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: a 52 year-old male with hcv cirrhosis, hiv, alcohol use, presenting with increased confusion and change in mental status. patient had increasing confusion since with symptoms of fatigue and decreased energy. he had decreased function, was not performing activities of daily living well and had decreased appetite. patient saw his primary care physician 1 week prior to admission. his ammonia level was checked as well as a chest x-ray. at that time the patient denied any fever, chills, urinary symptoms or abdominal pain. he did have a cough for approximately 1 week and was compliant with taking his lactulose 4x a day. dr. saw the patient in the liver clinic on the day of admission. at that time the patient was combative and agitated. he was transferred to the emergency department and admitted to the intensive care unit for observation. in the emergency department an abdominal ultrasound was performed which was a suboptimal study secondary to agitation and movement. a small amount of fluid anterior to the liver was noted. blood and urine cultures were sent off and patient was given lactulose with rifaximin. he was also given a dose of ceftriaxone and some haldol. on admission patient was confused but cooperative. past medical history: hcv cirrhosis. he was diagnosed 15 years prior to admission and was never treated for this. questionable history of diabetes. past hospitalizations for encephalopathy. history of iv drug abuse. hiv diagnosed 14 years prior to admission on haart therapy, in the past 5 to 6 year period off medications, recently restarted. diabetes on insulin. polysubstance abuse. low back pain. hypertension. upper gastrointestinal bleed approximately a year ago. social history: lives with wife and 13 year-old son. former alcohol counselor. iv drug abuse but quit 20 years prior to admission. recent cocaine injection use approximately 4 to 5 months ago. prior heavy alcohol use but none x 20 years ago. smoked 2 packs per 20 years and quit approximately 13 years prior to admission. originally from . currently not working. family history: no liver disease. physical examination: temperature 98.8, heart rate 82, blood pressure blood pressure 139/99, respiratory rate 13, o2 saturation 96% on room air. patient was pleasant in mild distress and agitation. alert and oriented to the date. head, eyes, ears, nose and throat: pupils equal, round and reactive to light, scleral icteric, mucous membranes moist. facial and cheek wasting. neck: no jugular venous distension, no lad. lungs clear to auscultation bilaterally, slight bibasilar crackles. heart: regular rate and rhythm, tachycardia, s1, s2, no murmurs, regurgitation, gallop. abdomen: positive distention but soft, nontender, no rebound, no guarding, no flank dullness bilaterally. liver edge not palpated. neurologic: positive asterixis. skin: jaundice, mild erythematous areas over anterior chest, no spider angiomas and palmar erythema. rectal: guaiac negative as per emergency department. electrocardiogram on admission was normal sinus rhythm with a left axis, no change from prior electrocardiogram. chest x- ray demonstrated minimal bibasilar atelectasis, no infiltrates. abdominal ultrasound: hepatopetal flow through the main portal vein. white count on admission 18.1, hematocrit 35.7, creatinine 0.9, bun 11, potassium 4.9, lactate 2.3. mono 86. brief hospital course: the patient was admitted under the medical service. he was given lactulose and rifaximin. hepatology was consulted and followed along throughout this course. he had a low sodium of 117. this was felt to be secondary to volume depletion. iv fluids were restricted. he underwent a diagnostic paracentesis on . he underwent liver transplant. the surgeon was dr. assisted by dr. and dr. . estimated blood loss was 6 liters. please see operative report for further details. postoperatively patient was maintained in the surgical intensive care unit. liver function tests trended down. baseline ast was 2,081. alt 1723, alkaline phosphatase 67 with a total bilirubin of 2.6. this trended down on postoperative day 3 to ast of 448, alt 1120, alkaline phosphatase 99, total bilirubin of 1.3. duplex of the liver demonstrated patent portal vein and hepatic arteries. postoperatively he was moving extremities and tracking with eyes. he was doing well. liver function tests started to climb. he suffered an acute severe rejection of the liver transplant. he was relisted and received on and abo incompatible liver transplant. he underwent a second liver transplant on . the surgeon was dr. . indication was for hyperacute severe cellular rejection of first liver transplant. biopsy of the explant demonstrated severe rejection. he had been treated with okt3 plasmapheresis but steroids but despite those he continued to have allograft failure with fresh frozen plasma and cryo requirements. on he was taken t the operating room for a second liver transplant. he received induction of immunosuppression again intraoperatively. postoperatively he received solu-medrol with taper cellcept 1 gram b.i.d. anti-a titers were followed and he received plasmapheresis, approximately 8 plasmapheresis treatments on alternating days. he received ivig as well as okt3 for a total of 8 treatments. prograf was started on postoperative day 3 at 2 mg p.o. b.i.d. prograf levels ranged between 4 to 10.7. prograf was gradually increased to 7 mg b.i.d. anti-a titers continued to 1 to 4. absolute cd3 was 0. vital signs were stable until postoperative day 3 when he spiked a temperature to 102. blood and urine cultures were done. he was started on iv antibiotics, linezolid and meropenem. blood and urine cultures were subsequently negative. sputum culture demonstrated greater than 25 pmns and greater than 10 epithelial cells. gram stain indicated extensive contamination with upper respiratory secretions. yeast was demonstrated. patient underwent a bronchoscopy. this demonstrated klebsiella that was pansensitive. he received linezolid and meropenem for a total of 14 days. on postoperative day 8 on sputum cultures demonstrated gram negative rods and staph aureus coag positive moderate growth. an hiv viral load at this time was done and demonstrated 626 copies. white count ranged between 12.5 and 13.7. hematocrit was fairly stable at 26 to 30. he did have 2 drain as well a nasogastric tube. liver function tests trended down nicely to as ast of 20, alt 51, alkaline phosphatase 115, total bilirubin of 0.9 and amylase of 47. throughout this hospital course he was maintained on iv ganciclovir for cmv prophylaxis. the cmv viral load was negative. he also received iv lasix to diurese the edema. duplex ultrasound demonstrated the portal vein and hepatic artery. chest x-ray demonstrated left lower lobe atelectasis. postoperative day 3 the patient was still fairly sleepy and he underwent a head ct. head ct demonstrated slight progression of prominence of petechial appearing hemorrhage within the left and right frontal regions, consistent with hemorrhagic products in the region of the prior infarct and continued sinus opacification in the setting of intubation. head mri was done that demonstrated no evidence of superior saggital sinus thrombosis. bifrontal brain infarction near the vertex with adjacent small foci of parenchymal hemorrhage was noted. he was very sleepy. neurology was consulted. an eeg was recommended. eeg demonstrated evidence for basically 2 electrophysiological states, 1 that seemed to be associated with the patient sleeping and that consists of suppressive bursts lasting up to 4 seconds in duration. the other was the background rhythm which was fairly well sustained in the beta range following vigorous stimulation. no focal or lateralized signs were noted. no seizure activity was seen but in comparison to the previous tracing that was done the second eeg was performed and slightly improved. neurologically throughout this hospital course he gradually awakened after being transferred out of the intensive care unit. he became agitated at times, restless and pulled out various tubes including his post pyloric feeding tube that had to be replaced various times. psychiatry was consulted for management of what appeared to be metabolic encephalopathy. he received haldol b.i.d., initially 1 mg b.i.d. and then 2 mg b.i.d. with improvement of agitation. it was recommended that the patient follow up with neurology for behavioral neurology, neuropsychiatry evaluation. during the surgical intensive care unit course the patient was intubated on respirator and it was difficult to wean the patient from the ventilator. he underwent tracheostomy on . an open tracheostomy was performed by dr. . please see operative report. estimated blood loss was minimal. there were no complications. he was maintained on the ventilator. gradually he was weaned from the ventilator and his tracheostomy was downsized. subsequently the tracheostomy was removed on . tracheostomy site was covered with a dry dressing. he was evaluated by speech and swallow as his mental status started to clear and this demonstrated aspiration. a post pyloric feeding tube was placed and he was transitioned off of hyperalimentation and placed on post pyloric feeding tube nutrition using 3/4 strength mepro at 60 cc per hour. he was able to tolerate this well. this provided 2160 k calories/76 grams of protein. his weight preoperatively was 72.9. this had trended down and has stabilized around 53 to 54 kilograms. he was evaluated by speech and swallow and had a video swallow that demonstrated silent aspiration with thin and clear fluid during the week of . he was gradually advanced using honey thickened liquids with constant 1 to 1 with feeding for observation and he tolerated this well. the patient has been followed by physical therapy secondary to long prolonged hospital course. it was felt that he would benefit from rehabilitation. he was able to transfer with maximum assist to the chair. physical therapy assessment included steady progress in all areas. findings included balance moderate but assist required to attain and maintain weight. gait was narrow, bos, decreased wf to the left with mid stance, decreased step length on the right. throughout the physical therapy session heart rate was steady at 70 to 74, respiratory rate 20, 99 to 120% on room air. he was able to ambulate left upper extremity of patient around the shoulder of the physical therapist. needed maximum assistance to ambulate. plan was to continue physical therapy at rehabilitation with 3 to 4 times a week sessions for therapeutic exercises, transfer, gait, and pulmonary monitoring. hepatology followed throughout the hospital course making recommendations. infectious disease followed along throughout the hospital course given management for hiv medications. patient completed a 14 day course of vancomycin for methicillin resistant staphylococcus aureus tracheobronchitis. vancomycin was stopped on . patient was diagnosed with a klebsiella urinary tract infection and received a 14 day course of meropenem. this finished on . chest x-ray on demonstrated left lower lobe atelectasis without any infiltrate. given his hiv medications, his need for prograf was diminished. of note, the patient is on protease inhibitors that affect the prograf level. he was dosed with prograf 0.25 mg for a total of 3 days on , and . this prograf was then stopped until . he maintained a prograf level of 9.4 to up to 14.7 and then back down to 10.8. he received prograf 0.5 mg on and then prograf was held and he has maintained the prograf level in the range of 15.6 to 9.5 with the 9.5 being on . he continued on cellcept mg t.i.d. this was decreased to b.i.d. on . solu- medrol was tapered down to prednisone and was decreased at 10 mg p.o. q.d. liver function tests remained stable with an ast of 32, alt of 37, alkaline phosphatase of 286 and total bilirubin of 2.5. he underwent an ultrasound on that demonstrated normal flow with hepatic and portal veins and arterial flow being normal. the liver biopsy on was normal. no acute rejection. creatinine increased during this hospital course to 2.9 and up as high as 4.6. his hiv medication doses were adjusted by infectious disease and his creatinine gradually decreased and returned to baseline of 1.2. nephrology followed during this time making medication adjustments. nutrition consult was obtained and patient was monitored by dietitian throughout the hospital course. of note, on patient was able to take in approximately 590 calories with 12 grams of protein. he was continued on his tube feeding. occupational therapy followed the patient. occupational therapy was recommended at rehabilitation 1 to 5 times a week to address activities of daily living, mobility, and cognition. patient was able to cooperate with occupational therapy intervention. as of this date on the patient was doing well. he was alert, oriented to place. rate was regular rhythm. lungs were clear to auscultation. tracheostomy site was covered by gauze. he was decannulated as previously mentioned. abdomen was soft. of note, the patient has a wound vac at the upper portion of his chevron incision. this wound measures approximately 5-1/2 cm x 2 cm x 3 cm in the wound bed. there are visible blue sutures. the wound is filling in, is granulating. wound vac drains very small amount of serous fluid. extremities: no edema. vital signs: 98.1, 89, 195/68 to 131/72, respiratory rate 20, 97% on room air. weight is 53 kilos. he is pleasant. he is able to verbalize his needs. abdomen is soft. he does have loose stools. stools were sent for c difficile and these were negative on , and . patient was able to have his foley removed and voided sufficiently. on patient was noted to not have voided for approximately 6 hours. a bladder scan was done. this demonstrated a residual of approximately 700 cc. patient was catheterized for 500 cc. foley was left in place for 2 days. foley was removed and patient was started on finasteride 5 mg p.o. q.d. he was able to void independently. urine output is typically 2300 cc of urine. patient was followed by clinic for management of blood sugars. blood sugars ranged from 79 to 225. nph insulin 10 units q a.m. and q p.m. have helped maintain blood sugars in the low 100 range. he has received intermittent sliding scale regular insulin. on an hiv viral load demonstrated less than 50 copies per ml. on patient was ready for discharge to hospital. he was alert and oriented, conversant and appropriate. haldol had been decreased to p.r.n. psychiatry saw the patient on and recommended outpatient neuropsychiatric testing followed up by behavioral neurology. of note, the patient required haldol for delirium, agitation that had resolved and he did not receive any haldol since converting from a b.i.d. dosing to p.r.n. dosing for the last 5 days. discharge diagnoses: hiv hepatitis c virus cirrhosis. insulin dependent diabetes mellitus. hypertension. depression. bifrontal intraparenchymal hemorrhages. abdominal incision wound infection requiring vac. adrenal insufficiency. status post orthotopic liver transplant complicated by severe acute rejection, orthoptic liver transplant with an abo incompatible liver. the patient underwent a splenectomy at that time. klebsiella urinary tract infection. methicillin resistant staphylococcus aureus pneumonia. malnutrition. dysphagia with aspiration risk. tracheostomy . discharge medications: cellcept 1 gram p.o. b.i.d., prednisone 10 mg p.o. q.d., linizudine 300 mg p.o. q.d., lopinavir-ritonavir 400-100 mg/5 ml solution, 5 ml p.o. b.i.d., tenofovir, disoproxil fumarate 300 mg tablets 1 tablet p.o. q.d., fluconazole 400 mg p.o. q.d., bactrim single strength 1 p.o. q.d., valsate 900 mg p.o. q.d., azithromycin 1200 mg p.o. q friday for map prophylaxis, metoprolol 75 mg p.o. b.i.d., hold if heart rate less than or blood pressure less than 100, florinef 0.1 mg tablet p.o. 3 x a week on monday, wednesday and friday for hyperkalemia, finasteride 5 mg p.o. q.d., lansoprazole 30 mg delayed release 1 p.o. q.d., ursodiol 300 mg capsule p.o. t.i.d., neupogen 4,000 units per ml 1 ml injection sc q monday, wednesday and friday, heparin 5,000 units per ml 1 ml sc b.i.d., percocet 5/325 mg 5 to 10 ml p.o. 4 to 6 hours p.r.n. as needed. albuterol 90 mcg per actuation 1 to 2 puffs p.r.n. q 6 hours. insulin nph 10 units sc b.i.d. regular insulin sliding scale per finger check q.i.d. please see sliding scale. for blood sugar less than 60 give juice, preferably not juice given hyperkalemia. patient should receive laboratory work every monday and thursday for cbc, chem-10, ast, alt, alkaline phosphatase, total bilirubin, albumin and trough prograf level with results faxed immediately to the transplant office at . the transplant surgeon will monitor prograf level and right dose the prograf dose p.r.n. please do not adjust heart medication or prograf level. please contact transplant office for adjustments. patient is scheduled to follow up with dr. . please call to make arrangements for follow up visit in 1 week. phone number is . please have the patient followed by neuropsychiatry for neuropsychiatric testing and behavioral neurology as well as social service, physical therapy, occupational therapy and nutrition. please call. discharge instructions: include call for fever, chills, nausea or vomiting, inability to tolerate tube feedings or medications, any purulence, redness, bleeding from abdominal incision. please obtain a repeat video swallow within the next 1 to 2 weeks to re-evaluate ability to swallow. discharge condition: stable. dr., 02-366 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine enteral infusion of concentrated nutritional substances hemodialysis closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus other transplant of liver other transplant of liver total splenectomy therapeutic plasmapheresis transfusion of packed cells transfusion of other serum transfusion of platelets other immobilization, pressure, and attention to wound endoscopic retrograde cholangiopancreatography [ercp] transfusion of coagulation factors injection or infusion of oxazolidinone class of antibiotics injection or infusion of biological response modifier [brm] as an antineoplastic agent other operations on lacrimal gland transplant from cadaver diagnoses: acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified acute and subacute necrosis of liver chronic hepatitis c with hepatic coma acquired coagulation factor deficiency unspecified septicemia unspecified protein-calorie malnutrition severe sepsis intracerebral hemorrhage human immunodeficiency virus [hiv] disease other shock without mention of trauma methicillin susceptible pneumonia due to staphylococcus aureus infection and inflammatory reaction due to other vascular device, implant, and graft metabolic encephalopathy complications of transplanted liver delirium due to conditions classified elsewhere iatrogenic cerebrovascular infarction or hemorrhage non-healing surgical wound 

Answer: The patient is high likely exposed to