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: azithromycin / bactrim attending: chief complaint: altered mental status, fevers major surgical or invasive procedure: central line placement intubation, mechanical ventilation history of present illness: 23 yo male with hiv/aids (last cd4 count of 2 on ) who presented initially with altered mental status from his residential treatment program. he was noted to have acute changes in mental status 2 days prior to admission from being fully oriented to lethargic, not oriented and not opening eyes to command. he also reportedly had worsening of his chronically poor po intake, thought to be secondary to dysphagia related to severe oral thrush. . of note, he was recently admitted to for confusion at which time he underwent an extensive workup and it was thought by neuro that he most likely was suffering from hiv encephalopathy (workup at that time included mri brain showed diffuse atrophy but otherwise unremarkable; total spine read as normal. lp negative, csf hsv pcr neg, hsv viral load neg. csf jcv pcr neg. crypto ag neg. cmv igg pos but igm and viral load neg. toxo igg/m neg. csf vdrl and serum rpr neg. cultures neg for bacteria neg while fungal and afb are neg to date. stool neg for o+p, salmonella, shigella, campylobacter, crypto, giardia; mycobacterium neg to date. stool was positive for c. diff on at which time a 2 week course of flagyl was initiated. . on initial presentation to the ed this admission, his vitals were: t 100.1 hr 133 bp 118/77 rr 14 sat 96% on ra. he had an lp done which showed 2 wbc, 1 rbc, protein 122, gluc 42. gram stain with no pml, no microorganisms. fluid, fungal, mycobacterial, viral cx pending. crypto ag neg. he received ceftriaxone 2 g iv, ampicillin 2 g iv, acyclovir 500 gm iv, and flagyl 500 mg iv and admitted to general medicine service, where he was also started on vanco 1000 mg iv. on the medical floor, the patient was noted to be febrile to 101.7 although his mental status improved improved. pt was nonverbal when he first came to the floor but was subsequently able to give short answers although he remained extremely lethargic with poor attention. . on , his mental status was waxing and . he became tachypneic to the 40s and his o2 sat dropped to the 80s; bp remained stable but hr increased to 110. pt was placed on nrb with improvement in o2 sat to 94% and given 2 l ns bolus with improvement in his bp before being tx to the icu given concern for sepsis and respiratory distress. . in the icu, he was intubated upon arrival out of concern for hypoxia and airway protection due to his depressed mental status. he underwent bronchoscopy on with 3+ pmns, but negative cultures, afb smear, and fungal cx ngtd, pcp . additional cx data including , urine and stool (including c. diff x3) have been negative this admission. in the icu he was started on cefepime and continued on vanco/ampicillin/flagyl/acyclovir. he was briefly on voriconazole for fungal coverage which was discontinued at recommendation of id team; ampicillin and voriconazole both were d/c'd on . additionally, acyclovir was discontinued on . as per id team recommendations, he was started on haart in the icu. past medical history: 1. hiv/aids - cd4 2, vl on ; dx in with pcp, unprotected sex with woman, not on haart x 1 year depression. 2. depression with paranoia and psychotic features 3. recent h/o c.diff colitis 4. oral thrush 5. pcp , ? in treated with bactrim but switched to atovaquone granulocytopenia 6. giardia 7. primary syphilis per pt, treated with im pcn 8. necrotizing granulomatous hepatitis, stage ii fibrosis and grade 3 inflammation by mri and path - neg viral hepatitis 9. hemorrhoids social history: patient has completed high school. he currently is living at a residential treatment facility. per previous notes (unable to get from pt) he has denied any previous history of illicit drug use or transfusions.he admitted to rare alcohol intake, approximately one to two timesper year, and notes tobacco use consistent with two to three cigarettes per day. family history: patient admits to a family history of diabetes and hypertension. he denies any liver disease in his family. physical exam: v/s: t 97.6 bp 118/62 p 82 rr 20 sat 92% nc general: young, thin male lying in bed with his eyes closed, barely opening his eyes when spoken to, nonverbal heent: patient resisted eye opening and moved his eyes away from the light - unable to assess his pupils, patient did not open his mouth to command. mouth slightly open with green material present between his teeth. neck: no lad, supple, jvp not seen heart: rrr, no mrg lungs: coarse breath sounds b/l abd: +bs, soft nd ext: no edema neuro: patient stuporous, will slightly open his eyes to voice, can squeeze his hands b/l to command, cannot move his toes to command or open his mouth. down-going toes b/l on babinski. when either arm is raised off the bed, he will slowly let them drift down when let go. when either leg is lifted off the bed, it will fall down immediately when let go. 2+ biceps and radialis on the rt side, 1+ biceps and radialis on the lt, unable to elicit patellar reflexes b/l skin: no rashes brief hospital course: #hiv-previous to this admission, the patient was not treated with haart therapy depression and poor compliance; given severity of infection he was started on haart therapy with darunavir, raltegravir, tenofovir, ritonavir and lamivudine per id recs. he tolerated these medications well. . # pt was tachypneic on floor and given ms changes unclear if could protect airway and adequately ventilate; thus pt intubated on arrival to micu. etiology of tachypnea unclear but possibly related to infectious process/pcp vs cap vs aspiration pna. pt was intubated for a period of time and underwent bronchoscopy during this admission, with 3+ pmns but otherwise unrevealing bronchial washings. pcp was negative from the bal, and fungal/viral cultures were negative. on the patient was successfully extubated with improvement in his respiratory status after several days of broad spectrum antibiotic coverage for possible bacterial, viral, and fungal infection. a code blue was called on the evening of when mr. went into respiratory distress. he was intubated and transferred to the micu under the micu-green service. a cxr revealed collapse of his rll from a mucous plug, with moderate mediastinal shift. the patient underwent urgent bronchoscopy with removal of several right sided mucous plugs. his right lung was better aerated after the procedure with near complete recovery of his mediastinal shift. vancomycin and cefepime were added back to his regimen that evening given his tenuous repsiratory state, and the bal washings were sent for culture. after the mucus plug was taken out, the patient's respiratory status improved rapidly and he was able to be extubated the next morning without difficulty. given this rapid respiratory improvement, his vancomycin and cefepime were d/c and during the remainder of his hospital course he did not have any further respiratory issues. he remained afebrile breathing room air. . #id/ pt has a poorly controlled hiv infection with low cd4 count (count of 1) and thus susceptibility to many opportunistic infections; he may have encephalitis with opportunistic infection; lp most c/w viral infection but need to r/o other sources. initially transferred to icu with fever, tachypnea (meets criteria for sirs) with presumed infection (and thus sepsis) although nothing has cultured and the source was unclear. lp with only 2 wbcs, 1 rbc, elevated protein but normal glucose which is not inconsistent with cryptococcus but pcr negative. csf for vdrl, hsv, cmv, ebv, , vzv, cryptococcus all negative by pcr. given negative ebv pcr, cns lymphoma unlikely. negative pcr still does not exclude pml as etiology. ct abdomen without source of infection. cxr with ? patchy infiltrates and pt does have elevated lsh. differential included pcp pneumonia, cmv, ebv, hsv, vzv, jcv, histo, cryptococcus, however pcp ruled out via negative bronch washings. central line was inserted and pt was aggressively fluid rescitated given his hypotension and fevers. pt intermittently required pressors for bp support, but at very low doses. lp cultures were negative for hsv, cmv, vzv, ebv, jcv, and cryptococcus. urine legionella antigen was negative. cultures to date with no growth. id followed closely and recommended continuing empiric treatment with vancomycin, cefepime (for pseumonas coverage), acyclovir, and pcp prophylaxis with atovaquone. ampicillin, voriconazole, and bactrim were discontinued. haart therapy was intiated during this hospitalization and were tolerated well. all of his cultures remained negative and a full infectious work-up for his altered mental status was negative, including multiple csf studies. he continued on his haart for the aids, atovaquone for pcp prophylaxis, rifabutin for mac prophylaxis, and completed a course of flagyl for possible c.diff infection, despite continual negative c.diff studies. . #mental status change - patient with hiv/aids (cd4 count of 1 on admission) thought to have hiv encephalopathy, but at baseline more alert and oriented than on admit. it is, however, not entirely clear as to whether his mental status is due to cns infective process (negative csf studies as above although elevated protein) vs. pml (despite negative pcr) vs. hiv encephalopathy vs. d/t underlying metabolic insult from different source of infection. bacterial meningitis ruled out via lp, however, persistently poor ms could be a progression of hiv encephalopathy, or could represent encephalitis (hsv). csf also negative for ace on therefore rule out neurosarcoid. head ct on admission showed no bleed. neurology was consulted and the patient underwent an eeg on which showed evidence of benzodiazepine or barbiturate effect (during which was the patient was intubated and sedated). eeg showed no ongoing epileptiform activity, and no focal abnormalities. the pattern was most consistent with a moderate to severe encephalopathy of toxic, metabolic, or anoxic etiology. of note however repeat mri again reveals atrophy suggestive of some chronicity to this cns process and abnormal signal in the basal ganglia (neuro reports nonspeicific), but no masses or focal lesions. continued work-up by neurology, including additional lp exams continued to not identify any other source for the patients altered mental status. he was continued on the above described medications and did show some overall improvement during his hospitalization while on haart treatment, although he remained profoundly weak from his shoulders down, essentially remaining non-verbal. on cd4 28, viral load 3200. speech and swallow assessment were done three times with the final assessment showing some progress to allow patient to have light po intake of fluids via straws. . #acute anemia - during his stay in the icu, the patient was noted to have a decline in his hct with a nadir of 24. one unit of prbcs was transfused. the patient was guiac negative and there was no evidence of gi bleeding. drug-related myelosupression/anemia was considered but given the timing of his recent initiation of haart therapy, this was considered unlikely. after transfusion, the patient's hct remained stable and his acute anemia was attributed to a combination of dilution and frequent phlebotomy while in the icu. . # pancytopenia: pancytopenic on presentation whereas prior to that was leukopenic and anemic (with nml platelets). unclear whether due to bm involvement and suppression from underlying hiv or whether bactrim as etiology. also ? due to other infectious process including viral, fungal, or bacterial despite no positive culture data to date. appears he had been off bactrim since last admission and was admitted on atovaquone so perhaps less likely due to this. was neutropenic on last admission, but has not been during this stay and wbc count has improved and is stable with broad spectrum abx and initiation of haart. baseline hct fluctuates but appears previously low-mid 30s, most recently in the high 20s and stable. had brbpr during last admission without further gi w/u at that time given concurrent c. diff infection. dic labs revealed normal inr, elevated fibrinogen and normal fdp. today with 1% bands and suspect less reflection of infectious process and more reflection of productive bm in setting of haart initiation. . # systolic dysfunction: lvef on this admission 25% and ? due to hiv or from other toxic metabolic insult particularly in the setting of sepsis upon presentation to the icu. was diuresed with prn iv lasix prior to extubation and currently does not appear markedly overloaded on exam. - will repeat tte this admission to eval for improvement now that sepsis has resolved . # transaminitis: has h/o granulomatous hepatitis with stage 2 fibrosis. transaminase elevation noted during last admission and upon this presentation, since having normalized as of most recent lfts. normal alk phos and t.bili. hcv viral load negative here, hep b and hep a neg. monitored intermittently and continued to show normal levels. . # recent c.diff infection: c. diff neg x3 on this admission, however given recent infection and on broad spectrum antibiotics otherwise, he was continued on a course of flagyl which he completed and was then taken off of. . # fen: patient nutrition was maintained through feeding tube, intially by ngt and then on patient had ir guided peg tube placed without complications. peg tube started to be used on without complications. nutrition continued to follow patient. received probalance feeds at 65 cc/hr with no complications. patient reported some throat pain and was placed on 5 days of fluconazole (during which time the rifabutin was stopped due to possible drug interactions); throat pain has since resolved. . # ppx: sc heparin; decrease tid dosing if ptt remains significantly elevated. . # access: rij placed (), 2 piv. will d/c ij pending continued hd stability on floor. # gu: patient initially placed on foley catheter. this was converted to condom catheter on and patient has been able to void. . # code: full (discussed with the patient's family); will need to have another family meeting in order to further address prognosis and course from here. . # dispo: pending further w/u and treatment as above. . # contact: mother, ; father, . a code blue was called on the evening of when mr. went into respiratory distress. he was intubated and transferred to the micu under the micu-green service. a cxr revealed collapse of his rll from a mucous plug, with moderate mediastinal shift. the patient underwent urgent bronchoscopy with removal of several right sided mucous plugs. his right lung was better aerated after the procedure with near complete recovery of his mediastinal shift. vancomycin and cefepime were added back to his regimen that evening given his tenuous repsiratory state, and the bal washings were sent for culture. medications on admission: 1. atovaquone 750 mg po bid 2. vancomycin 125 mg po q6h 3. dronabinol 5 mg 4. citalopram 30 mg daily 5. nystatin swich and swallow tid 6. clotirimazole qid 7. mvi discharge disposition: extended care facility: northeast - discharge diagnosis: 1. hiv encephalopathy 2. respiratory distress 3. systolic dysfunction 5. hiv 6. oral thrush 7. s/p peg tube placement discharge condition: hemodynamically stable, tolerating peg tubefeeds at goal, unable to ambulate, non-verbal discharge instructions: you have been diagnosed with hiv encephalopathy, and possibly pml. you should continue to take your haart medication until your follow up appointment with infectious disease clinic. your mouth can continue to be swabbed with nystatin solution. please take all medications as prescribed. you will continue to get nutrition via you peg tube. if you have any questions regarding your hiv treatment, please call dr. at ( followup instructions: 1. provider: , m.d. phone: date/time: 2:00 2. , : date/time: 1:00 provider: , md phone: date/time: 9:30 please follow up with dr. at 2:00 pm. you can call if you have problems with your appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: congestive heart failure, unspecified cirrhosis of liver without mention of alcohol unspecified septicemia unspecified protein-calorie malnutrition severe sepsis candidiasis of mouth human immunodeficiency virus [hiv] disease pulmonary collapse acute respiratory failure intestinal infection due to clostridium difficile acute systolic heart failure encephalopathy, unspecified meningitis, unspecified foreign body in other specified parts bronchus and lung pseudobulbar palsy 

Answer: The patient is high likely exposed to