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 70-year-old male, status post orthotopic liver transplant in , complicated by preservation injury requiring admission, now with increased lfts and diarrhea. had an ercp that demonstrated preservation injury. admitted now with hypotension, systolic bps in the 70s noted in the transplant office. past medical history: etoh cirrhosis, dm type 2, hypertension, cad, gerd, anemia. past surgical history: orthotopic liver transplant , cabg , inguinal hernia repair. allergies: no known drug allergies. social history: alcohol abuse in the past, none currently. tobacco: none in past history. family history: not addressed. meds at home: valcyte 900 mg p.o. once daily, protonix 40 mg once daily, ursodiol 300 mg t.i.d., lopressor 37.5 mg b.i.d., prograf 1.5 mg p.o. b.i.d., cellcept mg p.o. t.i.d., pentamidine 300 mg inhalation q. month, nph insulin 30 units sc q. a.m. labs on admission: white count 7, hematocrit 34.5, platelet count 188, coags within normal limits, blood sugar 27, sodium 142, potassium 3.8, chloride 110, co2 19, bun 42. physical examination: on admission, patient was alert and oriented, no acute distress. vital signs: temperature 96.3, heart rate 54, respiratory rate 18, 100% o room air, bp 112/54. lungs were clear bilaterally. cor: regular rate, rhythm. abdomen soft, nontender, nondistended, roux tube site no erythema. peripherally 1+ edema bilaterally. nonfocal neuro exam. hospital course: patient was given d50 with elevation of blood sugar. started on an iv of d5-1/2ns at 60. he was started on vancomycin and unasyn. chest x-ray on admission demonstrated heart size within the upper range of normal with a tortuous aorta. there were linear areas of opacity at the left lung base with interval improvement in the area compared to the previous study, with residual small left pleural effusion. the left lower lobe opacities were felt to be related to atelectasis. an ekg demonstrated sinus bradycardia with a rate of 52, with av conduction delay. q-waves were noted in leads iii and avf, felt to be possibly related to a prior inferior myocardial infarction. there was concern for cholangitis. infectious disease was consulted and recommended levofloxacin and flagyl, changed to zosyn 4.5 grams iv q. 6, with continuation of vanco. blood cultures on admission were subsequently found to be negative. bile culture demonstrated citrobacter pansensitive, enterococcus pansensitive and nonfermenter, resistant to bactrim other pansensitive. stool cultures were sent off. these were negative for c. diff. a cmv viral load was done. this was not detected. he was placed on flagyl for concerns for c. diff. c. diffs were negative x3. he continued on zosyn and vancomycin while awaiting final cultures. he was started on tpn for malnutrition. patient was noted to be extremely jaundice with an alkaline phosphatase of 154, t- bilirubin of 4.4, and an inr of 1.0. baseline creatinine was 0.9. hematocrit was stable. he had generalized edema. his ptca drained. a ct of his abdomen was done with nonionic contrast. this demonstrated decreased size of the subcapsular hepatic hematomas. there were new intrahepatic biliary dilatations noted predominantly in the left lobe of the liver. diffuse colon wall thickening was noted consistent with colitis. there was concern for c. diff, and there was increased right pleural effusion and increased ascites. his creatinine started to increase on hospital day 4 to 2.7 from baseline of 2. his prograf was adjusted. his prograf level was 11, and iv fluid was decreased. a nephrology consult was obtained, and it was felt that the patient had atn seen on a urinalysis secondary to hypotension, in addition to iv contrast for the ct, despite prophylaxis with iv bicarbonate and p.o. mucomyst. he underwent a cholangiogram to assess tube placement. compared to the cholangiogram performed on , the tip of the t-tube was lower than the prior location, but still located in the common bile duct. there was no evidence of bile leak or stricture. a renal ultrasound was done to evaluate elevated creatinine. there was no evidence of hydronephrosis in either kidney. a 2-cm cyst in the lower pole of the right kidney was noted, and there was a small amount of ascites noted. the patient underwent central line placement with tip in the correct position. after much consideration, the patient was relisted for retransplantation. he was taken to the or on by dr. , and he underwent a liver transplant from a diseased donor liver transplant piggyback, underwent a donor common hepatic artery to recipient proper hepatic artery, portal vein-to-portal-vein anastomosis, a roux-en-y hepaticojejunostomy and splenectomy. assistant surgeon was dr. . please see operative report. patient was intubated and transferred to the sicu immediately postop. he received induction immunosuppression intraop with solu-medrol 500 mg iv, cellcept 1 gram iv. postoperatively, he remained in the icu and gradually was weaned from the vent. his immunosuppression was titrated per protocol. his lfts started to trend downward. a postop liver duplex was done that demonstrated normal doppler study, small fluid collection adjacent to the right posterior aspect of the liver. pathology report from the liver biopsy from the recipient demonstrated extensive large bile duct necrosis with marked bile duct proliferation with associated neutrophils. the hepatic artery was with thrombus. there was negative portal vein. there was marked cholestasis, and trichrome and iron stains were evaluated. please see path report for further details. patient required frequent suctioning for thick yellow sputum. o2 sats remained in the 98-100% range. patient was in first degree av block. he required packed red blood cells for hematocrits of 26. on , he was noted to have a right neck swelling and a question of cellulitis. an ultrasound was done. this demonstrated thrombus within the right internal jugular vein. the right subclavian vein appeared patent. on , he underwent a t-tube cholangiogram that demonstrated no leak, or obstruction, or intrahepatic biliary dilatation. there was free contrast passage into the small bowel loops. of note, the patient did receive a cardiology consult for av block. recommendations included continuation of beta blockers. gradually, lfts trended down with an ast of 24, alt of 32, alkaline phosphatase of 154, and a t-bili of 4.4. creatinine decreased to 1.1. hematocrit was stable. he continued on tube feedings, as he failed a swallow eval at bedside. he required lasix for diuresis for fluid retention. atn was resolving. his creatinine trended down to 1.4. he required an insulin drip postoperatively for hyperglycemia. he was transferred to the medical surgical unit on postop day 11, on , and vital signs were stable. bedside swallow eval was done again. patient failed the swallow eval. he continued on his postpyloric feeding tube feedings. physical therapy followed him each day. his foley catheter was removed, and his feeding tube was capped. his lfts continued to improve. sodium increased to 140. he received free water via his postpyloric feeding tube for a free water deficit. sodium continued to stay elevated around 140-145. his mental status was noted to be confused with inaudible speech at times. patient was mumbling. his potassium was 5.1. this was treated with insulin, d50 and calcium gluconate per iv with a repeat potassium 4.6. respiratory status was of concern. respirations were 22-24 per minute. the patient had upper airway wheezing. albuterol nebs were given with positive effect. his lung sounds were diminished at the bases. he was assisted to do coughing and deep breathing. he was n.p.o. mental status started to decline. he became tachycardic and tachypneic. sepsis was suspected. blood cultures were sent off on . these were positive for klebsiella sensitive to imipenem and meropenem. he was initially started on vancomycin and levaquin, and upon finalization of blood cultures, he was switched to meropenem. a ua was positive, and urine culture also demonstrated klebsiella, sensitive to meropenem and imipenem. he was transferred back to the sicu for close monitoring given concern for aspiration pneumonia. a chest x-ray demonstrated no pneumothorax, small bilateral pleural effusions that were unchanged with retrocardiac linear atelectasis unchanged. his left ij line was changed over a wire with placement confirmed. he was given iv lasix, as well as iv fluid, and his sodium trended down. creatinine continued to be normal at 1.0, hematocrit was stable, and his white blood cell count remained within normal limits. throughout this, his lfts continued to improve, with a fluctuation in the alkaline phosphatase with the range between 145 and 188. total bilirubin trended down to a low of 1.5. he was transferred out of the sicu back to the medical surgical unit after aggressive respiratory hygiene and correction of hypernatremia. consult was obtained for management of hyperglycemia. his insulin was adjusted. vancomycin was stopped. infectious disease recommended continuation of meropenem through the . a repeat bedside swallow eval was done with a video swallow on which demonstrated mild delay in bolus formation with a single episode of penetration without aspiration. his diet was advanced to ground consistency with thin liquids with supervision. the patient was ordered to alternate every bite and sip. his tube feedings were changed to impact with fiber three-quarter strength with a goal rate of 100-cc. cardiac echo was done to assess for vegetations given klebsiella bacteremia. findings included normal size left atrium, elongated left atrium, mild symmetric left ventricular hypertrophy with an ef greater than 55%. due to suboptimal technical quality, a focal wall motion abnormality could not be fully excluded. the aortic valve leaflets appeared structurally normal. he had 1+ mitral regurgitation noted. there was moderate pulmonary artery systolic hypertension noted. no pericardial effusions were noted. patient was cleared for rehab at . physical therapy recommended continuation of strengthening exercises. patient was able to perform stand-step, and was able to get out-of- bed to the chair with moderate assist of 2. he continued to require use of the lift to ensure safety. occupational therapy evaluated the patient and recommended continuation of occupational therapy at rehab. on physical exam, he was alert and oriented, though forgetful at times with periods of confusion, and patient was noted to moan on and off at times, but unable to state exactly why he was moaning. respiratory wise, his lungs were decreased throughout in the bases. he continued on his incentive spirometer use. o2 sat was 95% on room air. he denied shortness of breath. abdomen was soft, nontender, nondistended with hypoactive bowel sounds. he was passing stools. his tube feedings, postpyloric feedings, via dobbhoff were continued. the foley catheter was in place draining adequate yellow urine. a central line on the left side, that site was clean and dry. heart rate was in the 70s with a bp in a range of 110/160 to a systolic in the low- teens. his heart rate was a bit irregular. he was monitored with telemetry without incident. he did not complain of any pain. his abdominal incision was clean and dry with steri- strips, and his t-tube was capped. his labs on were as follows: white blood cell count 9.6, hematocrit 32.8--this was stable, platelet count 365, sodium 136, potassium 5.4, chloride 100, co2 27, bun 40, creatinine 0.5, glucose 119, calcium 8.5, phosphorus 2.5, magnesium 1.8, ast 27, alt 29, alkaline phosphatase 211--this was noted to gradually increase each day on from 109 and each day gradually increasing up to 211. his total bilirubin remained stable at 1.6, with an albumin of 2.4. he continued on his immunosuppression of 10 mg of prednisone per taper. he was due to decrease his prednisone until , when he would start a decrease in his prednisone taper to 7.5 on . cellcept was held. his prograf dose was 1 mg p.o. b.i.d. with a level of 8.4. plan: discharge to rehab with follow-up in outpatient clinic within 1 week. he was scheduled to have twice weekly labs q. monday and thursday for cbc, chem-10, lfts, and trough prograf level. iv meropenem was to continue for a full course until . discharge diagnoses: status post liver transplant complicated by preservation injury, requiring retransplantation and underwent second liver transplant on . diabetes type 2. klebsiella urinary tract infection. klebsiella bacteremia. malnutrition. impaired swallowing. status post coronary artery bypass graft . discharge medications: included vitamin c 500 mg p.o. once daily, ferrous sulfate 300 mg p.o. once daily via dobbhoff, fluconazole 200 mg p.o. once daily, lasix 20 mg p.o. once daily, heparin 5000 units sc b.i.d., insulin - lantus 30 units sc at bedtime with humalog sliding scale starting at 121-160 - 2 units; 161-200 - 3 units; 201-240 - 5 units of humalog; 241-280- 7 units of humalog with accu-cheks q.i.d., lansoprazole 30 mg via ng tube once daily, metoprolol 37.5 mg p.o. b.i.d., meropenem 500 mg iv q. 6 h. through stopping on the , nystatin 5 ml p.o. q.i.d. p.r.n., prednisone 10 mg p.o. once daily, bactrim ss once daily, tacrolimus 1 mg p.o. b.i.d., valcyte 450 mg p.o. once daily. , procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances other transplant of liver total splenectomy transfusion of packed cells transfusion of other serum other cholangiogram other cholangiogram other operations on lacrimal gland transplant from cadaver diagnoses: acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified acute and subacute necrosis of liver unspecified protein-calorie malnutrition severe sepsis portal hypertension other specified cardiac dysrhythmias diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled other septicemia due to gram-negative organisms hepatic encephalopathy complications of transplanted liver hyperosmolality and/or hypernatremia cholangitis achalasia and cardiospasm 

Answer: The patient is high likely exposed to