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: demerol / haloperidol / ativan / percocet attending: chief complaint: fatigue and fevers, melena major surgical or invasive procedure: liver biopsy (endoscopic retrograde cholangiopancreatography) repeat (endoscopic retrograde cholangiopancreatography) - exploratory laparotomy, duodenostomy, and oversewing of bleeding location on the ampulla. history of present illness: 64-year-old male with a past medical history of hepatitis c cirrhosis and hepatocellular carcinoma who is status post liver transplantation on . . after his liver transplantation, his course was complicated by recurrent hepatitis c with fibrosing cholestatic hepatitis. he was treated with infergen and ribavirin, but this was discontinued as the patient developed seizures on this therapy. his recurrent hepatitis c was therefore addressed by changing his immunosuppression from prograf to rapamycin. the switch to rapamycin was also done due to the fact that he had hepatocellular carcinoma, and evidence has demonstrated reduced recurrence of hcc in patients on rapamycin therapy. . the patient was recently admitted to the hospital in early due to abnormal liver function tests. his liver biopsy demonstrated moderate acute cellular rejection. he was therefore treated with solu-medrol 500 mg daily for three days and then discharged on oral prednisone. he currently takes prednisone 20 mg daily. he was readmitted to the hospital on . this was due to the fact that he had worsening liver function tests, with an alt of 271 and an ast of 317. his liver biopsy demonstrated no features of acute cellular rejection, but there was evidence of grade 1 inflammation and stage i-ii fibrosis. his rapamycin levels at that time were elevated at 27.3, and therefore this medication was held. the patient was discharged on . upon discharge, he was told to have his rapamycin levels checked on the 29th and then to restart this medication on the 29th after getting his levels checked. these levels are not available in the system, but the patient did restart rapamycin. . the patient was seen in clinic on feeling relatively well. a rapamycin level was drawn: 18.2 on with plan for followup . . the patient describes being extremely fatigued for one week, but decided to come to the ed when he had fevers to 102.8 last night with chills. he describes having diarrhea bm per day despite using lomotil. however, he notes that his bm have not changed in frequency or consistency recently- instead he has had diarrhea since starting on an extensive course of liver medications, including bactrim for prophyolaxis while on sirolimus and prednisone taper. he does not that the color of his diarrhea has changed in the past few days from brown to caramel colored. he has some mild abdominal pain that he associates with his diarrhea, but no ruq pain. he denies chest pain, sob, dysuria or change in urinary frequency. he also denies confusion or change in skin color or abdominal girth. . in the ed, initial vs were: 57 125/80 16 97%. ct abdomen/pelvis in the ed showing no acute intraabdominal pathology. he was started on po vanc for presumptive c diff, and was given 1 mg rapamycin per gi recs. past medical history: -bipolar disorder: diagnosed in , past suicide attempt in the 70s during a manic phase or s/t to drug and alcohol abuse. had been stable on wellbutrin and lithium since and 93 respectively, except for during a trial of ifn therapy in where hospitalization was required. - hcv: genotype unknown. liver biopsy in showed stage 4 cirrhosis and small well-differentiated hepatocellular carcinoma. found to have grade 1 esophageal varices on egd in 4/. developed hepatic encephalopathy in requiring hospitalization at , started on lactulose with good effect. past treatments include peg interferon and ribavirin in . these meds were discontinued due to suicidal ideation. for recent history please refer to hpi. - hcc: recently noted 1.4 cm enhancing lesion on liver imaging, proved to be small, well-differentialed hcc on bx in s/p cadaveric liver transplantation on (dr. ) - hypothyroidism. on levothyroxine as an outpatient. - liver - psych: history of bipolar disorder managed with high dose wellbutrin. prior suicide attempts requiring hospitalization. social history: he lives w/ wife, who is a nurse and two teenage children. no beverage for 30 years. no tobacco use ever. family history: non-contributory. physical exam: gen: nad heent: mmm no lesions cv: rrr no mrg resp: ctab no wrr abd: soft, tender around incision site. no guarding or rebound wound: abdominal incision clean and dry, jp site recently opened with no evidence of active drainage. jp with serous drainage ext: no le edema pertinent results: admission labs: 09:00am urine rbc-0-2 wbc- bacteria-mod yeast-none epi-0-2 09:00am urine blood-mod nitrite-neg protein-75 glucose-neg ketone-neg bilirubin-sm urobilngn-1 ph-5.0 leuk-neg 09:00am urine color-amber appear-clear sp -1.024 09:00am pt-11.7 ptt-29.8 inr(pt)-1.0 09:00am hypochrom-normal anisocyt-1+ poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 09:00am wbc-5.1 rbc-4.02* hgb-11.0* hct-32.7* mcv-81* mch-27.4 mchc-33.6 rdw-14.8 09:00am alt(sgpt)-252* ast(sgot)-426* alk phos-392* tot bili-3.3* 09:00am glucose-191* urea n-27* creat-1.1 sodium-133 potassium-3.7 chloride-100 total co2-21* anion gap-16 09:12am lactate-1.4 . imaging: ct ab/pelvis : impression: 1. no acute abdominal pathology. 2. interval decrease in free fluid surrounding the liver with only a small amount remaining. 3. interval removal of cbd stent without intra- or extra-hepatic biliary ductal dilatation. . cxr : findings: in comparison with study of , there is no interval change or evidence of acute cardiopulmonary disease. no pneumonia, vascular congestion, or pleural effusion. . report: successful biliary cannulation with the sphincterotome. a caliber change was noted between the native and transplanted bile ducts. at the anastamosis there was some resistance as an 8.5 mm balloon was pulled through. otherwise normal post- cholngiogram a 11cm by 10fr biliary stent was placed successfully across the anastamosis . otherwise normal to 3rd portion of duodenum. . recommendations: if the lfts improve following stent placement, balloon dilation of the anastamosis could be performed in 1 month. if the lfts fail to improve following stent placement, we will remove the stent in 1 month. juices when awake and alert, then advance diet as tolerated. further management as per hepatology service. : right upper quadrant ultrasound with doppler: there are no focal or textural abnormalities within the liver. the common bile duct measures 5 mm and is not dilated. the pancreatic body and tail are obscured by overlying bowel gas. however, the remainder of the pancreas appears normal. there is splenomegaly with the spleen measuring 14.7 cm. incidentally noted is a left renal cyst measuring 5.6 x 5.8 cm in sagittal dimension. a single view of the right kidney shows no hydronephrosis. abdominal doppler: the left, main, and right portal veins are patent with hepatopetal flow. the hepatic veins are patent with normal directional flow. the main hepatic artery is patent with normal arterial doppler waveforms. impression: 1. normal hepatic echotexture with no focal lesions. 2. patent hepatic vasculature without evidence of portal vein thrombosis. 3. normal caliber common bile duct measuring 5 mm. 4. splenomegaly. liver, allograft, core needle biopsy: 1. moderate portal/periportal, and mild lobular mixed inflammation including lymphocytes, plasma cells, occasional neutrophils, and eosinophils. occasional apoptotic hepatocytes seen. 2. prominent bile duct damage with infiltrating lymphocytes are seen. 3. focal portal endothelialitis . 4. trichrome stain shows increased portal fibrosis with septa formation and focal minimal sinusoidal fibrosis (stage 2). 5. iron stain shows minimal iron deposition in hepatocytes. note: the findings are consistent with recurrent viral hepatitis c. there is also venulitis which is consistent with acute cellular rejection. brief hospital course: 64-year-old male with a past medical history of hepatitis c cirrhosis and hepatocellular carcinoma who is status post liver transplantation on and presents with fevers at home and diarrhea. . # fevers (micu added course, primary team please update): there was concern for c.diff in the ed given diarrhea with fevers; treatment was started with po vancomycin. of note, the patient's wbc is not elevated but he is immunosupressed so this is not sensitive/expected. of note, another concern in a patient with known liver rejection would be sbp, but the patient does not have ascites on exam or ct and has only mild tenderness to abdominal palpation. rest of infectious workup negative: u/a negative, cxr negative. during his micu course, he spiked a fever to 100.6 on . he was on daptomycin/zosyn at the time. patient was pan-cultured which grew nothing. . # gi bleed: while in the hospital, the patient began to pass burgundy colored stools with small blood clots on evening of and subsequently triggered on the floor for hypotension (85/48). he was subsequently transferred to the micu for closer hemodynamic monitoring in setting of gi bleeding for which colonoscopy indicated a bleeding at his sphincterotomy with hemostasis acheived. he received 4 units of prbc total. he did have some maroon stools after the egd, which may have represented a slow ooze with stable hgb. his hematocrits were stable until the afternoon of when he had a hct drop to 25.9. he was transfused 1 unit, and sent to angio where they could not located the bleeding vessel. he received another unit prbc that night, continued to have maroon stools and w/ continued low hct's. received 10 units as of . had positive tagged rbc scan, then went to angio on , but unable to localize on arteriogram so transferred to surgery service in case surgery indicated. . # s/p (immunosupression): transplanted . had episode of acr s/p steroids and re-bx confirming no evidence of rejection. patient being immunosuppressed with rapamycin. of note, levels have been fluctuating lately. the patient was continued on home med of rapamune 1 daily and mmf 500 was started by floor team. there was concern for rejection/hcv given elevated alkphos. his levels were followed and re-dose as appropriate . # direct hyperbilirubinemia (micu course, primary team to update) patient had admission bilirubin of 3.3 with subsequent uptrend to 12 mostly direct fraction with obvious jaundice. his recent showed a patent extrahepatic system. the concern is for an intrahepatic process or infectious etiology such as virus..... . # hcc: the patient is scheduled for a protocol ct scan on , which will be one year post-transplantation. as of yet, he has not had recurrence of hcc. gi following. . # psychiatric issues incl. bipolar disorder: continued modafinil, seroquel, keppra, effexor . # hypothyroidism: continued synthroid the following is a brief summary of the hospital course while on the surgery service beginning : the patient was taken to the operating room for massive melena s/p sphincterotomy on . see operative report for full details. the patient was transferred to the sicu in good condition. his sicu course was remarkable for post operative delirium, for which a psychiatry consult was obtained. they recommended zyprexa at night and good sleep hygiene which were followed. the patient's hematocrit stabilized and on pod 2 he was transferred to the floor. his ngt was discontinued on pod3, and the patient was started on a clear liquid diet. of note, the patient continued to have melanotic bowel movements after his operation. his hematocrit remained stable, and his hemodynamic status never faltered. he was started on ceftriaxone (later converted to po keflex) on pod 3 for erythema around his incision site. his diet was advanced to regulars on pod4. at this time, his bowel movements began to turn more brown in color. on pod5 he was given 1u prbc's for a hct of 28.3, down from 31 the day before. he responded appropriately. at this time his course was notable for persistent serous drainage in his jp bulb, close to ~500cc a day. by pod 8 the patient's pain was well controlled with oral medication, and was eating and voiding with no difficulty. his melena had completely resolved. he was ambulating with the assistance of a walker. he was discharged on a 7 day course of keflex for management of his wound incision. his jp drain was left in, and the patient had vna services arranged to help with it's care and output recording. lastly, the patient was given a 5 day course of oral lasix to aid with his lower extremity edema. of note, the liver biopsy performed during his operation was notable for recurrent hcv as well as acute rejection. see pathology report for full details. his rapamycin was transitioned to prograf in the interest of better wound healing, and his levels were aimed at slightly higher values. due to his history of prior seizures on high dose prograf, his keppra dosing was increased as well. medications on admission: modafinil 100 mg daily. folic acid 1 mg daily. daily multivitamin. seroquel 25 mg. at bedtime. keppra 500 mg b.i.d. effexor 37.5 mg b.i.d. synthroid 100 mcg daily. hydroxyzine 25 mg p.o. q.i.d. cholestyramine 4 g p.r.n. for itching. bactrim 480 mg daily. omeprazole 20 mg daily. prednisone 10 mg daily. valganciclovir 450 mg daily. mycophenolate (patient does not know dose; no notes mentioning this) rapamycin-- patient has been holding for 2 days per gi reccs, was given 1 mg today in ed discharge medications: 1. modafinil 100 mg tablet : one (1) tablet po qdaily (). 2. folic acid 1 mg tablet : one (1) tablet po daily (daily). 3. multivitamin tablet : one (1) tablet po daily (daily). 4. venlafaxine 37.5 mg tablet : one (1) tablet po bid (2 times a day). 5. levothyroxine 100 mcg tablet : one (1) tablet po daily (daily). 6. hydroxyzine hcl 25 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for itching. 7. cholestyramine-sucrose 4 gram packet : one (1) packet po bid;prn () as needed for itching. 8. sulfamethoxazole-trimethoprim 400-80 mg tablet : one (1) tablet po daily (daily). 9. omeprazole 20 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po daily (daily). 10. valganciclovir 450 mg tablet : one (1) tablet po daily (daily). 11. mycophenolate mofetil 500 mg tablet : one (1) tablet po bid (2 times a day). 12. olanzapine 2.5 mg tablet : two (2) tablet po hs (at bedtime). disp:*60 tablet(s)* refills:*2* 13. levetiracetam 250 mg tablet : three (3) tablet po bid (2 times a day). 14. cephalexin 500 mg capsule : one (1) capsule po q6h (every 6 hours) as needed for wound infxn. disp:*28 capsule(s)* refills:*0* 15. hydromorphone 2 mg tablet : one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*20 tablet(s)* refills:*0* 16. prednisone 5 mg tablet : two (2) tablet po daily (daily). 17. tacrolimus 1 mg capsule : two (2) capsule po twice a day. disp:*120 capsule(s)* refills:*1* 18. tacrolimus 0.5 mg capsule : take as directed capsule po as directed. disp:*180 capsule(s)* refills:*1* 19. lasix 20 mg tablet : one (1) tablet po once a day for 5 days. disp:*5 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: recurrent hepatitis c acute kidney injury gi bleed after sphincterotomy incision cellulitis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted for fever, fatigue, and increased diarrhea. because your lfts were elevated, a liver biopsy was done, which showed infection and recurrent hepatitis c. was done and had a stent placed. fevers continued with elevated liver enzymes, a second was done with placement of 2 stents and a procedure called a sphincterotomy was performed. after this procedure you had bleeding. you went to the or (dr. to stop the bleeding. bleeding stopped. the biliary duct stents have migrated down and are making their way through your intestine. please look at all of your bms to see if you pass 2 blue stents (tubes). if you do not pass these stents, you will have an abdominal xray called a kub on caregroup vna services have been arranged to see you at home for physical therapy. empty and record all output from your jp drain. you may shower. no driving while taking pain medication. no straining/heavy lifting/swimming/shoveling you will need to have labs every and thursday starting thursday at , medical office building followup instructions: provider: , md phone: date/time: 10:30 please reschedule your appointment with dermatology and laser with: , md building: (, ma) campus: off campus best parking: free parking on site department: radiology when: wednesday at 10:15 am with: cat scan building: cc clinical center campus: west best parking: garage provider: 2 (st-4) gi rooms date/time: 10:30 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other enterostomy endoscopic sphincterotomy and papillotomy exploratory laparotomy endoscopic control of gastric or duodenal bleeding endoscopic control of gastric or duodenal bleeding endoscopic insertion of stent (tube) into bile duct replacement of stent (tube) in biliary or pancreatic duct other control of hemorrhage of stomach or duodenum diagnoses: chronic hepatitis c without mention of hepatic coma unspecified acquired hypothyroidism hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure 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 epilepsy, unspecified, without mention of intractable epilepsy diarrhea complications of transplanted liver personal history of malignant neoplasm of liver surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cholangitis bipolar disorder, unspecified precipitous drop in hematocrit jaundice, unspecified, not of newborn other specified disorders of liver 

Answer: The patient is high likely exposed to