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: halothane / sulfa (sulfonamide antibiotics) attending: chief complaint: perforated bowel major surgical or invasive procedure: exploratory laparotomy, ileocecectomy, low anterior resection with an ileostomy and mucous fistula, and bladder repair. history of present illness: 65 f h/o dm-2, refractory crohn's diagnosed in p/w severe abdominal pain. she has a history of crohn's colitis and is currently undergoing pre-operative planning for surgical intervention with dr. on the colorectal surgery service. she now p/w sharp abdominal pain involving her lower abdomen and back. she reports this started 1 day ago as a typical crohn's flare in her llq but has progressed and is not worse than any previous flare. she has had associated nausea without emesis. she has not had any changes in bowel function and denies fevers or chills. she has been unable to tolerate anything except clear liquids. in the ed her wbc is 32 and she has a lactate of 6.4. she is hypotensive with sbp in 80's and is currently receiving ivf resuscitation and was started on levophed. after 3 liters of ivf her sbp is now 117 and the levophed is being weaned. her lactate is down to 4. she was diagnosed with crohn's in and was started on infliximab for about one year but lost response. she developed a perianal fistula on which has been healing. she has also been tried on humira, cyclosporine, mesalamine and prednisone without success. she recently presented to the ed with similar complaints on and had a wbc of 34. she was admitted to gi and underwent colonoscopy which revealed a polypoid lesion 2-3 cm in diameter at 25 cm into sigmoid colon. biopsies obtained revealed a degenerating crypt consistent with her diagnosis of crohn's. on she underwent ct abd which revealed adjacent stranding containing small foci of extraluminal air consistent with contained perforation, with stranding extending anteriorly with loops of small bowel suggestive of fistula formation. she was treated with iv antibiotics in house and prednisone and discharged with a 2 week course of antibiotics and prednisone. she is currently not taking any medications for her crohn's and reports being off steroids for approximately 3 weeks. past medical history: crohn's disease anemia benign hypertension osteoarthritis hyperlipidemia type 2 diabetes morbid obesity chronic knee pain murmur (never told she needed abx prophylaxis) adrenal adenoma social history: no smoking, drinking, or illicit drug use, has 2 children, lives with husband, works as a secretary in high school. no travel hx over the past 2 years. contact is husband, : family history: no history of ibd or other autoimmune diseases. physical exam: vs: 97.5, 93, 108/65, 20, 99% ra, blood glucose= 114 gen: appears uncomfortable, aox3 heent: eom-i, dry mucous membranes, neck soft, trachea midline cvs: rrr pulm: no resp distress abd: obese, firm and distended. extremely ttp throughout especially luq and llq. voluntary guarding, no rebound. rectum: deferred, pt having severe abdominal discomfort le: 2+ edema b/l with skin changes c/w chronic venous insufficiency abdominal wound: approximately 12 inches in length, approximately 5cm at inferior portion of the wound, red beefy granulation tissue in subcutaneous space, facia exposed with suture however wound closing, small area grey/yellow sloughing tissue along fascia at base of wound. mucus fistula: retracted with some grey exudate, it is not expected to drain a large amount illeostomy: stoma retracted, good liquid stool output, please see wound/ostomy nurse page 2. pertinent results: fluid cx: e.coli, klebsiella, c. perfringens, bacteroides: pan-sensitive bcx: e.coli, pan-sensitive sputum cx: gstain: 2+ gpc, 4+ pmns, cx: yeast echo: lv syst fx depr (ef<30%), mild ao valve stenosis, sm effusion echo: lv systdysfx (ef<30%), apex mildly aneurysmal, no pericardial effusion drain cx: g stain: 2+ pmns, cx: coag neg staph ct thorax: seg r lower pe, new thrombus r subclav partially occlusive, no abscess cystogram: contrast demonstrated at the dome of the bladder wbc curve: 32.4 ()->33 ()->24.2 ()->27.4 ()->43.5 ()-> 42.7 ()->37.2 ()->24.7 ()->22 ()->24.8 ()->28.8 () ->22 ()-> 19.4 ()-> 15.9 ()-> 13.8 ()-> 13.6 () ptt 56.9 () inr 2.7 () inr 6.4 () inr 7.8 () inr 7.9 () inr 5.8 () inr 2.6 () brief hospital course: 65yo f with crohn's disease with a known contained abscess in the pelvic inlet who was scheduled for elective surgery in the near future, presented with acutely worsened abdominal pain and hypotension requiring large volume fluid resuscitation and vasopressors. her ct scan was consistent with a bowel perforation and she was taken to the or for exploratory laparotomy, ileocecostomy, low anterior resection with an ileostomy,mucous fistula by dr. and a bladder repair with dr. . the case was complicated as documented in the operative note and there was a bladder laceration repaired by urology. two drains were placed. the abdominal wound was irrigated, closed with suture at the facia and left open given significant obesity and gross contamination. the patient was admitted from the operating room to the surgical intensive care unit. the patient was intubated and monitored closely by the surgical and intensive care unit teams. in the icu a wound vac was placed, which was changed every three days by the surgical team. her intraoperative fluid culture grew e. coli and klebsiella and her post-op blood culture grew e. coli and she was started on iv ciprofloxacin/flagyl. she continued to have leukocytosis and a mini-bal was performed which later grew yeast. at that point her antibiotic coverage was broadened to vancomycin/ciprofloxacin/flagyl/fluconazole. the patient was transferred from the surgical intensive care unit to the inpatient floor on on intravenous ciprofloxacin/metrodiazole. the patients lab values and fever curve were closely monitored and the patient was noted to have a consistently elevated white blood cell count. in an effort to determine the cause of this consistently elevated white blood cell count the blood cultures were drain, peritoneal fluid from the / drain was sent for culture, the patients sputum was cultured, and patient was sent for a ct scan of her torso and abdomen to rule out intra-abdominal abscess. the ct torso/abdomen showed no obvious intra-abdominal or intrapelvic abscess with filling defects within the segmental and subsegmental branches of the right lower lobe pulmonary arteries is concerning for pe. because of dry cough, shortness of breath with exertion, and atelectasis the patient was started on standing combivent nebulizing treatments. for treatment of the patient's pulmonary embolism a heparin drip was initiated and the patient was started on 5mg of warfarin on to bridge her to an inr of . the patient's inr level on was 1.5 and the patient recieved 5mg of warfarin. on the patient's inr value was 2.7 and the heparin drip was discontinued and the patient received 3mg of warfarin. the patient's inr value on was 6.4. at this time the warfarin was held and the patients inr continued to climb with a value of 7.3 on the afternoon of , 7.8 on , 7.7 on , and 7.9 on . on it was decided to reverse the inr with 10 mg of vitamin k orally. the patients inr on was 5.8 and the patient was again given 10mg of vitamin k orally, also on the patient concluded her antibiotic/antifungal therapy which may have contributed to this elevated inr. the patient's inr on was 2.6 and it was determined that the patient could receive her first dose of warfarin 3mg and be discharged to her selected rehabilitation hospital for inr checks and warfarin therapy. her goal inr is . the gram stain of the peritoneal fluid showed coagulase negative staphylococcus and at this time the patient vancomycin and fluconazole were added to her antibiotic regimen. 14 days after blood cultures came back negative for e. coli her antibiotics were narrowed to only vancomycin and fluconazole after which her wbc continued to decrease. the patient was tolerating a regular diet at this time with supplements at each meal and had adequate stool and gas output from the ileostomy. the mucus fistula continued to produce a small amount of mucus. the mucus fistula was flushed periodically with normal saline and covered with a dry sterile dressing. the patient was followed closely by the wound/ostomy nursing team. on post-operative day 13 the wound was assessed by the chief surgical resident and attending and noted to have necrotic fat and fibrinous tissue to the suture closure at the abdominal fascia. the wound was debrided at the bedside and packed with a moist to dry saline dressing for 3 days for continued mechanical debridement and then the vac dressing was replaced on post-op day 16. on post-op day 19, on vac change, the wound had good granulation tissue. antibiotic/antifungal therapy was discontinued on on post-op day 10 the abdominal jp drain was putting out minimal drainage and was discontinued. on post-op day 14 the patient underwent a cystogram to evaluate the bladder repair and was found to have a continued bladder . the foley catheter and the suprapubic jp drain were left in place. on post-op day 16 the jp drain fluid was found to have a creatinine level of 2.9, consistent with bladder . urology recommended continued bladder decompression with the foley catheter for an additional 14 days when a repeat cystogram will be obtained, this test is ordered to take place on in the building on the at 930 in the morning. dr. is operating that day at will eb in touch with the rehabilitation hospital to set up a follow-up appointment arrangement. because of severe deconditioning, physical therapy was consulted on transfer from the icu to the inpatient floor and they recommended that when ready for discharge, she should go to rehab and that in the meantime she should be out of bed to chair with every day, which she has generally been compliant with. due to the extensive volume requirement she had on admission due to her hypotension and sirs she became very edematous and her weight was 113 kg on admission. with diuresis as she improved her weight decreased to 95 kg on post-op day 16. on exam her legs continue to have significant venous congestion, but the global edema has decreased significantly over her hospital course. and her peripheral access improved. during the patient's stay on the inpatient unit, the patient verbalized feelings of anxiety and was observed to have a flat affect which was gradually improving at the end of her hospital stay. , np had discussions at length with the patient and the patient's husband about initiating anti-depressant therapy with celexa. because of the elevated inr and the patients apprehension to this therapy the medication was not initiated. on the last day of hospitalization , the patient verbalized that she would like to attempt to deal with the anxiety and mood on her own but would reach out to the care providers at the hospital regarding this therapy if she decided it was needed. upon discharge, the patient was evaluated by the clinical nurse specialist and she was found to have adequate access for peripheral blood draws for her inr monitoring. the central line in the upper left chest was removed. the vac dressing was taken down prior to discharge with the intent that it will be reapplied on her arrival to the rehabilitation facility. she recieved 3mg of warafrin prior to discharge on . medications on admission: atenolol 50mg daily diphenoxylate-atropine prn ezetimibe 10mg daily lasix 20mg daily metformin 50mg niacin sr 500mg daily omeprazole 20mg daily prochlorperazine maleate prn risedronate 35 qwk ergocalciferol 1000mg daily multivitamin daily percocet prn imodium prn discharge medications: 1. insulin regular human 100 unit/ml solution sig: sliding scale as written units injection asdir (as directed). 2. regular insulin sliding scale breakfast lunch dinner bedtime regular regular regular regular glucose insulin dose insulin dose insulin dose insulin dose 0-70 mg/dl proceed with hypoglycemia protocol 71-119mg/dl 0 units 0 units 0 units 0 units 120-159mg/dl 2 units 2 units 2 units 2 units 160-199mg/dl 4 units 4 units 4 units 4 units 200-239mg/dl 6 units 6 units 6 units 6 units 240-279mg/dl 8 units 8 units 8 units 8 units 280-319mg/dl 10 units 10 units 10 units 10 units 320-359mg/dl 12 units 12 units 12 units 12 units 360-399mg/dl 14 units 14 units 14 units 14 units 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for fungal skin infection. 6. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for breakthrough pain. 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inh inhalation q6h (every 6 hours). 8. ipratropium bromide 0.02 % solution sig: one (1) inh inhalation q6h (every 6 hours). 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours). 10. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 12. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 13. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 14. loperamide 2 mg capsule sig: one (1) capsule po tid (3 times a day). 15. psyllium 1.7 g wafer sig: one (1) wafer po tid w/meals (3 times a day with meals). 16. warfarin 3 mg tablet sig: one (1) tablet po once a day: please have inr check , goal inr is . discharge disposition: extended care facility: - discharge diagnosis: bowel perforation, crohn's disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the hospital after having emergency surgery to treat a bowel perforation caused by crohn's disease. you were very sick at this time and the procedure was very complicated. the perforation of your bowel required significant resection and an ostomy was created from your small intestine to give your colon a chance to heal. also, a mucus fistula was made. you should continue to care for the mucus fistula as well as the ostomy as you have instructed by the wound/ostomy nursing team. the large surgical wound in your abdomen was left open to prevent a large wound infection, your abdomen had a large amount of contamination during the procedure. this has been treated with vac therapy and debriedment and has showed signs of improvment, the wound has decreased in size and has healthy tissue formation. the vac therapy will continue with dressing changes every three days. the dressing will be changed by the nurses at the rehabilitation facility. ther are multiple pressure ulcers on your bottom, it is important to stay clean and the nurses at the rehabilitation center will apply dressings during your hospital stay, you developed a blood clot in your lung. you were started on the medication coumadin for treatment of this clot. you will need to continue this medication for approximately 6 months. the purpose of this medication is to thin the blood to prevent further clot formation. the inr level of your blood needs to be monitored frequently and in your case, it will need to be monitored closely as you have been very sensitive to this medication. at the rehabilitation hospital, they will monitor your coumadin therapy and regulate the dose as needed. when you are home, your primary care provider will need to do this. you will take 3 mg of coumadin daily at 4pm. you will have an inr monitored on . your goal inr is . you will need to take the coumadin daily for 6 months. continue your physical therapy as prescribed by a physical therapist with a goal of walking. no heavy lifting for 2 months, no bathing or swimming for 6 months after surgery. you should monitor your bowel function. the ileostomy will produce loose stool becuase it is the small intestine however the amount of stool produced should be between 500-1200cc daily. if it is less than 500cc or more than 1200cc please call the office for assistance. if it is greater than 1200cc in one day there is a risk that you could become dehydrated. you are currently taking immodium to help reduce the stool output and you may continue this therapy at rehab. eat small frequent meals, continue your boost suppplementation, and stay well hydrated. please continue the bowel regimen of immodium and metamucil wafers. as your output decreases the staff at the rehabilitaion facility can titrate your bowel regimen as needed. they may call dr. as needed. we have talked about starting the antidepressant celexa to help you with your mood and motivation. at this time you have decided to continue to cope with your anxiety on your own. please talk with the at the rehabilitation hospital about starting this medication if you feel you need continued help. please reach out to your family and other support systems. followup instructions: please make an appointment to see dr. in 2 weeks. call to make this appointment. cystogram ordered for to access bladder , take place on the of . and the results will be passed on to dr. and dr. . provider: upper gi (tcc) radiology phone: date/time: 9:30 please call to make an appointment to see dr. in clinic on , call ( to make an appointment. *** dr. is operating on the morning on at and his office will be calling the rehabilitation hospital to set up a follow-up arrangment*** procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances temporary ileostomy open and other right hemicolectomy suture of laceration of bladder anterior resection of rectum with synchronous colostomy cystometrogram diagnoses: other postoperative infection cellulitis and abscess of trunk congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified acquired coagulation factor deficiency severe sepsis perforation of intestine accidental puncture or laceration during a procedure, not elsewhere classified septic shock morbid obesity iatrogenic pulmonary embolism and infarction acute systolic heart failure septicemia due to escherichia coli [e. coli] peritoneal abscess fistula of intestine, excluding rectum and anus peritonitis (acute) generalized long-term (current) use of aspirin regional enteritis of large intestine 

Answer: The patient is high likely exposed to