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: tenofovir disoproxil fumarate attending: chief complaint: bright red blood per rectum and bilateral le edema major surgical or invasive procedure: colonoscopy , , egd history of present illness: 54m with h/o hiv (cd4 28 in ), hcv cirrhosis, s/p olt in , hcv recurrence, dm2, recently admitted thrice for rising lfts, multiple biopsies concerning for acute cellular rejection presenting with ble edema and brbpr x2 weeks. he states that for the past 2 weeks he has had worsening ble edema and brbpr. his prograf was stopped several weeks ago and per liver note, it appears that he had rejected his transplant. he had upper and lower endoscopies that showed esophageal, gastric and rectal varices, but no active bleeding. he has had mild crampy abdominal pain that is intermittent, increasing abdominal girth as well as orthopnea for the past 2-3 weeks. he denies fever, chills, confusion or h/o sbp. he has been taking valacyclovir for rectal hsv and antiretrovirals for his hiv. . in the ed, initial vs were: 97.8 82 102/58 18 100%. ruq ultrasound was performed which showed patent portal vasculature, cxr showed pleural effusion, labs notable for hct 20 (baseline mid to upper 20s). lenis negative for dvt. guaiac neg on rectal (but brown stool, not melena). received 1 unit prbc, post hct checked immediately after transfusion showed inappropriate rise in hct. hepatology was consulted who may do egd in am. overall, hepatology emphasized paucity of options for this gentleman. most recent set of vitals afebrile, 62, 103/61, 20 100% ra. ed to get additional piv prior to transfer to micu. . in the micu, the initial vitals were t-96.9, bp-106/65 p-56 r-18 o2:100% on ra. a repeat hct was 22.9. past medical history: hiv hcv cirrhosis hcc s/p rfa (4.5x3.4 cm hepatoma, which was biopsy-proven hepatocellular carcinoma (hcc).) olt c/b portal vein thrombectomy and roux en y ; c/b acute rejection vs hsv infection in - treated with steroids, atg, ivig, acyclovir, and foscarnet recurrent hcv portal vein thrombosis - on coumadin dm ii appendectomy at age 18 multiple r inquinal hernia repairs x4 ptc dilatation of hepaticojejunostomy site fanconi's syndrome tenofovir hsv social history: - lives alone in an apartment in . no children - high school graduate, previously worked as disk jockey in area - on medical disability, unemployed - denies current etoh, tobacco or drug abuse (prior iv cocaine use) family history: non-contributory physical exam: on admission vitals: t:96.9 bp:106/65 p:56 r:18 o2:100% general: alert, oriented, no acute distress, jaundice heent: sclera icteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad cv: normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, distended, organomegaly could not be appreciated secondary to the distention gu: no foley, edematous scrotum, with erythema on l side of scrotem ext: thin, warm, well perfused, 2+ pulses, 3+ edema with some weeping serious fluid on right on discharge: vss- afebrile bp 90s/40s, hr 60s, 100%ra general: aaox3, nad, agitated heent: scleral icterus with moist mucous membranes. cardiac: rrr< no mrg appreciated lungs: ctab, no wheezes or crackles appreciated abdomen: markedly distended, +fluid shift, +bs, nontender, soft, no rebound or guarding. gu- mild scrotal swelling extremities: shinny skin with 2+ pitting edema to the knees bilaterally 2+dp pulses bilaterally neuro: aaox3, no asterixis pertinent results: admission labs: 05:00pm blood wbc-5.6# rbc-2.25* hgb-6.3* hct-20.5* mcv-91 mch-27.8 mchc-30.9* rdw-20.4* plt ct-144*# 05:00pm blood neuts-91.0* bands-0 lymphs-6.6* monos-1.9* eos-0.2 baso-0.3 10:24pm blood hypochr-2+ anisocy-2+ poiklo-occasional macrocy-1+ microcy-1+ polychr-normal burr-occasional fragmen-occasional 05:00pm blood pt-17.1* ptt-29.3 inr(pt)-1.5* 05:10pm blood glucose-330* urean-35* creat-1.5* na-136 k-4.3 cl-108 hco3-14* angap-18 05:10pm blood alt-81* ast-91* alkphos-946* totbili-40.0* dirbili-29.7* indbili-10.3 05:10pm blood lipase-42 05:10pm blood albumin-2.9* discharge labs: 06:07am blood wbc-5.5 rbc-2.76* hgb-8.6* hct-24.7* mcv-89 mch-31.2 mchc-35.0 rdw-18.9* plt ct-80* 06:07am blood pt-16.8* ptt-31.6 inr(pt)-1.5* 06:07am blood glucose-228* urean-18 creat-1.3* na-135 k-3.8 cl-109* hco3-19* angap-11 06:07am blood alt-88* ast-96* alkphos-1021* totbili-29.0* 06:07am blood albumin-2.1* calcium-7.5* phos-2.0* mg-1.9 06:07am blood tacrofk-pnd pertinent labs: 05:25am blood wbc-2.5* rbc-2.66* hgb-8.2* hct-24.3* mcv-92 mch-30.7 mchc-33.5 rdw-19.0* plt ct-136* 09:25pm blood hct-18.3* 05:06am blood wbc-10.8# rbc-2.60* hgb-8.1* hct-23.4*# mcv-90 mch-30.9 mchc-34.5 rdw-17.7* plt ct-259# 06:41am blood tacrofk-8.9 06:30am blood tacrofk-5.1 05:12am blood type-art po2-83* pco2-28* ph-7.46* caltco2-21 base xs--1 11:33am urine color-dkamb appear-clear sp -1.014 11:33am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-lg urobiln-neg ph-6.0 leuks-neg 11:33am urine rbc-<1 wbc-4 bacteri-many yeast-none epi-<1 11:33am urine mucous-rare micro: blood culture x2 negative blood culture x 2 pending imaging: ekg : sinus rhythm. normal tracing. compared to the previous tracing the findings are similar. ruq u/s : impression: 1. patent hepatic and portal venous vasculature. 2. trace bilateral lower quadrant ascites. 3. splenomegaly. bilateral lower extremity doppler venous ultrasound : impression: no dvt. cxr: low lung volumes similar to prior exam. there is pleural effusion. it is unclear whether it is unilateral or on which side or possibly bilateral. in either case, if not new, this is unlikely to have enlarged recently. alternatively, this could be a new development. : ct angiogram of abdomen and pelvis preliminary report !! wet read !! no large bleed detected. ct sensitivity for a slow-flow gi bleed is very low. a rbc-tagged nuclear scan can be considered if a more sensitive test is desired. moderate simple ascites. small bilateral pleural effusions. s/p liver transplant. mild pneumobilia secondary to hepaticojejunostomy, without evidence of biliary obstruction. patent portal veins. no concerning hepatic lesions detected. splenomegaly and splenic and gastric varices, compatible with chronic portal hypertension. fat-containing left inguinal hernia (2:99). 12 mm rlq intrapelvic node, unchanged in size since , with interval calcification, likely a lymph node. endoscopies: : egd: varices at the lower third of the esophagus ulcer in the antrum. varices at the antrum. otherwise normal egd to third part of the duodenum : unable to visualize the rectum due to poor prep. significant amount of dark bloody stool and clots were seen in the rectum. otherwise normal sigmoidoscopy to sigmoid colon. : the scope was advanced to the mid-transverse colon but could not be advanced further due to significant looping. further attempts to advance to scope were limited by the fact that the patient was unsedated because of his marginal blood pressures. blood and clots were seen mostly in the distal colon (distal sigmoid and rectum). by the mid-trasnverse, there was no blood seen. no obvious bleeding site or source was identified. there was a single rectal varix withoutbleeding or stigmata of recent bleeding. otherwise normal colonoscopy to mid-transverse colon : colonoscopy: the terminal ileum was easily entered and appeared normal. there was bilious non bloody fluid in the terminal ileum. edema and loss of the normal vascular pattern consiistent with portal enteropathy in the mid-sigmoid colon two nonbleeding large rectal varices were seen in the rectum upon retroflexion. there were no stigmata of recent bleeding thus, the decison was made not to inject as per hepatology attending dr. . the distal rectum was somehow friable consistent with portal enteropathy. grade 1 internal hemorrhoids there was a small area of mucosal irregularity in the distal rectum, suggestive of condyloma. otherwise normal colonoscopy to cecum and terminal ileum brief hospital course: 54m with h/o hiv (cd4 28 in ), hcv cirrhosis, s/p olt in , hcv recurrence, dm2, recently admitted thrice for rising lfts, multiple biopsies concerning for acute cellular rejection presenting with ble edema and brbpr hematochezia- patient had hematochezia at home with a 7 point hct drop. he was admitted to the micu but had no further bleeding so was just given transfusions and once stable was transferred to the floor. on the floor the patient was stable,but on his third hospital day large bloody bowel movement with a hct drop to 18, and he was transferred back to the unit. in the micu he received a trauma line and 4 units of blood and 1 . there he underwent a colonoscopy and endocsocpy which showed no active bleeding and no interventions were taken. he was then transferred back to the floor. he had another episode of hematochezia but colonscopy the next day showed no evidence of bleeding. as it was felt this may be from his small bowel he udnerwent a ct angiogram of his abdomen which showed no bleeding sites that could be intervened upon palliatively. his hct was stable at the time of discharge at 24. goals of care- patient had multiple discussions with his primary hepatologist dr. as well as the team about the prognosis of his condition (rejection of the liver). palliative care was consulted and the patient changed his code status to dnr/dni. his hcp met with the micu team and palliative care. he will be discharge to home with hospice with good . edema- patient came in with anasarca, with 3+pitting edema of the legs and scrotal edema. he was diruresed with 40po lasix and had response to this, however still was markedly edematous. his scrotal edema improved during his stay however he continued to have 3+ pitting edema on the legs bilaterally and was limiting his ability to walk. s/p liver transplant- he was continued on his current course of treatment. his bilirubin was markedly elevated at 40 on admission, and his lfts were worsening. his tacro level became subtherapeutic during this admission (was being held) so he was given one dose and will continue weekly dose of 0.5mg po qwednesday renal failure- patient had elevated cr at 1.7 (with his baseline being around 0.6). he was started on treatment for hrs with midodrine and octreotide.he will be sent home on midodrine to help with his blood pressure as well. hiv- he was continued on his home regimen. this will be stopped as he is being discharged to home with hospice and this treatment is not expected to extend his life expectancy diabetes- patient was continued on his home nph regimen and he will continue this at home. . hcv- last viral load 3,733,519 copies on . not actively being treated . hsv- s/p acyclovir and foscarnet. lesion on his sacrum- hsv ii confirmed by dfa. he will not be on his valtrex on discharge. . hypothyroidism-this was stable during this admission and he will be discharged on his home dose of levothyroxine 25mcg daily transitional issues: you will be going home with hospice. we have started several new medications including some skin creams. please refer to the medication list for names and doses. medications on admission: 1. azithromycin 600 mg tablet sig: two (2) tablet po 1x/week (th). 2. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 3. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). 4. prednisone 10 mg tablet sig: three (3) tablet po daily (daily). 5. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 6. valacyclovir 500 mg tablet sig: two (2) tablet po three times a day. 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 8. ciprofloxacin 250 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. nph insulin human recomb 100 unit/ml suspension sig: thirty five (35) units subcutaneous each morning. 10. nph insulin human recomb 100 unit/ml suspension sig: ten (10) units subcutaneous each night. 11. insulin regular human 100 unit/ml solution injection 12. calcium carbonate-vitamin d3 oral 13. nadolol 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 14. abacavir 300 mg tablet sig: one (1) tablet po twice a day. 15. raltegravir 400 mg tablet sig: one (1) tablet po twice a day. 16. lopinavir-ritonavir 200-50 mg tablet sig: two (2) tablet po twice a day. discharge medications: 1. azithromycin 600 mg tablet sig: two (2) tablet po 1x/week (th). disp:*60 tablet(s)* refills:*2* 2. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 4. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. hydrocortisone 0.5 % ointment sig: one (1) appl topical tid (3 times a day) as needed for puritus. disp:*1 tube* refills:*0* 6. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for puritus. disp:*1 tube* refills:*0* 7. midodrine 5 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*60 tablet(s)* refills:*2* 8. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. disp:*60 tablet(s)* refills:*2* 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 10. tacrolimus 0.5 mg capsule sig: one (1) capsule po once a week: take on wednesdays. disp:*30 capsule(s)* refills:*2* 11. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: 2-20 mg po q1h as needed for pain. disp:*30 ml* refills:*0* 12. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 13. abacavir 300 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 14. lopinavir-ritonavir 200-50 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 15. raltegravir 400 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 16. valacyclovir 500 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 17. ciprofloxacin 250 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 18. nadolol 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 19. calcium carbonate-vitamin d3 oral 20. furosemide 40 mg tablet sig: one (1) tablet po once a day as needed for leg swelling. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: hospice of good discharge diagnosis: primary: rectal varices, portal gastropathy, acute on chronic rejection secondary:hiv, hepatitis c, cirrhosis, type ii diabetes mellitus, anemia 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: dear mr. , it was a pleasure caring for you during your stay at . you were admitted to the hospital because you were having rectal bleeding and your blood counts had dropped significantly, and you had a lot of swelling in your legs. you were initially in the icu receiving blood products and then monitored on the medical . on your third day of your admission you had a very large bloody bowel movememnt and your blood counts dropped and you were transferred back to the icu where you received more blood transfusions and you underwent two colonoscopies and one upper endoscopy. you were no longer having bloody bowel movements and transferred back to the floor. you had another episode of bleeding and underwent another colonoscopy on which did not see any areas of active bleeding. you were also noted to have worsening liver function tests and it was felt that this was a sign of rejection of your body against the liver transplant. we felt that there were no further treatment options to prevent this from progressing and palliative care became involved and helped to set you up with home hospice. transitional issues: you will be going home with hospice. we have stopped many of your medications as we are trying to get your medications just down to the few that you will need right now. your medications when you leave will be: followup instructions: please call dr. office with any questions about your medications or if you have any problems phone number is ( md procedure: other endoscopy of small intestine arterial catheterization colonoscopy colonoscopy flexible sigmoidoscopy central venous catheter placement with guidance diagnoses: cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute and subacute necrosis of liver acute kidney failure, unspecified hepatorenal syndrome portal hypertension unspecified acquired hypothyroidism unspecified viral hepatitis c without hepatic coma blood in stool infection with microorganisms without mention of resistance to multiple drugs other ascites encounter for palliative care do not resuscitate status complications of transplanted liver esophageal varices in diseases classified elsewhere, without mention of bleeding personal history of malignant neoplasm of liver surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation herpes simplex without mention of complication asymptomatic human immunodeficiency virus [hiv] infection status internal hemorrhoids without mention of complication carrier or suspected carrier of other specified bacterial diseases 

Answer: The patient is high likely exposed to