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: re-admitted with acute renal failure in major surgical or invasive procedure: : admission to w/ high output ec fistula (max 2700cc/day; initial albumin 1.9 trf 80) : repositioning of postpyloric feeding tube (dr ) 2/26/08ex lap, loa, closure of 2 enterotomies, transverse end colostomy, feeding jejunostomy #14 (dr ) : redo gastrostomy #20, change of jejunostomy tube #14 revision of end colostomy (dr ) : colonoscopy showing 5cm stricture in distal colon, stented w/ 20f latex catheter : ercp w/ pancreatic duct stent placed history of present illness: 71f discharged after ~3mos hospital stay, briefly summarized as follows: ruptured aaa in complicated by development of colocutaneous fistula s/p exploratory laparotomy, adhesiolysis, colocutaneous fistulectomy, transverse colostomy, and feeding jejunostomy on with dr. . on she had an g tube placed to assist in management of her increasing ngt output, but she continued to put out thick bilious fluid despite prokinetic therapy. stomal colonoscopy demonstrated a 5cm stricture at the colostomy site which was subsequently stented open with a 20f whistle-tip catheter draining within the ostomy appliance. at the time of discharge to rehab on she was to continue with tpn and tube feeding as well as increase her intake of a regular diet. her g tube was open to gravity and she was tolerating progressive clamping intervals. on the 20f whitsle-tip cath dislodged from her ostomy and she was sent back to the ed. prior to her transfer, labs drawn at were notable for a cr of 1.7, up from 1.0 on . upon arrival to our ed, she became hypotensive to 75/52 with a hr of 88. she had no complaints of fever, chills, rigors, abdominal pain, dyspnea or cough. she did have some difficulty urinating, describing needing to cough in order to void. past medical history: *open gastrostomy tube x 2 , *ruptured aaa; s/p endovascular abdominal aortic aneurysm repair *: colon cancer; s/p right hemicolectomy; treated with s/p radiation treatment (has bowel damage from xrt). *: postoperative radiation resulted in bowel damage; developed small bowel obstruction underwent exploratory lap with loa, complicated by developement ec fistula that closed with after 1 year of treatment with tpn/enteral feedings. *incarcerated hernia *coronary artery disease s/p pci (mi in ') *chronic obstructive pulmonary disease *chronic renal failure *hypertension *hypercholesterolemia *choleithiasis (asymptomatic) *urinary tract infection (kleb, vre) *chronic diarrhea *small bowel obstructions *weight loss (since ) from 200lbs to 80lbs per patient report *malnutrition/ failure to thrive *history of c. diff *hearing loss - wears right hearing aid social history: pt comes from rehab facility, prior to which she has been hospitalized since at various facilities. prior to she smoked 1 ppd for 55 years, and was drinking several drinks per night for 12 years as well. she denies any recreational drug use. prior to she was independent and living on her own. family history: significant for father who died of mi at age 79; grandmother with ? eye cancer physical exam: gen: nad, a&ox3, mm dry (-)scleral icterus, poor skin turgor pul: ctab cor: rrr abd: soft/nd (-)tenderness (-)guarding (-)rebound (-)tympani colostomy well-perfused with loose stool in appliance; gt to gravity with ~400cc dark brown fluid; jt capped; ext: well-perfused without edema, ankle contractures bilaterally pertinent results: 12:01am blood wbc-23.8*# rbc-4.34# hgb-12.2# hct-37.4# mcv-86 mch-28.0 mchc-32.6 rdw-15.5 plt ct-473* 12:52pm blood wbc-14.9* rbc-3.64* hgb-10.1* hct-31.0* mcv-85 mch-27.7 mchc-32.5 rdw-15.5 plt ct-320 07:33pm blood wbc-11.8* rbc-3.16* hgb-9.3* hct-27.3* mcv-86 mch-29.6 mchc-34.2 rdw-15.8* plt ct-306 04:18am blood wbc-9.4 rbc-2.73* hgb-7.8* hct-24.0* mcv-88 mch-28.4 mchc-32.4 rdw-15.7* plt ct-252 07:45pm blood wbc-11.6* rbc-3.55*# hgb-10.5*# hct-31.8*# mcv-90 mch-29.5 mchc-32.9 rdw-16.2* plt ct-273 10:37am blood wbc-10.7 rbc-3.46* hgb-10.2* hct-30.3* mcv-88 mch-29.5 mchc-33.6 rdw-16.0* plt ct-284 05:30am blood wbc-9.6 rbc-3.25* hgb-9.2* hct-28.4* mcv-88 mch-28.5 mchc-32.5 rdw-16.0* plt ct-273 12:01am blood glucose-90 urean-111* creat-3.9*# na-136 k-4.2 cl-84* hco3-37* angap-19 12:52pm blood glucose-112* urean-104* creat-3.6* na-136 k-3.0* cl-83* hco3-41* angap-15 07:33pm blood glucose-96 urean-93* creat-3.2* na-136 k-3.5 cl-89* hco3-42* angap-9 12:54am blood glucose-113* urean-81* creat-2.8* na-143 k-3.4 cl-100 hco3-37* angap-9 04:18am blood glucose-113* urean-77* creat-2.6* na-141 k-3.3 cl-101 hco3-34* angap-9 07:45pm blood glucose-112* urean-58* creat-2.0* na-143 k-3.4 cl-110* hco3-23 angap-13 10:37am blood glucose-106* urean-48* creat-1.6* na-144 k-3.4 cl-110* hco3-24 angap-13 05:30am blood glucose-96 urean-39* creat-1.4* na-149* k-3.5 cl-113* hco3-25 angap-15 04:48am blood wbc-6.2 rbc-2.86* hgb-8.6* hct-28.4* mcv-99* mch-30.1 mchc-30.3* rdw-17.2* plt ct-254 04:14am blood wbc-9.1 rbc-2.69* hgb-8.1* hct-25.3* mcv-94 mch-30.0 mchc-31.9 rdw-16.7* plt ct-237 07:00am blood wbc-9.3 rbc-3.20* hgb-9.1* hct-27.6* mcv-86 mch-28.6 mchc-33.1 rdw-16.4* plt ct-263 04:48am blood plt ct-254 05:35am blood plt ct-249 05:19am blood plt ct-232 04:48am blood glucose-83 urean-63* creat-1.1 na-146* k-4.6 cl-113* hco3-27 angap-11 03:56am blood glucose-91 urean-79* creat-1.3* na-135 k-4.4 cl-101 hco3-26 angap-12 05:09am blood glucose-81 urean-36* creat-1.0 na-141 k-3.8 cl-107 hco3-24 angap-14 03:32am blood alt-11 ast-14 ld(ldh)-131 alkphos-195* amylase-40 totbili-0.3 03:32pm blood alt-20 ast-17 alkphos-180* amylase-27 totbili-0.7 03:32am blood lipase-15 04:48am blood calcium-9.0 phos-3.1 mg-2.2 05:45pm blood albumin-2.7* calcium-8.9 phos-2.2* mg-2.0 04:52am blood calcium-8.9 phos-3.4 mg-2.1 03:32am blood caltibc-211* ferritn-439* trf-162* 04:47am blood caltibc-208* ferritn-610* trf-160* 05:16am blood caltibc-200* ferritn-515* trf-154* 09:52am blood caltibc-209* ferritn-600* trf-161* 09:00am blood caltibc-198* ferritn-725* trf-152* 04:25am blood caltibc-152* ferritn-842* trf-117* 05:11am blood caltibc-182* ferritn-761* trf-140* 02:24am blood caltibc-202* ferritn-1296* trf-155* 03:49am blood caltibc-189* ferritn-962* trf-145* 02:31am blood caltibc-135* ferritn-883* trf-104* 04:20am blood caltibc-107* ferritn-705* trf-82* 04:00am blood caltibc-176* ferritn-805* trf-135* 06:00am blood caltibc-125* ferritn-829* trf-96* 03:32am blood triglyc-76 hdl-36 chol/hd-4.7 ldlcalc-117 04:47am blood triglyc-101 hdl-28 chol/hd-5.8 ldlcalc-113 brief hospital course: patient's hpi as above. given the degree of hemoconcentration evident from her laboratory trend, the transient hypotension was likely secondary to severe hypovolemia although urosepsis was also considered. she was admitted to the hospital for iv antibiotics and fluid resuscitation for her acute renal failure. . hospital course by system: neuro: pt remained alert and oriented. her pain was well-controlled with low dose liquid oxycodone. cv: pt did have several episodes of hypertension of sbps in the 190's. this was treated with iv hydralazine. otherwise she remained hemodynamically stable. she continued to be in afib that was rate controlled with beta-blockers and diltiazem. pulmonary: no major issues gi: tubefeeds were initially held, then restarted at 10cc per hour and increased as tolerated with clamping trials. she was initially given nephramine while her renal function improved as well as nutrition via tpn and tubefeeds. however, on hd4 her tubefeeds were held for obstructive symptoms. for further details, see "events" section below. gu: 1) acute renal failure - she was treated with aggresive fluid resuscitation and nepthramine as well as a brief course of arginine. her bun and cr trended down towards normal level (as noted in the labs section above). 2) she was also found to have a uti and started on meropenum. her cultures grew out vre and she was switched to linezolid. endocrine: she was kept on an insulin sliding scale during her hospitalization and strict glucose control was employed. prophylaxis: pt was continued on sch as well as pneumatic boots t/l/d: pt has a g-tube, j-tube, a colostomy stent, and a picc line (this was exchanged over wire in interventional radiology on hd4) . events: on hd4, () she was transferred to the icu due to increased demand of nursing care in terms of fluid replacements and drain care - needing one-to-one care. . hd5 (): she had several episodes of vomiting and decreased colostomy output. she underwent a fluoroscopic fistulogram of her colostomy as well as contrast being injected through the j-tube. a small length of bowel was opacified, however, there was a failure of the contrast to communicate with the retrogradely opacified bowel loops to the colostomy suggesting that she was obstructed. this was felt to be due to swelling in the small bowel walls from aggresive fluid resuscitation and she was started on albumin. . hd6 (): full tpn continued, awaiting return of bowel function hd7 (): episode of wheezing, cxr showed slight fluid overload and lasix given with good effect hd9 (): her ostomy output decreased significantly. her stent was flushed thoroughly and hardened contents were able to be flushed out, showing that the pt likely had some inspisation. she was started on mineral via j-tube and up the ostomy. hd10 (): pt underwent contrast fistulogram of ostomy which again showed the same obstruction as demonstrated on the previous fistulogram. mineral oil and saline flushed were continued via j-tube and ostomy stent. hd11 (): pt was noted to be slighted disoriented with visual hallucinations. ekg, cxr, labs were unremarkable. her urine culture grew pseudomonas, but this was felt to be due to chronic colonization. her delirium was felt to be due to a response to her fentanyl patch and iv fentanyl. narcotic medication was withheld then given only in small doses for the next few days as needed. hd12-18 (): no major events, the pt was gently diuresed with lasix as she was noted to be slightly fluid overloaded given her weight was up, her chest exam revealed crackles with evidence of fluid overload on her cxr, as well edema in her extremities and elevated jvd. she seemed to be less confused as well. hd19-20 (): no major events. her ostomy output began to increase and we began j-tube clamp trials. her fluid balance was corrected and diuresis was discontinued. her mental status remained at baseline - alert and oriented. hd21 (): pt started on gentamycin for +pseudomonas and kleb in urine. volume (ml/day) kcal/day protein (g/day) dex/carb (g/day) fat (g/day) protein (g/kg/day) kcal/kg/day tpn 1650 1840 90 330 40 1.8 37 tf 1200 900 50 126 38 1.0 18 total 2 78 2.8 55 albumin 2.6 trf 160 (highest values during all of admission) 71yof admitted to ??????s hospital for enterocutaneous fistula, which developed while she was at rehab. conflicting fistulograms suggested either distal sb or colocutaneous fistula. pmh/psh prior to admission to : ?????? colon ca, s/p r hemicolectomy, s/p xrt (w/ resultant radiation bowel injury) ?????? sbo s/p ex lap, loa (dr ), c/b ec fistula, closed w/ tpn then enteral feeding x 1 yr ?????? ruptured aaa, s/p open aaa repair (dr ) ?????? cad, mi ??????83, s/p pci ?????? hypertension ?????? hypercholesterolemia ?????? copd ?????? cri ?????? recurrent uti (klebsiella, vre) - ? enterovesicular fistula on cystogram but none seen on barium enema (evaluated by dr , ??????s hospital; no intervention due to poor nutrition) ?????? chronic diarrhea (radiation injury?) ?????? hx of c diff colitis ?????? hearing loss, requiring r hearing aid ?????? bilateral cataracts, s/p intravitreal injections surgical history at : admission to w/ high output ec fistula (max 2700cc/day; initial albumin 1.9 trf 80) hematuria in the setting of asa, coumadin, heparin > resolved gastrostomy and postpyloric feeding tube (dr ) repositioning of postpyloric feeding tube (dr ) decreased fistula output to 500cc/day with tpn and tf support (40cc/day) discharged to tolerating soft mechanical diet + tpn at rehab readmit for planned or ex lap, loa, closure of 2 enterotomies, transverse end colostomy, feeding jejunostomy #14 (dr ) operative findings: 1) multiple transition points in sb due to adhesion 2) atrophic l colon and separation of her colonic anastomosis, resulting in colocutaneous fistula 3) fibrotic tail of pancreas (not biopsied) postop rapid afib treated with diltiazem prolonged postop ileus redo gastrostomy #20, change of jejunostomy tube #14 revision of end colostomy (dr ) colonoscopy showing 5cm stricture in distal colon, stented w/ 20f latex catheter discharged to readmitted w/ urosepsis colostomy output improved w/o requiring stenting catheter tf + tpn colostomy output 1400cc/day new pancreatico-cutaneous fistula (based on output 6340 lip ; fistulogram did not demonstrate it to be enterocutaneous fistula as initially presumed) mrcp showing normal anatomy, octreotide started ercp w/ pancreatic duct stent placed recurrent uti (vre , pseudomonas , esbl klebsiella, pseudomonas, vre ) ?????? on linezolid meropenem current nutritional status (based on feeding weight 50 kg): medications on admission: 1. papain-urea-chlrph cpr cmp sod -5 unit-mg-mg/gram foam : one (1) ml topical daily () as needed for prn clogged j tube. 2. sertraline 50 mg tablet : 1.5 tablets po daily (daily). 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : two (2) inhalation q6h (every 6 hours) as needed. 4. ipratropium bromide 0.02 % solution : two (2) inhalation q6h (every 6 hours) as needed. 5. camphor-menthol 0.5-0.5 % lotion : one (1) appl topical qid (4 times a day) as needed. 6. ascorbic acid 90 mg/ml drops : one (1) po daily (daily). 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 8. acetaminophen 160 mg/5 ml solution : po q6h (every 6 hours). 9. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension : 15-30 mls po qid (4 times a day). 10. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 11. oxycodone 5 mg/5 ml solution : po q4h (every 4 hours) as needed. 12. miconazole nitrate 2 % powder : one (1) appl topical hs (at bedtime) as needed. 13. diltiazem hcl 30 mg tablet : 1.5 tablets po qid (4 times a day). 14. ondansetron hcl (pf) 4 mg/2 ml solution : one (1) injection q8h (every 8 hours) as needed. 15. heparin, porcine (pf) 10 unit/ml syringe : one (1) ml intravenous prn (as needed) as needed for line flush. 16. hydralazine 10 mg iv q3h:prn for sbp>160 17. hydromorphone (dilaudid) 0.25 mg iv q4h:prn hold for rr<12 or excessive sedation 18. metoprolol tartrate 20 mg iv q6h hold for sbp<90, hr<60 19. octreotide acetate 50 mcg iv q8h 20. prochlorperazine 5 mg iv q6h:prn nausea 21. metoclopramide 10 mg iv q6h 22. alteplase (catheter clearance) 2 mg iv prn discharge medications: 1. papain-urea-chlrph cpr cmp sod -5 unit-mg-mg/gram foam : one (1) ml topical daily () as needed for prn clogged j tube. 2. sertraline 50 mg tablet : 1.5 tablets po daily (daily). 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : two (2) inhalation q6h (every 6 hours) as needed. 4. ipratropium bromide 0.02 % solution : two (2) inhalation q6h (every 6 hours) as needed. 5. camphor-menthol 0.5-0.5 % lotion : one (1) appl topical qid (4 times a day) as needed. 6. ascorbic acid 90 mg/ml drops : one (1) po daily (daily). 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 8. acetaminophen 160 mg/5 ml solution : po q6h (every 6 hours). 9. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension : 15-30 mls po qid (4 times a day). 10. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 11. oxycodone 5 mg/5 ml solution : po q4h (every 4 hours) as needed. 12. miconazole nitrate 2 % powder : one (1) appl topical hs (at bedtime) as needed. 13. diltiazem hcl 30 mg tablet : 1.5 tablets po qid (4 times a day). 14. ondansetron hcl (pf) 4 mg/2 ml solution : one (1) injection q8h (every 8 hours) as needed. 15. heparin, porcine (pf) 10 unit/ml syringe : one (1) ml intravenous prn (as needed) as needed for line flush. 16. hydralazine 10 mg iv q3h:prn for sbp>160 17. hydromorphone (dilaudid) 0.25 mg iv q4h:prn hold for rr<12 or excessive sedation 18. metoprolol tartrate 20 mg iv q6h hold for sbp<90, hr<60 19. octreotide acetate 50 mcg iv q8h 20. prochlorperazine 5 mg iv q6h:prn nausea 21. metoclopramide 10 mg iv q6h 22. alteplase (catheter clearance) 2 mg iv prn 23. linezolid 600 mg tablet : one (1) tablet po q12h (every 12 hours). tablet(s) 24. meropenem 500 mg iv q8h 25. fluconazole in saline(iso-osm) 200 mg/100 ml piggyback : one (1) intravenous q24h (every 24 hours) for 6 days. 26. lidocaine hcl 2 % gel : one (1) appl mucous membrane daily (daily). 27. sodium chloride 0.9% flush 3 ml iv prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. discharge disposition: extended care discharge diagnosis: 1. colon ca, s/p r hemicolectomy, s/p xrt (w/ resultant radiation bowel injury) 2. sbo s/p ex lap, loa (dr ), c/b ec fistula, closed w/ tpn then enteral feeding x 1 yr 3. ruptured aaa, s/p open aaa repair (dr ) 4. cad, mi ??????83, s/p pci 5. hypertension 6. hypercholesterolemia 7. copd 8. cri 9. recurrent uti (klebsiella, vre) - ? enterovesicular fistula on cystogram but none seen on barium enema (evaluated by dr , ??????s hospital; no intervention due to poor nutrition) 10. chronic diarrhea (radiation injury?) 11. hx of c diff colitis 12. hearing loss, requiring r hearing aid 13. bilateral cataracts, s/p intravitreal injections 14. enterocutaneous fistula 15. poor nutritional status discharge condition: stable long-term prognosis guarded due to radiation injuries followup instructions: transfer to the service of dr. (hospitalist - medical center, , ma ( f/u with pcp (dr. ) in 1 week. f/u with gi in 6 weeks re: stent assessment procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent nonexcisional debridement of wound, infection or burn transfusion of packed cells replacement of gastrostomy tube retroperitoneal fistulogram retroperitoneal fistulogram retroperitoneal fistulogram endoscopic insertion of stent (tube) into pancreatic duct diagnoses: anemia in chronic kidney disease coronary atherosclerosis of native coronary artery pure hypercholesterolemia urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation chronic kidney disease, unspecified nausea with vomiting other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypotension, unspecified unspecified hearing loss old myocardial infarction pressure ulcer, lower back personal history of malignant neoplasm of large intestine diarrhea other disorders of plasma protein metabolism unspecified intestinal obstruction other specified diseases of pancreas late effect of radiation radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure fistula of intestine, excluding rectum and anus other acquired deformities of ankle and foot mechanical complication of gastrostomy status of other artificial opening of gastrointestinal tract other colostomy and enterostomy complication other functional disorders of intestine psychophysical visual disturbances prickly heat 

Answer: The patient is high likely exposed to