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: ciprofloxacin / levaquin / opioid analgesics attending: chief complaint: recurrent high fevers, htn, increased o2 req major surgical or invasive procedure: central venous catheter insertion history of present illness: 59 yo m w/ pmh esrd s/p renal tx in , on immunosuppressants, htn, dm who presented to osh with fevers/fatigue and tx to for concern of sepsis. he experienced fatigue after working outside in hot weather, and later that day, was noted to have a fever to 104. he went to hosp where he was febrile to 104. he was given levofloxacin and ivfs and transferred to where he was admitted to the icu for sepsis. . he denies current f/c/sweats. he denies cp/sob/cough. he denies n/v/abd pain. he denies dysuria. he denies uri sx/sore throat/myalgias. he denies lad/swelling/rash. . past medical history: 1. congestive heart failure with ef 65% on 2. type 2 diabetes with triopathy, controlled. 3. hypertension. 4. hypercholesterolemia. 5. history of seizure disorder. 6. history of hepatitis c - no therapy - bx -minimal portal and lobular mononuclear cell inflammation, consistent with involvement by chronic viral hepatitis c ( grade 1 activity). 7. end-stage renal disease, status post cadaveric renal transplant, creatinine 1.2-1.5 in . 8. peripheral disease. 9. post-op afib s/p dccv in 10. rt rectus femoris intramuscular hematoma - (inr 4.2) 11. ? enlarged ln in his neck s/p bx - 2-3 years ago, pt reports nl 12. ebv igg positive in /cmv igg positive . past surgical history: 1. right ak -pt with nonreversed saphenous vein on by dr. . 2. left av fistula. 3. cadaver renal transplant in . induction with thymoglobulin and tacrolimus 4. cholecystectomy. 5. parathyroidectomy in by dr. - path c/w hypercellular parathyroid 6. status post second toe amputation in . 7. right first toe amputation. 8. aortic valve replacement - well seated aortic bioprosthesis with high-normal gradient and trace aortic regurgitation (). social history: denies smoking; rare alcohol; distant h/o ivda (>40yrs ago). lives w/girlfriend who is a pt. family history: father, mother and brother w/ dm. father died of mi @54. mother died of stomach ca. physical exam: 1. congestive heart failure with ef 65% on 2. type 2 diabetes with triopathy, controlled. 3. hypertension. 4. hypercholesterolemia. 5. history of seizure disorder. 6. history of hepatitis c - no therapy - bx -minimal portal and lobular mononuclear cell inflammation, consistent with involvement by chronic viral hepatitis c ( grade 1 activity). 7. end-stage renal disease, status post cadaveric renal transplant in . 8. peripheral disease. 9. post-op afib s/p dccv in 10. rt rectus femoris intramuscular hematoma - (inr 4.2) 11. ? enlarged ln in his neck s/p bx - 2-3 years ago, pt reports nl 12. ebv igg positive in /cmv igg positive pertinent results: 07:13am blood wbc-5.8 rbc-3.87* hgb-9.4* hct-29.3* mcv-76* mch-24.3* mchc-32.1 rdw-25.6* plt ct-109* 06:02am blood neuts-72.4* bands-6.7* lymphs-9.5* monos-5.7 eos-4.8* baso-0 myelos-1.0* nrbc-2* 04:07am blood neuts-58 bands-2 lymphs-16* monos-14* eos-4 baso-0 atyps-0 metas-4* myelos-2* nrbc-3* 07:13am blood pt-11.6 inr(pt)-1.0 06:02am blood fibrino-677*# d-dimer-1004* 06:02am blood fdp-0-10 02:35am blood glucose-230* urean-42* creat-2.2* na-138 k-4.0 cl-103 hco3-22 angap-17 07:13am blood glucose-88 urean-28* creat-1.1 na-146* k-4.2 cl-114* hco3-26 angap-10 02:35am blood alt-25 ast-24 ld(ldh)-399* alkphos-55 totbili-0.5 06:02am blood ld(ldh)-387* totbili-0.4 12:40am blood probnp-* 02:35am blood albumin-3.1* calcium-7.9* phos-2.2* mg-1.7 07:13am blood calcium-8.4 phos-2.7 mg-2.3 06:02am blood caltibc-273 vitb12-378 folate-12.2 ferritn-201 trf-210 02:35am blood crp-59.5* 07:13am blood rapmycn-8.3 02:29am blood lactate-2.0 09:03pm blood lactate-1.5 12:40am blood aspergillus galactomannan antigen- test 03:05pm blood b-glucan-test 2:00 pm bronchoalveolar lavage site: lung right lung. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): ~9000/ml oropharyngeal flora. yeast. 10,000-100,000 organisms/ml.. fungal culture (preliminary): yeast. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (pending): nocardia culture (preliminary): no nocardia isolated. 1:44 pm bronchoalveolar lavage left lower lung. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. modified acid-fast stain for nocardia (final ): test cancelled by laboratory due to lack of branching gram positive rods in the gram stain. gram stain is an equally sensitive means of detecting nocardia in a primary specimen. culture may be a more sensitive means of detecting nocardia and should be considered. patient credited. respiratory culture (final ): oropharyngeal flora absent. yeast. ~/ml. legionella culture (final ): no legionella isolated. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). immunofluorescent test for pneumocystis carinii (final ): pneumocystis carinii not seen. fungal culture (preliminary): yeast. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (pending): nocardia culture (preliminary): no nocardia isolated. serology/blood cryptococcal antigen-final inpatient blood culture aerobic bottle-final; anaerobic bottle-final inpatient catheter tip-iv wound culture-final inpatient urine urine culture-final inpatient blood culture aerobic bottle-final; anaerobic bottle-final inpatient blood culture aerobic bottle-final; anaerobic bottle-final inpatient urine legionella urinary antigen -final inpatient blood culture aerobic bottle-final; anaerobic bottle-final emergency urine urine culture-final emergency echocardiogram on : left ventricle: mild symmetric lvh with normal cavity size and systolic function (lvef>55%). normal regional lv systolic function. no resting lvot gradient. impression: well seated aortic bioprosthesis with high-normal gradient and trace aortic regurgitation. pulmonary artery systolic hypertension. mild mitral regurgitation. if clinically indicated, a tee would be better able to define a structural abnormality involving the aortic valve. ct chest on : impression: 1. three parenchymal abnormalities new over six months, the largest in the left lower and two in the right upper and right middle lobes. given their nodular appearance and patient's symptoms of infection, nocardia infection would be the most likely diagnosis, especially for the left lower consolidation. alternatively, the two, smaller right lung lesions could be ptld. 2. cardiomegaly. status post aortic valve replacement and cabg. sternal dehiscence with peristernal fat stranding and collections might represent osteomyelitis. if this diagnosis is plausible clinically, mri or radionuclide scanning would be be helpful to confirm. echocardiogram on : conclusions: the left atrium is moderately dilated. the right atrium is moderately dilated. there is symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic arch is mildly dilated. a bioprosthetic aortic valve prosthesis is present and appears well-seated. the transaortic gradient is normal for this prosthesis. trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is mild functional mitral stenosis (mean gradient 4 mmhg) due to mitral annular calcification. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. no vegetation seen. renal transplant ultrasound on : impression: unremarkable renal transplant in the left iliac fossa with some mild fullness of the collecting system, which is reduced when compared with the previous ultrasound from . brief hospital course: # pneumonia: patient improved on vancomycin/meropenem started empirically for sepsis broad spectrum coverage. however, culture-data and fungal organism tests remained negative. he was therefore transitioned to oral levofloxacin and discharged on this regimen, with specific instruction to contact his physician immediately if he had recurrence of any symptoms or fevers. due to finding of incidental lung nodules, will repeat chest ct in 1 month. . # hypertension: continued metoprolol. . # renal transplant: initially with renal failure that resolved with treatment of sepsis and hydration. continued sirolimus and cellcept. . # dm - continued riss, standing insulin. . # prophylaxis: pantoprazole, pneumoboots for dvt prophylaxis, bowel medications as necessary. . # code: full code medications on admission: bactrim 400-80mg 1tab po daily cellcept 500mg 1tab po bid rapamune 1mg 1tab po daily prednisone 5mg 1tab po daily lamivudine 100mg 1tab po daily valcyte 450mg 1tab po daily ecotrin 325mg 1tab po daily florinef 0.1mg 1tab po bid folic acid 1mg 1tab po daily lasix 80mg po bid insulin nph 50u humalog insulin ss metoprolol 100mg 1tab po bid omeprazole 40mg 1tab po daily pravastatin 80mg 1tab po qhs viagra 50mg 1tab po daily prn discharge medications: 1. insulin glargine 100 unit/ml solution sig: seventy (70) units subcutaneous at bedtime. disp:*3 vials* refills:*2* 2. trimethoprim-sulfamethoxazole 80-400 mg 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. rapamune 1 mg tablet sig: one (1) tablet po once a day. 5. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 6. lamivudine 100 mg tablet sig: one (1) tablet po daily (daily). 7. ecotrin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 8. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 9. furosemide 40 mg tablet sig: one (1) tablet po twice a day. 10. insulin syringe-needle u-100 1 ml 31 x syringe sig: one (1) miscellaneous once a day. disp:*30 syringes* refills:*2* 11. metoprolol tartrate 100 mg tablet sig: one (1) tablet po twice a day. 12. pravastatin 80 mg tablet sig: one (1) tablet po once a day. 13. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 14. viagra 50 mg tablet sig: one (1) tablet po once a day as needed. 15. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. disp:*7 tablet(s)* refills:*0* 16. fosamax 70 mg tablet sig: one (1) tablet po once a week. discharge disposition: home discharge diagnosis: sepsis secondary diagnoses: chronic renal insufficiency renal transplant type 2 diabetes mellitus hypertension hypercholesterolemia gastroesophageal reflux disease discharge condition: vital signs stable, afebrile, breathing comfortably and tolerating po diet. discharge instructions: you were admitted for possible infection of the blood stream and also pneumonia. you were treated with iv antibiotics, and then switched to antibiotics by mouth. please complete the entire course of antibiotics as prescribed, even if you no longer have symptoms. if you notice fevers, chills, worsening cough, chest pain, shortness of breath, or lightheadedness, please call your physician or report to the emergency room. followup instructions: dr. would like to see you in the office in the next 2-3 weeks. his office will call you to let you know when the appointment will be scheduled. please call ( with any questions or concerns. you also have an appointment with dr. , md on at 8:30 am. please call ( with any questions or to change your appointment. you have been scheduled for a follow-up ct scan, because the one done while in the hospital had some findings that need to be followed up. the ct scan is scheduled for at 12:45 pm in clinical center, on . please call to reschedule your appointment or with any other questions or concerns. procedure: venous catheterization, not elsewhere classified closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified anemia in chronic kidney disease pure hypercholesterolemia congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma acute kidney failure, unspecified unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes peripheral vascular disease, unspecified chronic kidney disease, unspecified epilepsy, unspecified, without mention of intractable epilepsy heart valve replaced by transplant surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy 

Answer: The patient is high likely exposed to