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: rapamune / ativan attending: chief complaint: dyspnea major surgical or invasive procedure: picc line history of present illness: 77 y.o. female with pmhx of pckd and pcld (s/p bil native nephrectomy and liver dissection) and s/p cadaveric renal transplant in with past history of multiple abd surgeries including rectopexy for irreducible rectal prolapse on presented to the ed with increasing shortness of breath. patient reports becoming acutely short of breath on the night prior to admission. on the following day, she was hypertensive to 199/90 with a mild headache and noted a temperature of 99. she also noted profound weakness and thus came into the er for further evaluation. she denies any chest pain, palpitations, fevers, recent sick contacts or travel. in the ed, vitals were t 99.5, p 76, bp 183/75, rr 25, o2: 77% on ra, 96% . o2 sats began to trend down on , she was eventually switched to cpap. given the hypoxia, a cxr was ordered which showed bibasilar pna and chf. bnp was elevated to 53,163. patient was also noted to have a distended abdomen, concerning for sbo. kub showed no ileus or obstruction. surgery was consulted and felt that there were no acute surgical issues and that a ct scan of the abdomen could be performed if there were increasing concern for obstruction. given the cxr findings, patient was started on levofloxacin. she was additionally given a dose of flagyl for concern of an intrabdominal process. she was then admitted to the icu for pna/chf. past medical history: 1. s/p cadaveric renal transplant in for polycystic kidney disease, status post bilateral nephrectomy (, ) 2. polycystic liver disease- s/p liver resection- left hepatic trisegmentectomy and right lobe cyst reduction ('). 3. recurrent partial small bowel obstruction 4. s/p cholecystectomy 5. s/p appendectomy 6. s/p excision of parathyroid adenoma ' 7. hypertension 8. breast cancer, s/p l radical mastectomy () 9. history of right elbow and humeral fracture 10. history of incarcerated hernias although per history "reduced" nonsurgically in the past 11. spinal stenosis 12. irreducible rectal prolapse, s/p abdominal rectopexy ()- social history: lives with husband who recently fractured his hip, has two children who live locally. denies tobacco, etoh, drugs. family history: polycystic kidney disease. physical exam: pe: bp 173/64, 16, hr 75, 97 on 4l gen: awake, alert, breathing comfortably on nasal cannula, nad heart: s1, s2 nl, ii/vi sem, ii/vi sem noted. lungs: bilateral lower lobe crackles diminished breath sounds, rul crackles abd: multiple surgical incisions, abdomen is firm, distended, nt, decreased bs rectal: guaiac negative per icu ext: warm, well perfused, no c/c/e. neuro: cn ii-xii grossly intact. skin: multiple ecchymotic lesions pertinent results: : portable abdomen: findings: a single portable ap view of the abdomen is obtained which excludes the upper abdomen. multiple surgical clips are again noted in the mid abdomen which are unchanged from prior study. there has been interval removal of the skin staples. the bowel gas pattern is nonspecific, though demonstrates no definite evidence of ileus or obstruction. the abdominal aorta is calcified and appears tortuous. visualized osseous structures are unremarkable. : abdominal us: findings: limited four quadrant views of the abdomen demonstrate large amount of simple-appearing ascites in all four quadrants, including the right perihepatic space. : chest x-ray findings: two bedside frontal views labeled "upright at 12:50, 1:00 p.m." with lordotic positioning, are compared with most recent study dated . there is dense retrocardiac opacity with air bronchograms and obscuration of that hemidiaphragm, likely representing combination of consolidation and effusion, new. there is also further patchy opacity at the right lung base; this process is likely pneumonic. there is cardiomegaly with pulmonary vascular congestion and blurring and small bilateral pleural effusions. noted are numerous surgical clips in the upper abdomen, particularly on the right and a right shoulder arthroplasty. : chest x-ray impression: 1. increasing right lung consolidation suggesting worsening infection. 2. increasing left basilar opacity possibly representing a combination of atelectasis and effusion, although infection cannot be excluded. : abdominal us impression: 1. patent hepatic vessels with normal directional flow. 2. numerous cysts throughout the liver. 3. dilated extrahepatic common bile duct measuring 16 mm in greatest dimension. : echo the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). transmitral doppler and tissue velocity imaging are consistent with grade ii (moderate) lv diastolic dysfunction. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , left ventricular diastolic function has worsened. the amounts of mitral regurgitation, tricuspid regurgitation, and estimated pumonary artery systolic pressure have increased. : ct torso findings: there is severe scoliosis of the thoracic spine. consecutive asymmetry of the rib cage. multicystic liver disease. in the thorax, the right-sided pleural effusion has a diameter of 5.2 mm at its largest size. considerably smaller left-sided pleural effusion. the most remarkable finding in the lung parenchyma is a right-sided extensive perihilar opacity with air bronchograms and central consolidations. this opacity has a subtle ground- glass halo and several satellite lesions. at the apex and the base of the right lung, linear areas of atelectasis are seen. _areas of hypoventilation at the lung bases. calcification of the mediastinal vessels, no pneumothorax. brief hospital course: 77 year old female with extensive pmh who was admitted with pna and pulmonary edema, requiring non-invasive ventilation. she was initially in the intensive care unit until her breathing status improved. in the icu, the patient was diuresed with iv lasix and received antibiotics for her pna. initially, she was on bipap but improved throughout her course of stay until she was saturating comfortably on room air. on admission the patient had a surgical eval for abdominal distention which resolved w/o intervention, her imaging was negative for sbo. she was transferred to the floor for further management. on exam, the patient had dyspnea and fever felt most likely secondary to a factor of both chf and pna noted on cxr. the patient was treated with levofloxacin for a likely community acquired pneumonia. she was also treated initially with iv lasix as her xray seemed consistent with a degree of heart failure. the patient has a history of multiple sbos in the setting of numerous abdominal surgeries. she denied any vomiting, though she did have some mild nausea at the beginning of her hospitalization. her last bm was the day before admission and she denies passing flatus since. she says that her current abdominal distention is not comparable to previous sbos. of note, she was started on iron supplements approximately one week ago and has noted constipation with this. the patient was treated with an aggressive bowel regimen. for her chronic polycystic kidney disease s/p transplant, the patient was treated with her usual dose of prednisone and a slightly decreased dose of cellcept given her neutropenia. her polycystic liver disease was stable. she did have a ruq us which showed dilation of her common bile duct. lfts and exam remained stable throughout her hospital course and she was discharged to follow this finding up with her pcp. the patient has a history of hypertension for which she was taking atenolol and diltiazem as an outpatient. her blood pressure was markedly elevated upon arrival. per her history, the patient has had problems with hypertensive urgency in the past. she was initially treated with metoprolol and diltiazem with prn hydralazine. doxazosin was introduced once the patient was called out to the floor, however, the patient experienced relative hypotension likely causing a bump in her creatinine. the doxazosin was discontinued with a slow improvement in her creatinine. her outpatient lasix was held and she was advised to discuss restarting this medication with her primary care doctor. the patient was continued on her outpatient epogen regimen for her anemia. she received one unit of packed red blood cells as well as six infusions of iv ferrlecit. the patient was continued on her outpatient regimens for her spinal stenosis, depression, anxiety and insomnia with the following medications neurontin, tramadol, zoloft, klonopin and ambien. # communication: (daughter) ; (son) . # code: full (confirmed with patient and daughter) medications on admission: ambien 5 mg qhs atenolol 75 mg qd (occasionally 150 mg for severe htn) cartia xt 240 mg po qd lasix 20 mg po qd zoloft 50 mg po qd prednisone 6 mg po qd cellcept mg po bid tramadol (dose unknown) neurontin (dose unknown, but taken tid) klonopin 1 mg po qd senna discharge medications: 1. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 2. tramadol 50 mg tablet sig: one (1) tablet po daily (daily). 3. gabapentin 100 mg capsule sig: one (1) capsule po tid (3 times a day). 4. epoetin alfa 4,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 5. diltiazem hcl 120 mg capsule, sustained release sig: two (2) capsule, sustained release po daily (daily). 6. mycophenolate mofetil 250 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 7. metoprolol tartrate 50 mg tablet sig: three (3) tablet po bid (2 times a day). 8. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 10. polyethylene glycol 3350 17 gram (100 %) powder in packet sig: one (1) powder in packet po daily () as needed for prn constipation. 11. prednisone 5 mg tablet sig: one (1) tablet po daily (daily): please take a total of 6 mg daily. 12. prednisone 1 mg tablet sig: one (1) tablet po once a day: please take 6 mg daily. 13. clonazepam 1 mg tablet sig: one (1) tablet po daily (daily). 14. outpatient lab work please have your cbc, chemistries, and renal function tests (creatinine, bun), drawn this friday, . these results need to be called into dr. office at ( 15. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. discharge disposition: home with service facility: discharge diagnosis: primary - pneumonia, complicated by a parapneumonic effusion acute on chronic renal failure secondary - polycystic kidney disease s/p transplant polycystic liver disease hypertension anemia spinal stenosis discharge condition: stable, o2 sats above 95% on room air discharge instructions: you were admitted for a pneumonia which required treatment with antibiotics and oxygen. you were also started on new medication for your blood pressure, doxazosin, which was stopped while you were in the hospital due to elevated kidney function tests. your lasix has been stopped and should not be started until you see dr. . you need to have your labs checked again this friday, including your renal function tests (lab slip included). these should be called into dr. at (. please continue all medications as instructed. you have an appointment with dr. on for follow-up. while you were in the hospital, an ultrasound demonstrated dilitation of your common bile duct. you did not have any lab abnormalities or symptoms associated with this finding. please follow up this result with your primary care physician at your appointment. if you experience any symptoms of fevers, difficulty breathing, shortness of breath, chest pain, or any other concerning symptoms, please seek medical attention immediately. followup instructions: provider: , md phone: date/time: 4:00 provider: , md phone: date/time: 1:00 md procedure: venous catheterization, not elsewhere classified thoracentesis diagnoses: pneumonia, organism unspecified anemia, unspecified congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified diastolic heart failure, unspecified kidney replaced by transplant congenital cystic disease of liver 

Answer: The patient is high likely exposed to