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 is a 28-year-old female with sle/lupus, nephritis, end-stage renal disease status post cadaveric renal transplant , complicated by delayed graft function/atn, biopsy done intraoperatively during reexploration post transplant for bleeding requiring multiple transfusions. the patient has had multiple admissions in the past since her transplant for abdominal pain and dehydration. on , the patient was admitted for respiratory distress. the patient was found to have agonal breathing/unresponsiveness. at that time, fingersticks were less than 20. the patient was treated with 1.5 amps of d50 but still not adequately awake. the patient was intubated in the emergency room for airway protection. at that time, her heart rate was in the 100s. systolic blood pressure was 90- 100. the patient was transferred to the icu, and labs demonstrated that the patient had a hematocrit of 14, sodium of 125, potassium 8.3, chloride 95, bicarb 11, bun and creatinine of 37 and 6.6. in the icu a line was placed, and a central line was placed. the patient was transfused with 2 units of packed red blood cells, 2 units of ffp, 1 unit of platelets and bicarb in the setting of severe acidosis. the patient remained hemodynamically stable. past medical history: 1. sle diagnosed in complicated by lupus/nephritis, anemia, serositis and ascites, currently in remission. 2. end-stage renal disease on hemodialysis monday, wednesday and friday secondary to lupus. 3. history of vsd status post corrective surgery at age 13. 4. hypertension. 5. itp. 6. mssa endocarditis. 7. cell trait. 8. status post left oophorectomy related to iud-associated infection. 9. restrictive lung disease noted on pfts from . in chest ct was with diffuse ground glass opacities. 10. gerd in . 11. history of domestic violence. 12. most recently is status post cadaveric renal on , , complicated by delayed graft function. allergies: levaquin, cephalosporin, unasyn, vancomycin and derivative, demerol and meperidine. medications on admission: prednisone 5 mg daily, bactrim ss 1 tablet daily, valcyte 450 mg every other day, __________ 2.5 mg daily, nifedipine 90 mg sustained release daily, protonix 40 mg daily, dronabinol 2.5 b.i.d., mirtazapine 15 mg q.h.s., mmf 500 mg b.i.d., nystatin suspension 5 ml q.i.d., epogen injection 3000 units monday, wednesday and friday, percocet 5/325 mg tablets 1 tablet q.4-6 hours p.r.n., labetalol 400 t.i.d., linezolid 600 q.12 for a total of 7 days, reglan 5 mg q.i.d., sodium bicarb 650 mg tablets 4 tablets t.i.d., coumadin 5 mg 1 p.o. daily for a left axillary thrombus, rapamune 6 mg once a day, the patient at that time was on linezolid because of a gram-negative staph urinary tract infection, and on coumadin for a non-occlusive thrombus of left axillary vein that was documented on . in the emergency room was intubated and sedation. ct of the abdomen was performed demonstrating a large right-sided hematoma displacing the transplanted kidney anteromedially and inferiorly. the hematoma is larger compared to the cat scan that was performed on , but appears smaller compared to the cat scan on . the transplanted kidney is barely discernable. the uv catheter is noted in situ. a 3.8 cm heterogenous lesion, likely arising from the uterus and probably a fibroid was noted. there was also diffuse thickening of small bowel wall with a differential of wide and intramural hemorrhage, and there was massive ascites. preoperative diagnosis: 1. anemia. 2. acute renal failure. 3. hyperkalemia. 4. metabolic acidosis. 5. coagulopathy. 6. sepsis. the patient was rushed to the or where surgery was performed on the morning of , performed by dr. . exploratory laparotomy and transplant nephrectomy was performed due to a ruptured kidney. a french drain was brought out through a separate incision and sutured in place with 3-0 nylon. the patient remained intubated and was taken to the icu in stable and satisfactory condition. postoperatively the patient was febrile. the patient had a right femoral arterial line and left triple lumen. cultures were obtained on , because the patient became febrile which grew out pseudomonas. the renal consulting team followed the patient closely. the patient continued with hemodialysis monday, wednesday and friday. cat scan was obtained postoperatively on , to evaluate the abdomen and hematoma which demonstrated interval removal of the transplant kidney with extravasation of right extraperitoneal __________ . at the surgical site remains an ill-defined collection consisting of residual hemorrhage and gas and hyperdense perihepatic fluid probably hemoperitoneum. there was free air present which may be related to surgery. according to the radiologist, there was nonspecific cecal thickening, new bibasilar consolidations and new gallbladder distention. the patient continued to be intubated. he was placed for tube feeds, and tube feeds were started for nutrition. the patient remained intubated. tube feeds were continued. the patient was continued on antibiotics, linezolid day 16, zosyn day 13. the patient was also continued on a fentanyl patch for pain control. at that time, , she was assist control 40%, peep of 10, 45 x 25. infectious disease was consulted for ongoing fever despite being on multiple antibiotics. the patient had a radial peroneal abscess that was drained. infectious disease closely followed the patient and made recommendations without switching antibiotics. on , central line change was performed complicated by a large left apical and basilar hemothorax. chest tube was placed that evening. another chest x-ray was performed demonstrating marked decrease of left-sided pneumothorax, residual small left apical and basilar pneumothorax. the patient had another cat scan on , because of ongoing abdominal pain. the patient required another catheter for drainage of collection. cat scan demonstrated 1) interval improvement in bilateral basal consolidations, 2) there was a collection along the right flank, decreased in size compared to the prior study with catheter in adequate position, 3) there was reduction of gallbladder distention, 4) stable small collection to the right of the uterus consistent with resolving hematoma, 5) stable splenic infarcts. the patient hemodynamically stable. the patient did complete a 7-day course for a possible mucocutaneous hsv. antibiotics were changed to meropenem. linezolid and gentamicin were discontinued. tpn was discontinued. nepro tube feeds were started per recommendations from nutrition. the patient was slowly weaning from the vent. tube feeds were advanced. on , the patient needed central venous access, and there was successful placement of an 8.5 french 16 cm long four-lumen catheter via the left common femoral vein. also the venogram demonstrated occlusion of the left ij and the left subclavian vein with multiple collaterals, and also the right ij was shown to be occluded on ultrasound scan. therefore the left femoral line was in place and ready to use for central access. on , the patient had a bronchoscopy to evaluate and assess airway patency. using an endotracheal tube, which was flexible, it was documented that her airway was clear. there were no complications. the patient continued with the dialysis 3 days a week. renal continued to follow the patient. on , the patient had an open tracheostomy performed by dr. because of respiratory failure and failure to wean off the ventilator status post tracheostomy tube with a 7 french non-fenestrated tracheostomy tube. the patient ventilated well, and the patient was transferred back to the recovery room in stable condition. on , the patient had another cat scan because of abdominal pain and persistent fever. the case was discussed with dr. who requested drainage of subhepatic fluid collection. 1. the size of the subhepatic fluid collection within an enhancing wall has decreased slightly since the prior study. this was drained with an 8 french pigtail catheter which was left in place. 2. there was a jp drain in the right pericolic fluid collection which was in good position. the size of the fluid collection was essentially from the prior study of . 3. there was a stable appearance of a cystic collection deep within the pelvis to the right of the uterus not easily amendable to percutaneous drainage. 4. there was anasarca with ascites. 5. there was bilateral lower lobe consolidation which was . 6. there were splenic infarcts, which was . we continued to check her labs which included cbc, electrolytes daily and were replaced as needed. the patient was evaluated for rehab. another cat scan was performed on at 1 a.m. because of abdominal pain, and was documented: 1. persistent, although smaller multiloculated fluid collection along the right flank, status post removal of drainage catheter. the presence of infection cannot be excluded. 2. there was a similar uterine mass. 3. there was ascites and edema. 4. improving bilateral lower lobe consolidations. 5. continued splenic infarcts, not well appreciated on that particular study. the patient continued on antibiotics for pseudomonas coverage and vre bacteremia related to lines and questionable abdominal fluid collections. later that day on , the patient had a ct- guided abdominal drainage using ct fluoroscopic guidance. needle was advanced to the right flank collection. approximately 40-50 ml of blood-tinged fluid was aspirated. postprocedural films demonstrated that the right flank collection appears in good position. the patient tolerated the procedure well. there were no immediate complications. the 8 french catheter remained in place after the ct was completed. on , the patient was evaluated for a passy- muir valve evaluation, and it was observed that she did tolerate wearing the pmv for 20 minutes with no oxygen desaturation and was able to speak with a clear voice and intelligible speech; however, she then began to cough at the end of the evaluator's exam suggesting either dryness/irritation or possibility of aspiration secretions. physical therapy and occupational therapy met with the patient for evaluation and treatment and definitely felt that the patient needed to go to rehab. the patient continued with hemodialysis. on , the patient had a chest x-ray because of ongoing fevers, and the radiologist documented the chest x- ray report as a long-standing interstitial abnormality in the right lower lobe present since . this probably represents irreversible changes of previous edema, pulmonary hemorrhage, vascular congestion or interstitial lung disease, not an acute process. top-normal heart size and dilatation of pulmonary arteries and left atrium are long standing. there are no findings to suggest further cardiovascular decompensation or current enterothoracic infection. feeding tube ends at the pylorus. tracheostomy tube in standard placement. no pleural effusion. pigtail catheter was removed on , and tracheostomy was downsized, and there were no adverse events over night. she was afebrile with vital signs stable. p.o. intake 640, tube feeds 710; does not void. the patient had jp drainage of 35 cc. infectious disease had recommended to continue tobramycin, p.o. vancomycin and cipro until her follow-up appointment with infectious disease on . at that time, abdominal/pelvic ct will be obtained to assess fluid collections to help define further duration of antibiotics. on , another cat scan was performed to evaluate the abdominal collections after the drains have been removed. on , pain service was consulted requires multiple narcotics. the pain service had stated to continue the fentanyl patch, to change her p.o. dilaudid regimen and to discontinue her iv dilaudid. currently the patient is on cipro for pseudomonas. the patient is also on linezolid for enterococcus and history of vre. the patient continues on vancomycin for prior c-diff. she is also receiving tobramycin. she has 2 pending cultures from blood cultures that were obtained on . her labs on , revealed the following: wbc 9.4, hematocrit 26.8, platelets 111; ptt 30.5, inr 1.1; sodium 131, 3.6, 95, 28, bun and creatinine of 20 and 3.5, glucose 88, calcium 9.6, phos 2.5, magnesium 0.7, albumin 2.6. the patient had a tobramycin level of 1.1 on . when the patient goes to rehab, the patient will need daily cbc, chem10 at least once-a-week. the patient will need to have a cbc with diff and a post dialysis tobramycin level. those results need to be faxed to infectious disease . the patient has a follow-up appointment with dr. on , from infectious disease, . this appointment is for , at 9 a.m. if you have any questions or problems with the appointment please dr. office immediately. also the facility should make an appointment with transplant surgery potentially on the same day; please call . discharge medications: prednisone 5 mg daily, mucomyst solution q.4-6 hours as needed, heparin 5000 units subcu b.i.d., vancomycin 125, which is the oral liquid, q.6 hours, prevacid 30 mg suspension 1 tablet daily, albuterol aerosol puff inhalation 1-2 puffs q.6 hours, lopressor 4.5 b.i.d., fentanyl patch 100 mcg, please change every 72 hours, __________ 750 q.24 hours, colace 100 mg b.i.d., dilaudid 2 mg tablets 1-3 tablets q.2 hours p.r.n., linezolid 600 mg q.12 hours, ativan 1 mg iv q.6 hours, tobramycin as needed, the last dose was 140 mg, but please check level prior to giving dose. if there are any questions in regards to the tobramycin, call infectious disease at . the patient is on tube feeds, nepro 3/4 strength, goal rate of 40 cc/hr. please check residuals q.4 hours and hold tube feeds for residuals greater than 100 ml. please flush with 50 cc of water q.8 hours. the patient should also receive calorie counts and have a dietician following the patient. the patient could be possibly transitioned from tube feeds to a regular diet. final diagnosis: this is a 28-year-old woman with lupus nephritis status post renal transplant on , with acute rejection and subsequent graft rupture. secondary diagnosis: 1. pseudomonas bacteremia. 2. peritoneal abscess/necrotizing fascitis. 3. left ij and left subclavian vein occlusion. 4. left pneumothorax requiring chest tube placement. 5. respiratory failure requiring tracheostomy. 6. intra-abdominal fluid collection status post drainage. , procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances removal of transplanted or rejected kidney hemodialysis percutaneous abdominal drainage percutaneous abdominal drainage temporary tracheostomy incision of perirectal tissue injection or infusion of oxazolidinone class of antibiotics biopsy of pituitary gland, transfrontal approach other local excision or destruction of vulva and perineum diagnoses: acidosis systemic lupus erythematosus end stage renal disease acute kidney failure with lesion of tubular necrosis cellulitis and abscess of trunk urinary tract infection, site not specified acute posthemorrhagic anemia severe sepsis acute respiratory failure iatrogenic pneumothorax intestinal infection due to clostridium difficile infection and inflammatory reaction due to other vascular device, implant, and graft other and unspecified coagulation defects complications of transplanted kidney herpes simplex without mention of complication septicemia due to pseudomonas other specified disorders of kidney and ureter other abscess of vulva ulceration of vulva, unspecified 

Answer: The patient is high likely exposed to