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: ultram attending: chief complaint: diarrhea, lightheadedness major surgical or invasive procedure: 1. total colectomy, abdominal with ileostomy. 2. gastrostomy tube placement. history of present illness: 41f s/p lap gastric bypass in followed by a revision of the jejunojejunostomy 1 month later for a ? obstruction. she was lost to follow up since and her surgical weight loss and medications are unknown. over the past year she was being seen by gastroenterology for persistent dry heaves, inability to tolerate pos and a 60lb weight loss. during her last admission she has a documented c.diff infection on and she was discharged on on a 14 day course of po vanc. she presented to the ed today with fatigue, lightheadedness and diarrhea. while in the ed she had a precipitous decline in her clinical status, she became septic, had to be intubated, and levophed had to be started to maintain an adequate blood pressure. past medical history: 1. seizure disorder, has not had seizure in 4+ years. described as grand mal seizure possibly in the setting of ultram. 2. status post gastric bypass in . 3. djd l5-s1, facet djd and l4-l5 annular tear. 4. systolic/diastolic congestive heart failure due to cardiomyopathy of unclear etiology, likely viral diagnosed in 9/. ebv igm neg, cmv igm equivocal, lyme neg 5. depression. 6. chronic back pain with narcotic dependence 7. nausea, weight loss, nutritional deficiencies of unclear etiology, possibly related to depression, malabsorption or related to her gastric bypass. 8. normocytic anemia per notes attributed to iron deficiency in the past although no evidence in lab values here. social history: she works as an administrative assistant. denies any previous or current tobacco use, no current alcohol use. no illegal drugs or iv drug use. family history: father with cirrhosis of the liver. physical exam: physical exam on admission: vs 97.9, 104, 100/46, 24 on vent gen: intubated and sedated chest: tachycardic, lungs clear abd: soft, markedly distended rectal: guaiac positive ext: no edema physical exam on discharge: vs gen: weak but alert and oriented x3, nad cv: rrr chest: ctab abd: soft, appropriately tender near incision, erythematous and abd with flaky skin and excoriations wound: 1.5x1.5 opened area of midline incision inferiorly, packed with iodoform gauze, also small 1.0x1.0 area of midline incision superior to umbilicus with is opened and pack with iodoform gauze rest of incision clean/dry/intact with steris; g tube in place and functioning ext: erythematous inferiorly, 1+ edema bilaterally pertinent results: 03:05pm wbc-37.0*# rbc-3.82* hgb-10.4* hct-33.4* mcv-88 mch-27.4 mchc-31.3 rdw-16.1* 03:05pm neuts-88* bands-3 lymphs-6* monos-3 eos-0 basos-0 atyps-0 metas-0 myelos-0 03:05pm hypochrom-2+ anisocyt-1+ poikilocy-normal macrocyt-normal microcyt-1+ polychrom-normal ct abd/pelvis : 1. bibasilar opacities concerning for infection and/or aspiration. 2. diffuse colonic wall thickening, consistent with pancolitis, unchanged from . 3. cholelithiasis. 4. ng tube in gastric pouch with sideport at ge junction. 5. ascites, similar to . 6. fatty liver. 7. status-post gastric bypass. ct abd/pelvis : 1. no evidence of loculated fluid collection or abscess formation within the abdomen or pelvis. 2. persistent ascites with simple fluid tracking along bilateral paracolic gutters into the pelvis. 3. unchanged diffuse hepatic steatosis without focal lesion. 4. cholelithiasis without cholecystitis. 5. unchanged pancreatic cystic lesions. 6. unchanged anasarca. brief hospital course: mrs. had been admitted to with c. difficile pancolitis from and discharged home at that time on po vancomycin. she represented to the ed on with headache and weakness and decompensated, requiring intubation and pressors. she was initially admitted to the micu but then, after consultation with id, gi, medicine, surgery, and the micu, it was decided to take her to the operating room for total abdominal colectomy with end ileostomy. she was kept intubated for 4 days and extubated on , and transferred to the floor a day later. she recovered on the floor slowly but surely and was finally discharged home on to complete another 7 days of flagyl. the rest of her stay is summarized below by system. neuro: in addition to her chronic back pain, mrs. had the addition of the new pain from the operation. she was started on methadone standing and dilaudid prn and her pain control is being given over to her pcp . . by the time of discharge, her pain was well controlled on this regimen. cv: upon admission she required pressor support and significant resuscitation for her sepsis, which continued after she went to the or. she was monitored in the icu with a swan-ganz catheter and was given fluids, blood products, derivatives, and pressors as needed. she underwent echocardiography on which showed a lvef of 70% and otherwise normal function except for new moderate pa hypertension. pressors were weaned appropriately and she was able to be transferred to the floor where she remained hemodynamically stable. vital signs were monitored regularly. pulm: she was intubated in the ed and remained so until when she was finally weaned from the ventilator and extubated. after extubation, she was weaned off oxygen appropriately and left the hospital on room air. gi/gu: she was quite surprised on awakening that she had a new ostomy and this will require a long time for her to adjust. an ostomy/wound care nursing consult was obtained and the ostomy was changed regularly and monitored for signs of breakdown. by the end of her hospital stay, mrs. was becoming slowly more comfortable managing her ostomy, but still required nursing help. due to the antibiotic received throughout her stay, she began to develop a vaginal yeast infection which was treated with fluconazole. f/e/n: electrolytes and fluids were monitore during her stay. she received appropriate repletion when necessary. tube feeds were started on , but not continued for long. she was started on tpn on and continued on that until . her diet was advanced appropriately to a bariatric stage v diet. she was not taking in enough orally however to meet her needs, thus tube feeds were started through her gastric remnant. the patient complained of being stuck to the iv pole while getting tube feeds and ultimately refused further feedings until it was suggested that she take the tube feeds as boluses. the patient learned how to do this herself and was ultimately much happier with this arrangement, giving herself four cans of replete with fiber daily. she was discharged home with qid tube feeds and a regular diet. heme: the patient was coagulopathic upon presentation due to her sepsis and required in total 6 units of packed rbcs, 6 units of ffp, 2 cryoprecipitates, and 11 vials of albumin for repletion of cofactors, treatment of her coagulopathy, anemia, and sepsis. as she normalized following her operation, she no longer required further products. id: the patient was put on po vanc and iv flagyl on admission as well as variably cefepime, zosyn, and tigecycline. after discharge from the unit, the patient was maintained on vancomycin and flagyl and eventually the vancomycin was dc'd. her flagyl was transitioned to po and she was discharged on a 7 day course of flagyl. her wound started to show some breakdown inferiorly and staples were removed on and a wound culture sent. for this she was started on unasyn, which was continued for a short course. on the day before discharge, another few staples were removed above the umbilicus with some serous drainage. the patient refused removal of further staples at that time and it was decided that the wound could be monitored for a little longer. psych: the patient has baseline depression and anxiety and this was exacerbated by the long and difficult hospital course as well as by the surprise finding, upon wakening, that she no longer had a colon and would have to pass stool through an ostomy for at least a number of months. these stressors were difficult for her and she had a tough time with acclimating herself to the idea. she initially refused to work with the ostomy nurse but later showed some willingness to start taking over some of the ostomy care herself. she was seen by psych consult in house who thought that the anxiety component was much more prevalent and recommended treatment with benzodiazepines. she was discharged with a short prescription for ativan and will follow up with her pcp for further management of her pain and anxiety. medications on admission: cyanocobalamin 1,000 mcg/ml once a month. calcium carbonate 500 mg po qam cholecalciferol 1000 units po daily venlafaxine 200 mg po daily topiramate 100 mg po hs omeprazole 40 mg po once a day. levetiracetam 500 mg po bid acetaminophen 500 mg po tid morphine 30 mg tablet sustained release po q12h morphine 15 mg po q6h prn ondansetron 8 mg tablet, rapid dissolve po three times a day as needed for nausea. vitamin d-3 1,000 unit tablet po once a day. ferrous sulfate 325 mg po once a day. compazine 5 mg po three times a day as needed for nausea. tizanidine 4 mg po at bedtime for muscle spasm. discharge medications: 1. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day): for lower extremity swelling. please follow up with your primary care doctor for further diuretic (water pill) needs. . disp:*60 tablet(s)* refills:*2* 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 5. fluconazole 100 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 days. disp:*2 tablet(s)* refills:*0* 6. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 7. multivitamin tablet sig: one (1) tablet po bid (2 times a day). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 9. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 10. methadone 5 mg tablet sig: three (3) tablet po q 8h (every 8 hours). disp:*250 tablet(s)* refills:*0* 11. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 7 days. disp:*21 tablet(s)* refills:*0* 12. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for breakthrough pain. disp:*54 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: c. difficile pancolitis and sepsis 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: please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. please call your doctor or come to the emergency room if you experience any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if 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 or have ileostomy output. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain is not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. *weigh yourself every morning, md if weight goes up more than 3 lbs. continue giving yourself the tube feeds as directed at least until your follow up with dr. . it will be helpful to your doctors for you to document your oral intake by keeping a log of what you eat and how many cans of tube feeds you give yourself so that the sufficiency of your oral intake can be assessed. followup instructions: please follow up with dr. in 2 weeks. you can call his office at ( to set up an appointment. please follow up with your primary care provider as soon as you can. you should discuss not only your recent hospitalization but also any need for diuretics (water-pills) for your lower extremity swelling as well as for your future pain and anxiety medication needs. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances other incision with drainage of skin and subcutaneous tissue other gastrostomy ileostomy, not otherwise specified open total intra-abdominal colectomy diagnoses: other primary cardiomyopathies other chronic pain other postoperative infection unspecified pleural effusion congestive heart failure, unspecified unspecified septicemia severe sepsis other chronic pulmonary heart diseases pulmonary collapse nausea with vomiting dysthymic disorder acute respiratory failure loss of weight septic shock intestinal infection due to clostridium difficile paralytic ileus iron deficiency anemia, unspecified calculus of gallbladder without mention of cholecystitis, without mention of obstruction nonspecific abnormal findings in stool contents hypovolemia acute vascular insufficiency of intestine other and unspecified coagulation defects cyst and pseudocyst of pancreas lumbosacral spondylosis without myelopathy other chronic nonalcoholic liver disease candidiasis of vulva and vagina bariatric surgery status unspecified nutritional deficiency chronic combined systolic and diastolic heart failure surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation 

Answer: The patient is high likely exposed to