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: ceftriaxone attending: chief complaint: fever major surgical or invasive procedure: multiple paracentesis history of present illness: pt is a 59 yo man w/ h/o hep c cirrhosis s/p liver xplant in , w/ chronic rejection (demonstrated on biopsy in ), recurrent hep c on inf and ribavirin, b cell lymphoma, who p/w fevers, abdominal pain, sbp. pt was in usoh until 1 week pta when began feeling fatigued, had n/v approximately 1-2 episodes per day, non-bloody, non-bilious. 3 days pta, pt began to have severe abdominal pain. he also noted increased abd girth, increased le edema, r > l, denied any calf pain. over past 3 days, pt also c/o cough with some sputum production, although difficult to bring up 2/2 abd pain. he also c/o laryngitis starting 3 days ago. ros otherwise negative for brbpr, melena, sob, cp/pressure." . on , the patient saw dr. in clinic, the complained of severe abdomninal pain, was noted to have a fever to 101, and therefore was sent to the ed for further evaluation. . in , pt was noted to be febrile to 102.8, hr 119, bp 104/74, o2 sat 95% on ra, decreased to low 90's on , placed on 2l nc and o2 sat increased to mid-90's. labs notable for wbc 10.7 with 17% bands, t elevated to 20.5 (last t 15 on ), lactate 2.4, inr 1.2 (elevated from 1.0). paracentesis was done that demonstrated 8520 wbc w/ 62% polys, c/w sbp. ct scan report demonstrated no free air, no bowel obstruction, increased ascites, and ?lll pna vs clot in lung vs hepatic vein clot. pt was given levofloxacin 500mg iv x 1, flagyl 500mg iv x 1, morphine. . due to pt's ill-appearance, and severe sbp, he was admitted to micu for further care and monitering. past medical history: 1. hepatitis c (s/p transfusion for bursitis surgery in ' vs. etoh cirrhosis), s/p orthotopic liver transplant on , followed by dr. . post-op complications have been recurrent hepatitis c viremia and development of cholestatic jaundice of uncertain etiology, both occurring four months after liver transplant. 2. b cell lymphoma: nodal marginal zone cd5 positive b-cell lymphoma noted at the time of transplant; bone marrow biopsy performed during hospitalization for pancytopenia and pna in revealed approx. 25% involvement. decision was for no chemo at that time. 3. h/o pna in : pseudomonas and staph. cx positive treated with aztreonam and levofloxacin. 4. headaches: rxn to prograf; was taken off for some time then restarted; ha are throbbing, constant and encompass whole head. responds well to cold compress; refractory to pain medications. 5. iddm 2: diagnosed in , hba1c 5.4 (). 6. arthritis s/p long hospitalization in the 70's. 7. chronic neck pain s/p cervical procedure . 8. r inguinal hernia; unable to operate given recent liver transplant. 9. alpha-1 antitrypsin deficiency - this diagnosis appeared in a prior discharge summary but was denied by the patient. social history: married >30 years. lives with wife and her 10 year old grandson, whom he takes care of. never previously married and never had children of his own. veteran and describes ptsd following 13 months of combat, which he received some counseling for but no formal treatment. he used to work as a custodian in the public schools but is now on disability following a work injury. . pt drank heavily in the past. last drink was >1yr ago, prior to liver transplant. admits to marjuana use and occasional cocaine use in the past. tobacco history, smokes 10 cigarettes daily, reports only taking 2 puffs and then throwing it away; up to one pack daily over the last 45 years. would like to quit, has tried in the past with the patch and been successful for up to 2 weeks. family history: mother died at 76 from lung cancer. father is 85, healthy. brother committed suicide ~10 years ago. two brothers and two sisters alive and healthy. physical exam: vitals - t 100.9/100.9, 102 on at 2pm , hr107 , bp102/58 , rr 14, o2 97% room air general - cachectic, non-toxic, alert, oriented x3 heent - scleral icterus cvs - tachycardic, regular, no noted m/r/g lungs - decreased bs at bases b/l, ?crackles at left base abd - distended, incisional and umbilical hernia noted, reducible, diffuse tenderness, no reboudn or guarding, tap site without focal tenderness, erythema ext - + le edema b/l, r>l--this was noted on admit as well skin - jaundiced neuro - no noted asterixis, oriented x 3 . on discharge, afebrile bp 114/77, hr 85, 97% ra. similar exam. abdomen distended, but soft w/o ttp, rebound, or guarding. pertinent results: on admission: 04:00pm blood wbc-10.7# rbc-3.62* hgb-10.8* hct-30.8* mcv-85 mch-29.9 mchc-35.2* rdw-19.1* plt ct-111* 04:00pm blood pt-13.8* ptt-31.7 inr(pt)-1.2* 04:00pm blood glucose-211* urean-22* creat-0.6 na-137 k-3.3 cl-102 hco3-21* angap-17 03:52am blood caltibc-144* vitb12-greater th folate-18.4 ferritn-247 trf-111* . 04:00pm alt(sgpt)-94* ast(sgot)-109* alk phos-1529* amylase-33 tot -20.5* 04:00pm lipase-27 04:00pm albumin-2.9* . on dishcarge wbc 2.3, hct 22.8, plt 101 na 134, k 3.4, cl 101, bicarb 21, bun 12, cr 0.6 tbili 17.4 ap 960, alt 51, ast 157 rapamycin 8.3 . microbiology: , , blood cx: pending peritoneal fluid cx: gbs, sensitive to levofloxacin sputum: beta strep . imaging: cxr: there is consolidation in the left lower lobe with marked leftward displacement of the mediastinum and elevation of the left hemidiaphragm suggesting complete or almost complete atelectasis of the left lower lobe. there are no other consolidations or masses. there is no sizeable pleural effusion. the heart size is normal. the mediastinal contours are unremarkable. revision of the recent pet/ct and ct abdomen demonstrates intermittent obstruction of the left lower lobe segmental bronchi with subsequent atelectasis. given this intermittent nature of the radiological findings and absence of any endobronchial obstructing lesion on the pet/ct from , , recurrent aspirations are the most likely diagnosis. . ct abdomen and pelvis: impression: 1. increase in abundant ascites. 2. left lower lobe consolidation is likely pneumonia, but pulmonary infarct is a consideration given presence of possible left lower lobe pulmonary embolus. 3. left lower lobe thrombus that is either within the pulmonary arteries or veins. brief hospital course: this is 59 year-old man with hep c cirrhosis s/p liver transplant 10 months ago complicated by recurrent hep c and chronic rejection who presented with abdmonial pain and was found to have severe spontaneous bacterial peritonitis. . due to pt's ill-appearance, and severe sbp, he was admitted to micu for further care and monitering. . while in the micu the patient was started on aztreonam, linezolid, flagyl and levoquin to cover sbp and a possible pneumonia. his antibiotic regimen was changed to vancomycin, levofloxacin, and flagyl when he was found to have group b streptococci growing from peritoneal culture. mr abdominal pain improved rapidly with antibiotic therapy as well as a therapeutic paracentesis. the gbs was found to be sensitive to levoquin and he was eventually transitioned to levoquin monotherapy and was discharged to finish a 14 day course with subsuquent ciprofloxacin sbp prophylaxis. . additionally mr. was briefly hypoxic in the micu (wich resolved). ct scan revealed a question of lll pneumonia versus pulmonary embolus versus atelectasis. the radiologists subsuquent discussions with the primary team indicated that the ct appearance was more consistent with atelectasis and mr. hypoxia resolved without heparin therapy. . mr. is 10 months s/p liver transplant and has both chronic rejection as well as reactivation of his hepatitis c. he was on treatment with interferon and ribavirin for his hepatitis c on admission in addition to his immunosuppressive regimen. he was admitted with an acute rise in his lfts over baseline most likely secondary to his rejection and hcv. his hepatitis c treatment had to be discontinued due to his acute illness, and it was difficult to increase his immunosuppressants to treat rejection due to his reactivation of hepatitis c. he was continued on his home regimen of rapamune, prednisone, and ursidiol. he was not encephalopathic in house and did not require lactulose. . mr also suffered from portal hypertension with resultant chronic ascites and lower extremity edema that were quite symptomatic. his diuretics were originally held in house due to his illness and concern for potentially initiating renal failure in his infected state. he was maintainted on a low sodium diet with one therapeutic paracentesis, which he tolerated. when he clinically improved from an infectious standpoint; lasix 40 and spironolactone 100 were reintroduced without significant renal dysfunction. . mr also received the standard care of a ppi; insulin to treat his diabetes, electrolyte repletion, heparin prophylaxis, nutritional input and physical therapy. . ultimately with regards to his chronic liver failure and difficult to manage ascites the patient initiated conversations with dr. and the hepatology team about his overall prognosis and therapeutic options. because of his ill health and particularly because he was found to have lymphoma in his explanted liver he is not a candidate for a second liver transplant. mr. decided he would prefer to therefore direct the remainder of his medical care to comfort measures. with the palliative care service along with the social workers were very involved in setting up hospice care for the patient at home and he was discharged with that goal in mind. . discharge medications: 1. oxycodone 5 mg tablet sig: six (6) tablet po q4h (every 4 hours) as needed. 2. ursodiol 300 mg capsule sig: two (2) capsule po bid (2 times a day). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 5. oxycodone 40 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po q12h (every 12 hours). 6. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. sirolimus 1 mg tablet sig: three (3) tablet po daily (daily). 8. hydromorphone 4 mg tablet sig: 1-2 tablets po every 4-6 hours as needed: please do not take if oversedated. disp:*40 tablet(s)* refills:*0* 9. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 8 days: last dose to be on . disp:*8 tablet(s)* refills:*0* 10. norfloxacin 400 mg tablet sig: one (1) tablet po once a day: to start on , after you complete the levofloxacin. disp:*30 tablet(s)* refills:*2* 11. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 12. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: vna of -east & visiting nurse hospice discharge diagnosis: 1. spontaneous bacterial peritonitis 2. hepatitis c s/p liver transplant 3. chronic liver rejection 4. lymphoma discharge condition: fair. afebrile, vss discharge instructions: you were admitted to the hospital with an infection in your abdomen, you will need to complete a 14-day course of levofloxacin for this, and afterwards you will need to be on a medicine called norfloxacin daily to prevent further infections. you should seek medical attention if you develop fevers, chills, or worsening abdominal pain because this may be a sign that your infection has returned. . to treat your ascites and leg swelling we have started you on lasix 40mg daily and spironolactone 100mg daily. . we are also asking that hospice be involved in your care and they will help you manage things like your pain, encephalopathy, and other comfort measures. followup instructions: provider: , md phone:. thursday ; dr office should contact you with an appoinment time. procedure: percutaneous abdominal drainage injection or infusion of oxazolidinone class of antibiotics diagnoses: tobacco use disorder diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled portal hypertension personal history of other infectious and parasitic diseases pulmonary collapse other malignant lymphomas, unspecified site, extranodal and solid organ sites complications of transplanted liver other specified antibiotics causing adverse effects in therapeutic use spontaneous bacterial peritonitis inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent) streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group b alpha-1-antitrypsin deficiency family history of malignant neoplasm of trachea, bronchus, and lung 

Answer: The patient is high likely exposed to