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: sulfa (sulfonamide antibiotics) / morphine / iodine-iodine containing / keflex / wellbutrin sr / simvastatin / demerol / xalatan / atropine / epinephrine attending: chief complaint: abdominal pain major surgical or invasive procedure: exploratory laparotomy, removal of foreign body, closure of small bowel perforation, and washout of soft tissue history of present illness: ms. is a 61 yo female with a history of crohn's disease on steroids who was in her usual state of health up until at around 2130 when she had burning pain in her llq which she describes as the "worst burn ever." she also noticed that her abdomen was distended, and her lower abdomen was red. this morning she was not able to get out of bed and says she was very sick. she felt feverish (though her temperature was 97-98) and had chills. she denies nausea and vomiting. after calling her doctor, she went by ambulance to . on ct scan at the osh, there was a ventral hernia containing a bowel loop with contrast extravasation from the bowel into the soft tissue of the anterior abd wall as well as air and inflammation in the abdominal wall. she was transferred to the for further workup. past medical history: pmh: crohn's dz dx age 16 (chronic prednisone 15 mg daily since ), glaucoma and macular degeneration, osteoporosis: l3 fracture after fall , right fifth metatarsal fracture in the , hip fracture in , toe fracture in , peripheral neuropathy, depression (recently stopped taking prozac), chronic pain, gerd, dm, htn, recurrent utis, hx of fe def anemia, obesity psh: ileocecal transverse colectomy in , "minor bowel surgery" at (), sigmoid colostomy (), prolapse colectomy (), colostomy reversal (), vertebroplasty for t12 compression fracture (), b/l hip fx's and rod placement social history: occupation: former nurse drugs: denies tobacco: denies alcohol: denies other: lives alone but many friends and family nearby. family history: brother and father with disease as well as neuropathy and diabetes. her father also had coronary artery disease and diabetes, he died of chf. her mother also has chf. physical exam: temp 99.1 hr 118 bp 106/64 rr 18 o2 sat 98% ra gen: a&o, nad heent: no scleral icterus, mucus membranes moist cv: rrr, no m/g/r pulm: clear to auscultation b/l, no w/r/r abd: obese, soft, nondistended. very tender to light palpation in llq and lower abdomen. large macular, erythematous rash extending throughout left lower quadrant. multiple well healed surgical scars. no appreciable abd wall hernia in this obese patient. ext: no le edema, le warm and well perfused. bilateral rashes. pertinent results: imaging: tte : the left atrium and right atrium are normal in cavity size. overall left ventricular systolic function is normal (lvef>55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the right ventricular free wall is hypertrophied. the right ventricular cavity is mildly dilated tricuspid annular plane systolic excursion is normal (1.7 cm) consistent with normal right ventricular systolic function. there are simple atheroma in the ascending aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. there are three aortic valve leaflets. the mitral valve appears structurally normal with trivial mitral regurgitation. moderate to severe tricuspid regurgitation is seen. tte : the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. right ventricular chamber size is normal with borderline normal free wall function. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. b/l le us: no dvt abd us : small fluid collection underneath an old scar in the left lower quadrant as described above. the area is too small for catheter drainage but aspiration could be performed if clinically warranted. microbiology: 10:00 pm swab source: abdomen. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. wound culture (final ): enterococcus sp.. sparse growth. staph aureus coag +. rare growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | staph aureus coag + | | ampicillin------------ <=2 s clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- <=0.25 s penicillin g---------- 8 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 2 s anaerobic culture (final ): no anaerobes isolated. pathology: : small bowel, foreign body removal: predominantly bone fragments with admixed fecal material; single fragment of small intestinal mucosa, within normal limits. 10:15pm wbc-12.0*# rbc-4.35 hgb-11.4* hct-33.4* mcv-77* mch-26.2* mchc-34.1 rdw-17.2* 10:15pm neuts-79* bands-12* lymphs-4* monos-2 eos-3 basos-0 atyps-0 metas-0 myelos-0 10:15pm pt-15.6* ptt-24.8 inr(pt)-1.4* 10:15pm alt(sgpt)-10 ast(sgot)-14 alk phos-52 tot bili-0.5 10:15pm glucose-109* urea n-12 creat-0.8 sodium-133 potassium-4.1 chloride-99 total co2-25 anion gap-13 brief hospital course: the patient was transferred from an osh w ct scan showing ventral hernia containing a bowel loop w contrast extrav from bowel into soft tissue of anterior abd wall. the patient was taken to the or emergently for procedure as above. intra-operatively, patient was noted to have pea arrest following closure of abdomen while dressing was being placed. cpr was immediately initiated, atropine was given and she recovered pulse and pressure nicely. echo showed no evidence of any cardiac dysfunction, except for mild tricuspid regurgitation. she was taken intubated to the sicu at the completion of the case. neuro: , pt was sedated/given pain control while intubated. she was extubated on post op day #1 and a chronic pain consult was obtained as she was on numerous medications pre op. pain control was implemented per their recommendations. long acting opioids and non-narcotic pain medication was used in combination to attain adequate analgesia. when tolerating oral intake, the patient was transitioned to oral oxycodone along with gabapentin, fentanyl patch and lidocaine patch which in combination were effective. cv: as above pt had pea arrest intra-operatively. cardiology c/s was obtained and despite extensive workup including repeat tte, ekgs, telemetry, no etiology of arrest was identified. electrolytes were optimized as appropriate and no further cardiac abnormalities were appreciated until when she had paf as high as 200bpm. she was asymptomatic but did have a low normal potassium and magnesium. these were repleted and she was started on a beta blocker. she remained on telemetry and remained in normal sinus rhythm. cardiology recommendation was to follow up as an outpatient with dr. for discussion of aicd placement. home cardiac medications were resumed pod1. she also developed some edema and redness of her left lower leg and a duplex scan was done on which ruled out dvt. her edema decreased with elevation and antibiotics which prmarily were for her abdominal cellulitis. pulmonary: patient was taken intubated to icu postop given cardiac instability at end of case. patient weaned ventilator appropriately and was successfully extubated pod1. following this, pulmonary toilet including incentive spirometry and early ambulation were encouraged. the patient was stable from a pulmonary standpoint; vital signs were routinely monitored. gi/gu: patient was admitted with small bowel perforation within ventral hernia. repair was performed as stated above. midline laparotomy wound was left open with packing to heal by secondary intention. post-operatively, the patient was given iv fluids until tolerating oral intake. her diet was advanced to clears pod2, which was tolerated well. she passed flatus on pod3 and had a bowel movement. she was then able to tolerate a diabetic diet without difficulty. she was started on a bowel regimen to encourage bowel movement. foley was removed on pod#3 and she had no difficulty urinating. intake and output were closely monitored. endo: patient is chronically steroid dependent related to crohn's disease and was given stress dose steroids -operatively. pod2 patient was returned to home dose steroids and this was continued throughout admission. her blood sugars were monitored routinely and she was placed on her pre op actos once she tolerated a regular diet. her sugars required coverage for > 200 at least daily. she was reluctant to start insulin and was instructed to record her blood sugars and follow up in 1 week with her pcp for review and possible medication adjustment. id: pre-operatively, the patient was started vancomycin, cipro and flagyl for free bowel perforation. on pod3, patient was noted to have area of fluctuance in abdominal wall. ultrasound was obtained pod3 showing fluid collection that was i&d'd at bedside. cultures were sent which revealed enterococcus. she was placed on a 7 day course of ampicillin iv and later switched to oral amoxicillin. she remained afebrile and her cellulitis was receding. prophylaxis: the patient received subcutaneous heparin during this stay, and 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, tolerating a regular, diabetic diet, ambulating, voiding without assistance, and pain was well controlled. she will be discharged with vna services for abdominal dressing changes . medications on admission: alendronate 70 qweek, baclofen 20 qid prn, celebrex 200-400', ciprofloxacin 500', citalopram 40', vit b-12 1000 qmonth, vit d2 2x/week, estradiol 25 2x/month, fentanyl patch 72hr 100mcg/hr 2 q2days, folic acid 1', furosemide 20', gabapentin 600 5x/day, gemfibrozil 600 mg'', hydromorphone ''' prn, lantanoprost, lidocaine patch 5% (700 mg/patch), lisinopril 20', loperamide q4h prn, lorazepam 1''', methylphenidate er 36-72', metronidazole 1% gel, omeprazole delayed release 20'', oxycodone 30-60''' prn, oxycontin 80'', pioglitazone 15', pravastatin 20', prednisone 20', quetiapine 25-50''', sucralafate 1'''', trazodone 25-100 mg qhs prn, vitamin c calcium carbonate, vitamin d3, flaxseed oil, vitamin e discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 2. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 3. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 4. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 5. pioglitazone 15 mg tablet sig: one (1) tablet po daily (daily). 6. pravastatin 20 mg tablet sig: one (1) tablet po daily (daily). 7. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). 8. gabapentin 300 mg capsule sig: two (2) capsule po 5 times per day (). 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day): hold for sbp < 100, hr < 65. disp:*90 tablet(s)* refills:*2* 10. insulin lispro 100 unit/ml solution sig: 0-8 units subcutaneous asdir (as directed) as needed for per sliding scale. 11. quetiapine 25 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for prn anxiety. 12. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 13. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 14. fentanyl 100 mcg/hr patch 72 hr sig: two (2) patch 72 hr transdermal q72h (every 72 hours). 15. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: two (2) tablet, chewable po tid (3 times a day). 16. gemfibrozil 600 mg tablet sig: one (1) tablet po bid (2 times a day). 17. trazodone 50 mg tablet sig: 0.5-1 tablet po hs (at bedtime) as needed for insomnia. 18. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po q8h (every 8 hours): thru . disp:*20 tablet(s)* refills:*0* 19. oxycodone 15 mg tablet sig: two (2) tablet po q3h (every 3 hours) as needed for pain. disp:*200 tablet(s)* refills:*0* discharge disposition: home with service facility: all care vna discharge diagnosis: 1. small bowel perforation secondary to a foreign body. 2. cardiac arrest 3. wound infection 4. rapid atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: * you were admitted to the hospital with abdominal pain secondary to a bowel perforation from a chicken bone. * you had some problems at the end of the operation with your heart and actually required chest compressions and medication to stimulate activity. your heart rhythme returned and you were transferred to the icu for further monitoring. you had one episode of of a rapid, irregular heart beat which is called atrial fibrillation but that resolved with correction of your electrolytes and starting lopressor to slow your rate. since then you have been in a regular rhythme but you will need to follow up with your doctor for further testing after you recover from the operation. * your abdominal wound was opened in a few areas to drain fluid collections and you will need to continue dressing changes at home as it closes from inside out. the vna will help you with that. * continue to eat a regular diet and stay well hydrated. * your pain medication can be constipating so make sure that you take stool softeners or a gentle laxative if needed. * the cellulitis on your abdomen is improving but check it daily to assure that the area is getting smaller. if it increases in size or you develop any chills or fevers > 101 please call your doctor or return to the emergency room. * your blood sugars have been elevated at times. now that your actos is resumed please check them before each meal and at bedtime, record the results and review them with your pcp in case any modifications are needed. followup instructions: call the acute care clinic at for a follow up appointment in 1 week for a wound check. call dr. for a follow up appointment in 1 week to persue further cardiac evaluation and blood sugar assessment. provider: , dpm phone: date/time: 12:45 provider: , md phone: date/time: 10:45 provider: , od phone: date/time: 1:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnostic ultrasound of heart incision of abdominal wall other lysis of peritoneal adhesions nonexcisional debridement of wound, infection or burn cardiopulmonary resuscitation, not otherwise specified suture of laceration of small intestine, except duodenum incisional hernia repair other incision of small intestine diagnoses: other chronic pain esophageal reflux cellulitis and abscess of trunk unspecified essential hypertension long-term (current) use of steroids cardiac complications, not elsewhere classified perforation of intestine diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes depressive disorder, not elsewhere classified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure regional enteritis of unspecified site cardiac arrest methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site long-term (current) use of other medications osteoporosis, unspecified diarrhea streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] obesity, unspecified closed fracture of one rib diseases of tricuspid valve foreign body in intestine and colon foreign body accidentally entering other orifice fistula of intestine, excluding rectum and anus incisional ventral hernia with obstruction pathologic fracture of vertebrae acquired absence of intestine (large) (small) 

Answer: The patient is high likely exposed to