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: history of present illness: the patient is a 33 year old at another institution. the patient had no immediate postoperative transplant complications there, but prior to admission here, the patient had been diagnosed with ptld (post- transplant lymphoproliferative disorder). the patient is currently off immuno-suppressant medications except for prednisone. following the cessation of immunosuppressant medications, the patient developed acute rejection. the patient's initial fever associated with the rejection subsided when she received treatments for the acute rejection with solu- medrol 500 times four and then her baseline prednisone dose increased to 20 mg per day from 10 mg. the patient was initially discharged home within a week of this admission and was doing relatively well. just prior to admission, the patient developed abdominal pain which was predominantly in the lower back and described as continuous pain in the moderate to severe range. the patient also had some nausea but denied urinary symptoms or diarrhea. the patient also complained of chills and rigor. past medical history: 1. bipolar disorder. 2. end-stage renal disease secondary to lithium toxicity. 3. increased cholesterol. 4. post-transplant lymphoproliferative disorder diagnosed in from a biopsy during a colonoscopy. at that time, the prograf, rapamycin was discontinued but the patient was continued on low dose prednisone. past surgical history: 1. renal transplant 06/. 2. appendectomy. medications: 1. prednisone 20 mg p.o. q. day. 2. depakote 1000/500. 3. zoloft 75 p.o. q. day. 4. atenolol 25 p.o. q. day. 5. norvasc 2.5 p.o. q. day. 6. lamictal 50 mg p.o. q. day. 7. seroquel 125 mg p.o. q. day. 8. lipitor 20 mg p.o. q. day. 9. prevacid 30 mg p.o. q. day. 10. bactrim ss, one. allergies: no known drug allergies. social history: the patient lives with her husband and denies the use of alcohol, tobacco or intravenous drug abuse. physical examination: initial physical, blood pressure 150/84; heart rate 114; respiratory rate 24; temperature maximum 101.6 f. cardiovascular: regular rate and rhythm. lungs are clear to auscultation. abdomen: initially there was tenderness localized over the kidney allograft . central nervous system: no neurological deficits. laboratory: white blood cell count 3,000, hematocrit 18.3 and platelets 80. blood cultures initially were negative. herpes virus 6 antigen was negative. parva b19 was negative. ebv pcr was negative and cmv was negative on . a chest x-ray at that time was negative for pneumonia. her initial chem-7 was 142/4.1, 107/25, 25/1.9, glucose of 164. ast 15, alt 33, and t-bilirubin 0.2. hospital course: the patient was initially started on solu-medrol 500 mg intravenously times three days. hematology/oncology was consulted for the ptld. the patient was transfused two units of blood on for a hematocrit of 15.4. the patient's initial cmv pcr analysis was positive for cmv, for which the patient was started on ganciclovir. on , psychiatry was consulted due to the patient's depressed mood and history of psychiatric disorders. on , the patient continued to have pancytopenia with a white cell count of 1.2 and a hematocrit of 21. the patient also continued to show some signs and symptoms of acute rejection of the graft and on the , the patient had a bun of 11 and a creatinine of 1.6. on the , the patient had the third dose of the patient's rituxan therapy which was started previous to her current admission. during the initial part of the hospital stay, she continued to spike intermittent fevers as high as 103.0 f., on with the infusion of intravenous ig therapy. during the end of and early part of , the patient's bun and creatinine continued to increase. the patient's signs and symptoms were consistent with acute renal failure secondary to rejection. on , it was concluded that the patient was in acute rejection with renal failure. the patient was scheduled for a nephrectomy of the allograft on . just prior to scheduling the nephrectomy, the patient's creatinine and bun had improved and the nephrectomy was put on hold by recommendations from the primary renal medicine service. on ; however, the patient suffered severe acute abdominal pain with generalized tenderness and the patient was brought to the operating room. an extensive discussion was had with the patient's mother, father, and husband regarding the diagnosis and the necessity for surgery, as well as the likely need to remove the transplanted kidney. all of the family's (and patient's) questions were answered and the patient was taken tho the operating room. small bowel perforation was found with frank extravasation of enteric contents. the patient had an exploratory laparotomy and resection of the mid-jejunum with primary anastomosis and an allograft nephrectomy. the patient tolerated the procedure well and was transported to the pacu in stable condition. the wound was also left open and packed due to the bowel perforation. discussion was then had with the family of the high likelihood for serious complications including infection prolonged hospitalization and even death. on , the patient showed signs of peritonitis and sepsis. the patient was brought back to the operating room with the initial diagnosis of perforated small bowel and exploratory laparotomy procedure was performed with primary repair of the small bowel perforation. the previous repair of the intestine was completely intact and a new 1 cm small bowel perforation distal to the previous anastomosis was noted. there was an abundant enteric content in the abdomen and the small bowel perforation was repaired. the patient tolerated the procedure well and was transported to the pacu in stable condition. following the surgery, the patient continued on antibiotics and was treated for her metabolic issues. the patient continued with low platelets and increased inr. following the surgery, the patient continued with hemodialysis on a regular schedule and her treatments for the post-transplant lymphoproliferative disorder. the wound continued to heal by secondary intention with regular dressing changes. the patient, following the surgery, spent a certain amount of time in the sicu and was later transferred to the floor. the infectious disease service continued to follow the patient and continued with their recommendations of gentamycin, fluconazole. over that time, the patient continued to spike intermittently and received multiple blood cultures, urine cultures, and chest x-rays which could not locate a source for the infection. throughout until the end of the time, the patient continued to spike fevers intermittently for which she continued to have multiple cultures and scans. the patient also continued to remain with pancytopenia which was followed by hematology/oncology regarding her diagnosis of lymphoma and the patient continued on hemodialysis. the wound continued to granulate and during that time, did not show signs of infection. there is no gross pus noted on the examination. during the hospitalization, the patient did have a wound culture which was positive for vre and also urinary cultures which were positive for vre which were treated with the appropriate antibiotics. the patient also had a catheter infection of methicillin resistant staphylococcus aureus which was treated with vancomycin for 14 days. in the beginning of , the patient had a repeat cmv pcr and - virus pcr to evaluate for possible viral infections. the cmv pcr was negative and on discharge the ebv pcr was still pending. the patient, in the beginning of , had a ct scan which showed marked improvement of abscesses in the abdomen. at that time, the patient continued on antibiotics, the wet and dry changes, physical therapy. on the 5th the patient continued to spike and at that point had a full work-up for febrile origins in anticipation of discharging the patient to rehabilitation services. the patient's blood cultures were negative. the patient's streptococcal antigen was negative. the patient's urinalysis was negative and urine cultures were negative. the patient's cmv pcr was negative and the patient's - virus pcr is pending right now. the patient's wound was healing nicely with granulation tissue and no signs of frank pus. the porta-cath was also cultured which was negative. an ultrasound was performed of the porta-cath which showed no abnormalities or fluid collections. on , it was decided through the transplant service with the renal, hematology/oncology and infectious disease services that most likely the cause of the intermittent temperature spikes were due to resolving lymphoproliferative disorder. the patient is chronically pancytopenic requiring blood transfusions. the patient will follow-up with hematology/oncology and will most likely require transfusions. on the 10th, hematology/oncology stopped by to evaluate the patient and left several recommendations prior to discharge. discharge physical examination: included a temperature maximum of 100.1 f., temperature current of 97.2 f.; pulse of 88; blood pressure 110/70; respiratory rate 20; o2 94%, p.o. of 600, output bathroom privileges with hemodialysis. in general, in no acute distress, alert and oriented. cardiovascular is regular rate and rhythm. respiratory: clear to auscultation bilaterally. abdomen soft, nontender, nondistended, obese, incision healing with secondary intention; good granulation tissue and no signs of infection. extremities: no peripheral edema with mild swelling. laboratory values were white cells 3.1, hematocrit 16.8, platelets 103,000, pt 12.7, ptt 30.9, inr 1.1. chem-7 is 140/4.2, 104/27, 17/0.6 and a glucose of 81. vancomycin level was 21.9, and valproic acid level was 38. discharge diagnoses: 1. status post allograft nephrectomy. 2. bowel resection for perforation secondary to lymphoproliferative disorder. 3. lymphoproliferative disorder. 4. pancytopenia. 5. bipolar disorder. 6. end-stage renal disease on hemodialysis. 7. hypertension. 8. increased cholesterol. discharge medications: discharge medications include: 1. protonix 40 mg p.o. q. day. 2. dulcolax one per rectum q. day. 3. epogen 10,000 units intravenously at hemodialysis three times a week. 4. nephrocaps times one p.o. q. day. 5. seroquel 25 mg p.o. q. h.s. 6. depakote 500 mg p.o. twice a day. 7. heparin 5000 units subcutaneously twice a day. 8. magnesium oxide 120 mg p.o. q. day. 9. mso4 1 to 2 mg intramuscularly q. three to four hours p.r.n. 10. dilaudid 3 to 4 mg p.o. q. four to six hours p.r.n. 11. tylenol 650 mg p.o. q. four to six hours p.r.n. 12. benadryl 25 mg intravenously q. six hours p.r.n. 13. vancomycin, one gram intravenously times one if the vancomycin level falls below 15. the patient is currently on 12 of 14 doses and will require two more doses of vancomycin before discharging. discharge disposition: stable/good. to rehabilitation services. discharge instructions: 1. the patient will follow-up with dr. in roughly one to two weeks. the patient or rehabilitation services should call the office to schedule an appointment. dr. clinic can be reached through the main number at . 2. the patient should continue on intravenous vancomycin which should be renally dosed. the patient should receive 1 mg intravenously times one if the vancomycin level drops below 15. 3. the patient's wound should be changed three times a day with wet-to-dry's. 4. the patient will require extensive physical therapy and occupational therapy. 5. the patient's calorie counts should also be monitored closely to assure proper nutrition. 6. the patient will also follow-up with hematology/oncology and have a pet scan at the center on , at 07:30. 7. the patient is also scheduled for an endoscopic examination with ultrasounds on , at 11 a.m. at one. the patient should be npo from midnight before the procedure. 8. the patient also should follow-up with dr. in hematology/oncology on , which is a friday, in the building on the . 9. the patient will also require a ct scan of the torso which should be done with intravenous contrast and scheduled with dialysis. 10. the patient should have basic laboratory studies, chem-7, cbc, drawn twice a week to monitor the pancytopenia and chemistries. 11. the patient should also have vancomycin levels checked regularly and to have the vancomycin dosed if the level falls below 15. the hematology/oncology plans were discussed with the patient and husband. the discharge plans and prognoses were also discussed with the patient, husband and father. on , the father agreed with the planned and thought that rehabilitation services was best for mrs. at this time. , md dictated by: medquist36 d: 11:44 t: 12:04 job#: procedure: parenteral infusion of concentrated nutritional substances other partial resection of small intestine removal of transplanted or rejected kidney hemodialysis closed [percutaneous] [needle] biopsy of kidney suture of laceration of small intestine, except duodenum diagnoses: other postoperative infection acute kidney failure, unspecified unspecified septicemia perforation of intestine cytomegaloviral disease complications of transplanted kidney 

Answer: The patient is high likely exposed to