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: zosyn / quinolones / ceftriaxone / flagyl / keppra / lisinopril / naprosyn / bactrim ds / phenytoin / nitrofurantoin / sulfa (sulfonamide antibiotics) / zofran / iv dye, iodine containing / latex attending: chief complaint: abdominal pain major surgical or invasive procedure: cholecystectomy evacuation of perihepatic hematoma history of present illness: ms. is 49 year old f with multiple medical complications including a urostomy, recurrent uti, and chronic abodminal pain with multiple abdominal surgeries who presents w/ 4 days of nausea, vomiting and abdominal pain and 3 days of diarrhea. in the ed, patient described her pain as most severe in epigastrum, radiating to luq and ruq. the pain is similar to prior episodes of abdominal pain, but more severe this episode. her last reported bm was this morning, non-bloody and loose. she denied f/c and is not sexually active. pt was admitted 2+ months ago s/p ercp for choledocholithasis and last month for uti, presented with similar complaints. notably, due to multiple severe allergies to antibiotics, she required 5 days of aztreonam for her last uti. initial vs were 97.7, 60, 107/87, 16, 99%ra. initial labs were remarkable for plt of 60k and grossly positive ua. she received morphine and reglan for pain and nausea, and aztreonam for her uti. due to persistent pain, she underwent unremarkable abdominal ct scan. she was admitted to medicine for further management. on arrival to the floor, patient appears acutely ill and is groaning in pain. she is a very difficult historian, and reports 'all over' abdominal pain. she reports feeling feverish, but denies sob or cough. she notes signficant nausea and emesis, and inability to take po for several days. she is unable to provide additional ros. past medical history: recurrent bullous hypersensitivity reactions (ivig, steroids) -presents w/ intensely edematous dusky plaques along the axilla, lat trunk and lat legs which have desquamtion at the sites of edema, but never progress beyond this. -previous admissions to burn unit asthma/copd hypertension gerd urostomy h/o vre pyelonephritis spina bifida (myelomengiocele) paraperesis depression mild mental retardation psychogenic dysarthria and tremor vs. pseudoseizures - eeg work-up at in frequent runs of regular bifrontal sharp delta activity although the clinical events which occurred during the record were not associated with eeg change atopic dermatitis back pain genital herpes uterine fibroid uterine prolapse diverticulosis external hemorrhoids - syndrome in . drug allergies & reactions: bactrim ds ceftriaxone flagyl iodine keppra latex lisinopril naprosyn nitrofurantoin phenytoin quinolones sulfa zofran zosyn social history: per omr: lives alone in an apartment in . she is able to transfer w/ wheelchair. reports assistance daily. has tobacco: 1 pack/wk etoh: denies illicits: denies ivdu ever. history of smoking crack cocaine. family history: per omr: 3 healthy children. mother died of lung cancer. father killed by his girlfriend. not in contact with her brother and sister. physical exam: admission physical exam: vs 97.4 142/82 90 18 98%ra gen: holds eyes closed, but awakens to voice, groaning in pain, inconsistently answers simple questions and can follow simple commands. perseverates on her abdominal pain and her nausea. oriented to person and 'hospital'. heent: ncat, dry mm, eomi, sclera anicteric, 2->1pupils bilaterally neck supple, no jvd, no lad pulm fair air movement, coarse with bilateral rhonci throughout cv rrr normal s1/s2, no mrg abd right urostomy in place, diffusely tender with voluntary guarding, most pronounced in ruq and llq, no rebound, normoactive bowel sounds ext wwp 2+ pulses palpable bilaterally, no c/c/e neuro symetric face, tongue midline, pupils equal, eomi, moving all extremities skin large hypopigmented plaques over legs bilaterally from prior reactions as noted in pmh labs: reviewed, see below discharge physical exam: o: 99.5 96-102/52-62 75-79 18-20 100%ra general: laying in bed, covered in sheet lungs: ctab cv: rrr, no murmurs, s1s2 abd: somewhat distended, some tenderness (but distractable), no rebound or guarding. ext: pnuemoboots, 2+ pulses neuro: alert and oriented to person, place, not year pertinent results: admission labs: 02:40pm blood wbc-4.2 rbc-4.43 hgb-13.8 hct-42.4 mcv-96 mch-31.2 mchc-32.6 rdw-14.4 plt ct-60*# 02:40pm blood neuts-32* lymphs-62* monos-6 eos-0 baso-0 02:40pm blood glucose-69* urean-3* creat-0.9 na-140 k-4.0 cl-102 hco3-31 angap-11 02:40pm blood alt-6 ast-12 alkphos-66 totbili-0.3 02:40pm blood albumin-3.1* 02:48pm blood lactate-1.6 07:30am blood valproa-104* 01:10pm blood ammonia-39 02:40pm blood lipase-16 05:20pm blood ck-mb-1 ctropnt-<0.01 01:10pm blood valproa-52 07:30pm blood valproa-30* 03:35pm blood lactate-2.6* 01:31pm blood lactate-1.0 discharge labs: 06:11am blood wbc-9.0 rbc-2.82* hgb-8.9* hct-27.6* mcv-98 mch-31.6 mchc-32.2 rdw-18.7* plt ct-331 05:44am blood pt-11.5 ptt-38.3* inr(pt)-1.1 06:11am blood glucose-68* urean-20 creat-0.9 na-138 k-4.5 cl-105 hco3-26 angap-12 06:11am blood calcium-8.8 phos-4.7* mg-2.3 05:24am blood albumin-2.2* calcium-8.9 phos-3.8 mg-2.3 imaging: ct abd/pelvis (no oral or iv contrast) ct of the abdomen: included views of the lung bases demonstrate mild dependent atelectasis. there is no pericardial or pleural effusion. the heart is mildly enlarged. focal hepatic steatosis lies adjacent to the falciform ligament (2:21). remainder of the liver is unremarkable. the gallbladder, pancreas, spleen, adrenal glands, stomach and intra-abdominal small bowel are normal. intramuralfat deposition is seen within the right and transverse colon, but theremainder of the colon appears unremarkable. common bile duct dilatation to 11 mm is unchanged, and no intra-hepatic biliary dilatation is grossly noted. the patient is post ileal conduit diversion via a right lower quadrant stoma,with no evidence of obstruction. there is expected mild bilateral ureteraldistension and renal pelviectasis, but no hydronephosis is present. corticalthinning along the posterior right kidney (2:26) is unchanged since the examination, likely noting prior infectious or vascular insult. ct of the pelvis: the rectum, sigmoid colon, and intrapelvic small large bowel are unremarkable.fibroid uterus is redemonstrated. fecalized material within the left pelvis(2: 73) is unchanged from prior examinations. there is no intrapelvic freefluid or lymphadenopathy. osseous structures: dysmorphic pelvic, spina bifida, and a sacral meningiocele are again seen (2:50). there are no bony lesions concerning for malignancy or infection. cerclage wires surround the proximal femurs bilaterally (2: 80). impression: no acute intra-abdominal or intrapelvic process. abdominal ultrasound findings: liver is homogeneous in echotexture without discrete masses or lesions. there is no intra- or extra-hepatic biliary ductal dilatation withthe common bile duct measuring 4 mm. a large shadowing stone is identified inthe gallbladder neck. the patient was unable to participate in positionchanges to allow assessment for gallstone mobility. no evidence ofcholecystitis present; specifically, there is no gallbladder distention,gallbladder wall edema or pericholecystic fluid. the midline including thepancreas and proximal aorta are obscured by gas. the demonstrated portions ofthe right kidney are unremarkable. the spleen is not enlarged measuring 8.3cm. limited assessment of the inferior vena cava is normal. no ascitic fluid evident doppler assessment of main portal vein shows patency and hepatopetal flow. impression: 1. cholelithiasis without evidence of cholecystitis. 2. doppler assessment of the main portal vein shows patency and appropriatedirectionality of flow. gallbladder scan impression: abnormal hepatobiliary scan with delayed visualization of the gallbladder consistent with chronic cholecystitis. there is significant patientmotion during the study. kub findings: supine and left lateral decubitus images of the abdomen demonstrate an unremarkable bowel gas pattern with no evidence of ileus or obstruction. there is no pneumatosis or intraperitoneal free gas. there is a dysmorphic pelvis and sacral spina bifida is seen, correlating to the previously seen findings on recent ct. there is demineralization of the osseous structures. cerclage wires are seen around the bilateral femurs. impression: unremarkable bowel gas pattern with no evidence of ileus or obstruction. head ct findings: there is no acute intracranial hemorrhage, edema, mass effect or major vascular territorial infarct. ventriculomegaly is unchanged from but has progressed since . cerebellar tonsils extend into the foramen magnum, as before, which in setting of a known sacral meningocele is compatible with chiari ii malformation. there is no shift of normally midline structures. -white matter differentiation is preserved. no osseous abnormality is identified. the visualized paranasal sinuses and mastoid air cells are clear. impression: 1. no evidence of an acute intracranial process. 2. ventriculomegaly is stable since but progressed since . low lying cerebellar tonsils in the setting of a chiari ii malformation. ct abdomen and pelvis : visualized lung bases demonstrate bibasilar opacification, which may represent atelectasis, however, aspiration or pneumonia cannot be excluded in the correct clinical setting. visualized heart and pericardium appear unremarkable. evaluation of solid organs and intra-abdominal vasculature is limited by non-contrast technique. within this limitation, the liver, spleen, bilateral adrenal glands appear unremarkable aside from a diffusely low density of the liver consistent with hepatic steatosis. the pancreas is within normal limits. the patient is status post cholecystectomy. cortical thinning along the posterior right kidney is unchanged since a prior examination and dating back to , likely representing a prior infectious or vascular insult. there is extensive hyperdense fluid surrounding the liver and extending through the right paracolic gutter into the pelvis consistent with hemorrhage. tiny locules of intraperitoneal air are expected post recent surgery. the patient is status ileal conduit diversion after cystectomy, via a right lower quadrant stoma with no evidence of obstruction. intramural fat deposition is noted within the right and transverse colon, but the remainder of the colon appears unremarkable. this is unchanged from the most recent prior examination. retroperitoneal and mesenteric lymph nodes do not meet ct size criteria for pathology. the bladder, rectum, sigmoid colon, and intrapelvic small and large bowel loops are unremarkable. the uterus appears mildly bulky but is difficult to distinguish from high-density blood. again noted is blood within the pelvis. pelvic side wall lymph nodes do not meet ct size criteria for pathology. mildly prominent inguinal lymph nodes are noted bilaterally. osseous structures and soft tissues: dysmorphic pelvis, spina bifida and sacral meningocele are again noted (301b:43) similar to the most recent prior examination. cerclage wires surrounding bilateral proximal femurs (2:87) are unchanged from the prior examination. a hematoma within the right anterolateral abdominal wall (2:30-59) is noted. impression: 1. large introperitoneal hemorrhage/hematoma surrounding the liver and extending along the right paracolic gutter into the pelvis. 2. right anterolateral abdominal wall hemorrhage. 3. free intraperitoneal air, expected post-surgically. above findings were discussed with dr. at 8:10 p.m. approximately five minutes after discovery of critical findings via telephone on . 4. prominent bilateral inguinal lymph nodes. 5. fatty infiltration of the right colon and transverse process likely representing chronic changes. 6. hepatic steatosis. ct abdomen/pelvis findings: visualized lung bases demonstrate small focal areas of consolidation which may represent atelectasis versus pneumonia given the correct clinical setting. the visualized portions of the heart and pericardium are unremarkable in appearance. ct abdomen: evaluation of the intra-abdominal solid organs and vasculature is limited in this non-contrast study. within this limitation, the liver appears diffusely hypodense, consistent with hepatic steatosis. otherwise, the liver is unremarkable with no focal lesions. the gallbladder is surgically absent. the pancreas, spleen, and bilateral adrenal glands are unremarkable in appearance. again seen is mild cortical thinning along the posterior right kidney likely representing prior ischemic or infectious insult. there has been interval resolution of the previously appreciated large perihepatic hematoma as well as a right abdominal wall hematoma with no evidence of active bleed. the stomach and small bowel are unremarkable with no evidence of obstruction. the large bowel is unremarkable in appearance. there is no retroperitoneal or mesenteric lymphadenopathy. there is no intra-abdominal free air, free fluid, or hernias. ct pelvis: the patient is status post cystectomy and ileal conduit diversion via right lower quadrant stoma with no evidence of obstruction. there is widespread hyperdense appearance of the soft tissues consistent with anasarca. the uterus is unremarkable in appearance. bilateral ovaries are not well visualized on this examination. there is a small amount of high-density fluid within the pelvic cul-de-sac, likely representing remnant blood. there are stably enlarged inguinal lymph nodes bilaterally. there is no pelvic wall lymphadenopathy. the rectum is unremarkable in appearance. osseous structures: there is a dysmorphic pelvis, spina bifida and sacral meningocele unchanged from previous examination. there are cerclage wires at the bilateral proximal femurs. there are no focal blastic or lytic lesions in the visualized osseous structures concerning for malignancy. impression: 1. interval resolution of perihepatic hematoma with no evidence of active bleed. 2. slightly improved bibasilar consolidations likely representing atelectasis. 3. generalized soft tissue edema representing anasarca. 4. hepatic steatosis. 5. scattered inguinal lymphadenopathy. this finding is nonspecific and clinical correlation is recommended. 6. stable right renal cortical thinning consistent with a previous vascular or infectious insult. 7. dysmorphic pelvis and spina bifida. microbiology: time taken not noted log-in date/time: 8:31 am urine taken from chem# j,added uri ucu @ 08:31am.. **final report ** urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination. brief hospital course: 49 year old female with history of urostomy, recurrent utis, ercp in , gerd, /pseudoseizures who presented with abdominal pain, decreased po intake, nausea and vomiting, s/p cholecystectomy for cholecystitis c/b post-op hematoma: # abdominal pain: abdomen initially diffusely tender, however as admission progressed, worst pain was in the ruq/epigastric area. patient with poor po intake. lactate 1.6 at presentation, improved with iv fluids. increased to 2.6 on after fluids had been discontinued, but again well to fluid bolus and maintenance fluids were begun. patient was initially treated for a uti, as ua was suggestive of infection and patient had similar symptoms with uti on past admission in which were successfully treated with aztreonam due to her extensive list of drug allergies. however, she was persistently afebrile with normal white count. urine culture showed mixed bacterial flora. a non-contrast ct of the abdomen and pelvis showed no acute changes. symptoms improved slowly with antibiotics, so ruq ultrasound was done, which showed cholelithiasis but not cholecystitis. her omeprazole dose was also increased, as there was some concern for gastritis vs. peptic ulcer disease and an h. pylori antibody assay was sent, which was negative. gi was consulted, and at their recommendation a hida scan was done which showed delayed gallbladder visualization suggestive of chronic cholecystitis. surgery was consulted, and patient had an laparoscopic cholecystectomy on . days later, she sustained a 10-pt hematocrit drop and ct of the abdomen showed a perihepatic and anterior abdominal wall hematoma around the cholecystectomy site. given poor iv access, she was emergently transferred to the micu for central line placement and prbc transfusion. her hematocrit remained stable after 2 units prbcs as she was monitored in the icu. she began to spike fevers and there was a concern for an infection of the hematoma itself. she was taken back to the or for evacuation of the hematoma (500cc). she received an additional 2 units of blood 9/17, as hct had been drifting down following transfer back to the floor. ct abdomen and pelvis was done, which showed interval resolution of hematoma and no signs of active bleeding. hematocrit was stable for the remainder of the admission. urine culture also showed recurrence of infection, initially covered with daptomycin and aztreonam for history of vre and prior infection. culture grew vancomycin sensitive enterococcus and she was subsequently treated with iv vancomycin and completed a 10 day course. she continued to be mildly hypotensive throughout her stay, initially felt to be sepsis, but persisted after appropriate treatments and asymptomatic. she continued to complain of non-descript pain. per the surgical service, she could continue to have residual irritation from bleed for weeks following surgery. she also developed constipation late in her hospitalization, which was likely contributing. kub on showed no signs of obstruction or ileus and she was treated aggressively with laxatives. had a bm on . # malnutrition: patient had poor oral intake for an undefined amount of time prior to admission, and was unable to tolerate oral intake throughout much of her hospitalization, leading to low albumin (2.2 on ), coagulopathy (inr of 1.6 which resolved after starting supplemental nutrition) and hypoglycemia. nutrition was consulted. patient refused ng tube placement for tube feeds, and tpn was begun. patient began to tolerate po intake by mouth # thrombocytopenia: patient had a platelet count of 60 on admission, with nadir of 40 on before eventually increasing back into the normal range. this was initially attributed to infection, as platelets dropped into the 70s during admission in and then rebounded with uti treatment. peripheral blood smear showed no signs of schistocytes. low on admission, so hit was not in differential. drug effects considered, but no major recent changes. heme/onc consulted, saw no signs of consumptive process on peripheral blood smear, attributed thrombocytopenia to infection. # mental status: waxed and waned through admission, patient initially lethargic and only intermittently able to answer questions (none in detail). per her pcp, is not her baseline. admission tox screen unremarkable, neuro exam non-focal. head ct done showed no acute changes. patient did have some episodes which appeared to be her pseudoseizures (see below), but nothing that appeared epileptic in nature. #pseudoseizures/?seizure disorder- patient continued on home divalproex, dose initially decreased to 125mg daily based on communication with outpatient pcp (also, level supratherapeutic on 250mg ), but upon further investigation, it was discovered that patient had been taking double prescribed dose at home. levels dropped out of therapeutic range, dose increased to 125mg , then to 250mg and then 250mg tid. patient with no witnessed seizure activity, did have a number of pseudoseizures, which varied and included rocking back and forth with eyes rolled back, shaking head from side to side, right arm straightening, rolling back eyes while laughing inappropriately. chronic issues: # depression: stable on home meds transitional issues: - monitor patient's oral intake and nutritional status. albumin level still low at time of discharge, but can take some time to respond. - patient will need to follow up in surgery clinic for post-surgical check as an outpatient - rehab stay is not to exceed 30 days. medications on admission: preadmissions medications listed are incomplete and require futher investigation. information was obtained from webomr. 1. albuterol inhaler 2 puff ih q6h:prn sob 2. aluminum-magnesium hydrox.-simethicone 15-30 ml po qid:prn abdominal pain 3. citalopram 20 mg po daily 4. divalproex (delayed release) 250 mg po bid 5. fluticasone-salmeterol diskus (100/50) 1 inh ih 6. omeprazole 20 mg po daily 7. quetiapine fumarate 25 mg po qhs 8. trazodone 50 mg po hs:prn insomnia 9. montelukast sodium 10 mg po daily discharge medications: 1. citalopram 20 mg po daily 2. divalproex (delayed release) 250 mg po tid 3. montelukast sodium 10 mg po daily 4. quetiapine fumarate 25 mg po qhs 5. trazodone 50 mg po hs:prn insomnia 6. clotrimazole cream 1 appl tp to lower back and groin skin folds 7. docusate sodium 100 mg po bid 8. hydrocerin 1 appl tp tid:prn dry skin or itch apply to dry areas prn 9. domeboro 1 pkt tp to skin folds 10. prochlorperazine 10 mg po q6h:prn nausea 11. acetaminophen 1000 mg po q8 please do not exceed 3000mg/day 12. heparin 5000 unit sc tid 13. senna 1 tab po bid 14. oxycodone (immediate release) 5-10 mg po q4h:prn pain hold for oversedation, rr<12 rx *oxycodone 5 mg tablet(s) by mouth q4-6h disp #*25 tablet refills:*0 15. albuterol inhaler 2 puff ih q6h:prn sob 16. aluminum-magnesium hydrox.-simethicone 15-30 ml po qid:prn abdominal pain 17. fluticasone-salmeterol diskus (100/50) 1 inh ih 18. omeprazole 20 mg po daily 19. lactulose 30 ml po daily:prn constipation hold for loose stools 20. polyethylene glycol 17 g po daily:prn constipation hold for loose stools discharge disposition: extended care facility: discharge diagnosis: uti chronic cholecystitis perihepatic hematoma discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , you were admitted to the hospital with abdominal pain, nausea, vomiting and inability to eat. you were diagnosed with a urinary tract infection, and treated with antibiotics. your pain did not improve, and you were diagnosed with chronic cholecystitis (inflammation of your gallbladder). your gallbladder was removed. you had internal bleeding after the procedure and a second surgery was performed to remove the blood and make sure the bleeding had stopped. you were also diagnosed with a second urinary tract infection and were treated with a second course of antibiotics. changes to your home medications include: -start clotrimazole cream, domeboro powder and hydrocerin for skin care -start prochlorperazine 10mg every 8 hours as needed for nausea -for pain, you can take acetaminophen. you can also take oxycodone 5-10mg every 4-6 hours for pain. your pain should be improving, so you should require less medication over time. you should not need long term narcotic treatment. it was a pleasure taking care of you during your hospitalization and we wish you a speedy recovery and all the best going forward. followup instructions: please call your primary care doctor, dr. , at to schedule a follow-up appointment after discharge from rehab please call the surgery clinic ( to be seen in 2 weeks for post-operative assessment. md procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances laparoscopic cholecystectomy excision or destruction of peritoneal tissue other laparotomy diagnoses: thrombocytopenia, unspecified abnormal coagulation profile esophageal reflux urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia unspecified protein-calorie malnutrition hematoma complicating a procedure other convulsions depressive disorder, not elsewhere classified calculus of gallbladder with other cholecystitis, without mention of obstruction other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation pressure ulcer, buttock other constipation streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] chronic obstructive asthma, unspecified examination of participant in clinical trial delirium due to conditions classified elsewhere paraplegia calculus of gallbladder with acute cholecystitis, without mention of obstruction hemoperitoneum (nontraumatic) insomnia, unspecified mild intellectual disabilities pressure ulcer, unspecified stage abdominal pain, right upper quadrant other artificial opening of urinary tract status spina bifida without mention of hydrocephalus, lumbar region 

Answer: The patient is high likely exposed to