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: history of present illness: the patient is a 44 year-old male with a past medical history significant for diabetes mellitus type 1, status post cadaveric renal transplant () with chronic rejection and pancreatic transplant () on chronic immunosuppressives, coronary artery disease, and history of gastrointestinal bleed who presents with complaint of general malaise, nausea, vomiting, sore throat and cough productive of white sputum. the patient was reportedly and his usual state of health until five days prior to admission when he developed general fatigue. three days prior to admission, the patient reports increasing malaise and productive cough. the patient's symptoms reportedly waxed and waned over several days, however, the morning of admission, the patient woke with acute onset nausea, vomiting, fever with chills, and decreased urine output. the patient presented to the emergency department for further evaluation. in the emergency department, the patient was found with a temperature of 102.2, heart rate 118, blood pressure 207/88, respiratory rate 19, oxygen saturation 95% on room air. given the patient's complaint of decreased urine output a foley catheter was placed with 120 cc of clear urine drained. an abdominal ct was obtained for complaint of abdominal pain with nausea and vomiting without evidence of acute pathology. while in the emergency department the patient's temperature spiked to 104.3. intravenous fluids (less then 1 liter normal saline), cooling blanket and ice packs were applied. the patient's oxygen requirement subsequently increased with decreased oxygen saturation on room air from 95 to 90%. the patient was placed on nasal cannula with increasing oxygen requirements and eventually intubated secondary to impending hypoxic respiratory failure. an initial chest x-ray in the emergency department demonstrated a right upper lobe and left lower lobe opacity, however, on repeat chest x-ray post intravenous fluids, the patient's pulmonary infiltrates increased consistent with pulmonary edema. the patient was started on broad spectrum empiric antibiotics including ampicillin, levofloxacin, and flagyl for multilobar pneumonia. the patient also received nitropaste and hydralazine 20 mg intravenous times one for hypertension with systolic blood pressures greater then 200. the patient was placed on versed post intubation for sedation. past medical history: 1. type 1 diabetes mellitus complicated by end stage renal disease requiring hemodialysis. 2. history of cadaveric renal transplant complicated by biopsy proven chronic rejection in . 3. status post pancrease transplant in . 4. coronary artery disease status post myocardial infarction in . 5. hypertension. 6. history of large gastrointestinal bleed (source unknown), felt to be secondary to cmv colitis. 7. history of c-difficile colitis. 8. status post appendectomy. 9. status post retinal detachment in . 10. status post cataract surgery in . 11. history of pancytopenia secondary to imuran . 12. history of left arteriovenous graft thrombus. allergies: lidocaine with a reaction of rash. c-mycin with a reaction of anaphylaxis. medications on admission: 1. diltiazem 60 mg po q.i.d. 2. clonidine 0.1 mg po b.i.d. 3. sevelamer 800 mg po t.i.d. 4. azathioprine 100 mg po q.d. 5. prednisone 5 mg po q day. 6. protonix 40 mg po q day. 7. iron sulfate 250 mg po b.i.d. 8. lopressor 50 mg po t.i.d. 9. lasix 80 mg po q.o.d. 10. folate 1 mg po q day. 11. isordil 10 mg po t.i.d. 12. sodium bicarbonate 1300 mg po t.i.d. 13. mycelex. 14. sirolimus 1 mg po q day. 15. bactrim single strength one tablet po q day. physical examination on admission: temperature 103.4. blood pressure 236/104. heart rate 130. respiratory rate 28. oxygen saturation 88% on 4 liters nasal cannula. in general, the patient is found agitated and rigoring in moderate to severe distress. heent examination normocephalic, atraumatic. pupils are equal, round and reactive to light and accommodation. extraocular movements intact bilaterally. anicteric. dry mucous membranes. neck examination supple, no lymphadenopathy. cardiovascular examination regular rate and rhythm with normal s1 and s2 and 3 out of 6 systolic murmur at the left upper sternal border. pulmonary examination diffuse rhonchi throughout bilaterally with egophony in the right lower lobe as well as left lower lobe. no wheezing or rales noted. abdominal examination soft, nontender, nondistended, normoactive bowel sounds, no masses appreciated. guaiac negative. extremities warm and well perfuse with 2+ dorsalis pedis pulses and posterior tibial pulses and 1+ lower extremity edema to the mid shin bilaterally. laboratories and studies on admission: cbc with a white blood cell count of 18.9 with a white blood cell differential of 87% neutrophils, 6% lymphocytes, 5% monocytes and 2% eosinophils. h&h is 8.9 and hematocrit of 26.3 and platelets of 132 (hematocrit on of 28.1). chem 7 with a sodium of 146, potassium 4.2, chloride 116, bicarb 14, bun 54, creatinine 4.8 (baseline 3.5 to 3.7) and glucose 121 with an anion gap of 16, calcium 8.5, phosphorus 3.5, and magnesium 1.3. liver function tests alt of 38, ast 24, alkaline phosphatase 180, amylase 66, total bilirubin 0.3. chest x-ray on admission demonstrated cardiomegaly with bilateral interstitial edema consistent with congestive heart failure, question possible pericardial effusion, right upper lobe vague opacity likely representing pneumonia and right sided subpulmonic effusion with a left lower lobe infiltrate. electrocardiogram on admission sinus at 120 with left atrial deviation, normal intervals, left ventricular hypertrophy, with delayed r wave progression and t wave inversions in v4, v6 and avl. echocardiogram in demonstrating ejection fraction of 60%, mild symmetric left ventricular hypertrophy. hospital course: 1. pulmonary: the patient presented with complaint of shortness of breath and productive cough and was found to have multilobar (right upper lobe and left lower lobe) infiltrates on chest x-ray in the setting of fever. while in the emergency department the patient's oxygen requirements progressively increased and the patient was intubated for impending hypoxic respiratory failure. the patient was maintained on the ventilator from through with adequate oxygenation and ventilation. the patient was initially started on assist control and eventually changed to pressure support for weaning mode. the patient underwent bronchoscopy on and later on to better sample the secretions in the lungs for microscopic data as well as visually evaluate the large airways. on a chest ct was obtained with evidence of a round cavitary lesion in the right upper lobe (upper apices). the patient was evaluated for ct guided biopsy, however, this was deemed too risky given its location and depth. the etiology of the patient's cavitary lesion remained unclear with negative sputum and bronchoscopy results. however, the patient had, per wife's report, a prior gram negative rod right upper lobe pneumonia. it was felt that the right upper lobe cavitary lesion may be secondary to pneumonia resolving with necrosis. the patient was noted with increased secretions requiring frequent suctioning as well as intermittent agitation requiring frequent sedation making ventilator weaning difficult. with improved mental status, off sedation the patient was successfully extubated on without complications. the patient is currently on face tent with adequate oxygenation at the time of dictation. 2. infectious disease: the patient presented febrile with a temperature of 104 with recent history of productive cough and malaise. the patient was found with multilobar infiltrates and initially started on ampicillin, levofloxacin and flagyl for empiric therapy for multilobar pneumonia. the patient was later switched to ceftriaxone and levofloxacin for double gram negative rod coverage. while in the emergency department (as previously reported) the patient underwent an abdominal/pelvic cat scan without evidence of pathology including fluid collection, mass, or signs of inflammation. despite broad spectrum antibiotics, the patient remained persistently febrile throughout the hospitalization to date with temperatures ranging from 100 to 102 without obvious source, extensive microbiology studies have been obtained to date including multiple blood cultures, myolytic blood cultures, bronchiolar lavage times two, acid fast bacteria smears and cultures times three, urinary legionella antigen, sputum culture, as well as cmv antigen without growth with the exception of several urine cultures, which were notable for candiduria. on , the patient underwent a chest ct, which demonstrated evidence of right upper lobe cavitary lesions (with bilateral basilar consolidation and right pleural effusion). the patient was subsequently started on flagyl for anaerobic coverage. the infectious disease service was consulted for further recommendations. given the funguria, the patient was treated with a five day course of fluconazole without significant response. the patient was subsequently started on amphotericin b bladder washes (continue at the current time) for a total of five days. given the persistent fevers despite broad spectrum antibiotics the patient underwent a repeat chest and abdominal ct with the addition of head and sinus ct on . the cat scans were notable for acute sinusitis with diffuse fluid collection throughout the sinuses right greater then left, overall smaller diameter of the right upper lobe cavitary lesion with increasing cavitary size, resolving bilateral lower lobe consolidation, as well as minimal omental swelling, moderately dilated calyces with decreased opacification of the transplanted kidney. post cat scan studies the patient's ceftriaxone (on day 15) was stopped secondary to potential drug reaction. at the time of dictation the patient continues on levofloxacin day 17, flagyl day 9, bactrim prophylaxis and amphotericin bladder washes. all cultures to date with the exception of yeast, urinary tract infection are negative to date. 3. renal: the patient is status post renal transplant with biopsy proven chronic transplant nephropathy with proteinuria and anemia on chronic immunosuppression. on admission the patient was found with acute on chronic renal insufficiency with a creatinine of 4.8. the patient's acute renal failure was felt secondary to acute tubular necrosis based on urinary sediment secondary to sepsis (and myocardial infarction). the patient was taken off imuran secondary to a history of bone marrow failure and was continued on sirolimus, tacrolimus, and prednisone. the patient's immunosuppressive drug levels were checked frequently with decreased doses by low normal levels in order to maximize the patient's immune response to infection. the patient continued with persistent metabolic acidosis throughout the early portion of the admission felt secondary to renal failure. the patient was started on sodium bicarbonate repletion, however, the patient's acidosis was refractory to medical therapy and the patient's urine output subsequently decreased in the setting of worsening renal failure. on , the patient was started on hemodialysis and ultrafiltration for volume management. the patient required multiple dialysis treatments and frequent ultrafiltration in order to maximize volume removal throughout the early portion of the admission. the patient's creatinine continues to slowly increase despite and at the time of dictation there is concern for significant compromise of the renal transplant. the patient will continue on hemodialysis for an undetermined duration. 4. cardiovascular: the patient has a history of coronary artery disease status post myocardial infarction. on admission the patient was found with severe hypertension and tachycardia. a transthoracic echocardiogram on hospital day number one demonstrated a depressed left ventricular systolic function with an ejection fraction of 30 to 35% with global hypokinesis of the left ventricular. there was no focal wall motion abnormality noted, however, a moderate (2 cm) pericardial effusion was demonstrated with 2+ tricuspid regurgitation and 0 mitral regurgitation. no tamponade physiology was noted on echocardiogram and the patient was followed with serial echocardiograms without evidence of increased pericardial effusion with the tamponade physiology. after receiving intravenous fluids in the emergency department the patient developed pulmonary edema consistent with congestive heart failure. while in the medical intensive care unit a pa catheter was placed to assess the patient's hemodynamics. the patient's initial cardiac output was 4.7 with an svr of 596 and pulmonary capillary wedge of 21. however, the patient became progressively hypotensive on hospital day number one requiring a brief period of blood pressure support. the patient was evaluated with three sets of cardiac enzymes with a peak ck of 755 with a negative mb and peak troponin of 15. elevations anteriorly and t wave inversions laterally on electrocardiogram. the cardiology service was consulted and the patient was started on aspirin and followed (as previously mentioned) with serial echocardiograms (last echocardiogram ) without evidence of increasing pericardial effusion, however, progressive improvement in the left ventricular systolic function with a current ejection fraction approximately 55%. after the patient's hypotension resolved the patient developed subsequent hypertension requiring multiple antihypertensive medications. the patient's blood pressure was titrated to a systolic blood pressure in the range of 140 to 160 in order to maintain renal perfusion. at the time of dictation the patient is currently on hydralazine 5 mg po q 6 hours, metoprolol 50 mg po t.i.d. and clonidine 0.1 mg po t.i.d. 5. hematology: the patient has a known history of anemia with a prior history of a large gastrointestinal bleed. the patient's admission hematocrit was 26.3 (previously 28.1 in of 03). the patient was transfused a total of 5 units of packed red blood cells to date for intermittent hematocrit drops less then 28 given the patient's coronary artery disease. the patient's hematocrit drop is of unclear etiology, however, possibilities include end stage renal disease, bone marrow suppression with immunosuppression agents, as well as slow gastrointestinal bleed (despite consistently negative guaiac studies). hemolysis studies were negative on multiple occasions. the patient also was noted to develop thrombocytopenia during the early portion of the admission with a nadir of 47. the patient's heparin was stopped, however, the hitt antibody was negative. the platelets stabilized at 60 without episodes of spontaneously bleeding or need for transfusion. the thrombocytopenia was felt secondary to immunosuppressive medications, acute illness, as well as potential antibiotics (ceftriaxone) drug effect. 6. endocrine: the patient is status post a pancreatic transplant for type 1 diabetes mellitus in . the patient is maintained on chronic low dose steroids for immunosuppression and received a course of stress dosed steroids early in the admission. per the transplant service the patient was started on an insulin drip (followed by sliding scale insulin) in order to avoid excessive taxation of the transplanted pancrease. the patient's blood glucose remained well controlled throughout the admission. 7. fen: the patient was started on tube feeds on and was advanced to goal without complications. the preceding dictation completes the hospital course from to . the remainder of the hospital course will be completed by the medical service assuming the patient's care. , md dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis other bronchoscopy diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified congestive heart failure, unspecified acute kidney failure, unspecified acute respiratory failure diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled complications of transplanted kidney pancreas replaced by transplant 

Answer: The patient is high likely exposed to