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: bactrim ds / cellcept attending: chief complaint: septic shock major surgical or invasive procedure: central line placement hemodialysis history of present illness: ms. is a 52 year old woman w/ esrd from sle s/p cadaveric renal transplant in which was complicated by fsgs and transplant failure now on hemodialysis who was recently treated for cmv viremia in the setting of c. difficle colitis, admitted with fever and hypotension from rehab. history per patient supplemented with i.d.: the admission was complicated by cmv viremia and c. diff colitis. she was discharged on iv ganciclovir (120mg iv daily), which was to continue until she had two negative cmv virals loads separated by one week's time. she finished iv ganciclovir treatment course and was transitioned to oral valganciclovir suppression. suppression therapy was discontinued on due to neutropenia (wbc 1.8, plt 59). per , pt had an interim hospitalization of a few days for septic shock in mid-, requiring pressors, details of which are unclear, which pt did not clearly confirm or deny. on pt began having fevers. a cmv viral load was rechecked (970) and repeat vl of 4059 on . it is unclear when ganciclovir was restarted, but by , she was on ganciclovir with hd dosing. she began to complain of dizzines and visual disturbances. then, still with fevers, she became hypotensive on without a localizing source of infection. she complained of some mild abdominal pain. she was transferred to for further management. in the ed, she had a temp to 100.3, bp 85/48 so levophed was started and she was transferred to the micu. past medical history: -esrd s/p cadaveric renal transplant in complicated by fsgs and transplant failure now on hd -sle, followed by dr. in rheumatology -paroxysmal atrial fibrillation -nsvt -hypertension -hyperthyroidism -s/p bilateral knee surgeries and r acl repair social history: single, lives with sister's family in . denies tobacco, etoh, and drugs. family history: mother and brother both with diabetes and , both deceased. physical exam: v/s: t 98 bp 117/63 hr 87 rr 17 02sat 98% on room air gen: aaox3, nad, pleasant heent: moon facies, no oral ulcers, mmm, supple, no lad, no jvp cardiac: rrr, no m/r/g, referred fistula bruit at lusb lungs: ctab a/p abdomen: bowel sounds present, soft, obese, nontender, nondistended; mass in rlq; no hsm. ext: warm, well-perfused. dp pulses difficult to palpate through lower extremity and pedal edema. no cyanosis or clubbing. striated ue bilaterally with loose adipose. left upper extremity with raises, scarred fistula tract. left hand with swan neck deformities. neuro: cn 2-12 intact, upper arm (prox + dist) strength, le strength, bilaterally derm: no rashes pertinent results: 01:51pm blood wbc-9.3# rbc-3.41* hgb-9.6* hct-32.1*# mcv-94 mch-28.0 mchc-29.7* rdw-17.8* plt ct-119* 01:51pm blood neuts-76* bands-7* lymphs-3* monos-9 eos-0 baso-0 atyps-0 metas-4* myelos-1* 01:51pm blood pt-14.0* ptt-29.7 inr(pt)-1.2* 01:51pm blood glucose-124* urean-12 creat-4.9* na-142 k-4.6 cl-108 hco3-24 angap-15 01:51pm blood alt-11 ast-16 ld(ldh)-336* ck(cpk)-10* alkphos-58 totbili-0.2 01:51pm blood albumin-2.4* calcium-7.8* phos-2.6* mg-1.5* cbc wbc-2.9 rbc-2.77 hgb-8.2 hct-27.0 mcv-98 mch-29.4 mchc-30.2 rdw-17.9 plt ct-126 pt-12.4 ptt-29.0 inr(pt)-1.0 k-2.8 glucose-79 urean-19 creat-4.7 na-144 k-3.9 cl-107 hco3-30 angap-11 microbiology 1) cmv viral load (final ): cmv dna not detected 2) direct influenza a antigen test (final ): negative for influenza a. direct influenza b antigen test (final ): negative for influenza b. 3) and 13: feces negative for c.difficile toxin a & b by eia. 4) clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. 5) stool culture negative for campylobacter, shigella, salmonella, enteric gram negative rods, viruses (final ) 6) bk virus pcr pending radiology cxr the cardiac, mediastinal, and hilar contours are unremarkable. except for right perihilar linear opacity, likely representing atelectasis, the lungs are clear without focal consolidation. no pleural effusion or pneumothorax is seen. the osseous structures demonstrate no acute skeletal abnormalities. kub there is no evidence of free air. there is no evidence of obstruction. there is no evidence of gas within the bowel wall. ct abd and pelvis 1. uncomplicated sigmoid diverticulitis. no evidence of abscess formation or perforation. 2. dilated main pancreatic duct worsened since . this might represent a segmental main duct ipmn (intraductal papillary mucinous neoplasm). consultation with the pancreas center at is recommended for further workup. 3. unchanged right anterior abdominal wall seroma. 4. transplanted kidney shows decreased enhancement consistent with history of evolving transplant failure. there is slightly increased perinephric stranding, but no evidence of abscess or acute infection. repeat cxr: compared to ap single view cxr on . previously identified right internal jugular approach central venous line remains in unchanged position terminating overlying the svc 2 cm below the carina. no pneumothorax is present. the pulmonary vasculature is not congested and the heart size has not increased. new, however, is a density occupying the left lower lobe basal portion and obliterating the diaphragmatic contours, most likely representing a new retrocardiac atelectasis, not identified on the next previous study of . in the right mid lung field, a plate atelectasis is seen, but appears as before. no other new abnormalities are seen. impression: development of sizeable left lower lobe atelectasis in retrocardiac position. renal u/s : findings: the transplant kidney is again seen in the right lower quadrant and it measures 12.1 cm in length. there is no hydronephrosis and no perinephric fluid collection is identified. no cyst or stone or solid mass is seen in the transplant kidney. within the superficial tissues a heterogeneous mass is again identified previously presumed to be a hematoma. this structure is unchanged in size and appearance from the prior ultrasound of measuring about 11 cm in its widest diameter. doppler examination: color doppler and pulse-wave doppler images were obtained. note is made that the doppler images were limited by the patient's body habitus. appropriate venous flow is seen within the main renal vein. limited views of the main renal artery demonstrate appropriate acceleration times. mildly elevated resistive indices are seen in the intraparenchymal arteries. impression: 1. somewhat limited doppler exam demonstrating essentially appropriate transplant vasculature. 2. no hydronephrosis or collections identified. 3. similar size and appearance of the subcutaneous hematoma in the right lower quadrant. echo : the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is normal(>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. 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. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the severity of mitral regurgitation is reduced (but was only mild on review of the prior study). brief hospital course: #septic shock - admitted to the micu and treated with vasopressor therapy, stress-dose steroids, and empiric po vancomycin, iv vancomycin, iv zosyn and iv gancyclovir. ct abd/pelvis showed uncomplicated sigmoid diverticulitis. all other culture data and infectious workup (including c. diff toxin negative x 3) was unrevealing as to another source of infection. due to asymptomatic relative hypotension after transfer to the medical floor, midodrine was started with improvement in blood pressure. metoprolol was discontinued due to hypotension. . #pancytopenia - counts remained stable off of zosyn. tacrolimus was decreased to 2 mg . . #renal transplant c/b graft fsgs and esrd on hd - continued usual schedule of hd tuthsa. prednisone tapered from stress-dose to 10 mg daily. tacrolimus dose decreased as above. . #cmv viremia: will continue iv ganciclovir pending cmv viral load results (sent ). #hyperglycemia: attributed to corticosteroid therapy. well-controlled on basal and sliding scale insulin. . #paroxysmal atrial fibrillation: in sinus rhythm on discharge. chads2 score of 1 so continued aspirin 325 mg. #anemia of chronic kidney disease: continued erythropoeitin and zemplar with hd. medications on admission: 1. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever/pain: not to exceed 4g tylenol per day. 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 4. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 5. petrolatum ointment sig: one (1) appl topical tid (3 times a day) as needed for for dry skin. 6. docusate sodium 100 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 8. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 9. insulin glargine 100 unit/ml cartridge sig: two (2) units subcutaneous at bedtime. 10. insulin lispro 100 unit/ml cartridge sig: as per sliding scale as per sliding scale subcutaneous qachs. 14. prednisone 5 mg tablet daily 15. vancomycin 125 mg capsule sig: one (1) capsule po q6h 16. ganciclovir 110 mg iv q24h start: in am give after hd on dialysis days 17. atovaquone 750 mg/5 ml suspension sig: two (2) po daily (daily). 18. tacrolimus 4.5 mg lactobacillus asa 325 nephrocaps erythropoetin 15,000u qhd magnesium oxide 200mg . medications on transfer: ganciclovir 110 mg iv qhd day 1= vancomycin 1000 mg iv hd protocol day 1 = piperacillin-tazobactam 2.25 g iv q 12h day 1 = tacrolimus 4.5 mg po q12h hydrocortisone na succ. 100 mg iv q8h insulin sc (per insulin flowsheet) sliding scale & fixed dose order aspirin 325 mg po/ng daily nephrocaps 1 cap po daily atovaquone suspension 1500 mg po/ng daily pantoprazole 40 mg po q24h heparin 5000 unit sc tid discharge medications: 1. atovaquone 750 mg/5 ml suspension sig: ten (10) ml po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 5. midodrine 5 mg tablet sig: two (2) tablet po tid (3 times a day). 6. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 days: through . disp:*2 tablet(s)* refills:*0* 7. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 2 days: through . disp:*6 tablet(s)* refills:*0* 8. tacrolimus 1 mg capsule sig: two (2) capsule po q12h (every 12 hours). 9. ganciclovir sodium 500 mg recon soln sig: one hundred-ten (110) mg intravenous qhd (each hemodialysis): please continue ganciclovir 110 mg iv qhd until instructed to discontinue this medication by the patient's infectious disease physicians (after cmv viral load sent returns negative). . 10. heparin (porcine) 5,000 unit/ml solution sig: one (1) unit injection tid (3 times a day). 11. transportation please provide transportation to and from appointments 12. insulin glargine 100 unit/ml cartridge sig: two (2) units subcutaneous at bedtime. 13. nph insulin human recomb 100 unit/ml cartridge sig: four (4) units subcutaneous qam. 14. humalog 100 unit/ml cartridge sig: asdir units subcutaneous qachs: per attached sliding scale. 15. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 16. ondansetron 4 mg iv q8h:prn nausea 17. epogen 10,000 unit/ml solution sig: () units injection qhd. 18. bisacodyl 5 mg tablet, delayed release (e.c.) sig: tablet, delayed release (e.c.)s po once a day as needed for constipation. discharge disposition: extended care facility: hospital- discharge diagnosis: septic shock cmv viremia acute uncomplicated diverticulitis end-stage renal disease on hemodialysis status post deceased donor kidney transplant discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:out of bed with assistance to chair or wheelchair discharge instructions: you were admitted with fever and low blood pressure, most likely due to an infection in your large intestine called diverticulitis. your infection was partially treated with antibiotics. please continue taking the antibiotics as prescribed through sunday, . the following medication changes were recommended: 1) started ciprofloxacin, an antibiotic. 2) started flagyl, another antibiotic. 3) started midodrine, a medication to raise your blood pressure. 4) stopped metoprolol due to low blood pressure. 5) tacrolimus decreased to 2 mg twice daily. followup instructions: provider: , md phone: date/time: 3:00 pcp , . as needed follow up with nephrologists as provider: , md phone: date/time: 9:40 md procedure: venous catheterization, not elsewhere classified hemodialysis diagnoses: chronic glomerulonephritis in diseases classified elsewhere systemic lupus erythematosus anemia in chronic kidney disease end stage renal disease adrenal cortical steroids causing adverse effects in therapeutic use unspecified septicemia severe sepsis atrial fibrillation thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm hypopotassemia paroxysmal ventricular tachycardia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease antiviral drugs causing adverse effects in therapeutic use septic shock surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cytomegaloviral disease complications of transplanted kidney other abnormal glucose diverticulitis of colon (without mention of hemorrhage) other specified aplastic anemias viremia, unspecified 

Answer: The patient is high likely exposed to