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: tetracyclines / demerol / penicillins attending: chief complaint: rlq pain major surgical or invasive procedure: 1. renal biopsy - 2. endotracheal intubation 3. tracheostomy 4. peg 5. central venous line placement - removed 6. arterial line placement - removed 7. picc line placement history of present illness: mrs. is a 46f with pmh significant for fsgs s/p live donor renal transplant in , on csa and prednisone, with h/o ureteral stricture s/p multiple stentings by urology service, last in . she presents today with few days h/o rlq pain (over transplanted kidney site), chills, and dysuria, with nausea, but no vomiting. she did have some non-bloody loose stools 2 days ago, for which she took immodium x 1, and resolved. she was also noted to have worsening of her her renal function, with elevation of her bun/cr to 35/3.0, from baseline creatinine 2.2. her creatinine has been gradually worsening over the past year, from 1.8 in to 2.2 on , to 2.5 on . she last saw dr. in clinic in , at which point he asked her to decrease her csa dose from 100mg po bid to 100mg po qd alternating with 200mg po qd; however, per her report, she has continued to take 100mg po bid. last csa level 264 on . . in the ed, her initial vs were t 99.3f, bp 170/82, hr: 105, rr: 18, satting 94% on ra. she was found to have a slightly elevated wbc to 11.1 (68% pmn), and, as above, bun/cr of 35/3.0. a transplant renal u/s was done, which demonstrated no evidence of hydronephrosis, normal vascular flow and indices, and no fluid collections. lactate was 1.8. ua demonstrated small blood, small le, neg nitr, 3-5wbc with 0-2rbc, few bacteria, 0 epi. a repeat ua was sent, which was similar, except demonstrating 0-2 wbc. renal service saw her in the ed, and recommended levofloxacin 500mg po x 1, followed by 250mg po q48h, and 1l ns, which she received. pt deferred pelvic exam. also recommended were urine lytes (fena 1.95%), lfts/amylase/lipase, which were pending at time of admission, and transplant surgery consult, who were notified of her admission. she was admitted to the hepatorenal service for further inpatient management. past medical history: 1. esrd s/p living related renal transplant in single left kidney and focal glomerulosclerosis; c/b ureteral stricture, s/p ureteral stent placement, last exchanged 2. hypertension 3. depression 4. chronic pain 5. hyperlipidemia 6. endometriosis 7. severe gastroparesis on gastric emptying study social history: significant for a 20 pack per year history of tobacco. denied any alcohol or ivdu. she lives with her husband and son. family history: nc physical exam: vs: t: 98.4f bp: 196/90 hr: 84 rr: 18 sao2: 100% ra gen: lying comfortably in bed, mild abd distress heent: perrl, mmm cv: rrr, nl s1 and s2, no m/r/g chest: ctab, no w/r/r abd: soft, mildly ttp over transplant kidney site extr: no le edema, 1+ dps bilaterally neuro: a&ox3, no asterixis pertinent results: admission labs: . 02:05pm plt count-197 02:05pm neuts-68.1 lymphs-26.8 monos-3.4 eos-1.0 basos-0.7 02:05pm wbc-11.1* rbc-4.71 hgb-14.7 hct-41.4 mcv-88 mch-31.3 mchc-35.6* rdw-13.9 02:05pm urine gr hold-hold 02:05pm urine uhold-hold 02:05pm urine hours-random 02:05pm urine hours-random 02:05pm albumin-3.7 calcium-8.9 phosphate-3.6 magnesium-1.8 02:05pm lipase-47 02:05pm alt(sgpt)-9 ast(sgot)-15 alk phos-115 amylase-57 tot bili-0.5 02:05pm glucose-92 urea n-35* creat-3.0* sodium-139 potassium-4.5 chloride-104 total co2-24 anion gap-16 02:17pm k+-4.6 04:37pm lactate-1.8 04:37pm comments-green top 05:15pm urine rbc-0-2 wbc- bacteria-few yeast-none epi-0 05:15pm urine blood-sm nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-sm 05:15pm urine color-yellow appear-clear sp -1.008 05:15pm urine uhold-hold 05:15pm urine hours-random 05:27pm cyclsprn-494* 06:19pm urine rbc-0-2 wbc-0-2 bacteria-occ yeast-none epi-0-2 06:19pm urine blood-sm nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-sm 06:19pm urine color-yellow appear-clear sp -1.006 06:19pm urine uhold-hold 06:19pm urine hours-random creat-41 sodium-37 potassium-14 chloride-23 pertinent labs/studies: . wbc: 11.1 ->> 24.2 ->> 8.0 creat: 3.0 ->> 4.0 ->> 1.6 . 02:58pm blood caltibc-178* ferritn-606* trf-137* 03:30pm blood hiv ab-negative 07:58am blood anca-negative b . . . imaging studies: : renal us - no evidence of hydronephrosis. . : echo - impression: normal biventricular global and regional systolic function. small pericardial effusion without echocardiographic signs of tamponade. . : ct c/a/p - impression: 1) no perinephric fluid collections or hematoma surrounding the transplanted kidney. 2) air in the collecting system of the transplanted kidney and bladder as described above. 3) endotracheal tube position approximately 1cm from the carina. . : ct a/p - impression: 1. diffuse small bowel dilatation. contrast passes throughout the colon to the rectum at the time of imaging. findings are most consistent with an ileus. if there is concern for developing small bowel obstruction, serial abdominal radiographs are reccomended. 2. new small amount of ascites around the liver. 3. residual droplets of air in the transplant renal collecting system and bladder. nephroureteral stent in place. no hydronephrosis of the transplant. . : echo - the left atrium is normal in size. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is a small circumferential pericardial effusion with no echocardiographic signs of tamponade. . : portable cxr - portable ap chest radiograph: compared to prior radiograph from . the area of consolidation in the right lower lobe has resolved and now remains residual atelectasis. the left retrocardiac opacity persists and likely represents consolidated portions of lung. no pleural effusions are seen. mild cardiomegaly is unchanged. no pulmonary vascular congestion or pulmonary edema is seen. mediastinal and hilar contours are normal. tracheostomy tube is seen in appropriate position. the tip of the left picc line overlies the expected region of the mid svc. . impression: resolution of right lower lobe consolidation, now with residual atelectasis. persistent left lower lobe/retrocardiac consolidation. . . pathology: : renal allograft biopsy - chronic allograft nephropathy. there is no evidence of acute cellular rejection in this sample. the differential diagnosis also includes "acute tubular necrosis", obstruction, and drug nephrotoxicity. cortical sample size is quite limited, and may not be representative of the organ. . . microbiology: . blood cultures: ; ; ; , , , , , : no growth : pending, no growth to date . urine cultures: , -> coag negative staph : no growth . bal - - 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive cocci. cx - 10k -100k coag + staph - no sensitivities performed (sputum revealed mssa) . sputum - : 4+ gpc, cx - sparse growth mssa - sparse growth coag + staph (presumed mssa) - cancelled due to op flora contamination - cancelled due to op flora contamination . : ebv - igm negative, igg positive ; - cmv viral load undetectable . stool: -> : c. diff negative x 10 samples . : rapid virus screen - negative discharge labs: . . 05:32am blood wbc-8.0 rbc-3.01* hgb-8.6* hct-26.6* mcv-89 mch-28.7 mchc-32.4 rdw-19.6* plt ct-484* 03:24am blood neuts-15* bands-9* lymphs-30 monos-13* eos-24* baso-1 atyps-4* metas-2* myelos-1* promyel-1* nrbc-17* 03:28am blood pt-12.8 ptt-26.0 inr(pt)-1.1 05:32am blood glucose-142* urean-54* creat-1.6* na-146* k-4.0 cl-109* hco3-29 angap-12 12:25pm blood alt-29 ast-23 alkphos-99 03:55am blood alt-26 ast-25 ld(ldh)-272* alkphos-89 amylase-88 totbili-0.2 03:55am blood lipase-118* 05:32am blood calcium-8.7 phos-2.9 mg-1.8 iron-pnd 05:32am blood ferritn-pnd trf-pnd brief hospital course: assessment: 46f with h/o fsgs s/p liver donor renal transplant c/b ureteral stricture s/p multiple stentings, presenting with few days of rlq pain, chills, and dysuria, and elevation in creatinine. . her initial course on the medical floor was notable for persistent acute renal failure. she was cultured and eventually underwent a renal biopsy that showed chronic allograft nephropathy. after the renal biopsy pt was noted to have decreased hct from 40-30, was given 2.5 liters of fluid through the day, then received 1u prbc finished at 12am, triggered at 4am for hypoxia, noted to desat to 60s, placed on nrb with increase of o2 sat to 80s, o/w vs were 98.8 112 144/90 rr 40, satting 80s on nrb. abg performed showed 7.26/47/74. pt given 40 lasix with increase uo of 140cc/hr then another 200 lasix. she was treated supportively for possible trali and placed on bipap with increases in her oxygenation to 95%. the remainder of her course will be by problem. . #. respiratory failure: felt to be initially be to trali (as happened around 48 hours after transfusion) did not improve with diuresis and cxr findings also suggestive. however, ultimate work up by blood bank was not consistent with this diagnosis. she was intubated within 12hours of the acute failure on and vent settings changed to ardsnet protocol for lung protective strategy. a discussion was taken with blood bank and it seems likely that this was trali initially based on initial clinical course, but the clinical picutre was confusing given prolonged course. this incidentally does not effect the ability to get future transfusions. her respiratory decompensated further while on the vent with fevers, elevated wbc and increase production sputum. mssa grew from sputum and bal, and she was treated initially on vanco and zosyn but swithced to nafcillin on when sputum returned with mssa. she was swithced back to vancomycin after a coag negative staph came back in her urine and completed a total of 8 days of vancomycin. she remained difficult to wean, felt mainly to be due to volume overload, agitation requiring heavy sedation (as below) and dense consolidations from the above mssa-ventilator associated pneumonia. as her respiratory failure persisted, a tracheostomy and j-tube placement was performed on . from there, a vent weaned continued, moving her at first to pressure support and slowly decreasing the support daily. the wean was delayed by a recurrent mssa ventilator-associated pneumonia, treated with an eight-day course of vancomycin (and briefly cefepime for the first few days; this was stopped after a few days, as below, as she was felt to be allergic to naficillin). at the time of discharge, she continued to require intermittent ventilatory support, but was doing well for hours at a time on trach mask. while on the ventilator, she appeared quite comfortable on pressure support of with 40%fio2, with rr's around 18 and tidal volumes easily in the 500's. the last few days the patient has been undergoing trach mask trials. on she tolerated 12 hours, 5 hours on , and only a few minutes on . on she was placed back on cpap/ps because of desat to low 80s. of note, the last few days prior to discharge patient has been having low grade temp to 100.5, although afebrile last 24 hours. repeat cxr on revealed resolution of previously identified right ll opacification but persistent left retrocardiac opacity. if the patient spikes a temperature again, consideration should be made towards repeat treatment of vap. . #. renal failure: the intial renal failure with which she was admitted was felt to probably be due to atn and resolved on its own back to a baseline cr of 1.7-2.0. she was continued on her mycophenolate 500mg po bid and prednisone 5mg daily. however, on in the setting of a drug rash, fever, and eosinophilia, as below, her cr worsened, eventually peaking at 3.1 on . this was felt to be due to acute interstitial nephritis; this responded well to high dose steroids (hydrocortisone 100mg tid x 1 day, then moved to , now 25mg ), with rapid improvement in cr back to 1.6 on the day of discharge. as requested by the renal transplant service, the patient will now be discharged on prednisone 5mg po bid and cellcept 500mg iv bid. it has been requested that the patient have follow up with dr. from transplant within one week at which time decisions towards appropriate immunsuppressive therapy will be made. the patient should have chem panel performed two to three times weekly to monitor renal function. if there are any abnormalities noted, dr. should be notified please at . . #. allergic reaction: on , mrs. was noted to have a truncal erythematous macular rash that became increasingly intense and confluent, spreading to her face and down her extremities. she also began spiking fevers and, as above, developed worsening renal function. dermatology saw the rash and felt that naficillin most likey caused this reaction and that it was worsening because of the cefepime, which was subsequently stopped. on high dose steroids (mainly started for probably ain) and topcial triamcinolone, her rash improved. she was not given any further beta-lactam based medications. . #. leukopenia: on , mrs. unexpectedly became leukopenic, dropping her wbc from 10 to 2. hematology was consulted and they felt that this was probably medication related. her leukopenia has since resolved. . #. agitation - during her period of ventilation, prior to wean attempts, the patient was noted to be very agitated, requiring large doses of fentanyl, versed as well as propofol. with addition of standing haldol, initially as much as 5mg iv q 6hours plus prn, the patient was slowly able to be weaned from sedation over a number of days. she most recently has been maintained on a fentanyl 72 hour patch 25mcg/hr, ativan .5mg + prn for ciwa > 10 (with little need for prns) and haldol has been decreased to 5mg . weaning attempts have been complicated by agitation with difficulty dissociating respiratory discomfort/distress from agitation. it is suspected that some of her agitation earlier was secondary to withdrawal from narcotics and benzos given the large amounts she was requiring previously for adequate sedation while vented. ongoing efforts should be made to decrease her ativan, and haldol as possible from standing to prns only to off. as mentioned above, additional consideration towards worsening respiratory status should be made given persistent left retrocardiac opacity (atelectasis vs. small effusion vs. pna) . #. ileus - the patient was intially noted to have some abdominal pain and distention. ct imaging revealed an ileus, likely secondary to large opiate requirements. with weaning of sedation and a trial of naloxone po to increase bowel motility, the patient's ileus resolved. she is now tolerating tube feeds at goal of 55/hr. (of note: after patient was discharged, dose of cellcept changed to 500mg iv bid per renal. this was communicated to the receiving rehab) medications on admission: cyclosporine 100mg po qod / 200mg po qod alternating prednisone 2.5mg po qd trazodone 100mg po qhs xanax 1mg po tid discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain, fever. 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed. 5. ipratropium bromide 17 mcg/actuation aerosol sig: eight (8) puff inhalation qid (4 times a day). 6. albuterol 90 mcg/actuation aerosol sig: 8-10 puffs inhalation q4h (every 4 hours). 7. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane qid (4 times a day). 8. lansoprazole 30 mg susp,delayed release for recon sig: one (1) po daily (daily). 9. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed. 10. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 11. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 12. metoclopramide 10 mg tablet sig: 0.5 tablet po qidachs (4 times a day (before meals and at bedtime)). 13. triamcinolone acetonide 0.1 % cream sig: one (1) appl topical (2 times a day). 14. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 15. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 16. fentanyl 12 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours). 17. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 18. epoetin alfa 10,000 unit/ml solution sig: () units injection qm/w/f (): dose recommended by renal. 19. haloperidol lactate 5 mg/ml solution sig: five (5) mg injection qpm (once a day (in the evening)): please taper as possible. 20. prednisone 5 mg tablet sig: one (1) tablet po twice a day: patient needs to follow up with dr. () for for directions towards appropriate taper. 21. haloperidol lactate 5 mg/ml solution sig: 3-5 mg injection (2 times a day) as needed for agitation. 22. lorazepam 2 mg/ml syringe sig: one (1) injection q6h (every 6 hours) as needed: taper off ciwa as tolerated. can d/c if no prn needed > 48 hours. 23. mycophenolate mofetil 500 mg iv bid discharge disposition: extended care facility: medical center - discharge diagnosis: primary: 1. respiratory failure, hypoxic 2. acute on chronic renal failure 3. end stage renal disease s/p living related renal transplant in 4. ventilator associated pneumonia 5. s/p renal biopsy 6. s/p tracheostomy 7. s/p j-tube placement 8. leukopenia, resolved 9. drug rash, resolved 10.anemia secondary - hypertension - depression - chronic pain - hyperlipidemia - endometriosis - severe gastroparesis discharge condition: stable - ventilated (with tracheostomy), on tube feeds. . vent settings: pressure support ventilation, 10 (insp)/5 (exp), 40% fio2 with daily trials of trach mask discharge instructions: 1. please continue to take all medications as prescribed. 2. please keep all outpatient appointments 3. if you experience any worsening fever, cough, sputum production, or worsening in your vent settings, please seek medical attention. followup instructions: 1. please follow up with your pcp . within two weeks of discharge from the rehab facility. please call his office at to make an appointment. . 2. patient requires follow up with dr. . transplant has requested the patient be seen within one week. unfortunately, this appointment could not be made prior to discharge. please call at (nurse who can help arrange scheduling) to make this appointment. if any difficulty, please call to arrange an appointment. patient will require appropriate transportation. thank you . 3. provider: , m.d. date/time: 3:30. if you are unable to make this appointment, please call dr. office at ( to reschedule an appointment. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other enterostomy insertion of endotracheal tube enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [percutaneous] [needle] biopsy of kidney central venous pressure monitoring transfusion of packed cells diagnoses: anemia in chronic kidney disease acute kidney failure, unspecified unspecified septicemia candidiasis of other urogenital sites infection with microorganisms resistant to penicillins sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hemorrhage complicating a procedure acute respiratory failure methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site paralytic ileus acute glomerulonephritis with other specified pathological lesion in kidney dermatitis due to drugs and medicines taken internally surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other and unspecified complications of medical care, not elsewhere classified precipitous drop in hematocrit complications of transplanted kidney gastroparesis acute edema of lung, unspecified mixed acid-base balance disorder cephalosporin group causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to