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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea, fever major surgical or invasive procedure: bronchoalveolar lavage history of present illness: mr. is a 45yo m with hiv (well controlled on art with cd4 542 and vl<75) and pulmonary fibrosis presenting with a day of high fevers, chills, cough and post-tussive emesis. . of note, the patient had a similar presentation in and was briefly in the icu for hypotension with similar presenting symptoms. diagnostic studies at that time were unremarkable and he was diagnosed with respiratory viral illness. . in the ed, initial vs were 105.9, 130, 126/107, 18, 98%ra. he received tylenol 1g, motrin 600mg, ceftazadime 1g, azithro 500mg, bactrim ds 1 tab, tamiflu 75mg. patient got 3l of ivf and had normal lactate of 1.3. cxr showed known fibrosis and ct head was unremarkable. vitals prior to transfer were 110, 109/74, 23, 94% ra. . on the floor, he reports feeling well the day prior to admission but developing rapid onset of fevers, chills, sweats and worsening productive cough today. patient endorses coughing fits and then has post-tussive n/v. he has some sob and mild headache during the coughing fit but no sob or ha at rest. no chest pain, constant headache, neck stiffness, visual changes, dysuria or hematuria. no diarrhea or constipation. no known sick contacts but he is a bus driver. no recent travel or unusual foods. past medical history: hiv (dx at least 7 years years ago). currently on haart and pcp . hypothyroidism. pulmonary fibrosis. mgus. systemic sclerosis. raynaud's phenomenon. previous hospitalizations for viral pneumonias. social history: lives in , ma with brother. with juvenile delinquents in a detention center. occasionally uses marijuana. no smoking or alcohol use. not currently sexually active. contracted hiv from homosexual partner. family history: brother has scleroderma. otherwise nc physical exam: admission physical exam: vs: 99.5, 116/70, 120, 18, 95% ra general: well-appearing man in nad, comfortable, appropriate. heent: nc/at, perrla, eomi, sclerae anicteric, mmm, op clear. neck: supple without stiffness, from heart: rrr, no mrg, nl s1-s2. lungs: cta bilat, no r/rh/wh, good air movement, resp unlabored. abdomen: soft/nt/nd, no masses or hsm, no rebound/guarding. extremities: wwp, no c/c/e, 2+ peripheral pulses. skin: no rashes or lesions. lymph: no cervical lad. neuro: awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout. pertinent results: admission labs: 09:25pm wbc-12.7*# rbc-5.36 hgb-14.8 hct-43.3 mcv-81* mch-27.6 mchc-34.1 rdw-15.5 09:25pm wbc-12.7*# rbc-5.36 hgb-14.8 hct-43.3 mcv-81* mch-27.6 mchc-34.1 rdw-15.5 09:25pm neuts-83.1* lymphs-12.8* monos-3.1 eos-0.7 basos-0.4 09:25pm alt(sgpt)-25 ast(sgot)-25 ld(ldh)-252* alk phos-130 tot bili-1.3 09:25pm glucose-101* urea n-14 creat-1.1 sodium-136 potassium-3.8 chloride-99 total co2-26 anion gap-15 09:31pm lactate-1.3 ct head: impression: no acute intracranial process. . cxr: impression: 1. new ground-glass and consolidative opacities, which could represent pulmonary edema, opportunistic infection such as pcp, hemorrhage, or acute exacerbation of known interstitial lung disease. 2. widened mediastinum is likely a combination of enlarged main pulmonary artery from pulmonary arterial hypertension and distended venous structures. however, attention to the mediastinum on standard pa and lateral chest x-ray would be helpful when the patient's condition permits. . ct abdomen () - 1. thickened appendiceal wall resulting in an appendix measuring 16mm in diameter. no luminal distention to suggest obstruction or features of acute appendicitis such as peri-appendceal stranding or fluid. differential diagnosis includes appendiceal neoplasm (cystadenoma, adeocarcinoma, carcinoid), granulomatous process of the appendix such as tuberculosis, or possibly other unusual inflammatory processes (e.g. crohns, chronic appendicitis). however, clinical correlation is recommended. 2. retroperitoneal and pelvic adenopathy, stable and unchanged when compared to prior ct, likely related to known systemic sclerosis / hiv. 3. bibasilar fibrosis consistent with known uip and systemic sclerosis. there has been an increase in thickening of the pleura on the right side since chest ct . . ct chest: impression: 1. basilar-predominant pulmonary fibrosis, most compatible with fibrotic nsip related to the patient's known diagnosis of scleroderma. associated esophageal dilatation also related to scleroderma is also noted. 2. extensive new ground-glass opacities seen throughout both lungs, most apparent at the right apex. this is most likely infectious in etiology. given the history of hiv, pcp should be considered. atypical infectious processes such as mycoplasma or viral pneumonias are also likely. bacterial or fungal pneumonia is considered less likely given the radiographic appearance. of note, the history of nsip raises the additional possibility of acute interstitial pneumonia, though this would be a diagnosis of exclusion. 3. septal thickening, suggesting mild interstitial edema. 4. stable mediastinal adenopathy, likely reactive. 5. prominence of the main pulmonary artery, suggesting pulmonary hypertension. . cxr: frontal chest radiograph: the heart remains enlarged. on background chronic basal predominant interstitial changes, ground-glass opacities have increased within the right hemithorax, particularly in the upper lobe. this may reflect worsening infection (especially atypical infection such as pcp), worsening edema, or less likely acute worsening of the background interstitial process. there is a small right-sided pleural effusion. no pneumothorax is appreciated. . cxr: frontal chest radiograph: the heart is moderately enlarged. superimposed on background chronic basal predominant interstitial changes, ground-glass opacities, particularly within the right hemithorax have mildly decreased in extent. the findings may reflect infection or mildly improving edema. there is a small right-sided pleural effusion. no pneumothorax is appreciated. . . microbiology: blood culture: blood culture, routine (final ): no growth. blood culture: blood culture, routine (final ): no growth. urine culture (final ): no growth. legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus. blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. fecal culture (final ): no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. ova + parasites (final ): no ova and parasites seen. this test does not reliably detect cryptosporidium, cyclospora or microsporidium. while most cases of giardia are detected by routine o+p, the giardia antigen test may enhance detection when organisms are rare. fecal culture - r/o vibrio (final ): no vibrio found. fecal culture - r/o yersinia (final ): no yersinia found. fecal culture - r/o e.coli 0157:h7 (final ): no e.coli 0157:h7 found. cryptosporidium/giardia (dfa) (final ): no cryptosporidium or giardia seen. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . 2:02 pm blood culture ( myco/f lytic bottle) source: venipuncture. blood/fungal culture (preliminary): no fungus isolated. blood/afb culture (preliminary): no mycobacteria isolated. . ova + parasites (final ): no ova and parasites seen. . respiratory viral culture (final ): no respiratory viruses isolated. . hiv-1 viral load/ultrasensitive (final ): hiv-1 rna is not detected. . 10:15 am sputum source: induced. gram stain (final ): <10 pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): budding yeast. quality of specimen cannot be assessed. respiratory culture (final ): rare growth commensal respiratory flora. yeast. sparse growth. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): yeast. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. . 1:49 pm bronchoalveolar lavage bronchial lavage. r/o cmv. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): no fungus isolated. nocardia culture (preliminary): no nocardia isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. . cryptococcal antigen (final ): cryptococcal antigen not detected. . b-glucan test ---- fungitell (tm) assay for (1,3)-b-d-glucans results reference ranges ------- ---------------- <31 pg/ml . brief hospital course: 45 year old male with hiv (on haart, cd488 and viral load <75), raynaud's, hypothyroidism, scleroderma, chronic renal insufficiency interstitial lung disease who initially presented with high fevers, chills, cough and post-tussive emesis x1 day, transferred to micu for recurrent fever, hypoxia and tachypnea. . this patient had a long and storied course here at with several transfers in and out of the micu for bouts of hypotension and tachypnea most likley related to underlying illness and/or medicaion effects. he never required pressor support or mechanical ventilation. a problem based list is found below as well as transitional issues that need follow up in the immediate future. . # fevers/ hypoxia: overall workup for his illness has been negative thus far including flu, respiratory viral panel, urine legionalla antigen, blood(bacterial and fungal) cultures, 2 negative pcp smears, serum cryptococcal and stool cultures on admission. his presentation is most consistent with a respiratory illness including atypical/viral pneumonia. patient was improving then acutely decompensated requiring micu transfer and there was concern of aspiration/hcap consequently was started on vanc/cefepime for broad coverage. he continues to improve on vanc and cefepime and should continue vancomycin and cefepime antibiotics until for a total of 8 days. patient was empirically treated for pcp on admission, then following bronch bal negative for pcp was decreased to prophlaxic dosing. the next day he developed increasing rr consequently decision was made to treat for pcp (as well as hcap vanc/cefepime as above). he will complete a 21 day course of bactrim treatment on after which he will reduce his dose to prophylaxic dose until his cd4 count recovers. he was afebrile with no oxygen requirement on the day of discharge. # : baseline cr of 1.1. patient had transient bump to 2.0 that responded to fluids. likely pre-renal. plan for cr f/u with pcp. . # transaminitis: patient had mildly elevated transaminases that were initially thought to be indicative of a viral process. have been stable for the duration of his hospitalization. will need to be trended as outpatient and consideration for further work up will be left to pcp . . # abdominal pain: on admission patient had one episode of acute abdominal pain. he underwent stat ct ab/pelvis which demonstrated a thickened appendix but no acute pathology. his abdominal pain resolved quickly and etiology is unclear. - please refer to results section for ct scan of thickened appendix (broad differential) and work-up will need to be completed as an outpatient. . # hiv: patient was maintained on haart therapy for the duration of his stay. was found to have cd4 count in the 80's but with non-detectable vl consistent with acute infection. his cd4 count will need to be checked as an outpatient. he will follow up with his pcp the day following discharge. at that time the following issues will need to be addressed: ****transitional issues****** - f/u pending mycoplasma, pertussis, and b-glucan - cr check - lfts - tsh in 6 weeks once illness has resolved - patient will need to have vancomycin level checked on evening of with dosing changes to be made as necessary. - thickened appendiceal wall (please refer to broad differential listed on final ct scan) - will need to be worked up as an outpatient - regular hiv care medications on admission: percocet 5-325 mg tabs 1 - 2 po q am and 1 po qhs prn gabapentin 300 mg caps 1 - 2 caps po at bedtime, prn extremity pain levothyroxine sodium 200 mcg tabs 1 tab po daily caltrate 600+d 600-400 mg-unit tabs on hold (per pt) levothyroxine sodium 25 mcg tabs 1 tab po daily (with 200mcg tab) albuterol aers via nebulizer reyataz 300 mg caps 1 cap po daily viagra 25 mg tabs outside md norvir 100 mg caps 1 po daily allopurinol 100 mg tabs 2 tabs po daily epzicom 600-300 mg tabs 1 tab po daily discharge medications: 1. gabapentin 300 mg capsule sig: capsules po hs (at bedtime) as needed for pain. 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for wheeze, sob. 3. levothyroxine 200 mcg tablet sig: one (1) tablet po daily (daily). 4. levothyroxine 25 mcg tablet sig: one (1) tablet po once a day. 5. ritonavir 100 mg capsule sig: one (1) capsule po daily (daily). 6. allopurinol 100 mg tablet sig: two (2) tablet po daily (daily). 7. epzicom 600-300 mg tablet sig: one (1) tablet po once a day. 8. vancomycin in 0.9% sodium cl 1.25 gram/150 ml solution sig: one (1) intravenous twice a day for 6 days. disp:*12 bags* refills:*0* 9. cefepime 2 gram recon soln sig: one (1) recon soln injection q8h (every 8 hours) for 6 days. disp:*24 recon soln(s)* refills:*0* 10. atazanavir 300 mg capsule sig: one (1) capsule po once a day. 11. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: three (3) tablet po tid (3 times a day) for 14 days: take three times a day until then take once daily until instructed otherwise by your physician. . disp:*126 tablet(s)* refills:*2* discharge disposition: home with service facility: home solutions infusion therapy discharge diagnosis: primary pneumonia, likely viral secondary hiv usual interstitial pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure participating in your care at . . you were admitted to the hospital with fever and cough. during your stay, many tests and images were ordered to determine the cause of your sickness. a ct scan of your chest revealed that you had a pneumonia, which we think was caused by a virus. you appear to be recovering from this viral infection. because your lungs and immune system are weaker after this infection, we are prescribing two antibiotics to prevent you from getting another kind of pneumonia caused by bacteria. otherwise, please continue with your medications as usual. you are also being set up with home oxygen to use until your lungs recover. please follow up with your primary care physician, whom an appointment has been made. you will also need to follow up with your primary care provider on the finding of a thickened wall of your appendix. followup instructions: name: , m. location: associates of health address: , 2nd fl, , phone: appt: at 12:40pm department: pulmonary function lab when: thursday at 9:40 am with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: thursday at 10:00 am with: , m.d. building: campus: east best parking: garage do 12-bdu procedure: venous catheterization, not elsewhere classified closed [endoscopic] biopsy of bronchus diagnoses: anemia, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism human immunodeficiency virus [hiv] disease postinflammatory pulmonary fibrosis raynaud's syndrome viral pneumonia, unspecified systemic sclerosis conjunctivitis, unspecified monoclonal paraproteinemia lung involvement in systemic sclerosis 

Answer: The patient is high likely exposed to