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: bactrim ds / cellcept / zosyn attending: chief complaint: hypotension major surgical or invasive procedure: tunneled hemodialysis line placement history of present illness: this is a 52 yo female with esrd on hd, s/p failed renal transplant, who was discharged 1.5 wks ago for septic shock thought due to cmv viremia and diverticulitis, who presented yesterday to with a fever to 104. to summarize her recent history, she was admitted / with arf leading to her graft failure, found to also have cmv viremia and c. diff colitis. she was discharged on iv ganciclovir until 2 negative cmv vls, and transitioned to oral valganciclovir secondary ppx to continue for 3 mos from her admission. how this was discontinued is unclear: possibly on due to neutropenia, and outside records note negative cmv vl on . she was also at medical center from septic shock due to pseudomonas bacteremia, completing a course of ?zosyn on . on pt began having fevers. a cmv viral load was rechecked (970) and repeat vl of 4059 on . it is unclear when ganciclovir was restarted, but by , she was on ganciclovir with hd dosing. she became hypotensive on with mild abdominal pain, sent to and admitted to micu on norepinephrine. she was treated with stress-dose steroids, empiric po vancomycin, iv vancomycin, iv zosyn and iv gancyclovir. ct abd/pelvis showed uncomplicated sigmoid diverticulitis. all other culture data and infectious workup (including c. diff toxin negative x 3) was unrevealing as to another source of infection. she was started on midodrine for persistent hypotension to 70-80s systolic. also was progressively pancytopenic, though to be from pip-tazo. she was discharged on po cipro and flagyl for diverticulitis, 10 mg daily prednisone, with her tacrolimus decreased to 2mg . also discharged on iv ganciclovir, planning to switch to oral after 2 negative vls, although stopped at some point in rehab. while in rehab, bps had remained normotensive. yesterday am, she awoke nauseated and febrile, with a temp of 104.0. blood cultures (2 sets) were sent from rehab. also c/o llq pain. in the ed, her tmax was 102, with bp 142/82. ct abd showed diverticulitis similar to prior. ua was positive. cxr improved from prior. was given vanco/zosyn/flagyl and admitted. on arrival to hd today, she was tachycardic to 130s, apparently sinus rhythm. hd was stopped after 1 hour due to progressive tachycardia to the 160s, with fever to 103.2, despite running her volume even. after stopping hd, she became hypotensive to sbp 60s, with preserved mental status. after 1l ivf, her bp improved to 86/44 with hr 107. temp improved to 100.3 after acetaminophen. currently c/o nausea and fatigue, no resting abd pain but 10/10 l sided abd pain with palpation. also c/o fevers, no chills or sweats. has some diarrhea that pt notes as chronic and unchanged. makes small amt urine and confirms dysuria, frequency, urgency. denies vomiting, cp, sob, cough, sputum, wheezing, ha, vision changes, confusion. past medical history: - esrd due to sle, s/p cadaveric renal transplant complicated by fsgs and transplant failure , now on hd - sle, followed by dr. in rheumatology - hypotension (started on midodrine ) - septic shock - cmv viremia - acute uncomplicated diverticulitis - hx of c. diff - paroxysmal atrial fibrillation - nsvt - hx of hypertension - hyperthyroidism - s/p bilateral knee surgeries and r acl repair social history: single, currently at rehab. denies tobacco, etoh, and drugs. family history: mother and brother both with diabetes and , both deceased. physical exam: vitals: t 101.2 bp 105/49 hr 113 rr 18 o2sat 98ra general: nad, aaox3, appropriate, comfortable heent: ncat, eomi, aniceteric sclerae, mmm neck: no jvd cardiac: rrr, no m/r/g lung: ctab abdomen: nabs. soft, nd, exquisitely ttp with in luq/llq with + rebound and grimacing, pain with bed movement, no significant guarding, graft palpable in rlq without ttp ext: warm and dry, 2+ dp pulses, avf in lue. no edema. pertinent results: hematology: 12:40pm blood wbc-2.4* rbc-3.37* hgb-9.5* hct-32.6* mcv-97 mch-28.3 mchc-29.2* rdw-17.1* plt ct-97* 09:00am blood wbc-4.1 rbc-3.70* hgb-10.3* hct-35.4* mcv-96 mch-27.8 mchc-29.0* rdw-17.0* plt ct-144* 12:40pm blood neuts-51 bands-20* lymphs-12* monos-13* eos-2 baso-0 atyps-0 metas-2* myelos-0 09:00am blood neuts-67 bands-2 lymphs-20 monos-8 eos-0 baso-0 atyps-1* metas-1* myelos-1* 12:40pm blood plt smr-very low plt ct-97* 12:12pm blood pt-15.1* ptt-29.8 inr(pt)-1.3* 09:00am blood plt smr-low plt ct-144* chemistries: 12:40pm blood glucose-96 urean-24* creat-5.9*# na-147* k-4.2 cl-108 hco3-27 angap-16 09:00am blood glucose-130* urean-30* creat-5.1* na-143 k-4.0 cl-106 hco3-26 angap-15 12:40pm blood alt-15 ast-12 alkphos-57 totbili-0.3 12:45pm blood calcium-7.4* phos-2.7 mg-1.7 07:30am blood vanco-19.5 12:47pm blood lactate-1.0 imaging: ct abdomen and pelvis : 1. extensive diverticulosis with diverticulitis of the sigmoid colon and distal descending colon, similar in extent when compared to the most recent study of . no evidence of perforation or abscess formation. 2. mild enhancement of the transplanted kidney in the right lower quadrant, which is similar in appearance to the prior study. no evidence of perinephric fluid collection or abscess. 3. persistently dilated pancreatic duct may be related to ampullary stenosis or ipmn. as noted previously, if not already performed, consultation with the pancreas center may assist in evaluation. cxr : since interval examination from , there has been improvement in left lower lobe atelectasis and removal of a central venous catheter. the lungs are clear with no signs of pneumonia or congestive heart failure. no pleural effusions or pneumothorax. the cardiomediastinal silhouette is stable in size. microbiology: blood cultures , - pending urine culture - 10,000-100,000 klebsiella clostridium difficle - positive cmv viral load - negative discharge labs: hematology: blood wbc-2.7* rbc-2.85* hgb-7.7* hct-26.9* mcv-94 mch-27.1 mchc-28.7* rdw-17.3* plt ct-182 neuts-41* bands-8* lymphs-37 monos-11 eos-0 baso-2 atyps-1* metas-0 myelos-0 blood pt-11.9 ptt-25.3 inr(pt)-1.0 blood glucose-89 urean-17 creat-4.2* na-145 k-3.7 cl-105 hco3-32 angap-12 brief hospital course: 52 yo female with esrd on hd, recent admission for septic shock from diverticulitis vs cmv, here with fever and hypotension. hypotension/fevers: patient presented with evidence of septic physiology with fevers and hypotension, along with abdominal pain and diarrhea. cultures revealed negative blood cultures, urine culture positive for klebsiella 10-100,000 colonies and positive clostridium difficle. she had a ct of the abdomen which revealed diverticulitis. cxr did not show evidence of pneumonia. she was initially started on broad spectrum antibiotics with vancomycin and cefepime and this was transitioned to po vancomycin and tigacycline for coverage of clostridium difficle as well as iv gancyclovir given her history of cmv viremia. her hypotension resolved with 1 liter of normal saline. she also received stress dose steroids given her history of long term steroid use. she was transitioned to the floor. cortisol stim test was performed which was negative. her hypotension was responsive to fluid boluses. she was continued on midodrine. on the floor she was found to have a positive c diff toxin. she was started on vancomycin taper with resolution of her abdominal pain and diarrhea. fevers abated. she was covered with valgancyclovir for cmv prophylaxis and atovaquone for pcp . towards the end of her hospitalization, her fevers reappeared without accompanying hypotension. pan culture revealed no organism repeatedly. her left arm at the fistula site was painful and ultrasound revealed extensive clot burden. transplant surgery did not feel immediate correction was required; a tunneled line was placed for hd. picc line was removed and cultures were negative. her fevers were felt secondary to clot burden. she was discharged on empiric vancomycin to be given with each hd treatment for a total of four weeks. she was discharged on vancomycin taper for c difficile and prophylaxis as mentioned above in addition to the vancomycin with dialysis. pancytopenia: patient has a history of pancytopenia of unclear cause. differential diagnosis considered includes drug reaction from zosyn, cmv viremia versus lupus related. her blood counts were stable from recent admission and were trended. cmv viral load was negative. renal transplant: complicated by graft fsgs and esrd on hd. she received stress dose steroids as above in the setting of sepsis. she was followed by the renal consult and transplant services. she was continued on tacrolimus 1 mg (decreased from 2 mg ) and atovaquone for prophylaxis. she received hemodialysis treatments three times a week as per her home schedule. given her clotted fistula towards the end of her hospitalization, a tunneled hd line was placed as mentioned above. transplant surgery will see her in outpatient follow up for consideration of placement of new fistula on the right arm. her tacrolimus was discontinued at time of discharge given that she does not require tacrolimus any longer secondary to graft failure. hyperglycemia: attributed to corticosteroid therapy. she was treated with a humalog sliding scale. paroxysmal atrial fibrillation: in sinus rhythm on discharge 10 days ago and currently. not on warfarin. she was continued on aspirin. . dispo - discharged to rehab following resolution of abdominal pain, diarrhea, fever work up, and tunneled line placement. medications on admission: home medications: (from d/c summary dated ) - atovaquone 1500mg (10ml) po daily - aspirin 325mg po daily - pantoprazole 40mg po q24hrs - b complex-vitamin c-folic acid 1mg capsule po daily - midodrine 10mg po tid - ciprofloxacin 500mg po q24hrs - ended - flagyl 500mg po q8hrs - ended - tacrolimus 2mg po q12hrs - ganciclovir 110mg iv qhd - heparin 5000units sq tid - insulin glargine 2units sq qhs - insulin nph 4units sq qam - insulin humalog sliding scale - prednisone 10mg po daily - zofran 4mg iv q8hrs prn nausea - epogen 15000units qhd - bisacodyl 5-10mg po daily prn constipation discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. midodrine 5 mg tablet sig: two (2) tablet po tid (3 times a day). 4. epoetin alfa 10,000 unit/ml solution sig: one (1) injection asdir (as directed): to be administered during dialysis and dosed according to the epoetin alfa p&t guidelines. . 5. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 6. atovaquone 750 mg/5 ml suspension sig: two (2) po daily (daily). 7. vancomycin 125 mg capsule sig: one (1) capsule po as below: one (1) capsule po every twenty-four(24) hours: starting , take 125 mg daily for one week (- ) (b) then take 125 mg every other day for one week () (c) then take 125 mg every third day for two weeks (/10). 8. prednisone 5 mg tablet sig: one (1) tablet po once a day. 9. valganciclovir 450 mg tablet sig: one (1) tablet po once a day: one (1) tablet po 2x/week (tu,th). 10. insulin glargine 2 u sq qhs nph 4 u sq qam 11. vancomycin 1000 mg iv hd protocol please check trough prior to each dose 12. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. discharge disposition: extended care facility: hospital discharge diagnosis: 1. clostridium difficile colitis 2. fistula repair 3. chronic kidney disease discharge condition: stable for discharge. on room air, ambulating with assistance. resolved diarrhea and abdominal pain, intermittent continued low grade fevers. discharge instructions: dear ms , it was a pleasure caring for you while you were in the hospital. you were first admitted to the hospital because of pain in your abdomen that was caused by clostridium difficile. because of this infection, you developed pain in your abdomen, fevers, and your blood pressure was low. during dialysis, your blood pressure fell even further. to treat you, we started you on antibiotics for the infection and your pain and fevers improved. you will need to continue to take these antibiotics for several more weeks. the course of antibiotics is described below. . during your hospital stay, your fistula on your left arm also stopped working. because you needed dialysis, we placed a new line (called a tunneled line) that will allow us to continue dialysis. the transplant surgeons want to create a new fistula for you to use, and you have a follow up appointment set up with them as an outpatient to arrange this. we also decided to continue you on antibiotics to be given during dialysis to treat the possibility of infection in the area of the fistula. . the medication changes we made during this hospitalization were: 1. we started you on oral vancomycin. you should continue to take this with the following regimen: (a) take 125 mg daily by mouth for one week ( - ) (b) then take 125 mg every other day for one week ( - ) (c) then take 125 mg every third day for two weeks ( - ) 2. you can take 5 mg of the prednisone every day instead of 10 mg. 3. you will be receiving vancomycin intravenously with hemodialysis until to complete a 4 week course. 4. you should take vangancyclovir 450 mg twice a week with dialysis. 5. you can take oxycodone 5 mg as needed every 6 hours for pain. 6. you should stop taking gancyclovir iv. 7. you should stop taking tacrolimus. . please keep the follow up appointments scheduled for you below. followup instructions: 1) you have an appointment with a transplant infectious disease doctor, , on at 930 am. please call if you have any other questions. 2) you have an appointment with your kidney doctor, dr. on at 9:40 am. if you have any questions, his phone number is . . 3) you have an appointment with dr. from transplant surgery at 1:40 pm on . if you have any questions regarding this appointment, please call . md procedure: venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis diagnoses: systemic lupus erythematosus anemia in chronic kidney disease end stage renal disease urinary tract infection, site not specified adrenal cortical steroids causing adverse effects in therapeutic use unspecified septicemia severe sepsis atrial fibrillation thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation septic shock intestinal infection due to clostridium difficile surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation complications of transplanted kidney other complications due to renal dialysis device, implant, and graft pseudomonas infection in conditions classified elsewhere and of unspecified site other abnormal glucose diverticulitis of colon (without mention of hemorrhage) 

Answer: The patient is high likely exposed to