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: the patient is a 74-year-old gentleman with a history of cadaveric renal transplant in who presented to the emergency department with a fever of 104, malaise, nausea, and vomiting times one day. the patient noted that the day prior to admission he developed some mild back pain which improved but did not abate with over-the-counter pain medications. the patient also complained of mild urinary frequency, and stated that because of his nausea and vomiting he had been taking very oral intake over the past four to five days. the patient denied any lightheadedness or any tachycardia with rising. he denied sweats, weight loss, headache, or a change in his chronic cough. the patient denied any sick contacts, recent travel, or recent changes in his medications. on presentation to the emergency department, the patient was febrile to 103 degrees fahrenheit. he was given 500 mg of by mouth levaquin and was fluid resuscitated with two liters of normal saline, and he was admitted to the medicine service. past medical history: 1. status post cadaveric renal transplant in for focal segmental glomerulosclerosis. 2. history of atrial fibrillation; status post vvi pacemaker. 3. left ventricular hypertrophy with mitral regurgitation. 4. hypertension. 5. grave's disease; status post subtotal thyroidectomy. 6. history of upper gastrointestinal bleed; status post truncal vagotomy in . 7. right eye blindness. medications on presentation: 1. valsartan 160 mg by mouth twice per day. 2. prograf 0.5 mg by mouth twice per day. 3. cellcept mg by mouth twice per day. 4. prednisone 5 mg by mouth once per day. 5. lasix 80 mg by mouth q.a.m. and 40 mg by mouth q.p.m. 6. terazosin 5 mg by mouth once per day. 7. amlodipine 5 mg by mouth once per day. 8. potassium chloride 20 meq by mouth once per day 9. levothyroxine 175 mcg by mouth every day. 10. carafate by mouth once per day. 11. multivitamin one tablet by mouth once per day. 12. prilosec. 13. timolol. allergies: no known drug allergies. physical examination on presentation: physical examination revealed vital signs with a temperature of 99.6 degrees fahrenheit, his temperature maximum was 103, his blood pressure was 116/31, his heart rate was 63, respiratory rate was 18, and oxygen saturation was 98% on 2 liters. in general, an ill-appearing gentleman in no apparent distress. alert and oriented times three. head, eyes, ears, nose, and throat examination revealed the patient was blind in the right eye. the patient had bilateral periorbital edema. the mucous membranes were moist. no exudates or lesions were noted. the tympanic membranes were clear. no cervical lymphadenopathy. the neck was supple. no jugular venous distention. cardiovascular examination revealed normal first heart sounds and second heart sounds. no murmurs, rubs, or gallops. the lungs were clear to auscultation bilaterally. the abdomen was soft, nontender, and nondistended. normal active bowel sounds. no costovertebral angle tenderness. extremity examination revealed 1+ pitting edema bilaterally in the feet. extremities revealed no rash or lesions. pertinent laboratory values on presentation: laboratories on presentation revealed his white blood cell count was 14.5 (with 92% polys and 34% lymphocytes, 5% monocytes, and no bands), his hematocrit was 39.9, and his platelets were 129. his sodium was 140, potassium was 3.8, chloride was 102, bicarbonate was 26, blood urea nitrogen was 36, and creatinine was 1.9 (with a baseline creatinine of between 1.7 to 1.9). his lactate was 2. calcium, magnesium, and phosphorous were all within normal limits. urinalysis revealed moderate leukocyte esterase, large blood, negative nitrites, 30 protein, 6 to 10 red blood cells, greater than 50 white blood cells, many bacteria, and less than 1 epithelial cell. urine cultures and blood cultures were taken. pertinent radiology/imaging: a chest x-ray revealed no infiltrates and no congestive heart failure. concise summary of hospital course: the patient was admitted to the resident-only medicine service and followed closely by the renal team given his history of a renal transplant. approximately one hour after admission, his blood pressure dipped down from 120 down to 85. the patient was given two liters of normal saline rapidly in the emergency department without a response in his blood pressure. the patient had a left femoral central line placed for rapid volume resuscitation. the renal team felt that, given his renal transplant, it was very important to maintain adequate renal perfusion. the patient was given two doses of intravenous zosyn and one dose of intravenous vancomycin in the emergency department given the fact that the patient was developing overwhelming sepsis. a medical intensive care unit evaluation was called. the patient was aggressively volume resuscitation in the emergency department with a total of up to eight liters of intravenous fluids and was started on dopamine. thereafter, the patient's blood pressure came up quickly to 140 systolic. during this entire time, the patient did not have any confusion of mental status changes, and he did not have any problems with chest pain. his electrocardiogram showed only minor transient lateral wall t wave inversions which normalized within one day and were thought to be nonspecific after consulting cardiology. the patient was taken to the medical intensive care unit and was followed in the intensive care unit for approximately four days. during that time, he was only on pressors for 24 hours. the dopamine was weaned off, and the patient was transiently on levophed. the patient's urine cultures grew out klebsiella which was sensitive to levaquin, and the patient was transferred once again to oral levaquin. the patient's blood cultures remained negative throughout his stay. his sputum cultures also, once again, remained negative. the patient complained of two to three bowel movements which were loose, and he had two clostridium difficile toxins were sent off; which were both negative. due to the risk of infection and his immunocompromised state, the patient's left femoral catheter was removed, and he had a left central line placed under sterile technique. the catheter tip from the femoral line was sent off for culture, and even after three to four days it was no growth to date. the renal team followed the patient's course closely. given the fact that the patient had a hypotensive episode, his creatinine levels were followed once per day. the patient's creatinine did rise as high as 2.3 from a baseline of 1.9 upon admission. his urinalysis revealed casts which were consistent with acute tubular necrosis due to his hypertensive episode. the renal team decreased his prograf to 0.5 mg by mouth once per day and checked a level to insure that he was not developing some renal damage due to the immunosuppressive medications. the patient continued to have some difficulty with shortness of breath in the intensive care unit. he had a repeat chest x-ray which did in fact reveal a pneumonia. it was thought that once the patient was adequately volume resuscitated, the pneumonia revealed itself. a bibasilar consolidation with prominence on the lateral view was seen on a posterior/anterior and lateral chest x-ray, and it was thought that the patient had an aspiration pneumonia. according to his wife, the patient had one period prior to admission where he was confused and vomited. it was most likely that he had aspirated during that event. due to this, levaquin was continued, and the patient was started on flagyl as well for anaerobic coverage. also, the patient was in gross volume overload in the intensive care unit given his volume resuscitation. the patient was diuresed with intravenous diuretics and also was on natrecor for two days to assist in his diuresis. the patient put out approximately 200 cc to 300 cc of fluid while in the intensive care unit once per day, but due to the volume of intravenous medications he was getting, they had difficulty making him negative and accomplishing adequate diuresis. the natrecor was discontinued after three days, and the patient was thought to be stable enough to return to the floor. on the floor, the patient continued to use continuous positive airway pressure at night. as his diuresis continued, the patient's respiratory status improved greatly over the next few days. the patient's respiratory rate at times had been as high as 28 on the floor, but over the next two days with diuresis and treatment of his pneumonia, as well as using continuous positive airway pressure at night, his respiratory rate was within normal limits. on the floor, the patient was initially maintained on 80 mg intravenously twice per day of lasix which was increased to 80 mg intravenous three times per day of lasix. on the three times per day dose of lasix, the patient put out 1.2 liters of fluid. unfortunately, the patient's creatinine did bump up from 2.1 to 2.3. it was thought that this dose of intravenous lasix was probably too aggressive. the renal team felt that the patient still had to diuresis approximately 4 liters to 5 liters of fluid to get down to his dry weight. it was thought that the patient should be transitioned back to by mouth agents, and that his diuresis should be done very slowly over the week, and this creatinine should be measured each day so that hopefully the slow diuresis will allow time for fluid shifts without causing his creatinine to bump and his kidney function to decompensate. of note, the patient also had an echocardiogram while he was in house to insure that his congestive heart failure was not due to some valvular dysfunction. the echocardiogram revealed a left atrium was mildly dilated, a symmetric left ventricular hypertrophy, with an ejection fraction of greater than 55%. there was trace aortic regurgitation noted and moderate-to-severe 3+ mitral regurgitation that was also noted. no wall motion abnormalities were present. it was thought that this echocardiogram over-estimated the patient's mitral regurgitation given the fact that he was in gross volume overload, and the patient was to have a repeat echocardiogram done as an outpatient to assess his systolic function and his mitral regurgitation once his volume status had returned to limits. of note, the patient was taken off his valsartan while he was in house given his acute tubular necrosis and his high creatinine. the patient was to be restarted on this due to his mitral regurgitation once he was discharged from the hospital. while he was in house, the patient was continued on hydralazine and isosorbide for afterload reduction, and on that regimen his blood pressures revealed adequate afterload reduction. the patient was also seen by physical therapy during his stay, and they felt that the patient might need one to two weeks of rehabilitation in a rehabilitation facility due to the patient's relative immobility and unsteadiness of gait. the rehabilitation team felt that there may be a risk of fall, and this was discussed both with the patient's family and with the patient. it was thought that may provide adequate benefit because they could both measure his creatinine and volume status and at the same time insure that his gait and strength returned to limits within one to two weeks' time. discharge diagnoses: 1. urosepsis. 2. aspiration pneumonia. 3. acute tubular necrosis. 4. gait instability (requiring rehabilitation). 5. diarrhea. 6. chronic renal insufficiency. 7. nausea and vomiting. medications on discharge: 1. prograf 0.5 mg by mouth twice per day. 2. cellcept mg by mouth twice per day. 3. prednisone 5 mg by mouth once per day. 4. lasix 160 mg by mouth twice per day. 5. terazosin 5 mg by mouth once per day. 6. amlodipine 5 mg by mouth once per day. 7. potassium chloride 20 meq by mouth once per day. 8. levoxyl 175 mcg by mouth once per day. 9. caltrate. 10. multivitamin one tablet by mouth once per day. 11. prilosec. 12. timolol. 13. valsartan 160 mg by mouth once per day (please note that the patient was on 160 mg by mouth twice per day prior to admission). discharge instructions/followup: 1. the patient was instructed to have his creatinine checked once per day for the next week to insure that his creatinine did not rise with the increased prograf dose, the restarting of his angiotensin receptor blocker at a lower dose, and with the continued diuresis. 2. the patient was thought to require 4 liters to 5 liters more of diuresis, and daily weights should be continued. the patient should be kept on strict ins-and-outs and should be fluid limited to 1.5 liters of free water per day. 3. the patient was instructed to undergo physical therapy to insure that his condition improved. 4. the patient was instructed to have an outpatient echocardiogram once his volume status was better. this should be set up by his outpatient primary care physician. 5. the patient was instructed to follow up with his primary care physician in one week's time. 6. the patient was instructed to return to the emergency department if he developed chest pain, fevers, chills, or any worsening of his condition. 7. the patient was instructed to continue a 10-day course of levaquin and flagyl for his aspiration pneumonia. condition at discharge: condition on discharge was good. discharge status: to rehabilitation. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified injection or infusion of nesiritide diagnoses: mitral valve disorders acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified unspecified septicemia atrial fibrillation pneumonitis due to inhalation of food or vomitus septic shock complications of transplanted kidney 

Answer: The patient is high likely exposed to