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: iodine / heparin agents attending: chief complaint: admitted from rehab with worsening renal failure major surgical or invasive procedure: tunneled hd cath placed by ir on liver and kidney transplant post pyloric feeding tube, later d/c'd history of present illness: 60 y.o. m with diabetes, etoh-induced cirrhosis, portal hypertension with esophageal varices, listed for combined liver-kidney transplant, encephalopathic at baseline, most recently admitted for edema, now re-admitted from clinic with worsening renal failure in the setting of continuing diuresis with 80 po lasix and 25 po spironolactone daily. per progress note, patient also had labile blood sugars, and has developed c diff colitis being treated with po vancomycin. . on interview, patient says he is very tired. he says he has been feeling better after discharge until about 6 days ago when he developed severe diarrhea. he says he has been sleeping poorly because of multiple night time stools. he also reports that while he initially felt that the swelling in his legs and abdomen was improving, that over the past few days he feels like his abdominal swelling has returned. denies sob, abd pain, or fevers. his previous l-sided leg pain of unknown etiology has improved. he got up for a brief walk with pt x 1, and has otherwise been bedbound. past medical history: -alcoholic cirrhosis -diabetes -hypertension -mild pulmonary artery hypertension -cri (baseline cr. 2.0 up to 2.4) -vitamin b12 deficiency -rectal adenoma -herniated lumbar disk -gastritis -hyperkalemia social history: - pt lives at rehab, previously lived alone at with the support of his sons. has 9 siblings. previous occupation was working in maintenance at a school. he has had occupational exposure to benzene working on ships. - quit smoking tob 16years ago, smoked 2ppd x 25years. - denies current etoh use x11 years, used to drink 1pint etoh daily x25years, started drinking at age 12. family history: -f: committed suicide at age 34 -m: colon ca, doing well physical exam: vs: 96.2 110/62 92 16 94% on ra general: elderly man in nad, lying in bed, appears sleepy but easy to arouse, speaking in full sentences heent: eomi, mmm, op clear, sclera slightly icteric heart: rrr, 2/6 systolic murmur heard throughout the precordium chest: cta b/l, no w/r/r abd: firm, distended, + bs, no fluid wave, nontender on palpation. ext: + 3 edema to hips bl. skin overlying both lower extremities is dry and cracked with several healing ulcers. pulses are 1+ bilaterally, skin dry with multiple healing ulcers. neuro: cn ii-xii grossly intact. speech clear. mild asterixis. moving all extremities without difficulty. mental status, alert and oriented x 3. pertinent results: on admission: glucose-244* urea n-136* creat-4.6*# sodium-133 potassium-5.1 chloride-101 total co2-18* anion gap-19 wbc-9.1 rbc-3.05* hgb-10.4* hct-31.0* mcv-102* mch-34.0* mchc-33.4 rdw-18.2* plt count-81* pt-15.7* ptt-40.0* inr(pt)-1.4* albumin-2.4* calcium-8.1* phosphate-7.4*# magnesium-2.6 alt(sgpt)-38 ast(sgot)-40 ld(ldh)-201 alk phos-312* tot bili-2.0* on discharge: glucose-145* urean-22* creat-0.7 na-136 k-4.9 cl-105 hco3-24 angap-12 wbc-9.6 rbc-3.69* hgb-11.6* hct-33.6* mcv-91 mch-31.3 mchc-34.5 rdw-20.2* plt ct-111* pt-14.5* ptt-33.8 inr(pt)-1.3* alt-38 ast-19 alkphos-135* totbili-1.3 albumin-2.9* calcium-8.1* phos-1.8* mg-1.4* 04:40am blood wbc-7.7 rbc-3.62* hgb-11.8* hct-32.9* mcv-91 mch-32.5* mchc-35.9* rdw-20.8* plt ct-96* 02:45am blood neuts-84.8* lymphs-11.6* monos-2.4 eos-0.9 baso-0.3 02:45am blood anisocy-2+ macrocy-2+ 04:40am blood plt smr-low plt ct-96* 04:45pm blood k-6.9* 04:40am blood glucose-165* urean-39* creat-1.1 na-137 k-4.3 cl-105 hco3-24 angap-12 07:15am blood estgfr-using this 04:40am blood alt-18 ast-20 alkphos-113 totbili-1.0 12:25am blood alt-261* ast-346* alkphos-91 amylase-23 totbili-5.3* dirbili-3.8* indbili-1.5 04:40am blood calcium-8.6 phos-2.7 mg-1.5* 04:06am blood vitb12-1702* 05:30am blood %hba1c-6.9* -done -done 02:40pm blood osmolal-288 11:51am blood osmolal-342* 01:48pm blood tsh-2.8 01:48pm blood t4-5.7 t3-82 04:45pm blood pth-68* 01:48pm blood cortsol-16.4 04:20pm blood hbsag-negative hbsab-positive hbcab-negative 06:00pm blood hbsab-positive hbcab-negative 04:40am blood fk506-9.3 04:20pm blood hcv ab-negative 06:00pm blood hcv ab-negative 11:15am blood renin-test brief hospital course: presented with baseline cr of 1.6-1.8 . worsening renal failure made him more resistant to his diuretics, leading to re-accumulation of his ascites. - abdominal u/s showed moderate-to-large amount of ascites. there was no evidence of sbp on tap. patient was encephalopathic at baseline and he continued on lactulose and rifaximin. urine cx + for e coli completed 7 days of cipro on . he started on hd and c/o cp when on dialysis. ekg without significant st-t changes. underwent persantine mibi which did not show any e/o ischemia, no abnormality was noted. tube feeds were given. he experienced hyperglycemia and insulin was adjusted by . on he was taken to the or by drs. and for liver and kidney transplant from a 16 y.o. brain dead donor involved in mvc. of note, he is hit + therefore, heparin was not used. the portal vein was found to be small but otherwise normal in appearance. the liver was reperfused after the portal vein had been freed of any clot but reperfused somewhat sluggishly. after the arterial anastomosis, the liver pinked up appropriately. please see op report for further details. two drains were placed; the medial drain under the biliary anastomosis and the lateral drain at the suprahepatic cava. a jp drain was placed near the renal transplant. on pod 1,fluid boluses, blood products and albumin were given for hypotension. he was extubated. on he spiked a temp to 102.2. he was coughing and raising thick yellow sputum. there was concern for aspiration pneumonia. wbc was 4.1. a cxr revealed lll collapse. nebs were given. o2 sats were in high 90's and abg's were good. periop iv vanco and levo were continued and flagyl was added. an insulin gtt was initially used for hyperglycemia then glargine was started. glucoses improved. a u/a had rbc>50, wbc 20-50 and no epi's. a urine cx subsequently was positive for 10-100,000 col of e.coli. flagyl and levo were changed to meropenum. meropenum was given for a 7 day course. on pod 2 he appeared tremulous, confused and at times appeared to be hallucinating. an u/s revealed normal doppler evaluation of transplanted liver, but the left hepatic vein was not assessed. creatinine and lfts trended down. he was started on prograf. on a head ct was done for confusion and tremors. this showed no acute intracranial hemorrhage or mass effect. neurology was consulted and recommended toxic metabolic and infectious workup including an mri as well as avoidance of dopamine blocking agents. mri was not done due to significant tremors. there was concern for leukoencephalopathy from prograf although prograf levels were low at 4.9. the left femoral hd line was removed. a post pyloric feeding tube was inserted and feedings were initially held given concern for aspiration. lasix was given for volume excess with good response. creat decreased to 1.6. on pod 4 neuro exam was improved. he required aggressive pulmonary toilet. fluid boluses were given for tachycardia and tube feedings were initiated. a bedside swallow eval was done to r/o aspiration. aspiration could not be r/o and he remained npo. on a video swallow showed evidence of premature spillover. penetration and aspiration after the swallow was noted with thin liquids. residue in valleculae greater than piriform sinuses also noted. speech and swallow recommended nectar thick liquids and ground consistency and tube feedings. tube feedings continued for insufficient po caloric intake. tremors lessened. he became more alert and oriented. diet was advanced. prograf level increased to 21.8 on pod 7. tremor was more pronounced with higher prograf levels. over several days, prograf dosage was decreased with levels dropping to 12.4. the jps were removed. urine output averaged liter/day. low dose lopressor was given for tachycardia in 90s then stopped when bps were on the low side. potassium started to trend up on pod 9. he was placed on a 2gram potassium diet. tube feedings were switched to nutren renal at 45cc/hour. treatment with insulin/dextrose, iv normal saline and kayexalate was given on for k of 6.9. over the day this decreased to 5.5. on pod 12() he became tachycardic into the 120s with bp of 72/50 while sitting in chair. an ekg was negative. he responded to 2 liters of iv ns with hr decreasing to 100 and bp increasing to 112/70. other vital signs, chem 7 and cbc were normal. blood and urine cultures were sent. on pod 13, he again required volume for tachycardia,but hr persisted in 110-117 range. iv fluid was stopped. weight increased 5 kg from previous day. iv fluid replacments were given to keep i/os even. polyuria persisted with concern for siadh. a head ct was negative for pathology. iv fluid was tapered off. a renal scan was done to differentiate whether native kidneys were functioning. findings demonstrated evidence of atn in both native kidneys with normal transplant kidney function. serum renin and aldosterone levels were sent on . prograf level was a little high at 14.9 on pod 20. potassium was persistently elevated. he continued on telemetry without ectopy. heart rate decreased to the 80-90 range. tube feedings were stopped given kcal intake of 2313. he experienced neuropathy in both feet with slight right foot drop. neurontin was increased with some improvement. neurology evaluated and recommended increase of neurontin if symptoms persisted. on pod 23, the patient fell in the bathroom, secondary to dizziness. a hip x-ray was negative for fracture or dislocation. the dizziness subsided with rest. by pod 24, the patient's urine output decreased, possibly due to the florinef that was started, and his ins and outs became roughly even. he still complained of occasional dizzness and sob when walking. on pod 26, a va scan was ordered to rule pulmonary embolus. the results of this scan did not suggest a pe. below is a summary of events and pertinent studies performed throughout this patient's course: studies: liver us: p liver us: patent vessels, increased velocities in portal vein distal to anastamosis. did not see l hepatic vein or cbd, no intrahepatic duct dil. cxr: lll collapse hida: normal visualization of gallbladder ruq us: cirrhotic liver; no focal lesions identified. large ascites. distended, nontender sludge-filled gallbladder. patent portal vein demonstrating hepatofugal flow. 2/13 persantine mibi: normal pharmacologic stress myocardial perfusion with normal left ventricular wall motion and cavity size. compared with the study of , no significant change. ef 64% 2/12 stress test: technically adequate dipyridamole pharmacologic stress test without symptoms, evidence of ischemia by ecg, or significant arrhythmia. nuclear report sent separately. head ct: nml . micro: urcx: ecoli intermediate senisitivity to cipro, sensi to meropenem blcx: negative, urcx: ecoli sensi to meropenem bld cx: pnd sputum cx: oropharyngeal flora r tunnelled line cath tip cx: negative c. diff/stool cx: negative blood and urine cult: neg . transfer to floor eeg: more consistent w/ encephalopathy, no seizures, ?attribute to compazine meropenem d/c'd end of (7 days total), tf nutren renal full strength 45cc/hr cont, dobhoff d/c'd, tfs stopped cvl d/c'd, k elevated to 6.9 (no ekg changes)-->rec'd 1lns bolus, kayexalate 30 x1, d50 + insulin 10u iv x2 w/ improvement to k 5.7 dobhoff post-pyloric via ir, bactrim restarted, jp d/c'd hypotensive, tachy, rec'd ns x2l, elevated bg - rec'd insulin renal scan shows atn in both native kidneys but nl fxn of txp. feeding tube repositioned - in duodenal-jejunal jxn. head ct negative neurology c/s - peripheral neuropathy dm, liver dz, poor nutrition, rx. rec: cont gabapentin, can incr to 300 tid if needed. renal recs: goal fk . pharm recs fk <10 hyperk+. recs: decr pm ss d/c'ing tfs. : start florinef. : s/p fall - pelvic x-ray no evidence of fracture : vq scan - no evidence of pe. the patient is being discharged on pod 26 to an acute rehab center. he should continue to have regular blood draws to monitor both his chemistries and his tacrolimus levels. his magnesium has consistently needed repletion and most likely will continue to need repletion. his potassium is now improved, but should be checked, along with his creatinine, in case of recurrence of atn and subsequent hyperkalemia. the patient is ambulating with the assistance of a walker, and tolerating a regular diet. medications on admission: 1. hexavitamin tablet sig: one (1) cap po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid 4. ferrous sulfate 325 (65) mg one (1) tablet po daily 5. phytonadione 5 mg tablet sig: one (1) tablet po daily 6. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 9. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical (2 times a day) as needed. 10. furosemide 40 mg tablet sig: two (2) tablet po daily 11. spironolactone 25 mg tablet sig: one (1) tablet po daily 12. propranolol 10 mg tablet sig: two (2) tablet po bid 13. epoetin alfa 3,000 unit/ml solution sig: 3000 (3000) u injection qmowefr (monday -wednesday-friday). 14. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) u injection tid (3 times a day): while patient immobile. 15. insulin please continue lantus at 14 u nightly as well as sliding scale insulin per the attached regimen. discharge medications: 1. prednisone 5 mg tablet sig: 3.5 tablets po once a day: 17.5mg qd x 10 days then follow taper. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 4. fluconazole 200 mg tablet sig: two (2) tablet po q24h (every 24 hours). 5. valganciclovir 450 mg tablet sig: two (2) tablet po daily (daily). 6. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 7. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 9. gabapentin 100 mg capsule sig: two (2) capsule po q8h (every 8 hours). 10. mycophenolate mofetil 500 mg tablet sig: two (2) tablet po bid (2 times a day). 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift discharge disposition: extended care discharge diagnosis: s/p combined liver and kidney transplant esld hit + esrd/esld dm anemia malnutrition encephalopathy polyuria with dehyration neuropathy discharge condition: good discharge instructions: call transplant office if fevers, chills, nausea, vomiting, inability to take medications, abdominal pain, incision redness/bleeding/drainage, jaundice, or any questions. labs every monday & thursday for cbc, chem10, lfts, and trough prograf level. fax to attn: , rn followup instructions: , md phone: date/time: 9:00 , md phone: date/time: 10:00 , md phone: date/time: 9:20 procedure: enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage other transplant of liver other kidney transplantation transfusion of packed cells transfusion of platelets other operations on lacrimal gland transplant from cadaver diagnoses: hyperpotassemia acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute and subacute necrosis of liver alcoholic cirrhosis of liver hepatorenal syndrome unspecified protein-calorie malnutrition other and unspecified alcohol dependence, in remission portal hypertension long-term (current) use of insulin intestinal infection due to clostridium difficile pressure ulcer, lower back anticoagulants causing adverse effects in therapeutic use hepatic encephalopathy dehydration esophageal varices in diseases classified elsewhere, without mention of bleeding unspecified hereditary and idiopathic peripheral neuropathy polyuria abnormal involuntary movements pain in limb 

Answer: The patient is high likely exposed to