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 47 year old female with type 1 diabetes status post kidney pancreas transplant in , status post cadaveric renal transplant on with dr. at , history of clostridium difficile toxic megacolon, status post subtotal colectomy , status post ileostomy reversal , and status post ventral hernia and pd catheter placed , most recently status post right ij permcath line changed over wire on , now with diffuse crampy abdominal pain since yesterday, which is , similar to one prior small bowel obstruction episode. no flatus nor bowel movement since yesterday. no fevers, cough. no vomiting. positive for nausea. regular bowel movements for 5 to 6 days. past medical history: type 1 diabetes, endstage renal disease, coronary artery disease, legally blind, osteopenia, history of zoster, hypertension, depression, gastroparesis, asthma, diarrhea, clostridium difficile, ejection fraction of 40%, mitral regurgitation on . past surgical history: coronary artery bypass graft status post pancreas transplant in , status post cadaveric renal transplant kidney , status post appendectomy, status post subtotal colectomy, ileostomy take down on , bilateral cataract surgery, bilateral vitrectomy, status post right open reduction internal fixation, status post ventral hernia/pd catheter . allergies: iodine. medications: 1. rapamune 4 mg once daily. 2. prednisone 5 mg once daily. 3. amiodarone 25 mg q od. 4. aspirin 81 mg once daily. 5. folate 1 mg once daily. 6. bactrim monday, wednesday and friday. 7. desipramine 150 mg once daily. 8. lopressor 100 mg b.i.d. 9. lipitor 10 mg once daily. 10. vasotec 15 b.i.d. 11. protonix. 12. multivitamins once daily. 13. hydralazine 50 mg b.i.d. 14. atrovent 2 puffs b.i.d. 15. exelon 2 b.i.d. 16. flovent 2 puffs b.i.d. 17. ventolin, predforte 1% one gt os q 3 days. 18. acular 0.5% one drop o.s. q 3 days. 19. zaditor ou p.r.n.. 20. alrex ou p.r.n.. 21. benadryl p.r.n.. 22. tylenol. 23. phoslo 667 t.i.d./ a.c. 24. norvasc 5 mg t.i.d. 25. ambien 5 mg p.r.n. 26. compazine p.r.n.. 27. claritin. 28. lomotil 2 to 3 q6. 29. colestid 2 b.i.d. 30. estrace 0.01% once daily. physical examination: vital signs: temperature 96.8, heart rate 81, blood pressure 113/82, respiratory rate 23, oxygen saturations 100% on room air. general: the patient is tired but awake. chest: clear to auscultation bilaterally. cardiovascular system: regular rate and rhythm. abdomen: bowel sounds present. nondistended. soft. well healed transplant scar. tender to touch left lower quadrant. rectal: guaiac negative. no masses or stool. normal rectal examination. laboratory data: white blood cell count 10.3, hematocrit 49.3, platelet count 199, neutrophils 67, lymphocytes 20, monocytes 40, eosinophils 8, sodium 145.0, 94, 25. bun and creatinine of 47, 5.8 to 0 104. alt 22, ast 55, alkaline phosphatase 126, amylase 45, lipase 72. the patient had a kub on , demonstrating probable small bowel obstruction, possible ascites, prompted to get a ct abdomen which demonstrated: 1) diffuse dilatation of small bowel loops, most consistent in appearance with ileus. small bowel obstruction is less likely, 2) there was a ventral hernia with small amount of fluid within the subcutaneous tissues. no bowel loops were identified within the hernia, 3) surgically absent colon, 4) transplanted kidney in the right lower quadrant, transplanted pancreas not well identified on this noncontrast examination. later that day ct abdomen with water soluble contrast enema was performed demonstrating 1) a patent ileoanal anastomosis, 2) obstructive narrowing located close to the ileoanal anastomosis which was most likely caused by adhesions. the patient for line access had a left subclavian line placement and x-rays confirmed that there was no pneumothorax, and that the catheter was in svc. on , an abdominal x-ray was obtained to assess any interval change in the partial small bowel obstruction demonstrating that there was partial improvement of small bowel obstruction. because there was a partial small bowel obstruction, ng tube was placed by radiology on , demonstrating satisfactory ng tube placement. also seen was bibasilar atelectasis. no pneumothorax. the patient on , was admitted to icu because of hypotension and responded well to boluses to maintain diastolics greater than 60, with more precautions to watch her overnight in the emergency room. the patient did have early temperatures. the patient was on levofloxacin and flagyl prophylactically. blood culture and urine culture obtained demonstrating no growth on , cmv was obtained demonstrating cmv, dna not detected. stool culture obtained which was unremarkable. while the patient was hospitalized the patient had dialysis 3 days a week. the patient received her first dialysis as an inpatient on this admission on . gi was consulted on , to evaluate whether or not endoscopic management of bowel obstruction secondary to anastomotic structure could be performed. nutrition was consulted because of diarrhea and on their recommendations the patient was continued wish ng tube. psychiatry saw her on , because of being overwhelmed by her diagnosis and "hysterical" and has a history of depression. on , the patient had a sigmoidoscopy demonstrating an ileosigmoid pouch with evidence of recent bleeding secondary to recent rigid scope. there were no active sites of bleeding. granulation tissue seen at the presumed area of the anastomosis. no actual opening was seen despite probing with biopsy forceps. the entire pouch was normal otherwise. the patient was transferred out of icu to regular floor on , with stable blood pressure, vital signs were stable. she was continued on levofloxacin and flagyl. the patient was continued on immunosuppressant medications which include rapamycin, prednisone, imuran and bactrim. the patient was potentially going to go to the or on , with a possible ileostomy versus anastomotic division. because the patient felt better, it was decided to hold off on surgery. the patient continued to have dialysis. the patient on , complained of some nausea. she was afebrile. vital signs stable, blood pressure was stable. the patient continued to be npo, iv fluids continued with good urine output. on , the patient was doing well clinically, so ng tube was removed. she was tolerating clears. the patient's diet was advanced. iv with hep-lock. since ng was removed, the patient still had nausea, vomiting, not tolerating po fluids; so the patient had a flexible sigmoidoscopy on , to evaluate the distal ileal luminal narrowing and flexible sigmoidoscopy with balloon dilatation. findings - 1) there was a high grade stricture noted at 20 cm from the anus; the scope could not traverse the lesion, 2) unable to pass a guidewire for balloon dilatation to the stricture due to sharp angulation high grade narrowing, 3) the mucosa of the colon up to 20 cm appeared normal. on , the patient went for a picc line placement and tpn was started to the left ij, and central line. on , another view of abdomen obtained to evaluate small bowel obstruction and findings demonstrated that there was interval worsening of small bowel obstruction since the prior examination. these findings were communicated to the primary team at the time if interpretation. it was decided that the patient probably would benefit from surgery. on , removal by right internal jugular permcath was performed and placing of left internal jugular permcath was performed by dr. . please see details in the operative note. then also on , the patient had exploratory laparotomy, lysis of adhesions, resection of ileorectal anastomosis, and ileoproctostomy because of ileorectal strictures performed by dr. and dr. assisted. please see details of the operation and operative note. postoperatively the patient was using a pca, npo. ng placed. the patient continued on rapamycin, prednisone and imuran. on , the patient went back to the or for malfunctioning catheter with removal of tunnel dialysis catheter, placement of tesio tunnel dialysis catheter with fluoroscopy performed by dr. . again please see details of that operation in the operative note. renal continued to see the patient for her elevated creatinine. physical therapy and occupational therapy were consulted. the patient continued to be npo. the patient had - drain placed. gi was consulted for ongoing very loose stools/ diarrhea and made recommendations. dr. was following the patient. the patient continued on tpn. his flagyl was discontinued on . he continued to be afebrile. vital signs stable. on , the patient had flatus, slight belching. the patient's diet was advanced slowly. because the patient had crampy abdominal pain on , abdominal x-ray was obtained demonstrating no definite features of mechanical or small bowel obstruction. on , ct of the abdomen was obtained because of acute abdominal pain status post bowel obstruction demonstrating, 1) persistent partial small bowel obstruction with minimally dilated loops of small bowel and an air fluid level. no focal transition point was identified. 2) there was also a 6 x 4.2 right adnexal fluid collection with drain in place within the fluid cavity, 3) subcutaneous fluid collection along the patient's incision. a smaller fluid collection at the level of the left upper lobe measuring 3.2 x 2.3 cm. a second fluid collection more inferiorly measures 5.7 x 2.5. this is smaller than on prior examination. also there was interval development of bilateral pleural effusions, right greater than left and diffuse subcutaneous edema. also there was a stable interval appearance of right pelvis renal transplant and pancreatic transplant within the mid abdomen and severe atherosclerosis was seen too. on , the patient's picc line was removed because of fevers. the patient was placed on vancomycin when fevers started prophylactically. cultures were obtained. blood cultures were obtained on , demonstrating staph coag negative, with sensitivities. also a swab culture from the abdomen was obtained demonstrating staph coag negative. picc line tip that was removed demonstrated that the organism was staph coag negative. renal was consulted because the peritoneal cavity catheter was instilled to 250 cc of pd fluid and then it was flushed and the fluid was sent off for culture because transplant team was concerned about questionable abscess/ peritonitis. dialysis fluid from , demonstrated gram positive cocci and the actual species was enterococcus faecium. the patient remained on vancomycin until sensitivities were demonstrated. linezolid was started on , since it was sensitive to the organism. tpn was discontinued. the patient was encouraged to eat, calorie counts were obtained. dilaudid was changed from iv to po dilaudid q3 to 4 hours p.r.n.. physical therapy continued to see the patient. the patient was having dressing changes daily, afebrile, vital signs stable. on linezolid. relatively good po intake with bathroom privileges. the patient does well overnight. the patient will be able to be discharged to home on , on the following medications: 1. hydralazine 50 mg b.i.d. 2. dilaudid 1 to 2 po q 3 to 4 hours p.r.n.. 3. tylenol 325 to 650 mg po q4 to 6 hours p.r.n.. 4. albuterol neb. 5. amlodipine 5 mg po b.i.d. 6. lipitor 10 mg once daily. 7. azathioprine 25 mg po q od. 8. calcium acetate 667 mg po t.i.d with meals. 9. desipramine hcl 1 to 2 mg po qhs. 10. diphenoxylate-atropine 2 tabs po b.i.d. 11. enalapril maleate 15 mg po b.i.d. 12. insulin sliding scale. 13. linezolid 600 mg q 12. the patient will need to take it for total of 2 weeks. the patient should take medications to . 14. also the patient will be taking lopressor 100 mg b.i.d. 15. protonix 40 mg q 24 hours. 16. the patient should take prednisone acetate 1% ophthalmology suspension. prednisone 5 mg q day. sirolimus 2 mg q day or it may change depending on the rapamune level on . 17. bactrim one tab every monday, wednesday and friday. 18. ursodiol 300 mg t.i.d. 19. zolpidem tartrate 5 to 10 mg po qhs. the patient should follow up with transplant surgery at . the patient needs to call transplant surgery immediately at for any fever, chills, nausea, vomiting, abdominal pain, decreased energy, change in bowel movement or urine output; and also if there any changes in skin color, question about her medications. the patient may or may not need labs every monday and thursday depending on the transplant coordinator. if she does, she needs to have them done every monday and thursday and have the results faxed to . final diagnoses: 1. abdominal pain secondary to small bowel obstruction. 2. bacteremia. 3. major surgical invasive procedures , removal of right ij permcath. 4. on , assessment with exploratory laparotomy with some adhesions and resection of the ileorectal anastomosis and ileo proctoscopy. 5. - status post removal of tunnel dialysis catheter and placement of tesio tunnel dialysis catheter. 6. status post placement and removal of picc line. condition on discharge: good. discharge disposition: the patient will need vna services to evaluate nutrition and just overall evaluation for home services. , procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other partial resection of small intestine hemodialysis venous catheterization for renal dialysis other and unspecified partial excision of large intestine flexible sigmoidoscopy flexible sigmoidoscopy transfusion of packed cells rigid proctosigmoidoscopy insertion of (naso-)intestinal tube injection or infusion of oxazolidinone class of antibiotics injection of locally-acting therapeutic substance into peritoneal cavity diagnoses: hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease bacteremia diarrhea infection and inflammatory reaction due to other vascular device, implant, and graft chronic vascular insufficiency of intestine complications of transplanted kidney mechanical complication of other vascular device, implant, and graft diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled gastroparesis profound impairment, both eyes, impairment level not further specified pancreas replaced by transplant peripheral autonomic neuropathy in disorders classified elsewhere 

Answer: The patient is high likely exposed to