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: abdominal pain and distention major surgical or invasive procedure: : lysis of adhesions, small-bowel resection. : right cephalic picc. : g-j tube placed by ir. : bedside tracheostomy. history of present illness: 88 m history of colon cancer s/p colectomy and end colostomy ~20 years ago presents with 1 day history of abdominal pain and distention. he reports having gradual onset abdominal pain which started this morning. he has had ~10 bouts of non-bloody, non-bilious emesis. he has had minimal output from his ostomy for "a few days". he presented to and a ct abdomen performed demonstrated a partial small bowel obstruction in the mid-abdomen. he denies any history of obstructions or similar symptoms. he denies fevers, chills, night sweats, syncope, chest pain. past medical history: pmh: history of colon cancer s/p open colectomy and end colostomy ~20 years ago psh: colectomy with end colostomy ~20 years ago, knee replacement, shoulder surgery (rotator cuff) social history: lives with wife tobacco no etoh family history: non contributory physical exam: vs: 98.0 94 150/96 16 96% ra gen: nad, aox3 cvs: reg pulm: no resp distress abd: softly distended ttp throughout, mainly epigastric region le: no cce pertinent results: 01:20am wbc-10.8 rbc-4.74 hgb-14.9 hct-43.4 mcv-92 mch-31.5 mchc-34.4 rdw-13.1 01:20am neuts-90.2* lymphs-6.0* monos-3.6 eos-0.2 basos-0.2 01:20am plt count-194 01:20am glucose-142* urea n-17 creat-1.0 sodium-137 potassium-4.7 chloride-98 total co2-27 anion gap-17 kub showed: 1. dilated small bowel loops containing residual oral contrast and air-fluid levels, which in the right clinical circumstances could be reflective of small-bowel obstruction. 2. residual contrast filling the right collecting system suggestive of partial or full obstruction of the renal right collecting system. 3. nasogastric tube looped above the diaphragm, likely in the patient's hiatal hernia. kub showed: in comparison with the study of , the contrast material from the right renal collecting system has cleared. there is still mild dilatation of small bowel loops containing some residual oral contrast from a previous ct scan and demonstrating air-fluid levels on the decubitus view. in the appropriate clinical setting, these findings could be consistent with small bowel obstruction. kub showed: there are several air-filled minimally dilated loops of small bowel seen particularly in the right abdomen. it appears that the contrast seen in the small bowel on the prior studies has advanced to the colon. there are several air-fluid levels seen within the small bowel on the upright image. this has the appearance of persistent small bowel obstruction. the nasogastric tube has been removed. ct chest/abdomen/pelvis showed: 1. new ground glass opacities and small foci of consolidation, most severe in the right upper lobe, is concerning for evolving aspiration pneumonia given large hiatal hernia and recent history of emesis. differential diagnosis does includes asymmetric pulmonary edema if the patient has underlying mitral valvular disease. 2. mild anasarca and mild fluid overload with minimal interlobular smooth septal thickening. 3. small amount of pneumoperitoneum consistent with recent exploratory laparotomy. 4. small bilateral effusions with associated atelectasis. mild cardiomegaly. cxr showed: consolidation in the right lung has spread from the juxtahilar right upper lobe to much of the right lower lung, accompanied by increasing moderate right pleural effusion. left lower lobe atelectasis persists. pleural surfaces are heavily calcified. heart size is enlarged but difficult to assess because of adjacent pleural and parenchymal abnormalities. no pneumothorax. left picc line ends in the mid svc. kub showed: 1. residual oral contrast is seen within the colon to the rectum without evidence of distention. this reflects a prolonged transit time, but no evidence of obstruction. 2. air-filled loops of small bowel without evidence of obstruction, improved compared to the prior. 3. no other significant change compared to the prior study. video swallow showed: frank aspiration with appropriate cough response with nectar consistency. cta chest showed: 1. acute pulmonary embolism involving a right upper lobe apical segmental branch. 2. new left upper lobe airspace consolidation and worsening right upper lobe airspace consolidation that is concerning for multifocal spread of infection. superimposed mild interstitial pulmonary edema. 3. stable prominent mediastinal lymph nodes and left hilar lymph nodes, likely reactive in nature. 4. several foci of intraperitoneal free air, newly apparent since post-surgical ct from . 5. calcified pleural plaques indicative of prior asbestos exposure. 6. findings compatible with tracheobronchomalacia. ct abdomen/pelvis showed: 1. loop of bowel containing air and oral contrast may be trapped between the right lobe of the liver and the right thoracic wall, although it does contain new oral contrast since the ct chest performed several hours prior. there is fluid around the dome of the liver and around this loop of bowel. 2. two locules of air at the dome of the liver. although no definite evidence for perforation is present, it is not excluded. the locules of air may represent residual air from abdominal surgery, although this surgery occurred several weeks prior, which would be unusual. 3. moderate right and small left pleural effusions. 4. extensive airspace opacities in the lungs concerning for infection. 5. nasogastric tube looped on itself within a hiatal hernia with the tip extending superiorly into the esophagus. 6. parastomal hernia but no bowel obstruction. 7. pleural plaques. ct head showed: no acute large vascular territory infarct, shift of midline structures or mass effect is present. the ventricles and sulci are normal in size and configuration. there is diffuse bihemispheric left greater than right periventricular and subcortical white matter hypoattenuation, consistent with small vessel ischemic disease. however, no loss of -white differentiation is noted. there is calcific atherosclerosis of the vertebral arteries and both carotid arteries. the orbits are unremarkable. the visible mastoid air cells and paranasal sinuses are well aerated. brief hospital course: mr. was evaluated by the acs service in the emergency room and admitted to the hospital for conservative treatment of his partial small bowel obstruction with iv hydration, gastric decompression with a nasogastric tube and serial exams. he was seen by the urology service initially as he had a ureteral stone noted incidentally on his abd ct that was done at . he had no pain and no elevation of his creatinine therefore this incidental finding would be worked up if it did not pass on its own. he did have some low urine output which responded to iv fluids but that was secondary to low intravascular volume as opposed to renal failure from an obstructing stone. his problem was that of his bowel obstruction. his ng tube was replaced due to persistent vomiting and eventually his abdomen was soft however his ostomy was not active. after waiting 6 days for resolution he was taken to the operating room on for an exploratory laparotomy, lysis of adhesions and a small bowel resection. he tolerated the procedure well and returned to the pacu in stable condition. his pain was controlled with a pca. a picc line was placed on for hyperalimentation as he continued to be npo. by post op day #5 he developed anasarca and was treated with iv lasix and 25% albumin. he continued to have minimal output and air from his ostomy. on post op day #7 he developed a fever of 101.6 and emesis. a nasogastric tube was replaced and he had a ct scan of the chest and abdomen revealing a new right upper lobe pneumonia. his wbc eventually rose to 15. urine and blood cultures were negative and he was placed on vancomycin and zosyn. he underwent vigorous pulmonary toilet including chest pt incentive spirometry and nebulizer treatments. his initial chest xray revealed a right upper lobe infiltrate but over time he devaloped multilobar infiltrates with a component of fluid volume overload. he was given a ten day course of antibiotics for his physical and xray findings and all of his cultures including sputum were negative. his bowel functioning remained minimal and he remained on tpn. he had his ostomy digitalized and eventually had an enema which helped to increase output. he began clear liquids on post op day 15 as his ileus seemed to resolve. unfortunately he became tachypneic, desaturated and was tachycardic to 120 bpm one day later and he also had a temp spike to 101.6. his chest xray showed the same multilobar infiltrates along with bilateral effusions and fluid overload. he improved with vigorous diuresis and was eventually placed on daily lasix. after his bowel function returned he was evaluated on multiple occasions by the speech and swallow service as he was deconditioned and had some episodes of aspiration. he eventually was able to take ground solids and nectar thick liquids without aspirating. on , zosyn was changed to cefepime for pneumonia. on , he was transfused 2 u prbc for acute post-op anemia with hct of 21.9. his hct responded appropriately. he became febrile on , and all antibiotics were stopped and picc was pulled with tip sent for culture. blood cultures and line tip culture up to ultimately showed no growth. on , cta chest was obtained for poor respirations, finding acute pulmonary embolism, and the patient was started on a heparin gtt. on , the patient suffered respiratory decompensation and was transferred to the icu. bal cultures showed mrsa and yeast. pleural effusion was drained for 900 ml and grew bacteroides fragilis. the patient was started on vancomycin and meropenem. a perihepatic abscess was found and a drain was placed by ir. the fluid grew mrsa and bacteroides fragilis. infectious disease did not recommend anti-fungal antibiotics. on serial cxr, the pneumonia and pleural effusion progressively improved. due to aspiration risk, on , a g-j tube was placed by ir. on , due to failure to wean off mechanical ventilation, the patient underwent bedside tracheostomy. the patient was continued on heparin gtt and started on warfarin for pe. from a physical therapy standpoint he was able to walk with a rolling walker 2-3 times a day despite his lengthy illness. when the perihepatic abscess drain ceased to produce fluid, it was withdrawn. at the time of discharge on , the patient's ventilatory dependence was weaned to cpap on peep 5. he was receiving vancomycin (most recent course started on ) and meropenem (most recent course started on ) for pneumonia and peri-hepatic abscess. antibiotic requirements should be reassessed after 4 weeks of antibiotics. medications on admission: vitamin a, vitamin c discharge medications: 1. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution sig: nine hundred (900) units/hour intravenous continuous gtt: titrate heparin gtt to ptt 60-80 while inr <2. 2. warfarin 2.5 mg tablet sig: three (3) tablet po daily (daily): check daily inr. titrate warfarin dose until inr . 3. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 4. acetaminophen 325 mg tablet sig: 1-2 tablets po every four (4) hours as needed for fever or pain. 5. vancomycin 500 mg recon soln sig: 1250 (1250) mg intravenous q 24h (every 24 hours): check vancomycin trough before 4th dose. titrate vancomycin dose to trough 15-20. 6. meropenem 1 gram recon soln sig: one (1) g intravenous q12h (every 12 hours). 7. pantoprazole 40 mg recon soln sig: forty (40) mg intravenous every twenty-four(24) hours. discharge disposition: extended care facility: northeast - discharge diagnosis: small bowel obstruction pneumonia post-op ileus pulmonary embolism failure to wean off ventilator 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 small bowel obstruction. please call your doctor or go to the emergency department if: *you experience new chest pain, pressure, squeezing or tightness. *you develop new or worsening cough, shortness of breath, or wheeze. *you are vomiting and cannot keep down 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. *you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. *your pain is not improving within 12 hours or is not under control within 24 hours. *your pain worsens or changes location. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *you develop any concerning symptoms. general discharge instructions: please resume all regular home medications, unless specifically advised not to take a particular medication. please take any new medications as prescribed. please get plenty of rest, continue to work with physical therapy, and drink adequate amounts of fluids. avoid strenuous physical activity and refrain from heavy lifting greater than 10 lbs., until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. please also follow-up with your primary care physician. incision care: *please call your surgeon or go to the emergency department if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until cleared by your surgeon. *you may shower and wash incisions with a mild soap and warm water. gently pat the area dry. g-j tube care: *please look at the drain site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warmth, and fever). *you may shower and wash the drain site gently with warm, soapy water. *keep the insertion site clean and dry otherwise. place a drain sponge for cleanliness. *avoid swimming, baths, and hot tubs. do not submerge yourself in water. *attach the tube securely to your body to prevent pulling or dislocation. warfarin (coumadin): what is this medicine used for? this medicine is used to thin the blood so that clots will not form. how does it work? warfarin changes the body's clotting system. it thins the blood to prevent clots from forming. what you should contact your healthcare provider : signs of a life-threatening reaction. these include wheezing; chest tightness; fever; itching; bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat, severe dizziness or passing out, falls or accidents, especially if you hit your head. talk with healthcare provider even if you feel fine, significant change in thinking clearly and logically, severe headache, severe back pain, severe belly pain, black, tarry, or bloody stools, blood in the urine, nosebleeds, coughing up blood, vomiting blood, unusual bruising or bleeding, severe menstrual bleedin, or rash. call your doctor if you are unable to eat for several days, for whatever reason. also call if you have stomach problems, vomiting, or diarrhea that lasts more than 1 day. these problems could affect your coumadin/warfarin dosage. coumadin (warfarin) and diet: certain foods and beverages can impair the effect of warfarin. for this reason, it's important to pay attention to what you eat while taking this medication. until recently, doctors advised taking warfarin to avoid foods high in vitamin k. this is because large amounts of vitamin k can counteract the benefits of warfarin. however, recent research shows that rather than eliminating vitamin k from your diet, it is more important to be consistent in your dietary vitamin k intake. these foods contain vitamin k: fruits and vegetables, such as: kiwi, blueberries, broccoli, cabbage, sprouts, green onions, asparagus, cauliflower, peas, lettuce, spinach, turnip, collard, and mustard greens, parsley, kale, endive. meats, such as: beef liver, pork liver. other: mayonnaise, margarine, canola oil, soybean oil, vitamins, soybeans and cashews. limit alcohol. alcohol can affect your coumadin??????/warfarin dosage but it does not mean you must avoid all alcohol. serious problems can occur with alcohol and coumadin??????/warfarin when you drink more than 2 drinks a day or when you change your usual pattern. binge drinking is not good for you. be careful on special occasions or holidays, and drink only what you usually would on any regular day of the week. monitoring: the doctor decides how much coumadin??????/warfarin you need by testing your blood. the test measures how fast your blood is clotting and lets the doctor know if your dosage should change. if your blood test is too high, you might be at risk for bleeding problems. if it is too low, you might be at risk for forming clots. your doctor has decided on a range on the blood test that is right for you. the blood test used for monitoring is called an inr. use of other medications: when coumadin/warfarin is taken with other medicines it can change the way other medicines work. other medicines can also change the way coumadin/warfarin works. it is very important to talk with your doctor about all of the other medicines that you are taking, including over-the-counter medicines, antibiotics, vitamins, or herbal products. followup instructions: please call to schedule a follow-up appointment in the acute care surgery clinic in weeks. please follow up with your pcp. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours 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 insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis percutaneous abdominal drainage other bronchoscopy arterial catheterization temporary tracheostomy other lysis of peritoneal adhesions percutaneous [endoscopic] gastrojejunostomy diagnoses: pneumonia, organism unspecified other postoperative infection unspecified pleural effusion acute posthemorrhagic anemia alkalosis surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation iatrogenic pulmonary embolism and infarction paralytic ileus personal history of malignant neoplasm of large intestine calculus of ureter peritoneal abscess intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) attention to colostomy other fluid overload edema of male genital organs physical restraints status 

Answer: The patient is high likely exposed to