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: iodine-iodine containing attending: chief complaint: right lower extremity wound dehiscence major surgical or invasive procedure: right lower extremity gastrocnemius flap reconstruction exploratory laparotomy with left hemicolectomy and splenorrhaphy with transverse end-colostomy and hartmann's pouch, for ischemic colon history of present illness: on admission (, by plastic surgery): mrs. is an 88 year old woman with history of right femur/tibial plateau fracture () complicated by multiple revisions/repairs, most recently with right total knee arthroplasty on , complicated by wound dehiscence, who was now admitted for right knee gastroc muscle flap reconstruction. on transfer to medicine (), 88f with htn, hyperlipidemia, and hypothyroidism, s/p tkr , who was initially admitted on for non-healing right knee wound. she underwent gastrocnemius flap reconstruction, with split-thickness skin graft . her post-operative course was complicated by septic shock (thought initially to be from c.diff given high wbc and daughter with h/o recent c.diff) from necrotic splenic flexure, for which she underwent resection of the splenic flexure with colostomy on . this was complicated by splenic laceration which was repaired intraoperatively. given sepsis, patient was started on flagyl/vanc/cefe/cipro which were peeled off on (cefepime d/c'd ). the patient had return of bowel function on , at which point her diet was advanced. she had persistent leukocytosis, which was investigated with ct abdomen/pelvis on . this showed no evidence of intraabdominal abscess. u/a showed wbc 8, with negative nitrates. of note, the ct abdomen/pelvis also showed ascites and anasarca. currently, the patient is tachypneic to about 30 but not dyspneic, o2 sat 95%/ra. exam notable for bronchial breath sounds at left base and trace bilateral le edema. cxr shows large left pleural effusion with smaller right pleural effusion and patient is complaining of persistent cough. . upon transfer, vitals were 97.3, 139/60, 88, 22, 95%ra. looking comfortable, breathing slightly fast but denies any dyspnea. states knee pain is well controlled. bothered only by persistent cough. denies recent fevers, chills, abdominal pain, changes in bowel movements, subjective dyspnea. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: - hypertension - hyperlipidemia - hypothyroidism - thyroid nodules - glaucoma - history of bilateral femur fracture and pelvic fracture after motor vehicle collision () social history: she is a retired secretary and does not currently smoke or drink. family history: non-contributory physical exam: discharge exam: 96.8, 115/47, 82, 18, 98%ra ga: aox3, elderly woman resting comfortably in bed in nad heent: perrla. mmm. no lad. no jvd. neck supple. cards: rrr s1/s2 heard. no murmurs/gallops/rubs. pulm: bronchial breath sounds bilaterally, worse at left base. no wheezes or rales. somewhat increased rate of breathing, good resp effort abd: with pink healthy looking ostomy in llq, and large linear stapled scar down midline abdomen, soft, nt, nd, +bs. no g/rt. neg hsm. gu: foley in place, minimal dark urine extremities: wwp, 1+ edema bilaterally. pts 2+. neuro/psych: cns ii-xii grossly intact. sensation intact to lt in toes bilaterally, though decreased on the right pertinent results: admission labs: 04:10pm blood wbc-9.7 rbc-3.71* hgb-11.0* hct-33.4* mcv-90 mch-29.5 mchc-32.8 rdw-16.2* plt ct-395 04:10pm blood pt-10.4 ptt-30.2 inr(pt)-1.0 04:10pm blood glucose-98 urean-16 creat-0.8 na-131* k-4.6 cl-95* hco3-29 angap-12 04:10pm blood albumin-4.1 calcium-9.1 phos-4.1 mg-2.0 iron-44 04:10pm blood caltibc-311 ferritn-452* trf-239 labs on (day of abdominal surgery): 04:23am blood wbc-19.0* rbc-3.47* hgb-10.2* hct-31.0* mcv-89 mch-29.4 mchc-32.9 rdw-15.5 plt ct-365 04:23am blood neuts-77* bands-3 lymphs-8* monos-12* eos-0 baso-0 atyps-0 metas-0 myelos-0 05:12pm blood pt-13.9* ptt-50.2* inr(pt)-1.3* 09:46am blood glucose-135* urean-36* creat-1.9* na-130* k-5.8* cl-98 hco3-15* angap-23* 04:23am blood calcium-9.9 phos-6.1* mg-3.9* 01:43pm blood type-art po2-264* pco2-32* ph-7.42 caltco2-21 base xs--2 intubat-intubated 04:39am blood lactate-4.0* 01:43pm blood glucose-126* lactate-3.2* na-128* k-4.2 cl-101 03:30pm blood glucose-109* lactate-2.5* na-129* 04:37pm blood glucose-118* lactate-2.6* na-129* 08:29pm blood lactate-3.2* 01:43pm blood hgb-8.0* calchct-24 03:30pm blood freeca-1.09* thoracentesis: 10:16pm pleural wbc-3100* rbc-5250* polys-76* lymphs-2* monos-0 macro-22* 10:16pm pleural totprot-2.0 glucose-127 ld(ldh)-312 amylase-60 cholest-38 discharge labs: 05:50am blood wbc-15.3* rbc-3.07* hgb-8.4* hct-27.2* mcv-89 mch-27.5 mchc-31.1 rdw-15.7* plt ct-680* 05:50am blood glucose-84 urean-12 creat-0.5 na-130* k-4.5 cl-95* hco3-30 angap-10 05:03am blood alt-7 ast-18 ld(ldh)-189 alkphos-45 totbili-0.3 05:50am blood calcium-7.4* phos-2.7 mg-2.3 microbiology: blood cultures pending. previous blood, urine, c.diff cultures negative. imagaing: ecg: rate 88, sinus rhythm. delayed precordial r wave transition as recorded on without diagnostic interim change. cxr: given the decrease in lung volumes, bibasilar opacification is more likely atelectasis than pneumonia. upper lungs are clear. pleural effusion is minimal if any. heart size normal. cxr: one supine portable ap view of the chest. low lung volumes. the left lower lobe opacity likely represents atelectasis. there is a small left pleural effusion, if any. no opacities concerning for pneumonia. heart size is difficult to evaluate, but likely normal. mediastinal and hilar contours are normal. no pneumothorax. echo (prelim): due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). a mid-cavitary gradient is identified. right ventricular chamber size and free wall motion are normal. no mitral regurgitation is seen. no aortic stenosis or regurgitation. impression: suboptimal image quality. preserved biventricular function. cxr: the et tube sits 5 cm above the carina. the endogastric tube side port tip sits well below the ge junction. a right ij central line tip sits in the lower svc. the heart size is within normal limits. the mediastinal contours demonstrate calcified atherosclerotic disease of the aortic knob. there is a small to moderate left pleural effusion with associated atelectasis. there is no pneumothorax. severe degenerative changes are seen in the left glenohumeral joint. impression: 1. lines and tubes in place. 2. small to moderate left pleural effusion with associated atelectasis. cxr: 1. left pleural effusion appears unchanged and right pleural effusion is likely increased. assessment is slightly limited due to different positioning of patient. 2. mild pulmonary vascular congestion. leni: no evidence for dvt. kub: air filled dilated loops of large and small bowel are most consistent with an ileus. ct abd: 1. splenorrhaphy, with mild perisplenic hemorrhage and surgicel packing. 2. small pleural effusions, mild ascites, and anasarca. no evidence of intra-abdominal abscess, within limitations of a non-contrast study. 3. left colectomy and transverse colostomy, without complications. there has been interval removal of the right ij central venous catheter tip. the heart size is large. the mediastinal and hilar contours are unchanged. there is a moderate left pleural effusion with underlying atelectasis. mild right basal atelectasis with a small pleural effusion is also present. impression: bilateral pleural effusions, left greater than right, with associated atelectasis. cxr: assessment of the heart size is limited by the large left and small right pleural effusions with associated atelectasis; an additional component of pneumonia, particularly on the left cannot be excluded. within that limitation, the heart size likely continues to be enlarged. there is no fluid overload. there is no pneumothorax. comparison is made with prior study performed the same day earlier. moderate left pleural effusion has markedly decreased. adjacent atelectases have decreased. there is a new left basal pigtail catheter. there is no evident pneumothorax. mild-to-moderate right pleural effusion with adjacent atelectasis, is unchanged. cardiomediastinal contours are partially obscured by pleuroparenchymal abnormalities. . brief hospital course: hopsital course: patient admitted to plastic surgery service in anticipation of gastrocnemius flap to rle chronic wound dehiscence. preoperative workup completed 12/6-7 uneventfull and patient taken to or for flap procedure . tolerated procedure well and was transferred to cc6 for further management. recovery proceeded uneventfully until when patient demonstrated altered mental status, nausea, vomiting and increasing abdominal distention. transferred to micu for these symptoms and surgery consult obtained for concern of altered mental status and worsening abdominal distention (see acs consult note for further details). patient taken to or by acs for colonoscopy with assistance of gi given concern for sigmoid/cecal volvulus. colonoscopy failed to demonstrate volvulus and exploratory laparotomy was undertaken which revealed necrotic splenic flexure. left colectomy was performed with mid transverse colon ostomy and long hartmann's pouch. patient tolerated procedure well and was brought to tsicu for further management under acs service. post-operatively, the patient was brought to the tsicu intubated/sedated. patient extubated successfully and iv pain regimen initiated prn. this was carried out with good effect and adequate pain control. when tolerating oral intake, the patient was transitioned to oral pain medications. she was then transfered to the floor on . she had urinary retention issues and a foley was placed which stayed in throughout hospital course as she failed 2 voiding trials. she was given methylnatrexone x1 and was started on a regular diet. however, she had some emesis and a kub showed ileus. she began to produce stool in her ostomy on and her diet was advanced to regular which she tolerated well. her wbc began to rise so a ct abd/pelvis was performed to r/o abscess and no intra-abdominal abscesses were identified. she had a chest x-ray on which showed bilateral pleural effusions. she continued to have a cough and medicine was consulted to evaluate. thoracentesis was performed and 1.5 liters of exudative fluid was drained (ldh 312, wbc 3100). pigtail catheter was placed which drained minimal serosangeous fluid. this was thought to be related to the abdominal surgery and resultant inflammation of the luq. her wbc dropped from 20.8 to 14.5 with the thoracentesis. patient remains feeling well without and is without fevers off all antibiotics. . pulmonary: pulmonary toilet including incentive spirometry and early ambulation were encouraged. the patient was stable from a pulmonary standpoint; vital signs were routinely monitored. cxr on showed bilateral pleural effusions l>r. she continued to have a cough and will be transferred to the medicine service for further evaluation and management. thoracentesis was performed and 1.5l transudative fluid was drained, effectively resolving her cough. wbc dropped from 20.8 to 14.5 with the procedure. patient remained tachypneic, and given her vascular congestion on xray, she was administered lasix with good urinary output. no antibiotics were administered, as there was no clear infection to be treated (afebrile, feeling well off antibiotics). pleural fluid studies were consistent with effusion secondary to adrenergic state likley splenic flexure infarct and splenic laceration. rpt chest x-ray showed improving pleural effusion s/p thoracentesis and her lung exam continued to improve until the day of discharge. . gi/gu: post-operatively, the patient was given iv fluids until tolerating oral intake. her diet was advanced to sips and regular diet . patient demonstrated some nausea w emesis 12/15pm and was made npo. advanced from sips to clears which was tolerated well. given methylnaltrexone . had gas and stool in ostomy . she was also started on a bowel regimen to encourage bowel movement. she was started on a regular diet on which she continued to tolerate well. . id: post-operatively, the patient was started on iv cefazolin, then switched to po cephalexin on pod#2. the patient's temperature was closely watched for signs of infection. her wbc began to slowly uptrend, for which a clear source was not identified. she was given roughly 4 days of cipro/flagyl/vanc/cefepime, all of which were discontinued around . u/a blood, urine, and c.diff was negative, her graft site did not appear infected, ct ab/pelvis on was negative for any intra-abdominal abscess, and cxr was signficant only for bilateral pleural effusions l>r. no antibiotics were administered as patient did not have a clear source of infection. all culture data was negative, she continued to be afebrile and vs were stable. her wbc was fluctuating and also with a reactive thrombocytosis. given no objective signs of infection antibiotics were never started. . # reactive thrombocytosis: likely in relation to inflammatory state from necrotic bowel, recent operations and pleural effusions irritating the pleural lining. this will need to be trended with repeat cbc within 1 week. . # hyponatremia: patient admitted with na+ 129, corrected to 139, now 129. thought to be siadh vs. hypervolemic hyponatremia as patient appears somewhat overloaded on exam (1+edema with ascites and large pleural effusion). serum osm is low (262), however urine lytes suggested patient was prerenal. given iv lasix for fluid overload and sodium initially trended up to 130, but then decreased to 126. there was likely a combine picture. lasix were stopped and the patient equilibrated to 130 at time of discharge. she will need repeat lab work within 1 week to re-evaluate na levels. . # urinary retention: patient failed trial of voiding twice while inpatient. urology was consulted and they felt that given recent operations and shock likel state it may take some time for her bladder to regain function. she will be discharged with her foley in place and follow up with urology within 1-2 weeks for another trial of voiding. . #. - patient had transient to 1.9 on , when she was septic and necrosing her bowel. creatinine improved with fluids and was likely prerenal in etiology given her septic physiology. . # anemia: remained at basline over admission (28-31). no signs of bleeding. iron borderline low and ferritin high, mcv normal (89). possibly anemia of chronic disease. hct trended. . #. htn: continued hctz, lisinopril, diltiazem, asa . #. hl: continued atorvastatin, asa . #. hypothyroidism: continued levothyroxine . #. glaucoma: continued latanoprost, dorzolamide . transitional issues: - at the time of discharge on pod 15, the patient was doing well, afebrile with stable vital signs, tolerating a regular diet, ambulating, with foley in place, and pain well controlled. patient failed 2 voiding trials, and is being discharged home with foley in place. she will have oruology follow up within 1-2weeks of discharge for voiding trial. - will also need stitches removed on - will need repeat cbc and chem-7 in 1 week to evaluate leukocytosis, reactive thrombocytosis and sodium level medications on admission: -alendronate 70 mg by mouth weekly -atorvastatin 10 mg by mouth once a day -cephalexin 500 mg by mouth four times a day take with food -diltiazem hcl 90 mg extended release by mouth once a day -hydrocodone-acetaminophen 5 mg-500 mg by mouth at night as needed for pain -latanoprost eye drops -levothyroxine 75 mcg by mouth once a day -aspirin 81 mg by mouth once a day -b complex vitamins daily -calcium/vitamin d3 by mouth twice a day -cholecalciferol 1,000 unit by mouth once a day -hydrochlorothiazide 50 mg by mouth once a day -multivitamin by mouth once a day discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. diltiazem hcl 90 mg capsule,extended release 12 hr sig: one (1) capsule,extended release 12 hr po once a day. 3. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 4. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. vitamin b complex tablet sig: one (1) tablet po once a day. 7. calcium 600 + d(3) 600 mg(1,500mg) -400 unit tablet sig: one (1) tablet po twice a day. 8. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 9. hydrochlorothiazide 50 mg tablet sig: one (1) tablet po once a day. 10. multivitamin tablet sig: one (1) tablet po daily (daily). 11. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 14. acetaminophen 325 mg tablet sig: two (2) tablet po tid (3 times a day). 15. oxycodone 5 mg tablet sig: 0.5 tablet po every four (4) hours as needed for pain: hold for rr<12, sedation. 16. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. discharge disposition: extended care facility: senior life discharge diagnosis: primary diagnosis: - right tkr would dehiscence - infarcted large bowel at splenic flexure - partially infarcted spleen - right sympathetic pleural effusion - urinary retention - anemia of chronic disease - reactive leukocytosis - hyponatremia surgical procedures: - right lower extremity gastrocnemius flap reconstruction - exploratory laparotomy with left hemicolectomy and splenorrhaphy with transverse end-colostomy and hartmann's pouch - right thoracentesis and pig-tail catheter placement secondary dignosis: - bilateral femur fracture s/p periprosthetic femur fracture secondary diagnosis: - traumatic pelvic and bilateral femur fractures - osteoporosis - hypothyroidism - hyperlipidemia - hypertension - hypothyroidism - glaucoma discharge condition: level of consciousness: alert and interactive. mental status: clear and coherent. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , it was a pleasure taking care of you at . you were initially admitted for a nonhealing wound for which you had a skin flap reconstruction. this healed well, however you developed poor perfusion to your bowel and had to have a colon resection with a colostomy (hartmann's pouch). part of your spleen was additionally resected. you remained in the hospital for some time as you had an elevated white blood count (usually a sign of infection) and fluid around your lungs that was making you breathe faster than normal. the fluid was drained from around your left lung and your white blood count began to return to normal and your breathing improved. you are safe for discharge to rehab for further care.. . the following medications were started: docusate 100mg by mouth twice a day senna 1 tab by mouth twice a day tylenol 650mg by mouth three times a day tamsulosin 0.4mg by mouth at bedtime trazadone 25mg by mouth as needed for sleep. followup instructions: please call the number below to schedule an appt with dr. in 2 weeks. division of plastic surgery , phone: fax: . please call the number below to schedule an appt with dr. in 2 weeks. , phone: fax: . urology appointment:needed please arrange new physician appointment with the urology department @ within 2 weeks from your discharge from the hospital phone: . please call your primary care doctor - dr. at to schedule an appt when you are discharged from rehab. procedure: insertion of intercostal catheter for drainage open and other left hemicolectomy colostomy, not otherwise specified other skin graft to other sites graft of muscle or fascia other lysis of peritoneal adhesions flexible sigmoidoscopy excision of lesion of other soft tissue repair and plastic operations on spleen diagnoses: acidosis anemia of other chronic disease unspecified pleural effusion unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia severe sepsis unspecified acquired hypothyroidism disruption of internal operation (surgical) wound unspecified glaucoma accidental puncture or laceration during a procedure, not elsewhere classified other and unspecified hyperlipidemia peritoneal adhesions (postoperative) (postinfection) osteoporosis, unspecified septic shock paralytic ileus retention of urine, unspecified other ascites surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation altered mental status accidents occurring in residential institution acute vascular insufficiency of intestine precipitous drop in hematocrit accidental cut, puncture, perforation or hemorrhage during surgical operation other digestive system complications encounter for change or removal of surgical wound dressing 

Answer: The patient is high likely exposed to