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: heparin (porcine) / erythromycin base attending: chief complaint: anemia, fatigue major surgical or invasive procedure: none history of present illness: 52 y.o. f with lupus s/p cadaveric renal transplant on immunosuppressive therapy, c4 tetraplegia, cad, chf, pvd, hcv, recently here for prolonged hospitalization /07 for multiple medical problems, now returns with complaint of anemia and fatigue, worsening x 1 day. hematocrit 23, baseline 28-29. no improvement with epo injections. patient also more lethargic over past day. therefore requesting blood transfusion. denies associated chest pain, fever, chills, nausea, vomiting. in er, hct 23. also found to have na 125 (baseline 126-128). head ct negative. admitted to the medicine service for anemia. ros: as above. also with chronic debilitation, sacral decubitus ulcers. bed bound. osteomy draining. foley catheter in place, producing concentrated urine. otherwise negative. past medical history: -s/p cadaveric renal translpltn (s/p post-strep gn? vs lupus-like syndrome )-> chronic allograft nephropathy -s/p parathyroidectomy for hyperparathyroidism -avn of hips -dilated cardiomyopathy -peripheral vascular disease -h/o hypothyroidism -osteoarthritis -s/p colectomy w/ end ileostomy perforated ischemic colon -cad - s/p perioperative mi -hcv -hemochromatosis 2/2 blood transfusions -acd -zenker's diverticulum -right first toe amputation -chronic allograft nephropathy. -status post bilateral femoral popliteal bypass. -left total hip replacement. -status post multiple av fistula revisions. -anemia of chronic disease - atrial fibrillation and nsvt on amiodarone - c spine cord compression with upper extremity weakness social history: bed-bound given progressive weakness and debilitation. no tobacco or etoh. husband is very involved in care; he is a employee, and is knowledgeable about her medical condition and course; he is the hcp. family history: no cad or cancers. father with lung ca. many family members with sle. physical exam: vs t 97.6, bp 102/62, hr 66, rr 16, 94% ra gen: chronically ill-apperanig female lying in bed in mild discomfot from decubitus ulcers heent: mm dry, perrl, eomi neck: no appreciable jvp. cv: rr, nl s1 and s2, 3/6 sem at rusb pulm: decreased bs throughout, no focal ronchi or wheezes, dry basilar rales. abd: ostomy pink, non-purulent or friable, +bs, non-tender, non-distended ext: upper extremity with multipodus splints. wrapped with gauze. skin: sacrum/coccyx with multiple deep decubitus ulcers, malodorous, covered with gauze rectal: guaiac negative in er pertinent results: admission labs: -------------- 06:58pm wbc-6.5# rbc-2.75* hgb-7.9* hct-23.1* mcv-84 mch-28.6 06:58pm neuts-88.0* lymphs-8.6* monos-2.9 eos-0.4 basos-0.2 06:58pm calcium-11.1* phosphate-3.4 magnesium-1.6 06:58pm pt-14.1* ptt-30.7 inr(pt)-1.2* 06:58pm glucose-69* urea n-48* creat-1.2* sodium-125* potassium-4.4 chloride-94* total co2-22 anion gap-13 09:00pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-sm urobilngn-neg ph-6.5 leuk-neg 09:00pm urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0-2 reports: - head ct: findings: no edema, masses, mass effect, hemorrhage or major vascular territorial infarction is noted. dystrophic calcification of the basal ganglia is visualized. the patient shows severe calcification of both vertebral arteries and the cavernous portion of both carotid arteries. the patient shows signs of hyperostosis frontalis. the paranasal sinuses and mastoid air cells are clear. impression: no acute intracranial pathology including no intracranial hemorrhage. brief hospital course: a/p: 52 y.o. f with lupus s/p cadaveric renal transplant on immunosuppressive therapy, c4 tetraplegia, cad, chf, pvd, hcv, recently here for prolonged hospitalization /07 for multiple medical problems, now returns with complaint of anemia and fatigue, worsening x 1 day. she was transferred to the icu for fever and hypotension concerning for possibility of sepsis. her course was unremarkable with stable blood pressure and respiratory status. she did have persistent oliguric renal failure throughout her icu stay unresponsive to ivf. . # goals of care: though her multiple medical problems are described below, in many ways the primary issue during much of her icu stay was that of goals of care. she seemed hesitant to undergo more invasive interventions (e.g., central lines, ng tubes, and other means of giving nutritional support) but was initially also reluctant to embrace the idea of a comfort-care plan. her husband also was torn about how aggressively to pursue attempts at prolonging life vs increasing comfort. two family discussions in the micu moved the patient's code status from full code (on arrival) to dnr and probably dni (but with a request to contact husband in the event of the possibility of intubation, which was not a sustainable code status); and to dnr/dni with the caveat that the patient and husband would be willing to reverse this code status for procedures. palliative care service was consulted and followed. . # fever, hypotension: concerning for possibility of sepsis bacteremia from recent debridement of sacral decubitus ulcers. pneumonia also considered although no evidence of infiltrate on cxr. she was treated with vancomycin and piperacillin-tazobactam for broad coverage. given oliguric renal failure vancomycin was dosed based on daily trough levels. she was bolused initially to maintain sbp >60 and then remained stable hemodynamically for the remainder of her icu stay. . # oliguric renal failure s/p renal transplant: likely from intravascular volume depletion given fever, hypotension, possible sepsis. she continues with oliguria despite ivf boluses and map > 60. she was followed by renal throughout her icu stay; a 24 hour urine collection suggested that she has profound renal failure, masked by standard chem 7 because her creatinine production is so low because of low muscle mass. she was continued on her transplant medications including mmf, prednisone and cyclosporine, though as she was less able to take po medications, this was being reconsidered as she was transferred back from the icu. her furosemide and ace inhibitor were held given oliguria. bactrim ds for pcp prophylaxis was continued. . # sacral decubitus and ischial ulcers - she has stage iii/iv ulcers, twice debrided by plastics. based on their second debridement they do think that osteomyelitis is a strong possibility and she will therefore need 4-6 weeks of antibiotics for suppression of presumed osteo. she was continued on vanc and zosyn. her extremely poor nutritional status would have to be corrected for these to even begin to heal (plastics recommended albumin at least >3.0); and given her immobility and the fact that these ulcers are located at each pressure point of any supine position, how she might heal even under better circumstances is not clear. . # hyponatremia: her sodium was often near her recent baseline around 126-128. on last admission this had gone down to 116. this was likely secondary to heart failure and poor perfusion, leading to adh response to defend volume. we attempted to give normal saline to the extent tolerated to try to increase her sodium, with slight success. . # acute on chronic anemia: her hematocrit was 23 as she came in, baseline 28-29. we transfused several times during the admission. she was guiaic negative suggesting against gi blood loss. she does receive epoeitin as an outpatient and her anemia is most likely secondary to her kidney failure. . # s/p cadaveric renal transplant: we continued cyclosporine, prednisone, and cellcept. as above, as she has increasing trouble with pos, these may need to be revisited. . # severe deconditioning: she remained highly deconditioned. palliative care was consulted for overall goals of care and help with pain and comfort control. see above regarding goals of care. one primary obstacle was her extreme weakness, at least partly due to poor nutritional status. as of the time of discharge from the an enduring strategy for her nutrition had not been agreed on. . # systolic chf, chronic: ef 30%. hypovolemic clinically. we held standing lasix. we continued her beta-blocker and ace-inhibitor but discontinued these later in admission with hypotension and renal failure. . # cad, native vessel: chest pain free. she did have some episodes of chest tightness, but ekg was negative and her presentation was of a constant mild chest tightness, not consistent with acs. . # h/o arrhythmia: we continued amiodarone. she remained in nsr. . # fen: repleted lytes prn, cardiac/renal diet with crushed medications. . # ppx: initially started on no heparin (possible hit), however, hit ab came back negative so she was restarted; ppi; pneumoboots; fall precautions; and air mattress. . # code: full code discussed with dr. (renal attending) - he has stated that pt. is dying, that renal transplant is failing (cr. does not adequately reflect degree of renal impairment in her as she has extensive muscle wasting), and that treatment with hd (if she would want the invasive procedure of hd access, which she does not) would extend her life but would not provide any improvement in graft function or lead to any other treatment options; treatment options essentially exhausted under these circumstances. . had extensive meeting with family today (75 minutes) in which we discussed the course of illness, state of renal failure, lack of treatment options - mr. (husband and hcp) expressed his wishes that only comfort measures be pursued from this point forward (he states that his wife has long expressed her wishes for no futher invasive measures, including no invasive iv or hd access). cmo status established. palliative care rn and sw present for discussion and will continue to follow. pt. expired peacefully night of . medications on admission: 1. gabapentin 300 mg po hs 2. aspirin 325 mg po daily 3. prednisone 7.5 tablets po daily 4. oxycodone 10 mg po q12h 5. amiodarone 200 mg po daily 6. epoetin alfa 4,000 qmowefr 7. escitalopram 10 mg po daily 8. lorazepam 0.5 mg po q4h 9. nystatin(5) ml po qid as needed. 10. cyclosporine modified 25 mg po q12h 11. fentanyl 75 mcg/hr patch 72 hr 12. sodium bicarbonate 650 mg po tid 13. carvedilol 3.125 mg po bid 14. isosorbide mononitrate 60 mg po daily 15. mycophenolate mofetil 500 mg po bid 16. allopurinol 100 mg po daily 17. pantoprazole 40 mg po q24h 18. calcitriol 0.25 mcg po daily 19. folic acid 1 mg po daily 20. acetaminophen 325 mg po q6h as needed. 21. docusate sodium 100 mg po bid 22. miconazole nitrate 2 % powder prn. 23. psyllium po daily 24. trimethoprim-sulfamethoxazole 80-400 mgpo qmowefr 25. oxycodone-acetaminophen 5-325 po q6prn 26. lisinopril 2.5mg daily 27. docusate sodium 100 mg prn 29. lasix 40 mg po daily prn discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: pt. expired followup instructions: pt. expired procedure: excisional debridement of wound, infection, or burn transfusion of packed cells diagnoses: anemia in chronic kidney disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia severe sepsis unspecified viral hepatitis c without hepatic coma unspecified osteomyelitis, other specified sites systolic heart failure, unspecified hypotension, unspecified pressure ulcer, other site pressure ulcer, lower back other chest pain encounter for palliative care complications of transplanted kidney volume depletion, unspecified unspecified osteomyelitis, pelvic region and thigh debility, unspecified muscular wasting and disuse atrophy, not elsewhere classified 

Answer: The patient is high likely exposed to