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: penicillins / shellfish / fish product derivatives / barium sulfate / iodine attending: chief complaint: abdominal pain major surgical or invasive procedure: none history of present illness: 54yo female presents with 4 days epigastric pain, nausea, vomiting. denies fevers, chills, chest pain, sob. has had decreased urine output but denies dysuria. no changes in bm. ct of abdomen shows pneumoperitoneum with fat stranding around head of pancreas of a perforated peptic ulcer. pt's chronic prednisone use for her ra was also of a perforated ulcer. past medical history: ra osteoporosis spinal stenosis s/p c4-7 fusion s/p l5-s1 fusion horseshoe kidney (cr 1.3-1.5) h/o pyelonephritis reactive airway disease rll nodules (noted ) chronic anemia ulcerative keratitis gerd t2dm social history: lives alone, has a visiting nurse. no tobacco or alcohol. family history: non-contrib physical exam: t 97.8 p 84 bp 125/52 rr 18 o2sat 100% ra gen: a&ox3, in apparent pain heent: perrl, eomi, neck supple cv: rrr w/nl s1, s2, no m/r/g lungs: ctab abd: soft, very obese, tender to palpation in ruq, +rebound/guarding. easily reducible large umbilical hernia ext: warm, dry pertinent results: 04:30am blood wbc-13.3* rbc-3.30* hgb-9.6* hct-27.5*# mcv-83 mch-29.1 mchc-34.9 rdw-15.8* plt ct-386 10:32pm blood hct-20.7* 03:39am blood wbc-10.3 rbc-3.08* hgb-8.9* hct-25.9*# mcv-84 mch-28.9 mchc-34.3 rdw-15.8* plt ct-276 09:45am blood wbc-8.9 rbc-2.95* hgb-8.5* hct-25.6* mcv-87 mch-28.8 mchc-33.2 rdw-16.4* plt ct-357 04:30am blood glucose-150* urean-70* creat-2.5*# na-132* k-8.7* cl-99 hco3-19* angap-23* 09:45am blood glucose-101 urean-12 creat-1.0 na-144 k-3.9 cl-107 hco3-22 angap-19 04:30am blood alt-24 ast-46* ck(cpk)-107 alkphos-158* amylase-53 totbili-0.2 04:30am blood lipase-32 04:30am blood ck-mb-2 04:30am blood ctropnt-<0.01 04:30am blood calcium-10.8* phos-5.3* mg-2.4 09:45am blood calcium-8.3* phos-2.5* mg-1.8 06:07am blood lactate-3.3* 06:40am blood lactate-1.9 k-6.7* brief hospital course: pt was admitted to sicu. ng tube, foley catheter, 2 lrage bore ivs were inserted. 40mg iv bid protonix was started as well as iv vancomycin, levofloxacin, and fluconazole. pt had serial abdominal exams and repeat labs to follow her progress. decision was made to manage expectantly and refrain from immediate surgery given pt's co-morbidities and the duration of her pain. pt was continued on iv steroids as she was on prednisone at home for her ra. hd#2 pt had an upper gi modified barium small bowel follow through which did not show any etravasation of dye. this correlated with the pt's improving abdominal exams and labs suggested that the perforation had sealed on its own. pt's h. pylori ab test was negative. pt was changed from vancomycin to flagyl. pt received 2 units of prbcs for a low hct. pt had melanotic stools and dark red liquid was coming out of her ngt. hd#3 pt was transferred to the floor. carafate was added to the pt's med regimen. hd#4 pt was given pt treatments and a stool c. difficile toxin assay was collected. hd#5 the ng tube was removed and pt was started on sips and progressed to a clear diet. pt's bp regimen of lopressor and hydralazine were increased to control the pt's bps. the pt was also given ativan for anxiety and because she routinely took valium and clonazepam at home. pt tolerated the diet well. hd#6 pt was put on a full liquid diet. the foley catheter was removed. pt was switched to po meds and was started on her po diabetes medicine, avandia. pt's bps improved on po meds and ativan. pt tolerated a soft regular diet for dinner. hd#7 pt received her last doses of levo/flagyl/fluc for a total of 7 days of treatment. pt was tolerating diet and po meds. pt was able to ambulate on her own with her walker. pt was discharged home in stable condition with home health aide services and home pt. pt was sent home on protonix and 2 wks of carafate. pt was to f/u with her pcp days and to get an egd in about a month. medications on admission: arava 20', prednisone 10', prilosec 20', plaquenil 200" discharge medications: 1. sucralfate 1 g tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*2* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po every twelve (12) hours. disp:*60 tablet, delayed release (e.c.)(s)* refills:*6* discharge disposition: home with service facility: discharge diagnosis: pneumoperitoneum likely secondary to perforated du vs antral ulcer discharge condition: stable discharge instructions: please call your doctor if you experience: - fever >101 - severe abdominal pain - persistent nausea and vomiting - inability to eat or drink - any other questions or concerns please follow up with dr. 2-3 days after discharge. call his office at for an appointment. please call gi at for an appointment for an upper endoscopy study to be done in about a month. you may resume your regular diet and activities as tolerated. please continue taking your home medications as prescribed and please take the medications prescribed to you at discharge as directed. followup instructions: please follow up with dr. in days after discharge. call for an appointment. please call gastroenterology at ( to schedule an upper endoscopy (egd) in approximately one month. procedure: arterial catheterization diagnoses: anemia, unspecified pure hypercholesterolemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled rheumatoid arthritis other specified disorders of peritoneum chronic or unspecified duodenal ulcer with perforation, without mention of obstruction chronic or unspecified gastric ulcer with perforation, without mention of obstruction 

Answer: The patient is high likely exposed to