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: ceftriaxone / aldactone / imuran attending: chief complaint: fever, nausea, ruq pain major surgical or invasive procedure: diagnostic paracentesis x 2 left orthotopic liver transplant, splenectomy history of present illness: 55 yo male w/ h/o hcv cirrhosis s/p transplant x 2 (1st transplant c/b primary graft failure believed to be due to small-for size syndrome), course c/b biliary obstruction s/p ptc/dilation at , outflow obstruction s/p ivc dilation at on discharged home on thursday, now presenting to clinic with low grade temperature, nausea, abdominal cramps since discharge. . he had been feeling unwell since discharge last thursday with fatigue, loose non bloody stools, chills, and nausea without vomiting. he further reports bilateral lower quadrant abdominal pain that is dull in nature. he had one low grade temperature but he does not recall the exact value. he denies cough, dysuria, urinary frequency, dizziness or lightheadedness. . patient has had an complicated course since his first transplantation at c/b primary graft nonfunction. on , he underwent a deceased donor liver transplantation. at the end of , he had a liver biopsy performed, which showed evidence of venous outflow obstruction. he underwent venograms x 2 the first, as above, that didn't show venous outflow obstruction, the second with dilation of the caval anastomosis with subsequent improvement in ascites but not liver function tests. bilirubin has remained elevated since . he has had 2 hepatic cholangiograms (one with a dilatation of the hepatico-jejunostomy) with a ptc drain left in place for 3 days and subsequently removed in . osh brushings have grown vre in the past. he was recently treated for acute cholangitis with a 10 day course of ertapenam and daptomycin. of note the patient was admitted on where he underwent ivc angiogram with subsequent angioplasty. . ros: + per hpi, denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria. past medical history: - hcv cirrhosis c/b sbp, esophageal varices (gr iii), nonocclusive thrombus in the portal vein within the smv/splenic confluence and extending into the main portal vein. mode of transmission unclear. - prostatitis - bph - left hydrocele - benign lesions in segment ii and segment iii liver - cholelithiasis - hypertension - anxiety - myocarditis - inguinal hernia - abdominal hernia - streptococcus gallolyticus pasteurianus bacteremia (01/). tte/tee on that admission negative. tx w/ vanc/ceftriaxone -> nafcillin/ciprofloxacin -> daptomycin/ciprofloxacin. social history: lives with wife, who works in quality imprrovement at . works in finance at mass eye & ear. denies tobacco, alcohol (h/o social drinking), or illicit drug use. family history: denies any significant illnesses including liver disease. 82 year-old mother generally healthy. physical exam: admission exam vs: 97.2 122/80 79 16 100% ra general: ill appearing m. comfortable. heent: sclera icteric. perrl, eomi. neck: supple with low jvp cardiac: pmi located in 5th intercostal space, midclavicular line. rrr, s1 s2 clear and of good quality without murmurs, rubs or gallops. no s3 or s4 appreciated. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use, moving air well and symmetrically. ctab, no crackles, wheezes or rhonchi. abdomen: distended but soft, + ttp over bilateral lower quadrants, + hepatosplenomegaly extremities: warm and well perfused, no clubbing or cyanosis. 2+ bilaterally to knees. neuro: cn ii-xii intact grossly, strength 5/5, sensation in tact to light touch discharge exam: vs: 98.5, 95, 134/91, 18, 100% ra, fsg 158 gen: nad, aox3 cards: rrr, no rmg, normal s1 and s2 pulm: ctab abd: soft, minimal tenderness, minimal distension, no rebound, no guarding, stitches and stables in place, no redness or drainage from wound, drain sites with suture, no drainage extrem: minimal edema pertinent results: admission labs 08:20am blood wbc-2.1*# rbc-3.70*# hgb-13.1*# hct-39.4*# mcv-107* mch-35.3* mchc-33.1 rdw-19.7* plt ct-143*# 08:20am blood pt-14.1* inr(pt)-1.3* 08:20am blood urean-27* creat-1.5* na-142 k-3.4 cl-102 hco3-22 angap-21* 08:20am blood alt-198* ast-348* alkphos-249* totbili-52.5* 08:20am blood albumin-3.9 calcium-10.5* phos-3.6 mg-2.4 07:52am blood cryoglb-no cryoglo 05:45am blood hbsag-negative hbsab-positive hbcab-negative hav ab-positive 05:00am blood c3-102 c4-24 hsv 1 igg type specific ab <0.90 index hsv 2 igg type specific ab >5.00 h index index interpretation <0.90 negative 0.90-1.10 equivocal >1.10 positive . urine 02:52pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-lg urobiln-2* ph-6.0 leuks-neg 02:52pm urine rbc-1 wbc-0 bacteri-mod yeast-none epi-0 . ascites 06:11pm urine eos-negative 03:17pm ascites wbc-400* rbc-* polys-7* lymphs-9* monos-40* nrbc-2* mesothe-3* macroph-39* . microbiology blood cultures 2/6, , - no growth 10:35 am blood culture blood culture, routine (preliminary): enterobacter cloacae complex. final sensitivities. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae complex | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic bottle gram stain (final ): reported to and read back by @ 2343 on - fa10. gram negative rod(s). blood cultures 2/17, , - negative . urine culture- , , - no growth . fecal culture (final ): no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. ova + parasites (final ): no ova and parasites seen. this test does not reliably detect cryptosporidium, cyclospora or microsporidium. while most cases of giardia are detected by routine o+p, the giardia antigen test may enhance detection when organisms are rare. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . rpr- non reactive . cmv igg antibody (final ): negative for cmv igg antibody by eia. <4 au/ml. reference range: negative < 4 au/ml, positive >= 6 au/ml. cmv igm antibody (final ): negative for cmv igm antibody by eia. interpretation: no antibody detected. greatly elevated serum protein with igg levels > mg/dl may cause interference with cmv igm results. cmv viral load (final ): cmv dna not detected. performed by pcr. detection range: 600 - 100,000 copies/ml. 3:17 pm peritoneal fluid peritoneal fluid. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (preliminary): no growth. anaerobic culture (preliminary): no growth. studies - ct abdomen pelvis 1. normal post-surgical appearance of the liver. no focal lesions to suggestabscess formation. 2. mild intrahepatic pneumobilia, likely secondary to recent percutaneous biliary instrumentation. 3. unchanged splenomegaly and extensive varices. 4. mesenteric edema with engorged vessels and a small amount of free ascitic fluid. no organized fluid collection to suggest abscess. 5. areas of bowel wall thickening in the duodenum, terminal ileum, cecum, and ascending colon, most severe in the right colon. these findings may be secondary to third spacing from extensive edema, however, other infectious and inflammatory etiologies should also be considered. cxr bibasilar areas of linear opacities representing atelectasis, slightly progressed since the prior study also might be attributed to lower lung volumes. aspiration might be another possibility given the interval placement of the dobbhoff tube with its tip being in the stomach. upper lungs are clear. there is no appreciable pleural effusion or pneumothorax. rus impression: normal renal son. hydronephrosis. liver us 1. patent hepatic vasculature. 2. unremarkable appearance of the liver with no biliary dilatation identified. 3. splenomegaly and small amount of ascites. peritoneal fluid cytology negative for malignant cells liver u/s impression: 1. elevated velocity in the main portal vein at the presumed area of anastomosis seen on exam has normalized. 2. small heterogeneously echogenic focus adjacent to falciform ligament may represent small postoperative hematoma. 3. hepatic hemangioma, as described above. . ekg: sinus rhythm at lower limits of normal rate. q waves in leads i and avl of uncertain significance. borderline intraventricular conduction delay. since the previous tracing of there is now less artifact. . liver u/s impression: 1. stable appearance of the transplant liver with a small hematoma at the site of falciform ligament. 2. patent hepatic vasculature, with appropriate directional flow and waveforms. stool c diff: negative bcx: negative /as ucx: negative discharge (or otherwise recent) labs: 06:44am blood wbc-4.1 rbc-3.09* hgb-9.6* hct-28.1* mcv-91 mch-31.0 mchc-34.1 rdw-18.4* plt ct-327 06:44am blood plt ct-327 04:58am blood pt-12.2 ptt-27.3 inr(pt)-1.1 06:44am blood glucose-84 urean-45* creat-1.8* na-140 k-5.4* cl-107 hco3-27 angap-11 06:44am blood alt-68* ast-40 alkphos-144* totbili-2.6* 06:44am blood calcium-8.2* phos-2.0* mg-1.5* 05:30am blood albumin-2.3* 05:30am blood tacrofk-8.4 05:05am blood tacrofk-12.7 05:20am blood tacrofk-11.8 01:38am urine color-yellow appear-clear sp -1.010 01:38am urine blood-neg nitrite-neg protein-30 glucose-70 ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 01:38am urine rbc-1 wbc-1 bacteri-few yeast-none epi-0 brief hospital course: mr. is a 55 yo male w/ h/o hcv cirrhosis s/p transplant x 2 (1st transplant c/b primary graft failure believed to be due to small-for size syndrome), course c/b biliary obstruction s/p ptc/dilation at , outflow obstruction s/p ivc dilation at on . he was readmitted to with low grade temperature, nausea, abdominal cramps initiatally attributed to cholangitis given recent decompensation with discontinuation of antibiotics. meropenam and daptomycin were empirically started then discontinued after a few days when pain lessened and cultures remained negative. c.diff were negative, ct showed intestional thickening c/w edema, stool studies were negative and cmv vl was negative. abdominal distension increased and diagnostic paracentesis was negative for sbp x 2. ultimately, enterobacter was isolated from one set of blood cultures. this was pan-sensitive and zosyn was started. admission creatinine increased from 1.5 to 7.2. fena was c/w pre-renal etiology, however, this did not respond to fluid challenge or albumin. renal us was negative. urine eosinophils were negative which argued against cyclosporine toxicity. nephrology felt he had hrs. octreotide and midodrine were initiated without response. a temporary hemodialysis catheter was placed. cyclosporine was held. mental status worsened and this was attributed to uremia and hepatic encepholopathy. id was consulted and recommended continuation of zosyn. repeat blood cultures remained negative. hct then decreased from 32 to 23. no active source of bleeding was ever identified. stools were brown and blood tinged which was attributed to hemorrhoidal bleeding. smear was without evidence of schistiocytes. anemia was believed from some hemolysis and splenic sequestration. on he had 2 episodes of coffee ground emesis. ppi and prbc were given and he was transferred to the sicu. meld was elevated >40. he was re-listed for liver transplant and was re-activated when blood cultures cleared. on , an ab liver donor was offered and accepted (patient's blood type is a). plasmapheresis was performed preop then he underwent orthotopic liver transplant with splenectomy with placement of 3 drains, 1 behind the right lobe, 1 behind the porta hepatis and 1 in the left upper quadrant. he required massive transfusions and cellsaver. surgeon was dr. . please refer to operative report for details. postop, he went to the sicu postop intubated. daily anti b titers ranged between negative and 1. no further plasmapheresis was done. a total of 7 doses of atg were given per abo incompatible protocol. cvvhd was continued. he was extubated without event. a feeding tube was place for nutrition and tube feeds were started. lfts decreased. liver duplex was wnl. jp outputs were bloody. he required blood products to mantain hemostatis for the first few days. cvvhd was stopped on postop day 5. he was transferred out of the sicu after 9 days. he required no further hemodialysis and once it was determined he no longer required plasmapheresis or hemodiaysis the catheter was removed. urine output increased and creatinine decreased to a low of 2.1 then increased up to 3.4 likely due to elevated prograf level of 19. prograf was held for a couple doses and creatinine decreased. 2 days prior to discharge he was restarted on his home lasix dose of 40 mg daily which was well tolerated. uop has been great since that time. he was broadly covered with linezolid and meropenum. linezolid was stopped after 5 days and meropenum after 11 days. he remained afebrile and other vital signs were stable. drains were removed. incision remained intact without redness or drainage. no other signs of infection. immunosuppression consisted of atg (7 doses), cellcept, steroid taper and prograf. prograf dose was adjusted per level. he was sent on 0.5 mg of prograf. this level may be adjusted fairly frequently. labs should be checked every monday and thursday with results fax'd to transplant center fax:, attention rn coordinator, : so she can coordinate further dose adjustments. please see the final med rec (below) for final immunosuppression regimen. please also see the final med rec for his prophylactic antiobiotic regimen which includs fluconazole, bactrim and valganciclovir. the patient has been having some anxiety/insomnia at night. he was deemed safe to receive 0.5 mg ativan at night to alleviate this. we do not recommend any higher levels of benzodiazpeines. food intake improved, however, kcals were not sufficient and tube feeds were continued. glucoses were elevated to the 400s. consult was obtained. insulin gtt was required then switched to sq nph and scheduled regular with improved control (glucoses decreased to low 200s). please see final med rec for final insulin regimen and sliding scale. his pain has been well controlled with oxycodone. pt worked with him and recommended rehab. a bed was available at . he will transfered there. he has a follow up appointment on with dr. , his attending surgeon, at which time dr. will provide further guidance of his care. please note - the patient was sent on 0.5 mg tacrolimus . when his level returned on (post discharge) it was 7.6. we decided to increase his tacrolimus to 1 mg and have his labs checked again monday. in was called regarding this medication change. medications on admission: - cyclosporine 125 mg po q12h - omeprazole 20 mg po daily - tamsulosin 0.4 mg po hs - valganciclovir 900 mg po q24h - multivitamin po daily - furosemide 40 mg po daily - magnesium oxide 400 mg po three times a day. - calcium carbonate-vitamin d3 600mg(1,000mg)-1,000 unit po bid - ursodiol 300 mg po bid discharge medications: 1. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours). 2. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 3. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). 4. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 5. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 7. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po qid (4 times a day). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 9. zaditor 0.025 % drops sig: one (1) drop ophthalmic q12 prn () as needed for dry eyes: both eyes. 10. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 12. valganciclovir 450 mg tablet sig: one (1) tablet po every other day (every other day). 13. oxycodone 5 mg tablet sig: 0.5-1 tablet po q4h (every 4 hours) as needed for pain. 14. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: no more than 2000mg a day. 15. nph insulin human recomb 100 unit/ml suspension sig: thirty seven (37) units subcutaneous qam: am dose. 16. nph insulin human recomb 100 unit/ml suspension sig: twenty (20) units subcutaneous with dinner: given with dinner . 17. insulin regular human 100 unit/ml solution sig: ten (10) units injection every six (6) hours: sub cutaneous. 18. insulin regular human 100 unit/ml solution sig: follow sliding scale injection four times a day: in addition to scheduled regular insulin. 19. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 20. tacrolimus 0.5 mg capsule sig: one (1) capsule po twice a day: to be given at 6 am and 6 pm daily and adjusted regularly according to levels by transplant clinic. 21. ativan 0.5 mg tablet sig: one (1) tablet po at bedtime as needed for anxiety/insomnia. discharge disposition: extended care facility: northeast - discharge diagnosis: abdominal pain hrs hyperbilirubinemia malnutrition hyperglycemia hepatitis c liver transplant history of prior liver transplant history of cholangitis portal vein thrombosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , please call the transplant office if patient has any of the following: temperature of 101 or greater, shaking chills, nausea, vomiting,jaundice, inability to take medications, increased abdominal/incision pain, incision redness/bleeding/drainage, constipation/diarrhea, decreased urine output, edema or weight gain of 3 pounds in a day, malfunction of feeding tube. -patient may shower, no tub baths or swimming -no heavy lifting/straining -labs to be drawn every monday and thursday and faxed to thank you for letting us participate in your care. we wish you a speedy recovery. followup instructions: provider: , md phone: date/time: 1:45 provider: , phone: date/time: 3:00 provider: , md phone: date/time: 2:45 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage arterial catheterization other transplant of liver total splenectomy therapeutic plasmapheresis injection or infusion of oxazolidinone class of antibiotics other operations on lacrimal gland transplant from cadaver diagnoses: acidosis thrombocytopenia, unspecified unspecified essential hypertension cirrhosis of liver without mention of alcohol chronic hepatitis c with hepatic coma acute kidney failure, unspecified hepatorenal syndrome other pulmonary insufficiency, not elsewhere classified unspecified protein-calorie malnutrition portal hypertension hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) anxiety state, unspecified bacteremia personal history of venous thrombosis and embolism other ascites acquired hemolytic anemia, unspecified diarrhea esophageal varices with bleeding complications of transplanted liver surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other specified disorders of stomach and duodenum obstruction of bile duct insomnia, unspecified other abnormal glucose other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms jaundice, unspecified, not of newborn unspecified hemorrhoids without mention of complication splenic sequestration 

Answer: The patient is high likely exposed to