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: patient recorded as having no known allergies to drugs attending: chief complaint: lower gi bleeding major surgical or invasive procedure: bronchoscopy with lavages percutaneous endoscopic gastrotomy tube placement percutaenous tracheostomy transesophageal echocardiogram central venous line access arterial line access flexible sigmoidoscopy chest tube history of present illness: 84f admitted to on with lower abdominal pain and hypotension found to have diverticulitis on ct scan and was admitted to the icu. pt was also found to be in acure renal failure with a cr of 2.7 (baseline 0.8). pt was hyponatremic with a na of 121 at time of admission. on pt underwent exploratory laparotomy with sigmoid resection, and end colostomy. intraoperatively she had a 1cm hole in her sigmoid colon and feculent peritonitis. pt extubated on , was reintubated the same day and has remained intubated since. since reintubation, pt has been minimally responsive with minimal improvement - occasionally moving her arms and and legs and rarely opening her eyes. she was alert and oriented at the time of admission to osh. upon transfer the pt has a pressor requirement on levophed. pt is approximately 15 kilos positive since her admission on . she has had multiple brinchoscopies for persistent partial left lung collapse at the osh. pt has had rectal bleeding since , continuously draining small amounts of blood. pt recieved one unit of prbc overnight with her last hct 31.5. pt transferred to on for further managemnet of lgib. past medical history: pmh: presyncopal episodes, hypertension, hyperlipidemia, h/o electrolyte disorders, hypothyroidism, asthma/copd psh: sigmoid colectomy, hartmanns social history: social history: no tobacco, no etoh, no ilicit drug use. retired food service worker. lives in with her son. family history: nc physical exam: exam: temp 99.6, hr 99, bp 86/43 (52), ps 0.5/10/5 500x20, 97% levophed 0.2 gen: intubated, unresponsive neuro: pupils 3-2mm bilaterally, symmetrical but sluggish, grimaces to abdominal palpation, extremities flacid x4 with no withdrawing or localizing to pain, babinski reflex absent cv: rrr, no r/g/m resp: slightly decreased on left, otherwise ctab abd: soft, non-distended, winces to palpation, midline laparotomy incision with retention sutures in place, incision c/d/i, llq colostomy with appliance in place and brown stool in bag rectal: small ammount of gross blood. one small non-thrombosed external hemorrhoid, no active bleeding gu: foley to gravity ext: trace-1+ ble edema, 3+ bue edema pertinent results: 03:42pm blood wbc-16.7* rbc-3.43* hgb-10.5* hct-32.5* mcv-95 mch-30.6 mchc-32.3 rdw-17.7* plt ct-235 01:58am blood wbc-1.2* rbc-3.45* hgb-10.4* hct-31.1* mcv-90 mch-30.0 mchc-33.4 rdw-17.3* plt ct-115* 01:58am blood neuts-0 bands-0 lymphs-78* monos-7 eos-0 baso-0 atyps-15* metas-0 myelos-0 02:06am blood neuts-0* bands-0 lymphs-74* monos-4 eos-0 baso-0 atyps-22* metas-0 myelos-0 04:25pm blood neuts-0 bands-0 lymphs-78* monos-9 eos-0 baso-0 atyps-12* metas-0 myelos-0 nrbc-1* other-1* 02:17am blood neuts-0* bands-0 lymphs-90* monos-6 eos-0 baso-0 atyps-4* metas-0 myelos-0 nrbc-2* 01:58am blood plt ct-115* 01:58am blood pt-19.8* ptt-48.2* inr(pt)-1.8* 01:58am blood glucose-82 urean-50* creat-0.8 na-137 k-3.8 cl-105 hco3-26 angap-10 03:42pm blood glucose-217* urean-80* creat-1.4* na-149* k-4.3 cl-112* hco3-30 angap-11 01:58am blood alt-14 ast-8 alkphos-208* totbili-1.5 03:42pm blood alt-31 ast-23 ld(ldh)-255* alkphos-429* amylase-80 totbili-0.4 03:42pm blood lipase-105* 06:59am blood lipase-75* 03:00am blood caltibc-138* trf-106* 02:54am blood caltibc-142* ferritn-358* trf-109* 04:25pm blood d-dimer-* 03:42pm blood triglyc-90 03:42pm blood tsh-5.9* 03:11am blood tsh-7.4* 02:06am blood tsh-1.5 03:42pm blood t4-3.2* t3-39* free t4-0.67* 02:06am blood free t4-1.1 09:59am blood glucose-95 lactate-1.8 k-3.7 ct head: 1. interval near-complete opacification of the mastoid air cells bilaterally, with scattered air-fluid levels. fluid in the nasopharynx, likely related to intubation. 2. no intracranial hemorrhage or mass effect. ct abd: 1. multicystic area in the mid-to-upper left hemothorax, poorly evaluated on this technically limited study, demonstrates multiple air-fluid levels within cystic spaces. this may represent loculated hydropneumothorax such as due to hemopneumothorax or empyema, or alternatively infection or hemorrhage within bullae (although no bullae were noted in this region on the prior study, there is evidence of severe emphysema). repeat ct scanning with a dedicated chest ct protocol would likely be helpful for further clarification. 2. new since the prior exam are multiple peribronchovascular nodules and ground-glass opacities in the left upper lung, consistent with infectious or inflammatory process. 3. 2.3 x 6.5 cm new hemorrhagic fluid collection in the anterior peritoneal cavity, adjacent to the surgical incision along the anterior abdominal wall. density in deep pelvis may represent free hemoperitoneum or possibly a loop of bowel. limited evaluation of the pelvis and the surgical bed due to technical problems encountered with the scan. additionally, oral contrast does not reach the distal bowel. recommend rescanning the patient after contrast has passed more distally, for better visualization of deep pelvic contents. 4. borderline enlarged loops of proximal small bowel, without other evidence of obstruction. 5. cholelithiasis. 6. atherosclerotic disease. mri head: extensive small vessel ischemic change. tiny acute infarction in the right parietal lobe in a periventricular location, without associated mass effect or edema. brief hospital course: 84f tx from on with h/o perf diverticulitis s/p ex lap, sigmoid colectomy with (). post-op course c/b hypoxia in setting of lul collapse requiring re-intubation , somnolence, renal failure. head ct demonstrated small vessel disease. multiple bronchoscopies for persistent partial left upper lobe collapse at as well as thoracentesis. on , she developed small amounts of rectal bleeding, and received 1 u prbcs overnight. hematocrit stable. on transfer, she was on a levophed gtt, minimally responsive, withdrawing to pain, massive generalized edema and had gained ~33 pounds since admission to osh. after admission to the intensive care unit, dr. surgical service, respiratory status was a concern. chest ct c/w pulmonary abscesses and she was placed of vancomycin, cipro, and zosyn. her hemodynamics improved while her mental status was very slow to recover. she was placed on escalating doses of levothyroxine as she had persistently elevated tsh values. over the days of , her white blood cell counts fell dramatically, requiring neutropenia precautions. hematology performed a bone marrow biopsy and viral and fungal studies were sent. id recommended adjusting her antibiotic regimen and to treat empirically for c. difficile. her remaining hospital course can be summarized by the following review of systems: neuro: patient's mental status continue to wax and wane. she will respond and move all extremities on command. initially, due to initial hypotensive phase, requiring pressors, concerns were for hypoxic-ischemic encephalopathy. mri and ct of her head did not show any acute processes but small vessel disease and a small focus acute infarct rt parietal lobe w/o mass effect. ventricles & sulci prominent but appropriate for age. no abscess noted. narcotics and analgesics were minimized. her mental status continues to fluctuate. cardio: pt arrived on vasopressors and as eventually weaned off. however, continued to be hypotensive and tachycardic. over stay, she had two transthoracic echocardiograms to evaluate cardiac function and possible infectious source. they both have been negative for any vegetations or abscesses. no intracardiac source of embolus identified; however, complex atheroma were noted in the aortic arch and descending aorta. her ef is > 55%. small left ventricular cavity suggestive of low preload/intravascular volume depletion; ef . she was switched to phenylephrine and midodrine added. she was eventually weaned off as her volume status was carefully repleted. lopressor was added for heart rate control but has been discontinued. she is currently hemodynamically stable and making sufficient urine. pulm: on arrival, patient clinically had a tenuous respiratory status. she remained intubated. several bronchoscopies and lavages performed to wash out mucus plugging performed by interventional pulmonology. to monitor her fluid status closely, a central venous line was placed, which unfortunately caused a moderate l-sided pneumothorax which was demonstrated on chest x-ray upon admission. a chest-tube was placed and the pneumothorax has since resolved; however, the multi-cystic area was noted on follow-up ct scan obtained today. thoracic surgery did not feel she was a suitable candidate for any invasive procedures. she responded to antibiotics and pulmonary toilet. she failed to wean successfully from the ventilator and was entirely dependent on mechanical breathing. icu team performed a tracheostomy with placement of a feeding gastrostomy tube for enteral feeds. she is currently doing well on trach mask. aside from occasional sleep apneic periods, requiring pressure support, she is stable on trach collar. speech and swallow evaluated and placed a passy-muir valve. she is currently using her passy-muir valve without issues. gi: she was transferred to for treatment and management of peritonitis and sepsis. ostomy care involved in wound care. with her gi bleeding, hct were trended. she received a colonoscopy through her hartmann which were negative for any active bleeding. we continued to trend her liver panel enzymes. there was an elevation with alkaline phosphatase. obtained a ruq us showing scattered hepatic cysts, unchanged from the comparison ct and no concerning hepatic masses. cholelithiasis and gallbladder mural edema in a non-distended gallbladder. given the presence of ascites, the mural edema is nonspecific and may be related to third-spacing of fluid. ascites with complex internal echoes and septations, raising concern for possible infectious or inflammatory process. gastrotomy tube placed for enteral feeds. her tube feeds were advanced. started on reglan for motility. an upper endoscopy performed by gastroenterology for maroon colored ostomy output associated with decrease in hct. study showed ulcers near tube site but no active bleed. bleeding and hct stabilized with transfusions, reversal inr with vit k, and ng lavage washed. she was maintained on higher dose ppi. h.pylori returned negative. ostomy continued to work without any concerns. fen: she is tolerating tube feeds (fibersource) at full strength (goal 40 ml/hour - (23 kcal/kg)). her electrolytes were repleted daily with intravenous and oral supplements as needed. she received 26 vials of albumin to effectively wean pressors and provide more intravascular volume. renal: with initial septic event, urine status was critical and carefully monitored. as she clinically improved, she is no longer oliguric and is making 20-30 ml/hr. lasix was used for diuresis to attempt ventilator wean given positive net fluid status. she is auto-diuresing. foley catheter is placed due to poor mobility. urine output carefully monitored with urinalysis for any colonization and changed if needed. id: pt was placed on iv vanco/zosyn/cipro at admission on . wbc was elevated at 16.7 on . surveillance bc remained neg. underwent chest ct imaging which demonstrated loculated collection in lul; technically difficult to drain and broad spectrum antibiotic therapy continued; underwent bal on ; culture no growth; had trach and g tube placement on . pt??????s wbc was noted to have declined to 2.0 on ; diff: 42 segs, 37 lymphs, 16 monos, 5 atypical. anc of 840. the wbc continued to decline over the next few days with wbc of 700 on ; diff 18 segs, 64 lymphs; 14 monos; 4 atypicals. bc on were no growth to date. with febrile neutropenia, she was placed on neupogen and infectious disease consult requested for further management. with fevers, she continued to be pan-cultured which all yielded negative results. with neutropenic state, she was started on empiric flagyl with anti-fungals since history indicated perforated intra-abdominal contents. zosyn discontinued due to concerns of causing neutropenia. viral serologies were sent and have been all negative. all antibiotics were discontinued on as fevers resolved. heme: please refer to hematology consult notes for more information. essentially, patient was neutropenic and thrombocytopenic secondary to zosyn. bone marrow biopsies taken and were otherwise inconclusive. her leukocyte numbers normalized as she was taken off antibiotics. patient was also coagulopathic likely from vitamin k deficiency in setting prolonged antibiotic use. she was given vitamin k with good effect. labs were cycled for concerns of dic given presumed sepsis. in review, bm results suggest a possibility of involvement by a t-cell lymphoproliferative disorder. but this clonal t cell proliferation can also be due to infectious / inflammatory stage. patient needs hem /onc follow up after her acute issues are resolved (follow up in 1 month). with low platelets, heparin discontinued for concerns of hit. during stay, she was transfused 9u prbc and one pack of platelets. she is not on heparin due to concerns of hit. she is receiving boots and lab values do suggest that she is coagulopathic. endo: patient maintained on her thyroid medication while in patient. thyroid function checked to assess levels as medication resumed and adjusted to her metabolic needs. she was provided with an insulin sliding scale for coverage. due to presumed initial hemodynamically unstable state, she was given stress steroid dosing which were effectively weaned off. consults involved: infectious disease, gastroenterology, heme/onc, general surgery, sicu, thoracic surgery, nutrition, speech/swallow, pt, neurology lines/tubes/drains: tracheostomy,gtube, foley, picc, colostomy wounds: midline laparotomy incision, tracheostomy she is still full code. medications on admission: vancomycin 1000mg iv daily zosyn, 3.375g iv q6h levophed gtt levothyroxine 150mcg po qday novolin insulin ss digoxin 0.125mg po q48h heparin 5000 units sc tid lopressor 25mg po qday hydrocortisone 50mg iv qday tylenol prn discharge medications: 1. insulin regular human 100 unit/ml solution : per sliding scale sliding scale injection asdir (as directed). 2. miconazole nitrate 2 % powder : one (1) appl topical (2 times a day) as needed for thrush. 3. acetaminophen 160 mg/5 ml solution : six y (650) mg po q4h (every 4 hours) as needed for pain/fever. 4. metoclopramide 10 mg tablet : one (1) tablet po bid (2 times a day). 5. levothyroxine 100 mcg tablet : two (2) tablet po daily (daily). 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 7. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. discharge disposition: extended care facility: ne discharge diagnosis: perforated diverticulitis s/p sigmoid colectomy acute respiratory distress syndrome prolonged intubation requiring tracheostomy encephalopathy, slowly resolving pulmonary abscess neutropenia lower gastrointestinal bleed anemia requiring transfusion discharge condition: mental status:confused - always level of consciousness:lethargic but arousable activity status:bedbound discharge instructions: *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 have a bowel movement. *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. . general 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 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. picc line: *please monitor the site regularly, and your md, nurse practitioner, or nurse if you notice redness, swelling, tenderness or pain, drainage or bleeding at the insertion site. * your md to the emergency room immediately if the picc line tubing becomes damaged or punctured, or if the line is pulled out partially or completely. do not use the picc line in these circumstances.please keep the dressing clean and dry. contact your nurse if the dressing comes undone or is significantly soiled for further instructions. monitoring ostomy output/prevention of dehydration:\ *keep well hydrated. *replace fluid loss from ostomy daily. *avoid only drinking plain water. include gatorade and/or other vitamin drinks to replace fluid. *try to maintain ostomy output between 1000ml to 1500ml per day. *if ostomy output >1 liter, take 4mg of imodium, repeat 2mg with each episode of loose stool. do not exceed 16mg/24 hours. followup instructions: please follow up with your surgeon who did your operation at the outside hospital. you will have follow up with dr. or one of his associates. please call his office at (, if they have not contact you with an appointment date in one week. your follow up with hematology/oncology is recommended for 1 month. procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus flexible sigmoidoscopy diagnoses: unspecified essential hypertension acute kidney failure, unspecified acquired coagulation factor deficiency unspecified septicemia severe sepsis unspecified acquired hypothyroidism atherosclerosis of aorta pulmonary collapse other and unspecified hyperlipidemia hemorrhage complicating a procedure iatrogenic pneumothorax anoxic brain damage septic shock intestinal infection due to clostridium difficile abscess of lung gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction other encephalopathy chronic obstructive asthma, unspecified drug induced neutropenia volume depletion, unspecified colostomy status peritonitis (acute) generalized diverticulitis of colon (without mention of hemorrhage) foreign body in respiratory tree, unspecified penicillins causing adverse effects in therapeutic use fever presenting with conditions classified elsewhere 

Answer: The patient is high likely exposed to