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: found unresponsive major surgical or invasive procedure: endotracheal intubation, ng tube placement history of present illness: hpi:62 y/o esrd s/p renal transplant, cad s/p cabg, and dm s/p multiple episodes of "diabetic coma," who is transferred from an osh, where he initially presented after being found unresponsive at home. his wife last saw pt well 6am--hours prior to presentation. she called home at 9:30am, & pt reported to be feeling well and was going for a drive. his sister stopped by at noon, became worried to see his car in the driveway and called police. the pt was found unresponsive in chair in front of the tv snoring loudly. there was a klonipin bottle close by the patient. bg in field normal. pt was responsive to only sternal from. there is an ill-defined report of arm shaking. . pt first presented to hosptial, where he was intubated for airway protection. blood cultures taken. got etomidate, pavulon, succinylcholine, versed 2.5, solumedrol 60 iv, ceftriaxone 2 gm. dilatin 500mg iv, bg on arrival 181. intubated. critcal care consult suggested loading with dilantin and transfer to for eeg. question of shaking activity on verbal sign out, no documentation of this in record sent with patient. . since , the patient has had medical problems. during the week prior to the patient was found outside of mall in hypoglycemic coma (his 4th episode in the last year) after taking insulin and hospitalized in . he was dischanged 3 days later. he represented days later to with a pna and uti. per family pt has been slowly regaining his strength since that hospitalization. he was discharged on augmentin and switched to amoxiciilin after developing diarrhea over the last 2 weeks. at worst, he was having bm daily, on day pta. . in the days pta, pt was oriented x3 but often fatigued and falling asleep. family reporst chills worsening over the last few days but no fever. positive ha. no known cp, sob< cought, abd pain, n/v. no focal weakness. . on arrival to ed, t 97, bp 179/69, hr 58, r 14, 100% on ra. received vanco 1gm, ceftriaxone 2g iv, hydral 10 iv past medical history: pmhx: chronic renal failure due to diabetic nephropathy s/p kidney transplant brittle dm on insulin w/ multiple episodes of hypoglycemia cad s/p cabg - stress without evidence of ischemia by report pud htn hyperlipidemia b aortoilliac bybass ex lap and aka amputation during after gunshot with phantom limb pain osteomylitis of l hip h/o kidney stone mva s/p splenectomy diabetic retinopathy bilateral carotid stenosis s/p cervical fusion anxiety with ptsd h/o colitis in s/p colonoscopy w/ ileitis/colitis, ? crohns vs microscopic colitis social history: lives in house with wife and son. retired veteran counselor. able to do adls without dificulty. distant 15-20 pack/yr smoking hitory. no alcohol use. no illicit drug use. per wife, pt would only take 0.5 to 1 klonopin pill infrequently, was not on pain meds. takes tylenol once every feww days. family history: fh: mother ovarian can, father, brain ca, dm in brothers. physical exam: pe: t:94.2 bp:120/59 hr:59 rr:17 o2 100% on cmv 40%/600/12/5 gen: intubated and sedated, withdrawing to painful stimuli (r > l) heent: no conjunctival pallor. perrla, no icterus. mmm. op clear. neck: supple, no jvd. cv: rrr. nl s1, s2. 2/6 sem, no rubs or . well healed cabg lungs: ctab, good bs bl, no w/r/c abd: soft well healed large midline abd scar, nt, nd. nl bs. no hsm ext: wwp, no cce. aka amb on left. large scar over left hip 2+ dp on r skin: fungal rash in left groin genital: tight but distentable r inguinal hernia. neuro: unresponsive to voice, withdraws to pain r > l. 2+ reflexes, equal bl. tone normal pertinent results: 06:50pm wbc-8.0# rbc-3.50* hgb-11.7* hct-35.1*# mcv-100* mch-33.4* mchc-33.4 rdw-16.5* 06:50pm urine bnzodzpn-pos barbitrt-neg opiates-pos cocaine-neg amphetmn-neg mthdone-neg 06:50pm asa-neg ethanol-neg acetmnphn-46.9* bnzodzpn-neg barbitrt-neg tricyclic-neg 06:50pm tacrofk-5.6 06:50pm ctropnt-0.03* 06:50pm lipase-55 06:50pm alt(sgpt)-28 ast(sgot)-44* alk phos-153* tot bili-0.8 06:50pm glucose-180* urea n-42* creat-2.0* sodium-135 potassium-5.3* chloride-100 total co2-25 anion gap-15 07:36pm type-art po2-501* pco2-34* ph-7.46* total co2-25 09:11pm lactate-1.1 1:17 am csf;spinal fluid source: lp. gram stain: no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture: no growth. 01:17am cerebrospinal fluid (csf) wbc-0 rbc-22* polys-2 lymphs-49 monos-49 01:17am cerebrospinal fluid (csf) wbc-2 rbc-1011* polys-80 lymphs-9 monos-11 totprot-77* glucose-117 discharge labs: 11:38am blood wbc-7.3 rbc-3.57* hgb-12.2* hct-35.0* mcv-98 mch-34.2* mchc-34.9 rdw-16.5* plt ct-348 06:35am blood glucose-123* urean-40* creat-1.8* na-136 k-4.7 cl-101 hco3-26 angap-14 06:35am blood alt-52* ast-45* ld(ldh)-486* alkphos-219* totbili-0.5 06:35am blood calcium-9.3 phos-3.9 mg-2.0 05:07am blood cea-2.0 afp-<1.0 06:35am blood tacrofk-5.2 . . echo: the left atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). however, the interventricular septum was suboptimally visualized - hypokinesis of this wall cannot be excluded with certainty. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . mri/mra: 1. small focus of abnoraml diffusion signal intensity in the subcortical white matter of the left cerebral hemisphere lateral to the body of the corpus callosum without corresponding signal abnormality in the adc map. these findings may represent a subacute or late ischemic vent. 2. two-third stenosis involving the proximal right internal carotid artery. the severity of the stenosis is not constant and was measured using the best plane possible, however, it may be underestimated. if clinically indicated, a cta may be helpful for further characterization. 3. small air-fluid level in the right maxillary sinus. . ct abd/pelvis: 1. large hypoattenuating liver mass and two smaller hypoattenuating liver lesions are incompletely characterized on this non-contrast study. for further evaluation in this patient with rising creatinine and renal transplant, ultrasound is recommended for further evaluation. 2. soft tissue mass seen anterior to the calcified splenic artery is continuous with the pancreatic tail and the gastric wall. findings are concerning for either a gastric mass or a pancreatic mass with extension into the stomach wall. 3. status post right pelvic renal transplantation. 4. extensive vascular calcifications. vascular stent in the right external iliac artery, the patency of which cannot be evaluated on this non-enhanced study. 5. small bilateral pleural effusions with dependent atelectasis. 6. status post cabg. . us abd: : multiple nonspecific hypoechoic liver lesions concerning for malignant process. pancreatic lesion not imaged due to overlying bowel gas. brief hospital course: this is a 62 y/o with multiple prior episodes of altered ms due to hypoglycemia, cad, esrd s/p transplant who presents with unexplained, acute change in mental status. . # altered mental status: etiology unclear, pt found at home unresponsive. at the time, his fsbs was within normal limits. broad workup undertaken. there was no clear evidence for infection: cxr was clear, neg ua, blood cultures were without growth. csf negative, cultures negative, as well as crypto antigen in csf, hsv pcr and jcv pcr. toxic-metabolic evaluation notable for tox screen positive for opiates and tylenol (level in 40s). pt treated with nac for possible tylenol od, though lfts were never significantly elevated. despite report of klonipin bottle at patient's side when he was found down, there were no benzos in his tox screen. once ms cleared, pt reported having no clear recollection of the events prior to his loc. however, he denied suicidal thoughts and feelings of depression. neurologic evaluation for his mental status changes included an mri/ mra, which showed no obvious cva, though there was a small focus of abnormal diffusion signal intensity in the subcortical white matter. neurology was consulted and did not believe these findings to be causing encephalopathy. imaging also showed ica & verterbral stenosis, both of which were thought to be unlikely related to his presentation. there was a question of the patient having seizure activity at the osh, and thus he was dilantin loaded there. as above, his lp was negative, cultures no growth. eeg at showed encephalopathy but no seizure activity. the patient's mental status gradually cleared, and eventually returned to baseline. no clear cause for his ms changes was ever found. . # fever: new onset cxr showed possible retrocardiac opacity and now on vent for > 48 hrs. ua negative. blood and urine cult drawn, remain negative. sputum cult growing only op flora. was cover for vap with vanc and cefepime, however d/ced on . . # liver masses: the patient was found to have 3 masses in the liver and one contiguous w/ panc tail and gastric wall on an abdominal ct done as part of evaluation of mental status changes. concern for lymphoma given ldh and renal transplant on immunosuppressive. ir was consulted for biopsy of the lesion(s). they requested that the patient be off of asa for a full 5 days. the patient was scheduled for an outpatient biopsy on . . #dm: history of 4 hypoglycemic episodes leading to "coma" according to family. bg ok on all hosptial records. possible having prolonged ms change in setting of hypoglycemia. however bg elevated on presentation. bg now stable on current dosing regimen. no documented hypoglycemia. . #esrd s/p transplant: cr 2.0 at baseline. continued prograf, azthioprin, prednisone. . #cad: s/p cabg, per family recent cath at . statin held due in setting of possible tylenol od/slightly elevated lfts. ekg showed improved conduction delay compared to ekg on admission pointing towards ingestion. . # htn: continue clonidine, lasix. increased coreg to 25 medications on admission: aspirin 81 mg daily lasix 20 mg daily carvedilol 12.5 mg prograf 0.5 mg azathioprine 50 mg daily protonix 40 mg daily prednisone 2.5 mg daily lipitor 40 mg qhs bactrim ds three times per week clonidine 0.1 mg lyrica 75 mg tid lantus 24 u qhs novolog sliding scale 61-100 no units, 101-150 4 units, 151-200 6 units, 201-250 8 u, 251-300 10 u, 301-350 12 u, 351-400 14 u, > 400 16 u clonazepam 1 mg prn anxiety discharge medications: 1. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 2. azathioprine 50 mg tablet sig: one (1) tablet po daily (daily). 3. tacrolimus 0.5 mg capsule sig: one (1) capsule po q12h (every 12 hours): a.k.a prograf. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. prednisone 2.5 mg tablet sig: one (1) tablet po daily (daily). 6. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po mwf (monday-wednesday-friday). 7. clonidine 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 8. clonazepam 1 mg tablet sig: one (1) tablet po once a day as needed. 9. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day) as needed for groin rash: apply to groin as needed for rash. . disp:*1 tube* refills:*0* 10. insulin lantus 24 units every evening. novolog sliding scale 71-200 mg/dl 0 units 201-250 mg/dl 2 units 251-300 mg/dl 4 units 301-350 mg/dl 6 units 351-400 mg/dl 8 units 11. carvedilol 25 mg tablet sig: one (1) tablet po twice a day: hold if feeling light-headed. disp:*60 tablet(s)* refills:*1* 12. novolog 100 unit/ml solution sig: per sliding scale subcutaneous with meals and at bedtime: see sliding scale. discharge disposition: home discharge diagnosis: altered mental status - unknown etiology liver biopsy diabetes end-stage renal disease s/p transplant cad discharge condition: good, ambulating, stable vitals. discharge instructions: you were admitted for altered mental status of unclear source. you had a ct abdomen which demonstrated liver masses which will be biopsed on wednesday . it is very important you attend this appointment, see instructions below. . we have made the following changes to your medication: 1) increased carvedilol to 25 mg twice a day 2) stopped your lipitor, please have your liver function tested before re-starting this medication 3) started nystatin cream for your groin skin infection. continue to use this until the rash resolves. 4) decreased your novolog sliding scale - follow the sliding scale on your medication list print out. 5) your aspirin was stopped for the liver biopsy. the doctors who the procedure will tell you when you can restart this. . please attend the following appointments: 1) liver biopsy: 10:15a west interventional/prostate us cc clinical center, . arrive at 8:45 am daycare unit, 1, building - ask for directions at entrance. nothing per mouth at midnight the night before. no aspirin, tylenol, ibuprofen before hand. 2) , md phone: date/time:01/27/0 8:20 3) , md phone: date/time: 9:10 . return to the er or call your doctor if you experience fever, chills, dizziness, nausea, vomiting or any other concerning symptoms. followup instructions: provider: west interventional/prostate us radiology phone: date/time: 10:15 provider: , md phone: date/time: 8:20 provider: , md phone: date/time: 9:10 md procedure: spinal tap incision of lung diagnoses: unspecified essential hypertension long-term (current) use of steroids aortocoronary bypass status occlusion and stenosis of vertebral artery without mention of cerebral infarction diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia anxiety state, unspecified long-term (current) use of insulin altered mental status diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy unspecified disorder of liver kidney replaced by transplant above knee amputation status peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction arthrodesis status unspecified disease of pancreas orthostatic hypotension inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent) dermatophytosis of groin and perianal area posttraumatic stress disorder occlusion and stenosis of basilar artery without mention of cerebral infarction 

Answer: The patient is high likely exposed to