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: no known allergies / adverse drug reactions attending: chief complaint: abdominal pain, hematemesis major surgical or invasive procedure: - exploratory laparotomy, ileocecectomy with primary anastamosis history of present illness: 36m with n/v x3 days. began as bilious, turned to hematemesis yesterday. developed abdominal pain and distention. felt weak, continued emesis so brought himself to ed. denies nsaid use, no history of ulcers, no significant abdominal history. no strange foods, excessive alcohol risk. in ed, received 3u crystalloid and 2u prbc which brought his sbp from 60's up to 110's. remained tachycardic to 140's. past medical history: pmh: iddm, htn psh: right knee surgery social history: social history: no tobacco, no etoh family history: non-con family history: no hx diabetes physical exam: on admission: vitals: t 98.2 p 155 bp 104/62 rr 42 o2 94 ra gen: a&o, nad heent: no scleral icterus, mucus membranes moist cv: rrr, no m/g/r pulm: clear to auscultation b/l, no w/r/r abd: distended, diffusely tender, + rebound dre: normal tone, no gross or occult blood ext: no le edema, le warm and well perfused pertinent results: admission data: cbc - 4.9 > 42.3 < 418 glucose 494 ca: 9.2 mg: 1.6 p: 4.4 alt: 36 ap: 76 tbili: 0.7 alb: 3.4 ast: 45 ldh: dbili: tprot: : lip: 52 imaging: cxr on admission - free air under r hemidiaphragm fast on admission - grossly positive in morissons pouch echo: normal left ventricular cavity size with global hypokinesis c/w diffuse process (e.g., toxin, metabolic, etc.). right ventricular cavity dilation with free wall hypokinesis. no valvular pathology or pathologic flow identified. ruq ultrasound: normal right upper quadrant ultrasound ct abd & pelvis with contrast: status post ileocecectomy with ileocolic anastomosis. post-surgical enhancing fluid collections, most notable right lower quadrant and left pelvis. ct abd & pelvis with contrast: 1. extravasated oral contrast and free intraperitoneal air consistent with anastomotic leak, most likely at the ileocecal anastomosis. 2. rectosigmoid colitis. 3. small bilateral pleural effusions and associated atelectasis. abdomen (supine & erect): 1. paucity of bowel gas without definite evidence of obstruction. if there is a concern for mechanical bowel obstruction, ct can be considered. 2. left lower lobe pneumonia. chest x-ray: retrocardiac opacity may represent atelectasis or pneumonia. bilateral pleural effusions. brief hospital course: mr was taken directly to the operating room on from the emergency department. he underwent exploratory laparotomy and ileo cecectomy for perforated appendicitis. there was frank purulence throughout the peritoneum. please see dr operative report for further details. he was take to the trauma icu still intubated for further resuscitation. he remained stable on and transferred to the surgical floor. he was taken emergently back to the operating room due to an anastomotic leak for washout and creation of a diverting ileostomy on . postoperatively he was taken back to the icu due to sirs response and remaining on pressors. on he remained hemodynamically stable off pressors and was transferred back to the floor. his overall hospital course is summarized below by organ system. neurologic: while intubated he was sedated with fentanyl & propofol. once extubated his pain was well controlled on a dilaudid pca which was subsequently changed to intermittent dilaudid. cardiovascular: he presented in hypotensive shock from sepsis and hypovolemia. following his inital operation, he had dual pressor requirement (vaso/levo) despite significant resuscitation with crystalloid and colloid (prbc/albumin). an echocardiogram on hd3 showed decreased ejection fraction and wall motion, consistent with his florid sepsis. he received a total of 5u prbc and 2u ffp peri-operatively. by , his pressors were able to be weaned off. he was transferred to the floor on with stable hemodynamics. postoperatively after return to the or on for anastamotic leak, he again required pressors for hypotension related to sepsis, but only for a transient period of less than 24 hours. on pressors were able to be weaned of and on he was transferred back to the surgical floor where he remained hemodynamically stable. his home lisinopril was restarted at a lowere dose 20 mg vs 40 mg daily and his hctz was not restarted as his blood pressures ranged in low to mid 110's during his hospital stay. pulmonary: he initially had respiratory failure, being unable to wean from the vent. as his sepsis improved, ventilation was weaned and he was extubated the morning of hd 4. pulmonary toilet was encouraged and he remained without respiratory compromise until he was again intubated for reoperation on , but was able to be weaned and extubated by when his sepsis improved. on he had a kub which showed ? infiltrate in the left lower lobe. a chest x-ray was then obtained to further evaluate which showed atelectasis vs. pneumonia. however, he remained afebrile without a cough or respiratory symptoms so incentive spirometry was encouraged as well as ambulation. gastrointestinal/abdomen: on admission he went emergently to the operating room for ileocectomy as described above. postoperatively, he developed an ileus and an ng tube was placed on for nauesa/emesis. due to persistent ileus and low grade fever, a ct scan was peformed on , which was only significant for an unorganized fluid collection in the pelvis. in discussion with radiology, this fluid appeared to be thin with low suspicion for abscess. however, patient had persistent nausea and fevers and ct was repeated on with placement of a percutaneous drain in pelvic collection. serous fluid drained with no growth on cultures. patient remained on his postop cipro and flagyl. on he began passing flatus and having multiple loose bowel movements and his ng tube was subsequently removed. however, on the night of , the patient had multiple episodes of emesis and ngt was replaced. despite normal wbc count and lack of fever, his persistent ileus was suggestive of an unidentified abdominal pathology and ct was repeated on . ct revealed an anastomotic leak and patient was taken to the or on for abdominal washout and end ileostomy. intraoperatively, patient had a sirs response and was brought to the icu postop on neosinephrine. his pressors were weaned over pod#1 and he was significantly improved by pod#2. ngt was clamped on and the patient was transferred to the floor. on tube feeds were initiated via ng tube. however, he demonstrated inablity to tolerate tube feeds with nausea and vomiting and therefore the ng tube was returned to suction. a picc line was placed and tpn was started given the patient's poor nutritional status. on a dobhoff tube was placed under radiology postpyloric and tube feeds were started. the patient tolerated the tube feeds via dobhoff with the ng tube continued to suction with bilious output. on his ng tube was removed as he continued to tolerate the tube feeds without nausea or abdominal distention. over the next 48 hours his diet was slowly advanced and his tube feeds were weaned and eventually stopped. renal: he presented with acute renal failure (cr 6.0, elevated k). a nephrology consult was obtained, who determined this to be a combination of pre-renal azotemia and atn. continued resuscitation was recommended, please see their consult note for further details. his electrolytes and creatinine normalized over post-op days . a foley was placed on admission and removed on at which time he voided adequate amounts of urine without difficulty. msk: there were no issues - he was able to able to ambulate independently during throughout his stay. hematology: he displayed an elevated inr as high as 3.6 post-operatively. this was not well explained, though believed to be due to rbc transfusions or coagulopathy from sepsis. coags were monitored and his inr trended downward toward normal at 1.7 on and 1.3 on . he was maintained on heparin subcutaneously for prophylaxis during his hospital stay. endocrine: he presented with blood glucose of 500 and elevated hba1c but no ketones in his urine. he reported being a type-ii diabetic but notes suggest he is type-i. he was initially controlled on an insulin drip which rapidly normalized his blood sugar. this was transitioned to sliding scale on pod 1. when started on tpn he again demonstrated uncontrolled blood glucose levels and in the 200's-300's. his insulin scale and standing dose were adjusted by , and his tpn formula was also adjusted as needed. he is being discharged on lantus and sliding scale insulin and will follow up with his new pcp and with . infectious disease: he was initially treated with iv vanco, cipro and flagyl for purulent peritonitis and septic physiology. his operating room cultures showed strep milleri and ecoli so he was narrowed to ceftriaxone and flagyl on based on sensitivity data. postoperatively on he was started on zosyn for empiric coverage given the anastamotic leak and stool spillage seen intraoperatively. at time of discharge he is afebrile and his white blood cell count was 7.0. his antibitoics were all eventually stopped. dispo: he was discharged to home with instructions for follow up in acute care surgery clinic and with his new pcp at . visiting nursing services were set up for his discharge. medications on admission: lisinopril 40', hctz 25', lantus 34u daily discharge medications: 1. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 2. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 3. loperamide 2 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. psyllium 1.7 g wafer sig: one (1) wafer po tid (3 times a day). disp:*90 wafer(s)* refills:*2* 5. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). disp:*120 tablet(s)* refills:*2* 6. ondansetron hcl 4 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for nausea. disp:*60 tablet(s)* refills:*0* 7. glargine sig: ten (10) units at bedtime. disp:*2 vials* refills:*2* 8. lisinopril 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. disp:*30 tablet(s)* refills:*0* 10. ostomy supplies 1 " convatec appliance. moldable wafer dist # # disp: 3 boxes refills: 6 11. ostomy supplies pouch dist # # disp: 3 boxes refills: 6 12. regular insulin sig: one (1) dose four times a day as needed for per sliding scale: see attached sliding scale. disp:*2 vials* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: perforated appendicitis hyperosmolar nonketotic acidosis acute kidney injury sepsis acute respiratory failure anastamotic leak postoperative wound infection right lower abdominal fluid collection 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 with abdominal pain and you were found to have a perforation in your bowels on ct scan. you were taken emergently to the operating room and underwent a procedure to repair the perforation. you experienced complication following your operation that required another procedure to repair an area that was found to be leaking and as a result you now have an ileosotmy bag that produces stool. this type of an ostomy is know to produce large amounts of stool and it is very important that you drink at least 64 to 80 ounces of non alcoholic fluids each day. you ahve also been prescribed medications to slow down the amount of stool - continue to take these as prescribed. you have a special device called a vac dressing on your abdominal incison that became infected. this device is used to aid in faster wound healing. a visiting nurse is being arranged for you to help care for your wound and the vac dresing. you also had extremely elevated blood sugars and required an insulin drip and admission to the icu and was followed closley by the diabetes doctors. you will need to continue to be followed by these specialists after you are discharged from the hospital. 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. wound care: you may shower, no tub baths or swimming. followup instructions: department: when: tuesday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage dr is your new physician at . he works closely with dr , both will be involved in your care. please call your insurance and name dr. as your pcp. must be done before your appointment. please also discuss follow up for your diabetes management. department: general surgery/ when: thursday at 3:15 pm with: acute care clinic with dr phone: building: lm bldg () campus: west best parking: garage procedure: parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage open and other right hemicolectomy other appendectomy ileostomy, not otherwise specified open and other cecectomy diagnoses: hyperpotassemia abnormal coagulation profile acute kidney failure with lesion of tubular necrosis other postoperative infection unspecified essential hypertension acute and subacute necrosis of liver unspecified septicemia severe sepsis alkalosis long-term (current) use of insulin septic shock paralytic ileus hematemesis hypovolemia streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus diabetes with ketoacidosis, type i [juvenile type], uncontrolled other and unspecified escherichia coli [e. coli] acute appendicitis with generalized peritonitis other digestive system complications 

Answer: The patient is high likely exposed to