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: patient is a 46-year-old male status post liver transplant in whose course has been complicated by hepatic artery thrombosis status post ptc catheter placement, high-grade vre bacteremia on long- term linezolid currently, ptc placement for biliary sepsis. he has been followed closely by dr. and dr. from id as a outpatient. recently valcyte was stopped on after 3 months of treatment. patient has been having labs drawn every 2-3 days, which revealed hematocrit, white blood cell, and platelet count being low that had been steadily trending down reaching critical levels today with a white count of 1, hematocrit of 17, and a platelet count of 45. the patient was called at home and asked to come in. his alt and ast were also elevated. alt was 124, ast 146 for which this is the 1st time since his transplant that his liver function tests had been abnormal. he denied any fevers, chills, nausea, vomiting, diarrhea, constipation, shortness of breath. he says he has had sweats x2 days and some increased fatigue over the past few weeks, but otherwise feels well. appetite was unchanged. allergies: penicillin, benzocaine. past medical history: liver transplant on , then roux-en-y hepaticojejunostomy, hepatitis c, cryptogenic cirrhosis complicated by hepatic artery thrombosis, very high- grade vre bacteremia on , source was the biliary tree treated with linezolid, status post ptc drain in for stricture, now capped, methemoglobinemia in from hurricaine spray during tee, history of cryptococcal pneumonia on fluconazole long-term. he should be on 200 mg p.o. daily for 1 year, nutcracker esophagus, chronic renal insufficiency, creatinine baseline is 1.2, right inguinal hernia, diverticulitis, esophageal varices, history of hyperkalemia treated with kayexalate p.r.n. and increased prolactin. medications at home: oxycodone 5 mg p.r.n., multivitamin 1 daily, regular insulin sliding scale, protonix 40 daily, nph 28 units q.a.m., epogen 20,000 units every week, colace, nifedipine 10 mg p.o. b.i.d., bactrim single strength 1 daily, fluconazole 200 mg daily, kayexalate 15 grams p.r.n., linezolid 600 mg p.o. b.i.d., valcyte 450 mg daily, rapamune 3 mg daily, ferrous sulfate daily. physical exam: temperature was 101. he was in no acute distress. lungs are clear. heart was regular rate and rhythm. abdomen: soft, nondistended. ptc catheter was in place and capped. reducible left inguinal hernia on the left and right. extremities: no clubbing, cyanosis, or edema. labs on admission: white count was 2.1, hematocrit 17.2. he was transfused with a total of 3 units of packed red blood cells. his hematocrit increased to 24. he was given an additional 2 units of packed red blood cells for a repeat hematocrit of 30. he was started on iv fluid. he spiked a temperature up to 102 in the evening of hospital day 1. blood cultures were sent off. he had 4/4 bottles positive for enterococcus faecium resistant to ampicillin, penicillin, and vancomycin, sensitive to daptomycin and linezolid. he remained on daptomycin as he had been previously on this for long-term. he was sent for an abdominal ct. this revealed markedly increased ascites seen throughout the abdomen and pelvis without fat stranding diffusely in the abdomen, especially surrounding the liver. there was a 7-cm fluid collection filled with contrast at the tip of the tube in the subhepatic area which likely represented a leak, abscess, or loop of bowel. it was noted that this was a limited study for evaluation of a major abdominal organs due to the lack of intravenous contrast . it was noted that he had a cirrhotic-appearing liver and splenomegaly, bilateral hydrocele greater on the right, bibasilar atelectasis, and tubular opacity in the left lower lobe measuring 1.2 cm unchanged since prior study, and gynecomastia. hospital course: on , a roux tube cholangiogram was done. this revealed a large contrast collection in the region of the left hepatic lobe consistent with a large bile leak. there was associated dilatation of the intrahepatic ducts with numerous filling defects consistent with sloughed mucosa and debris. these findings were concerning for biliary ischemia. on , he went to ct for successful aspiration and a drainage catheter placement in the large hepatic fluid collection. he also underwent a tte which was negative for vegetations on the heart valves. ejection fraction was approximately 55%. the fluid from the above tap of abdominal fluid grew 3 organisms: enterococcus gallinarum, strep viridans heavy growth, and enterococcus. the enterococcus was pansensitive and indeterminate for vancomycin. the enterococcus 2nd species was resistant to ampicillin, levofloxacin, penicillin, and tetracycline. he remained on daptomycin. he continued on his rapamune throughout this hospital course with dose adjustments based on level. his appetite was poor. he received calorie counts. he was taking in anywhere from 845 kilocalories per day to 1,100 kilocalories per day. his liver function tests on admission demonstrated an ast of 126, alt of 79, alkaline phosphatase of 134 with a total bilirubin of 0.4. these remained relatively stable. there was slight increase in the alkaline phosphatase noted. he went for repositioning of the ct-guided drain on . on , he spiked a temperature up to 101 again while on the daptomycin. repeat blood cultures were drawn daily on through . these were all negative. on , he underwent another ct-guided drainage. his pigtail catheter was in place. there was interval decrease in the size of the intrahepatic abscess with persistent ascites. he continued to drain small amounts of fluid from this pigtail catheter. infectious disease was consulted and followed the patient closely throughout this hospital course making recommendations with respect to antibiotic coverage. a cmv viral load was sent off on . this was subsequently found to be negative. bile was sent from the ptc drain. this demonstrated e. coli and enterococcus gallinarum. the e. coli was resistant to ampicillin, ciprofloxacin, levofloxacin, and bactrim. otherwise, pansensitive. the enterococcus was pansensitive. he was started on levofloxacin on hospital day 16, and he remained on levofloxacin for a total of 7 days. he continued to complain of upper abdominal discomfort for several days. white blood cell count improved from admission. white count of 2.1; it rose to 9.9 on hospital day 13. given poor appetite and low calorie counts, he was started on total parenteral nutrition via picc line. a right arm picc line was placed on . followed the patient for hyperglycemia helping to titrate his insulin. nutrition also followed this patient throughout this hospital course making recommendations. on , hospital day 16, he underwent successful ultrasound-guided therapeutic and diagnostic paracentesis. three-point 2 liters of dark-yellow fluid was withdrawn. this fluid demonstrated no growth and 4+ polymorphonuclear leukocytes. around hospital day 13, he started to complain of abdominal distention and tenderness in the upper abdominal area. he had a reducible hernia. he did experience some nausea and had some emesis. he was medicated with anzemet. he continued to complain of persistent burning upper abdominal pain that waxed and waned. the patient refused an upper endoscopy to evaluate nausea. it was noted that on his paracentesis, he had elevated white blood cells consistent with peritonitis for which he remained on levaquin for approximately 1 week. a ng tube was placed on hospital day 18 for nausea and vomiting. ng tube put out approximately 4 liters per day consistent with outlet obstruction. hepatology followed the patient closely throughout this hospital course. it is felt the patient had an ileus related to opioids for abdominal pain for which he was receiving p.r.n. dilaudid with good effect. he was taken to the or on for complete small bowel obstruction secondary to an internal hernia. he underwent a reduction of internal hernia, closure of mesocolon defect, tru-cut biopsy of the liver, and feeding jejunostomy. dr. did the surgery, assisted by resident, under general anesthesia. patient tolerated the procedure well. please see operative report. he did receive 2 units of packed red blood cells. blood loss was minimal. his abdominal pain was much better postsurgery. he remained on iv daptomycin and levaquin. he spiked a temperature on to 104, which he had a chest x-ray that demonstrated no pneumonia with improving right apical hydropneumothorax. he underwent an abdominal ct with successful replacement and drainage of the left hepatic lobe collection with a small 3.2 cm residual collection along its anteromedial aspect. of note, a new hypodense collection in the lateral subcapsular segment 5 yielded only a small amount of cc of purulent material. a small hemoperitoneum was noted postaspiration. he was transferred to the sicu for further management. blood cultures demonstrated e. coli. bile also grew e. coli resistant to ampicillin, levofloxacin, cipro, and bactrim. enterococcus was indeterminate to vancomycin, otherwise pansensitive. a urine culture was negative. he remained on daptomycin. in addition to the temperature spike of 104, his white blood cell count increased to 20.4. he also complained of some lightheadedness and dizziness. he was transferred to the surgical intensive care unit for iv resuscitation and monitoring. he was started on vasopressin. he remained on levaquin, flagyl, ceftazidime, and daptomycin as well as linezolid. repeat abdominal ct was done on with successful replacement and drainage of the left hepatic lobe collection as previously stated. he underwent a renal ultrasound at that time. this demonstrated patent main renal arteries bilaterally. renal artery stenosis could not be excluded on this technically limited exam. this was done for elevated creatinine of 1.4. creatinine trended back down with iv hydration. he experienced postop ileus as well. he had been started on j. tube feedings, and his tpn had been weaned off. while in the surgical intensive care unit, he was intubated. he was started on meropenem. the ceftazidime was discontinued. the left liver abscess collection had gram-positive cocci. the right abscess had also gram-positive cocci. blood cultures were positive for e. coli and gram-negative rods. gradually he improved. he was extubated on . his white blood cell count trended down. a repeat abdominal ct was done on . this demonstrated improving 5-cm segment 4 liver abscess with pigtail catheter. two other dominant fluid collections were unchanged. ascites was worse. there was resolution of the small bowel obstruction. on , he was relisted for liver transplant with resolution of small bowel obstruction. his j. tube feeding was resumed. he tolerated this without event. he continued to do well. he received a total of 6 days of meropenem. he was transferred out of the surgical intensive care unit on . he did experience some diarrhea for which stools were sent for c. difficile. these were subsequently negative. he remained on p.o. fluconazole for cryptococcal treatment. he had a history of cryptococcal pneumonia and was to remain on fluconazole for 1 year. he received empiric flagyl for diarrhea. on , he underwent an abdominal ct with contrast. this demonstrated slight increase in size of the previously seen segment 4 hepatic abscess/bile collection. previously placed pigtail catheter appeared to have been removed. there was slight increase also in segment 2 abscess with a new drainage catheter in place. the 3rd collection in the right lobe was unchanged. there was abundant ascites tracking into the pelvis and scrotum via the inguinal canals. this was unchanged. there were also bilateral small pleural effusions with associated atelectasis. a repeat abdominal ct was done on . a right-sided liver pigtail drain was inserted as well as the left side liver pigtail drain was placed. paracentesis was done, and the drain was inserted. three liters of straw-color fluid was sent off for culture and cell count. this demonstrated 2+ polymorphonuclear leukocytes and enterococcus resistant to ampicillin, penicillin, and vancomycin, but sensitive to linezolid. no anaerobes were isolated. on , the ascites fluid was increased. he still had a pigtail drain in place. two liters of fluid were drained off utilizing low wall suction, then 5 additional liters were removed via the standard paracentesis tube with suction bottle. patient tolerated this without incident, and the pigtail catheter was removed. this ascites fluid demonstrated enterococcus faecium resistant to vancomycin and sensitive to linezolid. he continued on daptomycin. he was started on caspofungin iv for yeast that was detected in the abscess drainage drawn on . he received 2 units of blood on for a hematocrit of 26. he was started on epogen. he received another unit of blood on for hematocrit of 29.5. his temperature spiked to 101 again on . picc was removed. no growth was demonstrated. urine culture was negative. blood cultures were sent daily for surveillance. these were all negative. his white blood cell count started to trend down into the 2.3 range. repeat abdominal ct was done on for this temperature spike of 101. no evidence of contrast extravasation or large hematoma within the abdomen or pelvis was noted to explain the patient's drop in hematocrit from 34.9 down to 26.2. there was persistent pleural effusions with bibasilar atelectasis. he had a stable appearing hepatic abscesses and bile collections within segments 4 and 2 of the liver. there was slight decrease in the size of the right lobe collection with a new drainage catheter in place. there was also slight interval decrease in abundant ascites tracking into the pelvis and scrotum. he was given iv lasix for edema. this was stopped when his blood pressure dropped down to 90/70. he had been on iv lopressor as well as p.o. lopressor for some tachycardia; though, the lopressor was stopped. he received some iv hydration. a podiatry consult was obtained for long toenails. these were debrided. an ophthalmology consult was also obtained for patient's complaint of progressive decrease vision in both eyes. findings demonstrated left greater than right subcapsular cataracts, presbyopia, and refractive error. glasses were suggested, and cataract evaluation as an outpatient. given drop in white blood cell count, meropenem was stopped. he had received a total of 14 days of this. caspofungin was also stopped after a total of 6 days, and ceftriaxone 1 gram was started daily as well as ambisome 675 mg daily. his white blood cell count still continued to stay in the 2.1-2.8 range. his hematocrit trended downward to 23.7. epogen was increased. his creatinine remains stable. his lfts were stable. rapamune was continued. his levels trended downward to 3.8. he was tolerating his tube feeding. foley catheter remained in place given large scrotal edema. physical therapy worked with him and recommended rehab. he was started on ambisome on for concern for mold in the abscess that could be consistent with zygomycetes. he continued to have low grade temperatures of 100.9. he remained on ceftriaxone for strep viridans replacing the meropenem. a repeat ct was done on . several fluid collections were again noted within the left and right lobes of the liver which were unchanged in size. there were 3 external percutaneous drainage catheters in place and 1 internal/external biliary catheter was unchanged in position. bilateral pleural effusions were noted and large amount of ascites was noted. wound care consult was obtained for sacral decubitus. he has a full-thickness ulcer coccyx site unable to stage due to yellow fibrinous wound bed. the ulcer is approximately 2 x 1 cm. wound bed is 100% yellow and fibrinous. wound edges were defined. there was minimal drainage from the site. no cellulitis was noted. wound gel, duoderm gel was applied to the ulcer. he remained on a ________low air loss pressure release mattress. in summary, the patient had a prolonged hospital course and became debilitated. he was relisted for a liver transplant pending clearance of multiple liver abscesses, infections. his p.o. intake was poor. he remained on cycled j. tube feedings at night. foley remained in place for large amount of scrotal edema. his right jp abscess drain continued to drain murky discharge with bilious drainage from his liver abscesses. his ptc catheter remained capped. he was assisted out of bed to the chair by pt. plan is to send him to rehab on daptomycin, caspofungin, and ceftriaxone. he will follow up with infectious disease. discharge diagnoses: status post liver transplant, status post hepatic artery thrombosis, liver abscesses growing yeast, enterococcus, vancomycin-resistant enterococci, malnutrition, status post small bowel obstruction with hernia, ascites, depression, sacral decubitus, history of cryptococcal pneumonia. discharge medications: albuterol nebulizers p.r.n. q.6., ambisome 675 mg iv q.24h. with prehydration, ceftriaxone 1 gram iv q.24h., daptomycin 450 mg iv daily, epogen 10,000 units subcutaneously every monday, wednesday, and friday, heparin 5,000 units subcutaneous twice a day, dilaudid 1 mg iv p.r.n. q.3-4h. for pain, insulin sliding scale and fixed dose of lantus, loperamide 2 mg p.o. b.i.d. for loose stools to be held if no bowel movements, nifedipine 10 mg p.o. b.i.d., oxycodone 5-10 mg p.o. p.r.n. q.4-6h., protonix 40 mg p.o. daily, rapamune 2 mg p.o. daily, bactrim single strength 1 tablet p.o. daily, tylenol p.r.n. , m.d. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other enterostomy diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed (percutaneous) [needle] biopsy of liver percutaneous abdominal drainage other cholangiogram percutaneous aspiration of liver other destruction of lesion of liver other injection into sympathetic nerve or ganglion other hernia repair diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified protein-calorie malnutrition bacteremia abscess of liver paralytic ileus pressure ulcer, lower back embolism and thrombosis of other specified artery complications of transplanted liver hernia of other specified sites, with obstruction cholangitis other specified antibiotics causing adverse effects in therapeutic use other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria 

Answer: The patient is high likely exposed to