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: patient recorded as having no known allergies to drugs attending: chief complaint: acute renal failure major surgical or invasive procedure: none history of present illness: 37 year old female with a past medical history of hepatitis c and etoh cirrhosis on transplant list recently admitted to with confusion and ascites now transferred from osh with acute renal failure and hyperkalemia. most recent labs were done tuesday and she was called last night with the results and went to hospital. she noted 3-4 days ago, she felt nausea (with vomiting while taking lactulose) and llq and epigastric abdominal pain and increasing abd girth, fatigue and decreased po intake. no vomiting. having diarrhea without blood or melena which is at her baseline. also feels mildly sob secondary to ascites. no fever or cough or wheezing. no recent nsaids. she was taking oxycodone with minimal relief at home for pain. she is not feeling confused at all. no change in taste. feeling more fatigued. no dizziness, cp, etc. ros otherwise negative. past medical history: hepatitis c (diagnosed 10 years ago, no antiviral treatment) alcoholic cirrhosis cesarean section depression social history: she contracted her hepatitis c through previous intravenous drug use. she used intravenous drugs including heroin and cocaine for several years and has now been off drugs for 16 years. in addition, she has a history of alcohol excess and previously drank up to a half pint of vodka on a daily basis for a number of years, approximately 10. she gave up drinking 5 years ago but restarted 2 years ago. she is off alcohol now for 6 months. she is enrolled in a relapse prevention program and goes to counseling on several occasions each week. she is single and has 2 children. her mother does most of the caring for the children. she is currently living alone close to her parents. she smokes a 3- 5 cigarettes per day and has done so for 20 years. family history: noncontributory. physical exam: vitals: t 96.6 bp 119/79 p 112 r 18 o2 sat 98% ra general: middle aged female in nad heent: eomi, sclera anicteric, op clear, mm mildly dry neck: supple, no lad, jvp at clavicle cv: rr, tacchycardic, 3/6 sem at lusb does not radiate lungs: patient breathing comfortably, ctab abd: +bs, very distended and tense, positive fluid wave, no murphys and no tenderness or guarding, dressing rlq from para last night which was c/d/i ext: no edema neuro: aao x 3, cnii-xii grossly intact, lower and upper extremity strength, sensation intact, no asterixis psych: alert and oriented to person, place and date skin: no rash or jaundice pertinent results: upon admission: wbc-8.6# rbc-3.43* hgb-11.4* hct-31.8* mcv-93 mch-33.1* mchc-35.7* rdw-17.8* plt ct-111* pt-18.6* ptt-37.6* inr(pt)-1.7* glucose-143* urean-91* creat-4.4*# na-117* k-4.4 cl-88* hco3-15* angap-18 alt-67* ast-127* ld(ldh)-164 alkphos-52 totbili-3.0* albumin-3.6 calcium-9.3 phos-9.4*# mg-2.7* tsh-1.9 hbsag-negative hbsab-negative hbcab-negative at discharge: wbc-4.9 rbc-3.10* hgb-8.9* hct-26.7* mcv-86 mch-28.7 mchc-33.3 rdw-16.9* plt ct-312 pt-15.8* ptt-28.2 inr(pt)-1.4* glucose-104 urean-39* creat-1.3* na-138 k-4.4 cl-104 hco3-25 angap-13 alt-24 ast-14 alkphos-112 totbili-0.4 calcium-9.1 phos-4.3 mg-1.6 brief hospital course: 37 year old female admitted with elevated creatinine and worsening ascites. she had previously been discharged post variceal banding about 2 weeks prior. pre-renal etiology vs hrs were considered. treatment for hrs was initiated with ocreotide, midodrine and albumin. nadolol was discontinued. cr peaked at 5.8 and patient became anuric. due to this decline, patient was initiated on hemodialysis. once patient was stabilized on hd. she was evaluated for liver transplant and was accepted on the liver transplant list on . throughout hospitalizaion patient was also followed by renal transplant team, who initially felt that her renal impairment was reversible, however after 3 weeks of hd, patient was listed for dual (liver and kidney) for transplantation. . cirrhosis and worsening liver function due to history etoh and hep c cirrhosis. meld calculated on admission labs as 30, peaked at > 40 and on was 38. pt had mild cognitive slowing and a trace asterexis on admission. she has varices that were banded during last admission. she has had no previous h/o sbp and has large volume ascites. paracentesis at osh showed no sbp. no clear source for exacerbation of liver failure was identified with exception of progressive liver disease. pt. underwent ruq u/s showing 9mm and 5mm lesions consistent w hcc, portal hypertension, patent main portal vein with forward flow. she underwent an egd and had grade iii varices banded on . patient reported sob at rest on admission. she underwent several diagnostic and therapeutic paracenteses including 7l on , 3l on , 5l, therapeutic on 3l, dx/tx 4l on . cx were always negative and ascitic fluid was always high in rbc content: 176k to 1.6m. patient had a likely hcc seen on ct but still within transplant guidelines. patient was hyponatremic, ranging 120s - 130s throughout admission, near her baseline (mid 120s). bilirubin usually elevated after transfusions then nadired at 5-6, similar to previous episodes. patient had intermittent episodes of encephalopathy that were associated with hypotensive episodes and day episodes of fevers. hypotensive episodes were deemed to be due to simultaneous hd sessions and large volume parecenteses as well as on one occasion gib requiring temporary micu admission for monitoring (sbps < 84mmhg). the source of fever could not be identified and patient was temporarily on iv vancomycin and ceftriaxone for empiric sbp and broad spectrum coverage. patient continued to have abdominal distension on exam which improved significantly w/ therapeutic paracenteses. on admission she was noted to have a lll consolidation and as treated with 7 day course of levaquin. subsequent chest xrays showed persistent lower lobe atelectasis. during and , underwent paracentesis, hemodialysis and stayed hospitalized in anticipation of the need for combined liver kidney transplant. on , the patient underwent combined liver and kidney transplant with dr and dr . at the time of surgery she was found to have a large volume of ascites (15 liters of straw-colored clear ascites was removed). she had an enlarged nodular liver and severe portal hypertension. the patient had normal anatomy. the kidney was placed following the liver. she was transferred to the icu in stable condition. immediately post op she had excellent kidney function and the liver function progressed nicely with daily downtrending of lfts. she was transferred to the regular surgical floor on pod4. over the next few days her urine output was noted to drop significantly to around 100 cc daily. renal ultrasound showed an increased ri in the renal artery, no evidence of hydronephrosis. on (pod 7) she had a transplant kidney biopsy with results showing an acute humoral rejection. she had positive c4d staining. plasmapheresis, ivig were intitiated on . she underwent a total of 10 sessions of plasmapheresis ( - ). each session was followed by ivig (10 gms each) and she received atg 100 mg x 6 doses ( - ) as well as a single dose of rituximab on . a repeat biopsy was performed on which was continuing to show some evidence of humoral rejection. she was maintained on hemodialysis following the transplant as recommended by the renal team. her last day of dialysis was on . at this time the urine output was noted to increase daily and she was having outputs of greater then one liter and by her urine output was greater than 2 liters daily. she was managed with daily iv lasix and this continues on discharge. her creatinine stabilized around 1.3 in the post op period, despite the fact that the liver synthetic function was improving daily, she was still having a large volume of ascites that required paracentesis. the last paracentesis was done on . her abdomen remains distended with ascitic fluid. she was also noted to have complaint of chest discomfort and burning. she underwent an egd on which showed diffuse circumferential ulceration with focal hemorrhagic areas in the upper and mid esophagus, a large adherent clot was noted in the mid esophagus and some oozing noted from the base of the clot. she also had some scarring from previous banding with no obvious varices noted. the scope was withdrawn to reduce risk of further bleeding. specimens were not taken at the time of the scope, so she was broadly covered with micafungin (14 days) and gancyclovir which was then converted back to valcyte after symptomatic improvement. she had also been given a short holiday on the antivirals as her white count briefly dipped as low as 1.5, but rebounded once the drug conversions were made. she has returned to fluconazole and the micafungin stopped after 14 days therapy. she is more able to tolerate po's, but still has some discomfort with swallowing, and advancement of diet should be done slowly to allow for additional healing. on , was noted to have fever to 101. all lines were removed including the triple lumen and the dialysis line. cultures were sent showing that the triple lumen catheter was positive for staph coag negative. the dialysis catheter did not show any growth, but the blood cultures obtained at that same time were also positive for staph coag nagative and she was started on vancomycin which will be complete on . post op, she was nutritionally maintained on tpn. a post pyloric feeding tube was placed on and tube feeds started and successfully advanced. a dual lumen power picc placed to provide access once the central lines were removed due to fever, and have been used for tpn and antibiotics. pain management has been an issue for during this hospitalization. she experienced much pain from the esophageal issues as seen on egd and also significant abdominal pain when ascites fluid volumes were high requiring paracentesis. we have increased her methadone dose on to 15 mg tid, and switched her to po dilaudid only with no iv breakthrough recommended. pain issues were followed by the chronic pain service, and in addition she was followed by the transplant social work team as well for ongoing issues with pain management and coping during a long term hospitalization . . medications on admission: 1. quetiapine 100 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 2. quetiapine 25 mg tablet sig: one (1) tablet po tid (3 times a day). 3. mirtazapine 45 mg tablet sig: one (1) tablet po at bedtime. 4. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 5. oxycodone 5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. disp:*20 tablet(s)* refills:*0* 6. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): goal 4 bowel movements/day. hold if >4bm. disp:*2700 ml(s)* refills:*2* 7. stopped taking - sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day) for 10 days. disp:*40 tablet(s)* refills:*0* 8. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 9. stopped taking - nadolol 20 mg tablet sig: one (1) tablet po daily (daily): hold if blood pressure (was not taking for past few days) discharge medications: 1. sertraline 50 mg tablet sig: 0.5 tablet po daily (daily). 2. mycophenolate mofetil 200 mg/ml suspension for reconstitution sig: five (5) ml po bid (2 times a day). 3. trimethoprim-sulfamethoxazole 40-200 mg/5 ml suspension sig: ten (10) ml po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. valganciclovir 450 mg tablet sig: one (1) tablet po daily (daily). 6. fluconazole 40 mg/ml suspension for reconstitution sig: ten (10) ml po q24h (every 24 hours). 7. triamcinolone acetonide 0.025 % ointment sig: one (1) appl topical tid (3 times a day). 8. prednisone 5 mg/ml concentrate sig: three (3) ml po daily (daily). 9. hydromorphone 2 mg tablet sig: two (2) tablet po q3h (every 3 hours) as needed. 10. methadone 10 mg/5 ml solution sig: 7.5 ml po tid (3 times a day): 15 mg tid. 11. ondansetron hcl (pf) 4 mg/2 ml solution sig: two (2) ml injection q8h (every 8 hours) as needed for nausea/vomiting. 12. heparin lock flush (porcine) 10 unit/ml solution sig: two (2) ml intravenous prn (as needed) as needed for line flush. 13. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gram intravenous q 24h (every 24 hours): through . via picc line. 14. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). 15. tacrolimus 1 mg capsule sig: four (4) capsule po twice a day: check daily prograf levels until further notice. 16. lasix 40 mg tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: -decompensation of liver failure, hepatorenal syndrome, hyperkalemia, anemia, hyponatremia, pneumonia, cirrhosis, hepatitis c, esophageal varices now s/p combined liver kidney transplant -humoral rejection of kidney (treated) discharge condition: stable/fair discharge instructions: please call the transplant clinic at for fever > 101, chills, nausea, vomiting, diarrhea, constipation, increased abdominal pain, inabilty to swallow food, fluids or pills. labwork daily until further notice for trough prograf level. chem 10, cbc, ast alt, alk phos, albumin, tbili twice weekly every monday and thursday. results to be faxed to the transplant clinic at shower, no tub baths or swimming no heavy lifting please see pain management recommendations for methadone, po dilaudid followup instructions: , transplant social work date/time: 10:30 , md, phd: date/time: 11:20 , md, phd: date/time: 11:40 md, procedure: venous catheterization, not elsewhere classified hemodialysis percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage closed [percutaneous] [needle] biopsy of kidney closed [percutaneous] [needle] biopsy of kidney other transplant of liver endoscopic excision or destruction of lesion or tissue of esophagus other kidney transplantation other operations on lacrimal gland transplant from cadaver other operations on lacrimal gland transplant from cadaver diagnoses: hyperpotassemia end stage renal disease anemia, unspecified chronic hepatitis c without mention of hepatic coma alcoholic cirrhosis of liver acute kidney failure, unspecified hepatorenal syndrome hyposmolality and/or hyponatremia portal hypertension bacteremia other ascites other specified disorders of stomach and duodenum complications of transplanted kidney other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria esophageal varices without mention of bleeding 

Answer: The patient is high likely exposed to