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: no known allergies / adverse drug reactions attending: chief complaint: osh transfer for evaluation of hrs major surgical or invasive procedure: diagnostic paracentesis : therapeutic paracentesis : diagnostic paracentesis : feeding tube placement : therapeutic paracentesis : placement of tunneled left ij hemodialysis catheter : combined liver/kidney transplant history of present illness: 47 yo m with etoh/hep c cirrhosis, htn, dm who was transferred from for liver transplant evaluation and management of hepatorenal syndrome. patient has a 10yrs of hcv (never tx and no bx, genotype 3a) and etoh hepatitis and cirrhosis. his initial decompensation appears to have occured in with ascites, edema and deconditioning. reportedly he quit etoh use at that time. he was seen at the state liver transplant center in may with w/up including egd with grade 1 varices and portal gastropathy, ct abd/pelvis () with hepatosplenomgealy w/o lesions, rml nodule in the lung and large ascites. he has never had a variceal bleed. he has been undergoing biweekly paracenteses since spring , however there is no documentation of diuretic refractory ascites. he did have grade 2 he and had no hx of hrs, hps or hcc. his labs at time of that evaluation were notable for cr of 0.9, inr 1.1 and bili of 0.9. fe studies were notabel for ferritin of 621, fesat 49% and fe 86. meld was 7 and cps 10. he was initially seen at state in and then in , when majority of the work up was initiated. of note he did not complete further evaluation as he moved to ma to be with his son 1 mo ago. . patient was in usoh with recurrent ascites, non-encephalopathic until ~ 2 wks ago when he developed increasing abdominal distension and pain. . per nf note: "the patient initially presented to on with 2 weeks of malaise, body aches, chills, poor po intake, non-bloody diarrhea, nausea/vomiting, abdominal discomfort, dysuria, and jaundice. no sick contacts. traveled to 3 months ago. . at , exam was notable for jaundice and ascites. admission labs showed wbc 8.8 (8% bands), hct 33.7, plt 136, na 126, cr 2.1 (up from normal on ), albumin 2.0, alt 53, ast 61, alkphos 314, tbili 18.9 (up from 1.9 on ), dbili 14.3, lipase 249, inr 1.5. urine sodium was 23. fena 0.3%. abdominal ultrasound showed normal portal and hepatic venous flow, moderate ascites, splenomegaly, no biliary dilatation, no stones or hydronephrosis." . his ua was positive with nitrates, but cx was negative. he received ketorolac for pain at ed. . "diagnostic and therapeutic paracentesis was performed, with wbc 50, 4% polyps. a total of 7.5 l of fluid was removed. the admission (written prior to the paracentesis) suggests empiric ertapenem for sbp, but it is unclear from the available records if this was given. quinapril was stopped. and the patient was challenged with fluids and albumin. midodrine and octeotide were started. renal was consulted and recommend transfer to for transplant evaluation. . on transfer, bun was 35, creatinine 3.1, tbili 22.3, dbili 16.8, inr 1.6. urine output during the 24 hours prior to transfer was 200 cc." . on the floor, patient appeared to be encephalopathic and had no complaints other then pain at the site of the foley catheter. above history was also confirmed with his son, . . . review of systems: as per hpi. past medical history: -hcv/etoh cirrhosis (see above). -htn -rll calcified granuloma -chronic low back pain -brittle diabetes mellitus (last a1c 10%) -s/p tonsillectomy -s/p hernia repair social history: recently moved to massachusetss to be near his son. previously living in being taken care of by his daughter, who no longer is able to care for him and moved to ct. he worked as a carpenter, and was incarcerated for 9 years with discharge in . tobacco: smokes 1 pack every 3-4 days etoh: last drink 10-11 months ago drugs: former heroin and cocaine, ivdu, with last use months ago family history: denies family history of liver disease physical exam: vs temp 98.2f, bp 110/68, hr 70, r 18, o2-sat 96% ra general - somnolent, opens eyes and follows verbal commands, jaundiced, chronically ill-appearing, nad heent - nc/at, sclerae icteric, dmm, op clear neck - supple, jv flat lungs - trace crackles b/l. heart - rrr, no mrg, nl s1-s2 abdomen - distended, shifting dullness, nt/nd, no rebound/guarding, cound not palpate spleen/liver. no bruit over the liver. extremities - wwp, no c/c/e skin - excoriations on upper chest, multiple tatoos, 7 spiders, palmar erythema. . neuro: somnolent, opens eyes and follows verbal commands. dowb took 3 minutes with multiple errors. repeats, reads and encodes, but 0/3 recall. vff, eomi, smooth, face symmetric and tongue is midline. shoulder shrug symmetric. moving all 4 extremities ag. dtrs not tested, but seems to have normal tone. there is asterixis. pertinent results: state labs: hcv vl afp 16 (nl < 6) cr 0.6 on na 140 ast/alt 46/33 bili 0.7 egd - grade 1 varices. ceruloplasmin 35h hab-ab pos hb sab, cab - negative hcv ab - positive genotype 3a positive 320:1 speckled antismooth - 29h antimitoab - 37h alpha1antitrypsine - mm cmv igm and igg - negative hsv 1 and 2 ab - positive hsv igm - positive rpr - nr vzv igg -equivocal hiv - neg labs on admission: wbc-6.8 rbc-3.19* hgb-10.5* hct-30.2* mcv-95 mch-32.8* mchc-34.6 rdw-14.7 plt ct-95* pt-18.2* ptt-40.5* inr(pt)-1.7* glucose-226* urean-33* creat-2.4* na-130* k-4.1 cl-103 hco3-18* angap-13 alt-32 ast-64* alkphos-138* totbili-27.4* albumin-3.0* calcium-8.8 phos-2.7 mg-1.7 iron-73 cholest-63 %hba1c-11.0* eag-269* triglyc-128 hdl-4 chol/hd-15.8 ldlcalc-33 brief hospital course: 47 y.o. male with h/o etoh abuse/hep c cirrhosis (see above for detailed history), htn, poorly controlled dm who was transferred from for transplant evaluation in the setting of markedly worsening hepatic and renal function, and concern for hepatorenal syndrome. meld was 34. admission labs revealed vre uti. he completed a course of linezolid. liver function worsened with sequelae. meld score increased to 40s. lactulose and rifaximin were started for hepatic encephalopathy. frequent therapeutic paracentesis were needed for refractory ascites. liver transplantation was pursued with subsequent workup. he agreed to participate in substance abuse relapse programs and his son agreed to be his advocate and care giver. pre transplant workup was completed and approved. as an outpatient he was given diagnosis of hrs as renal function worsened in setting of receiving toradol,and volume depletion post large volume paracentesis. renal us was unrevealing for abnormalities. nephrology was consulted. etiology for was likely pre-renal and some component of atn in the setting of worsening liver failure. octreotide/midodrine were started, but were discontinued as there was no improvement. hemodialysis was initiated. nephrology deemed him a suitable candidate for combined liver kidney transplant. he had a lower gi bleed requiring blood products and transfer to sicu. egd on showing severe gastropathy, previously banded varices were not actively bleeding. colonoscopy showed 4 cords of small rectal varices that were not bleeding. ulceration, friability, erythema and mosaic appearance from 50 cms until cecum were compatible with portal colonopathy which seemed to be bleeding spontaneously from low platelets and elevated inr. patient had been transferred to the icu for continued management, was on cvvhd and receiving transfusions prn. once stable, he transferred out of the icu and went on intermittent hd. however, brbpr recurred and he was transferred back to the sicu for management. he experienced diarrhea. stool cultures isolated c. diff. po vanco and flagyl were started on . on he received an offer for combined liver and kidney transplant. on , he underwent combined liver/kidney transplant. surgeon was dr. . postop, he was sent intubated to sicu for management. he was extubated on postop day 1. lfts decreased and liver duplex demonstrated normal vasculature. renal duplex also demonstrated normal vasculature with appropriate waveforms. creatinine decreased to normal. urine output was excellent. jp outputs were non-bilious. tube feeds were started. po vanco continued indefinitely for c.diff and iv flagyl was stopped after a 24 day course. he did well until when he spiked to 101.4. he was pan cultured and started on linezolid on . pseudomonas was isolated on urine culture from . linezolid was stopped on and switched to iv meropenem as blood cultures as well as urine isolated pseudomonas sensitive to meropenem. on blood culture isolated budding yeast. this was speciated out on as torulopsis. iv tip was negative. micafungin was started on . iv flagyl was resumed for diarrhea. repeat stool cultures were were c.diff negative. id recommended a slow po vanco taper other iv antibiotic course. surveillance blood cultures remained negative. id was consulted and recommended tte. tte was done showing systolic anterior motion of the mitral valve chordae (appreciated previously), but the suggestion of torn mitral chordae, and a possible mitral valve vegetation was new. a tee was attempted but tee probe could not be passed into the esophagus due to resistance and the patient's inability to cooperate despite adequate sedation and analgesia. the plan was to treat with micafungin for one month and repeat the tte to determine whether course should extend. tte will be scheduled as an outpatient. he was doing well until when creatinine started to increase from 0.9. this was initially attributed to supra therapeutic prograf level of 17.9 (goal of 10). doses were held and repeat levels decreased. creatinine continued to increase daily up to 3.6. renal duplex was done on noting no arterial flow seen in the transplant kidney and findings concerning for gas in the renal sinuses/collecting system. on , he was taken to the or for transplant nephrectomy. surgeon was dr. . a jp drain was placed. jp outputs were high (likely from a small tear in the peritoneum). the plan was to leave the jp in place until f/u in the clinic. postop, intermittent hd was resumed via a tunnelled hd line. last hd was . two liters were removed. vein mapping was done to assess vasculature. need for hd access will be reassessed in f/u with outpatient clinic visit. he was very depressed after nephrectomy and psychiatry was consulted. remeron was recommended and started with some improvement. he continued to c/o of rlq pain over nephrectomy site, r shoulder pain, lue picc line site pain and chronic back pain(xrays of shoulder were notable for slight subluxation and no fracture). dilaudid (po)with break thru iv dilaudid were given with only fair relief. methadone 2.5mg was started on pm of . po dilaudid was decreased from prn 6mg to 4mg. plan was to further taper dilaudid after 1-2 days of methadone. dietary intake was insufficient therefore tube feedings continued via a post pyloric feeding tube. he experienced diarrhea. stool cultures were negative for c. diff. imodium was started. diarrhea/frequent stools persisted. cellcept was stopped on as this was thought to be possible cause of gi symptoms. vancomycin oral was to continue on slow taper as outlined per id. immunosuppression: cellcept stopped for diarrhea. prednisone taper per protocol (decreased to 17.5mg on then decrease by 2.5mg every 10 days)and prograf per trough levels. trough level was 6.0 on . dose increased from 4mg to 5mg on . a trough level should be repeated on with stat results faxed to clinic . doses should only be adjusted by transplant center physical therapy worked with him and recommended rehab. a bed was available at rehab on . he will transfer there today. he is now ambulating with supervision. of note, explant liver path report noted punctate necrotic areas within the ex planted liver parenchyma corresponding to adenovirus infection. id reviewed. no change in antibiotic regimen. dm ii- this was poorly controlled as an out pt and presented to the hospital with an a1c of 11%. his blood sugars were difficult to control and was consulted for assistance with glucose management. patient was maintained on glargine and iss which was adjusted several times to maintain adequate control. he was also followed by following transplant. post transplant improved glycemic control was achieved with lantus and sliding scale regular insulin accounting for dietary intake and continuous tube feeding. medications on admission: albuterol 0.083% neb q6h prn, mvi', omeprazole 20', rifaximin 550'', tylenol 500 q6h prn, lidocaine patchy', vit d 50,000u qwk, miralax 17g', simethicone 40-80 qid prn, tramadol''' prn, insulin, mirtazapine 15' allergies: nkda discharge medications: 1. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: do not exceed 2 g in 24 hours. 3. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for pruritis. 4. valganciclovir 450 mg tablet sig: one (1) tablet po 2x/week (tu,fr). 5. prednisone 5 mg tablet sig: 3.5 tablets po daily (daily): follow printed taper. 6. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 7. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours): continue until then decrease to 125mg x 2 weeks then 125mg qd x2 weeks then 125mg every 48 hours x2 weeks then d/c. 10. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp < 100, hr < 60. 11. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain for 1 days: then taper to 2mg prn every 4 hours. 12. loperamide 2 mg capsule sig: one (1) capsule po tid (3 times a day). 13. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 14. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 15. micafungin 100 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours): continue until . 16. tacrolimus 1 mg capsule sig: five (5) capsule po q12h (every 12 hours). 17. epoetin alfa 2,000 unit/ml solution sig: one (1) injection 3x per week: at hemodialysis. 18. methadone 5 mg tablet sig: 0.5 tablet po bid (2 times a day): for pain. monitor for sedation/respiratory depression. started . 19. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) dose injection q8h (every 8 hours) as needed for nausea/vomiting. 20. insulin glargine 100 unit/ml solution sig: twenty two (22) units subcutaneous at bedtime. 21. insulin regular human 100 unit/ml solution sig: follow sliding scale injection four times a day. 22. dextrose 50% in water (d50w) syringe sig: one (1) intravenous prn (as needed) as needed for hypoglycemia protocol. 23. outpatient lab work stat labs wednesday then every monday and thursday for cbc, chem 10, ast, alt, alk phos, t.bili, albumin and trough prograf level -fax results to transplant, attention rn coordinator discharge disposition: extended care facility: hospital - discharge diagnosis: primary: acute kidney injury, hepatic encephalopathy secondary: liver cirrhosis, hepatitis c, etoh abuse history, diabetes mellitus, hrs s/p liver and kidney transplant s/p transplant nephrectomy for thrombosis malnutrition pseudomonas uti/bacteremia torulopsis bacteremia vre uti c.diff discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: please call the transplant clinic at please follow transplant clinic schedule for lab draws every monday and thursday with results to the transplant clinic at patient should not lift items greater than 10 pounds please continue tube feeds as ordered drain care as ordered dialysis will continue on mon-wed-fri schedule at rehab followup instructions: provider: , md phone: date/time: 3:00 tte to be schedule as f/u by to assess for vegetations (may need to extend micafungin course beyond 1 month based on repeat tte) provider: , md phone: date/time: 1:00 provider: , md phone: date/time: 3:00 procedure: other endoscopy of small intestine enteral infusion of concentrated nutritional substances removal of transplanted or rejected kidney hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis venous catheterization for renal dialysis percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage arterial catheterization colonoscopy other transplant of liver endoscopic excision or destruction of lesion or tissue of esophagus other kidney transplantation injection or infusion of oxazolidinone class of antibiotics other operations on lacrimal gland transplant from cadaver central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified hyperpotassemia end stage renal disease acute kidney failure with lesion of tubular necrosis other postoperative infection urinary tract infection, site not specified acute posthemorrhagic anemia acute and subacute necrosis of liver chronic hepatitis c with hepatic coma alcoholic cirrhosis of liver hepatorenal syndrome unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia portal hypertension sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease defibrination syndrome disorders of phosphorus metabolism intestinal infection due to clostridium difficile disseminated candidiasis other ascites streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] hemorrhage of gastrointestinal tract, unspecified esophageal varices in diseases classified elsewhere, without mention of bleeding other specified disorders of stomach and duodenum delirium due to conditions classified elsewhere complications of transplanted kidney vascular disorders of kidney hypercalcemia personal history of alcoholism pseudomonas infection in conditions classified elsewhere and of unspecified site acute edema of lung, unspecified mixed acid-base balance disorder spontaneous bacterial peritonitis septicemia due to pseudomonas diabetes with renal manifestations, type ii or unspecified type, uncontrolled acute pyelonephritis without lesion of renal medullary necrosis ulceration of intestine physical restraints status 

Answer: The patient is high likely exposed to