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: sulfa (sulfonamide antibiotics) / vancomycin analogues / gentamicin / ciprofloxacin hcl / cefazolin / benadryl / opioids-morphine & related attending: chief complaint: epistaxis major surgical or invasive procedure: right arm av graft - by dr. history of present illness: 54f w/ hx of esrd s/p renal transplant x 3, pe on coumadin anticoagulation, htn, hep c p/w epistaxis and elevated creatinine. since she has started anticoagulation she has experienced now 3 nosebleeds. 2 of these bleeds were approximately 2 weeks ago and short duration (< 10 min) but today starting at 2pm she experienced a persistent episode of epistaxis refractory to patient's own attempt at direct pressure. on presentation to the ed she was found to have inr elevated to 15.7 and hematocrit decrease of 8 points compared to . she otherwise has been well although she does complain of fatigue over the past several months. she denies any light-headedness, syncope, fever, chills, chest pain, dyspnea, nausea, vomiting, abdominal pain or dysuria. she states her urine output has not decreased acutely over the past several weeks, and in particulary denies any pain over her renal transplant. she does have dark stool, but takes iron. . of note she does complain of pain on the plantar surface of her left foot that is new onset today. she noticed this pain when she woke up this morning and denies any recent traumatic injury. she also describes painful "lumps" along the posterior aspect of her thighs bilaterally. . in the ed, initial vs were: 99.5 75 102/69 16 100% ra. she was given 2 units ffp and vitamin k 10mg iv. renal transplant was contact and will see the patient on during the day. she was t&c for 2 units, but no blood was given in the ed. she was noted as a difficult stick but her portacath was being used for access. . on arrival to the micu, she continued to complain of fatigue, but otherwise felt well. she does have the pain along the plantar surface of her left foot where she has a small hematoma. . review of systems: - negative except as noted in hpi past medical history: past medical & surgical history: 1. end-stage renal disease (due to rpgn, baseline creatinine previously in the 2.1-2.2 range; now since has been between 4.2-5, plans for new access establishment for possible future permanent hd needs; s/p renal transplantation x 3 (two failed transplant attempts), lrrt in (from brother), s/p dcd in and due to chronic allograft nephropathy (biopsy ) 2. hypertension 3. gerd 4. anemia of chronic disease 5. s/p gastric bypass surgery (had prior diabetes mellitus type 2 which was improved by the surgery) 6. hepatitis c (secondary to blood transfusions) 7. sinus bradycardia 8. s/p parathyroidectomy 9. s/p left chronic knee pain (following injury), s/p lumbar sympathetic block to limit pain on at pain clinic 10. neuropathic foot pain (unclear etiology) 11. spina bifida occulta 12. chronic tension headaches 13. fecal and urinary incontinence 14. recurrent urinary tract infections 15. osteopenia 16. s/p ventral hernia repair () - with marlex mesh 17. s/p partial excision of left upper arm av-graft and right upper arm av-graft social history: lives with boyfriend. not currently employed. denies tobacco use or alcohol use; no recreational substance use. family history: father with lung cancer, maternal grandmother with cancer and stroke. siblings with htn and esrd, dm, hypothyroidism. physical exam: general: alert, oriented, no acute distress heent: mmm, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: multiple surgical scars, soft, non-tender, non-distended gu: no foley skin: several small areas of ecchymosis along her legs, plantar surface of foot ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, several small, mobile nodules ttp bilaterally along posterior thigh l foot: ttp along plantar surface w/ small hematoma neuro: grossly intact rectal: noted to be trace heme positive on stool guiac pertinent results: admission labs: 07:45pm blood wbc-9.1 rbc-3.18* hgb-8.5* hct-25.4* mcv-80* mch-26.8* mchc-33.5 rdw-16.3* plt ct-314# 07:45pm blood neuts-90.8* lymphs-7.1* monos-1.9* eos-0.1 baso-0.1 07:45pm blood pt-150 ptt-138.8* inr(pt)-15.7* 07:45pm blood glucose-121* urean-127* creat-8.6*# na-142 k-4.4 cl-105 hco3-12* angap-29* pertinent labs: cxr: impression: no acute cardiopulmonary abnormality. renal us: impression: 1. no hydronephrosis. 2. patent renal vasculature. mildly elevated resistive indices up tp 0.84 slightly increased (previously highest measurement 0.77) c diff toxin screen: feces negative for c.difficile toxin a & b by eia. urine culture : urine culture (preliminary): gram negative rod(s). >100,000 organisms/ml.. proteus mirabilis. 10,000-100,000 organisms/ml.. presumptive identification. discharge labs: brief hospital course: primary reason for hospitalization: 54f w/ hx of renal transplant x 3, recent pe diagnosis on coumadin, htn, hep c presented with epistaxis in setting of supratherapeutic inr, acute on chronic renal failure, admitted to the icu for initial monitoring, experienced recurrent epistaxis on othe floor after re-initiating anticoagulation. . active issues: . # epistaxis/supratherapeutic inr: the patient was found to have epistaxis in setting of elevated inr to 15.7, found to have eight point hematocrit drop, nadir of 19.5. anterior packing was done in the ed and on arrival to the micu, the patient was no longer bleeding. she received ffp and vitamin k in the ed for reversal of her anticoagulation. while in the micu, the patient was transfused 2u prbc with appropriate hematocrit response. her coumadin was held. renal transplant team felt supratherapeutic inr was most likely due to drug interactions (coumadin, sirolimus). the packing was kept in for 4 days, and coumadin was re-started with a heparin bridge on day 3 of packing. clindamycin used for toxic shock syndrome prophylaxis. she experienced recurrent epistaxis about 36 hrs after packing was removed, with inr 2.0 and therapeutic ptt, required 1u prbc transfusion. left nostril was repacked by ent on ; right nare was also noted to have bleeding, though ent was unable to localize, controlled with surgifoam and afrin. there were intermittent maroon-colored stools secondary to epistaxis. on her l nare packing was removed. her hct remained stable and she had no recurrence of epistaxis. on she was started on iv heparin and restarted on coumadin 2mg daily (of note, iv heparin not started to bridge her to coumadin, but rather to monitor whether she would have recurrence of bleeding once anticoagulated). she did well without recurrence of bleeding, and on iv heparin was stopped. on day of discharge her inr was 1.3. she should have her inr monitored very closely after discharge. she will be monitored by the coumadin clinic. . # acute on chronic renal failure: the patient is s/p kidney transplant x3, again with failing graft. most recent creatinine range from 4 to 5 over past several months, elevated to 8.6 on presentation, though returned to baseline during hospitalization. ultrasound showed no hydronephrosis with patent vessels. the patient's spironolactone and lasix were held. she had no signs of uremia or need for urgent dialysis, though she will likely need to re-initiate dialysis in the next two months. transplant surgery placed av graft in rue on . nylon stitches to come out at followup with dr. on . on discharge, her creatinine was stable at 4.5. sirolimus was initially held on admission in setting of potential interaction with warfarin, but was restarted at 2mg daily on floor with appropriate sirolimus level. she was continued on home dose prednisone 5mg daily. she was advised to restart her home lasix dose but to continue holding her spirinolactone due to her risk of hyperkalemia with her worsening renal failure. she is scheduled to follow up with dr. in nephrology clinic. . # pulmonary embolism: ms. has been anticoagulated with coumadin for a pulmonary embolism diagnosed in . anticoagulation was reversed with 2 units of ffp and 10mg of vitamin k due to severe epistaxis as described above. her inr was 1.2 on when coumadin (bridged with iv heparin) was restarted. after recurrent epistaxis episode , she was given another 1u ffp and 2mg po vitamin k. no further bleeding noted, and she was restarted on coumadin on . she was discharged on 2mg coumadin daily (no bridge). her inr was 1.3 on discharge, and she will have her inr monitored closely by the . . # hypocalcemia secondary to hypoparathyroidism after parathyroidectomy in past. her calcitriol was increased from 0.25mcg daily to 0.5mcg daily. she was continued on calcium carbonate supplements. . # left lateral foot pain: small area of ecchymosis w/ hematoma on left lateral surface. patient does not remember any recent trauma, but in setting of elevated inr minor inciting injury could be causative factor. xrays show no fracture. pain was worsened with walking but improved by time of discharge. . # posterior thigh pain w/ painful nodules: on exam small, mobile nodules palpated along bilateral posterior thighs just deep to the subcutaneous tissue. reproducible pain on palpation of these nodules. differential includes lipoma, hematoma, lymphadenopathy. likely lipomas, but will need to be followed for interval changes. as these did not enlarge as an inpatient, their evaluation can likely be deferred to the outpatient setting. . # hypertension: ms. home diltiazem, labetalol, lasix, and spirinolactone were held during her hospitalization. upon transfer to the floor, her blood pressure was controlled with amlodipine 10mg daily. lasix and spironolactone were not restarted as she remained euvolemic. upon discharge she should restart her home lasix dose, but should continue to hold her spirinolactone as it increases her risk of hyperkalemia with her worsening renal failure. . # uti: ms. was discovered to have a grossly positive ua on , cultures grew klebsiella and proteus. she was treated with a 10 day course of ceftriaxone. . chronic issues: # gerd: the patient was continued on home omeprazole. . # chronic pain: per history has bilateral knee pain, some neuropathic foot pain. she was continued on her home oxycodone, lidocaine patch, cyclobenzaprine as needed. . # transitional issues: - medication changes: diltiazem, labetolol, and spirinolactone were discontinued, she was started on amlodipine for blood pressure control, sirolimus was decreased from 2.5mg daily to 2mg daily, calcitriol was increased from 0.25mcg daily to 0.5mcg daily. - she is scheduled to follow up with dr. (transplant surgery) and dr. (nephrology). she is asked to also follow up with her primary care physician 1-2 weeks of discharge. - she was restarted on coumadin 2mg daily on without a bridge. her inr should be monitored every other day for at least the first week. her inr will be monitored by the . - she maintained full code status throughout her hospitalization. medications on admission: - multivitamin - loperamide 2mg tid for loose stools - prednisone 5mg daily - pantoprazole 40mg - labetalol 50mg qam, 100mg qpm - folic acid 1mg daily - lasix 20mg daily - calcitriol 0.25mcg daily - clonazepam 0.5mg qhs prn anxiety - diphenoxylate-atropine 2.5-0.025 mg q6hrs for loose stools - prochlorperazine maleate 5 mg q6hrs for nausea - hydroxyzine hcl 25 mg twice daily for pruritis - acetaminophen 500-1000mg q8hrs for pain - spironolactone 25mg daily - lidocaine 5% (700mg/patch) topically daily - cyclobenzaprine 10 mg tid for pain, muscle spasm - sodium bicarbonate 650mg twice daily - oxycodone 5mg q6hrs for pain - sirolimus 2.5mg daily - warfarin 3mg on monday and saturday, 2mg all other days - calcium carbonate 200 mg calcium qid discharge medications: 1. multivitamin tablet sig: one (1) tablet po once a day. 2. loperamide 2 mg capsule sig: two (2) capsule po tid (3 times a day) as needed for loose stool. 3. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 5. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 6. folic acid 1 mg tablet sig: one (1) tablet po once a day. 7. clonazepam 0.5 mg tablet sig: one (1) tablet po at bedtime as needed for anxiety. 8. diphenoxylate-atropine 2.5-0.025 mg tablet sig: one (1) tablet po qid (4 times a day). 9. prochlorperazine maleate 5 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 10. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po twice a day as needed for itching. 11. acetaminophen 500 mg tablet sig: 1-2 tablets po three times a day as needed for pain. 12. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 13. cyclobenzaprine 10 mg tablet sig: one (1) tablet po three times a day as needed for pain: cause drowsiness. do not drive or operate machinery while taking. 14. sodium bicarbonate 650 mg tablet sig: one (1) tablet po bid (2 times a day). 15. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 16. sirolimus 1 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 17. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). 18. lasix 20 mg tablet sig: one (1) tablet po once a day. 19. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*0* 20. calcitriol 0.5 mcg capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*0* 21. darbepoetin alfa in polysorbat 40 mcg/0.4 ml syringe sig: one (1) injection injection q3 weeks. 22. amlodipine 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: nosebleed (epistaxis) recent pulmonary embolism hypertension chronic kidney disease stage 5 hepatitis c osteopenia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the hospital because you were having a lot of bleeding from your nose. you received blood transfusions and your nose was packed for a few days to stop the bleeding. you were also given antibiotics for your urinary tract infection. you have been restarted on your coumadin for the blood clot in your lungs. you should have your coumadin levels monitored very closely after you leave the hospital. if you have any signs of bleeding that concern you, please be sure to return to the emergency department. you had an av graft placed by the transplant surgery team while you were here. the nylon stitches will come out at your followup appointment. we made the following changes to your medications while you were in the hospital: -stop labetolol -stop spirinolactone -change sirolomus from 2.5mg daily to 2mg daily -change calcitriol from 0.25mcg daily to 0.5mcg daily -start amlodipine 10mg daily we made no other changes to your medications. please continue taking the rest of your medications as prescribed by your providers. we have scheduled appointments for you to follow up with dr. in the transplant surgery clinic and dr. in the nephrology clinic. we would also like you to see you primary care physician, . , within 1-2 weeks of leaving the hospital. please call to schedule. it was a pleasure taking care of you at and we wish you a speedy recovery. followup instructions: you have the following appointments scheduled at : department: transplant center when: thursday at 1:40 pm with: , md building: lm campus: west best parking: garage department: west clinic when: wednesday at 9:00 am with: , md building: de building ( complex) campus: west best parking: garage department: when: tuesday at 11:20 am with: , md building: campus: east best parking: garage md procedure: arteriovenostomy for renal dialysis control of epistaxis by anterior nasal packing control of epistaxis by anterior nasal packing control of epistaxis by cauterization (and packing) diagnoses: chronic kidney disease, stage v acidosis anemia in chronic kidney disease esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute posthemorrhagic anemia acute kidney failure, unspecified acquired coagulation factor deficiency unspecified viral hepatitis c without hepatic coma mononeuritis of lower limb, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use personal history of venous thrombosis and embolism unspecified accident diarrhea anticoagulants causing adverse effects in therapeutic use glucocorticoid deficiency hyperosmolality and/or hypernatremia surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation complications of transplanted kidney urinary incontinence, unspecified proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site epistaxis disorder of bone and cartilage, unspecified bariatric surgery status hypoparathyroidism arterial embolism and thrombosis of upper extremity chronic pulmonary embolism full incontinence of feces spina bifida occulta contusion of foot chronic glomerulonephritis with lesion of rapidly progressive glomerulonephritis chronic tension type headache 

Answer: The patient is high likely exposed to