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 / zestril attending: chief complaint: sepsis major surgical or invasive procedure: subtotal colectomy and ileostomy history of present illness: patient is a 72 year old female who recently underwent an aortic valve replacement on . her postoperative course was uneventful and she was discharged to rehab on . she presented to hospital yesterday with several days of worsening abdominal pain. in the ed she was febrile to 102, hypotensive, and hypoxic w/ rigors. of note, at the rehab facility she was started on vancomycin iv, gentamicin iv, and flagyl iv for the abdominal pain. upon arrival to the osh she was noted to have a wbc count of 20 with 39% bands with multiple electrolyte abnormalities. a cdiff culture was reportedly positive as well. she was intubated, started on levophed and admitted to the icu. a ct scan of the abdomen was obtained which per report showed significant ascites, dilated small and large bowel, and possible wall thickening of the colon, without evidence of perforation. she was transferred to for further care. past medical history: toxic colitis with full-thickness colonic ischemia on the sigmoid colon s/p exploratory laparotomy with subtotal colectomy and ileostomy pmh: - aortic valve stenosis - hypertension - dyslipidemia - diabetes mellitus type ii - history of renal cell carcinoma status post nephrectomy resulting in esrd, requires peritoneal dialysis since - history of peritonitis over five years ago - history of herpes zoster several years ago - history of c. difficile colitis - anemia - arthritis, history of gout - hyperparathyroidism social history: lives: alone tobacco: quit over 40 years ago etoh: denies family history: non contributory physical exam: pulse: 106 resp:22 o2 sat: 98% b/p right:118/61 left: ax aline 101/41 height:4'9" weight: general:intubated, sedated skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally decreased at bases heart: rrr irregular murmur abdomen: soft non-distended non-tender bowel sounds + firm, distended, absent bowel sounds extremities: warm , well-perfused edema varicosities: none 2+ le edema neuro: grossly intact pulses: femoral right:2+ left:2+ dp right:1+ left:1+ pt :1+ left:1+ radial right:2+ left:2+ carotid bruit right: left: pertinent results: 02:37am blood wbc-8.9 rbc-3.43* hgb-10.4* hct-30.2* mcv-88 mch-30.3 mchc-34.4 rdw-15.8* plt ct-127* 01:54pm blood hct-29.6* 02:55am blood wbc-10.5 rbc-3.77*# hgb-11.6*# hct-33.1* mcv-88 mch-30.7 mchc-34.9 rdw-16.4* plt ct-116* 02:37am blood plt ct-127* 02:37am blood pt-15.9* ptt-65.9* inr(pt)-1.4* 02:55am blood pt-14.7* ptt-58.8* inr(pt)-1.3* 02:15am blood pt-15.6* ptt-87.5* inr(pt)-1.4* 12:22pm blood pt-14.7* ptt-68.2* inr(pt)-1.3* 04:10am blood pt-14.9* ptt-72.0* inr(pt)-1.3* 02:37am blood glucose-123* urean-33* creat-2.4* na-140 k-4.4 cl-103 hco3-29 angap-12 02:55am blood glucose-97 urean-51* creat-3.1*# na-136 k-4.4 cl-99 hco3-27 angap-14 02:15am blood glucose-162* urean-35* creat-2.0* na-136 k-4.0 cl-100 hco3-34* angap-6* 12:22pm blood na-139 k-4.7 cl-100 02:37am blood alt-2 ast-13 ld(ldh)-290* alkphos-93 amylase-123* totbili-0.4 02:55am blood alt-5 ast-20 ld(ldh)-309* alkphos-113* amylase-187* totbili-0.4 02:15am blood alt-9 ast-31 alkphos-129* amylase-201* totbili-0.4 02:37am blood lipase-89* 02:15am blood lipase-158* 02:36am blood lipase-294* 04:11am blood lipase-287* 02:37am blood calcium-9.7 phos-3.8# mg-2.3 02:55am blood albumin-2.4* calcium-9.6 phos-5.4* mg-2.3 02:15am blood calcium-9.2 phos-3.9 mg-2.2 12:22pm blood mg-2.3 cxr final report ap chest, 4:11 p.m., history: repositioned picc line. comparison: ap chest compared to at 2:57 p.m.: right pic line has been repositioned, ending in the low svc, just proximal to the left internal jugular line that ends at the level of the superior cavoatrial junction and the dual-channel dialysis catheter that ends at and just below the superior cavoatrial junction. low lung volumes make it difficult to exclude mild interstitial edema. a small left pleural effusion is present. no pneumothorax. feeding tube passes into the stomach and out of view. dr. approved: mon 8:37 pm imaging lab brief hospital course: the patient was admitted for further management of c. diff colitis and septic shock. transplant surgery was consulted, and the patient was taken to the operating room for an exploratory laparotomy. or findings included toxic colitis with full-thickness colonic ischemia on the sigmoid colon. she underwent subtotal colectomy and ileostomy with dr. . post-operatively she was transferred back to the cvicu for invasive monitoring and recovery. renal was consulted to aid in transition to crrt from peritoneal dialysis. id was consulted and made appropriate recommendations for antimicrobial regimen. vancomycin was initiated for cdiff along with metronidazole. additionally, daptomycin and meropenem were started for gram negative and anaerobic coverage. amiodarone and anti-coagulation were resumed for paroxysmal atrial fibrillation. thrombocytopenia developed and hit would return negative. platelet count improved. the patient was extubated on pod 6. she received a tunneled hd catheter in ir on , and was transitioned to hd on . tpn and tube feeds were initiated. amylase and lipase rose. tpn was held, and enzymes would trend down. tpn was discontinued when the patient tolerated tube feeds at goal. she did receive a picc on for ongoing access and antibiotic administration. the patient will be discharged on 2 weeks of flagyl. she is discharged to rehab at the , in . renal will follow up with the facility for hd recommendations. the patient has been advised of all necessary follow-up. medications on admission: amiodarone iv drip norepinephrine iv drip fentanyl iv drip versed iv drip tigecycline 50 mg iv q12 hours flagyl 500mg iv q6hours gentamicin iv vancomycin 250mg po qid hydrocortisone 50 mg iv q6hours protonix 40mg iv daily allopurinol 150mg po daily midodrine 5mg po tid heparin 5000 units sq q8hours insulin sliding scale discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for temp >38.4 . 2. allopurinol 100 mg tablet sig: 1.5 tablets po every other day (every other day). 3. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 6-10 puffs inhalation q4h (every 4 hours) as needed for wheezing . 5. amiodarone 200 mg tablet sig: two (2) tablet po once a day: 400mg daily x 1 week, then 200mg daily until further instructed. 6. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 7. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed for wheezing/dyspnea. 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours). 9. cepacol sore throat + coating 15-5 mg lozenge sig: one (1) mucous membrane every four (4) hours as needed for sore throat. 10. lidocaine hcl 2 % solution sig: one (1) ml mucous membrane tid (3 times a day) as needed for mouth sores. 11. acyclovir 400 mg tablet sig: one (1) tablet po q12h (every 12 hours). 12. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 13. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours) for 11 days: through . 14. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). 15. ondansetron 2 mg iv q8h:prn nausea 16. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution sig: one (1) intravenous asdir (as directed): 700 units/hr for goal ptt 50-70, dx: afib. d/c when inr therapeutic on coumadin. 17. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm: md to dose daily for goal inr 2-2.5, dx: afib. 18. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous four times a day: per insulin sliding scale. 19. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 20. outpatient lab work labs: pt/inr coumadin for a-fib goal inr 2-2.5 first draw then please do inr checks monday, wednesday, and friday for 2 weeks then decrease as directed by md discharge disposition: extended care facility: discharge diagnosis: toxic colitis with full-thickness colonic ischemia on the sigmoid colon s/p exploratory laparotomy with subtotal colectomy and ileostomy pmh: - aortic valve stenosis - hypertension - dyslipidemia - diabetes mellitus type ii - history of renal cell carcinoma status post nephrectomy resulting in esrd, requires peritoneal dialysis since - history of peritonitis over five years ago - history of herpes zoster several years ago - history of c. difficile colitis - anemia - arthritis, history of gout - hyperparathyroidism discharge condition: alert and oriented x , intermittently confused deconditioned sternal wound c/d/i without erythema or drainage abdominal wound clean, packed wet to dry discharge instructions: 1) please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage. 2) please no lotions, cream, powder, or ointments to incisions. 3) each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart provided. 4) no driving for approximately one month and while taking narcotics. driving will be discussed at follow up appointment with surgeon when you will likely be cleared to drive. 5) no lifting more than 10 pounds for 10 weeks 6) please call with any questions or concerns *females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. #: date/time: 1:15 cardiologist: dr. : appointment on at 2pm please call to schedule appointments with your general surgery, dr. in 2 weeks, primary care dr. in weeks. please call to schedule your appointment. nephrology- please call dr. office on discharge from rehab to arrange for follow-up **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis other and unspecified partial excision of large intestine temporary ileostomy diagnoses: thrombocytopenia, unspecified end stage renal disease renal dialysis status diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia septic shock intestinal infection due to clostridium difficile heart valve replaced by transplant personal history of malignant neoplasm of kidney unspecified vascular insufficiency of intestine toxic gastroenteritis and colitis 

Answer: The patient is high likely exposed to