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: codeine attending: chief complaint: fever, altered mental status major surgical or invasive procedure: none history of present illness: 47 y.o. male with multiple medical problems to include c/b gastroparesis, retinopathy with legal blindness, nephropathy with resultant kidney transplant in , c/b chronic rejection, htn, s/p mitral valve replacement with mechanical valve for endocarditis in , atrial fibrillation, gout and arthritis who was brought in by his wife for altered mental status for two days and a tempertaure to 101 orally. he had been complaining to his wife about a headache, lower back pain, muscle aches/cramps, and joint pains in his feet for the several days prior to admission. his wife also noticed that he had been having shaking chills and sweats. he reported having nausea and vomiting for the last two months, which has improved recently, but deniesd diarrhea. his daughter was recently sick with a viral illness, but otherwise, no sick contacts. ros otherwise negative. past medical history: -dm2 c/b diabetic nephropathy, diabetic retinopathy and diabetic neuropathy. -prosthetic mitral valve placed for endocarditis to a dental procedure -hypertension -hypercholesterolemia -chronic l ankle pain social history: married, lives with wife and two stepchildren. moved to from 3y ago. unemployed since foot fracture. denies tobacco, alcohol, other illicits. family history: non-contributory. physical exam: vitals: t 99.8 hr 83 bp 158/84 rr 15 sat 98% on ra general: sleepy, awakes to verbal stimulation, in no distress heent: right pupil 2mm, left 1 mm, minimally reactive to light, eomi neck: no stiffness, no cartoid bruits, no lad chest: lungs slear to asculatation and percussion heart: 2/6 systolic murmur at upper sternal border, lound s1 abd: + bowel sounds, non distended, soft, nt ext: good perioheral pulses, no edema, no open wounds neuro: oriented to person only, cn ii- xii motor function intact, no neck stiffness, motor strength equal bilaterally. pertinent results: 12:15am pt-47.0* ptt-40.0* inr(pt)-5.5* 12:15am plt count-287 12:15am hypochrom-1+ anisocyt-3+ poikilocy-1+ macrocyt-3+ microcyt-1+ 12:15am neuts-75.0* lymphs-15.8* monos-8.2 eos-0.6 basos-0.3 12:15am wbc-8.3 rbc-2.96* hgb-10.2* hct-28.9* mcv-98 mch-34.6*# mchc-35.4* rdw-22.3* 12:15am calcium-8.5 phosphate-3.7 magnesium-1.7 12:15am ck-mb-notdone ctropnt-0.01 12:15am alt(sgpt)-37 ast(sgot)-25 ck(cpk)-42 alk phos-149* amylase-23 tot bili-0.8 12:15am estgfr-using this 12:15am glucose-317* urea n-44* creat-1.9* sodium-133 potassium-5.4* chloride-102 total co2-18* anion gap-18 12:18am glucose-278* lactate-1.0 12:18am comments-green top 12:22am cyclsprn-199 01:07am urine rbc-0 wbc- bacteria-rare yeast-none epi-0 01:07am urine blood-neg nitrite-neg protein-30 glucose-100 ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 01:07am urine color-yellow appear-clear sp -1.012 01:07am urine gr hold-hold 01:07am urine hours-random 01:42am k+-5.5* 01:42am comments-green top 03:48am glucose-234* 03:48am glucose-245* urea n-43* creat-1.8* sodium-135 potassium-4.7 chloride-106 total co2-19* anion gap-15 05:49am glucose-82 05:49am comments-green top 05:49am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 05:49am ck-mb-notdone ctropnt-0.01 05:49am ck(cpk)-48 09:03am urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 09:03am urine hours-random 12:32pm type-art temp-37.3 po2-104 pco2-42 ph-7.42 total co2-28 base xs-2 intubated-not intuba 01:06pm pt-50.4* ptt-41.7* inr(pt)-6.0* 01:06pm plt count-333 01:06pm wbc-8.0 rbc-2.99* hgb-9.8* hct-28.1* mcv-94 mch-32.9* mchc-34.9 rdw-21.9* 01:06pm acetone-negative 01:06pm albumin-3.6 calcium-8.8 phosphate-2.3* magnesium-1.9 01:06pm ck-mb-3 ctropnt-0.01 01:06pm alt(sgpt)-31 ast(sgot)-19 ld(ldh)-330* ck(cpk)-39 alk phos-133* tot bili-0.7 01:06pm glucose-165* urea n-36* creat-1.6* sodium-138 potassium-4.9 chloride-107 total co2-23 anion gap-13 02:25pm urine rbc-2 wbc-5 bacteria-none yeast-none epi-0 02:25pm urine blood-neg nitrite-neg protein-100 glucose-tr ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 02:25pm urine color-straw appear-clear sp -1.010 02:25pm urine osmolal-410 02:25pm urine hours-random 05:27pm pt-25.4* ptt-32.9 inr(pt)-2.6* 05:27pm tsh-1.4 05:27pm vit b12-242 folate-9.7 05:27pm albumin-3.6 calcium-9.3 phosphate-2.4* magnesium-1.7 05:27pm lipase-24 ggt-137* 05:27pm alt(sgpt)-30 ast(sgot)-21 ld(ldh)-342* ck(cpk)-105 alk phos-128* amylase-32 tot bili-0.7 05:27pm glucose-109* urea n-32* creat-1.5* sodium-139 potassium-4.7 chloride-104 total co2-22 anion gap-18 05:27pm glucose-109* urea n-32* creat-1.5* sodium-139 potassium-4.7 chloride-104 total co2-22 anion gap-18 05:56pm lactate-2.3* 09:51pm lactate-0.8 09:51pm type-art po2-50* pco2-46* ph-7.38 total co2-28 base xs-0 11:35pm pt-34.1* ptt-37.4* inr(pt)-3.7* 11:35pm plt count-330 11:35pm wbc-8.4 rbc-2.98* hgb-9.7* hct-29.0* mcv-97 mch-32.6* mchc-33.5 rdw-22.2* 11:35pm calcium-8.9 phosphate-3.0 magnesium-1.8 11:35pm glucose-40* urea n-27* creat-1.3* sodium-142 potassium-4.5 chloride-109* total co2-24 anion gap-14 . renal allograft needle biopsy (): chronic allograft nephropathy. . renal us (): mildly elevated resistive indices. no hydronephrosis. . cxr (): no failure or infiltrates are present. . mra brain (): 1. there is no change compared to and the abnormalities visible on today's mri appear to have been present on the ct of . 2. as noted previously, there is stable cortical and subcortical t2 hyperintensity involving the occipital poles, perhaps related to transplantation rejection medication. 3. there may be a small, old superior right frontal cortical infarct, unchanged. 4. there are ischemic lesions in the cerebral white matter and probably old white matter infarcts in the centrum semiovale bilaterally. . mr (): 1. the study is limited by patient motion. 2. there is a superior 3-mm projection of flow from the anterior communicating artery and a small aneurysm cannot be excluded. a repeat study is recommended when the patient can be more cooperative. 3. there is a questionable stenosis at the level of the proximal right p2 segment, but if real, this does not appear to be hemodynamically significant, given that there is good, symmetric distal flow. . ct chest/abdomen/pelvis (): 1. no ct evidence of acute process within the chest, abdomen or pelvis. 2. endotracheal tube positioned in the right mainstem bronchus, tube should be pulled back for proper positioning. 3. bilateral pleural effusions with adjacent compressive atelectasis. 4. trace ascites and free fluid within the abdomen and pelvis. . mr /l-spine (): 1. essentially unremarkable examination of the entire spine, with no evidence of vertebral osteomyelitis, discitis or epidural or paraspinal abscess. 2. t12-l1: small central protrusion with no evidence of neural impingement. brief hospital course: 47 y.o. male with mmp admitted to the for mental status change. the following issues were investigated during this hospitalization: . # fever/altered mental status - pt. was admitted to the where an extensive infectious workup yielded negative blood and urine cultures, an unremarkable lp with cultures negative for legionella, negative serologies for lyme, rpr and toxoplasma and nasal aspirates negative for influenza. he was called out to the general medicine floor on to finish an empiric course of ceftriaxone 1 mg iv q24 for a cns infection (questionable, but being treated as the results of all other workups were negative). on transfer to the floor, the patient was awake, alert, oriented x 3 and communicative. however, the following day he became febrile to 101.2 axillary (pt. was delirious and thus unable to cooperate with po temperature)and his coverage was broadened to vancomycin to empirically cover mrsa in this patient with multiple hospitalizations as well as zosyn to cover pseudomonas given his recent intubation in the . since his antibiotic coverage at this point was at best, empiric, given the negative cultures, antibiotics were stopped completely. concurrently, the patient was being weaned off of cyclosporine, which was thought to perhaps be contributing to encephalopathy. while off both the antibiotics and cyclosporine, the patient remained afebrile and his mental status improved to eventually no longer requiring restraints or frequent ativan and being well-related and polite. the etiology of the fevers and altered mental status were unclear, but thought to be multifactorial and shown to resolve with withdrawal of many of his medications. . # renal: pt. was s/p transplant complicated by chronic rejection with a baseline creatinine of 2.0. on admission, he was on cyclosporine, but after an inconclusive encephalopathy work-up, this was weaned off out of concern for cyclosporine-induced encephalopathy. simultaneously, the patient was started on rapamune. once cyclosporine had been completely weaned off, rapamune was increased to 3 mg. coincidentally, the patient's creatinine was noted to rise at this time, reaching a maximum of 5.3. a kidney transplant biopsy showed chronic rejection, but no evidence of acute rejection. urine electrolytes were consistent with a prerenal etiology and thus, diuretics were discontinued and the patient was encouraged to take po. because of continuously rising creatinine, rapamune was discontinued and eventually stopped completely with gradual resolution of the acute renal failure. on discharge, the patient's creatinine was approaching baseline. the patient was discharged with instruction to follow up in renal clinic for further management and eventual reinitiation of rapamune. . # dm: the patient was followed by diabetes consultants who made many adjustments to the patient's insulin regimen in an effort to accommodate for tube feeds initially and a steroid course, initiated for gout. the patient was discharged on the most current insulin regimen. . # gout: pt. developed polyarticular gout in the icu and was followed by rheumatology. a course of steroids were started, but maintenance agents such as allopurinol were not started given the chronic kidney disease. on transfer to the floor, the patient was finishing a steroid taper and 2 days after the completion of this taper, experienced another flare of gout, involving his left hand. he was continued on morphine and restarted on prednisone 20 mg, which had been tapered down to 15 mg at the time of discharge. additionally, the patient was started on colchicine, with good effect. . # atrial fibrillation/mechanical heart valve: shortly after transfer to the medical floor, the patient went into atrial flutter with rvr, necessitating a transfer to the cardiac intensive care unit. however, upon arrival to the floor, he spontaneously converted into sinus rhythm and remained in a sinus rhythm overnight. the following day, he was transferred to the medical floor where he remained for the rest of his hospitalization. he was monitored on telemetry and experienced episodes of atrial fibrillation, which were rate-controlled with stable vital signs. . the patient was on coumadin on arrival to the hospital. however, because of an inr of 6.0 on admission and because of procedures in the icu, his coumadin was held. eventually, the patient was started on a heparin drip with a bridge to coumadin. once coumadin was restarted, the patient's inr quickly increased to a maximum of 7.8. this was cautiously reversed with 1 mg of vitamin k, resulting in a drop to 2.8. the patient was discharged with instructions to continue his outpatient dose of coumadin, starting the following day. . # anemia: patient has a history of anemia, thought to be due to chronic kidney disease. during this hospitalization, he was maintained on his outpatient dose of epogen 10,000 units mwf . # htn: patient's blood pressure was controlled with his outpatient regimen of amlodipine, labetalol and diltiazem. medications on admission: sandimmune 50 mg azothiaprine 50 mg qpm prednisone 10 mg qd labetolol 400 mg tid norvasc 2.5 mg qd diltiazem xr 240 mg qpm zestril 5 mg qd lasix 20 mg prn insulin lantus 20 u qam and 15 u qpm novalog insulin sliding scale protonix 40 mg qd calcitrate 600d 600 mg qd reglan 5 mg androgel 1 pack qd ativan 1 mg qhs coumadin 5 m/w/f/sun, 7.5 t/th/sat discharge medications: 1. epoetin alfa 10,000 unit/ml solution : one (1) injection qmowefr (monday -wednesday-friday). disp:*30 doses* refills:*2* 2. acetaminophen 325 mg tablet : one (1) tablet po q4-6h (every 4 to 6 hours) as needed for fever. 3. cyanocobalamin 500 mcg tablet : two (2) tablet po daily (daily). disp:*120 tablet(s)* refills:*2* 4. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). disp:*60 tablet,rapid dissolve, dr(s)* refills:*2* 5. labetalol 200 mg tablet : four (4) tablet po tid (3 times a day). disp:*360 tablet(s)* refills:*2* 6. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po bid (2 times a day). disp:*60 tablet, rapid dissolve(s)* refills:*2* 7. diltiazem hcl 90 mg tablet : one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*2* 8. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. disp:*30 tablet(s)* refills:*0* 10. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 11. colchicine 0.6 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. amlodipine 5 mg tablet : two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 13. mycophenolate mofetil 500 mg tablet : one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 14. calcium acetate 667 mg capsule : two (2) capsule po tid w/meals (3 times a day with meals). disp:*180 capsule(s)* refills:*2* 15. furosemide 40 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 16. morphine 15 mg tablet : one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 17. prednisone 10 mg tablet : 1.5 tablets po once a day. disp:*45 tablet(s)* refills:*2* 18. outpatient lab work please have your cbc, electrolytes, bun, creatinine, pt/ptt/inr checked on monday, 19. insulin continue with 23 units of glargine at bedtime with frequent fingersticks and sliding scale novalog as needed 20. insulin syringe ml 28 x syringe : asdir syringe miscellaneous once a day: please use as directed per home regimen. disp:*60 syringes* refills:*2* 21. humalog 100 unit/ml solution : as directed units subcutaneous four times a day: please take the required amount of units, as called for by sliding scale provided. . disp:*1 bottle* refills:*2* 22. lantus 100 unit/ml solution : twenty three (23) units subcutaneous at bedtime: take 23 units at bedtime. . disp:*1 bottle* refills:*2* discharge disposition: home with service facility: gentiva discharge diagnosis: primary - fever of unknown origin encephalopathy, presumed to be secondary to cyclosporine acute on chronic renal failure secondary to rapamune gouty flare secondary - dm1 c/b gastroparesis retinopathy with legal blindness nephropathy with resultant kidney transplant in , c/b chronic rejection htn s/p mitral valve replacement with mechanical valve for endocarditis in atrial fibrillation gout arthritis discharge condition: stable, afebrile, inr<4.0 discharge instructions: -continue to take your medications as prescribed -do not take coumadin until you have your pt/ptt/inr checked on monday -please follow-up with dr. next wednesday in clinic and please have labs drawn prior to the visit and called in to dr. you epxerience any fevers/chills, worsening gout symptoms, bleeding from any source, or any other concerning symptoms, please seek medical attention immediately followup instructions: provider: . phone: date/time: 9:30 provider: , m.d. phone: date/time: 3:00 provider: phone: date/time: 9:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [percutaneous] [needle] biopsy of kidney transfusion of packed cells transfusion of other serum diagnoses: anemia in chronic kidney disease unspecified pleural effusion toxic encephalopathy unspecified essential hypertension gout, unspecified atrial fibrillation unspecified fall antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury hyperosmolality and/or hypernatremia other and unspecified coagulation defects complications of transplanted kidney diabetes with ketoacidosis, type i [juvenile type], uncontrolled legal blindness, as defined in u.s.a. 

Answer: The patient is high likely exposed to