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: patient recorded as having no known allergies to drugs attending: chief complaint: ms. was admitted to hospital in and again earlier this month with a partial small-bowel obstruction proximal to the level of the terminal ileum. she was discharged from hospital on and presented for an initial visit with dr. yesterday. since her discharge, her diet has consisted entirely of liquid nutritional supplements. although this has reduced her diarrhea from 15 episodes per day to 2, her abdominal distention has returned. she has been admitted for management of a high grade functional small bowel obstruction. major surgical or invasive procedure: - laparotomy, lysis of adhesions, small bowel resection (25cm) - right nephrostomy inserted in interventional radiology history of present illness: is a 59-year-old woman who underwent sigmoidectomy and total abdominal hysterectomy on for a large obstructing mass near the rectosigmoid junction. she had presented for a colonoscopy after developing small frequent bowel movements. pathology revealed t4 colon adenocarcinoma. surgical margins and 26 lymph nodes were negative. ms. was subsequently treated with infusional 5-fu and radiation for 5 weeks from to . on she began folfox chemotherapy. treatment was complicated by the development of diarrhea, abdominal distention, and 25-lb. weight loss starting in and requiring chemotherapy to be postponed on multiple occasions. she last received chemotherapy on . . ms. was admitted to hospital in and again earlier this month with a partial small-bowel obstruction proximal to the level of the terminal ileum. she was discharged from hospital on and presented for an initial visit with dr. . since her discharge, her diet has consisted entirely of liquid nutritional supplements. although this has reduced her diarrhea from 15 episodes per day to 2, her abdominal distention has returned. she has been admitted for management of a high grade functional small bowel obstruction. past medical history: pmh: colon cancer allergic rhinitis . psh: tonsillectomy segmental colectomy with tah social history: married, not working, 2 grown up children 10 pack-year tobacco history, smokes ppd occasional alcohol no drugs denies toxin exposure. family history: mother died of cervical cancer at age of 80 father died at age of 94. she believes he may have had colon cancer in his 60s and underwent resection. physical exam: vital signs: t 98.2 bp 120/60, p 58, r 18, o2 sat 100% ra general: cachectic but in no acute distress. cv: regular rate and rhythm. no murmurs, gallops or rubs. lungs: clear to auscultation and percussion bilaterally. abdomen: soft, nontender, minimally distended. normoactive bowel sounds present. liver margin is palpable but non-tender. no splenomegaly or ascites. extremities: no clubbing, cyanosis, or edema. pertinent results: radiology final report ct abdomen w/contrast 4:16 pm indication: status post small bowel resection and right ureteral damage. please assess fluid collections, urinoma, and damage of right ureter. impression: 1. findings consistent with small bowel obstruction with a transition point at the anastomotic site in the pelvis. new marked edema within a loop of bowel in the left lower quadrant is potentially concerning for ischemia. 2. progression of pneumoperitoneum, both free and loculated in a lower abdominal/pelvic collection with rim enhancement. 3. right-sided hydronephrosis and hydroureter with nephrostomy catheter in place. 4. anasarca. 5. bilateral pleural effusions and patchy opacities likely reflecting infectious or inflammatory process. 6. probable severe fatty infiltration of the liver. . radiology final report abdomen (supine only) port 4:23 pm reason: 59 yo abd pain r/o obstruccion impression: probable partial small-bowel obstruction, although if large-bowel contrast material was introduced from below this could represent a complete obstruction. . radiology picc line placment sch 8:54 am reason: please place dl picc unsuccessfull bedside placement impression: ultrasound and fluoroscopically guided left brachial picc line placement via the left brachial venous approach. final internal length is 39 cm with the tip positioned in the distal svc. the line is ready to use. . radiology final report abdomen (supine & erect) 10:04 am medical condition: 59 year old woman with sigmoidectomy for bowel cancer, now with high grade sbo impression: persistent features of mechanical small-bowel obstruction without evidence for free air or pneumatosis. . radiology final report chest (pre-op pa & lat) 4:50 pm reason: bowel obstruction findings: a port-a-cath is seen on the right with the tip in the svc and there is a left central venous catheter with the tip at the distal brachiocephalic vein. no ptx. left hemidiaphragm is slightly elevated with an air-filled loop of colon just below it. there is no focal consolidation and some left basilar atelectasis is seen on the lateral view. this is accompanied by posterior effusion likely on the left as well. there is no free air under the diaphragm. . radiology final report medical condition: 59 year old woman with ureteral injury s/p exlap/loa, now draining urine into abdomen. reason for this examination: placement of r nephrostomy tube indication: 59-year-old woman with ureteral injury and hydronephrosis based on recent ct. impression: ultrasound and fluoroscopically guided right nephrostomy tube placement for right-sided urinary obstruction . 06:45am blood wbc-7.5 rbc-2.87* hgb-9.5* hct-26.7* mcv-93 mch-33.0* mchc-35.4* rdw-14.3 plt ct-112* 02:18am blood wbc-11.6*# rbc-3.11* hgb-10.1* hct-29.2* mcv-94 mch-32.5* mchc-34.6 rdw-14.6 plt ct-103* 05:30pm blood wbc-3.4* rbc-2.95*# hgb-10.0*# hct-28.5*# mcv-97 mch-33.9*# mchc-34.9 rdw-14.1 plt ct-101*# 04:21am blood neuts-72.0* lymphs-17.1* monos-8.1 eos-2.4 baso-0.4 06:45am blood plt ct-112* 09:54am blood pt-14.8* ptt-32.1 inr(pt)-1.3* 05:30pm blood pt-13.4 ptt-27.0 inr(pt)-1.2* 05:30pm blood fibrino-255 02:19pm blood ret aut-1.9 06:45am blood glucose-105 urean-18 creat-0.4 na-136 k-4.0 cl-104 hco3-23 angap-13 05:30pm blood glucose-89 urean-17 creat-0.7 na-135 k-4.0 cl-105 hco3-23 angap-11 11:00am blood alt-149* ast-148* alkphos-385* totbili-0.9 05:30pm blood alt-66* ast-64* ld(ldh)-259* alkphos-139* amylase-76 totbili-0.8 06:45am blood albumin-2.9* calcium-7.8* phos-3.4 mg-1.9 iron-21* 05:30pm blood albumin-2.9* calcium-8.2* phos-3.6 mg-1.5* iron-52 cholest-100 06:45am blood caltibc-104* ferritn-849* trf-80* 02:19pm blood vitb12-1199* folate-17.3 hapto-136 06:45am blood triglyc-82 05:30pm blood triglyc-69 hdl-25 chol/hd-4.0 ldlcalc-61 02:19pm blood tsh-2.8 02:19pm blood cea-1.9 06:11am blood vanco-15.9 06:22pm blood freeca-1.15 . gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. tissue (final ): reported by phone to dr. on at 14:30. proteus vulgaris. sparse growth. escherichia coli. sparse growth. anaerobic culture (final ): bacteroides fragilis group. sparse growth. beta lactamase positive. of two colonial morphologies . 6:52 pm urine source: catheter. **final report ** urine culture (final ): enterococcus sp.. 10,000-100,000 organisms/ml.. enterococcus sp. | ampicillin------------ <=2 s nitrofurantoin-------- <=16 s tetracycline---------- =>16 r vancomycin------------ 2 s . 10:07 pm blood culture source: line-pic. **final report ** blood culture, routine (final ): proteus vulgaris. final sensitivities. proteus vulgaris | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic bottle gram stain (final ): gram negative rod(s). aerobic bottle gram stain (final ): gram negative rod(s). . brief hospital course: the patient was admitted on . she was made npo, a nasogastric tube was placed for decompression, and iv fluids were started. . -picc line placed, tpn started due to profound malnourishement. heme/onco team was consulted, and evaluated patient on for pancytopenia. . -continued with tpn, ngt, ivf . -after failing to resolve the obstruction conservatively, the patient was taken to the operating room where a laparotomy, lysis of adhesions, and 25 cm small bowel resection were performed. a nasogastric tube remained, a jp was placed intraoperatively, pain pump subcutaneously for pain relief, dilaudid pca for pain, and iv fluids for rescucitation were given. . -pod1-continued tpn and iv fluids, ng tube remained in place, continued monitoring on the floor. required 1 liter of fluid bolus for marginal urine output. urine output stabilized in the evening. ngt removed today, but remained npo. . -pod2-continued tpn and iv fluids. started with sips of clears. foley was removed. she was able to urinate without difficulty. she ambulates with assist. feels & appears weak. sbp-80-90 with some complaints of feeling dizzy. physical therapy consulted. her hct dropped from 30 to 20%. she was repleted with 2 units of prbc. . -pod3-increased jp bulb drain output- fluid dark red in color, previously more serosanguinous. . -pod4-nursing staff reported mental status changes resulting in a trigger. ekg revealed changes consistent with possible pulmonary embolism. cta ordered which ruled out pe, but considerable for either hemmorhage or pulmonary edema. due to patient's change in status, she was transferred to trauma icu for closer monitoring. . -icu: intubated due to progressive desaturation and tachypenia related to pulmonary edema & bilateral pulmonary infiltrates. patient aggressively diuresed. vasopressors initiated for decrease in blood pressure with adequate response. central line inserted at bedside. respiratory status monitored . -icu: continued with respiratory decompensation, remained intubated. new gnr in blood cx from -continues with vancomycin, levofloxacin, flagyl, & fluconazole. urology consulted. surgical intervetion not indicated due to patient's compromised respiratory status. right nephrostomy tube inserted per urology recommendations due to hydronephrosis, and fluid volume overload. vasopressors & sedation weaned as tolerated. . -icu: pain pump site erythematous & fluctuant. patient pre-medicated. site opened at bedside, pus-like exudate expressed from site. culture sent. continued to wean pressors and sedation as tolerated. labwork notable for mild thrombocytopenia-hit panel sent, and positive. all heparin products discontinued. culture data followed. continued with iv antibiotics for sepsis and tpn for severe malnutrition. nutrition and physical therapy consulted. albumin started for intravascular depletion. extubated on -respiratory status stablized. midline abdominal incision opened at bedside due to erythema. proximal wound with visible small loop of bowel. areas packed with w-d dressing. vacuum dressing applied on at bedside. patient's general status stabilized. . : transferred back to . fluconazole discontinued, other antibiotics & albumin continued. mental status with mild confusion-a/ox2-3. bed alarm set & other safety precautions initiated. started on a regular diet with supplements. calorie counts. vacuum dressing continued. . : avss, afebrile. tpn weaned and discontinued. tolerating regular high protein diet with ensure supplements. continued with vac dressing to abdominal incision, changed every 3 days. site improving, cdi. continues with iv vancomycin & zosyn to treat both bacteremia and enterococcus growth in urine both cultures from . right nephrostomy remains patent with clear, yellow urine. right abdominal jp drain continues to drain moderate amounts of serous fluid. check weekly creatinine levels. old bupivicaine subcutaneous pump site-continues with w-d packings. site healing with decreased erythema. evaluated per physical & occupational therapy. ambulates with assist. physical condition decompensated due to prolonged malnourishment. she will benefit from aggressive physical therapy, nutrition, and wound assessment & management. . urology: she will need to make an appointment to have right nephrosotomy replaced in 1 month, and then follow-up with dr. for further management. medications on admission: ativan prn benadryl prn discharge medications: 1. benadryl 25 mg capsule sig: one (1) capsule po every six (6) hours as needed for allergy symptoms. 2. imodium a-d 2 mg tablet sig: one (1) tablet po every hours as needed for diarrhea: do not exceed 16mg/day. 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q8h (every 8 hours) as needed. 4. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day): discontinue once more independent. 5. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)) as needed for agitation. 6. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain for 3 weeks. 7. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 9. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours) for 5 days. 10. vancomycin 500 mg recon soln sig: one (1) recon soln intravenous q 8h (every 8 hours) for 5 days. discharge disposition: extended care facility: - discharge diagnosis: primary: functioning high grade small bowel obstruction pancytopenia malnutrition post-op sepsis post-op urinay retention post-op hypovolemia post-op hypoxia post-op delirium . secondary diagnosis: colon cancer allergic rhinitis discharge condition: stable tolerating a regular diet adequate pain control with oral medication discharge instructions: crimson general d/c instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or becoming progressively worse, or inadequately controlled with the prescribed pain medication. *avoid driving or operating heavy machinery while taking pain medication. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. . incision care: *you may shower. pat incision dry. *avoid swimming and baths until further instruction at your followup appointment. *leave the steri-strips on. they will fall off on their own, or be removed during your followup. *please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. . jp drain care: *please look at the site every day for signs of infection (increased redness, swelling, tenderness, odorous or purulent discharge). *maintain the bulb deflated to provide adequate suction. *note color, consistency, and amount of fluid in drain. call doctor if amount increases significantly or changes in character. *be sure to empty the drain frequently and record the output. *maintain the site clean, dry, and intact. *keep drain attached safely to body to prevent pulling and possible dislodgement. . nephrostomy tube: *flush with 10 cc normal saline daily. followup instructions: 1. please call the office of dr. at to make a follow up appointment within 2-3 weeks. 2. please call to arrange follow up with dr. after having your nephrostomy tube exchanged in 1 month. 3. follow-up with your primary care provider, . , in 1 week or as needed. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other partial resection of small intestine insertion of endotracheal tube percutaneous nephrostomy without fragmentation other incision with drainage of skin and subcutaneous tissue other lysis of peritoneal adhesions transfusion of packed cells other immobilization, pressure, and attention to wound other immobilization, pressure, and attention to wound application or administration of an adhesion barrier substance diagnoses: pneumonia, organism unspecified other postoperative infection other pulmonary insufficiency, not elsewhere classified unspecified protein-calorie malnutrition severe sepsis accidental puncture or laceration during a procedure, not elsewhere classified other specified septicemias septic shock personal history of malignant neoplasm of large intestine hydronephrosis delirium due to conditions classified elsewhere personal history of irradiation, presenting hazards to health disruption of external operation (surgical) wound intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) 

Answer: The patient is high likely exposed to