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: erythromycin base / protamine attending: chief complaint: dka major surgical or invasive procedure: mr received a colonoscopy on for evaluation of diarrhea. the colonoscopy showed normal bowel, though several biopsies were taken. he also received an egd on that revealed extensive inflammation of the esophagus, liklely resulting from refluxed stomach acids into the esophagus. history of present illness: mr. is a 49 year old gentleman with dmi, cad, pvd and esrd s/p living related donor transplant who initially presented to the ed on with a two-week history of diarrhea, nausea, vomiting and fevers. the pt states that he was in his usoh until approximately two weeks ago when he developed diarrhea, which he describes as loose and watery, non-bloody and without mucous, approximately bm/day. he has also been having low-grade temps to 100.2 over the past 1-2 weeks with chills. he was started on an empiric trial of ciprofloxacin by his pcp . he subsequently developed nausea and bilious emesis over the past 2-3 days with myalgias and increasing fatigue and decreasing po intake. the patient reports a chronic cough for the past 6 months, which is unchanged. denies ha, neck stiffness, sob, chest pain, pnd, abdominal pain. he does report decreasing uop for the past days. he had a dental procedure three weeks ago. in ed, the patient was afebrile with lactate of 1.3. bp was initially 103/57 with hr 82 and glucose of 443 with anion gap of 25. he was given vanc/zosyn and started on an insulin gtt. his bp subsequently decreased to 85/44 with hr 87 and he was given hydrocortisone 100mg iv x 1. anion gap increased to 27 prior to transfer to micu. in the micu the patient was managed with fluids and insulin gtt. the cause of his dka was thought to be either a urinary tract infection or a community acquired pneumonia. he was also noted to have elevated cardiac enzymes and his nstemi was thought to be either a precipitant of his dka or a cuase of his dka. he continued to have a mixed acid/base disturbance due to persistant diarrhea. he was continued on aspirin and beta blocker for his nstemi. he also was noted to have acute renal failure. his was held. he was seen by the renal service who felt he had prerenal failure with a urine sodium of 10. today his insulin gtt was stopped at 7 pm and he received his regular glargine dose. past medical history: 1. dmi since age 11 c/b esrd, neuropathy, gastroparesis, retinopathy 2. esrd s/p lrd transplant , baseline creatinine 1.3-1.6 3. cad s/p mi s/p cabg 4. pvd s/p left aka, right bka, rt fem-tib bypass , rt distal revision , multiple finger amputations 5. chf ef<25%, dilated cardiomyopathy 6. gout 7. cellulitis lle, mrsa and dka 8. anemia 9. cataracts 10. pulmonary htn medications at home: insulin (lantus 42u with hiss) asa rapamune 1mg diovan 160mg daily norvasc 10mg daily reglan 10mg prn lasix 40mg lopressor 100mg daily feso4 prednisone 5mg daily advicor (lovastatin/niacin) 20/) zantac nitrostat 0.4mg prn medications on transfer: atorvastatin 20 mg po daily hydrocortisone 50 mg iv q6 hr aspirin 325 mg po daily heparin 5000 u sc tid metoprolol 25 mg po bid zosyn 2.25 gm iv q8 siroliums 2 mg po daily (hold dose 6/29) insulin glargine 21 u qam regular insulin sliding scale social history: he lives with his wife and previously worked as a mechanic. 15 pack-yr smoking history, quit 20 yrs ago. drinks alcohol socially. physical exam: vitals: t 97.2 bp 145-160/60-70 hr 82-94 rr 15 96% ra gen: well-appearing man in nad heent: perrl, eomi, mmm, op clear neck: supple, from, no jvd or lad lung: cta bilaterally cor: rrr, nml s1s2, hsm at llsb abd: obese, nabs, soft ntnd ext: s/p multiple amputations of fingers, btk on the right and atk on the left, no splinter hemorrhages neuro: cn ii-xii intact, mscl strength 5/5 pertinent results: 8.2\13.0/235 |103|56 /193 ag 13 /39.4\ 3.7| 24|3.9\ ck: mb: 6 - 6 - 4 tnt: 0.41 - 0.37 - 0.24 vanco 4 am 11 1 am 15.9 micro: 1. stool ova + parasites-pending; 2. blood culture aerobic bottle-pending; anaerobic bottle-pending; 3. urine urine culture- mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. 4. blood culture aerobic bottle-pending; anaerobic bottle-pending; ekg: : nsr at 90 bpm, left axis deviation, normal intervals, 1mm st-depressions in v5-v6, twi i and v6 : sinus at 79 bpm. lafb. lad. 0. depressions in v5-6, twi in i, avl and ii. cxr: small left-sided pleural effusion. no evidence of congestive heart failure. no consolidation. ett-mibi (): defect in the basal inferior wall similar to prior study. greater prominence of fixed defects in the inferolateral and anteroseptal walls. increased lv cavity size with increased transient ischemic dilatation. depressed lv function with diffuse hypokinesis, less pronounced in the anterior basal region; lvef calculated 28%. cath : comments: 1. selective coronary angiography of this right dominant system revealed multi vessel coronary disease. the lmca was without flow limiting stenoses. the lad contained a 90% proximal lesion before becoming totally occluded just after a large septal. the lcx contained diffuse disease, up to a 95% mid vessel. om1 was totally occluded. a ramus branch had a 70% proximal lesion. the rca was totally occluded proximally. 2. graft aniography revealed a patent lima-lad, svg-pda, and svg-ri. the svg to om was totally occluded (could not be engaged and no seen on aortogram). of note, the svg-pda graft was engaged with catheter. 3. limited resting hemodynamics revealed a central aortic pressure of 158/72 (elevated) and an elevated lvedp of 26mmhg. 4. of note, access was obtained from the left groin as the patient's renal xplant is located on the right. final diagnosis: 1. three vessel coronary artery disease. 2. patent lima-lad, svg-pda, svg-ri. 3. occluded svg-om. brief hospital course: 49m with dmi, cad, pvd and esrd s/p living related donor transplant presents with two-week history of diarrhea, nausea, vomiting and fevers found to have uti, dka and acute on chronic renal failure. 1. dka: pt had elevated glucose of 443 with anion gap of 25 with ph of 7.31 and only trace ketones, suggestive of dka. uti is likely precipitating factor, though has been on ciprofloxacin as an outpatient for five days. can also consider prostatitis. the patient was aggressively hydrated in the intensive care unit and transitioned from insulin gtt to glargine with sliding scale. anion gap on transfer to medicine floor was 13. pt was eventually restated on glargine nightly with insulin sliding scale for breakthrough coverage. 2. hemodynamics: pt was initially normotensive in the ed, but became hypotensive. did not meet sirs criteria. hypotension likely a result of hypovolemia related to diarrhea, emeisis, decreased po intake and infection. in the micu, pt was assessed for adrenal insufficiency which was negative. once on the floor, pt was maintained on ivf and throughout his course, bp continued to rise. patient was gradually resumed on home antihypertensive regimen, first metoprolol to 100mg daily, then with the addition of norvasc, and finally, once creatinine returned to baseline, with valsartan. 3. id: the patient presented with pyuria and diarrhea, despite starting ciprofloxacin five days prior to admission. patient was started on vancomyin and zosyn empirically in the micu, though urine cultures were unyielding throughout admission. patient reported some diarrhea at baseline, though infectious workup was pursued. stool was sent for culture, o and p, c. difficile toxin, cryptosporidium, cyclospora and fungus. all of these cultures were unyielding, and patient's diarrhea eventually resolved. vancomycin and zosyn were discontinued after several days, as patient had become a febrile and no definitive source was ever identified. . 4. diarrhea: given unyielding infectious workup in immunocompromised patient, intrinsic gi pathology pursued more aggressively as cause of diarrhea. pt had colonscopy with biopsy which showed no evidence of cmv or hsv. two biopsies were taken, one from an ulcer at 15 cm and one random biopsy; results of ulceration showed mucosal edema, neutrophils and focal crypt dropout. possible causes include biopsy procedure trauma and early ischemic change. results from random colon were wnl. given long course of antibiotics and continued diarrhea, pt was maintained on metronidazole and was discharged on this medication for the possibility of c. difficile colitis. . 5. arf: acute on chronic renal failure, c/w prerenal from dehydration in the setting of diarrhea, emesis, decreased urine output and infection. urine sodium was 10. has responded well to fluids, discharge creatinine at baseline of 1.5 from 7.7 on presentation. urine eosinophils were negative. rapamune monitored with daily levels and adjusted as necessary. . 6. erosive esophagitis: pt developed severe upper epigastric pain several days prior to discharge; in light of his immunocompromised status, nausea, vomiting and diarrhea, egd was performed to r/o cmv, hsv or h. pylori. egd demonstrated severe erosive esophagitis, and patient was started on protonix, 40 mg daily. . 7. gout: pt developed acute, painful swelling of r elbow and had history of gout. rhematology was called to perform and arthrocentesis; not enough fluid was obtained for evalaution. patient was presumed to have an acute flare of gout and was started on a prednisone taper on the day of discharge. he did not require rheumatologic follw up. . 8. elevated troponin: likely a result of acute renal failure, given flat ck. however, patient does have minor ekg changes which may represnt demand ischemia in the setting of known cad. asa and beta blocker were continued, no further cardiac asessment was pursued. medications on admission: on transfer to the medicine floor: atorvastatin 20 mg po daily hydrocortisone 50 mg iv q6 hr aspirin 325 mg po daily metoprolol 25 mg po bid zosyn 2.25 gm iv q8 siroliums 2 mg po daily (hold dose 6/29) insulin glargine 21 u qam discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. atorvastatin calcium 20 mg tablet sig: one (1) tablet po daily (daily). 3. zolpidem tartrate 5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed. 4. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 5. sirolimus 1 mg tablet sig: one (1) tablet po daily (daily). 6. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 7. insulin glargine 100 unit/ml solution sig: eighteen (18) units subcutaneous at bedtime. 8. amlodipine besylate 5 mg tablet sig: two (2) tablet po daily (daily). 9. valsartan 160 mg tablet sig: one (1) tablet po daily (daily). 10. sirolimus 1 mg tablet sig: one (1) tablet po every other day (every other day). 11. sirolimus 1 mg tablet sig: two (2) tablet po every other day (every other day). 12. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). 13. metronidazole 500 mg tablet sig: one (1) tablet po q 8h (every 8 hours) for 5 days. disp:*15 tablet(s)* refills:*0* 14. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 15. magnesium oxide 400 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 16. percocet 5-325 mg tablet sig: 1-2 tablets po every 6-8 hours as needed for pain. disp:*40 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnoses 1. dka 2. htn 3. diabetes mellitus 4. diarrhea 5. chronic renal insufficiency 6. gout discharge condition: good. patient feeling better, tolerating oral intake, blood sugars under good control. discharge instructions: you should follow up with dr or come to the emergency department for any worsening symptoms or diarrhea, including fever (>101f) or chills. chest pain, shortness of breath, dizziness and inability to maintain oral intake are also concerning and require evaluation by a physician. medication changes have been made while you have been in the hospital. specifically, for the next 2 days you should take 20 mg (4 tablets) of prednisone per day. for the following 4 days, you should take 10 mg (2 tablets) of prednisone. thereafter you should resume your normal dose of 5 mg (1 tablet) per day. the dosing of your rapamune has also been changed: you alternate between taking 1 mg daily and 2 mg daily (1 mg monday, 2 mg tuesday, 1 mg wednesday etc). other medications can be taken as directed. followup instructions: you should follow up with your primary within 2 weeks (). as discussed, you preferred to make that appointment based on your schedule. you should keep your previously scheduled appointment with your kidney doctor. you will not need to have any rheumatologic follow up unless you would like it. procedure: venous catheterization, not elsewhere classified esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine diagnoses: subendocardial infarction, initial episode of care esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified gout, unspecified other chronic pulmonary heart diseases polyneuropathy in diabetes hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled diarrhea complications of transplanted kidney unspecified gastritis and gastroduodenitis, without mention of hemorrhage background diabetic retinopathy gastroparesis diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled 

Answer: The patient is high likely exposed to