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: ciprofloxacin / opioid analgesics / levaquin attending: chief complaint: fever major surgical or invasive procedure: intubation/extubation rij central line, now removed lumbar puncture history of present illness: 60 y.o. m with hx of esrd s/p cadaveric renal tx in , on immunosuppressants, hep c, htn, , pvd presents from home with fever to 105.8. patient says he was in his usual state of health as recently as weds, when he saw his cardiologist in preparation for hernia repair surgery early next week. some of his usual medications including his prophylactic bactrim were held and he stayed home from work trying to avoid sick contacts pre-operatively. on thursday afternoon he started to feel some malaise and his temperature started to rise. he took some tylenol and his fever appeared initially to abate, but returned with nausea and vomiting, constant shivering, shoulder aches, headaches, and three episodes of loose stools. denies any urinary symptoms (no changes in color, consistency, dysuria, frequency, urgency), abd pain, neck stiffness, cough or cold symptoms. no sick contacts. recent travel. he was last admitted to from to for new diagnosis of atrial flutter, acute on chronic renal failure and hap. . in the ed, patient had labs which showed and elevated white count with a 10% bandemia. he had a cxr which was negative for any acute process. a r ij line was placed and he was started on vancomycin and gentamycin for presumptive endocarditis. ua, urine culture, and blood cultures were sent. no recent invasive dental work. no recent ivdu. past medical history: congestive heart failure with ef 65% on type 2 diabetes with triopathy, controlled. hypertension. hypercholesterolemia. history of seizure disorder. history of hepatitis c - no therapy - bx -minimal portal and lobular mononuclear cell inflammation, consistent with involvement by chronic viral hepatitis c ( grade 1 activity). end-stage renal disease, status post cadaveric renal transplant, creatinine 1.5 in peripheral disease. post-op afib s/p dccv in rt rectus femoris intramuscular hematoma - (inr 4.2) ? enlarged ln in his neck s/p bx - 2-3 years ago, pt reports nl ebv igg positive in /cmv igg positive hep b core ab + transplant: on lamivudine . past surgical history: 1. right ak -pt with nonreversed saphenous vein on by dr. . 2. left av fistula. 3. cadaver renal transplant in . induction with thymoglobulin and tacrolimus 4. cholecystectomy. 5. parathyroidectomy in by dr. - path c/w hypercellular parathyroid 6. status post second toe amputation in . 7. right first toe amputation. 8. aortic valve replacement - well seated aortic bioprosthesis with high-normal gradient and trace aortic regurgitation (). social history: lives with wife who is pt and 21 y.o. son. tobacco, etoh once monthly; distant h/o ivda (>40yrs ago) per record. family history: two brothers: 74yo with bladder cancer in remission, 68yo with kidney failure, , and polymyalgia rheumatica. mother: died of disease at age 82, hx of father: died of an mi at 54, hx of and leukemia at 18 months. physical exam: vs: t: 101.3 p: 92 bp: 132/48 rr: 33 o2 sat: 100% on gen: nad heent: at, nc, perrla, eomi, no conjuctival injection, anicteric, op clear, mmm, neck supple cv: rrr, sys murmur loudest at apex, with rdaiation to l carotid pulm: ctab to anterior exam abd: soft, nt, nd, + bs, no hsm ext: warm, dry, +2 distal pulses bl, multiple toes amputated neuro: alert & oriented, cn ii-xii grossly intact, 5/5 strength throughout. no sensory deficits to light touch appreciated. psych: appropriate affect pertinent results: cxr: limited study, no evidence of pna . echo (): the left atrium is markedly dilated. the right atrium is moderately dilated. the interatrial septum is aneurysmal. the estimated right atrial pressure is 10-15mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular free wall is hypertrophied. the right ventricular cavity is mildly dilated with normal free wall contractility. a bioprosthetic aortic valve prosthesis is present. the prosthetic aortic valve leaflets appear normal the transaortic gradient is higher than expected for this type of prosthesis. a paravalvular aortic valve leak is present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. mild (1+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the aortic prosthesis gradient is significantly elevated. preserved systolic function with elevated filling pressures is similar. . ct torso: : impression: 1. decreased volume of air within the collecting system of the transplant kidney. there is no significant perinephric stranding about the transplant or about the transplant ureter. this suggests possibility that this air may have been related to foley catheter insertion. 2. new ascites is seen within the peritoneal cavity which extends into the patient's left inguinal hernia. 3. increasing bilateral airspace opacities with infectious etiologies as a differential consideration. recommend clinical correlation. . : leni: impression: no dvt in both lower extremities. . : cxr: impression: ap chest compared to and 17: mild pulmonary edema, seen best in perihilar left lung has worsened slightly since , accompanied by persistent increase in caliber of mediastinal veins. right lung base is elevated, and atelectasis may explain consolidation in the right lower lung, but i am more concerned this is pneumonia. mild cardiomegaly stable. anatomic detail in the upper lungs is obscured by radiographic technique. no pneumothorax is present. pleural effusion if any is minimal, on the right. moderate cardiomegaly unchanged. right jugular line ends in the svc. . : nc head ct: impression: 1. no evidence of acute intracranial hemorrhage or large territory infarction; if suspicion for infarct is present, mri would be recommended for more sensitive evaluation. 2. air-fluid levels in paranasal sinuses and mastoid air cells may relate in part to recent intubation and recently removed ng tube. . : ru noninvasive: impression: there is no evidence of deep venous thrombosis in the right upper extremity. right cephalic vein was not visualized in the present exam. . : mr : findings: there is diffuse low signal visualized in the vertebral bodies which could be due to marrow hyperplasia or infiltration and clinical correlation recommended. there is no evidence of ligamentous disruption seen on limited evaluation on the sagittal inversion recovery images. from c2-3 to c4-5 no significant disc bulge, herniation, spinal stenosis or foraminal narrowing seen. at c5-6 there is posterior ridging and bulging with mild spinal stenosis and minimal extrinsic indentation on the spinal cord. mild bilateral foraminal narrowing seen. at c6-7 there is mild disc bulging and left-sided foraminal narrowing seen. at c7-t1 and t1-2 no significant abnormalities are noted. the paraspinal soft tissues are unremarkable. the previously noted abnormality on the mra of is not apparent on the current study on axial images. the spinal cord shows normal intrinsic signal. impression: limited study with motion on the sagittal images. mild spinal stenosis at c5-6 with minimal extrinsic indentation on the spinal cord. no evidence of increased signal within the spinal cord. other changes as described above. . : mr : impression: 1. no evidence of acute infarct. 2. chronic left frontal cortical and subcortical infarcts. 3. low signal in the visualized bone marrow could be due to marrow hyperplasia or infiltration. clinical correlation recommended. mra of the head: the head mra demonstrates normal flow signal within the arteries of anterior and posterior circulation. no evidence of occlusion or stenosis is seen. impression: normal mra of the head. brief hospital course: a/p: 60m pmh esrd s/p cadaveric renal transplant in on immunosuppressants, hbv/hcv, htn, dm2 presented from home with fever to 105.8, malaise, with nonspecific gi symptoms but no other localizing signs or symptoms. . # hypoxic respiratory failure: due to pneumonia versus infiltrates from sepsis with component of fluid overload which improved after diuresis. improved. now extubated and doing well on room air. he was maintained on antibiotics as discussed below for and has completed his course. . # fever: the patient was followed by the infectious disease teamand had an extensive infectious workup for possible source of his fever. i the end no definitive source was found. it was believed to be most likely pneumonia. urinalysis was positive but urine culture negative; csf suggested possible aseptic meningitis; rapid respiratory viral screen was negative; c. difficile was negative x3; tte was negative for vegetation to suggest endocarditis; bronchoalveolar lavage was negative; lfts were normal. he became hemodynamically unstable requiring aggressive volume resuscitation and pressors which were discontinued on . he was covered broadly with vancomycin, zosyn and flagyl, which were discontinued on . infectious disease followed throughout his stay and also raised the possibility of addisonian crisis as an etiology of these recurrent culture-negative septic episodes for which endocrine follow up would be indicated. he was given a course of stress dose steroids during his acute hypotension. . # right sided weakness: the patient was initially diffusely weak, then localized on the right side, more upper than lower extremity, with intact sensation. swallowing, which was also initially weak, began to improve and the patient passed his swallow exam. noncontrast head ct scan was negative, mri c-spine and head were negative for acute abnormalities as well. weakness is possibly due to deconditioning thorughout prolonged hospitalization and icu stay. he was seen by physical therapy, who recommended rehab stay for conditioning. . #penile lesions: pressure ulcers formed while in the icu, both a large frank ulcerated area on the glans penis (multiple smaller ulcerated areas on the foreskin) for which he was seen by urology, who recommended treatment with bacitracin with improvement, and a sacral decubitus ulcer for which we have tried turning patient and keeping him out of bed as much as possible, as well as general wound care. . # hypotension: most likely this was secondary to septic shock, also possibly relative adrenal insufficiency given chronic prednisone use. he was given cortisol empiric high-dose steroids and discontinued , without recurrence of hypotension. he required pressors for a short period in the icu. blood pressure has been stable on the floor. at the time of discharge we are continuing to hold his home avapro, but this may be restarted by his pcp as needed. . # acute on chronic kidney failure: baseline creatinine 1.5 per recent records but has had intermittent acute on chronic disease, thought due to prograf toxicity. peak creatinine was 5.6, which trended downwards and hit baseline of 1.5 on . arf was thought to be secondary to atn vs prerenal azotemia from septic shock with poor perfusion. he was anuric, then subsequently began to autodiurese. at the time of discharge his renal function is normal and we have restarted lasix at 1/4 of his home dose (prior home dose 80mg po qday). this may require uptitration as an outpatient as needed. . # acute on chronic systolic chf: the patient was admitted with a history of diastolic chf and an ef of 65%. he was on lasix at home. during his admission he was noted to have an ef of 40% on echocardiogram with global hypokinesis in the setting of his sirs. at the time of his discharge we have restarted lasix, but at only 20mg qday (less than his prior dose). this may need to be uptitrated in the future, but he is currently euvolemic on this dose. we anticipate that his ef may recover as the patient recovers overall and repeat echo may be considered in the future. # rash: a maculopapular rash appeared on the patient's feet . only new medications at that time were lasix iv and chlorthiazide so these were discontinued (lasix po is a home medication). the rash then resolved over the next three days. it was believed to be a drug rash, albeit an unusual location. . # diarrhea: the patient's diarrhea on this admission was ruled out for c diff x 3. it began to abate after cessation of antibiotics and was felt to be antibiotic associated diarrhea. . # anemia/thrombocytopenia: likely bone marrow suppression in the setting of sepsis versus side effect of cellcept. once coumadin was restarted, the patient's stool became guaiac positive and required 2 units total of prbc's (given on different days) to maintain hct > 21. his hematocrit was subsequently stable and he has no sign of active bleeding. he was hit ab negative. thrombocytopenia was stable. . # dm2: blood sugars were initially poorly controlled in the setting of sepsis and suspected pna. he improved on an insulin gtt was then resumed on his home lantus and an insulin sliding scale with good control. the patient began to have fs in hte 60s-70s and stated that although he is prescribed 40 units lantus qam and qpm, he often takes only 20. we decreased his dose to lantus 20units qam and 20 qpm. fs should be followed with likely uptitrating of his lantus dose at rehab as needed. . # atrial flutter: the patient remained rate controlled. coumadin was held on admission due to supratherapeutic inr. he was given vitamin k. coumadin was restarted on callout to the floor from the icu, however his inr was elevated after 5mg dosing. his coumadin is now being held for drifting down of inr and should be restarted at 1mg po qday once his inr is <2.5. his goal inr is and this should be checked in three days and eevery three days until stable. . # htn: initially, anti-hypertensives were held given septic shock. once hemodynamically stable, his metoprolol was restarted at half of his home dose, with plan to titrate up as tolerated. diovan was held in the setting of renal failure nad should be restarted as needed as an outpatient by his pcp. . # hepatitis c: no active issues. . # hepatitis b: core ab + in transplanted kidney. continued lamivudine, which was initially dosed for renal failure and now with improved creatinine is at regular dose. . # hyperlipidemia: no active issues. continued simvastatin. at the time of discharge we are holding his niacin, but this may be restarted by his pcp after discharge as needed. . #access: right ij was placed on and pulled on the day of discharge, the patient has a left av fistula. . #code: full medications on admission: asa 81 mg avapro bactrim mycophenolate mofetil 500 mg tablet one (1) tablet po bid warfarin 1 mg tablet sig: tablet po as directed amiodarone 200 mg tablet 1 po twice a day. tacrolimus 0.5 mg capsule sig: one (1) capsule po qam folic acid 1 mg tablet sig: one (1) tablet po daily (daily). fosamax lasix 80 in am, 40 in pm insulin glargine 100 unit/ml solution sig: forty (40) units subcutaneous twice a day. insulin lispro 100 unit/ml solution sig: 0-50 units subcutaneous four times a day: per your sliding scale. lamivudine 100 mg tablet sig: 0.5 tablet po daily (daily). metoprolol tartrate 100 mg tablet 1 tablet po bid niacin prednisone 5 mg tablet sig: one (1) tablet po daily omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. prograf simvastatin 80 mg tablet sig: one (1) tablet po once a day. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) viagra warfarin discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 3. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). 4. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day). 5. tacrolimus 0.5 mg capsule sig: one (1) capsule po q12h (every 12 hours). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. fosamax 70 mg tablet sig: one (1) tablet po once a week. 8. insulin glargine 100 unit/ml cartridge sig: twenty (20) units subcutaneous twice a day: note prior home dose was 40 twice per day, so may need uptitration in rehab. 9. insulin lispro 100 unit/ml cartridge sig: per sliding scale units subcutaneous four times a day. 10. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 11. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 12. ferrous sulfate 300 mg/5 ml liquid sig: one (1) po daily (daily). 13. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 14. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 15. bacitracin zinc 500 unit/g ointment sig: one (1) appl topical tid (3 times a day). 16. outpatient lab work pls check inr monday and every 2-3 days thereafter; pls restart coumadin 1mg when inr<2.5. goal inr 17. bactrim 80-400 mg tablet sig: one (1) tablet po once a day. 18. epoetin alfa 10,000 unit/ml solution sig: one (1) ml injection once a week. 19. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 20. lamivudine 100 mg tablet sig: one (1) tablet po daily (daily). 21. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: # high grade fever to 105.8 on presentation, sirs - ?infection with subsequent stress repsonse and adrenal insufficiency # congestive heart failure, previous ef 65%, in setting of sirs was 40%, and likely will recover # penile traumatic ulcers and paraphimosis # acute on chronic kidney failure, baseline creatinine 1.5 per - peak creatinine 5.6, trended downwards and hit baseline of 1.5 on . # anemia/thrombocytopenia - bone marrow suppression in the setting of sepsis versus side effect of cellcept. # weakness - head ct and mri with chronic changes and neuro c/s stated unmasking old stroke in setting of acute illness. # coagulopathy with inr elevated on presentation (likely from liver dysfn) . secondary diagnosis: # type 2 diabetes with triopathy, controlled. # hypertension. # hypercholesterolemia. # history of seizure disorder. # history of hepatitis c - no therapy - bx -minimal portal and lobular mononuclear cell inflammation, consistent with involvement by chronic viral hepatitis c ( grade 1 activity). # hepatitis b: core ab + in transplanted kidney # end-stage renal disease, status post cadaveric renal transplant, creatinine 1.5 in # peripheral disease. # post-op afib s/p dccv in # rt rectus femoris intramuscular hematoma - (inr 4.2) # ? enlarged ln in his neck s/p bx - 2-3 years ago, pt reports nl ebv igg positive in /cmv igg positive # hep b core ab + transplant: on lamivudine # right ak -pt with nonreversed saphenous vein on by dr. . # left av fistula. # cadaver renal transplant in . induction with thymoglobulin and tacrolimus # cholecystectomy. # parathyroidectomy in by dr. - path c/w hypercellular parathyroid # status post second toe amputation in . # right first toe amputation. # aortic valve replacement - well seated aortic bioprosthesis with high-normal gradient and trace aortic regurgitation (). discharge condition: stable discharge instructions: you were admitted and treated for a severe fever and severe inflammatory response syndrome and shock. the cause of this is unknown although may have been related to an infection with subsequent stress response. . if you develop fever greater than 101f chest pain, shortness of breath, severe dizziness, or if you at any time become concerned about your health please contact dr. , at or present to the nearest ed. . please take your medications as prescribed. we are holding the following medications on your previous medication list, please resume as indicated or instructed by md: - viagra - warfarin - avapro - niacin please maintain a low sodium diet (<2grams), weight yourself . please go to your scheduled appointments listed below: 1. provider: , md date/time: 10:10 followup instructions: 1. provider: , md date/time: 10:10 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified acute kidney failure with lesion of tubular necrosis long-term (current) use of steroids acquired coagulation factor deficiency unspecified septicemia severe sepsis unspecified viral hepatitis c without hepatic coma hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial flutter acute respiratory failure septic shock dermatitis due to drugs and medicines taken internally diarrhea heart valve replaced by transplant glucocorticoid deficiency surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation acute on chronic systolic heart failure complications of transplanted kidney diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta redundant prepuce and phimosis other diuretics causing adverse effects in therapeutic use unspecified antibiotic causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to