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: this is a 55 year old male with a history of diabetes mellitus, end stage renal disease, status post living related renal transplant in , congestive heart failure, coronary artery disease, status post silent myocardial infarction and stent to the left circumflex, who presents with poor appetite times two weeks, decreased urine output over the course of three days, as well as episodic band-like epigastric burning pain in the past couple of days. he describes the epigastric pain as eight out of ten, nonexertional, band-like burning in the epigastrium radiating around to his back. this pain is also associated with shortness of breath and mild nausea. it tends to last twenty minutes, although some episodes have lasted up to three hours. it also appears to be positional in nature and somewhat relieved by antacids. the patient reports no urine output over the past eighteen hours. he denies any tenderness over the site of his renal transplant. he also denies fever, chills and dysuria. he does report that he recently finished a course of biaxin which he was taking for mouth infection. he says that on the day prior to admission he put out only approximately 150 cc of urine. his creatinine at baseline is 3.0 to 3.5. the patient reports that he has had recurrent episodes of progressive shortness of breath related to his congestive heart failure. he was admitted to the in , with hypoxia and bilateral infiltrates. bronchoscopy at that time was negative for pcp but positive for alpha streptococcus. there was question of mediastinal adenopathy and ground glass opacities on ct at that time. he returned to the in , with similar symptoms which responded well to antibiotics and diuresis. echocardiography in , revealed an ejection fraction of 45 to 55%. currently he does report shortness of breath, dyspnea on exertion, however, denies paroxysmal nocturnal dyspnea and orthopnea. he also reports increased lower extremity edema. past medical history: 1. end stage renal disease, status post living related renal transplant in , currently on prednisone and cyclosporin for immunosuppression. baseline creatinine is 3.0 to 3.5. 2. diabetes mellitus with triopathy. 3. coronary artery disease, status post myocardial infarction and left anterior descending stent. 4. congestive heart failure with recent ejection fraction of 45 to 55%. 5. obstructive sleep apnea. he uses bipap at home. 6. squamous and basal cell skin cancers. 7. legal blindness with retinal hemorrhages. medications on admission: 1. cyclosporin 200 mg p.o. b.i.d. 2. prednisone 5 mg p.o. q.d. 3. neurontin 300 mg p.o. b.i.d. 4. pravachol 40 mg p.o. q.d. 5. procardia 120 mg p.o. q.d. 6 lasix 80 mg p.o. q.d. 7. lopressor 50 mg b.i.d. 8. epogen 3000 units b.i.week. 9. midodrine 10 mg p.o. t.i.d. 10. aspirin 325 mg p.o. q.d. allergies: 1. dicloxacillin. 2. compazine. social history: the patient is retired. he denies use of tobacco or alcohol. physical examination: vital signs reveal temperature 98.0, blood pressure 140/90, heart rate 80, respiratory rate 20, oxygen saturation 93% in room air. head, eyes, ears, nose and throat - right eyelid droop with fixed pupil. the left pupil is round and reactive to light. the oropharynx is clear. the neck is supple with no lymphadenopathy or jugular venous pressure equals 14 centimeters. lungs clear to auscultation bilaterally. bibasilar crackles and no wheezes. cardiovascular regular rate and rhythm, s1 and s2 normal, no s3 and no s4, no murmurs. the abdomen is soft, nontender, nondistended, positive bowel sounds, no hepatosplenomegaly, no masses. extremities - warm, no cyanosis and no clubbing and 1+ pitting edema bilaterally. neurologic -the patient is alert and oriented times three. cranial nerves ii through xii are intact, nonfocal. laboratory data: on admission, white blood count 7.7, hematocrit 26.7, platelets 205,000. sodium 134, potassium 4.6, chloride 102, bicarbonate 12, blood urea nitrogen 114, creatinine 5.8, glucose 224. calcium 7.7, phosphate 8.0, magnesium 2.2. urine sodium equals less than 10, urine creatinine equals 134, urine osmolality equals 350. urinalysis showed 20 to 30 white blood cells, 30 to 50 red blood cells, positive yeast, negative bacteria, negative casts. chest x-ray showed interstitial pulmonary edema, small left sided pleural effusion, right basilar atelectasis. electrocardiogram was unchanged from previous baseline. hospital course: 1. pulmonary - at the time of admission, the patient had shortness of breath and worsening dyspnea on exertion, and was found to have a possible right lower lobe pneumonia on ct, for which he was started on levaquin. on hospital day number four, the patient was transferred to the medical intensive care unit for congestive heart failure, related decline in respiratory function and decreased ph, for which he was started on 100% nonrebreather face mask. after spiking fever to 102, the patient was started on ceftaz and vancomycin for presumed pneumonia. after a short time in the medical intensive care unit, his respiratory status improved and he began saturating close to 100% in room air. antibiotics ere discontinued at that time as his rapid response was thought to be more indicative of congestive heart failure related symptoms rather than pneumonia. following removal of significant amounts of fluid at dialysis, as well as transfusion, the patient's respiratory status improved dramatically as did his appearance on chest x-ray. at the time of discharge, the patient had been breathing room air for approximately three days, oxygen saturation ranging from 95 to 100% in room air. 2. cardiovascular - on admission, serial enzymes were drawn and the patient was ruled out for myocardial infarction. no new changes were noted on electrocardiogram. episodes of epigastric pain were thought to be noncardiac in nature. on admission, the patient had shortness of breath, worsening dyspnea on exertion and jugular venous pressure up to the jaw on examination. during his hospitalization, the patient's congestive heart failure worsened and he was admitted to the medical intensive care unit for respiratory failure. following removal of fluid at dialysis, the patient's congestive heart failure related symptoms improved as mentioned above. 3. renal - on admission, the patient had oliguria and acute renal failure of unclear etiology. his creatinine was 5.8 which was up from his baseline of approximately 3.0 to 3.5. renal ultrasound did not show hydronephrosis, making postrenal obstruction an unlikely cause of his acute renal failure. renal showed no evidence of acute rejection or ain and only showed signs of chronic diabetes mellitus and chronic transplant changes. during his first few days in the hospital, the patient showed progressively worsening renal failure, and on hospital day three, it was decided to start him on hemodialysis. after being transferred to the medical intensive care unit, the patient continued dialysis three times a week, with subsequent relief of his congestive heart failure symptoms. on hospital day number two, the patient was switched from cyclosporin to rapamune, however, before leaving the medical intensive care unit, the rapamune was also discontinued and the patient was continued only on prednisone. following admission, arrangements had been made for the patient to undergo hemodialysis at the center in . 4. infectious disease - on admission, the patient was started on fluconazole for suspected fungal urinary tract infection. cultures subsequently came back positive, and were then followed up by negative cultures at which time the fluconazole was discontinued. on hospital day number three, the patient was started on levaquin for suspected right lower lobe pneumonia seen on ct. on hospital day number four, the patient developed profuse watery diarrhea which was c. difficile positive. he was started on flagyl at that time. in the medical intensive care unit, his diarrhea worsened, at which time he was started on p.o. vancomycin in addition to the flagyl. his symptoms persisted for several days and then declined at which time he was transferred back to the floor. prior to admission, subsequent c. difficile toxin screens came back negative, although the patient continued to experience mild diarrhea. at the time of discharge, he was instructed to continue fourteen day course of p.o. vancomycin and p.o. flagyl. after returning to the floor from the medical intensive care unit, the patient was found to have erythema, discharge from around his femora catheter site. the site was cultured and came back as methicillin resistant staphylococcus aureus positive. the patient was at that time started on intravenous vancomycin, and continued a seven day course of this. 5. gastrointestinal - following admission, the patient's epigastric pain was thought to be consistent with pancreatitis or gallbladder disease. liver function tests, amylase, and lipase were found to be normal, however. ct examination revealed gallstones, which were thought to be possibly contributing to his episodic positional postprandial pain. these symptoms gradually decreased in frequency and severity throughout his hospitalization. at the time of discharge, he was asymptomatic. by hospital day number three, the patient developed profuse watery diarrhea and was found to be c. difficile positive. he was started on p.o. flagyl, however, his diarrhea persisted in the medical intensive care unit and he was then started on p.o. vancomycin and intravenous flagyl with subsequent improvement in symptoms. at the time of discharge, his symptoms were much improved, however, he still had a small amount of diarrhea. 6. hematology - the patient has had chronic anemia thought to be secondary to his renal failure. during his hospitalization, his dose of epogen was increased from 3000 to 6000 units three times a week, which he would receive at the time of hemodialysis. after being started on rapamune, the patient developed thrombocytopenia, which resolved following discontinuation of the rapamune. 7. endocrine - initially the patient was started on his outpatient dose of nph with appropriate glucose control. following dialysis, however, the patient experienced recurrent episodes of hypoglycemia, which was appropriately treated with d50. in the medical intensive care unit, glucose control on nph remained difficult and the nph was discontinued and the patient was started on an insulin sliding scale. after returning to the floor, the patient was gradually increased to his prehospitalization doses of nph. 8. fluids, electrolytes and nutrition - following admission, the patient was found to be acidemic, likely related to his uremia. at that time, the patient was started on intravenous fluids with bicarbonate in order to correct his acidemia. in the medical intensive care unit, the patient again developed acidemia which was thought to be secondary to both renal failure and diarrhea. he was repleted again with intravenous fluids containing bicarbonate. with his diarrhea, the patient became severely hypokalemic and was appropriately repleted with potassium. at the time of discharge, the patient's electrolytes had remained stable for several days. condition on discharge: stable. discharge medications: 1. aspirin 325 mg p.o. q.d. 2. epogen 6000 units three times a week. 3. flagyl 500 mg p.o. t.i.d. times four days. 4. vancomycin 250 mg p.o. q.i.d. times four days. 5. lopressor 75 mg p.o. t.i.d. 6. prednisone 5 mg p.o. q.d. 7. nph 30 units a.m. and 10 units p.m.. 8. pravachol 40 mg p.o. q.d. 9. procardia 120 mg p.o. q.d. 10. neurontin 300 mg p.o. q.d. 11. protonix 40 mg p.o. q.d. 12. nephrocaps one tablet p.o. q.d. 13. midodrine 5 mg p.o. t.i.d. 14. vancomycin one gram intravenously times one. discharge diagnoses: 1. acute renal failure, etiology unclear, the patient started on hemodialysis. 2. congestive heart failure. 3. c. difficile diarrhea. 4. methicillin resistant staphylococcus aureus positive line infection. 5. cholelithiasis. follow-up: arrangements were made for the patient to undergo hemodialysis at . the patient was also instructed to follow-up with his primary care physician, . . , m.d. dictated by: medquist36 procedure: parenteral infusion of concentrated nutritional substances hemodialysis closed (percutaneous) [needle] biopsy of liver venous catheterization for renal dialysis diagnoses: nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere congestive heart failure, unspecified acute kidney failure, unspecified polyneuropathy in diabetes complications of transplanted kidney diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled 

Answer: The patient is high likely exposed to