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: vicodin attending: chief complaint: abdominal pain major surgical or invasive procedure: exploratory laparotomy, repair of duodenal perforation and placement of g -tube into the gastric remnant. multiple washouts of abdominal wound with vac placements. history of present illness: 33 yo female with history of gastric bypass in complicated by leak and several surgies for bowel obstructions with malabsorption and chronic pain with multiple hospital admiisions and discussion of reversal of bypass, presents from osh complaining of acute onset severe abdominal pain that started at 5pm last evening, more on the right side and in the groin. she describes it as intractable, constant, aching/stabbing pain. . states very different from baseline pain that is usually ruq simliar to prior gallbladder attacks, this is much more intense. loss of appetite and diarrhea, no nausea/ vomiting. last bm yesterday, no blood. osh imaging showed free air in retroperitoneum, concerning for perforation. received zosyn at osh and 1l ns and 1l lr. past medical history: pmhx: - community-acquired pneumonia - gastric bypass , multiple hospitalizations for abdominal pain, nausea, vomiting - recurrent small bowel obstructions secondary to adhesions s/p multiple adhesiolysis - hypertension - migraine headaches - post traumatic stress disorder - obesity - chronic pain with narcotic use - chronic anemia - b12 deficiency - electrolyte disturbance secondary to dehydration from diarrhea - poor access, has venous access port in right chest, states has been on tpn in past social history: lives with husband. 4 children. denies tobacco or alcohol use. family history: father with hypertension. mother died of pancreatic cancer. history of alcohol abuse in sister and brother. physical exam: physical exam at admission: gen: ill-appearing women, in acute distress, diaphoretic, pale, moaning in pain but conversing appropriately heent: mm dry, no scleral icterus resp: decreased breath sounds bases, distant cv: tachycardic abd: obese, non-distended, diffusely tender with rebound and guarding, peritoneal, guiaic negative, no stool in vault ext: no c/c/e pertinent results: labs at admission: (osh) wbc 14.3, hg 12.5, hct 39.6, plt 476 () k:3.8 lactate:1.7 hgb:13.8 calchct:41 137| 109| 12 <138 3.9| 15| 0.7 alt: 14 ap: 103 tbili: 0.4 ast: 12 lip: 70 (wbc 14)-> 4.6 >39.7< 456 n:80 band:10 l:7 m:3 e:0 bas:0 hypochr: 1+ anisocy: 1+ plt-est: high pt: 12.1 ptt: 20.8 inr: 1.0 imaging: 1) ct abdomen: significant for patchy infiltrate with left lung base. there is moderate perihepatic and perisplenic free fluid. there is a large duodenal diverticulum on measuring 4.6 x 4.9 cm (image 33, series 2). 2) ct pelvis: significant for diffuse small bowel dilatation with transition point in left lower quadrant. there are two closely apposed decompressed loops of small bowel suggesting a closed-loop obstruction. distal loops of ileum are decompressed compatible with high-grade obstruction. bowel loops within left lower quadrant demonstrate mild wall thickening with a moderate amount of free fluid in the pelvis. colon is decompressed. numerous colon diverticula. brief hospital course: this is a 33 year old woman who is status post open roux-en-y gastric bypass in with complicated postoperative course including anastomotic leak as well as some element of malnutrition. she was evidently recently under evaluation at for possible revision of her gastric bypass due to malnutrition. she presented to an outside hospital with new onset abdominal pain of approximately 5-hour duration. she was ultimately transferred to with 10 to 12 hour history of pain. upon presentation to she had an acute abdomen with peritoneal signs, acidemia and tachycardia. the ct scan at the outside hospital ( hospital)demonstrated retroperitoneal fluid consistent with abscess as well as free air in the region of the duodenum, most likely consistent with a perforated duodenal ulcer. she was resuscitated with intravenous fluids, administered intravenous antibiotics and urgently taken to the or for an exploratory laparotomy. her intra-operative course ( morning) was significant for a perforated duodenal ulcer, which was repaired, closure of internal hernia jejunojejunostomy, gastrostomy tube placement in the gastric remnant, as well as drainage and wash out of the retroperitoneal abcess. jp drains x2. please refer to the operative note for further details. post-operatively, she was taken to the icu without pressor support. on the evening of , she was taken back to the or for an exploratory laporatomy because of continued tachycardia with rising lactate. ex lap was negative. on the morning of , pt was showing improvement after washout. la returned to . bladder pressure in teens instead of 20's. pip was 30's pre take back, with abd open and with abd closed. now pip in 20s this am. still tachy hr 110-120 (but is it pt's baseline? on beta blockade) sbp 90's. pt fluid avid. 12l fluid positive. infectious disease evaluated patient and in the setting of intraabdominal peritoneal soiling perforation emperic treatment with zosyn x 5-7 days was adequate. pt was febrile 101.4 (), likely sirs. cxs from were followed. : minimized lasix gtt since auto-diuresing (~2l neg). cont w/ albumin. fever to 101. hct 22. given 1u prbc. leni negative. morphine for pain control confused started on zyprexa. febrile blood and urine cultures sent (neg) : given 1 unit prbc. continued fevers to 102, new onset right sided abdominal wall erythema/tenderness consisent with cellulitis. ct showing intra-abdominal fluid collection with necrotic tissue s/p retro exposure and i&d. confusion resolved, patient lucid and oriented. given 1 unit prbc. due to ct scan showing fasciitis, patient was brought to the operating room for right flank incision, drainage and debridement of right retroperitoneum with pulse lavage. the wound was packed with kerlex. the outer dressing had to be changed frequently over the next several days due to continued leakage of bilious material. given 1 unit prbc patient brought to operating room for exploration and washout of retroperitoneal abscess. her wound was repacked. picc line and tpn restarted. patient brought back to operating room for exploration and washout of retroperitoneal abscess. kerlex noted to be saturated with bilious material. a wound vac was applied. patient given 1 unit prbc. wound vac output was nearly 1 liter per day following this. : patient brought back to or for exploration and washout with vac change. still no visible fistula. : patient brought back to or for exploration and washout with vac change : abdominal ct with contrast showing markedly enlarged intrabdominal abcess and fistula track from 2nd/3rd portion of duodenum to flank. 1 jp drain was pulled (this drain had put out only 5-10cc/day for weeks) : went to ir for percutaneous drainage of intrabdominal fluid collection with return of a large amount of pus. pig tail catheter left in. taken to or for i+d and vac change. : patient brought back to or for exploration and washout with vac change. lenis of both lower extremities were negative for clot formation. : patient underwent ct of abdomen that showed fluid collection in lower abdominal wall and incidental finding of thrombus of left renal vein. spoke with vascular team, and she was started on heparin iv weight based dosing to reach therapeutic levels of ptt. : patient underwent ir guided aspiration of fluid collection in pelvis/lower abdomen and placement of pigtail catheter. she was continued on heparin iv. : patient brought back to or for exploration and washout with vac change. her heparin was stopped prior to leaving the floor for the or, and was restarted upon arriving back to the floor. : patient went to ir for drainage of pelvic abscess. antibiotics adjusted per infectious disease. and patient went to operating room for washout of r flank abscess and placement of wound vac. device. dermatology consulted for spreading red, raw rash on buttocks. started on fluconazole and fungal cream applied. - patient taken to the operating room for washout of r flank abscess and placement of wound vac. device. - patient taken to the operating room for washout of r flank abscess and removal of wound vac. wet to dry dressings applied. - wound care consult obtained. amd dressings applied as wound care suggest to r flank wound . - infectious disease consulted regarding po antibiotics. problems at discharge: 1. r flank wound abscess - continued dressing changes at home with vna to monitor. oral antibiotics per id. follow up with id to evaluate continued need for antibiotics. 2. lll pe and thrombus of l renal vein - on lovenox sq for total 3 months. follow up with dr. made for one month to assess continued need for lovenox. 3. nutrition - on regular diet currently and tolerating well. has needed intravenous tpn and electrolytes in past. will keep existing port in at this time. recommended follow up with dr. in 2 weeks, infectious disease, vascular and primary care provider. medications on admission: - atenolol 25 mg - percocet 1 tab tid - metoclopramide 10 mg 4x/day - fioricet 1-2 tabs prn - miralax and dulcolax discharge medications: 1. lorazepam 1 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for anxiety. disp:*30 tablet(s)* refills:*0* 2. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 3. enoxaparin 120 mg/0.8 ml syringe sig: one hundred-ten (110) mg subcutaneous q12h (every 12 hours). disp:*6600 mg* refills:*2* 4. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po q12h (every 12 hours). disp:*60 tablet sustained release(s)* refills:*0* 5. lorazepam 1 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for anxiety. disp:*30 tablet(s)* refills:*2* 6. hydromorphone 2 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for pain with dressing changes. disp:*30 tablet(s)* refills:*0* 7. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*1* 8. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours). disp:*30 tablet(s)* refills:*1* 9. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*60 tablet(s)* refills:*1* 10. cefpodoxime 100 mg tablet sig: two (2) tablet po q12h (every 12 hours). disp:*120 tablet(s)* refills:*1* 11. medication and follow up please continue all antibiotics until you see infectious disease on . please eat yogurt daily. please review all medications with your primary care physician and please get any new refills for narcotics from your primary care physician. 12. multivitamin tablet sig: one (1) tablet po twice a day. 13. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 14. commode please provide commode for home use 15. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush: please flush portacath per policy. disp:*30 ml(s)* refills:*0* discharge disposition: home with service facility: healthcare of discharge diagnosis: primary diagnosis: duodenal perforation discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: you are being discharged on medications to treat the pain from your operation. these medications will make you drowsy and impair your ability to drive a motor vehicle or operate machinery safely. you must refrain from such activities while taking these medications. please call your doctor or return to the emergency room if you have 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. 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 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. activity: no heavy lifting of items pounds for 6 weeks. you may resume moderate exercise at your discretion, no abdominal exercises. followup instructions: 1. please follow up with dr. on at 1:00 pm. , building . contact number or . 2. please follow up with infectious disease on wednesday at 11:30, dr. , . office number is . 3. please follow up with dr. (to follow up on your l renal vein thrombosis and l pulmonary embolism) office number = , wednesday, 10:45. , suite 5c. 4. please follow up with your primary care provider, . , in one to two weeks to draw labs, review your current medications and current health status. labwork needs to be done weekly and faxed to infectious disease at (labwork cbc w/diff, bun, cre, lft's.) procedure: percutaneous abdominal drainage percutaneous abdominal drainage incision of abdominal wall other nonoperative replacements nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn open biopsy of soft tissue other gastrostomy suture of duodenal ulcer site repair of other hernia of anterior abdominal wall application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing application of other wound dressing computerized axial tomography of abdomen computerized axial tomography of abdomen diagnoses: acidosis other chronic pain cellulitis and abscess of trunk unspecified essential hypertension acute posthemorrhagic anemia iron deficiency anemia secondary to blood loss (chronic) unspecified protein-calorie malnutrition other b-complex deficiencies dysthymic disorder infection with microorganisms without mention of resistance to multiple drugs other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation iatrogenic pulmonary embolism and infarction paralytic ileus streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] obesity, unspecified other and unspecified postsurgical nonabsorption migraine, unspecified, without mention of intractable migraine without mention of status migrainosus other alteration of consciousness fistula of intestine, excluding rectum and anus other retroperitoneal abscess candidiasis of skin and nails bariatric surgery status portal vein thrombosis unspecified peritonitis posttraumatic stress disorder other colostomy and enterostomy complication systemic inflammatory response syndrome, unspecified diverticulosis of small intestine (without mention of hemorrhage) panniculitis, other site acute peptic ulcer of unspecified site with perforation, with obstruction 

Answer: The patient is high likely exposed to