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: sulfamethizole / zosyn / penicillins / sulfa (sulfonamides) / iodine / vancomycin attending: chief complaint: fever, headache, nausea, vomiting, blurry vision major surgical or invasive procedure: hemodialysis history of present illness: this is a 24 year old woman with history of sle and esrd on dialysis mwf who presents with fever and mild headache after dialysis yesterday. . she underwent scheduled dialysis procedure yesterday and several hours later developed subjective fever and mild headache. she presented to the ed 12 hrs post dialysis where she was note to be hypotensive and tachycardic. she has had similar symptoms post dialysis in the past and was hospitalized at twice over last month. she could not qualify her headache, i.e. denied it being dull or sharp or squizing, but disclosed that it felt like lightheadedness. there is no neck stiffness, weakness or confusion. she also complains of nausea and vomiting x3 (no blood). no recent travel or sick contacts. she denies any other localizing symtoms for her fever, i.e. denies any abdominal pain, diarrhea, shortness of breath, chest pain, rashes, she has had no urine output in the past and she denies worsenig of her arthritis. denies night sweats or chills. no heat or cold intolerance. . initially was dialyzed through an av fistula but this was complicated by pseudoaneurysm and thereafter his fistula was replaced with a tunneled lij (placed ). on she was admitted to with post dialysis fevers and this was attributed to thrombosis in avf. transplant surgery attempted a thrombectomy, but was unsuccessful. on that admission it was felt that there was no evidence of infection in or around the thrombus and felt that her fevers were likely related to her significant clot burden. no other source of infection was identified. . sle diagnosed in ' after noted to have anasarca, pericardial effusion, leukopenia, arthritis and positive , ro, and p-anca. was on prednisone until and plaquenyl until . . she was diagnosed with esrl in ' and biopsy was nonspecific althought despite this there remains strong suspicion that her esrd is secodary to sle. she has been evaluated for, and is on a list for transplantation. she is hepatitis b surface antigen, surface antibody, and core antibody negative. at last check, hepatitis c antibody negative and hiv negative. . in the ed, initial vs were: 100.6 131 80/41 16 100%. cxr negative. ecg sinus tach. patient was given 2 lt ivf as well as gentamycin and daptomycin. she has extensive abx allergies. this was the same abx regimen that she was treated for similar admission recently. was also given acetaminophen in ed. prior to transfer her vitals were 100.1, 106, 94/40, 16, 100ra. baseline bp 100/60. . in the micu, patient received total og 5l ivf and sbp 100s. she was started on daptomycin/gent for emperic coverage given extensive abx allergies. she has had multiple line infxns in the past. she was also started on 20mg po prednisone. cxr negative. blood cultures no growth to date. ue ultrasound showed stable clot. tte ordered, but not yet done. tunnelled line was kept in and patient was dialyzed today (monday). rheumatology was consulted for concern of lupus flare, see recs below and recommended continuing current prednisone dose with start of taper. past medical history: 1. lupus (diagnosed ) c/b lupus nephritis and esrd on hd. outpt nephrologist is dr. . goes to on mwf. no longer on any bp meds given borderline low bps. 2. hypertension in the past. 3. diagnosis of sjogren's. 4. she has a swollen gland that was removed by ent last year 5. boop 6. inflammatory arthropathy 7. hx of myositis 8. history of pericarditis and pericardial effusion 9. numerous line infections 10.genital herpes 11. depression 12. history of thrombosed av fistula- l tunneled catheter placed on social history: lives in , moving to in 1 week. college student at baypath college. lives with mother, grandmother. smoking history. denies alcohol consumption. no illicit drug use. sexually active with boyfriend in stable relationship. family history: sister has sle. mother: dm. father: no diagnosed medical issues. maternal grandmother: asthma and htn. physical exam: v/s: t: 98.4, bp: 110/80, p: 91, rr: 18, o2sat: 97% ra general: alert, oriented, no acute distress. sitting in bed eating. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: tachycardic, regular rhythm, no murmurs, rubs, gallops. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. neuro: cn 2-12 intact, kernigs and brudzinski negative. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. r hand digits are mildly swollen. skin: hd line intact without erythrema or exudate, avf thrombectomy site clean. pertinent results: admission labs: . 06:10am blood wbc-9.0# rbc-3.99* hgb-10.1* hct-33.5* mcv-84 mch-25.4* mchc-30.2* rdw-15.4 plt ct-272 06:10am blood neuts-92* bands-2 lymphs-2* monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-0 06:10am blood hypochr-3+ anisocy-1+ poiklo-1+ macrocy-normal microcy-1+ polychr-normal ovalocy-occasional bite-occasional 06:10am blood plt ct-272 04:53pm blood pt-14.7* ptt-34.5 inr(pt)-1.3* 06:10am blood glucose-93 urean-14 creat-8.2*# na-138 k-4.1 cl-99 hco3-28 angap-15 04:53pm blood calcium-8.3* phos-3.9# mg-1.5* 06:13am blood lactate-1.5 04:53pm blood alt-4 ast-10 ld(ldh)-183 alkphos-52 . pertinent labs/studies: . 07:35am blood wbc-5.5 rbc-4.05* hgb-10.3* hct-34.5* mcv-85 mch-25.3* mchc-29.7* rdw-15.8* plt ct-194 07:00am blood wbc-8.3 rbc-3.36* hgb-8.5* hct-28.8* mcv-86 mch-25.4* mchc-29.6* rdw-15.0 plt ct-193 07:35am blood glucose-90 urean-21* creat-6.6*# na-138 k-3.8 cl-101 hco3-26 angap-15 07:00am blood glucose-82 urean-28* creat-8.9*# na-139 k-3.9 cl-100 hco3-28 angap-15 07:35am blood calcium-9.3 phos-3.1 mg-2.0 04:32am blood tsh-0.90 05:50am blood dsdna-negative 12:41pm blood -negative 06:10am blood c3-79* c4-30 05:50am blood genta-1.9* 04:32am blood genta-2.2* . . cxr (): no evidence of pneumonia or other acute cardiopulmonary process. . ct head/sinus (): no acute intracranial process. . lue u/s (): 1) no dvt. 2) partially thrombosed left-sided a-v fistula. . echo (): mild symmetric lvh. normal regional and global biventricular systolic function. no pathologic valvular abnormality seen. compared with the prior study (images reviewed) of , the degree of lvh is less. the other findings are similar. . ct l-spine w/o contrast (): no evidence of osteomyelitis. findings suggestive of renal osteodystrophy. there is mild diffuse disc bulge at l3-4, l4-5l and l5-s1 without significant central canal stenosis or neural foraminal narrowing. brief hospital course: 24 year old woman with lupus and esrd on hd (mwf) presents with fever after dialysis. . # fever, tachycardia, relative leukocytosis and hypotension, consistent with systemic inflammatory response syndrome: unknown etiology, with broad differential. have been multifactorial in nature. low grade fever may have been secondary to transient bacteremia due to seeding from tunneled catheter site, considering current resolution of symptoms, negative blood cx to date and lack of fever x3 days. hypotension and tachycardia could have been secondary to fluid shifts during dialysis. patient received a ct head and ct sinuses (given initial c/o ha) that were both negative. cxr on was negative for pna or acute pulmonary process. bilateral ue u/s on showed partially thrombosed l sided a-v fistula with no evidence of dvt. av fistula site remained non erythematous, non-tender and without any signs of infection throughout the hospitalization. given that the patient was recently admitted with a fever on , there was concern that she may have been having intermittent fevers for the past 2 weeks. lupus flare as the etiology of her low grade fever was explored and rheumatology was consulted. they were not confident that the myriad of symptoms could be appropriately attributed to sle alone. dsdna and ch50 were sent with complement returning mildly decreased(c3 79) and dsdna being negative. clinical suspicion for meningitis was low given that the presenting ha was better qualified as lightheadedness by the patient, absence of ams, neuro findings or meningismus. patient was started on gentamycin 80mg and daptomycin 400mg empirically on in the micu given her vancomycin and zosyn allergies and these were discontinued on given negative infectious workup to date. she did not develop any fevers for 48 hours following abx cessation. prednisone 20mg was also begun on in the micu, prior to the rheum consult, and discontinued on due to low suspicion for lupus flare as etiology. patient was monitored after discontinuation of abx and remained afebrile for more than 24 hours prior to discharge. on day 4 of hospitalization (), patient developed complaints of lower back pain. she reported that similar episodes have happened in the past after her hd sessions, but described this incident as more severe. lumbar ct without contrast (patient has contrast allergy) was performed and was negative for osteomyelitis but did show mild disc bulge at l3-4, l4-5l and l5-s1, which could explain her lower back pain. . # esrd on hd (mwf): etiology of patient's kidney failure still unknown, suspected secondary to lupus. patient's creatinine on admission was 8.2 and remained around her baseline throughout the hospitalization. she continued to be dialyzed while in house (, and ) and will follow up with her nephrologist, dr. , within 2 weeks after discharge. . # sle: patient has a likely diagnosis of sle and has been off immunosuppressants for three months. per rheumatology, sle flare less likely to be responsible for fever in this patient. rheumatology consulted her in-house and will plan to follow up with her as an outpatient within 2 weeks for possibly initiation of plaquenil therapy. medications on admission: 1. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 2. sevelamer hcl 400 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever: do not take more than 3500mg per day. discharge medications: 1. cinacalcet 30 mg tablet sig: one (1) tablet po once a day. 2. sevelamer hcl 800 mg tablet sig: one (1) tablet po once a day. 3. outpatient physical therapy please begin physical therapy for your low back pain as an outpatient. you may . 4. percocet 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours. discharge disposition: home discharge diagnosis: fever of unknown etiology sle, complicated by lupus nephritis end stage renal disease on hemodialysis - history of thrombosed av fistula. left tunneled catheter placed on sjogren's syndrome history of multiple line infections history of hypertension boop inflammatory arthropathy depression discharge condition: afebrile, vital signs stable. discharge instructions: you were admitted because you had a fever, your blood pressure was very low, and your heart rate was very fast in the emergency department. you were given fluids and started on iv antibiotics to treat any possible infection. you were also started on prednisone in the event that your symptoms were due to a lupus flare, which was stopped after three days. you were seen by the rheumatology service. several blood cultures were drawn, the results of which are still pending, however, they are negative to date. several imaging studies were performed to look for sources of infection and these were also negative. you underwent dialysis on monday, tuesday and wednesday of this week. . we have made no changes or additions to your medications. . please take all other medication as previously directed prior to your hospitalization. . should you develop lightheadedness, feeling faint, fever, chills, stiff neck, nausea, vomiting, or diarrhea, please call your primary care physician or visit the emergency room. followup instructions: please continue your dialysis schedule. . please follow up with dr. who is covering for dr. . date: time: 1:45 pm phone: . please follow up with dr. , a rheumatologist her at for you lupus. phone: provider: , md date: time: 2pm number: . please follow up with your previously scheduled appointment with your transplant surgeon, dr. . date: time: 1:30 pm procedure: hemodialysis diagnoses: systemic lupus erythematosus end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease fever, unspecified personal history of venous thrombosis and embolism sicca syndrome 

Answer: The patient is high likely exposed to