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: sulfa (sulfonamides) / ciprofloxacin attending: chief complaint: 1. retroperitoneal sepsis. 2. duodenal cutaneous fistula. 3. biliary obstruction. 4. extensive adhesions of intraabdominal contents. major surgical or invasive procedure: 1. exploratory laparotomy. 2. extended adhesiolysis. 3. duodenal cutaneous fistula takedown with primary closure of the duodenum. 4. choledochojejunostomy (roux-en-y). 5. gastroenterostomy. 6. j-tube placement. 7. drainage of retroperitoneal sepsis. 8. small-bowel resection. history of present illness: mr. is a 74-year-old gentleman who has suffered a difficult problem over the last 6 to 8 months. he originally had a peptic ulcer which was treated by embolization techniques of the gastroduodenal artery. in the process of this, the pancreatic head was necrosed. this led to a retroperitoneal sepsis which i had ultimately took care of. he required a retroperitoneal exploration and drainage originally. at that time, the head of the pancreas and duodenum were found to be necrotic from this process. he subsequently recovered from this, but over the last 6 months suffered from recurrent bouts of intraabdominal and retroperitoneal sepsis. these have been treated by percutaneous tube decompressions. however, on each occasion the sepsis has recurred. accordingly, a fistulogram was obtained in the last month and this indeed showed communication of this retroperitoneal right upper quadrant abscess collection with the duodenum. based on this, we knew that the source of this festering infection was in fact his duodenum. a cat scan was obtained and this suggested a lateral tenting of the duodenum into the retroperitoneum consistent with a fistula tract. furthermore, he had developed significant biliary dilation over this time with the bile duct over 1.5 cm in diameter. this had contrast within it and there was pneumoperitoneum indicated that there was connection perhaps with the gi tract. nonetheless, it was significantly dilated indicative of downstream obstruction. this would not be surprising given the fact that the head of his pancreas literally was necrotic where i first encountered him. after shepherding mr. through many months of rehabilitation and increase improving nutritional status, i posed to him that he is now suitably ready for definitive operation to address this persistent infectious problem. at this point had no forward progress being made because of this. we continued to support him through an enteral feedings through a j tube because his appetite was poor. i had many long and detailed discussions with mr. and his wife and daughter about this dilemma and the need for definitive surgical intervention on this area. i described to him the fact that i had hoped that this could be a limited excision of the fistulous tract and bypass the biliary system. on the other hand, i prepared him for a whipple's pancreaticoduodenectomy should there be evidence that the whole duodenum and pancreatic head was destroyed by this process and involved with the fistulous retroperitoneal sepsis. we discussed the risks and benefits of this operation, and his risks included poor wound healing, bleeding and infection as well as the significant chance of leaks or breakdowns in any of the connection. we also talked about the other traditional risks of major abdominal surgery including heart attack, stroke, pulmonary and renal failure as well as cardiac problems. i did quote him a significant chance of death from this operation on the terms of %. he and his wife understood these risks and he wished to proceed. we went to the operating room on the morning of with the intent of forming a duodenal cutaneous fistulas takedown and debridement and drainage of retroperitoneal sepsis as well as a biliary bypass. past medical history: pmh: htn, dyslipidemia, egd with gastric/duodenal ulcers, gout, neuropathy, back pain, h/o carpal tunnel, cervical radiculopathy social history: married, smokes 2 ppd, retired reader's digest editor family history: nc physical exam: avss gen: nad, neck brace heent: perrla, eomi, oc/op clear neck: brace; no lad cv: rrr, 2/6 sem at lusb, no gallops or rubs pulm: cta b/l abd: +bs, nd, soft, tender to deep palpation throughought, incisions are well healed; no cva tenderness; percutaneous drain in r flank, murky, yellow fluid le: no edema neuro: cn2-12 intact pertinent results: 11:44am freeca-1.33* 11:44am hgb-9.0* calchct-27 11:44am glucose-175* lactate-1.4 na+-134* k+-4.6 cl--101 11:44am type-art po2-174* pco2-37 ph-7.45 total co2-27 base xs-2 intubated-intubated vent-controlled 02:34pm hgb-9.2* calchct-28 02:34pm lactate-1.9 k+-3.9 02:34pm type-art po2-203* pco2-34* ph-7.44 total co2-24 base xs-0 intubated-intubated vent-controlled 04:36pm freeca-1.20 04:36pm hgb-9.7* calchct-29 04:36pm glucose-109* lactate-2.4* na+-134* k+-4.2 cl--105 04:36pm type-art po2-216* pco2-36 ph-7.41 total co2-24 base xs-0 intubated-intubated 07:17pm pt-17.1* inr(pt)-1.5* 07:17pm plt count-239 07:17pm wbc-8.4 rbc-2.75* hgb-9.4* hct-26.3* mcv-96 mch-34.1* mchc-35.7* rdw-14.3 07:17pm albumin-2.7* 07:17pm ck-mb-8 ctropnt-0.07* 07:17pm ck(cpk)-185* 07:17pm estgfr-using this 07:17pm glucose-111* urea n-31* creat-1.3* sodium-136 potassium-4.5 chloride-107 total co2-21* anion gap-13 11:57pm hct-25.9* . 01:10pm blood wbc-12.6* rbc-2.90* hgb-9.9* hct-28.6* mcv-99* mch-34.3* mchc-34.7 rdw-14.8 plt ct-421 08:40am blood glucose-114* urean-15 creat-0.7 na-133 k-5.0 cl-103 hco3-24 angap-11 01:10pm blood alt-12 ast-16 alkphos-97 totbili-0.6 08:40am blood calcium-9.4 phos-2.1* mg-1.6 . radiology report ugi sgl contrast w/ kub study date of 10:07 am impression: 1. contrast in the stomach flows very slowly into the duodenum and the afferent and efferent loops of the gastrojejunostomy. it is unclear whether contrast passes through the efferent limb into more distal small bowel. therefore, efferent loop obstruction or ileus cannot be excluded. no definite extravasation of contrast is seen, particularly in the region of prior duodenocutaneous fistula. 2. increased density of left retrocardiac opacity, with now obscuration of the left hemidiaphragm. while this likely represents increased atelectasis, aspiration or infection cannot be excluded. small left pleural effusion also cannot be excluded. . radiology report ct abdomen w/contrast study date of 3:04 pm impression: 1. no evidence of bowel obstruction. 2. anterior abdominal wall defect with underlying ill- defined collection deep with multiple foci of gas. 3. small rim-enhancing fluid collection with a focus of gas within the left abdomen. 4. right upper quadrant catheter terminating medial to the liver that does not appear to be within a defined collection. 5. moderate bilateral pleural effusions with underlying atelectasis or consolidation. . radiology report bas/ugi air/sbft study date of 2:59 pm impression: patent gastrojejunal anastomosis with free passage of contrast. . radiology report portable abdomen study date of 5:10 am preliminary report !! pfi !! no evidence of obstruction. reflex of contrast in the biliary tree, from jejunal limb. . 12:56 pm swab peritoneal abscess. gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram negative rod(s). wound culture (final ): reported by phone to @ 2:15 pm on . klebsiella pneumoniae. sparse growth. . brief hospital course: this is a 74 yo male well know to the service. he went to the or for 1. retroperitoneal sepsis. 2. duodenal cutaneous fistula. 3. biliary obstruction. 4. extensive adhesions of intraabdominal contents. name of procedures: 1. exploratory laparotomy. 2. extended adhesiolysis. 3. duodenal cutaneous fistula takedown with primary closure of the duodenum. 4. choledochojejunostomy (roux-en-y). 5. gastroenterostomy. 6. j-tube placement. 7. drainage of retroperitoneal sepsis. 8. small-bowel resection. events: : 1u prbc in pacu : extubated, unasyn d/ced, lr decreased to 100cc/h : ck and trop trending down, iv fluid changed to d5 1/2 ns @ 75cc/h. transfer to the floor : given albumin x 2, fena 0.09%, id recs 2 weeks of meropenem , ngt replaced for 1l> ? swelling to rue. us showed no clot. : cx + for carbapenamase producing klebsiella from abscess--> changed --> tobra per id recs. : stopped maintenance ivf, cont cc:cc replacement jp + ngt losses, restarted tube feeds (peptamen); albumin and lasix given : lasix given, clamped ng. thin barium study. nauseated. > 400 ml residual, reattached ng tube. : clamp trial. nauseous, ng reattached. rash per abdomen, lower extremity - worsened, stopped repletion of ng and jp. patient's weight 168 lbs. : dc , worsening rash to arms. ? allergy to flagyl. id consult agrees with allergy to antibiotics as cause - : failed multiple clamp trials. patient averaged about 4-5 hour of suction free period. : febrile to 101.9 (hr119), started vanc/unasyn for new retrocardiac opacity on cxr. nauseated on clamp trial, ngt put to suction. vanc and unasyn stopped due to rash. ugi/sbi: patent gastrojejunal anastomosis with free passage of contrast. peg placement. : g-tube capped, patient tolerating this. : discharged home with tubefeedings and capped g-tube. pathology i. small bowel segment (a-b): within normal limits. ii. small bowel fistula site (c): small bowel fragment with chronic active inflammation and marked fibrosis. iii. abscess bed (d-e): fibroadipose tissue with foreign body reaction and marked fibrosis. medications on admission: 1. fentanyl 50 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). 2. folic acid 1 mg tablet : one (1) tablet po daily (daily). 3. ferrous sulfate 325 mg (65 mg iron) tablet : one (1) tablet po bid (2 times a day). 4. atorvastatin 40 mg tablet : one (1) tablet po daily (daily). 5. lisinopril 10 mg tablet : one (1) tablet po daily (daily). 6. metoprolol tartrate 50 mg tablet : one (1) tablet po tid (3 times a day). 7. pantoprazole 40 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. trazodone 100 mg tablet : one (1) tablet po hs (at bedtime). 9. multivitamin tablet : one (1) tablet po daily (daily). 10. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 11. oxycodone 5 mg tablet : one (1) tablet po q6h (every 6 hours) as needed. disp:*40 tablet(s)* refills:*0* 12. kangaroo pump 13. jevity 1.2, 3 cans daily 14. doxycycline hyclate 100 mg capsule : one (1) capsule po q12h (every 12 hours): continue until surgery, as directed by infectious disease. disp:*60 capsule(s)* refills:*1* discharge medications: 1. metoclopramide 10 mg tablet : one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*2* 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). disp:*30 tablet,rapid dissolve, dr(s)* refills:*2* 3. feeding pump feeding pump for j-tube feeds at home. 4. tube feeding jevity 1.2. starting rate: 110 ml/hr; goal rate: 110 ml/hr cycle?: yes, starting now cycle start: 1800 cycle end: 1000 flush w/ 30 ml water q8h 5. acetaminophen 160 mg/5 ml solution : po q6h (every 6 hours) as needed for pain: do not exceed 4000mg of tylenol in 24 hours. feed via j-tube. disp:*600 ml* refills:*0* 6. oxycodone 5 mg/5 ml solution : 5-10 mg po every 4-6 hours as needed for pain: do not operate heavy machinery or consume alcohol. cause sedation. . disp:*500 mg* refills:*0* 7. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day): give via j-tube. take while using narcotics for pain control to help prevent constipation. disp:*600 ml* refills:*1* 8. fentanyl 50 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours). disp:*6 patch 72 hr(s)* refills:*0* testosterone patch discharge disposition: home with service facility: vna assoc. of discharge diagnosis: 1. retroperitoneal sepsis. 2. duodenal cutaneous fistula. 3. biliary obstruction. 4. extensive adhesions of intraabdominal contents. 5. post-op blood loss anemia 6. klebsiella pneumoniae. 7. rash related to antibiotic allergy discharge condition: hemodynamically stable, tolerating tube feeds, ambulating, pain controlled with an oral regimen discharge instructions: incision care: keep clean and dry. -you may shower, and wash surgical incisions. -avoid swimming and baths until your follow-up appointment. -please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. . you have been given teaching for your feeding jejunostomy tube and g-tube. please flush the tube as you have been taught & please call our office or come to the ed if you notice increasing swelling, redness or drainage around the insertion site. you may return to your original feeding regimen with jevity 1.2. . please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. * call you doctors office for inability to tolerate g-tube capping for >24 hours or >1.5 liter output over 24 hours. please also call if tolerating 24 hour capping for >1 week * 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. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. . * please resume all regular home medications and take any new meds as ordered. * do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * continue to ambulate several times per day. * no heavy ( lbs) until your follow up appointment. g-tube use: you recently had a g-tube placed to assist with managment of your nausea and vomiting. the g-tube should remain capped unless you feel nauseous or your abdomen becomes distended and uncomfortable. if you feel nauseous, remove the cap and attach the g-tube to a drainage bag as you have been taught. the bag will help to remove the contents of your stomach and decrease the nausea. please use care when capping and uncapping the g-tube so you do not accidentally pull it out. it is sutured in place, but care should be exercised. if you develop increasing redness/pain/swelling at the site of the g-tube call the office or come to the ed for evaluation. diet: you may take sips of clear liquid throughout the day for comfort. if you become nauseous uncap the g-tube and attach to a bag for drainage. if you are able to tolerate a capped g-tube for 24 hours you may cautiously increase your dietary intake of clear liquids and food (jello, clear broth etc.). do not advance diet beyond clears. you are recieving all the necessary calories and nutrition via your nightly tube feeds into your j-tube. followup instructions: please follow-up with dr. in 3 weeks. call his office at (. procedure: other enterostomy other partial resection of small intestine enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] incision of abdominal wall other gastroenterostomy without gastrectomy other lysis of peritoneal adhesions closure of fistula of duodenum choledochoenterostomy diagnoses: other postoperative infection unspecified essential hypertension acute posthemorrhagic anemia unspecified septicemia gout, unspecified sepsis dermatitis due to drugs and medicines taken internally obstruction of bile duct other retroperitoneal abscess intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) fistula of stomach or duodenum 

Answer: The patient is high likely exposed to