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: penicillins / oxycodone / codeine / sulfa (sulfonamide antibiotics) attending: chief complaint: fevers, confusion major surgical or invasive procedure: lumbar puncture history of present illness: mrs. is a 56yof with chronic renal failure s/p ddrt in due to congenitally malformed kidneys, htn, neuropathy, lung mass resection, gerd, depression who is transferred from hosptial for management of fevers and confusion, nosebleed, and unsteady gait. she was found by her neighbors found her stumbling, who then activated ems. at osh, she was febrile to 103 and empirically got vanco/ctx. cxr benign per report. ct head revealed a basal ganglia bleed versus mass, so she was given 100mg iv methylpred. transferred to . . at ed, initial vitals were t99.3, hr89, bp181/94, rr18, sat98%ra. neurosurgery consulted but felt patient would be better suited to medicine service due to elevated creatinine and mild transaminitis. recommended mri/mra for better evaluation of the bleed/mass with bp control to systolics<140. got iv lopressor x2 with bp to 160. creatinine appears at recent baseline- she has chronic renal disease of her graft with biopsy showing widespread sclerosis earlier this summer. . on arrival to the micu, initial vs were t99.4 p83 bp147/84 rr18 97ra. the patient is a difficult historian, needing directed questions to elicit a story. she relates intermittent fevers for the past 3 weeks up to 102. over past three days, noting vague abdominal pain with nausea and vomiting in the morning. diarrhea 4 times daily. she feels generally weak and has been walking unsteadily. she feels confused. no neck stiffness, though with some photophobia. mild sob. no dysuria, hematuria. no rashes past medical history: -htn -s/p crt in , secondary to a birth defect (born with half kidney on left and abnormally formed right kidney) ? mother taking anti-nausea medication during pregnancy. -herpes infection of kidney in -peripheral neuropathy -depression -gerd -splenic aneurysm, following radiographically -bronchitis/asthma -insomnia -osteoporosis -chronic elevated transaminases -fibromyalgia -right lung mass resection -lumpectomy, benign in on right social history: lives at . works as a secretary. smokes cigs/day x 10 years. social drinker. denies ivdu family history: nc physical exam: physical exam on arrival to micu t99.4 p83 bp147/84 rr18 97ra general: appears confused, aao to person and place, following commands heent: left pupil 4mm and reactive, right 2 mm and reactive, mmm lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. mild ttp over left renal transplant site. gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: anisicoria. strength 4/5 throughout, possibly decreased on right. right facial droop. discharge pe: vs: tc/m 97.8 146/88 (132-146/67-88) 98 (77-98) 20 98 ra 200 out/1080+50 general: well-appearing woman in nad, laying comfortably in bed heent: sclerae anicteric, right sided facial droop neck: supple heart: rrr, no mrg, nl s1-s2. lungs: cta bilat abdomen: bowel sounds present, obese, soft, non-tender, non-distended, midline surgical scar, kidney graft palpable in llq, no tenderness over graft site extremities: wwp, no c/c/e, 2+ peripheral pulses skin: no rashes or lesions. lymph: no cervical lad. neuro: aaox3, alert and appropriate pertinent results: blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient stool clostridium difficile toxin a & b test-final inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture, routine-pending urine culture-final inpatient blood culture, routine-pending blood culture, routine-preliminary listeria monocytogenes . studies: mr head: conclusion: interval development of extensive zone of t2 hyperintensity, with some mass effect in the left basal ganglia and subinsular white matter. right posterior temporal/occipital lesion, which is smaller compared to the other lesion. in the prior mr report, there was a provided history of renal transplantation and immunosuppression. the findings could represent multiple areas of infarction, with hemorrhagic elements. however, given the history of immunosuppression, it is conceivable, though not as likely, that a superimposed infectious process could be considered. obviously, a more detailed work-up is necessary at this time. . renal ultrasound transplant: impression: no evidence of hydronephrosis or perinephric collection. resistive indices of 0.75-0.82, slightly increased as compared to . . eeg: impression: this is an abnormal continuous icu monitoring study because of focal slowing and attenuation of faster frequencies over the left hemisphere indicative of focal cerebral dysfunction in this region. moderate diffuse background slowing is indicative of a moderate to severe diffuse encephalopathy which is etiologically non-specific. no epileptiform discharges or electographic seizures are present. . echo: impression: no echocardiographic evidence of endocarditis. normal regional and global biventricular systolic function. no significant valvular regurgitation seen. if clinically indicated, a transesophageal echocardiogram may better assess for valvular vegetations. brief hospital course: mrs. is a 56yof renal transplant recipient who presents with fevers, confusion found to have listeria bacteremia and brain abscess. . # listeria bacteremia and brain abscess: patient was initially covered with broad spectrum antibiotics for fevers, delerium, and concern for brain abscess, which included vancomycin, meropenem, and acyclovir. she grew listeria on day 2 of admission and antibiotics were narrowed to ampicillin and gentamycin. patient required desensitization to ampicillin. patient markedly improved after starting ampicillin. patient is currently on ampicillin (for planned 6 - 8 week course) and gentamyin (planned for at least one week). the patient was instructed to continue her ampicillin until and she has follow up with id at the beginning of . she also was instructed to get repeat brain imaging in 4 weeks to evaluate the abscess. . # delirium: the patient was delirius during her micu stay; likely secondary to her cns infection. neurology was consulted while the patient was in the unit, and given the concern for seizures, patient received one dose of keppra. however, the pt had two eegs, which were not suggestive of seizure activity and the keppra was stopped. . # anemia: patient had a drop in her hct when she was first admitted from 30 to 21.7 over one day. patient found to have guaiac positive brown stool. she was transfued 1 unit prbc with appropriate response. etiology of anemia unclear, in icu thought possibly secondary to marrow supression given infection. the patient had lower end of normal tibc and transferrin, with elevated ferritin possibly suggestive of anemia of chronic disease. however, because the patient was acutely infected, her ferritin levels are expected to be elevated because it is an acute phase reactant. . # s/p kidney transplant: the patient was continued on her immunosuppresive medications including her prednisone and mmf. the patient's mmf was initially decreased in the unit to 250 mg because of leukopenia, but was then increased back to her home dose of 500 mg when she was on general floor. . #. leukopenia: wbc dropped from 4.7 on admission to 1.9. patient's mycophenolate dose was decreased in response. however, after transfer to medicine floor, the patient's mmf was increased to her home dose of 500 mg . . # hyponatremia: thought possibly secondary to siadh, especially given the patient's brain abscess. urine sodium was 30, also supporting siadh. while on the floor, the patient was fluid restricted. on discharge, the patient's sodium was stable at 129. . # hypertension: the patient was started on labetolol 200 mg for blood pressure control and she was sent home on lisinopril 5 mg once daily (dose reduction given her recent kidney injury). . # acute on chronic renal failure: on admission, creatinine was 1.9 (near baseline), but increased to 2.5. icu team has carefully been watching creatinine while patient on gent. trending down to baseline, at 2 today. while on the the medicine floor, the patient was continued on the gentamycin for a total course of one week. her creat at discharge was 2.1. medications were renally dosed and nephrotoxic agents were avoided. . # chronic diarrhea: patient with chronic diarrhea. work-up of infectious etiology in icu unrevealing. stool studies, including c. diff, campylobacter, o&p negative to date. possible that cellcept may be causing diarrhea. however, by the time she got to the medicine floor, the patient reported that her diarrhea was resolving, and by day of discharge, she reports that her diarrhea had resolved. .. transitional issues: . # hyponatremia: please follow up the patient's sodium levels as an outpatient. . # repeat head imaging: the patient needs to get repeat head imaging in 4 weeks. medications on admission: furosemide 40 mg tablet - 1 tablet(s) by mouth once a day hydrocodone-acetaminophen - 5 mg-500 mg - as needed for pain lisinopril 10 mg - 1 tablet(s) by mouth twice a day mycophenolate mofetil - 500 mg tablet - 1 tablet(s) by mouth twice a day omeprazole dosage uncertain paroxetine hcl - 40 mg tablet - 1 tablet(s) by mouth every other day prednisone -5 mg tablet - 1 tablet(s) by mouth every other day ranitidine hcl - 150 mg tablet - 1 tablet(s) by mouth twice a day sodium bicarbonate - 650 mg tablet - 2 tablet(s) by mouth three times a day discharge medications: 1. ampicillin sodium 2 gram recon soln sig: one (1) recon soln injection q6h (every 6 hours) for 6 weeks: please take ampicillin until . disp:*296 grams* refills:*0* 2. lisinopril 5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 3. paroxetine hcl 20 mg tablet sig: two (2) tablet po every other day (every other day). 4. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 5. outpatient lab work please get weekly cbc, chem 7, and lfts every tuesday, starting tuesday, and fax results to dr. in the transplant center at , thanks 6. lasix 40 mg tablet sig: one (1) tablet po once a day. 7. hydrocodone-acetaminophen 5-500 mg capsule sig: one (1) capsule po q6h:prn as needed for pain. 8. omeprazole oral 9. ranitidine hcl 150 mg capsule sig: one (1) capsule po twice a day. 10. sodium bicarbonate 650 mg tablet sig: two (2) tablet po three times a day. 11. labetalol 200 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 12. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po twice a day. discharge disposition: home with service facility: home therapies discharge diagnosis: primary diagnosis: listeria bacteremia brain abscess status post renal transplant secondary diagnosis: hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you while you were hospitalized at . you were admitted to the hospital because you were very confused and had fevers. you were initially admitted to the intensive care unit because you were very sick and you were found to have bacteria in your blood. a scan of your head also showed that you might have had some bacteria in your brain as well (abscess). we started you on antibiotics through your veins. you have an allergy to these antibiotics, so we had to desensitize you by giving you very, very small doses until you were able to tolerate the medication. since starting these antibiotics, your infection has been improving and your mental status has returned back to your baseline; you are no longer confused or disoriented. because of the infection in your brain, you must be on a prolonged course of antibiotics through your veins. you are being sent home with a picc line, which allows us to keep giving you antibiotics through your veins for a total of six weeks. it is also very important that you re-image your head in 4 weeks. please make sure you discuss this with you transplant and id doctors. we made the following changes to your medications: start ampicillin 2 grams every 6 hours through your picc line; please continue unti start labetolol 200 mg by mouth twice daily decrease lisinopril from 10 mg by mouth daily to 5 mg by mouth daily . it is very important that you follow in transplant clinic and see your primary care doctor as well. appointments have been made for you, see below. if you have any confusion, high fevers, nausea or vomit, headaches, any weakness or loss of sensation, please call your doctor or return to the ed. followup instructions: name: , r. location: emerald physicians address: , , phone: appt: saturday, at 2pm***note appt is at the location*** . department: transplant center when: monday at 1:20 pm with: , md building: lm campus: west best parking: garage . department: transplant when: tuesday at 11:30 am with: transplant id building: lm bldg () campus: west best parking: garage md procedure: spinal tap incision of lung central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified asthma, unspecified type, unspecified chronic kidney disease, unspecified bacteremia diarrhea do not resuscitate status surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation complications of transplanted kidney leukocytopenia, unspecified unspecified causes of encephalitis, myelitis, and encephalomyelitis unspecified condition of brain listeriosis 

Answer: The patient is high likely exposed to