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: pertussis vaccine,fluid attending: chief complaint: fever major surgical or invasive procedure: : flexible bronchoscopy :roux-en-y duodenojejunostomy, gastrostomy, feeding jejunostomy. : bedside trach : bedside egd history of present illness: (history from medical record and patient's mother) this is a 29 y.o. non-verbal gentleman with a history of cerebral palsy, seizures, recurrent utis and sma syndrome, recent transferred from rehab on with fevers s/p recent admission to (/05). he was discharged from to on valproate 450 q6 (increased from prior dose), and a 2 week course of meropenem 1 gram q8 (given urine cultures showed klebsiella resistant to all antibiotics save meropenem. he was doing well at rehab until 3 days prior to admission when he was noticed to have fevers to 102.0 despite iv vancomycin and imipenem empirically. urine culture with yeast and started on fluconazole. his picc line was replaced in the left ue (from right ue). he was then noted to have edema at the left , u/s was performed on demonstrating a dvt. he was started on lovenox and coumadin. vitals at , bp:140/70, hr:100, rr:20, temp 102 rectally. vanco was started on . wbc noted to be 7.5 with 7% bandemia. he is transferred to for further evaluation of fevers. ros (limited by non-verbal status): negative: no diarrhea and able to tolerate j-tube with isocal at 80cc, no cp, sob, pain, wt loss (in fact the patient has gained weight and was 100 pounds on admission), mild nausea and dry heaves x 1 day. past medical history: 1) cerebral palsy with mental retardation 2) seizure disorder 3) history of h. pylori gastritis 4) recent right clavicular fracture on 5) history of multiple surgeries to the lower extremities for flexion contractures 6) recurrent klebsiella uti, treated with bactrim, rocephin and tequin. 7) sma syndrome: followed by dr. (surgery) sbo initially felt secondary to obstipation brought about by codeine use for pain managment secondary to clavicular fracture. a barrium swallow on was suggestive of partial obstruction at the second portion of the duodenum. however, he continued to have high ng residuals and radiographic features c/w partial sbo despite clearance of stools, which led to a consideration of sma syndrome. a ct on showed stable distension of the stomach and duodenum, with proximal duodenal distension without apparent dilatation of the distal duodenum. a repeat egd on was performed, at which time duodenal narrowing was not appreciated. a subsequent gastrograffin study, however, showed high grade partial obstruction of the duodenum. suspected gastric outlet obstruction/partial sbo due to sma syndrome suggested on radiographic studies, although duodenal narrowing not appreciated on repeat egd. the patient had had minimal improvement with conservative management, with continued weight loss and inability to tolerate pos. ng tube was maintained, and tpn was continued per nutrition recs. gi consulted, ct angio of abdomen was done. the patient underwent eus on , duodenal biopsies taken, unable to visualize pancreas, decision made for pancreatic mri to be done. surgery consulted, thought clinical picture c/w sma, plan to have patient undergo surgical decompression in the near future once his nutritional status has improved (goal weight of 105 pounds). the patient was continued on a ppi for gi protection given his history of fundus ulcers. the patient had a g/j tube placed under ir on , and tube feeds were started 24 hours after placement. biopsies from duodenum showed mild inactive duodenitis. 8) ards at hospital; admitted with abdominal pain, ? hematemesis and suspected sbo. a ct chest and abdomen was performed and reportedly showed multifocal pneumonia with bilateral pleural effusions, no abdominal mass. his clinical picture evolved into an ards picture requiring intubation on . he was treated with zosyn for presumed aspiration pneumonia; sputum cultures grew albicans. he self-extubated on , and has been stable from a respiratory standpoint since that point. 9) left le dvt, diagnosed on , initially treated with lovenox, then switched to coumadin. 10) pancreatic head cystic lesion, followed q1 year social history: mr. is a resident of meadows in . patient reportedly ambulates with assist and wears a helmet for safety in the nursing home. family history: not available. physical exam: on admission: temp 102 rectally, hr:144, bp:150/92, rr:12, o2:99 ra gen: cachectic gentleman with flexion contractures in all extremities, screaming. non-verbal. cv: reg tachy. no murmurs pulm: (exam limited by effort). no wheezes or rales abd: soft with j and g tubes without evidence of infection. ext: contracted in flexion. 1+ dp and radial. neuro: mae. babinski normal. pertinent results: single contrast upper gi study from g-tube: findings: the scout film demonstrated surgical clips overlying the left upper quadrant, as well as ivc filter and j-tube and g tube. 60 cc of water soluble contrast (conray) was administered from the g-tube into the stomach, however, the contrast pooled in the stomach, and the stomach did not empty even with semi- upright and right lateral decubitus position. impression: limited study, which showed pooling of contrast in the stomach, which did not show adequate emptying. at the end of the study, part of the administered contrast was drained and the g- tube was reconnected to drainage bags. ct chest/abd/pelvis: impression: 1. patchy bilateral ground-glass opacities. this is a nonspecific finding and may represent pulmonary edema secondary to volume overload or ards. infection cannot be fully ruled out. 2. moderate-sized bilateral pleural effusions. 3. a small amount of low-attenuation free intraperitoneal fluid with linear peritoneal enhancement. the enhancement is nonspecific, and likely due to inflammatory changes from recent surgery. infection can not be fully ruled out, but is considered less likely. left lower extremity ultrasound: impression: there is persistent thrombus seen within the left common femoral and proximal superficial femoral veins, but this has partially recanalized since the prior examination. some flow is seen within the common femoral and proximal superficial femoral veins. normal respiratory ariation is seen in the common femoral waveform. normal color flow with normal waveforms are seen in the mid and distal superficial femoral vein, deep femoral, and popliteal veins. of note, there appears to be a duplicated superficial femoral venous system, with no flow seen in the duplicated vein through the mid and distal portions. impression: partial recanalization of the previously seen thrombus within the left common femoral and proximal superficial femoral veins. gall bladder ultrasound: interpretation: serial images over the abdomen show prompt uptake of tracer into the hepatic parenchyma. at 6 minutes, the gallbladder is visualized with tracer activity noted in the small bowel at 6 minutes. note is made of reflux of tracer into a dilated stomach. impression: 1. no evidence of cholecystitis. 2. significant tracer reflux into a dilated stomach. bedside egd: showed "patent duodenojejunal anastomosis, stenosis of the first part of the duodenum, fluids in stomach, gastrostomy tube in gastric wall in antrum, and findings do not account for patients symptoms. recommendations: consider sbft to rule out distal obstruction" brief hospital course: 1) fevers/respiratory. has recurrent resistant uti on meropenem and vanco and picc. cxr on admission normal. yeast in urine on fluc. foley changed. yeast also in blood. id consulted recommended caspofungin for fungemia, meropenem/vancomycin/ flagyl for possible gi process. developed ards picture due to sepsis, pressors and vented with high peep. right chest tube was placed by thoracic surgery on after attempted cvl placement resulted in a pneumothorax. vancomycin was d/c'd on . he spiked after vanco d/c'd and it was restarted . echo obtained to rule out endocarditis and was negative. flagyl d/c'd after 3 negative cdiff stool samples.chest tube removed . patient extubated but could not handle secretions and re-intubated. on percutaneous tracheostomy tube was placed due to neuromuscular weakness with prolonged ventilatory requirement and copious secretions. he has since been doing very well with the trach and his vent settings have been weaned. patient was off antibiotics for a week or so, preparing for discharge when he again spiked a fever and leukocytosis. on urine culture grew psuedomonas and sputum grew psuedomonas and klebsiella. , , , cdiff stools were all negative, and repeat urine culture was also negative for growth. infectious disease again came onboard and patient started a two-week course of zosyn and meropenem which he completed. he has been afebrile for over a week upon discharge. 2) sma syndrome. plan was to increase weight to ~105-110 pounds and then perform blind pouch decompression of duodenum. on patient developed acute bleeding from g-j tube and subsequent anemia for which he received several units of blood. emergent egd showed large clot but no active source of bleeding. ir took for embolization- used gel to embolize. patient stable enough to take to or by dr. on for roux-en-y duodenojejunostomy, gastrostomy, feeding jejunostomy. please see operative report for details, but in general findings were as follows: "the duodenum was somewhat scarred to the retroperitoneum and the kidney was very thickened and fibrotic and dilated. there was a gastrojejunal tube going into the stomach and down to the jejunum through a previously placed site by radiology. the bowel was fairly delicate. no other abnormalities were noted." patient tolerated the procedure well. the abdominal incision was partially opened 2 weeks ago when there was concern for infection and a vac dressing was initially applied which was present for about one week before switching to wet to dry dressings. the wound is granulating very well and the wet to dry dressings will need to be continued at rehab until healing is complete. all staples have been removed. 3) dvt. the pt had been on lovenox but was on coumadin with inr goal of on admission. he was started on sc heparin and bled as described above. hit antibodies were tested and returned negative. now has ivc filter in. his heparin was restarted and he has not re-bled. his platelets occassionaly drift down as well as his hct but they have been stable recently and attributed mostly to medication side effects. 4) nutrition: he is npo. currently j tube feeding with g tube drainage (j-tube is red). j tube feeds are probalance strength at 80 an hour. keep the gtube clamped throughout the day, check for residual once daily. do not refeed residuals and reclamp the gtube. only modify this plan if the patient experiences persistent abdominal distension/vomiting. 5) seizure disorder. did not seize until . ct was negative. neuro consult obtained for management, depakote increased. patient has since had several seizures over the course of the admission and has been followed by neurology service throughout. head cts were obtained after both major seizures (, ) and did not demonstrate any mass effect, hemorrhage or acute change. the pt. was recently changed from a po dilantin order to iv. this enables his tube feeds to continue while he is being medicated. he is currently to get 100mg iv bid. he will continue to need daily dilantin and albumin levels checked and the dilantin level needs to be "corrected" for the current albumin level. the pt. had another seizure on , was evaluated by the neurology department and at that time they recommended no changes to his current medication regimen. the pt. then underwent another eeg which did not show any new activity since his previous eeg. neurology agreed that the patient will not likely achieve seizure-free state and recommended continuing his current dose of dilantin to achieve a level of 15-20. 6) dispo. rehab with instructions for tube feeding and refeeding of g tube drainage. the patient has been stable and afebrile, nutritionally managed on tube feeding via his j tube. he has been weaned to trach collar. the patient will follow up with dr. in his office. medications on admission: free water flushes 250ml q4h imipenem 500 mg iv q8 prevacid 30 promethazine 12.8 q8 depakote 650 po6 kcl 40 meq daily isocal hn @ 80cc/hour coumadin vanco 1 gram daily fluconazole 100 mg trazadone 25 qhs discharge medications: 1. metoclopramide 5 mg/ml solution sig: two (2) ml injection q6h (every 6 hours). 2. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). 3. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection (2 times a day). 7. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours) as needed. 8. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 9. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 10. acetaminophen 650 mg suppository sig: suppositorys rectal q4-6h (every 4 to 6 hours) as needed for fever. 11. insulin regular human 100 unit/ml solution sig: one (1) as directed injection asdir (as directed): per iss of facility. 12. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane prn (as needed). 13. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po daily (daily). 14. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4-6h (every 4 to 6 hours) as needed. 15. ferrous sulfate 300 mg/5 ml liquid sig: one (1) po daily (daily). 16. phenytoin sodium 50 mg/ml solution sig: 100 mg intravenous q12h (every 12 hours): - 2 ml for a total of 100 mg twice a day. 17. lorazepam 2 mg/ml syringe sig: injection q4h (every 4 hours) as needed for seizures. disp:*10 * refills:*0* discharge disposition: extended care facility: for the aged - acute rehab discharge diagnosis: superior mesenteric artery syndrome, cerebral palsy, seizure disorder discharge condition: good discharge instructions: please take medications as directed, please follow-up with dr. . please refer to the page 1 sheet for further instructions. followup instructions: please follow-up with dr. in weeks. you will need to call ahead of time to make an appointment. his office phone number is (. procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other enterostomy other endoscopy of small intestine insertion of endotracheal tube interruption of the vena cava enteral infusion of concentrated nutritional substances temporary tracheostomy other endovascular procedures on other vessels transfusion of packed cells other gastrostomy replacement of tracheostomy tube small-to-small intestinal anastomosis transfusion of other serum diagnoses: acute posthemorrhagic anemia acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified unspecified protein-calorie malnutrition severe sepsis other convulsions pneumonitis due to inhalation of food or vomitus other specified septicemias hemorrhage of gastrointestinal tract, unspecified chronic vascular insufficiency of intestine severe intellectual disabilities other and unspecified mycoses infantile cerebral palsy, unspecified 

Answer: The patient is high likely exposed to