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: abd pain and fever major surgical or invasive procedure: ir guided drainage of abd abscess history of present illness: 36 yo woman with hx of crohn's disease who at baseline has about 2 loose bms daily. she returned from a cruise to northern europe about one week prior to presentation. on last day of cruise / first day back, she noticed mild abd pain. over the ensuing week, she has few to no bowel movements while the abd pain gradually worsened. on the day of admission, she developed a fever and presented to ed where she had a ct which was concerning for a perforation in her ileum with a walled off abscess. she contact her outpt gi dr, dr. who arranged for her to be transferred here for evaluation and care. past medical history: crohn's disease x 9 yrs, on 6mp for past yrs social history: married, lives in , ma with husband and 3 kids who are 5, 7 and 10 yo family history: no family hx of perforations physical exam: 97.7 103/64 80 18 100%ra a & o in all spheres neck soft and supple perrla and eomi cv - rrr, no murmurs lungs - cta abd - +bs, pain to palpation to left and inferior to umbilicus, no rebound, +guarding ext - soft, nt neuro exam - nl, nl reflexes and nl strength, ambulatory pertinent results: hematology: 06:22am blood wbc-6.3 rbc-3.54* hgb-10.7* hct-32.5* mcv-92 mch-30.2 mchc-32.8 rdw-16.7* plt ct-572* 05:00am blood wbc-5.3 rbc-2.76*# hgb-8.2*# hct-25.1*# mcv-91 mch-29.9 mchc-32.8 rdw-16.8* plt ct-492* chemistries: 06:22am blood glucose-69* urean-13 creat-0.5 na-137 k-4.7 cl-104 hco3-26 angap-12 05:00am blood glucose-89 urean-5* creat-0.5 na-136 k-3.8 cl-108 hco3-22 angap-10 04:42am blood alt-11 ast-11 alkphos-85 totbili-0.5 05:14am blood lipase-70* 06:22am blood calcium-8.7 phos-4.0 mg-2.1 coagulation: 10:15am blood pt-11.5 ptt-25.6 inr(pt)-1.0 12:10am blood pt-13.0 ptt-35.8* inr(pt)-1.1 inflammatory markers/endocrine studies: 06:22am blood triglyc-73 04:30am blood triglyc-86 05:14am blood triglyc-113 04:42am blood tsh-2.1 blood gases: 10:42am blood type- po2-81* pco2-49* ph-7.41 caltco2-32* base xs-4 intubat-not intuba comment-green top 01:25pm blood type- po2-60* pco2-36 ph-7.46* caltco2-26 base xs-1 06:40pm blood type-art po2-121* pco2-17* ph-7.32* caltco2-9* base xs--14 11:09am blood type-art po2-127* pco2-21* ph-7.34* caltco2-12* base xs--12 intubat-not intuba right upper extremity venous ultrasound: the right internal jugular vein, axillary vein, brachial veins, subclavian vein, and basilic veins demonstrate normal color flow, respiratory phasicity, compressibility except the subclavian vein, which is expected. however, the cephalic vein demonstrates non-compressibility, and the lumen demonstrates expansion with echogenic material, consistent with thrombus. impression: cephalic vein thrombus; no involvement of other veins. ct abd: the lung bases are clear with minimal dependent atelectasis at the right lung base. the liver is normal in attenuation with no focal lesions or biliary dilation. hypoattenuation adjacent to the falciform ligament likely represents an area of focal fat. there is edema within the gallbladder wall, however no pericholecystic inflammatory stranding. the spleen, pancreas and adrenal glands are normal. the kidneys enhance and excrete contrast symmetrically with a 7-mm hypodensity incidentally noted in the lower pole of the left kidney which likely represents a cyst. there are again bilateral extrarenal pelves. the abdominal aorta is of normal caliber. the gonadal veins are again prominent bilaterally. the duodenum and proximal loops of the jejunum are normal. the terminal ileum is markedly abnormal. beginning from the ileocecal valve and moving proximally, there is a 17-cm stretch of abnormal terminal ileum with a markedly enhancing mucosal wall and areas of narrowing and dosacculation. before the loop moves anteriorly for an additional 9-cm segment of markedly abnormal bowel (with a avidly enhancing mucosal surface), there is a focal area of extraluminal air and fluid in the left mid abdomen (3:49) consistent with a contained perforation. this area measures approximately 2.7 x 2.5 cm and is slightly more well-defined than one day prior. there is a significant amount of surrounding stranding. more proximally within the mid ileum there are again areas of stricturing and dilation of the bowel, however no evidence of obstruction. there is proliferation of the fat surrounding the very distal terminal ileum as well as hyperemia within the mesentery. there are also multiple small reactive mesenteric lymph nodes. the appendix is normal. there is a moderate amount of fluid surrounding the cecum and extending into the pelvis, likely reactive. the colonic wall is not thickened and there is no obstruction. ct of the pelvis: simple fluid extends into the pelvis. the uterus and adnexa are unremarkable. the bladder is distended and appears normal. there are no suspicious lytic or sclerotic lesions. impression: 1. markedly abnormal mid to terminal ileum with focal perforation and abscess formation in the left mid abdomen which is similar in size but more discrete than one day prior, measuring up to 2.7 cm. the terminal ileum has marked mucosal enhancement consistent with active disease and there are areas of stricturing and dilation, however no obstruction. 2. ascites and pelvic free fluid, likely reactive. 3. gallbladder wall edema, also likely reactive. 4. geographic area of hypoattenuation in segment ivb likely represents focal fatty infiltration. ct abd findings: atelectasis is present at the lung bases. there are no pleural or pericardial effusions. a small hiatal hernia is present. abdomen: there has been interval placement of a drainage catheter, which traverses the left central abdominal wall and terminates near the root of the mesentery. there has been almost complete drainage of the extraluminal fluid collection in this region, with a small amount of residual fluid, loculated gas, and inflammatory fat stranding. in addition, there has been significant improvement in the diffuse mesenteric and reactive bowel wall inflammation. however, two persistent long-segment strictures persist in the mid-to-distal ileum, located within the lower abdomen and measuring approximately 9 and 8 cm in extent. these areas demonstrate moderate mural edema, mucosal hyperemia, fat stranding, and luminal stenosis. new bowel obstruction has also developed, demonstrating proximal small bowel dilation up to 4 cm with associated air-fluid levels, and relative decompression of the terminal ileum. the liver, pancreas, and spleen are normal. prior gallbladder wall edema has resolved. the adrenals are normal. the kidneys enhance and excrete contrast promptly and symmetrically. there is a stable 9-mm cyst in the left lower renal pole. bilateral extrarenal pelves are noted. multiple prominent mesenteric and retroperitoneal lymph nodes persist, but are not pathologically enlarged. note is made of abdominal wall rectus diastasis. pelvis: the colon is partially collapsed, but otherwise unremarkable. the bladder is distended. the uterus and ovaries are normal. a moderate amount of free fluid persists in the pelvis. mild lumbar levoscoliosis is present, likely positional. the sacroiliac joints appear preserved. impression: 1. interval drainage of extraluminal fluid collection, with decreased surrounding inflammation. 2. new small bowel obstruction, secondary to persistent long-segment strictures in mid-to-distal ileum. kub: impression: significant improvement in small-bowel obstruction now partial with evidence of air seen within the distal colon and rectum. brief hospital course: 1) crohn's disease with ileal perforation and abdominal abscess the pt had a repeat ct scan of her abdomen upon admission. she was treated with cipro and flagyl after blood cultures. gi and acute care surgery was consulted and they saw the pt. pt had hct of 25.4 on admission with co2 of 22 and lactate of 0.6. despite the ileal perforation, the pt looked well and the plan was to treat her conservatively with attempt to avoid surgery given the fact that she may lose up to an estimated 50cm of bowel with surgical intervention. the plan was to keep her npo on abx and tpn and transition her to outpt tpn and abx. on the second hospital stay, her chemistries were notable for a co2 of 13 but subsequent lactate level remained nl. the pt was not symptomatically any different but given concern for early sepsis, ir was asked to perform an ir guided drainage of her abd abscess. that was done and fluid was sent off for culture. a jp drain was placed. the id team was consulted. the pt was empirically broadened to cefipime and flagyl. iv vanco was added when the gram stain revealed some gram positives. overnight between her third and fourth hosp day, she developed nausea and a kub was consistent with a partial sbo. she had an ng tube placed and only several hundred cc of fluid output came out over next 24 hrs. she was very uncomfortable with tube down due to gagging. she had the ngt pulled less than 24 hrs after placement. she was treated symptomatically with anti-emetics. ct scan on showed concern for sbo, colorectal surgery team was consulted. as the patient clinically did not have evidence of sbo, and actually was clinically improving, surgery was deferred. iv solumedrol was started and changed to oral steroids given marked clinical improvement and improvement on kub. she was started on clear liquid diet and advanced to low residue / lactose free diet on . she will be discharged on to complete a 2 week of cefepime / flagyl. close gi follow up was arranged; dr will determine her future steroid dosing. 2) cephalic vein thrombosis the peripheral iv infiltrated early on her second hospital day. since she was going to need tpn, an order for picc line was placed. there were difficulties trying to place the picc line on right as the catheter would not advance - as it turns out, it was due to previous right clavicular fracture. the pt eventually had to go down to ir for advancement of that picc line. on the third hosp day her right upper arm was noted to be swollen. an ultrasound revealed a clot in her cephalic vein which was attributed to her previously placed peripheral iv which had already been pulled. hot compresses were applied to the pt's arm for the next couple of days to try and resolve the clot. while there was some reduction in size of swelling, a repeat u/s demonstrated persistent clot. although she did receive anticoagulation for about 10 days with lovenox, as this was a superficial thrombophlebitis, it was not felt indicated to continue this on discharge, particularly given the improvement in symtpoms. the patient was told to call dr. should she have any redness or swelling of the arm. 3) acidemia on the second hospital stay, her chemistries were notable for a co2 of 13 but subsequent lactate level remained nl. the pt was not symptomatically any different but given concern for early sepsis, ir was asked to perform an ir guided drainage of her abd abscess. on third hospital day, the pt's co2 remained low at 12 despite pt being asymptomatic. late in the day, the pt developed tachypnea. repeat co2 was down to 9. abg suggested metabolic acidosis with resp compensation. lactate remained nl. renal was consulted, bicarb was administered and she was briefly transferred to the icu given concern for early sepsis. in the icu, her acidosis resolved and she returned to floor next day. the acidemia was attributed to a combination of starvation ketosis and infection and her getting ns ivfs. 4) anisocoria - on the second hospital day, the rn noted significant anisocoria. opthomology and neurology were consulted. the anisocoria resolved without intervention and neurology attributed finding to exageration of baseline anisocoria in setting of opoioids. medications on admission: 6 mp discharge medications: 1. cefepime 2 gram recon soln sig: two (2) gram injection q12h (every 12 hours): last day: . disp:*qs * refills:*0* 2. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 3 days: last dose: . disp:*9 tablet(s)* refills:*0* 3. heparin flush 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. 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 5. prednisolone sodium phosphate 15 mg/5 ml solution sig: ten (10) ml po bid (2 times a day). disp:*400 ml* refills:*0* discharge disposition: home with service facility: home therapies discharge diagnosis: crohn's disease with ileal perforation and walled off abscess small bowel obstruction right cephalic vein thrombosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted for a crohn's flare, including an abcess that formed in your abdomen and a small perforation of your bowel. a drain was placed to help you recover. you also had a picc line placed to receive home antibiotics and tpn while you were not eating. since you are eating fine, you do not need to continue your tpn. the picc line can come out once you finish your antibiotics. you recieved heparin via your iv to help treat a small clot that developed in your right arm. as this clot is in a superficial vessel of the arm (not a deep vessel), we do not need to thin your blood. please call dr. if you experience any swelling or redness of the arm, or shortness of breath. followup instructions: department: infectious disease when: thursday at 10:00 am with: , md building: lm campus: west best parking: garage name: ,md specialty: primary care when: wednesday, at 1pm location: medical associates address: 28 dr, , phone: department: div. of gastroenterology when: wednesday at 8:35 am with: , md building: ra (/ complex) campus: east best parking: main garage procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances percutaneous abdominal drainage diagnoses: acidosis unspecified protein-calorie malnutrition perforation of intestine unspecified intestinal obstruction anisocoria regional enteritis of small intestine abscess of intestine chronic venous embolism and thrombosis of superficial veins of upper extremity 

Answer: The patient is high likely exposed to