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: no known allergies / adverse drug reactions attending: chief complaint: sub-diaphragmatic air major surgical or invasive procedure: 1. reopening of recent laparotomy with gastric wall biopsy and patch of gastric perforation, . 2. reopening of laparotomy for further exploration and complete facial closure . 3. exploratory laparotomy, washout of abdomen, placement of jejunostomy and multiple abdominal drains. placement of vac, 25 x 3 cm. history of present illness: 74m s/ patch for perforated antral ulcer xfer from osh w hypotension, pressor requirement and free air/fluid likely re-perforation. in usual state of health until presented to osh w four days of abdominal discomfort. ed workup at osh revealed perforated gastric ulcer for which patient was taken to or for patch repair of perforated antral ulcer. tolerated procedure well. postop course notable for self-limited episode of unresponsiveness of unknown etiology. given narcan with equivocal improvement. xferred to osh icu for further care. ct head obtained emergently was negative. in 24 hours prior to xfer patient became increasingly hypotensive, dyspneic and distended. ct showed increased intra-abdominal free air/fluid. as pt developed pressor requirement likely abdominal sepsis decision was made to xfer pt to for further mgmt. on arrival patient mentating well. complains of mild shortness of breath (on supplemental o2) and moderate abdominal pain. no nutrition since . no passage of flatus. no bm since . denies headache, visual change, chest pain, palpitations, cough, dysuria, nausea, vomiting. notably, patient comes with limited records from osh. history/hospital course obtained from patient/ and limited osh records. past medical history: htn, cad, hld, niddm psh: appy (unknown), cabg (), l inguinal hernia repair () social history: lives with wife. is hcp. retired funeral director. tobacco: denies. etoh: denies. recreational drugs: denies. family history: mother/father: dm physical exam: pe on admission: vs: t: 99.8 p: 90 bp: 103/52 rr: 28 o2sat: 96 6lnc levo gtt @ 0.1 gen: wd, obese m in nad heent: ncat, eomi, anicteric cv: rrr pulm: b/l wheeze w mild respiratory distress abd: soft, diffuse moderate tenderness (r>l) to mild palpation, +tense distention, upper midline incision w staples and no discharge/erythema, no mass, no hernia pelvis: deferred ext: wwp, 2+ b/l le edema neuro: a&ox3, no focal neurologic deficits pe on day of discharge t: 97 ax hr: 84 rr: 22 bp: 114/60 o2: 94 ra pertinent results: labs: 136 107 66 --------------------<260 agap=16 3.9 17 2.5 ca: 7.0 mg: 2.1 p: 4.0 ph: 7.30, pco2: 33, po2: 111, hco3: 17, basexs: -8 type:art freeca:1.12 lactate:1.7 32.4>-12.8/38.7-<319 ugi (): no evidence of leak from antral ulcer status post patch. ct abdomen/pelvis (): 1. no pulmonary embolism or acute thoracic aortic pathology. 2. moderate right and a small left pleural effusions with near-complete right lower lobe and partial left lower lobe atelectasis. 3. moderate amount of intraperitoneal free fluid and air, with a few locules of air are seen adjacent to the gastric antrum. large anterior abdominal fluid collection with an air-fluid level. given the above findings a leak at the gastric repair site cannot be excluded. ct abdomen/pelvis (: 1. multiple loculated fluid collections within the abdomen, some of which have increased in size since the prior study. no definite signs of infection. 2. status post patch placement. improvement of pneumoperitoneum with residual small foci of gas noted. new fluid around anterior abdomen drain. 3. unchanged small left and moderate right pleural effusion. ruq us (): 1. concentric gallbladder wall edema, likely secondary to third spacing given the patient's hypoalbuminemic state with evidence of volume overload. the gallbladder is not particularly distended and there are no gallstones identified. if there is a very high clinical concern for acute acalculous cholecystitis, further evaluation could be performed with a hida scan. 2. small volume ascites and right pleural effusion, as on prior ct from . brief hospital course: mr. was admitted to the surgical icu on pressors, had a central line and arterial line placed and then was taken to the or for emergent reopening of recent laparotomy with gastric wall biopsy and patch of gastric perforation. post-operatively, he was transferred back to the surgical icu intubated, sedated, on pressor support, npo with ivf and an ngt. his hospital course as follows by systems: neuro: fentanyl and midazolam were used for sedation/pain control while intubated. after extubation, patient exhibited confusion and sundowning consistent with mild icu psychosis. he was treated with zyprexa with good effect. intermittent confusion remained upon transfer to the floor, but improved during stay back to normal aaox3 baseline. pt received quetiapine prn confusion while on floor. he was readmitted to the icu on , shown to have a collections on ct scan and taken to the or on for exploration and washout. he returned intubated and sedated and his post-op course was complicated by hemodynamic instability and a need for pressors and prolonged ventilation. he was kept intubated during this time and appropriately sedated. when extubated on he was aaox3 and mental status was appropriate for the remainder of his hospitalization. cv: patient was initially hemodynamically unstable likely due to sepsis from abdominal source and required multiple pressors in the initial pre and post-operative period which was ultimately weaned to a single , levophed. this was weaned off by . patient developed svt on pod#5 that was controlled with metoprolol and then diltiazem drip/ patient was started on intermittent lasix for diuresis and diltiazem drip was converted to po. patient was rate controlled and hemodynamically stable upon transfer from the icu, and was maintained on diltiazem po on floor, which was kept in lieu of home carvedilol. pt was also placed on 20mg lasix, with good urine output for diuresis. however, sepsis recurred on with suspicion for recurrent leak and patient was taken to the or emergently on . he was on pressors postoperatively which were gradually weaned off with fluid resuscitation. once he was hemodynamically stable, patient was diuresed with cvvh and then lasix. an echocardiogram done on showed ventricular systolic function moderately depressed (lvef= 35-40 %) but was otherwise unremarkable. repeat echo on showed excellent systolic function (lvef >55%) and no wma. resp: intubated with attempts to wean. on pod 2 he had a bronchoscopy that was largely unremarkable. bal only grew a small amount of yeast. patient was extubated on pod#4, and was gradually weaned off of supplemental o2. patient was re intubated for surgery on and kept on ventilator postoperatively. he was gradually weaned off the vent with assistance from diuresis by cvvh, until he was extubated on . he was weaned off oxygen and had normal sats on room air. gi: after abdominal washout and repair of the perforation in the or, he was kept npo with ngt and ivf. the ngt remained in place until pod 4, when patient was extubated. jp drain was also placed in the or, output was measured daily and it was removed with minimal serous drainage. he received protonix and was kept on antibiotics (please see id section for more information). an ugi was performed with no evidence of leak or obstruction and patient was started on a regular diet. however, patient began to have confusion, nausea, and abdominal pain on . patient was transferred back to the icu and ct scan was performed, showing recurrence of his gastric leak. patient was taken back to the or on and his abdomen was washed out with drains placed anterior to the stomach. initial drain output was serous which turned bilious on . despite drainage and washout, patient had persistent fevers and leukocytosis. percutaneous drainage of the fluid collections seen on ct was performed on . no drain was left since the aspirated fluid was simple. cultures were negative for bacteria. over the following week, patient's fevers resolved with normalization of his wbc count. ngt was kept in place and patient was tolerated tube feeds via jtube. on the ngt was removed the output from the drains were monitored closely and was noted to decrease over his postoperative course. he will be discharged with the drains in place and when he returns for outpatient follow up in the acute care surgery clinic a log with his drain output should accompany him. he continues to receive his tube feedings which were changed to two cal hn full strength from the nepro formula given his electrolyte imbalances. he is otherwise npo. gu: he was in acute kidney injury likely from sepsis. his cr was 2.5 on admission to and was monitored, trending down to 0.8. he was also noted with scrotal edema, likely related to low albumin and aggressive fluid resuscitation while septic. edema improved with elevation and diuresis with lasix. after recurrent leak, patient's renal function worsened to a max cr of 4.2 and zero urine output for almost a day. nephrology team was consulted and he was started on cvvh which lasted from . his urine output gradually improved and he was treated with high dose lasix towards the end of his course of cvvh, to which he responded well. his cr on discharge from the icu on was 3.1 and upon discharge to ltac on was 3.3. his k+ was low intermittently and was repleted accordingly; he was also noted with hypernatremia up to 150 and was ordered for free water flushes per nephrology recommendation. no further plans for dialysis per nephrology despite his rising creatinine- it was felt that this would improve ove time and to continue with close monitoring of his electrolytes. the dialysis catheter was removed prior to discharge. heme: his hematocrit remained low but mostly stable during his hospital stay. he did receive 2 units of blood on for a low hematocrit in the setting of persistent need for pressors, and was transfused another 1 unit prbc on for a hct of 22 (mostly stable but down-trending) in the setting of tachycardia. sq heparin and venodyne prophylaxis was in effect throughout his stay. id: believed to be in intra-abdominal sepsis. placed on zosyn/fluconazole. his wbc was 32 on admission before briefly trending up to 36 in the initial post-op period before trending downward to 12 on transfer from icu to floor, where he remained <12. he was kept on zosyn, but fluconazole was stopped on hd 13. as noted above, his sepsis recurred on and he was readmitted to the icu and taken back to the or on . he was restarted on antibiotics at this time, vancomycin and zosyn, which was changed multiple times to different regimens (including vanc/cipro/ at one point) but ultimately tailored to an antibiotic course of meropenem. full course length and list of antibiotics that were used: /12 vanco cipro zosyn flagyl fluconazole (d/c'd ) his wbc count increased around the time of his recurrent sepsis, peaked at 24.9 and slowly and gradually decreased to 9.0 upon discharge from icu to the floor on . at time of discharge from the hospital on his wbc was 10.0. cultures data: multiple blood, urine, sputum, bal cultures from this admission. all negative except for several bals and sputum growing small amounts of yeast (<100,000) and a mini bal culture that grew pan sensitive pantoea species. he was seen by social work for issues related his lengthy hospitalization and coping. he was evaluated by physical therapy and is being recommended for an acute level of rehabilitaton care after his hospital stay. medications on admission: carvedilol 12.5mg , atorvastatin 40mg qd, lisinopril 20mg qd discharge medications: 1. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po hs (at bedtime) as needed for constipation. 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 4. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime). 5. sevelamer carbonate 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) inj injection tid (3 times a day). 7. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever. 8. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for pruritis. 9. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). 10. furosemide 20 mg iv bid 11. insulin glargine 100 unit/ml solution sig: fifteen (15) units subcutaneous at bedtime. 12. insulin regular human 100 unit/ml solution sig: one (1) dose injection four times a day as needed for per sliding scale: see attached. discharge disposition: extended care facility: - discharge diagnosis: antral ulcer perforation sepsis pulmonary edema acute kidney injury hypernatremia hypokalemia 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: you were admitted to the acute care surgery service for perforation of an antral ulcer and septic shock. you underwent an operation, where a patch was placed over the hole in your stomach and the infected material was cleaned out from your abdomen. you needed to be in the intensive care unit on a breathing machine for part of your recovery. you required 2 more operations due to complications and now have a specialized dressing on your abdomen called a vac dressing. this allows for quicker wound healing. jp drain care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *maintain suction of the bulb. *note color, consistency, and amount of fluid in the drain. call the doctor, nurse practitioner, or vna nurse if the amount increases significantly or changes in character. *be sure to empty the drain frequently. record the output, if instructed to do so. *keep the insertion site clean and dry otherwise. *avoid baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. followup instructions: * department: general surgery/ when: monday at 3:15 pm with: acute care clinic with dr phone: building: lm bldg () campus: west best parking: garage procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other enterostomy enteral infusion of concentrated nutritional substances hemodialysis percutaneous abdominal drainage arterial catheterization closed [endoscopic] biopsy of bronchus reopening of recent laparotomy site reclosure of postoperative disruption of abdominal wall suture of gastric ulcer site open biopsy of stomach diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis disruption of internal operation (surgical) wound other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure septic shock intestinal infection due to clostridium difficile hyperosmolality and/or hypernatremia unspecified peritonitis other fluid overload chronic or unspecified gastric ulcer with perforation, without mention of obstruction 

Answer: The patient is high likely exposed to