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: codeine / enalapril attending: chief complaint: ha x 2 days major surgical or invasive procedure: none history of present illness: mr. is a 47 year old man s/p renal transplant (06/??????03) secondary to amyloid, who felt the onset of a frontal headache 3 days prior to admission. he also noted diarrhea, malaise, and pains in his back and legs. he decided to come for evaluation when he failed to improve at home. at the ed, he was seen by ent after his sinus ct showed chronic sinusitis. a chest x ray showed rul pulmonary consolidation. chest ct showed no change but confirmed changes from aspergilloma. mr. received a renal transplant in ??????03 which was later showing signs of rejecion and was diagnosed with collapsing glomerulonephritis with worsening renal function. over the last few months, he was admitted several times for hyperkalemia, acute renal failure with baseline creatinine , and acidosis. pt on admission noted feeling very fatigued which is the similar complaint on previous admission with hyperkalemia. patient is also on immunosuppressant medications for his post renal management. in the ed, the patient??????s potassium level was recorded as 5.8; he received kayexalate. mr. was admitted to the floor for the further management of his infections and electrolyte imbalances. ros: negative for cough, photophobia, phonophobia, emesis, fevers, chills past medical history: 1. essrd s/p transplant on now collapsing glomerulonephritis 2. amyloidosis 3. sarcoidosis 4. hx of pulmonary aspergillosis 5. hx of hyperkalemia 6. hep b, c, d 7. htn 8. hx of iv drug use 9. sinusitis requiring drainage social history: lives with girlfriend, on disability; 1 packper day x30 years of tobacco use, still currently smoking.no alcohol, but previous history of abuse. family history: diabetes physical exam: vs: t 97.5 bp 1740/98 p 104 rr 16 o2 sat 98% on ra gen: thin aa man, looks very uncomfortable, lying in fetal position on stretcher, heent: dry mm, bilateral proptosis, facial edema, perrla, conjunctiva injected, neck supple lungs: cta bilaterally cor: tachycardic, regular rhythm no murmurs/rubs/gallops abd: ntnd, transplanted kidney palpable and nontender ext: no edema, 2+ dp, strength 5/5 lower extremities pertinent results: admission labs: 09:30am glucose-175* urea n-73* creat-7.2* sodium-137 potassium-4.9 chloride-108 total co2-19* anion gap-15 09:30am calcium-9.3 phosphate-7.5* magnesium-2.6 09:30am fk506-18.4 09:30am urine hours-random urea n-379 creat-56 sodium-64 09:30am urine osmolal-339 09:30am wbc-14.7* rbc-3.95* hgb-12.4* hct-37.3* mcv-94 mch-31.5 mchc-33.4 rdw-13.5 09:36pm lactate-1.7 head ct: no intracranial hemorrhage. obviously, lumbar puncture with cytological analysis is necessary to exclude microscopic quantities of hemorrhage as well as to determine whether a meningeal infection is present. cxr: there has been interval development of a large area of right upper lobe consolidation. the mediastinum also appears more widened than on the prior examination. the right hilar adenopathy and left apical pleural thickening and scarring are again demonstrated cardiac silhouette appears within normal limits. ct of the chest without iv contrast: at the left apex, again seen are soft tissue density opacities with crescentic segments of air with adjacent parenchymal reaction consistent with semi-invasive aspergellosis, which is not significantly changed from the prior study of . there are bilateral ground glass opacities, with calcified mediastinal and bilateral calcified lymph nodes, as well as fibrotic changes at both lung apices consistent with patient's history or sarcoidosis. there are no pleural effusions. there is no pneumothorax. the airways are patent at the level of the segmental bronchi bilaterally. no paracardial effusions are seen. there are coronary artery calcifications seen. a few images through the abdomen demonstrate some calcifications in the left renal artery. sinus ct: mucosal thickening and opacification of the paranasal sinuses, with bony changes consistent with prior history of chronic sinus disease and prior surgery. these findings are not significantly changed in comparison to prior study. cxr: an endotracheal tube and nasogastric tube remain in satisfactory position. calcified mediastinal and bilateral hilar lymph nodes are stable. there has been interval increase in right pleural effusion, which is freely layering on the supine radiograph. bilateral areas of apical pleural thickening appears stable. a hazy area of pulmonary opacification in the right upper lobe is considered stable allowing for differences in technique, and has previously been attributed to an improving area of pneumonia. ct abdomen w/contrast : 1) no definite intra-abdominal abscess. 2) progression of the markedly abnormal small bowel and ascending colon with dilatation and wall edema. there is no definite transition point, and these findings are consistent with peritonitis. 3) decreased amount of the interperitoneal air and ascites makes bowel perforation much less likely. 4) gallbladder wall edema, which can be correlated with the recent ultrasound. 5) bilateral pleural effusions and bibasilar atelectasis. 6) low attenuation regions in the liver, which could represent fatty infiltration. brief hospital course: mr is 45 yo man with mmp including failed kidney transplant on hd amyloid, h/o sarcoid, hep b/c/d, h/o pulm asperigillosis, htn, chronic sinusitis and h/o ivdu who originally presented on with frontal ha times 2 days with back pain, malaise and diarrhea originally admitted to medical service with suspected pna. pt with long and complicated medical course over 6 weeks inculding being on medical service twice, surgical service and sicu stay. this discharge summary is being composed by the second medical service and details his stay after being transferred back from surgery. surgical course as per dr and i will attempt to outline medical course on admission as i was not the primary team; any questions may be adressed to dr . medical course mr. was initially admitted with fevers and cough with evidence of sinusitis and pneumonia. his cultures eventually grew strep pneumoniae and so he was initially treated with unasyn/azithro and this was then tailored to levofloxacin for a 14 day course. since his cultures all remained negative for mrsa his vancomycin was eventually discontinued. other issues included atrial fibrillation with an echocradiogram showing a preserved lv but evidence of an enlarged atrium. he was rate controlled with a beta blocker and with diltiazem as no other combinations appeared to work. he reverted to sinus rhythm. attempts were made at starting heparin for anticoagulation but he kept having significant nosebleeds and so this was stopped with instead the plan to start low dose coumadin as an outpatient. he was noted to be guiaic positive before even teh noseblled started and so an egd was done to rule out pud on chronic steroids. this did not reveal significant disease. with respect to his renal failure his renal function continued to decline indicating failure of his transplant. he has known significant thrmobosis and narrowing of his chest vessels and so we consulted ir to see if any access was left. they felt that given the risk of sharp cannulation in teh chest we should proceed with either a leg access catheter or a pd catheter and arrangements were made for him to undergo pd catheter placement. on day of surgery he was oxygenating well, felt well with a normal exam, and was anxious to go home. surgical course after informed consent was obtained, he was brought to the operating room and was placed on the operating table in the supine position. mac anesthesia was performed. an area on the right side of the patient&#8217;s abdomen was identified, and he was prepped and draped for placement of peritoneal dialysis catheter. one percent lidocaine was used to infiltrate the skin overlying the insertion site of the catheter. a skin incision was made with a 15 blade scalpel. at this time, the patient began having desaturations and difficulty maintaining his airway. this was precipitated by placement of nasal trumped by anesthesia and subsequent bleeding after. the procedure was aborted. a respiratory code was called at this time, a direct laryngoscopy intubation was performed. the patient appeared to have suffered an epistaxis event and during the sedation process was unable to clear his airway, resulting in airway obstruction and desaturation. once the endotracheal tube was placed, then the position was confirmed with direct auscultation of the chest as well as with end tidal co2. the patient's saturations increased to 100 percent. he was suctioned for a minimal amount of blood in his airways, and an orogastric tube was also placed, with very minimal blood returned from his gastric cavity. the patient was transferred to the surgical intensive care unit in stable condition. the next day a second placement peritoneal dialysis catheter was attempted. the patient was taken to the operating room where general endotracheal anesthesia was maintained. sicu course once stable overnight, he was kept intubated and returned to the operating room the next day to place the catheter. preoperative antibiotics were checked and had been administered. a 4 cm incision was made lateral to the umbilicus and taken down to expose the anterior rectus sheath. this was incised and the rectus muscle was split revealing the posterior sheath. this was incised and a hole was made in the peritoneum. the perineal dialysis catheter was placed and immediately on placing it, purulent material came out. this was sent for a stat gram stain, which demonstrated 3 plus polys but no organisms. given this finding it was clear that the peritoneal dialysis catheter should not be placed at this time, however, there was the concern about some intra-abdominal pathology causing this problem. we then proceeded to an extensive exploratory laparoscopy including direct visualization of the liver which appeared nodular and possibly cirrhotic, the gallbladder which appeared normal and was easily distensible, the bowel looked normal. the pancreas was not visualized. there was a small amount of purulent fluid throughout the abdomen. the choice at this time was to do a full laparotomy for more definitive look, however i thought that in a patient with hepatitis c, possible cirrhosis, renal failure and the rest of his comorbidities that the risks of this procedure outweighed the benefits. in the icu a ct scan of the abdomen with iv and po contrast was done the same day. the finding were consistent with no evidence of intra-abdominal abscess. lab workup was consistent with a pancreatitis. on ct a right femoral venous line was seen with the tip of the line located in the ascending lumbar vein branch. if the position desired is the common iliac vein, recommend withdrawal of this line 2-4cm. pancreatic enzymes where send found to be elevated( lipase 3000's-) and ast 1200/alt 500() while in sicu, volume controlled with cvh (started ). for persistent fevers, abx regimen changed to include vanc/zosyn/fluc () empirically. the etiology of his pancreatitis was never elucidated - perhaps related to his gi procedure or perhaps due to his excessive drinking in the day pta. patient remained intubated for the next 3 weeks for airway protection. due to recurrent bleeding after ent removed the nasal blaoon placed with need of immediate replacement 2 times prior to extubation; he underwent fiberoscopic eval of his nasopharynx without visualization of his source of bleed. he was fluid overload, due to delay in dialysis and intraop fluid replacement. had no leak for the first 2 weeks. patient was extubated without complications. patient was always found to be confused especially at night pulled his picc line twice, his feeding tube 3 times and his dialysis catheter on /5. after perm cath was placed with out complication patient was transferred to medicine. medical course: on the medical service his issues remained as follows until discharge: 1) esrd: pt with h/o esrd amyloidosis s/ failed crt originally being immunosupressed with fk506 and prednisone. pt followed closely by the renal transplant unit here at . after sicu stay, surgical service placed a tunneled right femoral hd catheter and hd started. prior to which pt underwent cvh. pt tolerated hd well without complication. however hd catheter displaced twice and replaced by ir. during which, angiographic evidence of iliac dvt seen (see below for plan). pt maintained on hd 3times daily. pt discharged home with tunnelled femoral hd catheter. but he would benefit from pd catheter in future once recovered from this long hospital course. 2) id: pt with complex history as detailed above, but included sinusitis, pna and purulent ascites. all of which were properly treated and seemingly resolved. after transfer pt had one episode of low grade fever (100.4) prompted evaluation for possible infectious sources. pt started on vancomycin and ceftazidine empirically and in part due to positive urinalysis. cxr without pna. cdiff came back positive and flagyl added to antibiotic regimen. pt remained afebrile and without leukocytosis. as bcx and ucx remained without growth, abx scaled back to flagyl only to be continued for an additional 10 day course at rehab. this will complete on . 3) ms changes: as per notes, there was evidence that mr was sufferring from delerium and confusion most likely secondary to uremia during initial hospitalization. as pt was extubated in sicu, he remained confused and agitated. he was slow to improve over the next 3 weeks and was still with evidence of baseline confusion, but obviously improved. etiology of continued mental status changes unclear, but likely multifactorial including uremia, prolonged sicu stay, periods of hypoperfusion and possible hypoxia. pt seen and evaluated by neurology service who agreed with assesment and saw no acute neurologic process. mri obtained and reviewed which again showed evidence of old ischemic changes and increased signal in globi pallidi which could reflect metabolic abnormality. there was no evidence of acute infarction or any granulomatous masses. lumbar puncture performed which ruled out possible infectious origins; as it was completely normal including opening pressure. believed pt will comtinue to slowly improve with maximum supportive care and has his health improves i.e. nutritional/functional status so will his mental status. follow up with neurology as outpatient may be indicated if mental status change ceases to improve. 4) vte: pt with known history of extensive ue venous thrombosis. later in course pt found to have le dvt while having femoral hd catheter replaced. during which the inferior venacavagram demonstrated a patent ivc. venagram performed in the right iliac vein demonstrated thrombus surrounding the catheter within the common iliac, external iliac, and common femoral veins, with no significant venous flow around the thrombus. flow was seen in the ivc from a patent left iliac vein. catheter was replaced without difficulty. pt without signs of clot propagation or extension. in an ideal situation, mr would have been fully anti-coagulated yet this was not felt to be without risk: his history of severe epistaxis requring intubation for airway protection and balloon tamponade. ivc filter not reasonable high risk of thrombosis which would eliminate any chance of hemodialysis in future. decsion made considering the risks of rebleeding vs continued thrombosis with input from renal to anticoagulate with low dose coumadin for goal inr 1.5-2.0. he will required daily inr's and coumadin adjustments accordingly. he will need outpt f/u w/ coumadin clinic after dc/'d from rehab. 5) pancreatitis: during sicu stay, pt with asx pancreatitis (lipase 3000's) of unclear etiology but believed secondary to propofol. pt placed on bowel rest and given tpn. pancreatitis slowly resolved as lipase trending down slowly during course of admission. diet was advanced and tolerated well without pain or increased pancreatic enzymes. 6) hepatitis: pt with h/o hep b,c,d without evidence of decompensated liver failure. lfts normal at admission, however elevated during sicu stay precipitated by hypotension and presumed shock liver. lfts trended down and never with evidence of decreased synthetic function. 7) nutrition: mr obviously sufferring from malnutrition secondary to prolonged hospitalization and poor po. pt tolerated po but consumed little without encouragement. pt on tpn for a good portion of admission. unfortunately unable to get picc secondary to ue thrombosis, so tpn could not be continued. please give boost supplements with meals. 8) positive spep/upep: in w/u for hypercalcemia, found w/ elevated igg on spep and proteins on upep. has had elevated igg spike from past speps. he does not have previosu ct's or imaging showing bony erosion. in speaking w/ oupt renal and intpatient primary team, it was felt that further w/u could be done as outpt and for this reason, given number for hematology/oncology. 9) pulmonary aspergillus: continued on antifungals. has oupt f/u appt w/ dr. from id on . medications on admission: 1. tacrolimus 1 mg b.i.d. 2. prednisone 5 mg q.d. 3. itraconazole 200 mg b.i.d.. 4. bactrim single strength 400/80 q.d. 6. lisinopril 5 mg q.d. 7. kayexalate 30 mg twice/week 8. bicarb 650 9. nephrocaps 10. lasix discharge medications: 1. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 2. itraconazole 100 mg capsule sig: two (2) capsule po bid (2 times a day). 3. calcium acetate 667 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 4. coumadin 5 mg tablet sig: one (1) tablet po at bedtime for 1 doses: please give 5 mg on night of , then change to 3 mg. . disp:*30 tabs* refills:*2* 5. tacrolimus 0.5 mg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*0* 6. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 7. coumadin 3 mg tablet sig: one (1) tablet po at bedtime: please start on . please adjust dose based on daily inr checks. (goal inr 1.5-2.0). 8. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 9. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 10. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 10 days: to complete on . 11. diltiazem hcl 60 mg tablet sig: one (1) tablet po qid (4 times a day): please alternate with lopressor dose. 12. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po bid (2 times a day): hold for sbp<100, hr<60. 13. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 14. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 15. multivitamin tablet sig: one (1) tablet po once a day. 16. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day). 17. outpatient lab work please arrange for daily inr to be checked. goal inr is 1.5 to 2.0. he will receive 5 mg coumadin and then 3 mg following. please check inr daily as above. discharge disposition: extended care discharge diagnosis: pancreatitis lower extremity deep venous thrombosis epistaxis sinusitis pneumonia paroxysmal atrial fibrillation end stage renal disease on hd, s/p kidney transplant h/o aspergillosis, on itraconazole cdiff discharge condition: good discharge instructions: please return to the hospital or see your primary care physician if you experience bleeding, chest pain, shortness of breath, fevers >100.4, or any other concerns. please also return for recurrent epistaxis. followup instructions: the following appointments have been scheduled for you: 1. provider: , (transplant) transplant center-medicine where: lm center phone: date/time: 2:30 2. provider: , md where: lm center phone: date/time: 3:40 please call at to set up an appoitment with a primary care physician after you are discharged. please schedule an appointment at the clinic () contact information for the anticoagulation management service (goal inr 1.5-2.0): , 5. please call the oncology office at tomorrow for arranging for appt in several weeks for spep/upep procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis venous catheterization for renal dialysis laparoscopy esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine other incision of skin and subcutaneous tissue control of epistaxis by other means angiocardiography of venae cavae closed [endoscopic] biopsy of rectum infusion of vasopressor agent diagnoses: hyperpotassemia nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere urinary tract infection, site not specified congestive heart failure, unspecified acute and subacute necrosis of liver acute kidney failure, unspecified acquired coagulation factor deficiency other pulmonary insufficiency, not elsewhere classified atrial fibrillation sarcoidosis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease pneumonitis due to inhalation of food or vomitus blood in stool compression of vein intestinal infection due to clostridium difficile complications of transplanted kidney other complications due to renal dialysis device, implant, and graft acute pancreatitis epistaxis aspergillosis pneumonia in aspergillosis bacterial pneumonia, unspecified unspecified viral hepatitis c with hepatic coma chronic frontal sinusitis 

Answer: The patient is high likely exposed to