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: no known allergies / adverse drug reactions attending: chief complaint: diarrhea, hypovolemic shock major surgical or invasive procedure: endoscopy internal jugular central line placement history of present illness: mrs. is a 74 year old female with ulcerative colitis s/p total colectomy with ileostomy who presented to the ed with one week of diarrhea via her ostomy bag and was admitted to the micu for management of hypotension. she came to the ed today because she had not appetite and felt generally weak and ill. one week prior to admission she noticed loose to liquid tan colored, large volume ostomy output. this was associated with upper quadrant abdominal cramps, which have since resolved. she was seen in the ed on for upper quadrant abdominal pain. a ct abdomen with contrast showed no obstruction or small bowel problem (though it did show a possible sacral mass). she was evaluated by surgery at that time and her abdomen was benign. she was discharged home with pcp . she denies sick contacts and travel. she denies fevers, chills, nightsweats, nausea and vomiting. she had a recent dental procedure got premedicated with amoxicillin about 3 weeks ago. other than that, she has not taken any antibiotics. . in the ed, initial vs were: 98.9 hr 97 bp 68/42 rr 20 sao2 97% (delivery method not recorded) she triggered for hypotension and was given 4l ivns. the patient was mentating well despite hypotension. a right ij was placed and she was started on norepinephrine. labs were remarkable for k 6.1 bun/cr. 116/5.9, na 130, lactate 1.3. fena was 0.3%, renal u/s showed no hydronephrosis or stones, ct abdomen showed dialated loops of fluid filled bowel unchanged from , consistent with mild chronic obstruction. she as given ciprofloxaxcin 400mg iv, metronidazole 500mg iv, morphine 5mg and ondansetron 2mg. after fluid resucitation her bun/cr decrease to 93/4.2 . vitals on transfer: afebrile, 90, 103/47, 97ra, 17, cvp 10. on arrival to the micu, . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, constipation. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: -hx of stage i endometrial ca, s/p tah/bso and adjuvant radiation () -hypertension -ulcerative colitis, s/p tac w/ end ileostomy () and subsequent stenosis in -hypercholesterolemia -bilateral knee osteoarthritis -chronic peripheral neuropathy related to spondylosis -hyperthyroidism -hx herpes zoster -diabetes mellitus, type ii-- diet controlled . past surgical history: -total abdominal colectomy with end ileostomy, ~ -revision of ileostomy for stenosis, -exlap, peritoneal washing, pelvic adhesiolysis, tah/bso, -amputation of left second and third toes -open reduction and internal fixation of closed comminuted depressed lateral tibial plateau fracture, -right total knee replacement, social history: social history: retired and lives at home with her husband. - tobacco: never - alcohol: none - illicits: none family history: na physical exam: admission physical exam: vs- afebrile, 90, 103/47, 97ra, 17, cvp 10 general appearance: well nourished, no acute distress eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic cardiovascular: normal s1/s2, 1/6 systolic murmur rusb not radiating to carotids peripheral vascular: radial/dp pulses present bilaterally respiratory / chest: ctab abdominal: soft, non-tender, bowel sounds present, ileostomy site c/d/i; bag draining liquid tan colored stool, no organomegaly extremities: right lower extremity edema: trace, left lower extremity edema: trace neurologic: attentive, follows simple commands, cn ii to xii grossly in tact, strength at shoulders, elbows, wrists, ankles discharge physical exam: vs- 99.2 111/50(111-132/50-59) 79 20 99% ra exam largely unchanged, notable for +bs, soft, nt abdomen, ostomy with stool and flatus pertinent results: admission labs: wbc-6.7 rbc-4.10* hgb-11.0* hct-33.8* mcv-83 mch-26.8* mchc-32.4 rdw-14.0 neuts-73.7* lymphs-18.7 monos-6.5 eos-0.7 basos-0.4 plt count-438 . glucose-131* urea n-116* creat-5.9*# sodium-130* potassium-6.1* chloride-89* total co2-22 anion gap-25* calcium-8.7 phosphate-8.1*# magnesium-1.6 tsh-4.9* cortisol-20.7* . pertinent labs: 05:43pm glucose-88 lactate-0.7 k+-4.8 05:40pm alt(sgpt)-21 ast(sgot)-20 ld(ldh)-181 alk phos-66 tot bili-0.1 lipase-7 albumin-3.4* lactate-1.3 k+-5.4* . u/a- blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg . microbiology: blood culture- no growth to date x 2, pending final urine culture- no growth stool culture- clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. fecal culture (final ): no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. fecal culture - r/o e.coli 0157:h7: no e.coli 0157:h7 found. fecal culture - r/o vibrio (final ): no vibrio found. fecal culture - r/o yersinia (final ): no yersinia found. ova + parasites (final ): no ova and parasites seen. . imaging: ct abd/pelvis w/o contrast ()- 1. mildly dilated loops of small bowel in the right lower abdomen with normal caliber distal small bowel, may suggest early/ partial small bowel obstruction. 2. soft tissue seen in the presacral region, may represent post surgical/radiation fibrosis, but recurrent tumor not excluded. . ct abd/pelvis w/o contrast ()- multiple loops of fluid-filled dilated small bowel, slighty progressed since the examination, tapering somewhat near an area of surgical scar/remnant tissue at the rectal bed, concerning for partial small bowel obstruction secondary to presacral soft tissue to which the bowel appears adherent. this tissue may be due to prior post-operative change and radiation fibrosis although recurrent tumor is not excluded. no secondary signs of ischemia are present. there are no focal fluid collections. . renal ultrasound ()- normal ultrasound examination of the kidneys. the bladder is collapsed. egd - normal mucosa in the esophagus polyps in the stomach body (biopsy) friability and congestion in the whole stomach compatible with gastritis friability and congestion in the duodenal bulb compatible with duodenitis otherwise normal egd to third part of the duodenum discharge labs: 05:25pm blood hct-27.2* 05:57am blood wbc-5.3 rbc-3.26* hgb-8.9* hct-27.7* mcv-85 mch-27.4 mchc-32.2 rdw-14.2 plt ct-274 06:58am blood wbc-6.5 rbc-3.23* hgb-8.4* hct-27.0* mcv-84 mch-26.1* mchc-31.2 rdw-14.0 plt ct-291 06:58am blood glucose-115* urean-15 creat-0.9 na-144 k-4.4 cl-114* hco3-22 angap-12 studies pending at discharge: pathology from gastric biopsies h. pylori serologies brief hospital course: 74 year old female with ulcerative colitis s/p total colectomy with ileostomy who was admitted with diarrhea and hypovolemic shock. . #hypovolemic shock: likely etiology thought to be acute gastroenteritis. initial blood pressure was 60s/40s with hr low 90s. a rij cvc was placed in the ed. she was volume resuscitated with about 10 l of normal saline and lactated ringers over 16 hours. she was admitted to the micu. initially, she required a low dose levophed drip but this was weaned over the course of 12 hours. clinically she improved. she began a regular diet and had good po intake prior to discharge. her lisinopril was held and was not restarted prior to discharge. based on her blood pressures and renal function at follow up, her lisinopril could be restarted at pcp follow up visit. . #diarrhea: acute infectious gastroenteritis was suspected initially and patient was started empirically on ciprofloxacin and metronidazole. stool culture was negative for salmonella, shigella, e.coli, vibrio, yersinia. in addition, negative x 1 for c.difficile and ova and parasites. with finding of blood in stool and hematocrit drop (see below), it is possible that increased output from ostomy was secondary to the cathartic effects of blood, and once acute bleed stopped, output slowed. patient was discharged to complete an additional 5 days of ciprofloxacin and metronidazole and outpatient gastroenterology appointment scheduled. #probable acute blood loss anemia: patient had a hematocrit drop from last ed visit on (36.8) to (33.8) and dropped even further with fluid resuscitation to 27.0. stool guaiac was positive x 2. hemolysis labs were negative. gastroenterology was consulted and did an upper endoscopy which was notable for friable mucosa throughout the stomach and duodenum consistent with gastritis and duodenitis, in addition to two polyps which were biopsied. no ulcerations or specific sites of bleeding were noted. gi suggested outpatient capsule study for visualization of the small bowel for potential source of bleeding. patient's hematocrit remained stable for 48 hours and she was discharged on ppi with close pcp and gi scheduled. she was also instructed to notify her outpatient providers if she has recurrence of increased stool output or has any symptoms of dehydration or pre-syncope. . #acute renal failure: appeared to be prerenal azotemia in the setting of hypovolemia from large volume output. fena .3% supported this finding. creatinine also improved with fluid resuscitation, returning from peak of 5.9 to baseline of 1.1 and remaining stable thereafter. . #hyperkalemia: initially 6.1 and improved to 4.7 with volume resucitation as her prerenal azotemia improved. lisinopril held. ekg showed no pr shortening or significant tenting of the t waves; no qrs widening. . #soft tissue mass in the presacral region with adherent bowel based on ct with oral contrast from and : primary surgeon, dr. , suggested a pet ct for definitive evaluation. this study will be done as outpatient and patient will follow-up results with dr. and pcp . . . . #ulcerative colitis: home lomotil was held at the time of discharge until follow up. . #hypertension: as above, patient initially hypotensive, then normotensive following volume resuscitation. home lisinopril 20mg daily held at the time of discharge given normal blood pressure and recent acute kidney injury with plan for patient to restart at the discretion of pcp at appointment. . #hypercholesterolemia: patient continued on home atorvastatin and aspirin. . #bilateral knee osteoarthritis: patient continued on home acetaminophen prn. . #peripheral neuropathy secondary to spondylosis: dose adjusted for renal failure initially, then changed back to home dose gabapentin 200mg tid prior to discharge. . #hyperthyroidism: continued home methimazole 5mg daily . #diabetes mellitus, type ii: diet controlled in hospital . #gerd: patient on pantoprazole 40mg daily at home. with findings of gastritis on egd, pantoprazole was increased to 40mg . . #anxiety: continued home lorazepam 1mg as needed daily -lorazepam 1mg po prn daily . . #transitional issues: pet/ct to evaluate presacral tissue mass with adherent bowel ciprofloxacin and metronidazole to be continued through lisinopril held at time of discharge given recent and normotension endoscopy biopsy results pending blood culture final results pending h.pylori pending consider outpatient capsule study for evaluation of small bowel to continue anemia work-up patient scheduled for f/u with pcp, , and surgery medications on admission: -lipitor 20 mg daily -lisinopril 20 mg tab daily -neurontin 200 mg tid -methimazole 5 mg daily -protonix 40 mg daily -aspirin 81 mg daily -tylenol arthritis 650 mg (dose uncertain) -lorazepam 1 mg daily prn -lomotil 2.5 mg-0.025 mg tab 2 tablet(s) by mouth qid prn -centrum silver daily -calcium+d 400 mg -133.3 unit tab discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever/pain. 4. methimazole 5 mg tablet sig: one (1) tablet po bid (2 times a day). 5. ciprofloxacin 250 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 2 days: through . disp:*10 tablet(s)* refills:*0* 6. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 2 days: through . disp:*7 tablet(s)* refills:*0* 7. lorazepam 1 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for anxiety. 8. gabapentin 100 mg capsule sig: two (2) capsule po tid (3 times a day). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: 1. gastritis 2. anemia 3. gastroenteritis 4. acute renal failure 5. hypovolemic shock secondary diagnosis: #. ulcerative colitis s/p colectomy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mrs. , it was a pleasure taking care of you during your recent admission to . you were admitted because of increased output from your ostomy. because of the large volume loss, your blood pressure was very low, and you were briefly in the icu for medications and fluids to help bring your blood pressure up. you responded very well to these interventions, and were stable to be transferred to the regular floor. you were treated for potential bacterial infection in your gi tract with two antibiotics. please continue these medications for two more days. in addition, you had a drop in your blood counts and were found to have blood in your stool. the gastroenterologists did an exam of your esophagus and stomach and found irritation of the lining in your stomach. they also took samples of two polyps. you will need to follow-up with the gi doctors regarding results of these biopsies and the blood in your stool. you should discuss the benefit of a capsule study during your follow-up appointment. also, you have a blood test pending to look for an infection in your stomach that could be causing the irritation and bleeding called h.pylori, you should discuss this result with dr. at your follow up appointment. a ct scan of your abdomen noted a new mass in your abdomen, which is likely related to past radiation. this would be better evaluated with a pet scan. please have this examination performed prior to your follow-up with your surgeon, dr. . medication changes: - continue ciprofloxacin through - continue metronidazole through - increase protonix to twice daily - hold lisinopril until you follow-up with your primary care doctor continue the rest of your home medications without changes be sure to avoid nsaids (ibuprofen, advil, motrin) as these medication irritate your stomach. followup instructions: please call to schedule a pet scan department: gastroenterology when: tuesday at 4:30 pm with: , md building: lm bldg () campus: west best parking: garage department: when: wednesday at 10:00 am with: , md building: (, ma) campus: off campus best parking: on street parking name: , /general surgery address: ,ste 6b, , phone: when: thursday, :00 pm procedure: venous catheterization, not elsewhere classified esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: hyperpotassemia esophageal reflux pure hypercholesterolemia unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm personal history of malignant neoplasm of other parts of uterus anxiety state, unspecified other shock without mention of trauma duodenitis, without mention of hemorrhage ulcerative colitis, unspecified unspecified hereditary and idiopathic peripheral neuropathy knee joint replacement ileostomy status unspecified gastritis and gastroduodenitis, without mention of hemorrhage infectious colitis, enteritis, and gastroenteritis osteoarthrosis, localized, not specified whether primary or secondary, lower leg benign neoplasm of stomach 

Answer: The patient is high likely exposed to