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 attending: chief complaint: morbid obesity major surgical or invasive procedure: 1. diagnostic laparoscopy with conversion to open roux-en-y gastric bypass. 2. exploratory laparotomy. 3. placement of gastrostomy tube. 4. application of fibrin glue to gastro-j and jj. history of present illness: has class iii morbid obesity, weight 349.8 pounds, height 69.5 inches and bmi 50.9. previous weight loss efforts have included optifast, off-label prescription weight loss medications fenfluramine/phentermine. he has not tried any popular weight loss diets or used over-the-counter ephedra-containing appetite suppressants/herbal supplements. he does not remember what his weight at age 21 was but he is at his highest weight currently. he has been struggling with weight "all my life". factors contributing to excess weight include large portions, grazing, late night eating, and too many carbohydrates in saturated fats and lack of exercise regimen until recently when he started elliptical and treadmill at a gym 3 times per week. he denied history of eating disorders but does have eating issues stating that he always eats and is never satisfied and even if he is full he will still eat. he comments that the more food he sees the more food he will eat. he does have depression with adhd on medication but no hospitalizations for psychological issues. past medical history: pmh: -hypertension -type 2 diabetes hemoglobin a1c of 7.6% -obstructive sleep apnea on bipap -hyperlipidemia -mild asthma -vertigo -fatty liver psh: -fistulotomy -hemorrhoidectomy with rubber band ligation x 2, . social history: he denied tobacco or recreational drug usage, no alcohol and has occasional caffeinated beverage. he is disabled having been injured at work with a head injury. he is married living with his wife age 45 and they have two daughters ages 15 and 24 and a granddaughter living with them. family history: family history is noted for stroke in his parents and history of diabetes and obesity. his brother and daughter both had gastric bypass procedures done for morbid obesity at the hospital. physical exam: vital signs: temperature 98.3, heart rate 86, blood pressure 119/70, respiratory rate 20, oxygen saturation 100% on room air constitutional: no acute distress, anxious for discharge neuro: alert and oriented to person, place and time cardiac: regular rate and rhythm; no murmurs/ rubs/ gallops; normal s1 s2 lungs: clear to auscultation, bilaterally; no wheezes/ rales/ rhonchi abdomen: soft, non-tender, non-distended, no rebound tenderness or guarding; g-tube to gravity; jp drain x 1 w/ serous fluid wounds: abdominal midline incision without erythema or induration extremities: no cyanosis, clubbing, edema pertinent results: 07:00pm blood hct-41.6 05:29am blood hct-40.9 12:25pm blood wbc-13.7*# rbc-4.66 hgb-14.6 hct-43.4 mcv-93 mch-31.3 mchc-33.5 rdw-13.8 plt ct-201 04:35am blood wbc-13.9* rbc-4.30* hgb-13.4* hct-39.9* mcv-93 mch-31.1 mchc-33.5 rdw-13.8 plt ct-176 12:25pm blood plt ct-201 04:35am blood plt ct-176 12:25pm blood glucose-243* urean-19 creat-1.2 na-141 k-4.2 cl-101 hco3-27 angap-17 04:35am blood glucose-225* urean-16 creat-0.9 na-141 k-4.0 cl-104 hco3-27 angap-14 04:35am blood calcium-9.0 phos-1.9* mg-1.8 08:30am blood po2-235* pco2-48* ph-7.39 caltco2-30 base xs-3 08:30am blood glucose-237* lactate-1.4 na-141 k-4.1 cl-102 calhco3-28 08:30am blood freeca-1.11* 02:14am blood albumin-3.2* calcium-8.3* phos-2.1* mg-1.9 03:51am blood type-art po2-69* pco2-40 ph-7.44 caltco2-28 base xs-2 02:14am blood albumin-3.2* calcium-8.3* phos-2.1* mg-1.9 02:14am blood alt-301* ast-107* ld(ldh)-236 ck(cpk)-* alkphos-41 amylase-22 totbili-2.5* 08:24pm blood ck(cpk)-2110* 02:14am blood pt-15.6* ptt-25.6 inr(pt)-1.4* 02:14am blood plt ct-148* 02:14am blood wbc-11.7* rbc-3.88* hgb-12.5* hct-35.8* mcv-92 mch-32.1* mchc-34.9 rdw-13.8 plt ct-148* 02:21am blood glucose-228* urean-16 creat-0.9 na-142 k-3.7 cl-109* hco3-23 angap-14 07:28pm blood glucose-260* urean-17 creat-0.8 na-144 k-3.3 cl-111* hco3-24 angap-12 02:14am blood albumin-3.2* calcium-8.3* phos-2.1* mg-1.9 02:21am blood albumin-3.2* calcium-8.5 phos-1.7* mg-1.8 04:08am blood type-art po2-87 pco2-37 ph-7.45 caltco2-27 base xs-1 10:32am blood type-art po2-60* pco2-37 ph-7.47* caltco2-28 base xs-3 07:53pm blood type-art po2-63* pco2-33* ph-7.49* caltco2-26 base xs-2 10:32am blood glucose-239* lactate-1.8 na-143 k-3.5 04:08am blood freeca-1.11* 10:32am blood freeca-1.15 02:21am blood ctropnt-<0.01 02:21am blood alt-230* ast-82* alkphos-48 totbili-2.0* 02:21am blood plt ct-162 02:21am blood wbc-11.8* rbc-3.95* hgb-12.6* hct-36.6* mcv-93 mch-31.8 mchc-34.4 rdw-13.7 plt ct-162 07:28pm blood glucose-260* urean-17 creat-0.8 na-144 k-3.3 cl-111* hco3-24 angap-12 01:10am blood calcium-8.9 phos-2.2* mg-2.0 01:10am blood alt-187* ast-70* alkphos-54 totbili-1.4 01:10am blood plt ct-192 01:10am blood wbc-11.2* rbc-4.00* hgb-12.6* hct-37.6* mcv-94 mch-31.6 mchc-33.6 rdw-13.6 plt ct-192 01:13am blood glucose-263* urean-16 creat-0.7 na-142 k-3.7 cl-108 hco3-25 angap-13 01:13am blood calcium-8.8 phos-3.2 mg-1.8 01:13am blood alt-144* ast-46* alkphos-55 totbili-1.0 01:13am blood plt ct-208 01:13am blood wbc-9.8 rbc-4.21* hgb-13.3* hct-39.8* mcv-95 mch-31.5 mchc-33.3 rdw-13.9 plt ct-208 02:37am blood glucose-122* urean-22* creat-0.9 na-144 k-3.4 cl-110* hco3-27 angap-10 02:37am blood plt ct-228 02:37am blood wbc-11.8* rbc-4.30* hgb-13.4* hct-40.5 mcv-94 mch-31.2 mchc-33.1 rdw-14.0 plt ct-228 06:50am blood glucose-123* urean-24* creat-1.1 na-144 k-3.8 cl-108 hco3-30 angap-10 06:50am blood calcium-8.4 phos-3.5 mg-1.9 06:50am blood plt ct-220 06:50am blood wbc-12.3* rbc-3.89* hgb-11.9* hct-37.0* mcv-95 mch-30.5 mchc-32.1 rdw-14.1 plt ct-220 ugi sgl contrast w/ kub: high density material within the jp drain, suggests extraluminal leak. no definite leak is visualized, though there is a possible linear focus of extraluminal contrast near the gastrojejunostomy. no holdup or stenosis chest (portable ap) impression: 1. mediastinal and hilar venous engorgement. 2. retrocardiac atelectasis with possible small bilateral pleural effusions. chest (portable ap) impression: no pulmonary edema brief hospital course: the patient presented to pre-op on . pt was evaluated by anaesthesia and taken to the operating room for laparoscopic gastric banding. the patient was difficult to intubate due to thickened neck circumference. also, there was difficulty placing the -gastric tube into the stomach, therefore, an open roux-en-y gastric bypass was performed. otherwise, there were no adverse events in the operating room; please see the operative note for details. pt was extubated, taken to the pacu until stable, then transferred to the for observation. on hospital day #1 an ugi was performed, which showed high density material within the jp drain, suggestive of an intraluminal leak. given the results of the study, the patient was monitored closely with -gastric tube to low, intermittent suction, a jp drain to bulb suction, and strictly nothing by mouth. the patient remained clinically stable without abdominal exam changes throughout the day, however, overnight the patient became persistently tachycardic to the 120s. therefore, the decision was made to return to the operating room for exploratory surgical intervention. on post-operative day #2, the patient underwent an exploratory laparotomy, placement of a gastrostomy tube and application of fibrin glue to the gastro-jejunostomy and j-j anastomosis. intra-operatively, no leak was identified. there were no adverse events in the operating room; please see operative note for details. the patient remained intubated, was brought to the pacu until stable, then transferred to the surgical intensive care unit for close observation. neuro: the patient was alert and oriented throughout his hospitalization except for brief period of visual hallucinations which he experienced in the intensive care unit. the hallucinations, which were treated with intravenous haldol, resolved without further occurrence; pain was initially managed with a morphine pca, which required an increase in dosing on post-operative day #1 due incisional abdominal pain. in the intensive care unit, the patient was managed briefly with intravenous morphine, which was transition ed to rectal and then oral tylenol, with well-controlled pain. cv: on post-operative day #1 the patient remained stable from a cardiovascular standpoint, however, overnight the patient became persistently tachycardic as described above. post-operatively, in the intensive care unit, the patient became hypertensive to the 170-180s. he was initially managed with intravenous metoprolol and hydralazine. labetalol was trialed, but he eventually required a nicardipine drip. on post-operative day #6/ #4, intravenous enalapril was added to the regimen as nicardipine was weaned. the patient was subsequently managed successfully with intravenous metoprolol and enalapril until he resumed an oral diet. oral medication management included losartan and amlodipine at the suggestion of his primary care provider who will see him next week. pulmonary: the patient self-extubated in the intensive care unit on post-operative day #3/#1 and was maintained on cpap. he developed a brief period of respiratory distress which resolved once the cpap mask was adjusted for his -gastric tube. arterial blood gasses were within acceptable limits at this time. on the floor, the patient was weaned from oxygen and maintained on cpap at night due to known obstructive sleep apnea. he subsequently remained stable from a pulmonary standpoint. good pulmonary toilet, and incentive spirometry were encouraged gi/gu/fen: on post-operative day #1 the patient was npo, given intravenous fluids and had -gastric tube in place for decompression of his gastric pouch. following his ugi study described above, the patient was kept strictly npo with a -gastric tube maintained to low, intermittent wall suction. the jp drain was maintained on bulb suction. serial abdominal exams were performed every 2-3 hours until the patient returned to the operating room. upon return to the operating room, a g-tube was placed which remained to gravity throughout the remainder of his hospitalization. total parenteral nutrition was initiated in the intensive care unit and continued until the patient was tolerating a stage 3 diet on post-operative day #10/#8. the patient tolerated an oral diet well. patient's intake and output were closely monitored with adjustments made to the intravenous fluids as needed. electrolytes were monitored and repleted as needed routinely. the patient's foley catheter was discontinued on post-operative day #8/#6 without subsequent issues with voiding. on day of discharge, one of the two jp drains was pulled and the central line was discontinued. id: on post-operative day #1 the patient remained afebrile with a stable white blood cell count. on post-operative day #2, while in the pacu, the patient spiked a temperature. pan culture was performed with negative results. intravenous ciprofloxacin and metronidazole were initiated and continued through post-operative day #9/#7. the patient remained afebrile without signs and symptoms of infection throughout the remainder of his hospital course. heme: the patient's hematocrit level was monitored routinely without signs of bleeding. prophylaxis: the patient received subcutaneous heparin and dyne boots were used during this stay; he was encouraged to get up and ambulate as early as possible. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a stage 3 diet, ambulating, voiding without assistance, and pain was well controlled. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. medications on admission: hydrochlorothiazide 12.5 mg daily avapro 150 mg daily lantus insulin 70 units twice daily actos 45 mg daily metformin 1000 mg twice daily simvastatin 10 mg daily baby aspirin 81 mg daily modafinil 200 mg twice a day strattera 60 mg daily for adhd flintstones complete multivitamins daily vitamin d units discharge medications: 1. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily): please crush. 2. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. ranitidine hcl 15 mg/ml syrup sig: ten (10) ml po bid (2 times a day) for 1 months. disp:*600 ml* refills:*0* 4. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily): please crush. 5. losartan 50 mg tablet sig: two (2) tablet po bid (2 times a day): please crush. disp:*120 tablet(s)* refills:*2* 6. vitamin d 2,000 unit capsule sig: one (1) capsule po once a day. 7. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily): please crush. disp:*30 tablet(s)* refills:*2* 8. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day): please crush. disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: care group discharge diagnosis: 1. obesity, body mass index of 51. 2. obstructive sleep apnea. 3. type 2 diabetes. 4. hypertension. 5. metabolic x syndrome 6. tachycardia, etiology unknown. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: discharge instructions: please call your surgeon or return to the emergency department if you develop a fever greater than 101.5, chest pain, shortness of breath, severe abdominal pain, pain unrelieved by your pain medication, severe nausea or vomiting, severe abdominal bloating, inability to eat or drink, foul smelling or colorful drainage from your incisions, redness or swelling around your incisions, or any other symptoms which are concerning to you. diet: stay on stage iii diet until your follow up appointment. do not self advance diet, do not drink out of a straw or chew gum. medication instructions: resume your home medications, crush all pills. you will be starting some new medications: 1. you are being discharged on medications to treat the pain from your operation. these medications will make you drowsy and impair your ability to drive a motor vehicle or operate machinery safely. you must refrain from such activities while taking these medications. 2. you should begin taking a chewable complete multivitamin with minerals. no gummy vitamins. 3. you will be taking zantac liquid 150 mg twice daily for one month. this medicine prevents gastric reflux. 4. you will be taking actigall 300 mg twice daily for 6 months. this medicine prevents you from having problems with your gallbladder. 5. you should take a stool softener, colace, twice daily for constipation as needed, or until you resume a normal bowel pattern. 6. you must not use nsaids (non-steroidal anti-inflammatory drugs) examples are ibuprofen, motrin, aleve, nuprin and naproxen. these agents will cause bleeding and ulcers in your digestive system. activity: no heavy lifting of items pounds for 6 weeks. you may resume moderate exercise at your discretion, no abdominal exercises. wound care: you may shower, no tub baths or swimming. if there is clear drainage from your incisions, cover with clean, dry gauze. your steri-strips will fall off on their own. please remove any remaining strips 7-10 days after surgery. please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. followup instructions: an appointment with your dr. has been scheduled for at 3 pm. it is imperative that you keep this appointment. provider: , md phone: date/time: 11:45 provider: , rd,ldn phone: date/time: 12:30 provider: , md phone: date/time: 11:00 procedure: parenteral infusion of concentrated nutritional substances other gastroenterostomy without gastrectomy reopening of recent laparotomy site other gastrostomy diagnoses: obstructive sleep apnea (adult)(pediatric) unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other pulmonary insufficiency, not elsewhere classified asthma, unspecified type, unspecified other and unspecified hyperlipidemia morbid obesity other ascites tachycardia, unspecified delirium due to conditions classified elsewhere benign paroxysmal positional vertigo other chronic nonalcoholic liver disease laparoscopic surgical procedure converted to open procedure dysmetabolic syndrome x body mass index 50.0-59.9, adult physical restraints status 

Answer: The patient is high likely exposed to