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: mercaptopurine attending: chief complaint: bowel perforation major surgical or invasive procedure: : exploratory laparotomy, resection of terminal ileum, end ileostomy and mucous fistula. . : decompressive laparotomy, abdominal washout. . : exploratory laparotomy, abdominal washout, closure with a vac. . : tracheostomy, abdominal washout, partial closure, maturing of the ileostomy and placement of vac and drains. history of present illness: 61 m with a history of from hospital with free air seen on xray. he was driving to dinner with his wife on the eveningof presentation and he had some mild abdominal discomfor. then had all of a sudden abdominal pain. it has been diffuse, worse in epigastrium, nothing improves, worse with movement, has never has before. past medical history: pmh: -crohn's disease x 25 years -prostate cancer . psh: -inguinal hernia repair -vasectomy -exploratory laparotomy, resection of terminal ileum, end ileostomy and mucous fistula -decompressive laparotomy, abdominal washout -exploratory laparotomy, abdominal washout, closure with a vac social history: no tob, occasional etoh, no drugs, supportive wife family history: noncontributory physical exam: pe: 97.9 136 101/69 20 97% 3l ra aaox3, distressed tachycardic ctab diffusely firm tender abdomen, tenderness worse at epigastrium no edema, extrem warm rectal - guaiac negative, no masses or external fistulas pertinent results: 03:28am blood wbc-5.7 rbc-3.34* hgb-10.0* hct-30.6* mcv-92 mch-29.8 mchc-32.6 rdw-15.4 plt ct-381 09:25pm blood wbc-2.5*# rbc-5.53 hgb-16.1# hct-49.6 mcv-90 mch-29.1 mchc-32.5 rdw-14.1 plt ct-399 05:00am blood pt-18.0* ptt-31.9 inr(pt)-1.6* 09:25pm blood pt-13.0 ptt-19.2* inr(pt)-1.1 03:43am blood glucose-121* urean-44* creat-4.5* na-134 k-3.5 cl-96 hco3-27 angap-15 09:25pm blood glucose-146* urean-19 creat-1.5* na-142 k-3.8 cl-105 hco3-23 angap-18 07:36pm blood alt-40 ast-45* alkphos-671* amylase-45 totbili-3.9* 05:06am blood alt-47* ast-42* ld(ldh)-276* alkphos-645* totbili-5.6* 09:25pm blood alt-19 ast-23 alkphos-76 totbili-0.5 07:36pm blood lipase-62* 09:25pm blood lipase-118* 03:43am blood calcium-8.0* phos-5.8*# mg-2.2 03:01am blood caltibc-104* ferritn-878* trf-80* 03:08am blood triglyc-82 . culture data: ucx : no growth bcx : no growth catheter tip cx : no growth peritoneal fluid : enterococcus, peritoneal fluid : haemophilus (sparse), bacteroides fragilis . path: : ileum: crohn's ileitis . imaging: ct chest/abd/pelvis : 1. status post small bowel resection with end ileostomy and distal terminal ileum connected to the lateral aspect stoma as a mucous fistula. 2. catheter along the lateral stoma appears to follow the mucous fistula for a few centimeters before entering the peritoneum with the tip in the right lower quadrant. 3. rectal contrast is seen within the peritoneum around the mucous fistula, tracking up to the open abdominal wound and down to the sigmoid. please note that wound vacuum drainage also increased after rectal contrast administration. 4. 8 x 6 cm fluid collection inferior to the greater curvature of the stomach, location is not amenable to percutaneous radiology-guided access. . ruq us : 1. moderately distended gallbladder with wall edema. no gallstones. in the setting of a known low albumin, these findings are nonspecific, although it is not possible to exclude acalculous cholecystitis. further evaluation could be obtained with hida. 2. echogenic liver lesions consistent with hemangiomas as seen previously on mri of . . ct abd/pel : three small fluid collections within the abdomen: a) along the greater curvature of the stomach, b) in the right lower quadrant and c) along the left iliopsoas muscle. the small size and inaccessible locations makes these unsuitable for percutaneous drainage. . duplex us abdomen : 1. scattered ill-defined hypodensities in the right and left lobes of the liver (segment ii, ii/iii, v, vi) concerning for parenchymal infection/abscess given time course of appearance. no areas of drainable fluid are identified within the lesions at this time. 2. stable left hepatic hemangioma. 3. persistent gallbladder distention, wall thickening, and pericholecystic fluid, with interval development of sludge. in the setting of low albumin these findings are not specific but remain compatible with acalculous cholecystitis. would recommend hida scan for further evaluation if clinically indicated. . tunneled line placement -->removal tunneled line placement brief hospital course: severe crohn disease with chronic obstruction from ileosigmoid fistula with perforation and terminal ileum at the fistula site. on mr was taken emergently to the operating room for acute onset of abdominal pain, nausea, vomiting secondary to his longstanding crohn's disease. the patient underwent exploratory laparotomy, resection of terminal ileum, end ileostomy and mucous fistula for severe crohn disease with chronic obstruction from ileosigmoid fistula with perforation and terminal ileum at the fistula site. immediately postoperatively he was taken to the surgical icu in critical condition on 3 different pressors which were quickly weaned off. however, on the morning of he developed increased pressor requirement, much more tense abdomen with a drop in urine output consistent with compartment syndrome. he then underwent a decompressive laparotomy with an abdominal washout. he also had bilateral chest tubes placed for effusions so large that there were causing cardiac compromise. following the washout his events were as follows: : had bedside ex-lap with esophageal balloon placement (concern for compartment syndrome. pt required bilateral chest tubes for bilateral layering pleural effusions, with subsequent improvement. his hemodynamics improved over the next few days, but abdomen was left open. : milrinone weaned off, started tpn : weaning hydrocortisone, no acute vents. hemodynamically stable. : l chest tube removed originally placed on for increasing pleural effsusions bilaterally. : also 8x6cm fluid collection inferior to the greater curvature of the stomach. : started d5w at 75cc/h for 2.3l free water deficit. on renal was consulted for and reccomended keeping i/os net even. and thought due to his previous hemodynamic instability this was likely atn, supportive measures were deemed most important and dialysis was going to be necessary.d5w was continued at 75cc/h to replace insensible free water losses. the patient was off of pressor support at this time with vanco/zosyn/flagyl/micafungin for antibiotic coverage. a thera-ab vac was in place for his open abdomen. at this time it was also noted that hoisbilirubin was increasing to tbili of 2.5 and ruq u/swas neg. this was thought to be tpn cholestasis. both chest were now out. trophic tube feeds were started on . however,on his vac was changed and an increase in intraperitoneal fluid c/w with either purulence or tf were found. he was then taken back to the operating room for abdominalwashout and it was found that this was pus and not tube feeds. 3 separate drains were placed in the pelvis and right and left paracolic gutter respectively. tf were restarted the next day. pt underwent repeat washout and tracheostomy. hd was begun pt then tolerated trach collar well over the course next few days his antibiotics were removed 1 at a time and jp culture returned as vre for which he was placed on linezolid. we discontinuefd the flagyl on but the next day his lfts rose with alow grade temp prompting another u/s which showed hepatic abscesses flagyl was restarted. the pt was transferred to the floor on with 2 drains to bulb suction. left jp was pulled on and pt had a passy-muir valve/ picc line placed. pt failed swallow study. a tunnelled hd line was placec on . and vac changes (now with white over bowel and black sponge was being changed q 2-3 days. a 19f drain was placed at the bedside on in the left gutter as more fluid seemed to accumulate there on previous vac changes. zosyn was d/c'd leaving pt on linezolid and flagyl. pt received rehab bed and was discharged to rehab in good stable condition medications on admission: budesonide - 3 mg capsule, sust. release 24 hr tid cholestyramine-aspartame - 4 gram powder once a day ciprofloxacin - 500 mg tablet qday cyanocobalamin (vitamin b-12) folic acid - 1 mg tablet - 3(three) tablet(s) by mouth once a day iron sucrose - dosageuncertain aspirin - 81 mg tablet, delayedrelease (e.c.) ergocalciferol (vitamin d2) - dosage uncertain discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 2. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever. 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 5. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 6. heparin (porcine) 1,000 unit/ml solution sig: 4000- units injection prn (as needed) as needed for line flush: original order: heparin flush (1000 units/ml) 4000- unit dwell prn line flush dialysis catheter (temporary 3-lumen): dialysis lumens/ dialysis nurse only: withdraw 4 ml prior to flushing with 10 ml ns followed by heparin as above according to volume per lumen. . 7. linezolid 100 mg/5 ml suspension for reconstitution sig: six (6) ml po q12h (every 12 hours) for 14 days: to complete a 14 day course. last day should be . 8. famotidine 20 mg iv q24h 9. thiamine 100 mg iv daily 10. labetalol 10 mg iv q6h:prn sbp>170 11. methadone 5 mg iv q8h 12. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours) for 14 days: please complete a 14 day course last . 13. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 14. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 15. hydromorphone (dilaudid) 0.25 mg iv q3h:prn pain 16. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for thick secretions. 17. insulin slinding scale insulin sc fixed dose orders breakfast bedtime nph 7 units nph 7 units insulin sc sliding scale breakfast lunch dinner bedtime regular regular regular regular glucose insulin dose insulin dose insulin dose insulin dose 0-70 mg/dl proceed with hypoglycemia protocol proceed with hypoglycemia protocol proceed with hypoglycemia protocol proceed with hypoglycemia protocol 71-119 mg/dl 0 units 0 units 0 units 0 units 120-159 mg/dl 2 units 2 units 2 units 2 units 160-199 mg/dl 4 units 4 units 4 units 4 units 200-239 mg/dl 6 units 6 units 6 units 6 units 240-279 mg/dl 8 units 8 units 8 units 8 units 280-319 mg/dl 10 units 10 units 10 units 10 units 320-359 mg/dl 12 units 12 units 12 units 12 units 360-399 mg/dl 14 units 14 units 14 units 14 units instructons for npo patients: evening prior to surgery/procedure: if on glargine or detemir: give 80% of usual dose; if on nph: give 100% usual dose. morning of surgery/procedure: if on glargine or detemir: give 80% of usual dose; if on nph: give 50% of usual dose; if on premix insulin (e.g. 70/30, 75/25): take total number of am units ordered, divide by 3, and give that many units as nph; if on sliding scale of short acting insulin: administer according to hs schedule. hold all oral antidiabetic medications, and consider sliding scale coverage; if appropriate, give ivf with dextrose to prevent hypoglycemia. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: crohns disease, perforation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital after a bowel perforation which caused you to become very sick. you have been in the icu and on the floor for quite some time. your abdomen remains open to decompress the area and it wil granulate in with a vac dressing. you have - drains in your abdomen as well which will stay in place after discharge to the rehabilitation hospital. you have a new ileostomy and it is important that the output is monitored. the output should be between 500cc-1500cc daily. it is important that you are monitored for signs and symptoms of dehydration and symptoms of constipation. you have a tracheostomy tube that is protecting your airway and the nurses at the rehabilitation hospital will care for this tube as their nursing protocol indicates. you have been doing well but you are still unable to pass your speech and swallow consult. you will need to be reevaluated by the speech and swallow team at the rehab hospital. you have tolerated the valve that allows you to talk well and should continue to use this. you will be sent to rehab to recieve very important care and help you recover. followup instructions: please make a follow-up appointment to see dr. in 7 days, call to make this appointment. . provider: ,/kalmykow pcc/urology phone visits date/time: 9:00 provider: ,/kalmykow pcc/urology phone visits date/time: 9:00 provider: , md phone: date/time: 11:15 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other partial resection of small intestine enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis thoracentesis percutaneous abdominal drainage other bronchoscopy temporary ileostomy temporary tracheostomy colostomy, not otherwise specified closed [endoscopic] biopsy of bronchus revision of stoma of small intestine reopening of recent laparotomy site peritoneal lavage central venous catheter placement with guidance diagnoses: acidosis acute kidney failure with lesion of tubular necrosis unspecified pleural effusion severe sepsis perforation of intestine other specified intestinal obstruction acute respiratory failure septic shock abscess of liver malignant neoplasm of prostate other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other specified complications of procedures not elsewhere classified hyperosmolality and/or hypernatremia streptococcal septicemia fistula of intestine, excluding rectum and anus other suppurative peritonitis nontraumatic compartment syndrome of abdomen other fluid overload regional enteritis of small intestine cholecystitis, unspecified 

Answer: The patient is high likely exposed to