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 66-year-old gentleman status post cadaveric renal transplant in secondary to autoimmune glomerulonephritis who presents with fevers and rigors. the patient was recently discharged from on for pneumonia, congestive heart failure exacerbation, and gastrointestinal bleed (on heparin), as well as transaminitis. the patient was in his physician's office at approximately 3 p.m. on the day of admission when he developed rigors. the patient was being seen by his nephrologist when he developed rigors and was sent to the emergency department. the patient states his only symptoms prior to admission were one to two days of explosive stools four to five times per day (loose/watery stools). the patient denies any other symptoms including cough, upper respiratory infection symptoms, dysuria, headache, chest pain, or shortness of breath. however, the patient states he has been a bit more fatigued recently with some increase in his lower extremity edema. the patient states he had some mild abdominal cramping associated with his stools and some mild nausea in the emergency department. the patient states he has a nephew that was recently sick with upper respiratory infection symptoms. in the emergency department, the patient received kayexalate, 1 ampule of dextrose 50, zofran, 10 units of insulin, and ceftriaxone. past medical history: (the patient's past medical history includes) 1. status post cadaveric renal transplant in complicated by delayed graft rejection. 2. coronary artery disease; status post coronary artery bypass graft and status post myocardial infarction times two. 3. congestive heart failure (with an ejection fraction of approximately 40%) and a dry weight of 208 pounds. 4. end-stage renal disease secondary to autoimmune glomerulonephritis. 5. atrial flutter; status post ablation in with resultant atrial fibrillation. 6. history of pulmonary endocardia in . 7. history of bladder cancer; status post esophagogastroduodenoscopy treatment in . 8. gastrointestinal bleed on heparin. 9. history of line-related deep venous thromboses. 10. history of a right adrenal lesion that remains stable. medications on admission: (the patient's medications included) 1. nph 20 and 12. 2. humalog sliding-scale. 3. sirolimus 4 mg by mouth once per day. 4. cyclosporin. 5. prednisone 5 mg by mouth once per day. 6. mycophenolate 100 mg by mouth twice per day. 7. digoxin 0.125 mg by mouth every other day. 8. iron. 9. vitamin d. 10. sodium bicarbonate three times per day. 11. calcium acetate 1334 mg by mouth three times per day. 12. neurontin 100 mg by mouth once per day. 13. pentamidine every month. 14. protonix 40 mg by mouth twice per day. 15. metoprolol 50 mg by mouth twice per day. 16. aspirin. 17. lipitor. 18. epogen every week. allergies: allergies include bactrim, pravachol, mevacor, and vancomycin. social history: the patient is in early retirement as a computer illustrator. he lives with his wife, and daughter, and mother-in-law. quit tobacco 25 years ago. no laceration use. physical examination on presentation: the patient's physical examination revealed his temperature was 103 degrees fahrenheit in the emergency department, his blood pressure was 180/53, his heart rate was 67, and his oxygen saturation was 100% on 2 liters. in general, the patient was well-appearing but pale. in no acute distress. head, eyes, ears, nose, and throat examination revealed the sclerae were anicteric. the mucous membranes were moist. the tongue with whitish plaques. the cheeks were flushed. jugular venous pressure was approximately 12 cm. cardiovascular examination revealed a 2/6 systolic ejection murmur. a regular rate and rhythm. lung examination revealed good air movement. the lungs were clear to auscultation aside from bibasilar crackles (right greater than left). the abdomen was soft, nontender, and nondistended. there were positive bowel sounds. extremity examination revealed 1+ pitting edema pretibially. there were venous stasis changes bilaterally on the right greater than the left. there was some increased warmth on the right lower extremity. the patient's left wrist had a 3-cm x 3-cm eschar surrounded by erythema. neurologically, the patient was alert, awake, and oriented times three. the patient was conversant. there were no focal deficits. cranial nerves ii through xii were intact. pertinent laboratory values on presentation: laboratories revealed the patient's white blood cell count was 13.1 (with 64% neutrophils, 0% bands, and 27% lymphocytes), his hematocrit was 32.2, and his platelets were 259. chemistry-7 revealed the patient's sodium was 139, potassium was 7.4 (on repeat was 6.4), chloride was 107, bicarbonate was 62, blood urea nitrogen was 3.6, creatinine baseline has ranged from 3 to 4, and his blood glucose was 160. his calcium was 9.6, his magnesium was 2.1, and his phosphorous was 4. his alanine-aminotransferase was 245 (from 26). his aspartate aminotransferase was 328 (from 21). his lactate was 2.5 to 3.2; originally 6.2. pertinent radiology/imaging: a chest x-ray revealed questionable bilateral patchy infiltrates; unchanged from prior examination. electrocardiogram revealed atrial fibrillation with a right bundle-branch block. peaked t waves. concise summary of hospital course by issue/system: the patient was sent to the intensive care unit from the emergency department for treatment and evaluation given concern for sepsis. the patient was placed on a sepsis protocol in the emergency department despite never having an episode of hypotension. the patient was treated in the intensive care unit with ciprofloxacin and linezolid given concern for a possible right lower extremity cellulitis and/or pseudomonal infection of the lung or community-acquired pneumonia. 1. sepsis issues: the patient had an elevated lactate on presentation to the emergency department as well as a fever and elevated white blood cell count. the patient never required hemodynamic support. no clear source of an infectious process was ever found. blood cultures remained negative throughout the hospital stay. stool cultures, given the patient's history of explosive bowel movements, were negative as well for clostridium difficile, campylobacter, escherichia coli, and yersinia. the urine cultures were also negative. given the patient's level of immunosuppression, cytomegalovirus viral load as well as - virus pcr were sent. the patient had elevated transaminases as well as diarrhea. therefore, there was significant concern for cytomegalovirus with associated colitis. the infectious disease service was consulted for input regarding treatment. the infectious disease service was recommended the patient be started on empiric ganciclovir treatment with induction therapy with adjustment for his renal insufficiency. please also note that his stool cultures were negative for shigella and salmonella as well. given the patient's complaint of a sore throat on the second hospital day as well as some red blood cells with questionable casts seen on urine microscopy, an aso titer was sent for concern for a streptococcal infection. the patient's aso titer was positive; indicating a likely recent streptococcal infection. his cytomegalovirus viral load was not detected. an - virus igm was also negative. the patient's linezolid was discontinued on his second hospital day, and his ciprofloxacin was continued until his stool cultures returned negative for concern of bacterial colitis. when the cytomegalovirus viral load returned negative, the patient's intravenous ganciclovir was discontinued. the patient was started on penicillin therapy given his positive aso titer and treated for a total of 10 days with penicillin vk four times per day dosing. the patient was to have follow-up aso titers as an outpatient. there was some thought that the possible streptococcal infection was briefly a toxic shock syndrome caused by streptococcus resulting in elevated liver function tests. however, this acute streptococcal infection affecting the kidney was thought less likely given his normal compliment levels. the patient was to follow up with dr. on as well and get his blood work checked on . 2. elevated transaminases/transaminitis issues: the patient's elevated liver function tests were felt likely secondary to a viral cause, and the hepatobiliary service was consulted. the viral serologies that were sent were negative for cytomegalovirus, hepatitis a, and hepatitis c. the patient appeared to have a past hepatitis b infection, but currently not chronically infected. in addition, medications were held that were thought to be hepatotoxic including his statin as well as his cyclosporin. in addition, all tylenol was held. a right upper quadrant ultrasound was checked times two which showed no ductal dilatation. there was some gallbladder wall edema. otherwise, a negative right upper quadrant ultrasound. the patient's liver function tests trended down throughout his hospitalization and were close to his baseline upon discharge. he was to follow up with outpatient laboratory work on , and dr. will contact the patient regarding any abnormal results. the patient was restarted on his cyclosporin at half his initial dose prior to discharge and was to restart his lipitor per dr. (his nephrologist). 3. hemolysis/anemia issues: the patient had some laboratories concerning for hemolysis with an elevated total bilirubin, decreased haptoglobin, and elevated lactate dehydrogenase. however, his coombs test was negative and schistocytes were seen on his smear. the patient did require a blood transfusion of 1 unit of packed red blood cells. he was occult-blood negative times two during his hospitalization, and his hematocrit stabilized after his blood transfusion. the patient may have had a brief episode of autoimmune-related hemolytic anemia versus anemia related to his chronic renal insufficiency. he was to have a follow-up complete blood count checked on . 4. left wrist eschar issues: the patient has had an eschar with surrounding erythema which developed during his last hospitalization after an intravenous site infiltrated. the vascular surgery service saw the patient and debrided the eschar and recommended wet-to-dry dressing changes three times per day with normal saline and to follow up with them in approximately three weeks as an outpatient. the site appeared slightly erythematous, and gram-positive coverage with penicillin was started for both his questionable wrist cellulitis as well as for his aso titer positivity for questionable streptococcal infection. a wound culture was obtained of the left wrist eschar which showed no growth and no polys on gram stain. the patient was to follow up with the vascular surgery service in approximately three weeks. condition at discharge: the patient's condition on discharge was good. discharge status: the patient's discharge status was to home. discharge diagnoses: (the patient's discharge diagnoses included) 1. status post cadaveric renal transplant complicated by delayed graft rejection. 2. acute renal failure. 3. hepatitis of thought viral in origin. 4. congestive heart failure. 5. coronary artery disease. 6. type 2 diabetes. 7. left wrist wound. 8. chronic venous stasis changes. medications on discharge: (the patient's discharge medications included) 1. gabapentin 100 mg by mouth once per day. 2. colace 100 mg by mouth twice per day. 3. digoxin 0.125 mg by mouth every other day. 4. sodium bicarbonate 650 mg by mouth three times per day. 5. calcium acetate 667-mg tablets two tablets by mouth three times per day. 6. metoprolol 50 mg by mouth twice per day. 7. aspirin 325 mg by mouth once per day. 8. sirolimus 4 mg by mouth once per day. 9. epogen 10,000 units on monday, wednesday, and friday. 10. calcium carbonate 500 mg by mouth three times per day. 11. vitamin d 400 international units by mouth every day. 12. prednisone 5 mg by mouth once per day. 13. nystatin swish-and-swallow 5 ml by mouth four times per day. 14. insulin 20 units subcutaneously in the morning insulin nph 12 units subcutaneously in the evening. 15. cyclosporin 25 mg by mouth in the evening (adjust per dr. . 16. penicillin vk 500 mg by mouth four times per day. discharge instructions/followup: 1. the patient was instructed to get his blood work checked on ; complete blood count, liver function tests, and chemistry-7. 2. the patient was instructed to follow up with dr. on . 3. the patient was instructed to follow up with vascular surgery service in three weeks regarding his left wrist wound. 4. the patient was instructed to follow up with the transplant center on . 5. the patient was instructed to follow up with dr. of the cardiology service on . , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified nonexcisional debridement of wound, infection or burn transfusion of packed cells diagnoses: hyperpotassemia congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation cellulitis and abscess of upper arm and forearm complications of transplanted kidney acute on chronic combined systolic and diastolic heart failure unspecified viral hepatitis without mention of hepatic coma 

Answer: The patient is high likely exposed to