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: remicade attending: chief complaint: blocked picc line and fever major surgical or invasive procedure: r midline access placement history of present illness: hpi: the patient is a 52 year old female with a history of crohn's disease and multiple abdominal surgeries, now with short gut syndrome on chronic tpn. the patient also has a history of difficulty with chronic venous access. she reports that for the past few weeks, she has noted that one of the lumens of her picc is "clogged." earlier today, the patient went to hospital for further evaluation. the patient states that she was informed that the other lumen of her picc was "blocked." the patient has undergone previous recanalization of her veins by ir in the past, so she was transferred to the ed. on presentation, she was noted to have a sbp in the 60s. she reported having a t=104 at home earlier in the day. she also reported feeling "weak" over the past few days. multiple attempts were made to obtain l subclavian access, yet these attempts were unsuccessful, so a l femoral line was placed and the patient was given aggressive ivfs (5 l total in ed). she was also placed on levophed. her bps improved to 90s/50s. of note, the patient states that her baseline sbp is around 90. the patient's labs were notable for a leukocytosis and a positive ua. the patient was administered doses of vanco, levo, and flagyl. she has been transferred to the for further management. past medical history: pmh: crohn's disease sarcoidosis avascular necrosis of the r hip, complicated by chronic pain tpn dependent s/p c-section x 2 s/p hysterectomy, oopherectomy, and lysis of adhesions, which was complicated by colon perforation () s/p multiple abdominal surgeries (18 in total), including a colostomy in , after which she developed a fistulous tract depression anxiety htn "irregular heart beat" h/o svc occlusion secondary to chronic central access, s/p superior vena cava recanalization by ir () chronic diarrhea . all: remicade-> anaphylaxis social history: sh: the patinet lives with her ex-husband. she has 2 sons. she is not working at this time. she denies use of tobacco or illicit drugs. she notes occasional etoh use. family history: fh: noncontributory physical exam: note . cc:. hpi: the patient is a 52 year old female with a history of crohn's disease and multiple abdominal surgeries, now with short gut syndrome on chronic tpn. the patient also has a history of difficulty with chronic venous access. she reports that for the past few weeks, she has noted that one of the lumens of her picc is "clogged." earlier today, the patient went to hospital for further evaluation. the patient states that she was informed that the other lumen of her picc was "blocked." the patient has undergone previous recanalization of her veins by ir in the past, so she was transferred to the ed. on presentation, she was noted to have a sbp in the 60s. she reported having a t=104 at home earlier in the day. she also reported feeling "weak" over the past few days. multiple attempts were made to obtain l subclavian access, yet these attempts were unsuccessful, so a l femoral line was placed and the patient was given aggressive ivfs (5 l total in ed). she was also placed on levophed. her bps improved to 90s/50s. of note, the patient states that her baseline sbp is around 90. the patient's labs were notable for a leukocytosis and a positive ua. the patient was administered doses of vanco, levo, and flagyl. she has been transferred to the for further management. . pmh: crohn's disease sarcoidosis avascular necrosis of the r hip, complicated by chronic pain tpn dependent s/p c-section x 2 s/p hysterectomy, oopherectomy, and lysis of adhesions, which was complicated by colon perforation () s/p multiple abdominal surgeries (18 in total), including a colostomy in , after which she developed a fistulous tract depression anxiety htn "irregular heart beat" h/o svc occlusion secondary to chronic central access, s/p superior vena cava recanalization by ir () chronic diarrhea . all: remicade-> anaphylaxis . outpt meds: buspirone 30 mg po tid clopidogrel bisulfate 75 mg po metoclopramide 10 mg po qidachs diphenoxylate-atropine 4 tab po qid ferrous sulfate 325 mg po bid oxycodone 30 mg po q8h:prn fluoxetine hcl 40 mg po bid pantoprazole 40 mg po tid promethazine hcl 25 mg po q6h:prn loperamide hcl 2 mg po tid . sh: the patinet lives with her ex-husband. she has 2 sons. she is not working at this time. she denies use of tobacco or illicit drugs. she notes occasional etoh use. . fh: n/c . ros: the patient notes a low grade temp yesterday, and she states that she had a temp = 104 earlier today. she denies any chills, cough, rhinorrhea, sob, cp, abd pain, rash, or change in her bowel/bladder habits. she reports that she has chronic diarrhea. she has felt "weak" for the past few days. . physical examination: gen: patient is lying in bed in nad. vs: 97.1 100/54 with map 70 (on levophed 0.05) 84 17 100% ra heent: nc/at. perrl. eomi. mmm. op clear. cards: rrr. s1, s2. no m/r/g. lungs: ctab. abd: soft, nt. patient has a ventral hernia. she has multiple scars from previous abdominal surgeries, including a skin graft. ext: no c/c/e. warm. picc site in r arm w/o erythema or tenderness. l femoral line in place. skin: no rashes. . laboratory data: . 12:21a . venous gas ph 7.26 pco2 60 po2 42 hco3 28 basexs -1 type:mix lactate:1.0 o2sat: 71 . 10:26p lactate:1.1 . 10:25p . 131 95 21 87 agap=14 3.7 26 0.8 . color yellow appear clear specgr 1.015 ph 5.0 urobil neg bili neg leuk sm bld tr nitr neg prot neg glu neg ket tr rbc 0-2 wbc bact many yeast none epi 0 . 9:22p lactate:2.1 . 9:15p 129 94 21 86 agap=15 3.8 24 0.9 . 95 21.4 9.8 271 28.5 n:92.6 band:0 l:3.8 m:3.0 e:0.3 bas:0.3 . pt: 12.5 ptt: 28.0 inr: 1.0 . radiology data: cxr: ? retrocardiac opacity. . a/p: the patient is a 52 year old female with a h/o crohn's disease and multiple abdominal surgeries, with short gut syndrome and chronic venous access issues. she has been admitted to the for management of sepsis. . #sepsis: likely due to line infection, though there is also the possibility of an early lll pneumonia. patient cites a h/o chronic diarrhea, but would also consider possibility of c diff colitis. will continue empiric coverage with vanco, flagyl, and levaquin and f/u blood cx data. will also obtain fungal cx given h/o chronic tpn use and risk of fungemia. at present, pt's hypotension is responding to ivf resuscitation, so will wean levophed with goal to keep sbp>90 (pt's baseline) and uo>30 cc/hr. , #access: pt currently has l femoral line due to difficulty obtaining l subclavian vein access. will need to contact ir re: venous access issues. picc will need to be removed and tip sent for culture. , #chronic diarrhea: will send sample for c diff, though suspect her diarrhea is related to her short gut syndrome. will continue patient's antidiarrheal medications. patient is on empiric flagyl. . #anxiety/depression: will continue outpt psych meds. . #chronic pain: confirmed pain medication dosages with patient. will continue her methadone and oxycodone. . #anemia: patient has h/o anemia with baselne hct 26-29 w/ mcv 95. anemia likely related to her chronic illness, but possible nutritional deficiency. will continue fe supplement. will check b12/folate levels. . #metabolic acidosis: vbg notable for co2=60, possibly related to pt's somnolence. will obtain repeat vbg. . #prophylaxis: ppi and sq heparin. . #dispo: icu. . #code status: full. for pager pertinent results: cxr: retrocardiac opacification concerning for early consolidation. no evidence of chf, or pleural effusion bilaterally. . ekg: nsr, nl axis, nl intervals . ct abdomen: 1. very short gi tract, with dilated loops of small bowel and remaining colon with air fluid levels present. the findings suggest partial obstruction vs. ileus, but there is fluid down through the rectum. no discrete transition point is identified. 2. mild intrahepatic biliary ductal dilatation. in addition, the common bile duct is large measuring 11 mm at the pancreatic head. 3. single gallstone. 4. posterior/superior dislocation of the right hip, with formation of a pseudoacetabulum in the right ilium. 5. compression fractures of t8, t11, and t12. . rij central line placement: 1. successful placement of a right internal jugular tunneled central venous catheter with tip in the superior vena cava just above the junction with the right atrium. the catheter can be used immediately. catheter is a 10-french double-lumen catheter. 2. angioplasty of a tight stenosis of the right subclavian vein, with good angiographic result. 3. removal of the right upper extremity picc. . echo: conclusions: 1. the left atrium is mildly dilated. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). 3.right ventricular chamber size is normal. right ventricular systolic function is normal. 4.the ascending aorta is mildly dilated. 5.the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. no mass or vegetation is seen on the aortic valve. 6.the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. no mitral regurgitation is seen. 7.there is moderate pulmonary artery systolic hypertension. 8.there is no pericardial effusion. impression: no echocardiographic evidence of endocarditis seen. . 11:20pm iron-24* 11:20pm caltibc-95* ferritin-1079* trf-73* 11:20pm cortisol-21.0* 06:08pm potassium-3.3 06:08pm cortisol-4.5 04:55am type- po2-39* pco2-55* ph-7.26* total co2-26 base xs--2 04:55am lactate-0.7 04:28am glucose-84 urea n-14 creat-0.6 sodium-136 potassium-3.6 chloride-106 total co2-20* anion gap-14 04:28am albumin-2.1* calcium-6.9* phosphate-3.2 magnesium-1.5* 04:28am vit b12-953* folate-19.9 04:28am wbc-10.1# rbc-2.54* hgb-7.8* hct-24.5* mcv-96 mch-30.5 mchc-31.7 rdw-13.7 04:28am neuts-90.0* bands-0 lymphs-7.3* monos-2.3 eos-0.3 basos-0.2 04:28am hypochrom-1+ anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal target-occasional 04:28am plt smr-normal plt count-224 02:36am type-mix 02:36am lactate-0.8 02:36am o2 sat-55 01:32am type-mix 01:32am lactate-0.8 01:32am o2 sat-69 12:21am type-mix po2-42* pco2-60* ph-7.26* total co2-28 base xs--1 12:21am lactate-1.0 12:21am o2 sat-71 12:15am glucose-108* urea n-18 creat-0.7 sodium-137 potassium-3.4 chloride-106 total co2-23 anion gap-11 10:25pm glucose-87 urea n-21* creat-0.8 sodium-131* potassium-3.7 chloride-95* total co2-26 anion gap-14 10:26pm lactate-1.1 10:25pm urine color-yellow appear-clear sp -1.015 10:25pm urine blood-tr nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-sm 10:25pm urine rbc-0-2 wbc-* bacteria-many yeast-none epi-0 09:22pm lactate-2.1* 09:15pm glucose-86 urea n-21* creat-0.9 sodium-129* potassium-3.8 chloride-94* total co2-24 anion gap-15 09:15pm wbc-21.4*# rbc-3.00* hgb-9.8* hct-28.5* mcv-95 mch-32.6* mchc-34.3 rdw-14.1 09:15pm neuts-92.6* bands-0 lymphs-3.8* monos-3.0 eos-0.3 basos-0.3 09:15pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-1+ stippled-occasional 09:15pm plt smr-normal plt count-271 09:15pm pt-12.5 ptt-28.0 inr(pt)-1.0 brief hospital course: hospital course: 52 year old female with a h/o crohn's disease and multiple abdominal surgeries, with short gut syndrome, on chronic tpn, and with chronic venous access issues. she was admitted to the for management of sepsis. . # sepsis: initial blood cultures were positive for mrse. sepsis was likely due to a r picc line infection. the r picc line was removed, and cath tip culture was positive for oxacillin-sensitive coag neg staph. there was also the possibility of an early lll pneumonia. patient cites a h/o chronic diarrhea, but would also consider possibility of c diff colitis. patient was empirically covered with vanco, flagyl, and levaquin. given h/o chronic tpn use, risk of fungemia was high, but fungal cultures were negative. in the , patient's hypotension responded to ivf resuscitation, so levophed was weaned. pt had a l femoral line placed due to difficulty in obtaining l subclavian vein access, followed by a r midline placed by ir. followup blood cultures were negative, hypotension stopped, and patient improved. . # chronic diarrhea: was likely associated with patient's short gut syndrome, and was c diff negative. patient was continued on antidiarrheal medications, and empiric flagyl was stopped. . # anxiety/depression: outpatient psych meds were continued. . #chronic pain: patient was continued on her home regimen of methadone and oxycodone. . #anemia: patient has h/o anemia with baselne hct 26-29 w/ mcv 95. anemia likely related to her chronic illness, but also nutritional deficiency due to short gut syndrome. patient was continued on her fe supplement. . #prophylaxis: patient was maintained on ppi and sc heparin. . #code status: full. medications on admission: outpt meds: buspirone 30 mg po tid clopidogrel bisulfate 75 mg po metoclopramide 10 mg po qidachs diphenoxylate-atropine 4 tab po qid ferrous sulfate 325 mg po bid oxycodone 30 mg po q8h:prn fluoxetine hcl 40 mg po bid pantoprazole 40 mg po tid promethazine hcl 25 mg po q6h:prn loperamide hcl 2 mg po tid discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po tid (3 times a day). 2. diphenoxylate-atropine 2.5-0.025 mg tablet sig: four (4) tablet po qid (4 times a day). 3. buspirone 10 mg tablet sig: three (3) tablet po tid (3 times a day). 4. fluoxetine 20 mg capsule sig: two (2) capsule po bid (2 times a day). 5. methadone 10 mg tablet sig: seven (7) tablet po qid (4 times a day). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. oxycodone 5 mg tablet sig: six (6) tablet po q8h (every 8 hours) as needed. 9. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid: prn. disp:*120 tablet, chewable(s)* refills:*2* 10. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 11. vancomycin in dextrose 1 g/250 ml solution sig: one (1) intravenous once a day for 5 weeks. disp:*qs qs* refills:*0* 12. promethazine 25 mg tablet sig: one (1) tablet po q6h:prn. 13. loperamide 2 mg tablet sig: one (1) tablet po three times a day. 14. line care hickman care per protocol 15. outpatient lab work for the next 5 weeks, please check cbc, chem 7, vancomycin trough weekly satrting - please send results to pcp . # discharge disposition: home with service facility: home therapies discharge diagnosis: principal diagnoses: 1. line sepsis - mrse bactermia. 2. partial small bowel obstruction. secondary: 1. crohn's disease. 2. tpn dependent short gut syndrome. 3. multiple bowel resection. 4. s/p tah/bso/loa c/b colon perforation and colostomy and fistula. 5. sarcoidosis. 6. chronic diarrhea. 7. chronic svc occlusion secondary to central access, s/p ir recanalization. 8. hypertension. 9. anxiety/depression. 10. iron deficiency anemia. 11. vertebral compression fractures. 12. avascular necrosis of right hip w/ superior/posterior dislocation and iliac pseudoacetabulum. discharge condition: good discharge instructions: please take all of your medications as prescribed. ** please call your doctor or return to the emergency department if you develop feveres/chills, nausea/vomiting, if you develop shortness of breath, chest pain, dizzness, if you pass out or other symptoms that are concerning to you. followup instructions: follow up with your pcp . call to schedule appointment in one week. ** please make sure your pcp checks your blood sugar when you see her. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances angioplasty of other non-coronary vessel(s) infusion of vasopressor agent procedure on single vessel diagnoses: pneumonia, organism unspecified anemia of other chronic disease urinary tract infection, site not specified unspecified essential hypertension severe sepsis sarcoidosis opioid type dependence, continuous regional enteritis of unspecified site compression of vein septic shock diarrhea infection and inflammatory reaction due to other vascular device, implant, and graft other and unspecified postsurgical nonabsorption aseptic necrosis of head and neck of femur unspecified intestinal obstruction mechanical complication of other vascular device, implant, and graft other staphylococcal septicemia 

Answer: The patient is high likely exposed to