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: patient recorded as having no known allergies to drugs attending: chief complaint: fever major surgical or invasive procedure: endoscopic gastroduodenoscopy with biopsy temporary dialysis catheter placement in right femoral vein picc line placement history of present illness: patient is a 52yo f with hiv/hcv coinfection (not on haart, cd4 250s, vl 4k), esrd on hd - admitted with fever to 104.9. she did not have any pain or cough or urinary/bowel sx. hd stopped early today due to fevers, given vanco there. here in ed given levo/flagyl/vanco, also recieved gent. patient has tunnel cath-- recent stripping at 1 wk ago. patient had a recent admission for esophagitis and tear for which she was treated with fluc. and acyclovir (d/c'd ). in ed, cxr was neg, blood cx were taken, patient rec'd vanc,levo,flagyl, gent x 1. also rec'd vanc at dialysis. past medical history: hiv: diagnosed approximately 6 years ago. never been on antiretroviral therapy. no history of opportunistic infections. no other hiv associated complications. hepatitis c hepatitis b hypertension end-stage renal disease: hypertensive nephrosclerosis. gets hemodialysis on tuesday, thursday, and saturdays. has previously been on peritoneal dialysis but that was changed to hemodialysis approximately 1-2 years ago, secondary to complications of peritonitis. status post burn injury to lower anterior abdomen. sigmoid colon polyp: status post polypectomy on , pathology showing adenoma with high-grade dysplasia. no evidence of invasive carcinoma. social history: hx of tobacco, denies alcohol or ivdu. pt says she contracted hiv after being raped several years ago. family history: no history of diabetes, coronary artery disease, kidney disease, or liver disease. history of colon cancer in her father who died when she was very young. physical exam: temperature 97.7 hr 60 bp 110/66 (113-137)/(66-74) p 56-62 o2 100% ra i/o= 90/0 general: nad heent: oropharynx is clear without blood or petechia. no thrush. no scleral icterus. neck: supple. tunneled ij cardiovascular: normal s1, s2. regular rate and rhythm. no murmurs/rubs/gallops. lungs: clear to auscultation bilaterally. abdomen: soft/nontender/nondistended. no rebound/guarding. no masses. no peritoneal signs. no organomegaly. positive bowel sounds. extremities: warm and well perfused. +2 bilateral radial and dp pulses. symmetric pulses. skin: no rashes or other lesions noted. neurologic: alert, awake, oriented x3. motor and sensory grossly nonfocal. pertinent results: micro: 1:30 pm blood culture aerobic bottle (final ): reported by phone to at 9:25am. pseudomonas aeruginosa. final sensitivities. pseudomonas aeruginosa. 2nd morphology. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | pseudomonas aeruginosa | | cefepime-------------- 2 s 2 s ceftazidime----------- 4 s 4 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ 2 s 2 s imipenem-------------- 2 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin---------- <=4 s <=4 s piperacillin/tazo----- <=4 s 8 s tobramycin------------ <=1 s <=1 s anaerobic bottle (pending): . 2:00 pm blood culture aerobic bottle (final ): pseudomonas aeruginosa. sensitivities performed on culture # 221-4221m . anaerobic bottle (pending): . 6:45 am serology/blood helicobacter pylori antibody test (pending): . cardiology report echo study date of patient/test information: indication: ? endocarditis. height: (in) 65 weight (lb): 122 bsa (m2): 1.60 m2 bp (mm hg): 140/90 hr (bpm): 63 status: inpatient date/time: at 11:40 test: portable tte (complete) doppler: full doppler and color doppler contrast: none tape number: 2006w000-0:00 test location: / 6 technical quality: adequate referring doctor: dr. . measurements: left atrium - long axis dimension: 3.0 cm (nl <= 4.0 cm) left atrium - four chamber length: 4.1 cm (nl <= 5.2 cm) right atrium - four chamber length: 4.1 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: 1.1 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: *1.3 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 4.4 cm (nl <= 5.6 cm) left ventricle - ejection fraction: >= 55% (nl >=55%) aorta - valve level: 3.4 cm (nl <= 3.6 cm) aorta - ascending: 3.1 cm (nl <= 3.4 cm) aortic valve - peak velocity: 1.3 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 0.6 m/sec mitral valve - a wave: 0.9 m/sec mitral valve - e/a ratio: 0.67 mitral valve - e wave deceleration time: 243 msec tr gradient (+ ra = pasp): <= 20 mm hg (nl <= 25 mm hg) pulmonic valve - peak velocity: 0.8 m/sec (nl <= 1.0 m/s) interpretation: findings: left atrium: normal la size. right atrium/interatrial septum: normal ra size. the ivc is normal in diameter with >50% decrease collapse during respiration (estimated rap 5-10 mmhg). left ventricle: mild symmetric lvh with normal cavity size and systolic function (lvef>55%). no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. aortic valve: moderately thickened aortic valve leaflets. no as. no ar. mitral valve: mildly thickened mitral valve leaflets. moderate mitral annular calcification. calcified tips of papillary muscles. trivial mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. normal pa systolic pressure. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: trivial/physiologic pericardial effusion. general comments: echocardiographic results were reviewed by telephone with the houseofficer caring for the patient. conclusions: the left atrium is normal in size. the estimated right atrial pressure mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened with a 5mm non-mobile echodensity suggested on the lvot side of the non-coronary leaflet c/w a possible vegetation. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets and supporting structures are mildly thickened. there is trivial mitral regurgitation. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. impression: possible vegetation on the aortic valve without evidence for aortic regurgitation. if clinically indicated, a tee would be better able to define the aortic valve morphology. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate a low risk (prophylaxis not recommended). clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. electronically signed by , md on 14:00. physician: , j. . discharge labs: 06:45am blood wbc-2.5* rbc-3.52* hgb-11.2* hct-33.3* mcv-95 mch-31.9 mchc-33.7 rdw-14.7 plt ct-219 06:45am blood neuts-45* bands-0 lymphs-32 monos-18* eos-1 baso-0 atyps-4* metas-0 myelos-0 06:45am blood hypochr-normal anisocy-2+ poiklo-occasional macrocy-occasional microcy-occasional polychr-normal schisto-occasional burr-occasional 06:45am blood pt-12.2 ptt-32.0 inr(pt)-1.0 06:45am blood gran ct-1020* 06:45am blood glucose-85 urean-27* creat-11.7*# na-135 k-4.0 cl-96 hco3-26 angap-17 06:45am blood albumin-3.5 calcium-10.7* phos-4.2 mg-2.3 06:55am blood genta-2.5* brief hospital course: 53 y/o female with hiv, hep b, hep c, htn, esrd on hd, with pseudomonal bacteremia, blood cultures quickly cleared, on gent and ceftaz, with evidence of possible aortic valve vegitation on tte. . 1. pseudomonal bacteremia: blood cultures positive on . cleared the next day. remained clear for several more days. discharged on gentamycin and ceftazapime. tte showed possible aortic valve vegitation. she will need tee on tuesday and course of antibiotics (to be given with hd) to be determined by result of tee. likely will need at least six weeks. . 2. esrd: temporary dialysis line placed sunday by surgery. dialysed sunday. line removed before discharge. next dialysis should be tuesday . she is scheduled for a tunneled line, to be done tuesday by ir. her nephrologist is . . 3. htn: controled on 5 mg lisinopril. metoprolol xl 100 mg qd was held initially because of hypotension and restarted on discharge. . 4. hiv: last cd4 248. not on haart. needs follow up with . . 5. hep b/hep c: stable. needs to follow upo with . . 6. leukopenia: trending down. monocytosis. not neutropenic (anc>1000). needs cbc checked to ensure trend of wbc count. . 7. anemia: newly anemic this admission. she is iron deficient, but has a high ferritin and low tibc consistant with acd. needs cbc to trend hct. . 8. esophagitis on egd: continued on pantoprazole. h. pylori serology positive on . had h. pylori serology resent and needs to be followed up. needs esophageal biopsy results followed up. medications on admission: medications at home: lisinopril 5mg qd nephrocaps renalgel/sevelamer 800 mg tablet sig metoprolol xl 100 mg po qd . discharged additionally on: pantoprazole 40mg carbamide peroxide 6.5 % drops acyclovir 200 mg capsule capsule po q24h fluconazole 100 mg tablet sig: one (1) tablet po q48h discharge medications: 1. gentamicin in normal saline 60 mg/50 ml piggyback sig: sixty (60) mg intravenous qhd (each hemodialysis) for 6 weeks. 2. ceftazidime-dextrose (iso-osm) 1 g/50 ml piggyback sig: one (1) gram intravenous qhd (each hemodialysis) for 6 weeks. 3. sevelamer 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). disp:*90 tablet(s)* refills:*2* 4. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours): please check with gastrointestinal doctor before stopping. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 7. metoprolol succinate 100 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. disp:*30 tablet sustained release 24hr(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis: pseudomonal bacteremia secondary to dialysis line infection aortic valve endocarditis leukopenia anemia esophagitis secondary diagnosis: end stage renal disease hypertension hiv hepatitis c hepatitis b discharge condition: afebrile. o2 saturation of 100%. dialysed sunday . ambulatory. discharge instructions: you had an infection in your blood which may have caused bacteria to attach to your heart valve. if you notice fever or chills, please call your doctor or come to the emergency room for evaluation. please come back to on tuesday at 9:00am to the -fourth floor cardiology department on the in order to get the ultrasound of your heart. you should not have anything to eat or drink starting monday night at midnight until after the procedure on tuesday. you will then go to the interventional radiology department on the in the clinical center- to have a new dialysis line placed. please ask to see . you will then get dialysis here at that day. please be sure to folow up with dr. of the infectious disease clinic for evaluation of your hiv infection and hepatitis. you can call ( to make an appointment. this is very important. followup instructions: tee on tuesday to evaluate aortic valve for vegitation ir to place tunneled dialysis line tuesday for dialysis h. pylori results form egd/biopsy cbc to evaluate trend of leukopenia needs to consider starting haart therapy for hiv infection procedure: hemodialysis venous catheterization for renal dialysis esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: anemia in chronic kidney disease end stage renal disease chronic hepatitis c without mention of hepatic coma hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute and subacute bacterial endocarditis infection and inflammatory reaction due to other vascular device, implant, and graft chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta asymptomatic human immunodeficiency virus [hiv] infection status other esophagitis leukocytopenia, unspecified septicemia due to pseudomonas 

Answer: The patient is high likely exposed to