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: captopril / prednisone / infed attending: chief complaint: abdominal pain major surgical or invasive procedure: nephrostomy tube placement central venous catheterization placement history of present illness: pt is a 62 yo with history of lurt in and pancreas-after-kidney transplant in , complicated by rejection and subsequently a transplant pancreatic artery-small bowel fistula and massive gi bleed in necessitating explantation of the pancreas and r iliac covered stent. patient awoke with sudden onset sharp rlq pain awakening him from sleep overnight, which radiates to his back. he also has non-bloody, non-bilious vomiting associated with the pain. denies hematuria, hematochezia, chest pain, shortness of breath, or dysuria. he had a colonoscopy one week ago to evaluate the etiology of 6 weeks of diarrhea, which was unrevealing. . in the ed, initial vs: 99.5 87 143/55 16 100% ra. patient had ua without evidence of uti, ct abdomen and pelvis showing mod-severe hydronephrosis and hydroureter of the r native kidney w/ perinephric stranding w/o obvious stones. transplant surgery saw patient in ed and felt pt had pyelonephritis on right native kidney - recommended admission to medicine for antibiotics and percutaneous nephrostomy tube by ir. in the ed patient spiked fever to 101.7, received 2l ns, tylenol 1000 mg po x1, and unasyn 3 g iv x1. he also got 8 mg iv morphine. he took his long acting insulin last night and was not eating so he was started on d5ns in the ed for downtrending fingerstick. vitals on transfer are 100.0 116 130/66 18 95% 3l. . currently, pt complains of 5 - rlq abdominal pain. he is sleepy and falls asleep during interview. he denies chest pain/shortness of breath. . on floor he was noted to be hypoxic at 1:30 in the am to 80% on 2 l. he triggered for that, and at that time his bp was fine. he was broadened to zosyn. however, later his bp dropped to 80s/doppler. he subsequently got 1.5 l fluid. past medical history: celiac sprue depression diabetes s/p failed pancreas transplant renal failure s/p lurt diabetic retinopathy oa osteoporosis diabetic neuropathy cad hx tia hx afib . psh: tonsillectomy removal bladder tumor lap chole b/l cataracts lurt pak ex lap/pancreatic graft explantation/sbr/bl chest tubes abdominal closure social history: lives with his wife. etoh, tobacco or illicit drug use family history: father with bleeding stomach ulcer physical exam: vs - temp 103.5 f, bp 132/60 , hr 116, r , 85% on 2l, improved to 94% on 4l general - sleepy, but arousable to voice, a&ox3, appears uncomfortable heent - perrla, eomi, sclerae anicteric, mmm neck - supple, no thyromegaly, no lad heart - tachy, s1, s2, av fistula heard throughout the precordium lungs - tachypnic, bibasilar crackles abdomen - nabs, mildly distended, soft, moderate rlq tenderness to deep palpation, no rebound tenderness or guarding back - right sided cva tenderness extremities - wwp, no c/c/e skin - no rashes or lesions lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact pertinent results: labs on admission: 01:35pm wbc-10.7 rbc-3.88* hgb-10.7* hct-33.7* mcv-87 mch-27.6 mchc-31.8 rdw-15.4 01:35pm neuts-91.1* lymphs-3.6* monos-3.5 eos-1.4 basos-0.3 01:35pm plt count-159 01:35pm glucose-146* urea n-38* creat-1.9* sodium-141 potassium-4.6 chloride-109* total co2-23 anion gap-14 02:06pm lactate-1.2 01:35pm ck(cpk)-50 01:35pm ck-mb-3 ctropnt-0.01 09:15pm urine color-yellow appear-clear sp -1.016 09:15pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 09:15pm urine rbc-0 wbc-<1 bacteria-none yeast-none epi-0 09:15pm urine hyaline-3* 09:15pm urine mucous-rare cxr : findings: removal of central venous catheter and nasogastric tube. stable cardiomediastinal contours. mild pulmonary vascular congestion accompanied by interstitial edema and a small amount of fluid within the minor fissure. patchy bibasilar retrocardiac opacities are present, and likely reflect atelectasis. . ct abdomen pelvis 1. new moderate-to-severe hydronephrosis and hydroureter of the native right kidney. dilated ureter can be seen to the level of small soft tissue density at the site of previously removed pancreas transplant. 2. locule of gas within the right lower quadrant may be within a tethered loop of small bowel or a contained locule of intra-abdominal gas; a small gas/fluid collection cannot be entirely excluded or potentially fistulization. if clinically indicated, a repeat ct with oral and/or iv contrast or enhancement may be considered. . liver us impression: normal appearance of the liver parenchyma. no focal lesions. pulsatility in the main portal vein is suggestive of right heart dysfunction . tte the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 65%). the right ventricular free wall is hypertrophied. right ventricular chamber size is normal. with normal free wall contractility. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened (the noncoronary cusp is moderately thickened and displays reduced systolic excursion). there is a minimally increased gradient consistent with minimal aortic valve stenosis. the mitral valve leaflets are mildly thickened. there is borderline/mild posterior leaflet mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . renal transplant us 1. left lower quadrant renal transplant without hydronephrosis. 2. perinephritic fluid is present, although may be confounded by presence of a small ascites as seen on prior ultrasound dated . 3. intraparenchymal arterial resistive indices of 0.84-0.9, previously 0.71-0.74 in . 4. thickened bladder wall may be accentuated by underdistension. . nephrostogram impression: complete obstruction at the mid right native ureter. . microbiology c. difficile toxin pcr-negative . 10:00 pm blood culture #2. **final report ** blood culture, routine (final ): klebsiella pneumoniae. final sensitivities. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r aerobic bottle gram stain (final ): reported to and read back by dr. , 10:25am. gram negative rod(s). anaerobic bottle gram stain (final ): gram negative rod(s). blood cultures (- no growth to date , , , , ) . cmv viral load (final ): cmv dna not detected . 10:05 am urine source: kidney. gram stain add-on requested by fax per dr. on at 11:27am. urine-gram stain - unspun (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. = or >1 per 1000x field gram negative rod(s). fluid culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r anaerobic culture (final ): no anaerobes isolated. fungal culture (final ): no yeast isolated. acid fast culture (preliminary): viral culture (preliminary): no virus isolated. . c diff toxin , , . microsporidia stain (final ): no microsporidium seen. cyclospora stain (final ): no cyclospora seen. fecal culture (final ): no salmonella or shigella found. no enteric gram negative rods found. campylobacter culture (preliminary): ova + parasites (final ): no ova and parasites seen. this test does not reliably detect cryptosporidium, cyclospora or microsporidium. while most cases of giardia are detected by routine o+p, the giardia antigen test may enhance detection when organisms are rare. cryptosporidium/giardia (dfa) (final ): no cryptosporidium or giardia seen. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). brief hospital course: this is a 62 year old with pmh of lurt in and pancreas-after-kidney transplant in who presented with rlq abd pain, n/v, diarrhea, and found to have urosepsis with a dilated hydroureter of the native right kidney which drained frank pus. . #. septic shock: patient presented with acute onset rlq abdominal pain and was found to have hydronephrosis and hyrodureter of his native right kidney without evidence of obstruction. transplant surgery evaluated him and recommended percutaneous nephrostomy which drained frank pus. he was covered for pyelonephritis with vanco/zosyn/cipro given his fever and fat stranding seen around his native right kidney. he was narrowed to just ceftriaxone when his blood and urine cultures grew out pansensitive klebsiella. subsequent blood cultures were negative. his blood pressure was initially supported on levophed which was quickly weaned off. maps were kept above 65 and cvps between . id was consulted and recommended continuation of ceftriaxone for a total of 14 days from his first negative blood culture (last dose ) with transition to oral ciprofloxacin 500 mg until definitive procedure is completed. . # respiratory failure: likely secondary to sepsis and resultant leaky capiliaries. he was intubated on arrival and vented via ardsnet protocol to support his respiratory distress. he was extubated within 48 hours. oxygen saturations remained stable on room air. . # pyelonephritis- as above the patient was initially treated with broad spectrum antibiotics for pyelonephritis of his native r kidney. a nephrostomy tube was placed by ir. attempts were made to place a ureteral stent but were unsuccessful. the patient will ultimately need embolization of the renal artery or a nephrectomy of the native kidney. his nephrostomy tube will need to stay in place until a definitive procedure is completed. he will follow-up with transplant surgery as an outpatient regarding this procedure. . # acute on chronic kidney injury, esrd s/p lurt: baseline creatinine is around 2 s/p renal transplant. his creatinine peaked at 3.5 in the setting of sepsis, likely prerenal vs. atn. creatine was improving to 3.1 upon transfer to the floor. creatinine continued to trend downward and was 1.7 on discharge. transplant nephrology was consulted and his home tacrolimus, prednisone, doxercalciferol, and bactrim prophylaxis were all continued. his tacrolimus levels were running high in his home dose therefore his dose was decreased to 3 mg with appropriate levels. . # elevated transaminitis: transaminitis to the 300s on admission likely secondary to the beginnings of shock liver. transaminitis improved with ivfs, pressors, and improved blood pressures. ruq u/s showed normal appearance of the liver parenchyma with patent portal vasculature. lfts trended downward and were normal at the time of discharge. . # diarrhea- patient noted a 6 week history of diarrhea of unclear etiology. stool studies were performed. c diff was negative x 3. cyclospora and microsporidium were negative. salmonella and shigella were negative. cryptosporidium and giardia were also negative. the patient was started on loperamide. . #. coronary artery disease s/p stenting: held home asa, plavix, and simvastatin. asa and simvastain were restarted but plavix was held at the time of discharge. . #. hypertension: home diovan was held throughout the admission and at the time of discharge. patient will follow-up as an outpatient regarding restarting this medication. . #. thrombocytopenia: platelets fell from peak of 188 to 103 upon transition to the floor. possibly reflective of low grade dic in the setting of sepsis. patients platelet count trended upward and were normal at the time of discharge. . #. anemia: hct trended downward from 33.7 to 25.4 upon transition to the floor likely in the setting of fluid resuscitation. hct remained labile (23-25) but was relatively stable. his ldh was elevated by haptoglobin and bilirubin were normal, making hemolysis unlikely. output from nephrostomy tube was bloody however only put out approxmately 50 ml per day making this an unlikely source of hct drop. . #. diabetes mellitus: continued home insulin regimen . #. hypothyroidism: continued home levothyroxine 100 mcg daily. . #. depression: continued home sertraline 150 mg daily. . transitional issues - blood cultures were pending at the time of discharge - patient will follow-up with transplant nephrology - patient was full code throughout this hospitalization -plavix stopped during this admission as patient had placed in and no coronary events since, full dose asa continued medications on admission: clopidogrel 75 mg daily doxercalciferol 0.5 mcg daily lantus 9 in am 18 in pm regular insulin sliding scale levothyroxine 100 mcg daily pantoprazole 40 mg daily prednisone 5 mg daily sertraline 150 mg daily simvastatin 20 mg daily bactrim ss daily tacrolimus 4 mg diovan 320 mg daily aspirin 325 mg daily ferrous sulfate 325 mg daily mvi discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis pyelonephrosis respiratory failure septic shock bacteremia secondary diabetes coronary artery disease celiac sprue discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr , it was a pleasure participating in your care while you were admitted to . as you know you were admitted because you were having abdominal pain. it was ultimately determined that you had an infection in your kidney. a drain was placed to drain the infection. you were given antibiotics through the iv which you will need to continue for 6 more days. you will need to continue oral antibiotic pills until you are instructed to stop by your doctors. you will also need to have a procedure in the future to solve this problem. will therefore need to follow-up with the surgeons to have this done. we made the following changes to your medications. 1. stop plavix 2. decrease tacolimus to 3 mg twice a day 3. start loperamide 2 mg twice a day 4. start ceftriaxone 1 gram daily for 6 more days 5. start ciprofloxacin 500 mg by mouth twice a day once you finish the iv antibiotics until instructed to stop by your doctor 6. stop diovan, and please measure your blood pressure at home. if your blood pressure is more than 160/80 call your primary care physician and restart this medication you should continue to take all other medications as instructed. please feel free to call with any questions or concerns. . please check cbc with differential, chemistry panel,tacrolimus level, lfts and coagulation studies on monday and fax results to renal transplant clinic at followup instructions: name: , e address: , , , phone: *please call your primary care physician to book follow up appointment for your hospitalization. you need to book an appointment within 1 week of discharge. department: transplant center when: tuesday at 9:00 am with: , md building: lm campus: west best parking: garage md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube percutaneous nephrostomy without fragmentation replacement of nephrostomy tube central venous catheter placement with guidance diagnoses: acidosis thrombocytopenia, unspecified anemia in chronic kidney disease coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis severe sepsis unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified acute respiratory failure long-term (current) use of insulin osteoporosis, unspecified septic shock other septicemia due to gram-negative organisms other ascites hypoxemia diarrhea hydronephrosis diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy kidney replaced by transplant pyelonephritis, unspecified other ureteric obstruction 

Answer: The patient is high likely exposed to