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: patient recorded as having no known allergies to drugs attending: chief complaint: diarrhea, fever major surgical or invasive procedure: right subclavian cvl -> removed during course of stay history of present illness: 57 yo f with history of ckd s/p kidney transplant in , on immunosupressants, lymphangioleimeiomatosis, diabetes, who was admitted with one week of diarrhea, fever to 102.7 and shortness of breath. she started having watery diarrhea about one week ago. she denies abd pain, nausea, vomiting, brbpr, dark stools. she does have decrased appetite and poor po intake. she also complains of sob, doe and orthopnea since about the same time. she has a nonproductive cough and chills adn increased lower extremity edema. she denies dysuria, hematuria, chest pain, rash. in the ed, temp 102.7, hr 113, 183/67, 18, 84%2l - > 100%nrb, lactate 2.3, elevated wbc to 14 with left shift, elevated creatinine to 4.1 from baseline of 3.2, + anion gap of 17. she was given 2 l of ivf and had abdominal ct that was unrevealing. she was started on levofloxacin and flagyl for presumed gastroenteritis. she was admitted to the icu becuase of her oxygen requirement. in icu abg showed profound metabolic acidosis (anion gap and non anion gap) 7.17/45/268 on nrb. past medical history: hepatocellular carcinoma, dx , grade 2 (focal clear cell differentiation, immunohistochemical stains highlight canalicular patterns by cea, the tumor cells are focally positive for cam 5.2 and negative for cytokeratin a1/a3, the tumor cells are positive for hep par1 and ttf-1). scan in negative for mets. s/p splenectomy diabetes esrd (secondary to dm and htn), s/p renal transplant on immunosuppressants, episode of allograft nephropathy documented by biopsy, basleine creatinine 3 hypertension b/l thoracotomy for spontaneous ptx, hyperlipidemia lymphangioleimyomatosis (cystic dz) of lung, on home oxygen 2l nc all the time pulmonary artery hypertension cardiac stress test (p mibi) in with no perfusion defects seizures in setting of hypertensive emergency social history: pt was raised in the phillipines, immigrated to the us in . married lives with husband. 2 kids. no tob/etoh/drugs. family history: fh - mother died from pancreatic ca physical exam: 99, 82, 154/68, 20, 97%nrb genl: mild distress heent: no elevated jvp, op clear with slightly dry membranes cv: rrr +systolic murmur best heard at apex. lungs: crackles at r base, otherwise clear without rhonchi abd: tender over transplanted kidney and in r lq, but soft, no hepatomegaly, +bs ext: 2+ edema to kness bl, 1+ dp pulses pertinent results: 05:55am blood wbc-14.3*# rbc-3.05* hgb-8.5* hct-27.7* mcv-91 mch-27.7 mchc-30.5* rdw-18.6* plt ct-312 07:59pm blood wbc-10.7 rbc-2.83* hgb-7.9* hct-25.8* mcv-91 mch-28.1 mchc-30.8* rdw-18.0* plt ct-242 11:52pm blood hct-28.2* 02:21am blood wbc-13.2* rbc-2.97* hgb-8.4* hct-26.9* mcv-91 mch-28.3 mchc-31.2 rdw-18.4* plt ct-263 03:50am blood wbc-10.1 rbc-2.84* hgb-8.0* hct-25.4* mcv-89 mch-28.2 mchc-31.6 rdw-18.5* plt ct-226 03:13am blood wbc-7.8 rbc-2.82* hgb-7.8* hct-25.1* mcv-89 mch-27.7 mchc-31.2 rdw-18.0* plt ct-221 03:34am blood wbc-8.8 rbc-3.02* hgb-8.3* hct-26.5* mcv-88 mch-27.4 mchc-31.2 rdw-17.8* plt ct-257 05:15am blood wbc-9.8 rbc-3.09* hgb-8.5* hct-27.2* mcv-88 mch-27.7 mchc-31.4 rdw-18.0* plt ct-265 05:20am blood wbc-9.1 rbc-3.07* hgb-8.7* hct-27.1* mcv-88 mch-28.2 mchc-32.0 rdw-18.1* plt ct-301 05:45am blood wbc-8.6 rbc-3.11* hgb-8.8* hct-27.6* mcv-89 mch-28.1 mchc-31.7 rdw-17.8* plt ct-334 06:15am blood wbc-7.1 rbc-3.22* hgb-9.0* hct-28.6* mcv-89 mch-27.8 mchc-31.3 rdw-18.3* plt ct-375 05:30am blood wbc-8.3 rbc-3.40* hgb-9.2* hct-30.5* mcv-90 mch-27.1 mchc-30.3* rdw-18.1* plt ct-456* 04:14am blood glucose-130* urean-42* creat-4.5* na-141 k-4.0 cl-108 hco3-20* angap-17 03:13am blood glucose-128* urean-44* creat-4.7* na-137 k-3.7 cl-105 hco3-20* angap-16 03:50pm blood creat-4.7* na-135 k-3.8 09:45pm blood na-134 k-3.9 02:48am blood glucose-112* urean-46* creat-4.8* na-134 k-3.6 cl-101 hco3-20* angap-17 05:20am blood glucose-213* urean-57* creat-4.9* na-137 k-3.2* cl-103 hco3-26 angap-11 05:45am blood glucose-206* urean-60* creat-4.4* na-139 k-3.4 cl-103 hco3-24 angap-15 brief hospital course: this is a 57 yo f with esrd s/p renal transplant, lymphangioleimeiomatosis, admitted with fever, diarrhea, acute renal failure and metabolic acidosis. the patient was sent to the medical intensive care unit from the emergency department because of increased oxygen requirement. . her micu course was notable for an ongoing ag and non-ag acidosis attributed to the combination of renal failure/ketosis and diarrhea, which has since improved with hd x 1, lessening diarrhea, bicarb, and lasix. she also had an ongoing respiratory acidosis from hypercarbia, likely underlying poor lung reserve and fatigue. she required bipap several times during her course for ventilation assistance. intubation was considered at several points, but was not required. id and renal were involved in the care of this patient. ct studies of the abdomen were unremarkable for an infectious source. blood, urine cultures were negative while patient was in the micu. stool cultures were also negative. the patient was continued empirically on levo/flagyl for a presumed gi source, given diarrhea. urine legionella was negative. cmv and ebv were checked given immunosuppression, but were negative. her course was also notable for a fluid overload state given evidence of pulmonary edema on cxr and exam, requiring agressive diuresis with lasix gtt and iv chlorothiazide. after her diarrhea, fever, arf and metabolic acidosis improved, she was transferred to medicine floor for further care with a 5.5 l oxygen requirement. 1. fever - resolved after transfer to the medical service. blood cultures from subsequently grew coag negative staph (sensitivities pending) from the central line site. the central line was d/c'd and the patient was started on vancomycin empirically (1 gram dosed for daily levels<15). surveillance cultures remained negative, patient remained stable without a fever or white count. the positive cultures may be contamination, but it is unclear. she was treated with 5 days of iv vancomycin and transitioned to oral therapy with doxycycline for a further 8 days on discharge. her urine on also grew out <10,000 enterococcus senstive to iv vanc and iv ampicillin. although this is not a true uti as it is less than <10,000 and her u/a was sterile, it was decided to treat with vanc as she is a renal transplant patient. given her cri, she should be dosed 750 mg/qd and have levels checked in days to ensure therapeutic levels - done for 5 days as above, and no evidence uti on d/c. her initial fever on presentation was attributed to a gi source, give negative blood, urine, and stools cx. she was treated with levofloxacin and flagyl empirically for 14 days. cmv negative. . 2. hypoxia - required 6 l -> nrb on admission from her baseline of 2 l nc. this was all most likely lymphangioleimeimatosis combined with fluid overload; no sign of pneumonia on cxr. with diuresis, her pulmonary edema removed and her oxygenation status returned to baseline of 2 l nc. she shoudl continue aggressive pulmonary toilet to improve her lung function as much as possible. on d/c to rehab she was subjectively near her baseline, but allowed to remain on 3l since she is not at risk for oxygen toxicity at that level . 3. esrd s/p transplant with arf - likely intrinsic process as fena of 1.21% and feurea = 47.8; no evidence of obstruction on u/s; creatinine stable at 4.0 - cont immunosuppressants for now - restrict phosphate and potassium intake - may require hd in the future, patient refusing currently; transplant renal followed during course - need to follow renal function carefully as pt may require hd in the near future . 4. niddm - initially on a hiss during her course, added nph due to elevated bs on a hiss. currently suguars controlled with 12 u nph in am, 6 u nph at dinner, and hiss. continued diabetic diet with fs qachs. . 5. htn - continued norvasc and metoprolol, bp well controlled . 6. f/e/n - the patient was placed on a diabetic, low sodium diet. she was restricted to < 1.5l/day fluid intake, 1 gram phosphate as patient was hyperphosphatemic on admission, and 2grams of potassium daily. nutritional status should be carefully monitored. medications on admission: meds (at home) - crestor 5 mg qd alendronate qw bactrim 3 x per wk prednisone 5 mg qd metoprolol 100 regular insulin sliding scale plus 70/30, iron norvasc 10 mg qd cellcept 1 g calcitriol 0.5 mcg qd procrit was on prgraf previously but pt says not anymore. . meds (on transfer) - tylenol prn albuterol prn amlodipine 10 mg qd calcitriol 0.25 mcg qd chlorothiazide 500 mg iv bid levoflox 250 mg iv q48 ativan prn metoprolol 100 mg tid flagyl 500 mg tid cellcept mg iv bid protonix 40 mg iv qd lasix gtt hep sc riss labetolol gtt prednisone 5 mg qd bactrim ss 3x/week discharge medications: 1. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 2. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 3. furosemide 40 mg tablet sig: 1.5 tablets po bid (2 times a day). 4. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 5. mycophenolate mofetil 500 mg tablet sig: two (2) tablet po bid (2 times a day). 6. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 7. ferrous sulfate 325 (65) mg tablet sig: 325mg tablets po once a day. disp:*30 tablet(s)* refills:*2* 8. epoetin alfa 10,000 unit/ml solution sig: 10,000 units injection qmowefr (monday -wednesday-friday). 9. calcium carbonate 500 mg tablet, chewable sig: three (3) tablet, chewable po once a day. disp:*90 tablet, chewable(s)* refills:*2* 10. calcitriol 0.25 mcg capsule sig: 0.25 microgram capsule po daily (daily). 11. insulin please see attached sliding scale sheet 12. doxycycline hyclate 100 mg capsule sig: one (1) capsule po q12h (every 12 hours) for 8 days: do not take within two hours of taking iron or calcium. disp:*16 capsule(s)* refills:*0* 13. colace 100 mg capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*2* discharge disposition: extended care facility: discharge diagnosis: primary: fever, acute renal failure, diarrhea, pulmonary edema . secondary: lam, hypertension, niddm, hcc . discharge condition: afebrile, oxygen saturation 94-100% on 2l nasal cannula, other vital signs stable discharge instructions: -please follow up with dr. in 2 weeks; your appointment has already been set -take all medications as prescribed -please call your doctor or return to the er if you experience fever, increased shortness of breath, or if you have any other symptoms that concern you. followup instructions: provider: , md phone: date/time: 2:40 md procedure: hemodialysis venous catheterization for renal dialysis diagnoses: acidosis other and unspecified noninfectious gastroenteritis and colitis unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified complications of transplanted kidney neoplasm of uncertain behavior of trachea, bronchus, and lung 

Answer: The patient is high likely exposed to