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: aspirin / nsaids attending: chief complaint: nausea, vomiting diarrhea and fever major surgical or invasive procedure: 1. colonoscopy 2. placement of right ij 3. placement of picc history of present illness: 59 year old female 170 days post allogenic bmt for myelodyspasia presents with sudden nausea and vomiting, found to be hypotensive in dr. clinic to 60/p, af with rvr to 150s. ext warm, pt mentating. received hydrocort 100mg. in the ed, bp initally responded to 113/91 after 2l ns. however, pt remained hypotensive after 6l. temp was 101.8. must protocol was activated. started on cefipime & flagyl empirically after blood/urine cx's taken. lactate=1.5. pt started on dopamine and transitioned to levophed. pt converted to nsr spontaneously with stabalization of blood pressure. pressors changed from dopa to levophed in ed. vanco and gent dose given for broader covergage. initial cxr was negative, but repeat cxr on showed lll hazy opacity (effusion vs. pna). ct abd/pelvis showed no acute process; enlarged gb without evidence of cholecystitis. blood, urine and stool cx are negative to date. cmv level pending. in micu, started on stress dose steroids, prednisone held, cellcept held. levophed was weaned off. pt was ruled out for mi. bedside echo without signs of tampanade. . pt is now afebrile. pt has not had any more diarrhea since admission, until this morning, when she had 3 episodes of watery diarrhea. she had had abdominal crampy pain throughout hospitaliziation, which she feels is getting better. no other localizing complaints of cough, dysuria. past medical history: 1. polycythemia with subsequent myelofibrosis s/p non-myelo-ablative allobmt in 2. hx paroxysmal afib in , s/p cardioversion (successful for only 72 hrs), was on amiodarone for some time, is now only on digoxin social history: no tobacco, rare glass of wine with dinner, married and lives with husband on . 3 children all healthy. family history: 4 brothers who were hla matches physical exam: 101.6, 125, 77/28- in clinic on bp = 122/74, cvp = 9, rr =25, sao2 = 100%3l nc p.e. ill appearing, nad pleasant vs: 101.6, 125, heent: dry mmm, jvp, neck: supple lungs: ctab heart: hyperdynamic, irregular abd: soft, diffuse mild tenderness, lower > upper ext: 2+dpp, no demema neuro: grossly inctac skin: multiple non-blanching punctate erythematous rash pertinent results: admission labs: * cbc: wbc-3.5* rbc-4.14* hgb-13.4 hct-37.0 mcv-90 plt 111 * lfts: alt(sgpt)-32 ast(sgot)-18 ld(ldh)-143 alk phos-187* tot bili-1.3 dir bili-0.6 indir bil-0.7 * chem: glucose-115* urea n-17 creat-0.9 sodium-137 potassium-3.2* chloride-101 total co2-27 albumin-3.4 calcium-7.9* magnesium-1.6 * lactate-1.5 * u/a: blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg * admission abdominal ct: 1. no evidence of colitis, or intraabdominal pathology. the appendix is visualized within the right lower quadrant and appears normal. 2. enlarged gallbladder without evidence of acute cholecystitis. 3. ossifications within the spleen consistent with prior granulomatous infection. * admission chest x ray: negative * micro: urine cx: <10,000 organisms blood cx: negative stool cx: negative stool cx: negative stool cx: negative cmv vl: not detected cmv vl: not detected stool cx: no c diff stool cx: no c diff tissue cmv culture pending * ct abdomen/pelvis : 1. unremarkable appearance of the bowel. specifically, no evidence of infectious or ischemic colitis. 2. unchanged appearance of gallbladder distention. this can be an expected finding in a fasting patient. there is no pericholecystic fluid or gallbladder wall edema. please correlate with patient's clinical symptoms. 3. 2-cm aneurysmal dilatation of the splenic artery. * colonoscopy : erythema and granularity in the ascending colon (biopsy). ulcers in the terminal ileum (biopsy). otherwise normal colonoscopy to terminal ileum. . biopsy results: a. terminal ileum biopsy: fragments of granulation tissue with acute and chronic inflammation consistent with ulceration and a fragment of ileal mucosa with reactive and atrophic changes. b. right colon biopsies: colonic mucosa with focal atrophic and reactive changes. c. left colon biopsies: no significant pathology. d. rectal biopsies: no significant pathology. note: the changes are not specific. ulceration may be seen in chronic graft versus host disease but may also be seen in ischemia, infection, inflammatory bowel disease, etc. clinical correlation is needed. an occasional apoptotic cell is seen. immunostains for cmv are negative with appropriate positive control, and no viral inclusions were seen on routine sections. special stains for fungi and afb are negative with appropriate positive controls. brief hospital course: 59 yo woman with pcv s/p mini allo-bmt on , admitted with sepsis now resolved, w/ persistent diarrhea. see hpi for icu course prior to transfer to bmt. a brief problem based course is outlined below. 1. hypotension/sepsis - on transfer to bmt her hypotension had resolved. she had initially presented with hypotensive episode (60's systolic), which resolved after iv fluids, pressors and stress dose steroids in the icu. no clear source was identified, with initial blood cx, urine cx, and cxr all negative. initial lactate was 1.5. a gi source of sepsis was suspected, which could have been predisposed by gut gvhd, through a cytokine mediated event. other potential etiologies were considered including dehydrational state from emesis/diarrhea vs adrenal insufficiency, or a combination of factors. in either case, she subsequently stabilized on broad antibiotics, which were continued on admission to the transplant service. stress dose steroids were stopped, and she was re-started on a gvhd treatment regimen of cellcept and solumedrol as outlined below. she remained hemodynamically stable off pressors, and off stress dose steroids. 2. diarrhea - unclear etiology. the differential included cmv infection, gut gvhd, or other infectious etiology. factors supporting a "late" acute gvhd were her recent skin changes of gvhd and precipitation of diarrhea (>500cc/day) when cellcept and solumedrol were abruptly held in the icu. in addition, symptoms improved following re-initiation of these meds. other infectious etiologies were searched for, including cmv, which was negative by viral load testing. c diff, campylobacter and shigella stool cultures were also negative. ct scan was performed which was negative for intra-abdominal pathology. no evidence for micro-perforation, ischemia, or colitis was seen. the gi service was consulted, and plan was made for potential biopsy if diarrhea continued to evaluate for gvhd vs. cmv. pt's diarrhea improved but then got worse when she began to advance her diet. she therefore underwent colonoscopy as her abdominal pain and diarrhea were persistent and worsening. this showed a nonspecific acute on chronic inflammatory process, particularly in the terminal ileum, which could be consistent with acute on chronic gvhd versus infection versus ibd. of note, ihc for cmv was negative. gi was reconsulted; ursodiol was stopped, as this could induce a bile-acid diarrhea. it was thought that perhaps the inflammation in the terminal ileum was preventing bile acid reabsorption in the enterohepatic circulation, causing diarrhea. pt began to improve somewhat and increased her ambulation, which also seemed to result in improvement of abdominal pain. her diet was advanced, and her abdominal pain got better. pt still had diarrhea on discharge, but stool output was only about 200cc/day. 3. polycythemia s/p allo-bmt - >100 days out. continued with gvhd medications, including solumedrol and cell-cept. she was well-engrafted, with wbc >1500, plt >100k, and stable hematocrit. donor/patient same blood type=o+. pt's solumedrol was ultimately changed to prednisone 20mg po daily, which can be tapered as tolerated as an outpatient. 4. cad - presented wtih lateral changes on ekg with rapid afib. pt was ruled out for mi. remained chest pain free throughout her admission. bedside echo in unit was without tamponade signs. pt had no further cardiac issues after the resolution of her sepsis. 5. atrial fibrillation - presented with afib with rvr in ed in setting of fever, hypovolemia. now in sinus rhythm, with no further issues. 6. fen - pt was begun on tpn as her albumin was in the 2's, and it was thought that she would likely not be able to manage adequate nutrition in the setting of continued abdominal pain and diarrhea. she was discharged on tpn, as well, and she will continue to advance her diet as tolerated. of note, she required calcium and phosphorus repletion to the point that she may need extra infusions of these, as the ca x phos product is greater than what can be given in the tpn solution. pt had picc line placed in r arm in interventional radiology on the day of discharge. 7. code - full medications on admission: prednisone 25 mg po qd cellcept = 500 mg po tid ursodiol 300 mg bactrim mwf protonix ativan ambien acyclovir folic acid benadryl discharge medications: 1. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. acyclovir 200 mg capsule sig: two (2) capsule po q8h (every 8 hours). 3. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po mwf (monday-wednesday-friday). 4. lorazepam 1 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for anxiety. 5. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po tid (3 times a day). 6. oxycodone hcl 5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*20 tablet(s)* refills:*0* 7. zolpidem tartrate 5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed. 8. budesonide 3 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po tid (). disp:*90 capsule, sust. release 24hr(s)* refills:*2* 9. prednisone 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: critical care systems discharge diagnosis: 1. diarrhea 2. graft versus host disease 3. atrial fibrillation with rapid ventricular response in setting of sepsis discharge condition: stable, tolerating po, ambulating discharge instructions: please keep all of your appointments and take all of your medications. if your abdominal pain or diarrhea get worse, please go to the emergency room or call your primary care doctor. followup instructions: provider: , md where: hematology/bmt phone: date/time: 11:30 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified closed [endoscopic] biopsy of large intestine closed [endoscopic] biopsy of rectum diagnoses: unspecified septicemia severe sepsis atrial fibrillation septic shock complications of transplanted bone marrow diarrhea surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation chronic ulcer of other specified sites polycythemia vera ulceration of intestine unspecified myeloid leukemia, without mention of having achieved remission 

Answer: The patient is high likely exposed to