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: sepsis and ards major surgical or invasive procedure: tracheostomy placement and later decannulation, -jejunum tube placement history of present illness: 45yo f s/ patch and repair of perforated gastric ulcer at (dr. . by report she had been complaining of epigastric pain for nearly 10 days, presenting on 3 separate occasions to their ed. eventually admitted to medical service with diagnosis of sbo. surgical consult obtained, found patient to be hypotensive and in acute renal failure, transferred to icu, and then ct abdomen/pelvis revealed pneumoperitoneum, free fluid, and enteral contrast extrav. taken to or where intraoperatively found perforated gastric ulcer, free succus within the abdomen, and a generalized rind to the peritoneal cavity due to a presumably extended period of intraabdominal perforation. a primary repair and patch was performed and a closed suction drain was left near the anastamosis. postoperatively the patient has been suffering from the sequelae of her intraabdominal sepsis, with review of systems as follows: n - maintained on propofol, as well as ativan prn ciwa scale cv - requiring two pressors (levophed and neo), at a stable low-dose r - challenging oxygenation, presumably due to ards. recent vent settings were ac .60 600x18 5 with abg 7.36 / 43 / 79. gi - closed suction drain has been serous, an ngt to wall suction has been bilious gu - initial arf now resolved, with ~100cc/hr of uo. gyn - a cystic mass was noted in the pelvis intraoperatively, this has not been assessed or addressed up to now id - has been solely on zosyn post-operatively, with intraabdominal cultures pending. initial wbc 4, concerning for failure to mount septic response, but increased to 15 today in the context of a fever to 102 h - stable cbc (today 10.5 > 31.7 < 252). inr 1.5 suggestive of intrinsic liver disease or secondary to sepsis fen - albumin 1.5 endo - riss tld: r ij cvl, r radial a-line, foley, ngt, suction drain proph - lovenox, scds, ppi due to the concern for ards and persistent sepsis, patient being transferred to to escalate her critical care management. past medical history: pmh: pna, ? copd, substance abuse (etoh, cocaine, husband's prescription meds), insomnia psh: tubal ligation ~20y ago, ex-lap for perf'd gastric ulcer with primary repair and patch (unclear where on stomach the ulcer was found) social history: history of etoh and polysubstance abuse (husband's perscription meds and cocaine, marijuana). history of long-standing cigarette use. lives with husband. family history: non-contributory physical exam: on admission: neo 0.8, levo 0.07, propofol 50 100.2 / 99.6, 91 sr, 96/58, 28, 96%, cvp 16 ac .80 380x18 5 intubated, sedated, no spont mvmt coarse bs with crackles at bl bases rrr soft, mild distended. midline incision packed with wtd gauze, c/d/i without erythema, drainage, fluctuance, nor any areas of necrosis. r-sided drain (appears to be ) to bulb suction with serous fluid. wwp, 2+ anasarca r ij tlc, r radial a-line, foley, ngt pertinent results: 05:11pm type-art po2-82* pco2-57* ph-7.20* total co2-23 base xs--6 03:52pm wbc-16.6* rbc-3.71* hgb-10.9* hct-34.3* mcv-93 mch-29.4 mchc-31.8 rdw-16.0* 03:52pm neuts-85.4* lymphs-9.8* monos-3.3 eos-1.3 basos-0.2 03:52pm plt count-303 03:52pm pt-12.6 ptt-31.7 inr(pt)-1.1 brief hospital course: mrs. presented back to the ed at an osh on with increasing abdominal pain, nausea/vomiting, and was diagnosed with an sbo, surgical consultation was obtained. at the time the patient was hypotensive, in arf w/cr of 2.0, an abdominal ct scan was obtained demonstrated gross pneumonperitoneum, subsequently she was taken to the operating room for and exploratory laparotomy. at laparotomy gross periotoneal contamination was noted from a perforated gastric ulcer, it was repaired via patch, and a drain was placed. post-operatively the patient began to develop increasing ventilatory support requirements, ards type physiology and the decision was made to transfer the patient. . icu course: - transfused 1u prbc for hct 21.9 --> 26.2 - post-pyloric nj tube placement - trach - vomiting, ng placed - perisplenic and perihepatic drains placed in ir - restarted vanc/cefepime for vap coverage fevers, persistently elevated wbc. l sc cvl placed, restarted tpn. bronch at bedside, bal ngtd. - erythromycin started as promotility , weaned to trach collar - ngt withdrawn 3" per x-ray location, then clamped. tfs advanced slowly. lasix 20mg iv bid today. speech/swollow consulted for pmv, which pt was unable to tolerate - will address again in couple of days. lopressor increased to 37.5mg tid. - pt pulled out ng and nj tubes. ng replaced, tube feeds restarted. lasix to goal 1l negative. abdominal drains d/c'd. tee requested for ?vegitations. - pt had tee (negative for endocarditis, positive pfo). trach downsized to 7.0, dobhoff replaced (several times as pt kept pulling out). pt reassessed for pmv valve, which she tolerated well except for copious secretions and so swallow will have to be reevaluated . . pt was transfered to general surgery floor. she was maintained as npo with ivf/wound vac/trach/ngt/tf and pain medication. once the trach and ngt were removed speech and swallow evaluated her and recommended ground food with nectar thick liquids. she was reevaluated once she had her dentures at the bedside. her diet was than advanced to regular. . she was continued on iv abx. however her cultures only grew out yeast. the abx were d/c'd and she was continued on micafungin. id was consulted secondary to yeast infection in sputum/wound/urine. the micafungin was then discontinued prior to discharge. . on hd 36 she became c/o nausea with vomitting. a kub was concerning for obstruction, however she was still passing gas and bowel function. she was made npo and then slowly advanced back to regular diet as she continued to have bowel movements. narcotics were discontinued as they were thought to be contributing to her ileus. . on hd 37, her wbc had normalized and she was tolerating an oral diet. she is being discharged afebrile, with stable vital signs, toleraing an oral diet and with controlled pain. she will have vna services for her wound v.a.c. management. medications on admission: at home: ventolin, trazadone prn discharge medications: 1. white petrolatum-mineral oil 42.5-56.8 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dryness. 2. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for const. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for const. 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for wheezing. disp:*1 inhaler* refills:*2* 7. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 9. nicotine 7 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*2* 10. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*0* 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. multivitamin tablet sig: one (1) tablet po daily (daily). discharge disposition: home with service facility: , discharge diagnosis: perforated gastric ulcer complicated by sepsis, and acute respiratory distress syndrome. discharge condition: stable, tolerating a po diet, ambulating, adeqaute po pain control. vac dressing remains in place. discharge instructions: please call your doctor or return to the er for 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. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. *avoid lifting objects > 5lbs until your follow-up appointment with the surgeon. *avoid driving or operating heavy machinery while taking pain medications. * 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. * continue to ambulate several times per day. . incision care: -you vac dressing will be changed by the visitng nurse. -avoid swimming and baths until your follow-up appointment. -please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. followup instructions: please call dr. at ( for a follow-up appointment in weeks. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances temporary tracheostomy diagnoses: acute kidney failure, unspecified unspecified septicemia severe sepsis paralytic ileus chronic or unspecified gastric ulcer with perforation, without mention of obstruction 

Answer: The patient is high likely exposed to