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: lisinopril attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: mr. is a 47 year old male with hiv( last cd4 301 ), esrd on pd, dilated cardiomyopathy (ef 30%) who presents with cough and sob. patient notes being in his usual state of health until ~ 2 am this morning when he awoke with severe cough and sob. he notes chronic sob x 3-4 months but does note feel this was significantly worse recently. he notes chronic cough due to cigarette smoking but did not note significant change in his cough until waking up the morning of admission. since the coughing began this am it has been productive of frothy white sputum. denies any blood or other colors. he notes fevers and chills for months but no changes recently. denies any recent travel or sick contacts. denies any significant le swelling. he denies orthopnea or pnd. he has not taken any of his haart regimen or bactrim ppx for the last month as he ran out of prescriptions. the only medications he has been taking are cinacalcet, clonidine, and sevelamer. . in ed, 98.6, 177/134, 116->140, 20, 100% ra(?). exam notable for bibasilar crackles and wheezes. labs remarkable for leukocytosis to 11,600, anemia with hct of 26, . abg on ra was 7.45/35/60. lactate 1.8->1.2. bun/cr 68/16.5. cxr showed diffuse ground glass opacities. head ct was unremarkable with the exception of mastoid opacification. ecg showed sinus tach to 140s. he received azithromycin 500 mg po, bactrim ds 1 tab po, 60 mg of po prednisone, 1 gram of iv ceftriaxone, atrovent nebulizer, benzonatate 100 mg, morphine 4 mg iv, ativan 2 mg iv, and reglan 5 mg iv. cta showed no evidence of pe but did show diffuse infiltrates, consolidations, and moderate edema. . ros was positive as above. in addition, he does note a ha beginning this am. he denies any vision changes, numbness, or weakness. he does not make any urine at baseline. he has been doing his pd regularly and his last ultrafiltrate this morning was ~990 cc. he denies any chest pain, abdominal pain, diarrhea. he notes constipation and has not had a bm in several days. he denies any nausea, vomiting. past medical history: hiv with a cd4 360 in , viral load 45,900 at that time end-stage renal disease secondary to hiv nephropathy. on pd anemia secondary hyperphosphatemia. sickle cell trait. polysubstance abuse - including cocaine dilated cardiomyopathy (last ef 30% on ) htn atrial fibrillation following cocaine use. social history: -cocaine use; last use 4d ago -h/o etoh abuse; 1 drink a month now -smokes 1 ppd x 35 yrs -works as a waiter -lives with friends -receives care and medications through center. family history: significant for ethanol abuse in the mother as well as diabetes and multiple myeloma. negative for renal disease. physical exam: vitals - t: 98.3 bp: 133/99 hr: 95 rr: 20 02 sat: 96% ra general: nad/ comfortable heent: eomi, perrl, op - no exudate, no erythema, jvd not appreciated cardiac:no m/r/g appreciated, nl s1, s2 lung: decreased bs at bases bilaterally, cta-b/l abdomen: slightly distended, nt, soft, pd catheter in place ext: no c/c/e neuro: non-focal skin: no rashes noted pertinent results: admission: 02:30pm blood wbc-11.6*# rbc-2.67* hgb-9.1* hct-26.0* mcv-97 mch-34.2* mchc-35.2* rdw-14.6 plt ct-437 02:30pm blood neuts-79.6* lymphs-11.7* monos-7.1 eos-1.3 baso-0.4 09:04pm blood pt-13.1 ptt-31.0 inr(pt)-1.1 02:30pm blood wbc-11.6* lymph-12* abs -1392 cd3%-83 abs cd3-1162 cd4%-18 abs cd4-253* cd8%-61 abs cd8-850* cd4/cd8-0.3* 02:30pm blood glucose-90 urean-68* creat-16.5*# na-138 k-3.6 cl-98 hco3-28 angap-16 09:04pm blood alt-13 ast-37 ld(ldh)-447* ck(cpk)-1224* alkphos-94 totbili-0.3 09:04pm blood ck-mb-22* mb indx-1.8 ctropnt-0.24* 03:45am blood ck-mb-23* mb indx-1.3 ctropnt-0.23* 01:14pm blood ck-mb-33* mb indx-1.1 ctropnt-0.22* 06:40am blood ck-mb-43* mb indx-1.0 ctropnt-0.25* 09:04pm blood albumin-3.0* calcium-9.4 phos-5.3* mg-1.4* 06:40am blood caltibc-191* ferritn-300 trf-147* 09:04pm blood hiv ab-positive 09:04pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 04:34pm blood po2-60* pco2-35 ph-7.45 caltco2-25 base xs-0 02:34pm blood lactate-1.8 04:34pm blood lactate-1.2 04:34pm blood o2 sat-88test 06:10am blood wbc-5.5 rbc-2.79* hgb-9.4* hct-26.9* mcv-96 mch-33.6* mchc-34.8 rdw-15.9* plt ct-464* 06:10am blood neuts-51.6 bands-0 lymphs-32.1 monos-11.4* eos-4.4* baso-0.6 06:25am blood pt-13.0 ptt-31.8 inr(pt)-1.1 06:10am blood glucose-114* urean-75* creat-16.8* na-135 k-3.4 cl-93* hco3-24 angap-21* 06:10am blood ck(cpk)-720* 06:05am blood ck(cpk)-1247* 06:25am blood ck(cpk)-2352* 01:14pm blood ck(cpk)-3127* 03:45am blood ck(cpk)-1824* 06:10am blood calcium-8.0* phos-5.8* mg-1.9 06:40am blood caltibc-191* ferritn-300 trf-147* result reference range/units cocaine/metabolites none detected see below ng/ml rep. limit 20 analysis by enzyme-linked immunosorbent assay (). test result reference range/units cocaine and metabolites tnp rep. limit 20 ng/ml confirmation (cocaine) following oral or nasal intake of 2 mg/kg: up to 200 ng/ml. test result reference range/units cocaethylene tnp rep. limit 20 ng/ml (cocaine/ethanol by-product) benzoylecgonine (cocaine tnp rep. limit 50 degradation product) **final report ** rapid respiratory viral antigen test (final ): respiratory viral antigens not detected. specimen screened for: adeno,parainfluenza 1,2,3 influenza a,b and rsv. this kit is not fda approved for the direct detection of respiratory viruses in specimens; interpret negative result with caution.. refer to respiratory viral culture for further information. viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. 4:01 pm sputum site: induced source: induced. legionella culture (preliminary): no legionella isolated. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. gram stain (final ): <10 pmns and >10 epithelial cells/100x field. gram stain indicates extensive contamination with upper respiratory secretions. bacterial culture results are invalid. please submit another specimen. respiratory culture (final ): test cancelled, patient credited. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): gram stain of this specimen indicates contamination with oropharyngeal secretions and invalidates results. specimen is only screened for cryptococcus species. new specimen is recommended. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): 2:40 pm influenza a/b by dfa source: nasopharyngeal aspirate. **final report ** direct influenza a antigen test (final ): negative for influenza a viral antigen. direct influenza b antigen test (final ): negative for influenza b viral antigen. blood culture, routine (final ): no growth. imaging: cxr impression: improvement of the right upper lobe opacification. given short time interval of clearance suggests aspiration. otherwise, diffuse ground-glass opacities bilaterally are similar in appearance. cxr impression: focal progression of disease in the right upper lobe and bilateral pleural effusions (more clearly seen on chest ct) favor a general bacterial infection over pcp. echo the left atrium is dilated. there is severe symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is severe global left ventricular hypokinesis (lvef = 30-35 %). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the aorta does not appear as dilated on the current study. the other findings are similar. cta impression: 1. extensive bilateral airspace opacification, with severe consolidation in right upper lobe, less extensive consolidation in the left upper lobe, and diffuse ground- glass opacity in the lower lobes bilaterally. these findings suggest an advanced infectious process such as pcp or cmv pneumonia, less likely bacterial pneumonia. 2. no evidence of pulmonary embolism. 3. moderately extensive mediastinal and hilar lymphadenopathy, likely reactive to the pulmonary process. 4. mild pulmonary edema and small pleural effusions. cxr impression: diffuse air space opacification, which may represent pulmonary edema or diffuse pneumonia (including pcp). ct head impression: 1. no acute intracranial hemorrhage or mass effect. mri is more sensitive for detection of intracranial malignancy. 2. near complete opacification of the right mastoid air cells. please correlate clinically for evidence of otitis media or mastoiditis. brief hospital course: 47 year old male with hiv(cd4 301), esrd on pd, dilated cardiomyopathy(ef 30%) here with diffuse pulmonary ground glass opacities, consolidations, and pulmonary edema. # sob/hypoxia: the day of admission the patient awoke with cough and sob that had acutely worsened. he noted 3-4 months of sob prior. he reportedly had a lot of salt over the holiday and missed some of his lisinopril doses. of note, he has not had his haart or bactrim ppx for the last month as he ran out of prescriptions. he states he has been doing his pd regularly. in the ed he was notable for bibasilar crackles and wheezes with labs significant for leukocytosis of 11,600, anemia with hct of 26. abg on ra was 7.45/35/60. lactate 1.8->1.2. bun/cr 68/16.5. cxr showed diffuse ground glass opacities. head ct was unremarkable with the exception of mastoid opacification. ecg showed sinus tach to 140s. he received azithromycin 500 mg po, bactrim ds 1 tab po, 60 mg of po prednisone, 1 gram of iv ceftriaxone, atrovent nebulizer, benzonatate 100 mg, morphine 4 mg iv, ativan 2 mg iv, and reglan 5 mg iv. cta showed no evidence of pe but did show diffuse infiltrates, consolidations, and moderate edema. he was transferred to the micu due to his respiratory status. . in the micu, the patient was initially treated with bactrim and steroids. id was consulted and an induced sputum was sent for pcp and dfa for was also sent, that eventually returned negative. given the fact that the likelihood of pcp was low given that cd4 > 250. bactrim and steroids were stopped, and he conitued on iv ceftriaxone and azithromycin for cap. nephrology also followed the patient for his pd and fluid was taken off. chf regimen also changed to carvedilol and stopped ccb. his respiratory status improved. the patient continued to improve and completed a 10 day course of antibiotics for cap with azithro and cefpodoxime. he also had repeat pcp and legionella that was negative. additionally, viral screen showed was negative. # tachycardia: the patient was previously noted to have sinus tachycardia on ecg. given acute presentation, mi was on the list of potential etiologies however ecg and enzymes were not consistent with this picture. there is question whether he has been compliant with his diltiazem, as he was both tachycardic and hypertensive on presentation. given his cardiomyopathy his ccb was changed to carvedilol. a serum cocaine tox show was negative. #elevated ck: the patient's ck continued to trend upward during his admission. the cause was thought to potentially be due to infectious insult vs. sickle cell trait (elevated ldh at baseline as well). the patient's ck trended upwards to 4170 on . the ck then trended down and was 720 on discharge. . # htn: persistently hypertensive during admission, and was continued on his clonidine. the patient's ciltiazem was discontinued and he was started on coreg. . # dilated cardiomyopathy: the patient's ce were negative. an echo was performed this admission had showed an ef of 30-35%. the patient was started on coreg. the patient should have follow-up with cardiology. # hiv: id consulted for this morning. patient has been non-compliant with medications in the past, his cd4 count was 251 on admission. his haart was held given that he had not been taking the medications in the last month. he has no h/o oi and was not started on ppx. he was restarted on his haart regimen on and also started on bactrim ppx. # esrd: the patient was followed by renal and continued on peritoneal dialysis. # hyperparathyroidism: thought to be secondary to renal disease, on cinecalcet. patient noted not being compliant with this medication at times as well (due to insurance issues). . # anemia, the patient's baseline hct high 20s - low 30s, highly variable. he has a h/o sickle cell trait. there was no evidence of bleed, or hemolysis (although ldh is elevated, but this is chronic). his hct was trended throughout the admission. . # fen: advance diet as tolerated . # ppx: heparin sc. ppi. # access: piv, 18g x 2. # code: full, confirmed with patient # comm: (aunt) . (friend) medications on admission: ritonavir 100 mg once a day (not taken for 1 month) zidovudine 300 mg once a day (not taken for 1 month) fosamprenavir 1400 mg once a day (not taken for 1 month) lamivudine 50 mg daily (not taken for 1 month) tenofovir disoproxil fumarate 300 mg tablet q week (not taken for 1 month) diltiazem sr 240 mg daily (not taken for 1 month) trimethoprim-sulfamethoxazole 400 mg-80 mg once a day (not taken for 1 month) omeprazole 20 mg daily prn lactulose 30 ml prn cinacalcet 60 mg clonidine 0.1 mg sevelamer 3 pills with each meal discharge medications: 1. azithromycin 250 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 4 days. disp:*8 tablet(s)* refills:*0* 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 3. cinacalcet 30 mg tablet sig: two (2) tablet po bid (2 times a day). 4. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 5. clonidine 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 6. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 7. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal (2 times a day). disp:*qs * refills:*2* 10. fosamprenavir 700 mg tablet sig: two (2) tablet po q24h (every 24 hours). disp:*60 tablet(s)* refills:*2* 11. tenofovir disoproxil fumarate 300 mg tablet sig: one (1) tablet po qfri (every friday). disp:*4 tablet(s)* refills:*2* 12. zidovudine 100 mg capsule sig: three (3) capsule po daily (daily). disp:*90 capsule(s)* refills:*2* 13. ritonavir 100 mg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*2* 14. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*2* 15. lamivudine 100 mg tablet sig: 0.5 tablet po once a day. disp:*15 tablet(s)* refills:*2* 16. calcitriol 0.5 mcg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*2* 17. cefpodoxime 100 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 4 days. disp:*8 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: community aquired pneumonia seconday: hiv end-stage renal disease dilated cardiomyopathy (last ef 30% on ) hyperparathyroidism anemia secondary hyperphosphatemia htn atrial fibrillation sickle cell trait s/p r inguinal hernia repair discharge condition: stable, ambulating, satting well on room air discharge instructions: it was a pleasure taking care of you while you were in the hospital. you were admitted to because of an infection in your lung. you were treated with antibiotics and improved. you were continued on antibiotics for a total of 10 days. your respiratory status improved and you felt much better. you were ruled out for pcp, , and other infectious diseases. you were also restarted on your haart and bactrim for pcp . please follow the medications prescribed below. new medications: 1) bactrim ss 1 tab daily 2) flonase 3) restart your haart therapy as previous: ritonavir 100 mg once a day zidovudine 300 mg once a day fosamprenavir 1400 mg once a day lamivudine 50 mg daily tenofovir disoproxil fumarate 300 mg tablet q week 4) nicotine patch 5) azithromycin 10 days total 6) cefpodoxine 10 days total 7) carvedilol 6.25mg 8) calcitriol 0.5mcg your diltiazem was discontinuned. please follow up with the appointments below. please call your pcp or go to the ed if you experience chest pain, palpitations, shortness of breath, nausea, vomiting, fevers, chills, or other concerning symptoms. followup instructions: please follow-up with your pcp weeks pcp: , . please follow up with the clinic telephone: provider: , md phone: date/time: 9:00 procedure: peritoneal dialysis diagnoses: pneumonia, organism unspecified other primary cardiomyopathies anemia in chronic kidney disease end stage renal disease human immunodeficiency virus [hiv] disease hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease secondary hyperparathyroidism (of renal origin) chronic glomerulonephritis with unspecified pathological lesion in kidney sickle-cell trait 

Answer: The patient is high likely exposed to