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: history of present illness: the patient is a 54-year-old male with a history of congestive heart failure (with a recent admission in of this year), end-stage renal disease, status post kidney transplant times two (once in and once in ), status post pancreas transplant in who presented with a 4-day history of progressive diffuse abdominal pain and occasional nausea. the patient reports that prior to this episode he had been feeling well, but he started to develop some crampy abdominal pain followed by some dark watery stools over the past day prior to admission. he had been febrile with occasional chills and had poor oral intake for several days prior to admission. he denied any chest pain, shortness of breath, and any back pain. the patient presented for evaluation. past medical history is significant for a kidney and pancreas transplant in by dr. and a second kidney transplant in . also, the patient is disabled by his congestive heart failure and dyspnea on exertion but denies any history of liver disease. past medical history: (past medical history is significant for) 1. end-stage renal disease; status post renal transplant. 2. diabetes mellitus. 3. status post pancreas transplant. 4. congestive heart failure. 5. coronary artery disease. 6. hypertension. 7. history of atrial fibrillation. 8. peripheral vascular disease. 9. gastroesophageal reflux disease. past surgical history: (as noted above and includes) 1. status post left femoral-popliteal in situ saphenous vein bypass graft. 2. multiple arteriovenous fistulas for dialysis. 3. multiple amputations of his upper extremity digits secondary to severe peripheral vascular disease. medications on admission: (medications on admission included) 1. aspirin 81 mg p.o. once per day. 2. toprol-xl 25 mg p.o. once per day. 3. imdur 30 mg p.o. once per day. 4. lasix 80 mg p.o. twice per day. 5. plavix 75 mg p.o. once per day. 6. lipitor 10 mg p.o. once per day. 7. amiodarone 200 mg p.o. once per day. 8. avandia 2 mg p.o. twice per day. 9. prednisone 5 mg p.o. once per day. 10. cellcept mg p.o. twice per day. 11. sirolimus 2 mg p.o. once per day. 12. prilosec 20 mg p.o. once per day. 13. cardura 8 mg p.o. once per day. 14. epogen 8000 units three times per week. 15. niferex 150 mg p.o. once per day. allergies: gentamicin (which causes vertigo) and codeine (which causes some stomach upset). physical examination on presentation: physical examination revealed temperature was 102.6, heart rate was 80, and blood pressure was 130/70. the patient was in mild distress. he had diffuse crackles halfway up the bases. cardiovascular examination revealed a regular rate with a 1/6 systolic ejection murmur. the abdomen was distended, tense, and diffusely tender; but mostly tender in both lower quadrants. there was no hernia. rectal examination was guaiac-negative with normal tone. extremity examination revealed a left femoral scar with a monophasic right posterior tibial dopplerable signal. no left posterior tibial dopplerable signal. no dorsalis pedis pulses bilaterally. he had 2+ femoral pulses bilaterally. pertinent laboratory values on presentation: laboratories on admission revealed white blood cell count was 3.9, hematocrit was 28, and platelets were 170. blood urea nitrogen was 64 and creatinine was 2.8. liver function tests were within normal limits. urinalysis was negative. pertinent radiology/imaging: a computerized axial tomography done on the night of admission showed bilateral pleural effusions, large amounts of intra-abdominal ascites, and colonic wall thickening in the ascending and transverse colon and some of the proximal descending colon, but no evidence of obstruction. a chest x-ray was consistent with cardiomegaly and pulmonary vasculature congestion. electrocardiogram revealed a sinus rhythm with no ischemic changes. hospital course: the patient was admitted to the transplant surgery service. a hepatology consultation was obtained secondary to the tense ascites which was seen on the computerized axial tomography. he was also started on empiric antibiotics for the diffuse colonic thickening, though to be question colitis. an ultrasound-guided paracentesis was performed, and this was shown to be polymicrobial in the cultures. he was started on zosyn and treated for spontaneous bacterial peritonitis. also on initial evaluation, based on examination and the chest x-ray, there was evidence of worsening cardiac function and congestive heart failure. the patient was seen by the cardiology team who suggested continued diuresis with intravenous lasix. they also suggested starting a natrecor drip for augmentation of his urine output and following daily weights. this was initiated as well to help in treatment. by hospital day four, the cultures from the paracentesis had shown multiple organisms. at that point, the patient's examination had significantly improved, and his white blood cell count had risen to 12. the decision was made to take the patient to the operating room for an exploratory laparotomy. further details of this surgery are detailed in the operative note. in brief, there was thickening of the descending colon seen and multiple diverticula. a sigmoid colectomy was performed. a transverse colostomy and a hartmann's procedure were completed. postoperatively, the patient recovered in the surgical intensive care unit. his hemodynamics were optimized via a pa catheter. early in the postoperative course, the patient required pressor support to maintain mean arterial pressures of greater than 60. this was successfully weaned over the initial 24 hours postoperatively, and the patient's hemodynamics then stabilized. the patient was ruled out for a myocardial infarction via enzymes. the patient was initially kept intubated postoperatively. early on, he was weaned to pressure support and once sedation was off the patient was following commands. he was extubated on postoperative day one without incident. he has remained extubated since that time. the patient was started on total parenteral nutrition for nutrition. after several days postoperatively, the patient was started on post pyloric trophic tube feeds which he tolerated. the ostomy began to function with gas and small amounts of stool, and this was advanced accordingly while he was in the intensive care unit. the patient's renal function remained stable. his creatinine remained around 1.8 to 2 with adequate urine output. he was maintained on a natrecor drip to help with diuresis, and he was also continued on the lasix which was optimized using the pa catheter to avoid intravascular volume depletion. his blood sugars remained in good control; although he was covered occasionally with a regular insulin sliding-scale. the patient was continued on antibiotics postoperatively and had occasional low-grade temperatures, but otherwise his white blood cell count responded and decreased during the postoperative course. the patient's immunosuppression continued. he was on solu-medrol until adequate oral intake was achieved. the patient's sirolimus level was checked and adjusted accordingly, and the patient was continued on cellcept with a decrease in dose secondary to renal function. on postoperative day 10, the patient was transferred to the floor on a natrecor drip and remained in stable condition. the remainder of his hospital course was significant for the following events. on postoperative day 15, on examination the patient was found to have tense ascites and some abdominal pain. a computerized axial tomography was performed which showed tremendous amounts of ascites with decompressed bowel. he underwent an ultrasound-guided tap for 5 liters of ascites. this was supplemented with intravenous colloid to maintain intravascular volume. he tolerated this well. then, on postoperative day 23, the patient's spiked a temperature to 101.1. his white blood cell count remained at 4. blood cultures were sent. urine cultures were sent, which were negative to date. he underwent a second paracentesis which was consistent with spontaneous bacterial peritonitis. he was started on zosyn, and a follow-up tap done on postoperative day 27 showed resolution of the spontaneous bacterial peritonitis. also of note, the patient's renal function continued to steadily improve with a current creatinine of 1.6. the patient's urine output has remained adequate. the patient has been tolerating a diet and is supplementing this with cans of nepro nutrition supplements. the post pyloric tube was removed due to his adequate caloric intake. the patient's immunosuppressive regimen has been maintained and will be adjusted through the transplant office. the patient has been seen by physical therapy and will require additional physical therapy to aid in his recovery. in addition, the patient also underwent a peripherally inserted central catheter line placement for prolonged antibiotics secondary to his spontaneous bacterial peritonitis. discharge disposition: the patient is now stable and ready for discharge to rehabilitation. discharge diagnoses: 1. status post sigmoid colectomy, transverse colostomy, and hartmann's procedure for diverticulitis. 2. status post renal transplant. 3. status post pancreas transplant. 4. congestive heart failure with cardiac ascites. 5. renal insufficiency. 6. spontaneous bacterial peritonitis. 7. hypertension. 8. history of atrial fibrillation. 9. gastroesophageal reflux disease. medications on discharge: (medications on discharge included) 1. lasix 60 mg p.o. twice per day. 2. amiodarone 200 mg p.o. once per day. 3. avandia 2 mg p.o. twice per day. 4. imdur-xr 30 mg p.o. once per day. 5. atenolol 25 mg p.o. once per day. 6. lipitor 10 mg p.o. once per day. 7. aspirin 81 mg p.o. once per day. 8. plavix 75 mg p.o. once per day. 9. protonix 40 mg p.o. once per day. 10. colace 100 mg p.o. twice per day. 11. lactulose 30 cc p.o. four times per day as needed. 12. cardura 2 mg p.o. q.h.s. 13. insulin sliding-scale. immunosuppression medications include: 1. prednisone 5 mg p.o. once per day. 2. sirolimus 0.5 mg p.o. once per day. 3. cellcept mg p.o. twice per day (this will be on hold and will only be restarted if white count is greater than 3; and his current white count is 2.3). 4. bactrim single-strength one tablet p.o. on monday, wednesday, and friday. 5. .................... 450 mg p.o. once per day. discharge instructions/followup: 1. cellcept shall be held for a white count of less than 3. his current white count is 2.3, so no doses until it is rechecked on . 2. also, the patient should receive a hematocrit check on . 3. the patient will need daily weights, ins-and-outs, physical therapy, occupational therapy, and colostomy care teaching. 4. the patient was to follow up with dr. next week (on thursday) in clinic and should call the transplant office for an appointment. 5. the patient was also to follow up in the congestive heart failure clinic with dr. and should call for an appointment. 6. the patient can follow up with the renal medical team at the clinic. condition at discharge: the patient's condition on discharge was stable. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances percutaneous abdominal drainage pulmonary artery wedge monitoring open and other sigmoidectomy exteriorization of large intestine injection or infusion of nesiritide diagnoses: acidosis urinary tract infection, site not specified congestive heart failure, unspecified atrial fibrillation complications of transplanted kidney diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled pancreas replaced by transplant diverticulitis of colon (without mention of hemorrhage) 

Answer: The patient is high likely exposed to