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: amoxicillin / fish product derivatives / codeine attending: chief complaint: hyperglycemia major surgical or invasive procedure: none history of present illness: mrs is a pleasant 49 yo female with history of dmi, kidney transplant, igg deficiency who was transported from today by ambulance for hyperglycemia after presenting for f/u for her neuropathy. the patient was at an appointment for back pain when she was found to be symptomatic. she states that she has been feeling fatigued for the past 3 weeks, feeling "awful". she was feeling sob, with general fatigue and malaise, muscle aches, n/v, no fevers, + cough not productive of sputum. she has not had her flu shot this year. she has been taking her bactrim daily. she presented to an osh for evaluation of her respiratory complaints but states that she was not treated with anything. last night her bs was 124, over 500 this am. there was concern that her insulin pump had bbroken or patient states that she may have run out of insulin in the setting of the power outage. at her md's office today, fingerstick was found to be 570. in the ed, initial vs were: 98.2 88 96/39 20 91% 6l sat. ekg showed no acute changes. labs were notable for a vbg with ph of 7.25, anion gap of 25, glucose of 602, urine ketones and creatinine of 1.5. she was given 1 l ivf, then 20meq kcl/1l ns over 2 hours, started on an insulin gtt, given morphine and zofran for bilious vomiting. there was a concern for a small focal opacity in ll lung field, therefore she was started on ceftriaxone and levofloxicin. on the floor, pt complaints of "pain everywhere" worse in her feet and hip. she has no respiratory complaints and states that her cough has improved. she also c/o nausea. past medical history: -dm1, last hba1c 9% -s/p renal transplant, baseline creatinine 1.5-1.7 -igg deficiency on chronic immunosuppression, recurrent pneumonias, asthma, and rhinitis, on igg -depression -history of appendectomy and tubal ligation -hx hospitalization and intubation in icu for 6 wks, ards, pt states current inhalers are left over from this episode and are used infrequently -anxiety/panic attacks since last icu admission social history: married. has an 18 year-old daughter. smokes 1 pack per week x 4 months, history of use prior. occasional alcohol use. denies street drug use. five brothers who all use ivdu. one sister committed suicide. currently on disabiliy. family history: father: stroke, hypercholesterolemia, skin cancer, prostate. substantial psychiatric history in family. no family history of iddm or immunodeficiency. physical exam: admission exam: vitals: t:97.1 bp:106/52 p:81 r: 16 o2:100% general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, mildly tender in lower quadrants, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: a&ox3, cnii-xii intact, sensation and strength grossly intact in all extremities pertinent results: admission labs: 04:20pm blood wbc-7.8# rbc-4.48 hgb-13.0 hct-40.9 mcv-91 mch-29.1 mchc-31.8 rdw-13.4 plt ct-268 04:20pm blood neuts-80.9* lymphs-13.3* monos-4.0 eos-1.6 baso-0.2 12:50am blood pt-12.7 ptt-32.1 inr(pt)-1.1 04:20pm blood glucose-602* urean-36* creat-1.5* na-126* k-4.5 cl-87* hco3-14* angap-30* 04:20pm blood calcium-9.9 phos-4.3 mg-2.2 01:02am blood type- po2-61* pco2-47* ph-7.26* caltco2-22 base xs--5 comment-peripheral 04:28pm blood lactate-1.5 . urine: 05:10pm urine color-straw appear-clear sp -1.017 05:10pm urine blood-neg nitrite-neg protein-neg glucose-1000 ketone-80 bilirub-neg urobiln-neg ph-5.0 leuks-neg . microbiology: bcx: no growth mrsa screen: negative dfa: negative for influenza a/b cmv viral load: undetectable . studies: cxr: no acute pulmonary process. . discharge: 06:50am blood wbc-5.0 rbc-3.69* hgb-10.4* hct-31.6* mcv-86 mch-28.3 mchc-33.0 rdw-13.6 plt ct-198 06:50am blood glucose-189* urean-13 creat-1.2* na-136 k-4.5 cl-102 hco3-31 angap-8 06:50am blood calcium-8.9 phos-2.6* mg-2.0 06:50am blood rapmycn-7.4 09:25pm blood hcg-<5 06:55am blood cortsol-12.5 06:55am blood tsh-0.98 brief hospital course: ms. is a 49 yo woman with hx of dm1, s/p renal transplant, who was admitted with hyperglycemia, dka. # dka: admitted with with anion gap. in the icu she was treated with ivf and insulin gtt and her gap resolved. she was hemodynamically stable and transferred to the floors. etiology of dka is most likely pump malfunction. she did not have any localizable infection. on the floor, pt's bg was well controlled. was consulted in the micu started pt on calorie counts. her pump was interrogated by and found to be working. she was discharged on pump and will need close follow up with pcp and . . #. malaise: infectious source was worked up but no focal source of infection was identified. pt did not have fever or leukocytosis and cultures were negative. a cmv viral load was undetectable and influenza was negative as well. sirolimus levels were checked and were wnl. pt is on multiple sedating medications, which certainly could be contributing to current symptoms. her oxycodone dose was cut in half and pt became less sedated. in the future, stopping other medications should be considered in outpt setting. pramipexole might be a good choice in the future if she can tolerate stopping, as it can be quite sedating. . #. s/p renal transplant: on admission her renal function was at her baseline. she had no been seen by transplant service in quite some time, so a consultation was placed. sirolimus levels were checked and within normal limits. her mycophenalate dose was changed to 500 mg and she was discharged on her regular dose of sirolimus and bactrim. . # chronic pain: given pt's sedation and malaise, we decreased her oxycodone dose to oxycontin 40mg . she tolerated dosage change well and was discharged on all other home pain control medications. . # igg deficiency - pt was continued on weekly igg . # ekg changes: with new q waves in inf leads, no evidence of acute ischemia. would consider outpatient echo/stress, will defer to pcp. . # depression: pt denied suicidal ideations. she was continued on home paxil . # restless leg syndrome: pt was continued on home pramiprexole. should consider stopping as outpt if can tolerate and malaise persists. . # allergies: continued on montelukast . transitional: - outpt stress/ echo - follow up with - follow up pcp, stopping other sedating medications - follow up with transplant nephrologist for management of immunosuppressant therapy medications on admission: albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 puffs(s) every four (4) hours as needed for shortness of breath or wheezing (takes occassionally) clobetasol - 0.05 % ointment - apply to hands two to three times daily wrap/glove hands at night with severe eczema. no not use on face fluticasone-salmeterol - 250 mcg-50 mcg/dose disk with device - 1 puff(s) inhaled qd to twice a day (takes occasionally) ibuprofen - 600 mg tablet - one tablet(s) by mouth three times a day for 7-10 days immune globulin (human) (igg) - 16 % (160 mg/ml) solution - 30 ml weekly infused via pump as instructed (weekly on tuesday) insulin lispro - (prescribed by other provider) - 100 unit/ml cartridge - per pump lidocaine - 5 % (700 mg/patch) adhesive patch, medicated - apply for 12 hours and remove for 12 hours daily as needed for pain. apply over painful areas. lidocaine hcl - 3 % cream - apply to finger tips with severe pain twice a day lorazepam - 1 mg tablet - 1 tablet(s) by mouth 1 hour prn anxiety mirtazapine - 30 mg tablet - 1 tablet(s) by mouth daily montelukast - 10 mg tablet - 1 (one) tablet(s) by mouth once a day mycophenolate mofetil - 500 mg tablet - 2 tablets daily oxycodone - 80 mg tablet sustained release 12 hr - 1 tablet(s) by mouth 6 hourly no sub - no substitution oxycodone-acetaminophen - 10 mg-325 mg tablet - 1 tab tid paroxetine hcl - (prescribed by other provider) - 20 mg tablet - not sure of dose pramipexole - 0.5 mg tablet - 2 tablet(s) by mouth at night - no substitution sirolimus - 1 mg tablet - 4 tablet(s)(s) by mouth qam (4 1mg tablets total 4mg/day) sulfamethoxazole-trimethoprim - 400 mg-80 mg tablet - 1 tablet(s) by mouth once a day medications - otc blood sugar diagnostic - strip - use as directed to test blood sugar at hoome for diabetes 8 times per day one touch ul ultrasmart system - kit - test strips for home monitoring of blood sugar brittle type one diabetes with insulin pump discharge medications: 1. mirtazapine 30 mg tablet sig: one (1) tablet po hs (at bedtime). 2. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 3. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po tid prn pain () as needed for pain. 4. sirolimus 1 mg tablet sig: four (4) tablet po daily (daily). 5. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). 6. pramipexole 1 mg tablet sig: one (1) tablet po qhs (). 7. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 8. oxycodone 40 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po q12h (every 12 hours). disp:*4 tablet extended release 12 hr(s)* refills:*0* 9. clobetasol 0.05 % ointment sig: one (1) application topical 2-3 times daily. 10. immune globulin (human) (igg) 15-18 % range solution sig: thirty (30) ml intramuscular once a week: 16% solution, weekly on tuesdays . 11. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation q4hr prn as needed for shortness of breath or wheezing. 12. advair diskus 250-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. 13. insulin lispro 100 unit/ml cartridge sig: one (1) per pump subcutaneous per pump: per pump. 14. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). 15. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical (2 times a day) as needed for dry itchy skin. disp:*qs qs* refills:*0* 16. ondansetron hcl 4 mg tablet sig: one (1) tablet po three times a day as needed for shortness of breath or wheezing. disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: dka fatigue nos discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mrs. , you were admitted to the hospital for diabetic ketoacidosis. this could have occurred because of a malfunctioning of your insulin pump. we treated you with iv insulin and iv fluids. your sugars improved and you were started on a carb counting and basal insulin regimen. it is important to make sure that you are going to eat before taking your insulin to avoid hypoglycemia. was consulted and they helped put together a new insulin regimen for you. you restarted your insulin pump on the day of discharge with no problems. should monitor your blood glucose frequently, and call your endocrinologist or pcp if the values are abnormal (<70 more than twice or >300 for greater than 12 hours). during this hospitalization, we also worked you up for your fatigue. we checked your thyroid function, adrenal function and made sure that your immune suppressive medication levels were not too high or too low. all of these tests came back negative. we also monitored you for signs if infection and do not believe that these symptoms are being caused by an infectious process. on admission, we noticed that you are on multiple sedating medications. we decreased your oxycontin dose to 40 mg twice daily. i urge you to follow up with your pcp to work on adjusting your medications even more. we also changed your mycophenolate mofetil from two pills once per day to one pill twice per day, as this could have been causing nausea. you had some mild swelling of your right arm/hand, but an ultrasound demonstrated no evidence of clot. we have made the following changes to your home medications: 1. resume insulin pump 2. decrease oxycontin 80 mg by mouth twice daily to oxycontin 40mg by mouth twice daily 3. change mycophenolate mofetil to 500 mg tablet sig: one (1) tablet by mouth (2 times a day). 4. add camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical (2 times a day) as needed for dry itchy skin. 5. add ondansetron hcl 4 mg tablet sig: one (1) tablet po three times a day as needed for shortness of breath or wheezing please continue with all of you other home medications it is important that you follow up with your pcp and . followup instructions: please contact dr. at and the center to schedule a follow up appointment within the next week procedure: venous catheterization, not elsewhere classified diagnoses: nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere unspecified essential hypertension unspecified acquired hypothyroidism depressive disorder, not elsewhere classified long-term (current) use of insulin mononeuritis of unspecified site diabetes with renal manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled kidney replaced by transplant restless legs syndrome (rls) mechanical complication due to insulin pump insulin pump status other selective immunoglobulin deficiencies 

Answer: The patient is high likely exposed to