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: patient recorded as having no known allergies to drugs attending: chief complaint: end stage liver disease;primary sclerosing cholangitis with resulting cirrhosis. major surgical or invasive procedure: :living unrelated liver transplantation with right hepatic artery to right hepatic artery donor recipient. :revision of roux-en-y hepaticojejunostomy to right anterior hepatic duct, tru-cut biopsy of the liver, intraoperative ultrasound, oversewing of right posterior hepatic duct. history of present illness: mr. is a 47-year-old male with a history of primary sclerosing cholangitis. he initially presented to us approximately 1-year ago where he was taken to the operating room for a laparoscopic cholecystectomy and liver biopsy. at that time, his symptoms were consistent with cholecystitis and it was thought that a cholecystectomy would overall improve his sense of well-being. the liver biopsy that time demonstrated stage iii stage iv fibrosis and he had no postoperative complications. he has been followed by the transplant center for the past year, during which time he has had a developed increasing jaundice and fatigue, and now presents for a live unrelated liver transplantation. past medical history: pmh: 1) primary sclerosing cholangitis (psc) - diagnosed in ; secondary liver disease, as noted in liver biopsy results from (above), with evidence of portal and peri-portal fibrosis with focal nodule formation 2) s/p cholecystectomy, 3) s/p nasal polypectomy - approximately 4 years ago (dr. ; no significant history of sinus symptoms 4) h/o anal fistula - 15 years ago; s/p repair 5) hyperlipidemia (not currently on lipid-lowering agents) 6) h/o of "bilateral interstitial pneumonia", in , rx.'d with azithromycin, followed by clarithromycin social history: married (for 14 years), lives with wife and 4 children, in , . no known tuberculosis contacts. employed as a retail pharmacist. no history of smoking. previous occasional social etoh consumption for the past 10 years (although admits to heavier etoh consumption during college years), but none since diagnosis of psc (). family history: paternal grandmother diagnosed with primary biliary cirrhosis at age y/o. father deceased secondary to glioblastoma. mother currently alive (age 74 y/o) and well, with hypertension. older brother (2 years older), with hepatitis c (for the past 2 years), but currently otherwise healthy. four children (4 sons), all healthy (ages range from 2 y/o to 8-1/2 years old). physical exam: preop exam per documentation: on physical examination, his blood pressure is 115/84, pulse 80, respirations 20, temperature is 98.8, and his weight 153 pounds. his chest is clear to auscultation and percussion bilaterally. cardiac exam is regular rate and rhythm murmur. his abdomen is soft, nontender, and nondistended. he does have both hepatomegaly and splenomegaly. i do not appreciate any significant ascites. his trocar incisions from the laparoscopic cholecystectomy has well healed nicely. there is no wound breakdown or discharge. his femoral pulses are 2+ and equal bilaterally. he has no peripheral edema. pertinent results: 05:47am blood wbc-7.3 rbc-3.00* hgb-9.3* hct-28.1* mcv-94 mch-30.9 mchc-33.0 rdw-18.3* plt ct-331 05:47am blood alt-66* ast-40 alkphos-880* totbili-11.4* 05:47am blood glucose-146* urean-46* creat-1.8* na-132* k-5.0 cl-101 hco3-21* angap-15 05:58am blood pt-14.7* ptt-25.9 inr(pt)-1.4 07:56pm blood glucose-179* urean-9 creat-0.7 na-144 k-3.8 cl-104 hco3-25 angap-19 07:56pm blood alt-748* ast-939* alkphos-250* amylase-23 totbili-9.4* dirbili-6.3* indbili-3.1 07:05pm blood ebv pcr, quantitative, whole blood- test 10:16am blood wbc-3.1* rbc-3.75* hgb-11.9* hct-34.7* mcv-93 mch-31.8 mchc-34.3 rdw-16.7* plt ct-191 11:45am ascites wbc-1500* rbc-* polys-99* lymphs-0 monos-1* 05:03pm ascites totbili-142 09:38am ascites totbili-119.0 04:00pm ascites totbili-21.3 12:25pm ascites totbili-8.9 06:58pm ascites totbili-7.1 08:49pm other body fluid totbili-33.8 microbiology 10:35 am bile medial t. tube. viridans streptococci. heavy growth. enterococcus sp.. heavy growth. staphylococcus, coagulase negative. moderate growth. gram positive rods. moderate growth. unable to id further. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ =>32 r chloramphenicol------- 8 s levofloxacin---------- =>8 r penicillin------------ =>64 r vancomycin------------ =>32 r vre 8:00 am bile kluyvera species. heavy growth _________________________________________________________ kluyvera species | cefazolin------------- 16 i ceftazidime----------- <=1 s ceftriaxone----------- <=1 s gentamicin------------ <=1 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s 10:39 pm blood culture enterobacter cloacae. final sensitivities. _________________________________________________________ enterobacter cloacae | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin----------<=0.25 s meropenem-------------<=0.25 s piperacillin---------- =>128 r tobramycin------------ <=1 s 8:30 am blood culture cvl. kluyvera species. _________________________________________________________ kluyvera species | cefazolin------------- 16 i ceftazidime----------- <=1 s ceftriaxone----------- <=1 s gentamicin------------ <=1 s levofloxacin----------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s 8:30 am blood culture: kluyvera species. 11:45 am peritoneal fluid & peritoneal clot. fluid culture enterococcus faecium vancomycin------------ =>32 r vre 7:05 pm immunology (cmv) cmv dna not detected. liver biopsies: procedure date tissue received report date diagnosed by fragmented biopsy with few portal areas showing mild mononuclear cell inflammation. focal bile duct proliferation with associated neutrophils; cannot rule out biliary obstruction. no evidence of acute cellular rejection. prominent cholestasis. indeterminate for acute cellular rejection; bile duct proliferation and cholestasis cannot exclude biliary obstruction. mild acute cellular rejection;mild cholangitis with bile duct proliferation;mild cholestasis consistent with harvest injury. mild acute cellular rejection with endotheliitis; mild cholestasis; the degree of rejection moderate acute cellular rejection with mixed portal inflammation with predominantly mononuclear cells, scattered neutrophils, portal venular endothelialis, and focal central venular endothelialitis; cholestasis, central. radiology: ct abdomen w/o contrast 9:04 pm impression: in comparison with the most recent ct of , the large contrast- containing fluid collection has resolved. no large fluid collections are identified within the abdomen and pelvis, limited examination due to lack of oral or iv contrast. duplex dopp abd/pel 1:47 pm impression: patent hepatic vasculature with normal doppler waveforms as above. interval decrease in previously evident mild biliary ductal dilatation change perc biliary drainage catheter 11:44 am a pull-out cholangiogram was performed outlining free passage into the jejunum from the bile duct. the 6.3 biliary drainage catheter was then placed across the anastomosis with good results and free passage of contrast material into the jejunal limb. duplex dopp abd/pel 2:31 pm impression:patent intrahepatic vasculature, as discussed above. tube cholangiogram 7:27 am biliary cath check 1. antegrade cholangiogram to both biliary drains demonstrates no evidence of leak. the anastomosis is widely patent. 2. successful exchange of biliary drain to new 8-french catheter. we plan to down-size it to a 6-french biliary drain in the next few days. 3. injection of contrast through the j-p drain fails to demonstrate communication with the biliary tree. mrcp (mr abd w&w/oc) 6:17 am overall unchanged appearance of the biliary system. there is no evidence of worsening biliary ductal dilatation. there has been interval placement of three biliary catheters, and both the fluid signal intensity lesions within the liver, as well as regions of focal arterial enhancement in the peripherqal zone (not present 10 days ago) probably relates to post- traumatic and hyperemic effects from the recent manipulation. follow up examination may be performed in six months, or as otherwise clinically indicated; both the native and recipient hepatic arteries demonstrate good vascular filling, although the evaluation of the anastomosis is again limited by technical factors; decrease in the amount of ascites and there is less fluid in the region of the hepatic hilum biliary stricture dilation no stent 7:34 am we were able to communicate the right posterior biliary system to the bile duct; successful balloon dilatation of the distal segment of the right posterior duct; successful placement of an 8-french biliary drain going through the anastomosis into the bowel; no evidence of leak was seen. tube cholangiogram 7:35 am impression: right anterior biliary tree system demonstrating free flow of contrast into the jejunum without evidence of narrowings, obstruction, or extravasation of contrast; catheter within the right posterior biliary tree system which does not demonstrate any communication with the right anterior biliary duct system nor does it drain into the jejunum. no evidence of biliary duct dilatation or leakage of contrast from the right posterior biliary duct system. intro perc transhepatic stent 9:10 am status post percutaneous transhepatic biliary drainage of 3 segmental ducts, one of which was accomplished with passage through the obstruction near the region of the anastamosis. two catheters are in place for external drainage only .approximately, 120 ml of bile was evacuated from the subhepatic space through the pigtail catheter. chalnagiography via existing catheter 7:29 am impression: 1. contained leak identified along the medial cut surface of the liver which appears to connect to the smaller contained leak identified on the prior cholangiogram. there is internal drainage from this contained leak into the bowel. 2. second perihepatic contained leak identified along the inferior and lateral margin of the liver, which appears to connect to the other contained leakage collections. 3. biliary tree partially opacified due to probable retrograde filling from the bowel. compared to the prior cholangiogram, the biliary tree is not visualized to the same extent, likely secondary to injection of contrast via the more medially located t-tube, with the tip appearing to be located within the most medially contained leak. ct abdomen w/contrast 1:44 pm impression: 1) compared to the previous exam of , there is a new bilious fluid collection tracking along the undersurface of the liver parenchyma, which drains into a larger pocket of fluid within the right flank. as described above, this fluid collection was subsequently drained and a 10 french drainage catheter was placed. 2) interval increase in the amount of abdominal ascites. a diagnostic paracentesis was also performed, as discussed above. the fluid was subsequently sent for a bilirubin level. 3) a triphasic scan through the liver demonstrates patent hepatic arteries, portal veins and hepatic veins. liver or gallbladder us (single organ) 8:15 am impression: 1). patent intrahepatic vasculature, as described above. 2). mild intrahepatic ductal dilatation. 10:57 am ct abdomen w/contrast; ct pelvis w/contrast impression 1. diffuse dilatation of both the large and small bowel. no transition point is identified, and this is consistent with an ileus. no free air or bowel wall inflammation is identified. a metallic density in the left lower quadrant small bowel is likely surgical suture, clinical correlation recommended. 2. a small-to-moderate amount of ascites which is slightly increased when compared to previous study. 11:34 pm ct abd w&w/o c; ct pelvis w/contrast reason: r/o biloma, abscess impression: 1) small amount of perihepatic fluid and small right-sided pleural effusion consistent with prior ultrasound. 2) periportal edema. 3) patent hepatic vasculature. 4) small wedge shaped area of hypodensity in the anterior aspect of the transplant liver which could represent an area of relative . t-tube cholangio (post-op) impression: 1) slow contained leak of contrast extending from the anastomosis. 2) no evidence of stricturing, obstruction, or intrahepatic biliary ductal dilatation 8:21 am us abd limit, single organ; duplex dopp abd/pel impression: 1. patent hepatic vasculature, as discussed above, with improved appearance of the hepatic arterial waveforms compared to the exam of . 2. persistent perihepatic ascites and right pleural effusion. duplex dopp abd/pel 8:35 am status post liver transplant, postoperative day #1;evaluate vasculature. impression: 1) patent hepatic vasculature; trace perihepatic ascites; probable small right pleural effusion. brief hospital course: the patient is a 47-year- old male who underwent a living donor right hepatic lobe liver transplant on . the patient subsequently has developed evidence of hepatic artery stenosis requiring stenting of the hepatic artery, and a bile leak demonstrated on cholangiography. on he therefore underwent a revision of roux-en-y hepaticojejunostomy to right anterior hepatic duct, tru-cut biopsy of the liver & oversewing of right posterior hepatic duct. hospital course complicated by vre in infected acsites, treated , as well as bactermeia/sepsis treated, (see microbiology for details); also has rejection of his transplant which on the last biopsy prior to dc showed mild inflammation but no longer an acute rejection. medications on admission: had included multivitamins, actonel 35 mg once a week, actigall 500 t.i.d., pancreas one t.i.d., vitamin d four hundred units once a day, calcium, and peptamen discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily) for 2 weeks. 3. insulin regular human 100 unit/ml solution sig: one (1) injection per sliding scale. 4. oxycodone hcl 5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*60 tablet(s)* refills:*0* 5. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 6. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). 7. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 8. valganciclovir hcl 450 mg tablet sig: two (2) tablet po daily (daily). 9. outpatient lab work labs every monday and thursday: cbc, chem 10, alt, ast, alk phos, t. , albumin, pt, ptt, prograf (tacrolimus)trough level. fax results to transplant ctr 10. ursodiol 300 mg capsule sig: one (1) capsule po tid (3 times a day). 11. fluconazole 200 mg tablet sig: two (2) tablet po q24h (every 24 hours). 12. mycophenolate mofetil 500 mg tablet sig: two (2) tablet po bid (2 times a day). 13. tacrolimus 1 mg capsule sig: 1.5 capsules po bid (2 times a day) for 2 doses. 14. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). 15. white petrolatum-mineral oil cream sig: one (1) appl topical prn (as needed). discharge disposition: home discharge diagnosis: s/p living unrelated liver transplant, complicated by biliary leak, exploratory laparotomy with revision roux-en-y anastomosis, ptc bile drains. liver rejection, treated vre in ascites discharge condition: stable/ fair discharge instructions: call transplant office if any fevers, chills, nausea, vomiting, inability to take medicines, abd pain, increasing jaundice, abdominal pain, lack of drainage from drains or if bile drain pulls out. followup instructions: provider: , md where: lm center phone: date/time: 11:00 provider: , md, phd: lm center phone: date/time: 11:10 provider: , md, phd: lm center phone: date/time: 11:00 please obtain cbc, chem 10 ast, alt, alk phosph, albumin, t. , and prograf every monday and thursday. please either come to lmob basement or go to a local facility to have blood drawn. make sure facility faxes the results immediately to procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver colonoscopy other transplant of liver other cholangiogram other percutaneous procedures on biliary tract anastomosis of hepatic duct to gastrointestinal tract injection or infusion of oxazolidinone class of antibiotics percutaneous extraction of common duct stones repair of other bile ducts transplant from live non-related donor diagnoses: other postoperative infection cirrhosis of liver without mention of alcohol unspecified protein-calorie malnutrition hemorrhage complicating a procedure bacteremia paralytic ileus complications of transplanted liver cholangitis other and unspecified coagulation defects 

Answer: The patient is high likely exposed to