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: erythromycin base / indomethacin / actonel / reglan attending: chief complaint: headache fever, headache, neck pain and altered mental status for four days major surgical or invasive procedure: exploratory laparotomy, evacuation of intra- abdominal blood, exploration of retroperitoneal hematoma, left salpingo-oophorectomy. left iliolumbar artery coil/gelfoam deployment of a 6 mm x 18 mm stent in the main hepatic artery. joint aspiration bronch history of present illness: the patient is a 65 yo woman with h/o dm2, esrd, afib on coumadin, and nonalcoholic steatohepatitis s/p liver and kidney transplant in , on cellcept/prograf, and prednisone taper (for gout flare), who presents with a four-day history of fever (tmax 101 at home), headache, neck pain, and confusion. she reportedly presented to hospital yesterday with similar complaints and was found to have a wbc of 21. it was thought that this was secondary to her steroids, so she was discharged home. she then presented back to hospital today with similar complaints, but at this time she had meningismus. she was given ceftriaxone 1g and vancomycin (at 3:25pm), and was transferred to for further evaluation. . in the ed, the patient's initial vs were t 101.2, p 76, bp 126/60, r 18, o2 99% on 4l. she was unable to have a lp because her inr was 2.7, and there was concern that her picture was more consistent with an epidural abscess. neurology was consulted, who recommended lp after inr reversal. neurosurgery was then c/s, who recommended ct spine with contrast, as a mri cannot be performed because of her pacemaker. she was given another 1 g of ctx, ampicillin, acyclovir, and decadron 10 mg in the ed. her mental status began to decline and she was thus admitted to the micu for further evaluation. at the time of transfer, her vs were 76, 147/59, 17, 96% on 2l. . on the floor, she continues to have ha, described as sharp, pounding, constant, and diffuse, as well as stiff neck. denies photophobia, visual changes, nausea, vomiting, rash. no recent travel; last trip was to in to visit her son. known tick exposures. . review of systems: (+) per hpi (-) denies night sweats, recent weight loss or gain. denies sinus tenderness, rhinorrhea or congestion. denies shortness of breath or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - diabetes mellitus type 2, on insulin, c/b retinopathy, nephropathy, and neuropathy - dyslipidemia - hypertension - atrial fibrillation, on coumadin - high-degree av block, s/p ppm ( sensia ddd pacemaker), now pacer dependent - diastolic heart failure, nyha ii-, >65% on tte - calcific aortic stenosis, moderate (area 1.0-1.2cm2) on tte - moderate mitral annular calcification and mitral regurgitation - mild tricuspid regurgitation - moderate pulmonary hypertension . - end-stage renal disease, diabetes & contrast-induced nephropathy, s/p cadaveric transplant - non-alcoholic steato-hepatitis cirrhosis (stage iv, grade 2), c/b portal htn, ascites, encephalopathy, grade i-ii esophageal varices s/p banding s/p tips , s/p oltx - saphenous vein interposition graft repair of the hepatic artery and harvesting of the left saphenous vein graft , hepatic artery s/p stent - s/p vats decortication - splenic vein thrombosis, on coumadin - anemia - thrombocytopenia - h/o c.diff - h/o seizures -headaches ? occipital neuralgia - meningioma, small left frontal lobe - gerd - osa has cpap at home but does not use - cervical djd - dermoid cyst - right adrenal mass -osteoporosis - recurrent mdr uti (esbl klebsiella) - status post cholecystectomy followed by tubal ligation - status post left oopherectomy - status post appendectomy - ? restless legs syndrome social history: widowed, lives in facility in ma. has 4 children, 3 in ma, one in . smoking: none; etoh: never; illicits: none. family history: mother and father with cad. father with stroke at 90. no other family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission labs vitals: bp:141/52 p:76 r:18 o2:96% ra general: alert, oriented x3, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: stiff, tender to palpation, unable to touch chin to chest lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, systolic murmur (old per patient) abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. no rash or petechiae. there are some excoriated red lesions on the r shoulder, but these appear to be secondary to scratching. neuro: aox3 (", "), moving all extremities, strength 4/5, sensation intact throughout. cn 2-12 intact. negative kernig/brudzinski signs. baseline intention tremor but no asterixis. pertinent results: admission labs 07:38pm blood wbc-19.2* rbc-3.57* hgb-10.6* hct-31.6* mcv-89# mch-29.8 mchc-33.7 rdw-17.5* plt ct-479* 07:38pm blood neuts-88.8* lymphs-5.6* monos-5.4 eos-0.1 baso-0.1 07:38pm blood pt-27.9* ptt-35.8* inr(pt)-2.7* 07:38pm blood glucose-105* urean-28* creat-1.4* na-141 k-3.6 cl-99 hco3-31 angap-15 05:16am blood alt-27 ast-29 ld(ldh)-278* alkphos-178* totbili-0.5 07:38pm blood calcium-8.6 phos-4.4 mg-1.7 05:16am blood tacrofk-12.6 07:55pm blood lactate-1.2 . pertinent reports ct spine with contrast (): no evidence of abscess on noncontrast ct. note that this study has low sensitivity for infection. if the patient cannot undergo mr imaging, a contrast ct may be the next best alternative, although far less useful for detecting intraspinal infection. . 10:30am cerebrospinal fluid (csf) wbc-9 rbc-438* polys-89 lymphs-10 monos-1 10:30am cerebrospinal fluid (csf) wbc-4 rbc-1125* polys-93 lymphs-5 monos-2 10:30am cerebrospinal fluid (csf) totprot-28 glucose-93 05:21am blood wbc-25.0* rbc-2.96* hgb-9.3* hct-28.3* mcv-96 mch-31.5 mchc-33.0 rdw-18.0* plt ct-941* 06:00am blood pt-12.6 ptt-32.9 inr(pt)-1.1 05:33am blood glucose-77 urean-96* creat-1.1 na-136 k-4.1 cl-101 hco3-27 angap-12 05:21am blood glucose-92 urean-90* creat-1.0 na-136 k-4.3 cl-99 hco3-27 angap-14 05:33am blood alt-45* ast-30 alkphos-250* totbili-1.8* dirbili-1.1* indbili-0.7 05:21am blood albumin-3.0* calcium-8.7 phos-3.7 mg-2.6 09:00am blood vanco-5.5* brief hospital course: 65 year old female with extensive medical history including dm, esrd, afib on coumadin, and nonalcoholic steatohepatitis s/p liver and kidney transplant, on immunosuppression, who presented with fever, headache, neck pain and altered mental status for four days. she was initially admitted to the medical service for management. symptoms were concerning for meningitis versus epidural abscess. empiric antibiotic therapy was initiated which included vancomycin, ceftriaxone, ampicillin and acyclovir along with a 4 day course of dexamethasone to be completed which completed on . ct neck did not show epidural abscess while ct head at outside hospital was negative for acute intracranial process. lp obtained 20 hours out from presentation showed few wbc (), rbc (diluting from tube 1 to 4) with normal protein and glucose. neurology and infectious disease were consulted and suggested continuing current care. she was clinically doing well with no fever, improved mental status and mild headache and neck pain so she was transferred to the floor for further workup and evaluation. antibiotics were discontinued per id recommendations. she remained afebrile and symptoms improved. there was concern that her symptoms are related to bad arthritis. flexion/extension x-ray of the neck showed no evidence of subluxation. she continued to have tenderness to the left of her vertebrae at the level of c5. etiology was unclear, but it did not seem to be infectious. . creatinine of 1.4 on admission with baseline of 1.0. improved to 1.3 with intravenous fluids. she then developed a new oxygen requirement and cxr showed some concern for vascular congestion and fluid overload. she was diuresed aggressively and her creatinine rose to 1.6. clinical exam and urine lytes showed a pre-renal picture and the patient's lasix was temporarily held and she was given iv fluids. creatinine 1.1 and she was restarted on her home dose lasix. inr was elevated as she had been on coumadin for atrial fibrillation and splenic vein thrombosis. ffp was given for lumbar punction. inr dropped below 2 and a heparin drip was started pending decision for any invasive procedures. once this was determined her coumadin was restarted and she was being bridged with lovenox. lost iv access and was switched to lmwh bridge. inr trended up above 2 and her lmwh was discontinued. . gout - continue allopurinol 200mg daily; when dexamethasone was disconitnued, pt gout flared up again. she was started on a prednisone taper and then the renal attending decided that given she has been on multiple pred tapers in the past, she may benefit from colchicine therapy while her allopurinol is being titrated up. she was started on colchicine and rheumatology was consulted. . transplant surgery was consulted on for severe abd pain and hypotension. she was taken to the or on for exploratory laparotomy, evacuation of intra-abdominal blood, exploration of retroperitoneal hematoma,and left salpingo-oophorectomy for retroperitoneal bleed. surgeon was dr. . please refrer to operative note for futher details. postop, she was transferred to the sicu intubated. sicu course was notable for volume overload requiring diuresis and cvvhd for ultrafiltration. on , an abd ct was done to evaluate for repeat bleeding. a small right abdominal wall fluid collection was noted. there was mild interval increase in the size of a left iliopsoas retroperitoneal hematoma. no further intervention was done. she experienced atn related to contrast nephrophathy. atn gradually resolved and cvvhd was stopped. creatinine slowly improved. she required bronchoscopy with bal which was negative. once volume status improved she was weaned and extubated. lfts increased and liver duplex was done concerning for impaired hepatic artery flow. cta was done noting concerns for hepatic artery stenosis. on , ir performed an angiogram via the right common femoral artery placing a 6 mm x 18 mm in the main hepatic artery. she exerienced a right groin hematoma at the groin site, but right leg csm was intact. once hcts were stable, aspirin and plavix were started. no coumadin was indicated. also, while in the sicu, she had rue weakness and was noted to have significant pain in wrists and ankle. rheumatology tapped the right wrist noting crystals consistent with gout. a head ct was negative for mass or bleed. steroid taper was started on consisting of 30mg x3 days then 20mg x3 days then 10mg x 3 days then resumption of home dose of prednisone 2.5mg qd for transplant immunosuppession along with cellcept and prograf. rheumatology recommended holding off on previous allopurinol for several weeks to prevent flare up of gout. gout symptoms were dramatically resolved at time of discharge. she will require a rheumatology f/u as an outpatient in a couple of weeks. overall, the remainder of the hospital stay was uncomplicated. while in the sicu, she was confused and delerious. this improved. psyche was consulted given h/o bipolar illness. ariprazole 5mg daily was increased to on . she required rare doses of intermittent ativan 0.5mg for anxiety. given h/o diastolic heart failure previous home dose of lasix 120 mg po qam was initiated on . carvedilol and valsartan were continued. atrial fibrillation: coumadin was discontinued and the plan was to not resume this. seizure disorder - cont she continued on keppra 500mg . she did not experience any seizures during this hospital stay. depression - continue home aripiprazole, desvenlafaxine, trazodone. primary biliary cirrhosis - continue ursodiol 300mg . this was not an active issue during this hospitalization. given prolonged hospital course and poor appetite and intake, post pyloric tube feeds were started in the sicu and continued during the hospital stay. she tolerated novasource renal with beneprotein, 21 gm/day at 40ml/hour continuous. physical therapy worked with her and was able to get her oob to the chair. rehab was recommended. rehab screen was persued and a bed became available on . she will transfer there today. medications on admission: acyclovir 700 mg iv q12h ampicillin 2 g iv q6h ceftriaxone 2 gm iv q12h vancomycin 1000 mg iv q 24h dexamethasone 10 mg iv q6h sulfameth/trimethoprim ss 1 tab po/ng daily . mycophenolate mofetil 500 mg po bid tacrolimus 2 mg po q12h . allopurinol 100 mg po/ng daily insulin sc (per insulin flowsheet) aripiprazole 5 mg po/ng daily levetiracetam 500 mg po/ng atorvastatin 10 mg po/ng daily carvedilol 25 mg po/ng oxycodone (immediate release) 5 mg po/ng q4h:prn pain senna 1 tab po/ng ursodiol 300 mg po bid docusate sodium (liquid) 100 mg po bid docusate sodium 100 mg po bid valsartan 160 mg po/ng daily ferrous sulfate 325 mg po/ng daily venlafaxine xr 112.5 mg po daily furosemide 120 mg po/ng qam trazodone 100 mg po/ng hs furosemide 80 mg po/ng qpm discharge medications: 1. glucagon (human recombinant) 1 mg recon soln : one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 2. miconazole nitrate 2 % powder : one (1) appl topical (2 times a day). 3. carvedilol 12.5 mg tablet : two (2) tablet po bid (2 times a day). 4. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 5. desvenlafaxine 50 mg tablet extended release 24 hr : one (1) tablet extended release 24 hr po daily (). 6. oxycodone 5 mg tablet : 1-2 tablets po q4h (every 4 hours) as needed for pain. 7. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 8. aspirin 325 mg tablet : one (1) tablet po daily (daily). 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath/wheezing. 11. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath/wheezing. 12. amlodipine 5 mg tablet : two (2) tablet po daily (daily). 13. prednisone 10 mg tablet : one (1) tablet po daily (daily) for 3 days: then decrease to 2.5mg qd. 14. aripiprazole 5 mg tablet : one (1) tablet po bid (2 times a day). 15. furosemide 40 mg tablet : three (3) tablet po daily (daily). 16. ursodiol 300 mg capsule : one (1) capsule po bid (2 times a day). 17. omeprazole 20 mg capsule, delayed release(e.c.) : two (2) capsule, delayed release(e.c.) po daily (daily). 18. prednisone 2.5 mg tablet : one (1) tablet po daily (daily): start . 19. lorazepam 0.5 mg tablet : one (1) tablet po bid (2 times a day) as needed for anxiety. 20. sulfamethoxazole-trimethoprim 400-80 mg tablet : one (1) tablet po daily (daily): pcp . 21. levetiracetam 500 mg tablet : one (1) tablet po bid (2 times a day). 22. mycophenolate mofetil 500 mg tablet : one (1) tablet po bid (2 times a day). 23. tacrolimus 1 mg capsule : one (1) capsule po q12h (every 12 hours): trough levels every monday and thursday am. 24. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 25. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 26. insulin glargine 100 unit/ml solution : thirty (30) units subcutaneous twice a day: am and hs. 27. insulin regular human 100 unit/ml solution : follow printed sliding scale units injection four times a day. 28. outpatient lab work every monday and thursday for cbc, chem 10, alt, ast, alk phos, t.bili, albumin, trough prograf level and ua fax to transplant coordinator discharge disposition: extended care facility: hospital - discharge diagnosis: h/o liver/kidney transplant retroperitoneal hematoma hepatic artery stenosis, stented atn, resolved fluid overload, resolved gout flare h/o bipolar, anxiety discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you will be transferred to transplant office should be called if the following are noted: fever, chills, nausea, vomiting, inability to take any medications, increased abdominal pain/distension, jaundice, joint pain/swelling/redness or any concerns weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: provider: , m.d. phone: at 3:20 provider: , md phone: date/time: 8:30 provider: phone: date/time: 9:00 provider: , m.d. phone: date/time: 10:00 md, procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances hemodialysis angioplasty of other non-coronary vessel(s) venous catheterization for renal dialysis incision of abdominal wall closed [endoscopic] biopsy of bronchus aortography arteriography of other intra-abdominal arteries arteriography of other intra-abdominal arteries arthrocentesis insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) other endovascular procedures on other vessels other unilateral salpingo-oophorectomy cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel central venous catheter placement with guidance diagnoses: hyperpotassemia abnormal coagulation profile acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute and subacute necrosis of liver acute kidney failure, unspecified atrial fibrillation other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes other and unspecified hyperlipidemia other shock without mention of trauma long-term (current) use of insulin long-term (current) use of anticoagulants mitral valve insufficiency and aortic valve stenosis cardiac pacemaker in situ epilepsy, unspecified, without mention of intractable epilepsy anticoagulants causing adverse effects in therapeutic use ventilator associated pneumonia delirium due to conditions classified elsewhere complications of transplanted kidney diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled chronic diastolic heart failure acute gouty arthropathy hemoperitoneum (nontraumatic) diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy cervical spondylosis without myelopathy other drugs and medicinal substances causing adverse effects in therapeutic use bipolar i disorder, most recent episode (or current) depressed, unspecified other and unspecified ovarian cyst vascular complications of other vessels 

Answer: The patient is high likely exposed to