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: penicillins / imuran / cephalosporins / sulfa (sulfonamide antibiotics) / reglan / ampicillin / lactose / neomycin / metoclopramide / doxepin attending: chief complaint: chills, low grade temp major surgical or invasive procedure: femoral cvl removal of femoral cvl history of present illness: 61 year old female with t1dm s/p pancreatic transplant , cabg, prior nstemis, chf, esrd with failed renal transplants and now on peritoneal hd, chf, orthostatic hypotension on midodrine and fludrocortisone, presented to ed with chills, low grade temp and poor temperature who was noted to be hypoxic and hypotensive. upon review of her records, she is always hypotensive and she is very at her baseline upon present. of note, she was seen by dr. in , at which point an immunologic workup was performed, revealing cd4 lymphopenia. she had normal iga and igm as well as igg levels at that time. she was started on pneumocystis prophylaxis as well as prophylaxis and reported negative hiv testing at the rehab center. she was seen by id on at which point she was switched from pentamidine to mepron for pcp (**verify with pt). her cd4 count was rechecked and found to be 165. in the ed, initial vitals were 98.8 70 85/60 22 98%. labs were notable for normal cbc and chem7 except for cr of 6.1 (at baseline). cxr was notable for no acute process. she was started on vanc, levo, and flagyl for presumed septic process. she was noted to have a temp of 101.4. she also got tylenol for fever and levophed for hypotension to the 60s systolic. a right femoral cvl was placed. vitals on transfer: 77 86/49 16 99%. on arrival to the , her vitals were 106/57, 85, 97% on 3l. the pt reports that last night she began shivering incessantly and had a low grade temp of 99 (she normally runs 96-97). she has also been feeling very drowsy and weak. in the ed, they were having to tell her to take her medications multiple times before she would finally respond. she denies pain anywhere except for her sacrum, which is baseline. she frequently has diarrhea with on and off positive c.diff cultures. she reports that her last c. diff infection was 6-8wks ago. she did have diarrhea about 2 nights ago, but it was mainly loose, soft stool - nothing like her normal c. diff diarrhea. she took an immodium and it resolved like usual. she is not having and chest or abdominal pain or trouble breathing. no dizziness or lightheadedness, just weakness. in addition, this morning she was nauseated but did not vomit. she feels that her blood pressure may be low because the rehab facility took off too much fluid during peritoneal dialysis. past medical history: # ischemic cariomyopathy/chf; ef 35% in -> 30% # h/o severe mr s/p repair in # nstemi , s/p to lad # cabgx5 vessel # s/p renal transplant () -- c/b chronic rejection -- second renal transplant () # s/p pancreas transplant -- with allograft pancreatectomy () -- redo pancreas transplant () -- admission for acute rejection (), resolved with increased immunosupression # diabetes mellitus type i -- c/b neuropathy, retinopathy, dysautonomia -- no longer requires regular insulin after the pancreas transplant, but has been given ss while on high-dose prednisone in house # autonomic neuropathy # sleep disordered breathing -- unable to tolerate cpap; uses oxygen 2l nc at night # osteoporosis # hypothyroidism # pernicious anemia # cataracts # glaucoma # anemia of ckd, on aranesp in the past # r foot fracture c/b rle dvt # chronic lle edema # recurrent e. coli pyelonephritis # s/p anal polypectomy () # s/p bilateral trigger finger surgery () # s/p left () social history: child psychiatrist, on disability. has been in and out of hospitals in the last 9 months. was longest at , most recently at livingcenter - - . mobile with wheelchair but unable to do transfers. - tobacco: denies - alcohol: denies - illicits: denies family history: father with mi at 57. no family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission exam: vitals: t:98.7, bp:106/57 , p:87 , r: 18, o2: 100% 3l nc general: alert, oriented, malnourished chronically ill appearing female in no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: soft rales diffusely over anterior chest, no wheezes/rhonchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly, pd site intact/clean/dry : femoral cvl in r groin, limbs warm, well perfused, 2+ pulses, pitting edema to knees discharge exam: vs: 98.5 98/56 (85-100/45-68) 69 20 100%ra gen: wd wn f appropriate, comfortable in nad heent: ncat, pupils equal, eomi, op clear, missing left upper molar neck: supple, no jvd, no lad cv: rrr, s1,s2, iii/vi systolic murmur, no r/g lungs: normal respiratory effort, no accessory muscle use, rhonchi and crackles present in bases, no wheezes abdomen: soft, distended, peritoneal catheter present in rlq, nt, no r/g, +bs extrem: left , 1+ dp pulse, 2+ radial pulse r femoral central line, nails thickened and neuro: awake, alert, oriented x3, cnii-cnxii grossly intact, no focal neurologic deficits pertinent results: admission labs 01:13pm blood wbc-8.5 rbc-2.91* hgb-11.2* hct-36.2 mcv-125* mch-38.5* mchc-30.9* rdw-17.2* plt ct-159 01:13pm blood neuts-83.8* lymphs-10.4* monos-3.3 eos-2.0 baso-0.4 01:13pm blood pt-34.4* ptt-35.1 inr(pt)-3.2* 01:13pm blood glucose-77 urean-80* creat-6.1* na-139 k-4.3 cl-99 hco3-25 angap-19 10:47pm blood alt-4 ast-41* ld(ldh)-342* alkphos-61 totbili-0.2 10:47pm blood calcium-8.3* phos-5.1* mg-1.6 04:38pm blood lactate-1.4 micro mrsa screen mrsa screen-final {positive for methicillin resistant staph aureus} inpatient blood culture blood culture, routine-pending emergency peritoneal fluid gram stain-final; fluid culture-final; anaerobic culture-preliminary emergency imaging cxr: impression: left pleural effusion with overlying atelectasis, underlying consolidation is difficult to exclude. echo: the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is moderate regional left ventricular systolic dysfunction with inferior and inferolateral, as well as distal septal akinesis. there is mild hypokinesis of the remaining segments (lvef = 25-30%). right ventricular chamber size is normal. with mild global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. a mitral valve annuloplasty ring is present. the mitral annular ring appears well seated with normal gradient. moderate to severe (3+) transvalvular mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: moderate to severe regional and global left ventricular systolic dysfunction, c/w multivessel cad. well-seated mitral annuloplasty ring with moderate to severe residual regurgitation. mild aortic regurgitation. pleural effusions. compared with the prior study (images reviewed) of , mitral regurgitation is more prominent (may be secondary to increased volume). the other findings are similar. cxr: portable ap radiograph of the chest was reviewed in comparison to . post-sternotomy wires and replaced most likely mitral valve are unchanged in appearance. no progression of interstitial pulmonary edema is demonstrated and might reflect need for dialysis. bilateral pleural effusions, right more than left, have developed in the interim, most likely small to moderate in size. no new focal consolidation to suggest infectious process is seen with re-assessment after dialysis is required. discharge labs 09:30am blood wbc-4.0 rbc-2.62* hgb-9.6* hct-31.4* mcv-120* mch-36.6* mchc-30.5* rdw-16.3* plt ct-175 09:30am blood glucose-87 urean-80* creat-6.6* na-134 k-4.5 cl-91* hco3-28 angap-20 09:30am blood calcium-7.9* phos-5.0* mg-1.7 brief hospital course: 61y f with t1dm s/p pancreatic transplant , cabg, prior nstemis, chf, esrd with failed renal transplants and now on peritoneal hd, orthostatic hypotension on midodrine and fludrocortisone who presented with hypotension and low grade fever from rehab facility. active issues: # hypotension: patient's baseline sbp is in the 80's (on fludrocortisone and midodrine as outpatient) and she presented with sbp's as low as 60's. she is known to have severe orthostatic hypotension. she was started on levophed in the ed but weaned off in the . her hypotension was concerning for sepsis given her low grade fever in ed and empiric antibiotics were administered in ed to cover broadly. peritonitis was unlikely based on peritoneal fluid cell counts. in addition patient has been compliant with pcp currently taking atovaquone. another possible etiology for hypotension was over dialysis, as patient is on pd and very sensitive to fluid shifts. a lactate of 1.4 was reassuring. a random cortisol was checked and peritoneal and blood cultures were sent and came back without growth. a b-glucan and galactomannan were sent and results are pending on discharge. patient continued pd with a conservative volume removal strategy. #fever: patient initially presented with low grade fevers, which were concerning for evolving sepsis given hypotension. she was initially treated with vancomycin, levofloxacin and metronidazole for broad prophylactic coverage. her blood, urine, and peritoneal cultures were all negative and so antibiotics were stopped. #cd4 lymphopenia: possibly related to prior atg therapy for previous transplants or myelosuppressive effects from the mmf (discontinued 7/). patient's last cd4 count was 165 on , up from 66 in at which point she was started on pcp . currently on acyclovir, fluconazole, and mepron. patient was continued on acyclovir, fluconazole, and atovaquone prophylaxis. # esrd: patient is on peritoneal dialysis. we discussed possible volume depletion as a cause of hypotension with the nephrology team, who recommended the lowest concentration of pd fluid to avoid further hypotension. rehab pd settings had been: ccpd if sbp <80 use one 6l 1.5% bag with one 6l 2.5% bag. if sbp>80 use two 6 liter 2.5% bag 2000cc fills x 4. on discharge her pd regimen was: 4 exchanges per 24 hours, 3 hours dwell time per exchange, 2l volume per dwell, with 4 cycles of 1.5% dextrose daily, one cycle of 2.5 % dextrose as needed for patient comfort or signs of volume overload. # s/p renal/pancreatic transplant: patient stopped mmf in due to anemia. she was continued on tacrolimus and prednisone. # cad: patient has an extensive cardiac history including cabg. she was formerly on , and warfarin. now on aspirin and warfarin with supra therapeutic inr (anticoagulated for global hypokinesis of lv). most recent tte 09/. patient was continued on aspirin and coumadin was held given supra therapeutic inr. # pulmonary edema: patient's chest x-ray and clinical exam were concerning for pulmonary edema. she had an echo showing an ef that was unchanged at 25-30% and increased mitral regurgitation. we contact her cardiologist dr. who will see her as an outpatient for further evaluation for her severe mr. # coccygeal pain: patient was repositioned frequently and a pad support was used to decrease pressure # scleral injection and photophobia: patient's scleral injection and photophobia were concerning for worsening glaucoma vs. viral conjunctivitis, though lack of exudates makes conjunctivitis less likely and lack of eye pain was reassuring. she was seen by ophthalmology, who recommended continuing current eye drop regimen. # macrocytosis: patient has longstanding macrocytosis. we contact her outpatient hematology team, who thought it might be secondary to erythropoietin-stimulating agents given that it has persisted after discontinuation of cellcept. transitional issues: 1. pt will need to follow up with dr. in cardiology as an outpatient for her severe mitral regurgitation. medications on admission: the preadmission medication list is accurate and complete. 1. calcium acetate 667 mg po tid w/meals 2. docusate sodium 100 mg po daily:prn constipation 3. dorzolamide 2% ophth. soln. 1 drop both eyes daily 4. creon 12 2 cap po tid w/meals 5. cyanocobalamin 1000 mcg im/sc qmonth 6. epoetin alfa 12,000 units sc mwf start: hs 7. oxymetazoline 1 spry nu tid:prn dry nares duration: 3 days 8. ferrous sulfate 325 mg po bid 9. fluconazole 100 mg po mwf 10. fludrocortisone acetate 0.1 mg po bid 11. folic acid 1 mg po daily 12. artificial tear ointment 1 appl both eyes prn dry eyes 13. lactase *nf* 1000 units oral unk 14. levothyroxine sodium 150 mcg po daily 15. atorvastatin 80 mg po hs 16. loperamide 2 mg po qid:prn diarrhea 17. atovaquone suspension 1500 mg po daily 18. methazolamide 50 mg po tid 19. preparation h *nf* (phenyleph-shark liv oil-mo-pet) unk rectal daily 20. midodrine 15 mg po q 8h hold for sbp >130 21. gabapentin 100 mg po qod 22. omeprazole 40 mg po daily 23. potassium chloride 20 meq po daily duration: 24 hours hold for k >5 24. prednisone 5 mg po daily 25. restasis *nf* (cyclosporine) 0.05 % ou 26. simethicone 80 mg po qid:prn gas 27. sodium chloride 500 mg po daily 28. tacrolimus 1 mg po q12h administered at 800 and 29. travatan z *nf* (travoprost) 1 drop ou qhs 30. ondansetron 4 mg po q4h:prn nausea 31. ureacin-20 *nf* (urea) unk topical on palms, nails 32. aspirin 81 mg po daily 33. acyclovir 400 mg po q12h 34. albuterol 0.083% neb soln 1 neb ih q4h:prn dyspnea 35. amiodarone 200 mg po daily 36. brimonidine tartrate 0.15% ophth. 1 drop both eyes q8h 37. calcitriol 0.25 mcg po mwf 38. warfarin 0.5 mg po daily16 discharge medications: 1. acyclovir 400 mg po q12h 2. calcium acetate 667 mg po tid w/meals 3. docusate sodium 100 mg po daily:prn constipation 4. ureacin-20 *nf* (urea) 0 unk topical on palms, nails 5. creon 12 2 cap po tid w/meals 6. cyanocobalamin 1000 mcg im/sc qmonth 7. oxymetazoline 1 spry nu tid:prn dry nares duration: 3 days 8. ferrous sulfate 325 mg po bid 9. fluconazole 100 mg po mwf 10. epoetin alfa 12,000 units sc mwf 11. fludrocortisone acetate 0.1 mg po bid 12. folic acid 1 mg po daily 13. artificial tear ointment 1 appl both eyes prn dry eyes 14. lactase *nf* 1000 units oral unk 15. levothyroxine sodium 150 mcg po daily 16. atorvastatin 80 mg po hs 17. loperamide 2 mg po qid:prn diarrhea 18. atovaquone suspension 1500 mg po daily 19. methazolamide 50 mg po tid 20. preparation h *nf* (phenyleph-shark liv oil-mo-pet) 0 unk rectal daily 21. midodrine 15 mg po q 8h hold for sbp >130 22. gabapentin 100 mg po qod 23. omeprazole 40 mg po daily 24. prednisone 5 mg po daily 25. restasis *nf* (cyclosporine) 0.05 % ou 26. simethicone 80 mg po qid:prn gas 27. sodium chloride 500 mg po daily 28. tacrolimus 1 mg po q12h administered at 800 and 29. travatan z *nf* (travoprost) 1 drop ou qhs 30. ondansetron 4 mg po q4h:prn nausea 31. aspirin 81 mg po daily 32. albuterol 0.083% neb soln 1 neb ih q4h:prn dyspnea 33. amiodarone 200 mg po daily 34. brimonidine tartrate 0.15% ophth. 1 drop both eyes q8h 35. calcitriol 0.25 mcg po mwf 36. dorzolamide 2% ophth. soln. 1 drop both eyes daily 37. warfarin 1 mg po daily16 38. mepilex *nf* (foam bandage) 4 x 4 topical as needed skin breakdown on sacrum rx *foam bandage 4" x 4" one pad as needed disp #*30 unit refills:*0 discharge disposition: extended care facility: livingcenter - discharge diagnosis: orthostatic hypotension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , it was a pleasure caring for you during your hospitalization at . you came to the hospital because your blood pressure was low and you were having fevers and chills. your blood pressure was low due to removal of too much fluid while on peritoneal dialysis. reassuringly we did not find any sources of infection in your blood, urine, peritoneal fluid, or in your lungs. furthermore you have not had any more fevers while in the hospital. the following changes were made to your medications: changed: 1. increase warfarin to 1 mg daily (this dose may be adjusted according to your inr) weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: the following appointments have been scheduled for you: department: transplant center when: wednesday at 11:30 am with: , md building: lm campus: west best parking: garage department: cardiac services when: wednesday at 2:20 pm with: , md building: campus: east best parking: garage department: transplant center when: monday at 1:20 pm with: , md building: lm campus: west best parking: garage md procedure: peritoneal dialysis central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease renal dialysis status mitral valve disorders congestive heart failure, unspecified unspecified acquired hypothyroidism aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease osteoporosis, unspecified old myocardial infarction fever, unspecified hypoxemia diarrhea surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation complications of transplanted kidney below knee amputation status diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled pancreas replaced by transplant orthostatic hypotension acute on chronic combined systolic and diastolic heart failure peripheral autonomic neuropathy in disorders classified elsewhere lymphocytopenia 

Answer: The patient is high likely exposed to