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: vicodin / sustiva attending: chief complaint: acute renal failure and pneumonia (transfer from outside hospital) major surgical or invasive procedure: bronchoscopy, lumbar puncture x2 history of present illness: pt 46 y/o female with pmhx significant for hiv who presented to good hospital on with cough, fever, and diarrhea. she had visited her freind in the hospital with pna 2 weeks prior to presentation. patient was initially put on 5 day course of zithromax outpatient but did not improve and was admitted to the hospital. on admission her cxr was significant for right sided pneumonitis. patient was admitted and being treated for cap with levofloxacin and ceftriaxone when she apparently decompensated from a respiratory standpoint on , requiring intubation. at that point she had ct chest which showed dense consolidation of rul with b/l ground glass air space disease throughout both lobes. patient was put on respiratory isolation for concern for tuberculosis and x2 sent, fist one came back negative. . while at the osh patient also developed arf with cre going from 2.7 on admission to 5.5 on day of transfer. renal was consulted and felt could be secondary to volume depleation from diarrhea. she underwent renal u/s at osh which was negative. she was started on bicarb gtt for treatment of metabolic acidosis. on patient started on steroids and pentamidine given concern for pcp . she also become hypotensive at osh and was started on neo and transferred to . . also during admission at osh patient found to have 7mm left posterior parietal hemorrhage on head ct without mass effect. she was seen by neurosurgery at osh who felt hemorrhage unlikely after repeat head ct showed no change in mass. patient also noted to have severe sinusitis. past medical history: 1. hiv diagnosed in ; cd4 675 hiv vl 209 in . presented with cmv retinitis 2. h/o cmv retinitis of r eye 3. s/p tah with blo in 4. htn 5. history of brain cancer/meningioma 6. hyperlipidemia 7. h/o chronic diarrhea since starting haart in . has had many gi w/u and colonoscopy in the last year 8. rectal cancer: had xrt, chemo, and surgery. since her cancer has had brbpr social history: lives at home with sister, denies etoh use, states quit smoking 4 days prior to admit at osh. denies any iv drug use . family history: maternal grandparents died of cancer (unknown type) in their 60s or 70s. her parents are alive in their 70s. no other known cancer in the family. paternal grandmother diet of cirrhosis. physical exam: t 96.0 bp 116/68 p 64 rr 22 o2 95 on 2l fs 131 wt 153 lbs gen: nad, tired appearing heent: perrl, sclera anicteric chest: decreased breath sound at bases, breathing comfortably cardiac: rrr s1/s2 no murmurs abd: soft non-distended ext: patient with erythema of all toe-nails at nail-bed where nail meets skin; no edema, r subclavin iv in place neuro: alert and awake interactive, appropriate pertinent results: 07:27pm wbc-14.3* rbc-2.80* hgb-9.6* hct-28.1* mcv-100* mch-34.3* mchc-34.3 rdw-15.0 07:27pm neuts-99.0* lymphs-0* monos-1.0* eos-0 basos-0 07:27pm plt smr-normal plt count-343 07:27pm pt-13.6* ptt-29.5 inr(pt)-1.2* hit antibody: negative . iron 53, tibc 183, ferritin 980, folate 14.3, b12 abs cd4 30->195 . 07:27pm glucose-137* urea n-83* creat-5.3* sodium-135 potassium-4.8 chloride-110* total co2-17* anion gap-13 07:27pm alt(sgpt)-30 ast(sgot)-68* ld(ldh)-531* alk phos-106 amylase-119* tot bili-0.7 dir bili-0.6* indir bil-0.1 07:27pm lipase-51 07:27pm albumin-2.4* calcium-7.1* phosphate-5.3* magnesium-2.9* . csf total protein 22, glucose 69 total protein 42, glucose 43 ebv, hsv pcr: negative flow cytometry from : pending (prelim negative for evidence of cns lymphoma) . hiv vl: pending . 07:30pm urine blood-mod nitrite-neg protein-30 glucose-tr ketone-neg bilirubin-sm urobilngn-neg ph-6.5 leuk-neg 07:30pm urine rbc-15* wbc-2 bacteria-rare yeast-none epi-0 07:30pm urine eos-negative . fungal blood cx: no growth to date blood cx: no growth to date cath tip cx: negative cmv vl: undetectable rapid respiratory viral screen: negative, viral culture: pending urine legionella antigen: negative . 12:07 pm bronchoalveolar lavage gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): ~/ml oropharyngeal flora. yeast. ~3000/ml. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. legionella culture (final ): no legionella isolated. immunofluorescent test for pneumocystis carinii (final ): pneumocystis carinii not seen. fungal culture (final ): yeast. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (pending): . 8:02 pm csf;spinal fluid source: lp. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (preliminary): no growth. . 6:24 pm csf;spinal fluid tube 3. r/o hsv. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. fungal culture (preliminary): no fungus isolated. viral culture (preliminary): no virus isolated so far. . cxr: 1. right upper lobe consolidation, likely pneumonia. 2. moderate interstitial abnormality is likely pulmonary edema, though viral pneumonia is also possible. 3. possible mediastinal lymphadenopathy - recommend chest ct for further evaluation on a nonemergent basis. . cxr: markedly improved airspace process in the right upper lobe and mildly improving interstitial edema. . mr head: 1. abnormal flair sulcal hyperintensity , differential includes any leptomeningeal process. in a patient with hiv, meningitis is not excluded and correlation with lumbar puncture is recommended. also, contrast enhanced study could be performed if patient's renal function improves, or hemodialysis can be arranged. 2. a 6 mm lesion within the left occipital cortex, which may represent a meningioma, but is incompletely characterized. a hemorrhage in this area is not entirely excluded, and short interval followup with non-contrast ct was recommended. 3. pansinus opacification. . cxr: cardiac size is top normal. et tube is in the standard position. ng tube is in the stomach. right subclavian vein catheter terminates in the cavoatrial junction. there has been mild interval worsening of mild-to-moderate pulmonary edema. right upper lobe consolidation is stable. ill-defined right lower lobe perihilar opacity is new. this could be due to asymmetric pulmonary edema, but infection cannot be completely excluded. . spinal fluid: negative for malignant cells. lymphocytes and monocytes. . cxr: mild improvement in the degree of pulmonary edema as well as the previously noted right upper and lower lung field consolidations. . eeg: this is an abnormal eeg due to the right greater than left central sharp waves, the bursts of generalized slowing and the slow and disorganized background rhythm. the first two abnormalities suggest dysfunction of deep subcortical midline structures, while the slow background suggests a mild to moderate encephalopathy. an encephalopathic picture may result from infections, toxic metabolic abnormalities or medication effect. . ct head: 1. unchanged hyperdensity along the left occipital convexity likely represents meningioma, but a hemorrhage cannot be entirely excluded. unchanged from prior examinations. 2. pansinusitis. . single ap portable view of the chest: cardiomediastinal contour is unchanged. right subclavian vein catheter terminates in the svc. there is no pneumothorax or pleural effusion. diffuse mild interstitial abnormality has improved since , . right upper lung consolidation is increasing. . unilat up ext veins us right: no evidence for dvt. . ct abd/pelvis: 1. no intra-abdominal source of fever identified. diffuse anasarca with interval increase in small amount of simple free fluid noted within the cul- de- sac. 2. mild stranding/wall thickening of the distal rectum/anus consistent with known history of anal carcinoma. wall thickening may also be related to post- radiation changes in correct clinical setting. 3. marked improvement in multifocal pneumonia with interval appearance of small simple right pleural effusion. incidental note is also made of a mucous-filled left lower lobe bronchus. 4. diffuse enlargement to kidneys bilaterally. findings suggestive underlying renal dysfunction may be due to hiv nephropathy. . ct head: 1. no significant change from most recent ct examination; however, current examination is limited due to motion artifact. 2. stable appearance to left occipital density, likely representing a meningioma. 3. stable appearance to opacification of sphenoid sinus with mild improvement to opacification within the ethmoid air cells. maxillary sinuses were not included on current study. if high clinical suspicion for sinus disease as a source of fever, may be better evaluated with dedicated sinus ct. . cxr: improvement in the appearance of the interstitial process together with the right upper lobe airspace disease since the prior examination. . brief hospital course: # multifocal pneumonia: patient required intubation at the outside hospital. bronchoscopy here with sputum negative for pcp. negative x 3, urine legionella antigen negative, and viral screen negative. swallow evaluation was done during her admission due to her poor mental status and showed no evidence of aspiration. patient improved on zosyn/vanco and finished a total of 12 days of antibiotics on levo/vanco. at the time of discharge she was stable on room air and received the pneumovax prior to discharge. . # drug fever: at the end of patient's course of antibiotics for her pneumonia, she began to have fevers as high as 103 but was also noted to have developed a rash. suspect drug reaction to either acyclovir (started for ? hsv meningitis but discontinued once pcr negative) versus zosyn. her fevers resolved off all antibiotics. work-up was otherwise negative, including ct abd, ct head to reevaluate for progressive sinusitis, and repeat cultures. she did grow yeast in her urine, so her foley was discontinued and she received a single dose of diflucan. her subclavian line was also discontinued, despite negative cultures. the tip culture was negative. . # abnormal mri: mri done for altered mental status while in the icu showed an abnormal flair sulcal hyperintensity and an occipital density, thought to be a meningioma. neurology was consulted and followed along during the patient's stay. they suspect the occipital lesion is a meningioma given it is stable compared to a prior mri in . however, they have requested a follow-up mri as an outpatient and will also see her in outpatient follow-up. as for the meningeal enhancement, concern raised for possible cns lymphoma. hematology was consulted and followed along. patient found to have ebv in her csf with rare atypical cells on cytology. a repeat lp was done to send csf for flow. preliminary flow does not suggest lymphoma. repeat cytology is pending. . # acute renal failure: renal followed along. suspect acute tubular necrosis. creatinine improved to 2.0 by the time of discharge. she had no severe electrolyte disturbances. medications were renally dosed. patient will be following up with renal as an outpatient. . # hiv: id followed throughout the admission. at discharge, given persistent renal dysfunction and complaints of diarrhea on kaletra, her haart regimen was adjusted. she will follow-up with dr. for continued care. repeat cd4 and hiv viral load sent prior to discharge. bactrim prophylaxis deferred given cd4 count has been steadily climbing. this can be started at her id follow-up if her cd4 remains < 200. she did require nystatin for oropharyngeal +/- esophageal candidiasis. . # neutropenia: suspect medication-induced given onset during her stay. following the discontinuation of all antibiotics, anc recovered and patient no longer neutropenic at the time of discharge. . # history of anal cancer: patient will discuss with her id provider whether she can do screening anal paps. if not, patient will need referral to dr. for this reason. patient given dr. name for future reference. . # anemia: folate and b12 normal. high ferritin suggests anemia of chronic disease. certainly renal failure will be a contributing factor. . # altered mental status: likely due to residual effects of sedating meds administered while intubated. mri issues discussed above. lp did not suggest infectious etiology. eeg showed no evidence for seizures. patient had a normal mental status at the time of discharge. . # fen: regular diet, nutrition recommended supplement . # dispo: discharged home with services (pt and home safety evaluation) medications on admission: acyclovir 800mg albuterol mdi prn didanosine 250mg daily diflucan 100mg qam and 150mg afternoon flonase fuzeon kaletra 200/50 lipitor 80mg qhs lodine 500mg loratadine 10mg daily oxycodone 50mg q6 pepcid 20mg daily prednisone 10mg daily premarin 0.625mg daily reyataz 150mg tricor 145mg daily truvada 1 tab daily zithromax 150mg daily motin for back pain discharge medications: 1. didanosine 200 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* 2. fuzeon 90 mg kit sig: one (1) injection subcutaneous twice a day. disp:*60 prefilled syringes* refills:*0* 3. atazanavir 300 mg capsule sig: one (1) capsule po once a day: must take with ritonavir, do not take with any antacids. disp:*30 capsule(s)* refills:*0* 4. abacavir 300 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*0* 5. ritonavir 100 mg capsule sig: one (1) capsule po once a day: must take with atazanavir. disp:*30 capsule(s)* refills:*0* 6. lamivudine 150 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 7. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puffs inhalation four times a day for 7 days. disp:*1 inahler* refills:*0* 8. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*0* 9. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) for 7 days. disp:*140 ml(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary: multifocal bacterial pneumonia neutropenia hiv, symptomatic likely meningioma but needs follow-up mri to confirm stability ebv in csf - preliminary work-up does not suggest cns lymphoma but final cytology pending acute renal failure due to acute tubular necrosis anemia of chronic disease drug fever encephalopathy - resolved prior to discharge hypokalemia secondary: history of anal cancer discharge condition: good: afebrile, anc steadily improving, stable on room air discharge instructions: please call your doctor or go to the emergency room if you experience temperature > 101, worsening cough or shortness of breath, chest pain, or other concerning symptoms. please continue to take a nutritional supplement twice daily to improve your nutritional status. please note your new hiv medication regimen. please monitor for signs and symptoms of abacivir hypersensitivity and call dr. if you notice any of the following: anaphylaxis, fever, rash, fatigue, diarrhea, abdominal pain, sore throat, shortness of breath, cough, headache, muscle or joint pain, swelling in your arms or legs, numbness in your arms or legs, nausea and vomiting, mouth ulcerations, eye irritation, or gland swelling followup instructions: 1. provider: , ob/gyn pps cc8 (sb) phone: date/time: 1:00. building . 2. provider: , md (new primary care doctor) phone: date/time: 3:30. building, . 3. provider: . (nephrology) phone: date/time: 3:00. building medical specialties. 4. you have an mri of your head scheduled on tuesday at 4:45 in the basement. 5. you have an appointment scheduled with dr. , m.d. (neurology) phone: date/time: 2:00. building . 6. please follow-up with dr. on wednesday, , at 9:00 am. phone: (. , ., suite gb (ground level) procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung spinal tap incision of lung enteral infusion of concentrated nutritional substances arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: acidosis acute kidney failure with lesion of tubular necrosis unspecified essential hypertension candidiasis of other urogenital sites hypopotassemia human immunodeficiency virus [hiv] disease other and unspecified hyperlipidemia acute respiratory failure hypotension, unspecified neutropenia, unspecified candidal esophagitis bacterial pneumonia, unspecified personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus infectious mononucleosis benign neoplasm of spinal meninges 

Answer: The patient is high likely exposed to