/f gram negative bacteremia as she was at high risk for gi translocation. she states that she has had multiple family members who have had symptoms consistent with viral ge recently. concern also that she could have prolonged course of norovirus given that she is on humira. she was initially treated with aggressive ivf resuscitations which failed in the ed and she required levophed in the icu. zosyn and cipro were started for source control and double coverage. aggressive hydration was continued. levophed was able to be weaned. home anti-hypertensives were held and electrolytes aggressively repleted. this resolved with treatment . # acute gastroenteritis: the patient presented with brb via her ostomy site (see gib below) and abdominal pain, c/f infection vs chrohns flare vs ostomy trauma. some purulent drainage around the ostomy site which was sent for culture. surgery examined the site and felt that the ostomy looked fine. gi was consulted and they felt most likely this was an infectious etiology. steroids were held. no scope was felt to be necessary at this point. stool cultures for yersinia, vibrio, e.coli, c.diff, and cmv viral load were negative. all cx were no growth to date. she completed a 5 day course of cipro/flagyl, though this was likely an acute viral illness. - c. diff pcr and norovirus serology pending at discharge . #gi bleeding: pt presented with brb per ostomy site. hct was slightly decreased from baseline on admission and dropped further with aggressive iv hydration. hct was trended and remained stable. there was no further evidence of bleeding . # coagulopathy: pt with inr 8.3 on admission despite taking regular warfarin dose, likely due to her acute infectious process. repeat inr 2.1 s/p iv vitamin k. inr 1.6 on hospital day two. warfarin was initially due to concern for gib. however, when this issue was excluded her warfarin was resumed at home dose. she was bridged with heparin gtt and transitioned to lovenox bridge 1mg/kg q12 until her inr is >1.9 - repeat inr in days, goal inr . resumed home dose warfarin. . # acute kidney injury: creatinine 2.1 on admission from baseline of approximately 0.6. fena 0.21% felt to be likely prerenal or possibly atn in setting of hypotension. pt was aggressively rehydrated with ivf as above with improvement in creatinine. . # atrial fibrillation: diltiazem and metoprolol initially held in setting of sepsis with hypotension. digoxin was continued for positive effect on cardiac output. prior to leaving the icu, hypotension had resolved and metoprolol was restarted. dilt was also restarted at a lower dose (30mg daily vs home dose of 360mg daily) - her home regimen was resumed on discharge. . # asthma: no evidence for acute exacerbation, although slight expiratory wheeze at bases. maintained on albuterol nebs prn. . # htn: hypotensive on admission and home antihypertensives were held and then restarted at lower doses, see afib above. . # hld: continued statin. medications on admission: medications: (confirmed with patient - hctz 12.5 mg qd - simvastatin 10 mg qd - warfarin 4 mg qd - lisinopril 20 mg qd - diltiazem 360 mg qd - digoxin 250 mcg qd - lantus 38 units qam - humalog 8 units before meals - humira - advair 250/50 - metformin 500 mg - proair 2 puffs q3-4h prn sob, wheeze - omeprazole 20 mg - cyclobenzaprine 14 mg tid prn - metoprolol 50 mg - nystatin powder - codeine sulfate 30 mg prn diarrhea - lorazepam 2 mg tid prn anxiety - tylenol prn - vitamin d - vitamin b12 - ferrous sulfate discharge medications: 1. hydrochlorothiazide 12.5 mg tablet sig: one (1) tablet po once a day. 2. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. 4. lisinopril 20 mg tablet sig: one (1) tablet po once a day. 5. diltiazem hcl 360 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po once a day. 6. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 7. lantus 100 unit/ml solution sig: thirty eight (38) units subcutaneous once a day. 8. humalog 100 unit/ml solution sig: eight (8) units subcutaneous qac: resume home dosing based on blood sugars. 9. humira please resume at usual dose 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. metformin 500 mg tablet sig: one (1) tablet po twice a day. 12. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 13. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 14. cyclobenzaprine 10 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for spasm. 15. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 16. lorazepam 1 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for anxiety. 17. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 18. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 19. cyanocobalamin (vitamin b-12) 1,000 mcg tablet sig: one (1) tablet po once a day. 20. enoxaparin 100 mg/ml syringe sig: one (1) injection subcutaneous every twelve (12) hours for 7 days: continue until inr >1.9, then stop. disp:*14 syringes* refills:*0* 21. outpatient work pt/inr, cbc within 2-3 days. name: , a. location: medical group fax: 22. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 6-8 hours as needed for pain : avoid with alcohol or driving. disp:*10 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: sepsis due to gastroenteritis hypotension coagulopathy atrial fibrillation parastomal hernia crohn's disease hypertension type 2 diabetes mellitus discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with an acute diarrheal illness which caused low blood pressure. because of this, you spent time in the icu. with iv fluids and antibiotics, you improved. the gi service evaluated you and felt this was most consistent with a viral gastroenteritis and not due to crohn's. you were also found to have a hernia around your ostomy. this is currently stable. please follow up with your surgeon for this. finally, your inr was found to be high on admission, likely due to your acute illness. your warfarin was reversed and then restarted. please continue your home warfarin dose. until your inr is 2, please take the lovenox (enoxaparin) shots. resume all your home medications. new medications include lovenox and percocet. do not use percocet with alcohol or driving. followup instructions: pcp: , . - please call for an appointment within the next 7-10 days department: endo suites when: monday at 10:30 am department: digestive disease center when: monday at 10:30 am with: ,md building: building (/ complex) campus: east best parking: main garage department: div. of gastroenterology when: monday at 2:00 pm with: building: ra (/ complex) campus: east best parking: main garage procedure: venous catheterization, not elsewhere classified diagnoses: abnormal coagulation profile esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation asthma, unspecified type, unspecified other and unspecified hyperlipidemia regional enteritis of unspecified site septic shock long-term (current) use of anticoagulants personal history of malignant neoplasm of cervix uteri intestinal infection due to other organism, not elsewhere classified other colostomy and enterostomy complication 

Answer: The patient is high likely exposed to