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 / compazine / codeine / morphine attending: chief complaint: body pain and diarrhea major surgical or invasive procedure: flexible sigmoidoscopy history of present illness: this is a 47yo f admitted 1m ago for le cellulitis, treated with vancomycin iv then bactrim po, presents with total body pain, nausea, and diarrhea of one day duration. pain includes chest, abdomen, and legs, unable to localize further. nausea has included infrequent emesis, non-bilious. diarrhea has been copious for last 24 hours, non-bloody. in ed, bp drifting to 90s, received total of 4l of ivf thus far and begun levophed. given broad-spectrum abx empirically (vanco iv, levaquin, and flagyl iv). cvl and foley placed. ct torso obtained to identify source finding edema of rectum and sigmoid colon and gallbladder, prompting surgical consultation for ? colitis or cholecystitis. ros: no prior episodes. no fever or chills. no cp, mild dyspnea. last abx dose was ~. no ha or dizziness. still having diffuse body pain, partially relieved with prn iv pain meds in ed. no current nausea. past medical history: cardiac history: percutaneous coronary intervention: pt reports previous c. cath done in which was done in ' which was negative for blockages. there is a note in omr re: a history of 2vd, however pt denies this. . other past history: 1) fibromyalgia 2) neuropathy - self reported. 3) gastroesophageal reflux disease. 4) hypertension 5) osteoarthritis - right knee with severe disease 6) migraine has 7) hyperkeratosis of the skin on le bilat with ulcerations 8) previous hx of obesity. 9) previous h/o impaired glucose tolerance vs. dmii, resolved entirely s/p weight normalization. last hba1c 5.5. 10) h/o anemia - improved with fe, vit 12 and folate. . psurgh: 1) gastric bypass surgery in . social history: moved to from and is living with sister in . worked in accounting, but has been on disability due to her fibromyalgia for past yrs. current smoker. smokes ppd x 25yrs, denies etoh or ivdu/illicit drug use. family history: all 5 siblings with dm. pt reports one sister died of mi & chf at age 44. reports a nephew had an mi in his 30s. there is no history of sudden death. physical exam: on admission: 97.6 125 92/58 12 100 on ra levophed 0.04 4000 ivf || 360 uo since foley placement ~2h ago a&ox3, nad although uncomfortable appearing ctab, no rales tachycardic, regular rhythm soft, mildly distended, diffusely tender to light palpation, poorly localizing but greater in lower abdomen, + rebound. well-healed upper-midline scar without hernia rectal declined by patient wwp, dp 2+ bl. 1+ edema bl le between knees and ankles, no erythema. dry flaking skin bl soles. no open lesions. at discharge: 98.1 79 99/71 18 100%ra a&ox3, nad ctab, no rales rrr, no murmurs soft, nondistended, mild ruq discomfort but no rebound/peritonitis. well-healed upper-midline scar without hernia rectal declined by patient wwp, dp 2+ bl. 1+ edema bl le between knees and ankles, no erythema. dry flaking skin bl soles. no open lesions. pertinent results: 2am: 6.1 > 28.3 < 112 n:58 band:28 l:7 m:5 e:0 bas:0 metas: 2 pt: 20.1 ptt: 35.6 inr: 1.9 fibrinogen: 232 137 98 12 27 2.8 19 1.3 estgfr: 44/53 ck: 29 mb: notdone trop-t: <0.01 alt: 29 ap: 96 tbili: 1.6 alb: ast: 73 ldh: 182 dbili: tprot: : lip: 6 lactate 8.1 6am: 4.1 > 22.2 < 79 n:48 band:28 l:17 m:4 e:0 bas:0 metas: 3 pt: 23.7 ptt: 39.8 inr: 2.3 135 105 11 115 2.7 16 1.1 lactate 7.9 . imaging cxr 1am: no infiltrate or effusion. 7mm lll granuloma cxr 4am: r ij cvl tip in ra, no ptx ct torso 5am (iv contrast, no po contrast): significant wall thickening of rectum and sigmoid/descending colon, fair sparing of transverse colon, and additional edema of ascending colon. no pneumoperitoneum, no pneumatosis. distended gallbladder with trace wall edema, no pericholecystic fluid, cbd not well visualized. bypass anastamoses appear patent and in proper position/alignment (although limited by lack of po contrast). , sma, and celiac all patent. cxr 5:30am: r ij cvl tip in svc/ra juntion xr bl ankles 5:30am: no fx, no subcutaneous gas. soft tissue swelling and degenerative joint disease. ct chest no pe ruq u/s fatty liver, no gallstones; no biliary dilatation mrcp: l. gallbladder distention with no discrete calculi within the gallbladder. possibility of cholecystitis cannot be excluded given the degree of gallbladder distension. 2. no obvious peribiliary hyperemia, no overt ductal calculi. hida: tracer uptake in the gallbladder following morphine injection, consistent with a patent cystic duct and no evidence of cholecystitis. . micro bcx pending at discharge bcx group a beta strep, e. coli cdiff negative ucx negative bcx no growth vre screen negative stool cx negative cdiff negative cdiff negative blood culture, routine (final ): escherichia coli. final sensitivities. beta streptococcus group a. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r flexible sigmoidoscopy findings: very mild blunting of vascularity was noted in the sigmoid colon. two cold forceps biopsies were performed for histology at the sigmoid colon. two cold forceps biopsies were performed for histology at the distal sigmoid colon. very mild erythema of mucosa was noted in the rectum consistent with mild inflammation. cold forceps biopsies were performed for histology at the rectum. impression: normal vascularity of the colon (biopsy, biopsy) abnormal mucosa in the colon (biopsy) otherwise normal sigmoidoscopy to distal sigmoid colon recommendations: return patient to floor await biopsy reports and viral culture results brief hospital course: the patient was admitted to the west3 general surgery service on for proctocolitis and septic shock; she was found to have blood cultures positive for e. coli and group a strep. she was initially admitted to the sicu due to hypotension. neuro: the patient had difficulty with pain control during her hospitalization, likely as a result of chronic opiate use at home and significant cross-tolerance. she was treated with dilaudid pca with prn dilaudid while npo. when tolerating oral intake, the patient was transitioned to oral pain medications with moderate effect. she was also initially placed on a valium ciwa scaled, but this was weaned in the icu. she was given a banana bag and started on thiamine, folic acid. cv: on the first day of admission the patient was transiently on iv pressor support, but this was weaned as she was resuscitated with iv fluids. for the remainder of her hospitalization, she was kept on telemetry and vital signs were routinely monitored. pulmonary: the patient was stable from a pulmonary standpoint; vital signs were routinely monitored. gi: the patient was admitted for proctocolitis. given her history of recent antibiotic use for cellulitis (2 weeks prior to admission), she was initially treated for presumed cdiff colitis. however, after c. diff was negative x 3, this treatemtn was stopped on hd#6. her abdinal exam improved, and was soft and fairly nontender at discahrge. additionally, stool cultures were negative. due to elevated lfts on admission, a hepatitis panel was sent which was negative. the pt does need a hep b vaccine. she had a ruq u/s on which fatty liver, no gallstones; no biliary dilatation. she underwent an mrcp to rule out cholangitis, which showed no biliary duct dilatation, non-specific gb dilatation and wall edema. hida scan likewise showed no cholecystitis. gi evaluated the patient and thought her elevated lfts were c/w cholestasis of sepsis. gi also performed flexible sigmoidoscopy on the patient, which showed normal vascularity of the colon and abnormal mucosa in the colon. biopsies and viral cultures were sent. nutrition: in regards to nutritional status, the patient was aggressively resuscitated with iv fluids and albumin after admission and was kept npo initially; however, with clinical improvement her diet was advanced, which was tolerated well. gu: foley was removed on hd#5. although the patient was initially in mild acute renal failure with a creatinine of 1.3, it came down to 0.7 with resuscitation. intake and output were closely monitored. she was placed on famotidine for ulcer ppx. id: she was treated initially with broad spectrum iv antibiotics including vancomycin (po&iv), iv cefepime, iv flagyl, and iv levaquin in consultation with id. her antibiotic regimen narrowed to ceftriaxone alone after c. diff was negative x 3 and she had negative stool cultures. she additionally had blood cultures positive for group a beta strep and e. coli from the day of admission. id recommended a 14 day course of iv ceftriaxone. a picc line was placed to continue this course (day 1 = , last day = ). endocrine: the patient had several episodes of hypoglycemia (cbgs in 40s) in the sicu when off of dextrose infusion. this resolved as her clinical situation improved. cpeptide and insulin level were sent, which were pending at time of discharge. hematology: while admitted, the pt became coagulopathic with elevated inr (1.8). this was stable during her hospitalization. she also became thrombocytopenic with platelets reaching a nadir of 25. all heparin products were discontinued, hit antibodies were sent which were negative. these abnormalites were likely due to sepsis coagulopathy, and improved as the pt's clinical situation improved. at discharge, t bili = 1.2, inr = 1.7 and plt = 90. prophylaxis: the patient received subcutaneous heparin during this stay, and was encouraged to get up and ambulate as early as possible. although this was stopped when she developed low platelets, it was subsequently restarted when plt count recovered. she was treated with famotidine . wounds: the patient has bilateral lower ext chronic venous stasis wounds. wound care was consulted to make recommendations regarding these. at the time of discharge on hd#9, the patient was doing well, afebrile with stable vital signs, tolerating a regular diet, ambulating with assistance, voiding without assistance, and pain was fairly well controlled. medications on admission: asa 81', amitriptyline 75', omeprazole 20', ca 500'', vit b12 100', 60''prn itching, hydroxyzine 25q6prn, eucerin prn, lac-hydrin 12% ' discharge medications: 1. ammonium lactate 12 % lotion sig: one (1) appl topical asdir (as directed). 2. mupirocin calcium 2 % cream sig: one (1) appl topical (2 times a day). 3. white petrolatum-mineral oil cream sig: one (1) appl topical (2 times a day). 4. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day). 8. hydromorphone 2 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain for 10 days. 9. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) piggyback intravenous q24h (every 24 hours) for 8 days: last day for 14 day course. 10. amitriptyline 75 mg tablet sig: one (1) tablet po once a day. 11. calcium 500 500 mg (1,250 mg) tablet sig: one (1) tablet po twice a day. 12. fexofenadine 60 mg tablet sig: one (1) tablet po twice a day as needed for itching. discharge disposition: extended care facility: - discharge diagnosis: primary: 1. proctocolitis, 2. bacteremia, 3. sepsis, 4. venous stasis cellulitis, 5. fibromyalgia secondary: 1. htn, 2. gerd discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: *you were admitted to to the general surgery service for proctocolitis inflammation of the bowel. you were also found to have bacteria in your blood. initially you were admitted to the icu because your blood pressure was very low. you were treated with iv fluids, iv antibiotics and iv pressors (medications to raise the blood pressure). your symptoms improved with these treatments. you were also seen by the gastroenterologist (gi) doctors. *you will need to take 14 days of iv antibiotics for the infection in your blood. a midline iv line was placed for this. * you were evaluated by gastroenterology and underwent a flexible sigmoidoscopy, which showed abnormal mucosa but normal vascularity of the distal colon. you will need to follow up with clinic to get the results of cultures and tissue specimens sent. * please resume all regular home medications and take any new meds as ordered. * do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. return to the er if: * if you are vomiting and cannot keep in fluids or your medications. * if you have shaking chills, fever greater than 101.5 (f) degrees or 38 (c) degrees, chest pain, shortness of breath, worsening abdominal pain, or anything else that is troubling you. * any serious change in your symptoms, or any new symptoms that concern you. followup instructions: please follow up with dr. with general surgery in weeks. call for an appointment. please also follow up with gastroenterology clinic with dr. in 2 weeks. please call ( for an appointment. you will need a colonoscopy, as directed by dr. . please call your regular doctor and let them know about this hospitalization. you should follow up with them in weeks to discuss it. procedure: venous catheterization, not elsewhere classified arterial catheterization closed [endoscopic] biopsy of large intestine transfusion of packed cells transfusion of other serum closed [endoscopic] biopsy of rectum diagnoses: thrombocytopenia, unspecified anemia, unspecified esophageal reflux unspecified essential hypertension unspecified septicemia severe sepsis hypopotassemia cellulitis and abscess of leg, except foot septic shock other and unspecified coagulation defects knee joint replacement myalgia and myositis, unspecified ulcer of other part of lower limb venous (peripheral) insufficiency, unspecified bariatric surgery status ulcerative (chronic) proctitis 

Answer: The patient is high likely exposed to