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: iodine; iodine containing / trileptal / dilantin attending: chief complaint: respiratory distress major surgical or invasive procedure: : simultaneous liver and kidney : bronchoscopy : ultrasound-guided right thoracentesis : ultrasound-guided left thoracentesis. history of present illness: 63 yo female with polycystic kidney/liver with esld and esrd on hd, h/o budd chiari, h/o ich from ruptured aneurysm, discharged on after a prolonged hospitalization for anemia, sbp, now presents from rehab after a witnessed episode of aspiration this morning during breakfast leading to tachypnea and dyspnea. she was transported to ed and was intubated in ed because she respiratory rate was 40-50. meanwhile, she had 100 degree in her rectum temp. ros:: unobtainable because of sedation past medical history: - (autosomal dominant w renal/liver involvement, c/b aneurysmal bleed and esrd) - esld with recent meld in high 20s - multiple liver cysts - esrd now s/p bilateral nephrectomies -liver & kidney - subarachnoid hemorrhage 2/2 l mca aneurysm s/p surgical clipping c/b peri-operative hemorrhagic stroke resulting in right hemiparesis() - htn - secondary hyperparathyroidism - anemia - acidosis - nephrolithiasis - stress fracture of the right ankle. - seizure disorder social history: had been at rehab prior to admission. at baseline, she lives with her husband in . ambulates with a cane (more recently from rehab with walker). worked as a city planner. she was transferred directly from rehab today. smoking: denies etoh: 1 glass of wine/day drugs: denies family history: father and son with . f - died in his 80s, and prostate cancer m - died at yrs of old age sister w . physical exam: pt is sedated and intubated and on pressers t99 p105-119 r 16-17 bp 62-69/39 sao2 96%40% heent: preeal, oral dry neck: supple, no jvd, no ln chest: clear, no wheezing cvs: regular, no murmur abd: distent, i was unable to appreciate if pt has tender or not because pt is sedated. bs present. liver enlarged significantly. the skin in her low abd was significant red. ext: pitting edema lab: 129 93 51 86 agap=19 5.6 23 2.9 ck: 65 96 16.1 8.8 321 29.8 n:84.9 l:6.2 m:6.8 e:1.6 bas:0.5 pt: 37.9 ptt: 39.3 inr: 3.9 pertinent results: 07:15am blood wbc-10.6 rbc-3.40* hgb-10.3* hct-31.7* mcv-93 mch-30.4 mchc-32.5 rdw-17.3* plt ct-428 05:49am blood pt-10.8 ptt-26.2 inr(pt)-0.9 07:57am blood glucose-119* urean-91* creat-2.0* na-135 k-4.9 cl-101 hco3-23 angap-16 05:40am blood glucose-95 urean-95* creat-1.9* na-135 k-5.1 cl-102 hco3-23 angap-15 07:15am blood glucose-95 urean-95* creat-1.8* na-140 k-5.6* cl-107 hco3-22 angap-17 05:40am blood alt-11 ast-16 alkphos-111* totbili-0.9 07:15am blood alt-9 ast-17 alkphos-110* totbili-0.9 07:15am blood calcium-8.8 phos-4.1 mg-1.9 05:49am blood caltibc-166* ferritn-greater th trf-128* 02:15am blood tsh-27* 02:15am blood t4-3.0* t3-61* brief hospital course: hypotension and respiratory distress were most likely 2nd to aspiration vs sepsis vs pulmonary edema. pt was intubated and on started on antibiotics. she was treated with improvement in the micu. on , a liver and kidney donor became available. she was cleared for surgery. on , a liver was transplanted by dr. . attempt was made to do a splenectomy prior to the renal , but this was too difficult secondary to the extremely large polycystic liver wrapped around the spleen. she was very coagulopathic. bleeding was controlled then a renal was performed by dr. with a 6-french double-j stent inserted into the ureter and a jp drain. drains were also placed posterior to the liver and at the hilum as well as in the splenic bed. induction immunosuppression was administered consiting of atg, cellcept and steroids. postop, she was transferred to the sicu for management. postop course was complicated requirining cvvh for delayed renal graft function. lfts trended down immediately. duplex of the liver was appropriate. renal duplex us demonstrated lack of diastolic flow of the interpolar arteries, with an ri of 1. there was flow within the main renal vein. she experienced atn. she failed to extubate and a trache was considered, but eventually with improving renal/liver function, she managed to extubate on *****. of note, on , tsh was noted to be 27, t3 61 and t4 3.0. levothyroxine was increased. she remained tachypneic and short of breath. on , a bronchoscopy was performed as she has aspirated bilious appearing emesis. bal was performed in the anterior segment of the left upper lobe. twenty ml of greenish aspirate was obtained. culture grew 10-100,000 colonies of enterobacter cloacae. she was treated with cipro for 14 days from . vancomycin was administered from thru . micafungin was administered from trough for antifungal coverage per protocol. on , a cvl was removed to simplify lines. tip was sent for culture and grew vre. linezolid was started on until stop date . cxr demonstrated bilateral pleural effusions with right greater than left. on , a right thoracentesis was done removing 1.5 liters. this fluid was cultured and had no growth. a left thoracentesis was done on for 1100ml. this also had no growth on culture. respiratory status improved with room air sats of 99%. respiratory rate averaged 20 bpm. bp ranged between 130/90-145/100. she was mantained on lopressor. cvvhd was continued during most of her sicu stay. as urine output increased, cvvhd was stopped on . creatinine averaged 0.6 on dialysis. once off cvvhd, creatinine increased to 2.0 on . by , creatinine had decreased to 1.8 with daily urine output averaging 2.9 liters/day on lasix. a daily dose of oral lasix was prescribed. florinef was added on for hyperkalemia. on , she was transfused with 2 units of prbc for a hct of 23.3. immunosuppression consisted of atg (75mg each dose x3 doses), cellcept and steroid taper. prograf was initiated on postop day 2 and adjusted daily per trough levels with goal achieved. goal prograf was 10. on , she transferred out of the sicu to the med unit. preop, she was very debilitated with muscle wasting. postop, she was more so and required pt. a lift was recommended for transfers. rehab was recommended. diet was poorly tolerated and nasojejeunal tube feedings were administered using novasource renal. she did have some diarrhea. stools were negative for c.diff. cellcept dosing was adjusted to qid with decreased gi side effects. on , a speech and swallow evaluation was completed without s/sx of aspiration at bedside. she appeared safe for initiation of regular diet, thin liquids, pills whole with thin. energy level improved overall although she is still very debilitated. she will transfer to in with twice weekly lab monitoring. tunnelled hd line should be flushed with saline/heparin every 2-3 days as she is currently off dialysis. immunosuppression should be managed only by the service at . a tsh should be repeated in weeks as levoxyl was increased on . medications on admission: 1. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. clotrimazole 10 mg troche sig: one (1) troche mucous membrane qid (4 times a day). 3. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 4. metoclopramide 10 mg tablet sig: 0.5 tablet po tid (3 times a day). 5. levothyroxine 112 mcg tablet sig: one (1) tablet po daily (daily). 6. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 7. midodrine 5 mg tablet sig: two (2) tablet po bid (2 times a day). 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 9. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for diaper rash. 10. clotrimazole 1 % cream sig: one (1) appl topical tid (3 times a day) as needed for diaper rash . 11. ipratropium bromide 0.02 % solution sig: one (1) inhalation inhalation q6h (every 6 hours): must give standing, and even wake out of bed for this overnight. 12. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 13. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 14. lactulose 10 gram/15 ml syrup sig: 15-30 mls po daily (daily): please titrate to bowel movements daily. 15. sevelamer hcl 400 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 16. warfarin 1 mg tablet sig: four (4) tablet po once daily at 4 pm: monitor inr at least once weekly while taking this medication. 17. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 18. acetylcysteine 20 % (200 mg/ml) solution sig: one (1) ml miscellaneous q 8h (every 8 hours): must give standing, and even wake out of bed for this overnight. 19. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours): patient has been receiving this standing in the days prior to discharge, as has been frequently sob. must give standing, and even wake out of bed for this overnight. 20. heparin (porcine) 1,000 unit/ml solution sig: one (1) flush injection prn (as needed) as needed for line flush: withdraw 4 ml prior to flushing with 10 ml ns followed by heparin as above. 21. medication critic-aid - apply in morning to buttocks and prn throughout the day as needed to maintain seal discharge medications: 1. tacrolimus 1 mg capsule sig: three (3) capsule po twice a day. 2. tacrolimus 0.5 mg capsule sig: one (1) capsule po twice a day. 3. florinef 0.1 mg tablet sig: one (1) tablet po monday-weds-. 4. lasix 40 mg tablet sig: one (1) tablet po once a day. 5. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 6. white petrolatum-mineral oil 42.5-56.8 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 7. insulin regular human 100 unit/ml solution sig: follow sliding scale injection asdir (as directed): see printed scale. 8. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 9. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours). 10. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q4h (every 4 hours) as needed for wheezing/sob. 11. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 12. valganciclovir 450 mg tablet sig: one (1) tablet po every other day (every other day). 13. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 14. prednisone 5 mg tablet sig: 3.5 tablets po daily (daily): follow taper. 15. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po qid (4 times a day). 16. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 17. levothyroxine 150 mcg tablet sig: one (1) tablet po daily (daily). 18. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp <110 or hr <60. 19. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) mg injection q8h (every 8 hours) as needed for nausea/vomiting. 20. dextrose 50% in water (d50w) syringe sig: 12.5 gm intravenous prn (as needed) as needed for hypoglycemia protocol. discharge disposition: extended care facility: - discharge diagnosis: s/p liver/kidney txp delayed renal graft function atn hypothyroidism pleural effusions discharge condition: stable/fair a+ox3 ambulatory status: requires intensive rehab discharge instructions: please call the clinic at for fever, chills, nausea, vomiting, diarrhea, constipation, inability to take or keep down food, fluids or medications, jaundice, decreased urine output, weight gain of 3 pounds in a day, pain over liver/kidney . call if there are problems with the post pyloric feeding tube or intolerance to the tube feeds such as diarrhea labwork every monday and thursday with results faxed to clinic at . monitor the incision for redness, drainage or bleeding monitor urine output daily and keep record to send with patient to clinic. followup instructions: , social work date/time: 2:30 , md phone: date/time: 3:20 , md phone: date/time: 3:40 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis thoracentesis closed [endoscopic] biopsy of bronchus closed [percutaneous] [needle] biopsy of kidney other transplant of liver other kidney transplantation injection or infusion of oxazolidinone class of antibiotics removal of other device from thorax other operations on lacrimal gland transplant from cadaver other operations on lacrimal gland transplant from cadaver diagnoses: other iatrogenic hypotension anemia in chronic kidney disease end stage renal disease pneumonia due to other gram-negative bacteria acute kidney failure with lesion of tubular necrosis unspecified pleural effusion cirrhosis of liver without mention of alcohol acquired coagulation factor deficiency hyposmolality and/or hyponatremia unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonitis due to inhalation of food or vomitus late effects of cerebrovascular disease, hemiplegia affecting unspecified side other sequelae of chronic liver disease surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other and unspecified infection due to central venous catheter urinary complications, not elsewhere classified hematuria, unspecified complications of transplanted kidney other drugs and medicinal substances causing adverse effects in therapeutic use congenital cystic disease of liver polycystic kidney, autosomal dominant 

Answer: The patient is high likely exposed to