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: service: transplant history of present illness: this is a 49 year-old gentleman with insulin dependent diabetes and end stage renal disease. the patient had been on hemodialysis for two and a half years however is now status post cadaveric renal transplant performed on . the patient presents for a review of systems: the patient denies any nausea, vomiting, fever, chills. he has had normal bowel movements since his cadaveric renal transplant. past surgical history: 1. left av fistula in . past medical history: 1. hypertension. 2. insulin dependent diabetes mellitus. 3. end stage renal disease. allergies: no known drug allergies. medications on admission: 1. prograf 4 mg po bid. 2. prednisone 10 mg po q day. 3. cellcept mg po tid. 4. aspirin 325 mg po q day. 5. nph 22 units q a.m. 6. bactrim one po q day. 7. ganciclovir 500 mg po tid. 8. lopressor 50 mg po bid. 9. paxil 20 mg po q day. 10. pravachol 20 mg po q day. summary of hospital course: mr. had a very long and complicated hospital course. on the day of admission, , he underwent pancreas after kidney transplant. the procedure was performed by dr. assisted by drs. , and . the procedure was performed with a 500 cc blood loss. during the operation the patient received 300 cc of packed red cells. the pancreas transplant was performed with an arterial y graft without any vein extension graft. there was an enteric anastomosis of exocrine secretion. please see previously dictated operative note for more details. mr. the procedure well, was extubated in the operating room and transferred to the post anesthesia care unit in stable condition. from the post anesthesia care unit he was transferred to the intensive care unit. he was in the intensive care unit for monitoring. he was started on immunosuppression therapy including prednisone taper, and zenapax. however, no antithymocyte thymoglobulin was given because of prior reaction with his kidney transplant. rapamune and fk506 were initiated on pod# 3. his initial hospital course was uncomplicated until he was ready for discharge on postoperative day nine. on postoperative day nine he had an episode including fall from standing and an episode of blood pressure in to the 60s with a hematocrit of 21. on he was brought to the operating room once again this time for an exploratory laparotomy. an abdominal hematoma was found which explained his drop in hematocrit. after a long icu course he eventually demonstrated septic physiology which worsened when he thrombosed the allograft approximately 1 week later. this necessitated removal of the allograft pancreas on postoperative day 19. summary of hospital course by organ / system: 1. neuro - neurologically mr. hospital course was relatively uncomplicated. it was noted several times that he complained of some mild confusion at night which was attributed to "sundowning". his mental status resolved during the time. while in the intensive care unit mr. was occasionally on a dilaudid drip for sedation. 2. cardiovascular - initially mr. stay after his first operation in the intensive care unit was for blood pressure control. he was controlled with lopressor, hydralazine and nitro paste. on mr. second trip to the intensive care unit his course was marked by myocardial infarction and cardiac arrest. he necessitated pressure support with multiple pressors. of note it was noted that he had decreased right ventricular function which improved by serial echo during his second stay in the intensive care unit. his left ventricular ejection fraction was 50% on his last echocardiogram. mr. is presently on lopressor both for blood pressure control and for cardio protection. additionally he is on univasc 7.5 mg po q day also for cardiac protection and pressure control. 3. pulmonary - mr. during his cardiac events and septic event demonstrated multi organ system failure, dysfunction physiology. he necessitated mechanical ventilation for an extended period of time in the intensive care unit. he was on the ventilator from the time of his second operation until two weeks after his second operation when he was finally able to be weaned from the ventilator. it was never demonstrated that he suffered from a pneumonia. it was felt that he had an element of ards syndrome. after mr. was weaned from the ventilator, his pulmonary issues remained stable. of note during his episodes of hypotension he was considered a diagnosis of pulmonary embolism was entertained. for this a vq scan was obtained which was read as normal. 4. gastrointestinal - while in the intensive care unit he was started on tube feeds which were designed to meet his caloric needs. eventually mr. mental status improved. we were able to remove the dobbhoff catheter from his nose and feed him. eventually mr. was able to tolerate a regular diet and in fact consumed a sufficient number of calories with his diet. 5. renal - sepsis led to atn of his allograft which over time did resolve. he is discharged with a normal creatinine and a good functioning kidney transplant. 6. hematology- his white count after the second operation dropped to as low as 1.0. hematology was consulted and he was started on intermittent g-csf. obviously this was discontinued once his white count started to rise prior to his third operation. on discharge mr. white count had resolved to normal. his hematocrit was stable. there was also an episode in which mr. platelets dropped down to 30,000. this was shortly after his third operation. a diagnosis of heparin induced thrombocytopenia was obtained however heparin induced hrt antibody was negative. his platelets resolved and were in the 300,000 range on discharge. 7. endocrine - after the removal of mr. allograft pancreatectomy he obviously needed vigorous blood sugar control. while in the intensive care unit he was maintained on an insulin drip. he was able to be weaned from the drip when he was transferred to the patient care floor for the final time. the clinic assisted the surgical team in the management of his blood sugars and he was maintained on a stable regimen of nph and regular insulin at the time of discharge. 8. infectious disease - mr. had multiple infections related to intraperitoneal spillage after thrombosing his allograft, as well as the original septic hematoma episode. during his second trip to the intensive care unit blood cultures were obtained which were positive for peptostreptococcus and corynebacterium. since blood cultures he was started on a regimen of vancomycin and meropenem and was continued on the fluconazole which he was already taking. these antibiotics were continued for a total of 30 days and then discontinued without incident. also mr. peritoneal fluid grew out enterococcus, coag-negative staph aureus, stenotrophomonas. he was already treated with vancymycin and meropenem for these cultures. of note, a urine culture obtained on grew out stenotrophomonas maltophilia. for this asymptomatic bacteria bactrim was changed from single strength to double strength . 9. musculoskeletal - during mr. tenuous stay in the intensive care unit he suffered from systemic hyperperfusion. this including profusion to his legs. he first began having 3+ edema bilaterally, eventually formed which were felt to be due to hyperperfusion. during the course of time in the intensive care unit his toes suffered from perfusion and he developed dry gangrene in his great toe in either foot. vascular surgery was consulted who obtained non-invasive arterial studies as well as magnetic resonance angiogram on lower extremities. he will follow with vascular surgery after discharge to plan an amputation and / or bypass to his lower extremities. discharge condition: stable. discharge diagnosis: 1. status post pancreas after kidney transplant. 2. status post exploratory laparotomy and hematoma evacuation. 3. status post allograft pancreatectomy. 4. status post myocardial infarction. 5. status post sepsis, urinary tract infection, hypoperfusion and gangrene of great toes on both feet. medications on discharge: mr. will be discharged to rehabilitation on: 1. rapamune 5 mg po q day. 2. fk 506 4 mg po bid. 3. prednisone 5 mg po q day. 4. bactrim double strength one tab po bid. 5. valcyte 450 mg po q day. 6. protonix 40 mg po q day. 7. lopressor 50 mg po bid. 8. univasc 7.5 mg po q day. 9. humalog sliding scale. nph 6 units q a.m. and 2 units q p.m. as prescribed by the clinic. 10. paxil 10 mg po q day. 11. ritalin 5 mg po q day. 12. trazodone 25/50 mg po q hs. 13. vitamin c 500 mg po. 14. zinc 220 mg po q day. 15. silver sulfadiazine to both lower extremities . instructions: at rehabilitation mr. will have a wet to dry saline dressing to his abdominal wound which is closing by secondary attention to change twice a day. at least once a day he should hibiclens scrub to cleanse his wound. mr. feet should be in multi podas boots to prevent contractures. should apply silver sulfadiazine cream to the necrotic appearing areas to keep them in dry sterile dressings. follow up: mr. will see dr. of vascular surgery one week after discharge for follow up for planning of amputation of the gangrenous toes. the patient will also follow up with dr. , appointment has already been arranged. , md dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis arterial catheterization reopening of recent laparotomy site pancreatic transplant, not otherwise specified total pancreatectomy diagnoses: acute kidney failure with lesion of tubular necrosis hematoma complicating a procedure hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure defibrination syndrome other specified septicemias diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled kidney replaced by transplant complications of transplanted pancreas 

Answer: The patient is high likely exposed to