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: sulfa (sulfonamide antibiotics) / shellfish derived / monosodium glutamate / heparin agents attending: chief complaint: chief complaint: diarrhea . reason for micu transfer: hypotension major surgical or invasive procedure: ? history of present illness: ms is a 40 year-old female with type i dm, esrd s/p lurt with recent acute cellular rejection who presented for repeat renal transplant biopsy today and was found to be hypothermic and hypotensive. she had 20 bouts of watery diarrhea yesterday. she developed belly aches three days prior to admission. . she had been admitted from to and was treated for a presumed uti with ciproflocin. prior to that, he had an admission for acute cellular rejection with atg and pulse steroids. . in the ed, initial vitlas were 96 73 100/55 18 100% ; his exam was significant for hypothermia, hypotension, diffuse "aches" but no central foci of pain, dry mm. she was found to have dka with a anion gap of 14 and glucose in the 300s (400s in the field) and elevated lactate. l subclavian placed. svo2 92. cvp 8-12. ekg sr w/ qtc 501. she was given dexamethasone 10mg iv once, 250 cc d51/2ns w/ 10meq k, vancomycin 1g iv once, zosyn 2.25mg iv once, flagyl 500mg iv once, insulin 10 u regular iv once, insulin gtt 7u/hr gtt, levophed gtt, fentanyl 50mg once. total 5l ivf. . on arrival to the micu, she complained of mild low back pain. she had not had diarrhea for several hours. . review of systems: (+) per hpi (-) denies fever night sweats, recent weight loss or gain. denies headache. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - renal transplant : living un-related donor - esrd chronic dmi - dm1 social history: -lives in bermuda flys to for renal evals -works as a dietician. -tobacco history: none -etoh: none -illicit drugs: none family history: the patient has no family history of diabetes or chronic kidney disease. physical exam: general appearance: well nourished, no acute distress eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic lymphatic: cervical wnl, supraclavicular wnl, no(t) cervical adenopathy tmax: 37.4 ??????c (99.3 ??????f) admission physical exam: tcurrent: 35.9 ??????c (96.7 ??????f) hr: 80 (74 - 91) bpm bp: 130/83(92) {100/50(63) - 146/89(96)} mmhg rr: 14 (6 - 17) insp/min spo2: 100% heart rhythm: sr (sinus rhythm cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: clear : ), no wheezing, ronchi or crackles abdominal: soft, non-tender, bowel sounds present, renal graft llq is nontender to palpation extremities: right lower extremity edema: absent, left lower extremity edema: absent skin: warm, facial erythematous patches neurologic: attentive, follows simple commands, responds to: not assessed, movement: not assessed, tone: not assessed, cn ii-12 in tact; strength 5/5 in upper and lower extremities bilaterally, a and o times three . discharge physical exam: afebrile, vss regular rate and rhythm, no murmurs lungs clear bilaterally without rales abdomen soft and non-tender no peripheral edema pertinent results: admission labs: 08:56pm urine color-straw appear-hazy sp -1.006 08:56pm urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 08:56pm urine rbc-2 wbc-47* bacteria-few yeast-few epi-<1 08:56pm urine hyaline-1* 08:56pm urine mucous-rare 05:14pm glucose-146* urea n-33* creat-5.0* sodium-132* potassium-3.9 chloride-114* total co2-6* anion gap-16 05:14pm calcium-7.4* phosphate-3.8 magnesium-1.9 04:48pm type-art po2-60* pco2-22* ph-7.08* total co2-7* base xs--22 04:48pm lactate-0.7 02:42pm k+-3.7 01:06pm k+-3.8 12:00pm type-central ve po2-106* pco2-27* ph-7.00* total co2-7* base xs--24 comments-add on abg 01:00pm calcium-6.7* phosphate-4.6* magnesium-1.3* 12:00pm lactate-1.3 12:00pm o2 sat-93 11:56am glucose-202* urea n-33* creat-4.8* sodium-136 potassium-3.8 chloride-115* total co2-6* anion gap-19 11:12am type- temp-33.7 o2-20 po2-118* pco2-23* ph-7.02* total co2-6* base xs--24 intubated-not intuba comments-green top 11:12am glucose-208* lactate-1.2 na+-137 k+-3.7 cl--124* 10:20am urine color-yellow appear-hazy sp -1.014 10:20am urine blood-tr nitrite-neg protein-100 glucose-tr ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-sm 10:20am urine rbc-1 wbc-14* bacteria-none yeast-none epi-16 10:20am urine mucous-occ 10:15am lactate-1.0 10:08am glucose-334* urea n-38* creat-5.6* sodium-130* potassium-4.6 chloride-109* total co2-5* anion gap-21* 10:08am ck(cpk)-99 10:08am tacrofk-15.0 09:03am albumin-3.3* calcium-7.8* phosphate-4.9* 09:03am tacrofk-7.8 09:03am wbc-7.6# rbc-2.87* hgb-7.6* hct-24.0* mcv-84 mch-26.3* mchc-31.5 rdw-14.9 09:03am urine color-yellow appear-hazy sp -1.010 09:03am urine blood-neg nitrite-neg protein-30 glucose-150 ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 09:03am urine rbc-2 wbc-23* bacteria-few yeast-none epi-33 09:03am urine rbc-2 wbc-23* bacteria-few yeast-none epi-33 09:03am urine ca oxal-few 09:03am urine mucous-occ . discharge labs: 07:35am blood wbc-2.8* rbc-3.40* hgb-9.5* hct-28.6* mcv-84 mch-28.0 mchc-33.3 rdw-17.2* plt ct-269 07:35am blood glucose-151* urean-27* creat-5.9* na-136 k-4.6 cl-108 hco3-16* angap-17 07:35am blood calcium-8.0* phos-4.3 mg-1.9 07:35am blood tacrofk-16.9 . micro: stool cultures negative for pathogens blood culture negative x 2 . imaging: ct abd/pelvis: comparisons: renal ultrasound exam of . technique: mdct-acquired contiguous images through the abdomen and pelvis were obtained without intravenous contrast at 5-mm slice thickness. coronally and sagittally reformatted images were displayed. findings: ct of the abdomen: small bilateral non-hemorrhagic pleural effusions are noted with adjacent areas of compressive atelectasis. otherwise, imaged lung bases are clear. the heart size is normal without pericardial effusion. small hiatal hernia is noted. evaluation of abdominal visceral organs is limited due to lack of intravenous contrast. within this limitation, liver appears unremarkable. trace amount of fluid is seen surrounding the liver. there is no evidence of intrahepatic or extrahepatic biliary ductal dilatation. mild gallbladder wall edema is noted. there are no calcified gallstones within its lumen. a 2.3 x 1.1 cm hypodense splenic focus with peripheral areas of calcifications is noted (2:18), which may represent sequela of prior injury. pancreas appears unremarkable without ductal dilatation or peripancreatic fluid collection. right adrenal gland is normal. left adrenal gland appears prominent, without discrete nodule or lesions. native kidneys are unremarkable. imaged small and large bowel loops appear normal, without evidence of bowel obstruction. there is no free air or free fluid within the abdomen. there is no evidence of retroperitoneal hematoma. intra-abdominal aorta and its branches are notable for extensive calcified atherosclerotic disease without associated aneurysmal changes. mild ectasia of the sma at its origin is noted. ct of the pelvis: foley is in place with small amount of air locules within the bladder lumen, which is likely related to its placement. the rectum and sigmoid colon appear unremarkable. uterus appears normal. there is no free air within the pelvis. a transplant kidney is present within the left lower pelvis and there is an unremarkable appearance without hydronephrosis. there is no surrounding fluid collection. extensive arterial calcifications are seen without associated aneurysmal changes. there are no pathologically enlarged pelvic oringuinal lymph nodes. osseous structures: no suspicious lytic or sclerotic lesion is seen. impression: 1. no ct evidence of acute intra-abdominal process. there is no evidence of intra-abdominal hemorrhage. transplant kidney appears is unremarkable appearance without hydronephrosis or surrounding fluid collection. 2. small bilateral non-hemorrhagic pleural effusions with adjacent areas of compressive atelectasis. 3. small hiatal hernia. 4. extensive calcified atherosclerotic disease of the aorta and its branches without associated aneurysmal changes. 5. non-distended gallbladder with mild wall edema, which may be related to low albumin level and underlying liver disease. correlate clinically. assess further with ultrasound exam if clinically indicated. brief hospital course: ms. is a 40 year-old female with type i diabetes mellitus (dmt1), end-stage renal disease (esrd s/p lurt transplant ) with recent acute cellular rejection who presented for repeat renal transplant biopsy today admitted to the micu from the ed for managment of hypotension, hypothermia, dka, and persistent diarrhea. . active issues: #hypotension: felt likely to be hypovolemic shock given large volume diarrhea. briefly on levophed in the micu but weaned within 12 hours. total 7.6l volume resuscitation. empirical vanc/zosyn/flagyl initiated. flagyl d/ced on day 2. vanc/zosyn the following day, she was transferred to the general . she remained normotensive with autodiuresis of the volume as her dense atn resolved. . # diabetic ketoacidosis (dka)/anion gap metabolic acidosis with respiratory compensation: anion gap of 16 reduced to 12 on insulin drip. on hospital day 2, insulin gtt was d/ced and sq insulin initiated at half home dose. bicarbonate gtt continued until the afternoon of day2 at which point bicarbonate was changed to po. she was discharged on bicarbonate 1300 mg po bid. . #diarrhea: her stool studies were negative for all bacterial pathogens so it is possible that this was virally mediated vs. medication-side effects from ciprofloxacin. vancomycin and zosyn were discontinued on day #2 of admission given negative micro workup and stable hemodynamics. . #acute kidney graft injury: there was a mixed component of acute rejection with prerenal atn (acute tubular necrosis) resulting from hypotension/hypovolemia as above. her creatinine was improving to 5.9 on discharge and her tacrolimus level was therapeutic. her tacrolimus was decreased to 2 mg po bid, mycophenolate continued at 1000 mg . continued atovaquone, nystatin, and valgancyclovir ppx. . # anemia and leukopenia: she has these chronically, with baseline hct around 30 and has had episodes of leukopenia in the past as well. it might be due to medication effect. she is asymptomatic from the anemia now. these will be further monitored as an outpatient. . transitional issues: - check labs including cbc, cr, bicarbonate, potassium, tacrolimus level and follow-up with renal medications on admission: medications: from last discharge summary as he does not know his medications 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 4. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 5. losartan 50 mg tablet sig: one (1) tablet po daily (daily). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 8. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 9. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for sob, wheezes. 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 12. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 13. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 14. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 15. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 16. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po once a day as needed for constipation. 17. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 18. vitamin d-3 1,000 unit tablet, chewable sig: one (1) tablet, chewable po once a day. 19. diltiazem hcl 120 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). 20. bisacodyl 5 mg tablet, delayed release (e.c.) sig: tablet, delayed release (e.c.) discharge medications: 1. sodium bicarbonate 650 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*0* 2. mycophenolate mofetil 500 mg tablet sig: two (2) tablet po bid (2 times a day). 3. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 4. valganciclovir 450 mg tablet sig: one (1) tablet po 2x/week (tu,fr). 5. clindamycin phosphate 1 % solution sig: one (1) appl topical qhs (once a day (at bedtime)). 6. vitamin d 50,000 unit capsule sig: one (1) capsule po once a week. 7. atovaquone 750 mg/5 ml suspension sig: ten (10) ml po daily (daily). 8. outpatient lab work please draw cbc, creatinine, bicarbonate, and potassium twice weekly starting . please draw tacrolimus level once weekly 9. tacrolimus 1 mg capsule sig: two (2) capsule po twice a day. 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain or fever. 11. lantus 100 unit/ml solution sig: 9-18 units subcutaneous once a day. 12. novolog 100 unit/ml solution sig: as directed units subcutaneous three times a day: fbs 100-150=2u 151-200=4u 201-250=6u 251-300=8u, 301-350=10u. discharge disposition: home discharge diagnosis: diarrhea secondary to viral gastroenteritis or medicine side effect discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms , . you were initially admitted to the hospital for high blood sugars because of diffuse diarrhea and dehydration. you were aggressively rehydrated and your blood glucose and blood pressures normalized. your low blood pressure was thought to contribute to kidney damage. after receiving fluids your kidney function stablized and your urine output picked up. you will need to follow-up closely with renal for further discussion regarding need for biopsy. . changes to your medications: start taking sodium bicarbonate tabs 1300 mg by mouth twice daily change your tacrolimus to 2 mg by mouth twice daily . it was a pleasure taking care of you in the hospital! followup instructions: department: transplant when: tuesday at 11:00 am with: , md building: lm campus: west best parking: garage md procedure: venous catheterization, not elsewhere classified diagnoses: anemia, unspecified acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified hyposmolality and/or hyponatremia other shock without mention of trauma long-term (current) use of insulin complications of transplanted kidney diabetes with ketoacidosis, type i [juvenile type], uncontrolled intestinal infection due to other organism, not elsewhere classified leukocytopenia, unspecified 

Answer: The patient is high likely exposed to