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: dilantin / prozac attending: chief complaint: - abdominal pain major surgical or invasive procedure: - exploratory laparotomy - extensive lysis of adhesions - small bowel resection with re-anastomosis - radical resection of pelvic tumor - rigid proctoscopy history of present illness: this is a 51-year-old woman with a history of pseudomyxoma peritonei, with initial debulking in and recurrence and second debulking in . she presented from her rehab facility to the ed on with abdominal pain. a ct scan of the abdomen and pelvis revealed a likely small bowel obstruction with multiple transition points, as well as multiple cystic structures concerning for recurrence of her mucinous cystic ovarian cancer. past medical history: - pseudomyxoma peritonei - epilepsy - history of right paralysis - depression and post-traumatic stress disorder - hypothyroidism - gastroesophageal reflux disease . - left temporal lobectomy, - total abdominal hysterectomy, bilateral salpingo-oophorectomy, debulking, - debulking of recurrent pseudomyxoma peritonei, social history: - denies tobacco, alcohol, and recreational drug use - lives in rehabilitation facility given functional impairment due to seizures family history: - denies family history of malignancy physical exam: on admission: vitals - t:97.6 hr:61 bp:161/81 -> 117-146/64-88 rr:18 o2sat:100% room air general: asleep, easily arousable, uncomfortable appearing, winces when moving lungs: ctab cv: rrr abdomen: healed vertical midline incision, distended, tympanic in upper abdomen, dull to percussion in lower abdomen, non-tender with percussion, tender to palpation diffusely, worst in upper abdomen, + voluntary guarding pelvic: normal external genitalia, significant tenderness on palpation of cervix and posterior vaginal wall limiting exam, unable to palpate any masses but exam very limited . on discharge: vitals - t:98.5 bp:110/60 hr:104 rr:16 o2sat:96% room air general: nad, resting comfortably cv: rrr lungs: ctab abdomen: soft, bowel sounds present, healing vertical mid-line incision c/d/i with steri-strips in place extremities: no calf edema or ttp pertinent results: wbc-6.0 hgb-12.1 hct-35.7 plt ct-309 neuts-84.3 lymphs-12.5 monos-1.9 eos-1.1 baso-0.3 wbc-2.5 hgb-12.7 hct-36.6 plt ct-224 neuts-32 bands-19 lymphs-33 monos-13 eos-1 baso-0 metas-2 myelos-0 wbc-4.3 hgb-13.1 hct-38.2 plt ct-227 neuts-69 bands-10 lymphs-14 monos-6 eos-0 baso-0 metas-1 myelos-0 bc-10.2 hgb-10.5 hct-31.8 plt ct-229 neuts-77 bands-0 lymphs-11 monos-6 eos-5 baso-0 metas-1 myelos-0 wbc-11.8 hgb-11.5 hct-34.8 plt ct-455 wbc-9.9 hgb-10.8 hct-32.0 plt ct-557 wbc-6.6 hgb-10.6 hct-31.5 plt ct-293 glucose-117 urean-16 creat-0.9 na-139 k-4.4 cl-97 hco3-34 glucose-120 urean-9 creat-0.6 na-139 k-3.3 cl-104 hco3-26 glucose-115 urean-10 creat-0.4 na-139 k-4.1 cl-103 hco3-30 glucose-134 urean-17 creat-0.6 na-143 k-3.8 cl-107 hco3-30 blood glucose-94 urean-16 creat-0.6 na-141 k-4.0 cl-107 hco3-28 glucose-95 urean-18 creat-0.8 na-136 k-4.3 cl-103 hco3-26 calcium-9.4 phos-3.8 mg-1.8 calcium-8.5 phos-1.9 mg-1.9 calcium-8.6 phos-4.5 mg-2.0 calcium-9.1 phos-4.1 mg-1.8 calcium-9.3 phos-4.0 mg-1.8 alt-12 ast-23 alkphos-86 totbili-0.2 alt-7 ast-17 alkphos-37 totbili-1.1 triglyc-38 triglyc-61 tsh-8.0 tsh-3.0 t3-60 free t4-1.0 t3-117 free t4-1.3 ct abdomen/pelvis: impression: 1. small-bowel obstruction with small bowel measuring up to 3.5 cm in diameter. multiple transition points representing multiple strictures in the mid lower abdomen are noted, please note that closed loop obstruction cannot be excluded. 2. multiple cystic structures within the pelvis. given history of prior mucinous cystic tumor of the ovary, this is most consistent with recurrence. no definite solid component identified. ct head: impression: no acute intracranial process. cta chest: impression: 1. no acute pulmonary embolism or acute thoracic aortic pathology detected. 2. cluster of tiny 2-mm pulmonary nodules in both lung bases, a few of which are calcified, likely represent prior granulomatous disease. 3. no evidence of metastatic disease in the chest. brief hospital course: *) small bowel obstruction she was taken to the operating room for surgical exploration. intra-operative findings were significant for recurrent pseudomyxoma peritonei, extensive adhesions of the bowel to the anterior abdominal wall and to other portions of bowel, and small bowel obstruction. she underwent a small bowel resection with re-anastamosis and resection of pelvic tumor. please see the operative report in omr for full details. a nasogastric tube (ngt) was placed intra-operatively and left in place, and she was maintained on bowel rest. total parenteral nutrition (tpn) was initiated. on post-operative day #5, ngt output had decreased, and after clamping the tube with minimal residual output, it was removed. however, the following day she developed nausea and vomiting, and the tube was replaced. her ngt output gradually decreased and her bowel function slowly returned; the ngt was clamped on post-operative days #14-15, with a low residual output, and was removed on post-operative day #16. her diet was slowly advanced as bowel function returned. tpn was weaned off and then discontinued as her diet was advanced. she was discharged on a regular diet with nutritional shake supplementation. *) hypotension/shock intra-operatively she developed hypotension and was placed on pressors; she was admitted to the icu post-operatively. on admission to the icu she had a white blood cell count of 2,000 and tachycardia, meeting criteria for sirs. she was aggressively hydrated with ivf boluses and continuous drips. she was also given 2 units of ffp to reverse coagulopathy and transfused with prbc due to intra-operative blood loss and a hematocrit that drifted down in the post-operative period. she was initially on a norepinephrine drip, but this was weaned off with good effect. vancomycin and zosyn for broad coverage of enteric pathogens were started. she stayed in the icu for 4 days post-operatively; she was hemodynamically stable when transferred to the surgical floor. *) id in the immediate post-operative period she had a low white blood cell count with a bandemia to 19. vancomycin and zosyn were initiated for broad-spectrum coverage of enteric pathogens, due to her extensive bowel surgery. for the first 3 days post-operatively she continued to intermittently become febrile, with gradual resolution of her fevers. the antibiotics were discontinued once she had been afebrile for 48 hours. on post-operative day #7 she had a low-grade fever to 100.8, which spontaneously resolved, and remained afebrile after this. all cultures (urine, blood) negative, and chest imaging was negative for pneumonia. her fevers were attributed to intra-abdominal exposure to intestinal contents/bacteria, as well as inflammation after extensive surgery. during the last 3-4 days of her hospitalization she developed diarrhea, but no fevers or other associated symptoms. stool was sent for c. difficile, which was negative, and her symptoms were overall stable on discharge with 3-4 loose stools per day. she was started on clotrimazole lozenges and oral nystatin for thrush on post-operative day #19 and received one dose of iv fluconazole and two doses of oral fluconazole, with subsequent improvement of her thrush. *) cardiovascular she was initially tachycardic up to the 120's after surgery, which was attributed to her fevers and general state of inflammation post-operatively. her heart rate gradually normalized to the 80-90's. on post-operative day #20, she was again noted to be intermittently tachycardic, low 100's to 110's. on post-operative day #22, as this persisted, an ecg and cta chest were performed. the ecg was unremarkable and unchanged from prior, and cta was negative for pulmonary embolism. her oxygen saturation was good, and her heart rate was stable at 90-low 100's on discharge. *) pulmonary she was electively intubated for surgery and remained intubated in the setting of hypotension and possible sepsis/shock post-operatively. she was successfully extubated on post-operative day #3. on the surgical floor she had one episode of desaturation to 87% on room air, but this was in the setting of a likely post-ictal state and immediately normalized with supplemental oxygen. the oxygen was weaned off and she afterwards maintained excellent oxygen saturation on room air. on cta chest performed to rule out pulmonary embolism, 2mm tiny pulmonary nodules consistent with prior granulomatous disease were noted incidentally. *) epilepsy ms. has a longstanding history of seizures and has undergone a temporal lobectomy in the past. as an outpatient, her regimen consisted of 3 agents - keppra, lamictal, and ativan. due to her small bowel obstruction, she was made npo. neurology was consulted for input regarding her medications, and recommended continuing iv keppra and increasing iv ativan to cover her usual lamictal (unavailable in an iv form). post-operatively, ativan was initially held due to sedation/intubation. her keppra was continued throughout her hospital course. when she was extubated and more alert, ativan was re-started at a low dose. she continued to have intermittent seizure activity, but these were consistent with episodes in the past in which she became symptomatic but had no epileptiform activity on eeg, suggesting that there may be a component of stress/anxiety. her ativan was slowly titrated up, with subsequent good control of her seizure activity. lamictal was re-started on post-operative day #18 and gradually titrated up per neurology's recommendations. *) depression/post-traumatic stress disorder due to being npo for a prolonged period of time, she was unable to receive her usual anti-depressant medication. psychiatry was consulted and continued to follow and provide support during her hospital course, as did social work. her anti-depressant was re-started when she was able to tolerate oral intake. *) hypothyroidism her levothyroxine was continued, after conversion to iv dosing ( po dose = iv dose). thyroid function tests were checked at the suggestion of neurology, who felt that thyroid function could be affecting her seizure activity. tsh was initially elevated, with normal free t4. endocrinology was informally consulted and thought this to be consistent with sick euthyroid syndrome after surgery/illness. labs were re-checked 1 week later and her tsh had normalized, with normal free t4 and t3, so her usual dose of levothyroxine was maintained and transitioned back to oral dosing when she was able to tolerate oral intake. *) fall on post-operative day #7 she attempted to move out of her bed and fell onto her hands and knees; the fall was unwitnessed but she maintained consciousness and denied any head trauma. her vital signs were normal, and a ct of the head was negative for acute injury. medications on admission: - colace - lamotrigine 1500mg/2000mg - keppra 1500mg/2000mg - levothyroxine 88mcg daily - ativan 1mg daily, prn for increased seizure activity - nefazodone 100mg/200mg - metamucil - multi-vitamin - senna discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain,fever. 2. nystatin 100,000 unit/ml suspension sig: five (5) ml po tid (3 times a day). 3. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 6. nefazodone 100 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 7. nefazodone 100 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 8. clotrimazole 10 mg troche sig: one (1) troche mucous membrane daily (daily). 9. levetiracetam 500 mg tablet sig: three (3) tablet po qam (once a day (in the morning)). 10. levetiracetam 500 mg tablet sig: four (4) tablet po qpm (once a day (in the evening)). 11. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas pain. 12. lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours). 13. hydromorphone 2 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:40 tablet(s) refills:0 14. ibuprofen 600 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 15. lamotrigine 100 mg tablet sig: one (1) tablet po bid (2 times a day). 16. lovenox 40 mg/0.4 ml syringe sig: one (1) syringe subcutaneous once a day: until ambulating more frequently. discharge disposition: extended care facility: healthcare center - discharge diagnosis: - recurrent pseudomyxoma peritonei - small bowel obstruction . - epilepsy - depression - hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: please take your medications as prescribed. no heavy lifting or strenuous activity for 4 weeks. . please call your doctor for the following: - fever greater than 100.4 - severe pain that does not improve with medication - persistent nausea or vomiting - difficulty breathing or chest pain - increasing redness around your incision - bleeding or thick discharge from your incision - if your incision re-opens . instructions for titrating lamotrigine and lorazepam: - currently lamotrigine 100 mg , started - in 4 days (from ) increase the dose to 200 mg - in 4 days, increase the dose to 300 mg - for lorazepam, reduce dose by each week, now 0.5mg every 4 hours followup instructions: - follow up with dr. in early - please call to make an appointment, md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other partial resection of small intestine other lysis of peritoneal adhesions rigid proctosigmoidoscopy suture of laceration of small intestine, except duodenum excision or destruction of lesion or tissue of abdominal wall or umbilicus diagnoses: esophageal reflux acute posthemorrhagic anemia unspecified septicemia severe sepsis unspecified acquired hypothyroidism other specified intestinal obstruction candidiasis of mouth accidental puncture or laceration during a procedure, not elsewhere classified acute respiratory failure septic shock epilepsy, unspecified, without mention of intractable epilepsy accidents occurring in residential institution tachycardia, unspecified intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) secondary malignant neoplasm of retroperitoneum and peritoneum unspecified peritonitis accidental cut, puncture, perforation or hemorrhage during surgical operation posttraumatic stress disorder other functional disorders of intestine secondary malignant neoplasm of other urinary organs 

Answer: The patient is high likely exposed to