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: novocain attending: chief complaint: periurethral abscess and fournier's gangrene major surgical or invasive procedure: 1. laparotomy and end-ileostomy 2. 1. removal of back bolster. 3. examination under anesthesia with partial release of his gracilis inset and washout of his prerectal space and drain tracts space. 4. lavage of rectum and lower sigmoid intraluminal contents with ortho enema. 5. distal rectal fecal diversion by way of flex-seal intrarectal drainage tube placement. 6. replacement of skin graft bolster dressing 7. 1. irrigation and debridement of perirectal cavity. 8. right gracilis flap transposition into the perirectal cavity. 9. excisional preparation of skin graft recipient site. 10. split-thickness skin graft coverage of penile shaft, left testicle and perineal cutaneous defect measuring over 500 cm2 in surface area. 11. application of negative pressure sponge bolster. 12. laparoscopic diverting end loop sigmoid colostomy 13. suprapubic tube placement. 14. right orchiectomy. 15. perineal and abdominal debridement. 16. urethrectomy history of present illness: 39 m with h/o alcoholism (now sober for 20 years) who noted penile and scrotal swelling approximately one week ago. he was seen by his primary care physician, placed him on antibiotics for four days (unclear which one). the swelling did not improve significantly, and earlier today, he presented to hospital, where he was immediately transferred to for workup and treatment of ?fournier's gangrene. urology was consulted and a ct with iv contrast was recommended, which showed significant air within what appears to be a penile abscess. he denies fevers/chills/nausea/vomiting. he last urinated earlier today, and also had a recent bowel movement. no dizziness, lightheadedness, chest pain, or shortness of breath. past medical history: pmh: alcoholism (goes to aa, been sober for 19-20 yrs) psh: none, but was scheduled to have l inguinal hernia repair social history: works as tow truck driver for last 6 yrs. nonsmoker, former alcoholic, now sober. family history: noncontributory physical exam: on initial evaluation: tm 101.0 tc 97.0 hr 107 bp 118/70 rr 18 o2sat 95 on ra sitting in bed, in no acute distress tachy, regular ctab abd s, nt, mildly distended, nonperitoneal penis with massive edema, tense, fluctuant, pain on palpation, noncircumcized. scrotum bilaterally edematous, testicles unable to be palpated, mildly tender to palpation, no fluctuance noted. legs c/c/e pertinent results: labs on admission: 05:41pm blood wbc-24.1* rbc-4.45* hgb-10.9* hct-33.4* mcv-75* mch-24.4* mchc-32.5 rdw-14.7 plt ct-1019* 05:41pm blood neuts-91.2* lymphs-4.7* monos-3.5 eos-0.4 baso-0.2 05:41pm blood pt-15.2* ptt-25.9 inr(pt)-1.3* 05:41pm blood glucose-104 urean-12 creat-0.7 na-133 k-4.5 cl-95* hco3-26 angap-17 05:41pm blood alt-15 ast-22 ld(ldh)-291* alkphos-89 05:41pm blood albumin-3.1* calcium-8.5 phos-2.8 mg-1.9 05:40pm blood glucose-108* lactate-1.4 na-133* k-4.0 cl-93* calhco3-28 labs prior to discharge: 09:27pm blood hct-29.3* 04:58pm blood wbc-4.6 rbc-3.53* hgb-9.5* hct-28.6* mcv-81* mch-27.0 mchc-33.3 rdw-17.7* plt ct-636* 04:58pm blood pt-13.2 ptt-23.4 inr(pt)-1.1 06:38am blood glucose-127* urean-14 creat-0.8 na-137 k-4.6 cl-100 hco3-26 angap-16 06:38am blood phos-3.7 mg-1.9 imaging: ct pelvis w/contrast study date of 6:00 pm 1. 7 x 7 cm abscess involving nearly the entire length of the corpus spongiosum with resulting superior displacement of otherwise normal-appearing corpi cavernosum. innumerable locules of gas within the corpus spongiosum. these findings are consistent with fournier's gangrene. 2. air in the nondependent portions of the bladder indicating possible progression of infection into and possibly involving the bladder. foci of air is also seen within the prostatic urethra. 3. no pelvic abscesses identified. nonobstructed fluid-filled loops of bowel are present likely due to ileus due to patient's severe illness. 4. marked soft tissue swelling of the scrotum, penile, and perineal soft tissue but no evidence for subcutaneous gas in these tissues. ct cystogram (pel) w/contrast study date of 3:12 pm contrast leakage with the likely source at the level of the urethral ligation. there is also a fistula with the bowel and contrast seen in the rectum. contrast is also seen leaking inferior to the penis and tracking anteriorly into the patient's wound. ct abd/pelvis w/contrast study date of 5:22 pm 1. extensive inflammatory changes in the pelvis involve the distal small bowel, urinary bladder and rectum, with stellate fistulous tracts connecting all structures. dense contrast material in the rectum, refluxing to the level of the colostomy likely originates in both urinary bladder and small bowel. in comparison with the original exam on , abnormalities around the cecum suggest this process may have originated with an intra-abdominal process such as perforated appendicitis or an exacerbation of crohn's disease. 2. dilated left ureter, with bilateral ureteral contrast excretion to the urinary bladder. this suggests that the nephrostomy catheters, particularly on the left, may not be providing adequate urinary diversion. 3. left renal medial lower pole persistent contrast enhancement suggests renal injury due to trauma, or infection. 4. 3-cm heterogeneous collection adjacent to the left perineal wick, containing contrast material on delayed images, indicates fistulous connection from the perirectal or peri-urinary bladder inflammatory collections. the material may be too thick to be drianed by the wick. 5. congested, mildly dilated large bowel extending to the ostomy raises the question that the diverting ostomy may not be draining well. micro: wound culture: mixed bacteria; prevotella species (anaerobic) streptococcus anginosus (milleri) group (pan sensitive) brief hospital course: patient was immediately taken to the or for emergent debridement of fournier's gangrene by urology. please see dr. operative note for details. postoperatively, the patient was initially on pressor support for sepsis. id was consulted, recommending broad spectrum antibiotic therapy. the patient was off pressors and extubated by pod2. he was transferred to the floor pod3. his wound has been managed with wet-to-dry dressings. a small area of necrosis along the r edge of the defect was debrided at the bedside on pod5. plastic surgery was consulted for assistance with closure, and the patient was scheduled for his initial skin-grafting procedure on pod7. on pod6, however, he was noted to have a large amount of urine passing onto his bed. it was unclear whether this was associated with bowel movements and was also unclear whether it was passing from his rectum or from the lower aspect of his wound. to clarify matters, a ct cystogram was obtained, showing a rectourethral fistula at the level of the prostate with urine leaking into rectum as well as from distal aspect of residual urethra. the patient??????s plastic surgery was delayed. general surgery was consulted, and the patient underwent lap diverting loop sigmoid colostomy on pod8. with a plan for initial proximal urine diversion via b pcns with eventual ic after wound healing from below, the patient underwent b pcn placement pod11. on patient underwent multiple stsgs to perineum as well as a gracilis transfer flap to inferior perineal cavity defect. intraoperatively a large amount of stool was evacuated from the rectum before he was prepped and draped. please see dr. operative note for details. patient tolerated the procedure well and was transferred to the pacu and then to floor in stable condition. postoperatively, his pain was well controlled with iv and then po narcotics. he was continued on vanc/levo/flagyl. on pod1, he was noted to have a significant amount of stool per rectum. it was unclear at that time whether this stool represented failure of the diverting colostomy. patient returned to the or for irrigation of wound. a small amount of pus was evacuated around the gracilis flap. wounds were thoroughly irrigated and a penrose drain was placed into inferior perineal wound. a rectal tube was placed to divert stool. on pod2 and 3 patient continued to have a significant amount of stool from rectum. on pod 3 we also noted urine again draining from his rectum. concurrently, his left nephrostomy tube dropped in output. ir was reconsulted. we obtained an i+/o+ abd/pelvis ct at that time, which showed po contrast to the rectum and iv contrast in bladder on delayed imaging. also noted were multiple areas of stellate fistulous tracts connecting distal small bowel, urinary bladder and rectum. this represented failure of both urinary and fecal diversions. the following day, his left nephrostomy was replaced. he returned to or by general surgery for a ileostomy and mucous fistula creation. please see dr. operative note for details. postoperatively, his diet was slowly advanced. his pain was well controlled with iv and then po narcotics. his nephrostomy tubes were regularly flushed. his ostomy was functional with good stool output and gi was consulted for a flex sigmoidoscopy to r/o rectal/sigmoid mass to explain his gi findings in total. mr. refused a flex sig during this hospital stay. he was strongly encouraged to go to his gi appointment for a flex sig scheduled on . in regards to id, patient will receive 7 more days of levofloxacin and flagyl. he will follow up in plastics clinic in weeks. he will follow up with dr. for exchange of his suprapubic catheter in 2 weeks. he will follow up with dr. in 2 weeks. at the time of discharge, the patient was doing well, afebrile with stable vital signs, tolerating a regular diet, and pain well controlled. he is being discharged today to rehab. medications on admission: none discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever/pain. 2. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for anxiety, insomnia. 5. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for rash on buttocks. 6. enoxaparin 30 mg/0.3 ml syringe sig: one (1) subcutaneous q12h (every 12 hours). 7. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 9. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 7 days. 10. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. discharge disposition: extended care facility: senior healthcare - discharge diagnosis: 1. fournier's gangrene 2. enterovesical and enterocolitis fistulae 3. perineal wound with stsgs discharge condition: good discharge instructions: return to the er if: * if you are vomiting and cannot keep in fluids or your medications. * if you have shaking chills, fever greater than 101.5 (f) degrees or 38 (c) degrees, increased redness, swelling or discharge from incision, chest pain, shortness of breath, or anything else that is troubling you. * 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. take all antibiotics as prescribed. followup instructions: please schedule a week follow up with dr. at . please schedule a 2 week appointment with dr. . your suprapubic catheter will be exchanged at that time. it is very important that you schedule and attend this appointment. please schedule a 2 week appointment with dr. . please follow up with gastroenterology for a flexible sigmoidoscopy on (see below). it is very important that you go to this appointment. provider: (st-3) gi rooms date/time: 11:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours percutaneous nephrostomy without fragmentation other skin graft to other sites graft of muscle or fascia excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn nonexcisional debridement of wound, infection or burn other suprapubic cystostomy exteriorization of large intestine biopsy of parathyroid gland excision or destruction of lesion or tissue of scrotum anoscopy exteriorization of small intestine unilateral orchiectomy replacement of nephrostomy tube other local excision or destruction of lesion or tissue of urethra local excision or destruction of lesion of penis other repair of penis diagnoses: severe sepsis other and unspecified alcohol dependence, in remission septic shock other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation vascular disorders of male genital organs retention of urine, unspecified hydronephrosis streptococcal septicemia fistula of intestine, excluding rectum and anus persistent postoperative fistula intestinovesical fistula orchitis, epididymitis, and epididymo-orchitis, with abscess other inflammatory disorders of penis urethral abscess 

Answer: The patient is high likely exposed to