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 was seen in the emergency department on with the onset of fever and hypotension. the patient is a 44-year-old white gentleman with a past medical history of end-stage renal disease secondary to ureteral reflux nephropathy. he underwent a living-related renal transplant and has a history of mesenteric ischemia requiring a -tex superior mesenteric artery aorta bypass graft in . the patient now presents after a prior admission for occlusion, status post t-pa, of the superior mesenteric artery with a 24-hour to 36-hour history of increasing weakness, malaise, and fever. temperature was 102.8. the patient admits to chills. he denies chest pain, shortness of breath, or cough. there was no bright red blood per rectum. he denies any associated symptoms or abdominal discomfort or pain. he is now admitted for further evaluation and treatment. past medical history: 1. history of end-stage renal disease. 2. history of peripheral vascular disease. 3. history of gastroesophageal reflux disease. 4. history of a 25-pack-year smoking history. 5. history of squamous cell carcinoma of the lower lip. 6. history of esophagus. 7. history of duodenitis. past surgical history: 1. living-related renal transplant in . 2. aorta superior mesenteric artery bypass with polytetrafluoroethylene in . 3. t-pa of superior mesenteric artery graft times two in . allergies: he has no known drug allergies. medications on admission: (his medications included) 1. coumadin 3 mg by mouth every day. 2. imuran 50 mg by mouth once per day. 3. prednisone 10 mg by mouth once per day. 4. levoxyl 125 mcg by mouth once per day. 5. furosemide 20 mg by mouth once per day. 6. bactrim single strength by mouth every monday, wednesday, and friday. social history: the patient is divorced. he has one child. he is an electronic technician. physical examination on presentation: physical examination revealed vital signs with a temperature of 100.3 degrees fahrenheit, heart rate was 108, blood pressure was 75/55, respiratory rate was 16, and oxygen saturation was 99% on 2 liters. general appearance revealed a male sitting in bed in no acute distress. oriented times three. lung examination revealed left inspiratory basilar crackles. heart examination revealed distant heart sounds; regular. no murmurs, gallops, or rubs. the abdomen was slightly distended and tympanic. diminished bowel sounds. there was no guarding. there was a right iliac fossae renal transplant noted. rectal examination was without abscess and was guaiac-positive. extremity examination was without edema. the feet were warm. there were no ulcerations. pulse examination revealed intact femoral pulses and popliteal pulses bilaterally with triphasic dorsalis pedis pulse on the right and a palpable posterior tibialis pulse on the right with a triphasic dorsalis pedis pulse on the left with a palpable posterior tibialis pulse on the left. pertinent laboratory values on presentation: admission laboratories revealed white blood cell count was 3.6 and hematocrit was 26.5 (down from 28). inr was 3. blood urea nitrogen was 17. creatinine was 1.2. potassium was 3.9. pertinent radiology/imaging: a single view chest x-ray revealed no infiltrate or effusions. heart mediastinal shadows were okay. concise summary of hospital course: the patient was placed in the vascular intensive care unit. linezolid, flagyl, and levaquin were instituted after cultures were obtained. the patient was transfused two units of packed red blood cells with a post transfusion hematocrit of 28. the renal transplant service followed the patient. he another unit of packed red blood cells for his hematocrit of 28. the endocrinology service was consulted because of the patient's elevated thyroid-stimulating hormone of 51. recommendations were to check ft4 and antimorph antibodies. his levothyroxine dose required adjustment. the patient remained in the vascular intensive care unit. his hematocrit after three units of packed red blood cells was 33. it was felt that he would require further evaluation for a gastrointestinal bleed. the infectious disease service was consulted and the gastrointestinal service was consulted. the infectious disease service did see the patient. they felt, in light of the patient's previous perirectal abscess, escherichia coli to the cecum, bacteremia, and superior mesenteric artery thrombosis, he improved in house. the evaluation at this time was unrevealing for potential sources. recurrent abscesses with computed tomography scans were negative. clostridium difficile has been negative, but blood can interfere with cytoxan assay. they recommended continuing current antibiotics, check transthoracic echocardiogram, repeat blood cultures if fever recurs, send stools for clostridium difficile, cytoxan d, and recommended change to bactrim from single strength to double strength. these recommendations were followed through on. the echocardiogram demonstrated biventricular hypokinesis consistent with diffuse process (i.e. toxic/metabolic). there were no computed tomography or doppler evidence of endocarditis. blood cultures from admission were no growth but not finalized. repeat cultures were done on which were pending. urine cultures were finalized at no growth, and repeat urine cultures on had not been finalized. at the time gastrointestinal service saw the patient, stool culture were unremarkable except for yeast. the chest x-ray was without infiltrates or effusions. recommendations indicated the patient would require endoscopic examination with upper and lower endoscopies to rule out ischemic colitis, but this could only be done once the patient's inr was below 1.5. coumadin was discontinued on admission. initial computed tomography demonstrated a hydronephrotic native atrophic left kidney of uncertain clinical significance. there were no secondary signs of inflammation. the upper left collecting system in the past has shown various decrease of dilatation and decompression. there was a diffuse large-bowel and small-bowel dilatation without evidence of obstruction. the superior mesenteric artery bypass was patent. a repeat computed tomography of the abdomen done on did not reveal any source of the patient's fevers. an ultrasound of the gallbladder was negative for cholelithiasis or intrahepatic ductal dilatation. blood cultures done on grew enterococcus to the cecum. it was susceptible to streptomycin, linezolid, and methacycline. resistant to vancomycin, penicillin, and levofloxacin, and ampicillin. all cultures were negative. the patient then underwent on and upper esophageal endoscopy. this showed a normal esophagus. there was localized erythema of the mucosa. no bleeding was noted in the antrum of the stomach. these findings were compatible with gastritis. there was no evidence of active bleeding. the duodenum was normal. the patient then underwent a colonoscopy. although there was neither blood nor obvious lesions identified, the preparation was poor and small mucosal lesions might have been missed. if further bleeding occurs, it is likely to be colonic. then it would be appropriate to do a repeat study after a better preparation. the patient underwent a white blood cell tagged study on . this demonstrated findings consistent with infectious or inflammatory process with increased activity in the loops of the small bowel within the upper pelvis. recommendations included a positron emission tomography scan be considered for anatomical localization of findings if clinically warranted. on , there was one blood culture which grew parapsilosis. the patient continued to spike fevers and rigors despite antibiotics. cultures from grew 2/4 bottles of gram-negative rods on the blood cultures. on , the gastrointestinal service was consulted again, and the patient underwent an upper endoscopy the same day. it demonstrated a normal esophagus and a normal stomach. the duodenum showed gastrografin through the duodenum. there was no bleeding noted around the site of erosion. general surgery was consulted after the endoscopic findings. total parenteral nutrition was begun. antibiotics were continued. on , the patient had a drop in blood pressure and hematocrit requiring a transfusion of three units of packed red blood cells. he was transferred to the surgical intensive care unit for continued monitoring and care. the drop in the hematocrit was secondary to a spontaneous bleeding into the neck, not intra-abdominal bleeding. the patient was stabilized. the patient underwent a right axillar bifemoral bypass graft on . he returned to surgery on and underwent a repair of duodenal fistula, gastrostomy, and jejunostomy. a #14 french jejunostomy tube was placed, and a #16 french foley gastrostomy tube was placed. the superior mesenteric artery graft was removed with a redo aorta superior mesenteric artery bypass with superficial femoral vein from the left leg. at the time of repair, antibiotics included fluconazole 400 mg intravenously q.24h. (this was day 21), linezolid 600 mg q.12h. (this was day 19), meropenem 1 g q.12h. (this was day 17). his postoperative hematocrit remained stable at 33.6. his inr was 1.3. partial thromboplastin time was 68. blood urea nitrogen was 9. creatinine was 0.7. his alt, ast, and alkaline phosphatase were unremarkable. the patient was continued on total parenteral nutrition. his protein needs were 55 to 70 of protein per kilogram with 30 to 32 calories per kilogram with a total calorie need of 1400 cc to 1500 cc. goal rate for the total parenteral nutrition was 1200 cc per 24 hours. the patient was transferred to the vascular intensive care unit on for continued care. tube feeds were started on . the meropenem was discontinued on . cefepime 2 g was started intravenously q.12h. the foley catheter was discontinued on . physical therapy was requested to see the patient in anticipation for discharge planning. they felt that he would be at a level that would be safe for discharge to home after two to three more sessions (and this was on ). the patient underwent g2 study which was negative for duodenal leak. on , the infectious disease service signed off with recommendations of continuing the cefepime for a total of four weeks, the fluconazole for a total of four weeks, and we could convert him to oral agents once he was allowed to use his gastrointestinal tract. linezolid should be continued until central venous access is discontinued. the last dose of cefepime and fluconazole will be . the patient was to follow up in the infectious disease clinic on with dr. . the patient will require monitoring of his liver function tests/renal function on a weekly basis while on fluconazole and cefepime. total parenteral nutrition was slowly tapered, and his tube feeds were increased to meet goal at 60 cc per hour. tube feeds were brought to goal on , and cycling was begun at 60 cc per hour (2 p.m. to 8 a.m.). a regular diet was instituted. total parenteral nutrition was discontinued. the patient had a peripherally inserted central catheter line on under fluoroscopy. his patient-controlled analgesia was discontinued, and he was converted to vicodin on . physical therapy continued to work with the patient. he continued to progress in his endurance and mobility. during the remainder of his hospital course, he continued to show improvement. reglan was begun with improvement in his oral tolerance. his central line was discontinued, and linezolid was discontinued. case management was in the process of screening. condition at discharge: the patient's condition on discharge was stable. medications on discharge: 1. regular insulin sliding-scale four times per day before meals and q.h.s. as follows: glucose of less than 120 use no insulin; glucose of 121 to 160 use 2 units subcutaneously, glucose of 161 to 200 use 4 units subcutaneously, glucose of 201 to 240 use 6 units subcutaneously, glucose of 241 to 280 use 8 units subcutaneously, glucose of 281 to 320 use 10 units subcutaneously, glucose of 321 to 360 use 12 units subcutaneously, glucose of 361 to 400 use 14 units subcutaneously, glucose of greater than 400 use 16 units subcutaneously. 2. cefepime 2 g intravenously q.12h. (to be continued until ). 3. dulcolax suppository per rectum at bedtime as needed. 4. hydrocodone/acetaminophen tablets one to two tablets by mouth q.4-6h. as needed (for pain). 5. protonix 40 mg by mouth once per day. 6. reglan 10 mg by mouth before meals and at bedtime. 7. bactrim single strength one tablet by mouth twice per day. 8. levothyroxine 125 mcg by mouth every day. 9. azathioprine 50 mg by mouth once per day. 10. prednisone 10 mg by mouth q.48h. 11. acetaminophen 325 mg to 650 mg by mouth q.6h. as needed. 12. fluconazole 400 mg once per day (until ). 13. metoprolol 12.5 mg by mouth twice per day (hold for a systolic blood pressure of less than 80 or a heart rate of less than 60). discharge diagnoses: 1. enterococcal cecum septicemia. 2. candidiasis septicemia. 3. graft erosion of the duodenum. 4. blood loss anemia; corrected. 5. status post renal transplant (on immunosuppression). discharge instructions/followup: the patient was to follow up with dr. status post discharge from rehabilitation. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other enterostomy other endoscopy of small intestine other endoscopy of small intestine other revision of vascular procedure enteral infusion of concentrated nutritional substances other (peripheral) vascular shunt or bypass colonoscopy other gastrostomy injection or infusion of oxazolidinone class of antibiotics closure of fistula of duodenum diagnoses: esophageal reflux iron deficiency anemia secondary to blood loss (chronic) peripheral vascular disease, unspecified disseminated candidiasis infection and inflammatory reaction due to other vascular device, implant, and graft streptococcal septicemia mechanical complication of other vascular device, implant, and graft kidney replaced by transplant persistent postoperative fistula 

Answer: The patient is high likely exposed to