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 69-year-old male with a history of polycystic kidney disease, status post cadaveric renal transplant in , on rapamune, prednisone and gengraf. the patient has a history of polycystic liver disease with recent cyst infections treated with iv antibiotics recently, presents with 2 week history of fevers up to 101, chills, malaise and shortness of breath with increasing abdominal distention and right upper quadrant pain. the patient saw dr. in the clinic the week prior and was instructed to go to the hospital for further evaluation. the patient felt worse, however, and came to the emergency department for evaluation and workup. the patient complained of malaise and shortness of breath but denied chest pain. he denied any anorexia or urinary symptoms or new bowel changes. he did complain of nausea and some dry heaves. the patient has a history of polycystic kidney disease with also polycystic liver disease with multiple large liver cysts, one of which became infected secondarily with a pansensitive pseudomonas following episode of ercp induced cholangitis and bacteremia in . at that time, he was initially treated with pip/tazo, followed by recurrence of fevers and persistence of the abscess. he was drained in , and treated with 6 weeks of cipro plus 2 weeks of augmentin for an unidentified gram positive cocci through late . he did well through , when he had recurrent low fevers and malaise. repeat mri showed enlargement of the left lateral liver abscess that was impinging on the diaphragm and pericardium. he was started on oral cipro as an outpatient. he continued to have low grade fevers. allergies: no known drug allergies. past medical history: polycystic kidney disease, hypertension, gerd, endstage renal disease, status post cadaveric renal transplant in , chf, biliary stones, diverticulosis, chronic pancreatitis, cholestasis. past surgical history: cadaveric renal transplant in , biliary stenting and an av fistula. medications: at home, prednisone 5 mg, lopressor 75 mg p.o. b.i.d., cyclosporin 25 mg b.i.d., doxazosin, rapamune 1 mg p.o. daily, protonix, allopurinol 50 mg p.o. b.i.d., lasix 20 mg p.o. daily, and bactrim single strength daily. the patient was admitted to the transplant service. full labs were sent off. a kub and chest x-ray were done that demonstrated massive cardiomegaly and pericardial effusion. blood cultures and urine cultures were sent. these were subsequently negative. physical examination: on admission, temperature was 99.7, heart rate 89, blood pressure 133/68, respiratory rate 24, o2 saturation 96% in room air. he was mildly uncomfortable, appeared uncomfortable. no scleral icterus. eomi. respiratory rate regular. lungs were decreased on the left base with end expiratory crackles at base. he was tachypneic especially when supine. heart: regular rate and rhythm, no murmurs, but distant sounds. abdomen moderately distended, tender over right upper quadrant. he was tympanitic, no rebound, no guarding. extremities: warm, no clubbing, cyanosis, 1+ edema, no calf tenderness. gu: enlarged prostate, normal rectal tone, guaiac positive. neurologically, he was for strength throughout. cranial nerves ii through xii grossly intact. alert and oriented. hospital course: he was started on iv zosyn and vancomycin renally dosed with iv hydration and cardiology was consulted. after a right subclavian catheter was inserted, chest x-ray confirmed placement. the patient was transferred to the sicu, surgical intensive care unit. cardiology was consulted for cardiac tamponade. he was found to have purulent pericarditis with pseudomonas, likely from translocation of bacteria from the abscess in the pericardium. a pericardiocentesis was done and he was drained for approximately 2-3 liters of fluid and culture was positive for pansensitive pseudomonas and second gram negative organism was not identified. he was started on iv vancomycin and zosyn on admission. cipro was also added for double coverage while the sensitivities of the pseudomonas and the id of the gram negative rods were pending. the patient went to the operating room for a pericardial window and resection of the liver abscess on . surgeon was dr. , assisted by resident , as well as dr. . the patient underwent left lateral segmental resection of the liver including the offending cyst which was found to be densely adherent to the undersurface of the diaphragm with frank perforation through the parietal pericardium. please see operative report for further details. the patient was transferred to the surgical intensive care unit postoperatively with chest tubes, intubated. he remained in the surgical intensive care unit for a prolonged period of time during which time he received cvvhd for fluid overload. he also experienced atrial fibrillation and required an amiodarone drip. he was converted to a sinus rhythm and started on digoxin. he had an abdominal j-p and was draining large amounts of serosanguineous fluids as high as 1.5 liter per day. this was sent off for culture and was negative. thoracic followed the patient for most of this hospital course. repeat chest x-rays demonstrated no pneumothorax. his chest tubes were removed on , and . repeat chest x-ray demonstrated right basilar atelectasis and left effusion. he was gradually weaned from cvvhd and intermittent hemodialysis was initiated although he experienced some drops in his blood pressure. nephrology followed the patient throughout this hospital course. during this time, he was maintained on his regularly scheduled prednisone dose. he experienced a rise in his creatinine from a baseline of 2.2 up to a high of 4. gengraf was held as well as rapamune in the immediate postoperative period to prevent over immunosuppression. gengraf was resumed at 25 mg p.o. b.i.d. and rapamune was eventually resumed at 1 mg per day. this was adjusted to 0.5 mg per day for a level of 14.4. rapamune was later diminished to 0.5 mg once a day. he was eventually weaned from the ventilator and was stable on nasal cannula o2. his o2 saturations were satisfactory. he was eventually transferred out of the surgical intensive care unit where he was then sent down to the medical surgical unit where he had a prolonged stay for postoperative pancreatitis. his amylase and lipase increased to a high of 652 for amylase and lipase of 1403 around postoperative day 17. his liver function tests increased during this hospital course. pancreatitis etiology was unclear. a mrcp was done. this was negative and an endoscopic ultrasound was done that showed no evidence of sludge or stones. during this time, the patient was npo and was maintained on iv tpn. he remained on this. his diet was gradually advanced. he experienced a rise in his amylase and lipase. his diet was downgraded to low fat. it was felt that possibly the tpn was worsening his liver function. he was switched to postpyloric feeding tube and enteral feedings were started. nutrition was consulted and he was initially maintained on half strength nepro. during this time, he experienced bouts of diarrhea and some abdominal discomfort. multiple stools were sent off for culture and c. diff. all of these were subsequently found to be negative. his liver enzymes continued to remain elevated with an ast of 268, alt of 112, alkaline phosphatase of 788, total bilirubin of 0.7, albumin of 2.2, his amylase and lipase trended down. his - was sent off and was negative for . the - was eventually removed and the site was sutured without further incident. zosyn was continued for a total of 39 days. vancomycin had been stopped previously given finalization of cultures which revealed pseudomonas pansensitive. vancomycin was also stopped at the time the patient was found to be vre positive by rectal swab. he was mrsa negative. all stool cultures were finalized and negative. abdominal ct on , demonstrated no evidence of pancreatitis, multiple low attenuation lesions of the liver, many of which represented cysts, but could not exclude abscesses without iv contrast. polycystic kidneys were noted and unchanged. a pericardial and pleural effusion with subcutaneous stranding with free fluid was found to be consistent with anasarca. new air pockets were noted with surrounding soft tissue density anterior to the bladder. this was felt to be due to recent catheterization. a liver ultrasound demonstrated no gallstones, no gallbladder wall thickening. the patient remained in sinus rhythm and tte demonstrated a moderate loculated pericardial effusion and no tamponade on . he also underwent a retroperitoneal ultrasound that demonstrated no evidence of biliary dilatation. the pancreas was poorly visualized on that exam. a portable kub demonstrated feeding tube terminating in the distal duodenum without any bowel obstruction. also during this hospital course, he had a renal transplant duplex that demonstrated patent renal vasculature with no hydronephrosis or perinephric fluid collection. his creatinine gradually decreased to a low of 2.5. throughout this time on the medical surgical unit, he was afebrile. his blood pressure remained stable. he continued to be fluid overloaded. hemodialysis was stopped. he was treated with iv torsemide with mild response. his weight continued to remain around 84.3 kilograms. he demonstrated some upper extremity edema. he did have a known right subclavian thrombus. his left arm appeared edematous and it was noted that he had a left ij central line in place. on , he underwent an ultrasound of the left upper extremity that demonstrated no left upper limb deep venous thrombosis. in summary, the patient is a 69-year-old male with complicated hospital course, status post pericardiocentesis and left segmentectomy, complicated by postoperative pancreatitis and renal insufficiency. his nutritional status was of concern. he remained in hospital pending a rehabilitation bed for enteral nutrition. physical therapy followed the patient and felt the patient would benefit from continuation of physical therapy to increase endurance and strength. he was ambulating in the hallway with supervision. his lungs were diminished on the left lower lobe and bibasilar crackles. heart rate was regular. abdomen was soft, positive bowel sounds, abdominal incision had a small open area with a 2 x 2 normal saline dressing that was changed daily and that wound was healing. old j-p site was clean and dry as well as the old chest tube sites were well healed. he continued with 3+ bilateral edema in his legs to his knees. labs: white count 7.5, hematocrit 27.9. his hematocrit was relatively stable. platelet count 214,000. sodium 136, potassium 3.5, chloride 97, co2 of 25, bun 65, creatinine 2.5, glucose 109. his glucoses were in the of 109 to 168. the plan is to send the patient to rehabilitation for continuation of postpyloric feeding tube feedings using peptamen full strength with banana flakes being cycled from 6:00 p.m. to 6:00 a.m. with a goal rate of 100 cc per hour. the patient was maintained on iv heparin until coumadin reached a therapeutic goal range of between 2 and 3. heparin was stopped. inrs were therapeutic at 2.6 to 2.7. discharge medications: tylenol 650 mg p.o. p.r.n. q.4-6 hours, albuterol 1-2 puffs mdi p.r.n. q.6 hours, atrovent 1-2 puffs p.r.n. q.6 hours, anzemet 12.5 mg iv q.8 hours p.r.n., gengraf 25 mg p.o. b.i.d., prednisone 5 mg p.o. daily, rapamune 0.5 mg p.o. daily, dilaudid 0.5 mg p.o. p.r.n. q.6 hours, imodium 2 mg p.o. p.r.n. b.i.d., insulin sliding scale p.r.n. q.6 hours, phenergan 12.5 mg p.r.n. q.8 hours if no result from anzemet, torsemide 80 mg p.o. daily, coumadin 5 mg p.o. daily alternating with 7.5 mg p.o. every other day, ambien 5-10 mg p.o. p.r.n. at bedtime, protonix 40 mg p.o. daily, nitroglycerin 0.3 mg sl p.r.n. chest pain, metoprolol 37.5 mg p.o. b.i.d. discharge diagnoses: 1. polycystic liver disease. 2. cardiac tamponade. 3. pericardial effusion. 4. status post cadaveric renal transplant in , complicated by chronic renal insufficiency, pancreatitis, atrial fibrillation, right internal jugular nonocclusive thrombus, occlusive right subclavian thrombus. 5. malnutrition. 6. pseudomonas pericardial fluid infection treated with zosyn. condition on discharge: stable. , procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis pericardiocentesis other incision of pleura pericardiotomy right heart cardiac catheterization other destruction of lesion of liver diagnoses: other postoperative infection acute kidney failure, unspecified unspecified septicemia unspecified protein-calorie malnutrition severe sepsis atrial fibrillation unspecified disease of pericardium complications of transplanted kidney acute pancreatitis other specified disorders of liver other acute pericarditis congenital cystic disease of liver 

Answer: The patient is high likely exposed to