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: hypoxia major surgical or invasive procedure: rij triple-lumen placement intubation arterial line placement history of present illness: 50 yo male with history of hiv ( - cd4 908, vl < 50 copies) and previous episode of pcp was admitted with 2-3 days of fevers, myalgias, and malaise. . patient reports that 2-3 days ago, he developed sudden onset of increased fatigue, malaise, and muscle aches in his legs bilaterally. additional ros was notable for the following: - vomiting after trying to drink water - decreased po intake - sick contacts including multiple co-workers sick with fatigue, fevers, and cough - loose stools - 2 loose, watery stools per day - fevers and chills to 104 at home - bitemporal headache pain which is now slightly improved - reported abdominal pain in the ed but denies upon arrival to the floor . he otherwise denies productive cough, facial pain, postnasal drip, nasal congestion, sore throat, abdominal pain, dysuria, hematuria, melena, or shortness of breath at home. denies any recent travel or antibiotic use. did not receive the flu shot. patient has only tried tylenol at home for relief. . upon arrival to the ed, temp 100.6, hr 118 (98-130), bp 144/78 (119-144/59-79), rr 36, and o2 sat 93% on 4l. while in the ed, his temperature peaked to 101.3, o2 requirement increased to 97% on 100% nrb. cxr was notable for a right lower lobe infiltrate. ruq us and head ct were unremarkable. he received motrin 800mg x 1, zosyn 4.5g x 1, levofloxacin 750mg x 1, combivent, and tylenol 1g x 1. he received 3-4l ns in the ed. past medical history: 1. hiv/aids 2. h/o pcp social history: home: lives with mother in occupation: machinist etoh: denies drugs: denies tobacco: 25 ppy history family history: n/c physical exam: t 98.9 / hr 132 / bp 182/95 / rr 42 / 91% on nrb gen: resting in bed, uncomfortable appearing but no acute distress heent: clear op, dry mucous membranes neck: supple, no lad, no jvd cv: tachycardic but no murmurs, rubs or gallops lungs: scattered wheezes throughout with crackles at llb abd: obese, decreased bs, soft, nt, nd, no rebound ext: no edema. 2+ dp pulses bl. onychomycoses on all toenails skin: no lesions neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. normal coordination. gait assessment deferred psych: listens and responds to questions appropriately, pleasant pertinent results: admission labs: na 129 / k 3.5 / cl 93 / co2 20 / bun 18 / cr 1 / bg 128 ca 9 / mg 1.6 / phos 1.4 alt 34 / ast 62 / alk phos 55 / tuberculosis .5 / amylase 15 / lipase 19 ldh 320 wbc 17.5 / hct 42.9 / plt 212 n 91 / bands 4 / l 5 / m 0 / e 0 / b0 inr 1.2 lactate 1.7 ua large blood, neg nit, neg prot, neg glu, neg ket, 0 rbcs, wbcs, occasional bacteria, no yeast, 0-2 epis . ph 7.39 / pco2 32 / po2 61 . baseline hct 42-45 . microbiology: urine legionella antigen presumptively positive blood cultures from grew coagulase negative staphylococcus otherwise, several blood, urine, bal, csf and sputum cultures were negative csf showed 2+ pmns . admission studies: - ecg - sinus tachycardia - portable cxr - - new right hilar opacity and vague opacity in the left lung which likely represent pneumonia. dedicated pa and lateral films may be helpful suggest followup to resolution. - ruq us - - no evidence of cholelithiasis, gallbladder wall thickening, or edema. - ct head w/o contrast - - no acute hemorrhage or mass effect. . csf: cytology: negative protein 46/ glucose 74/ 100 wbc's/ 213,500 rbc's/ with 92% polys . mri findings: there is marked flair hyperintensity within the bilateral posterior parietal and occipital subcortical white matter and milder flair abnormality within the bilateral cerebellar hemispheres, suggestive of posterior reversible encephalopathy syndrome (pres). no diffusion abnormality is seen in these areas, also consistent with pres. tiny scattered punctate areas of restricted diffusion are seen within the left frontal and right parietal lobes, suggesting tiny embolic infarcts. there is no evidence of hemorrhage or mass effect. the ventricles are normal in size and configuration. fluid is seen in the mastoid air cells and nasopharynx, likely related to prolonged intubation. on post-contrast images, there is a small amount of enhancement within the right occipital cortex, also likely related to pres and breakdown of the blood -brain barrier. mra of the head and neck: the mra is normal, with normal caliber of the carotid and vertebral arteries and their intracranial branches. no evidence of stenosis or aneurysm. impression: 1. marked edema within the posterior parietal, occipital, and cerebellar hemispheres without diffusion abnormality, suggestive of pres (posterior reversible encephalopathy syndrome). 3. small punctate foci of restricted diffusion within the left frontal and right parietal lobes, likely small embolic infarcts. . ct head dramatically progressed subcortical hypodensities in bilateral cerebral hemispheres with early left uncal herniation. the differential in the context of hiv is broad and includes vascular etiologies (posterior reversible encephalopathy syndrome), infectious etiologies, pml, metabolic encephalopathy, and less likely hiv encephalopathy. brief hospital course: hospital course by problem: . respiratory failure: legionella positive (matching clinical sx of (1) diarrhea, (2) hyponatremia, (3) office coworkers ill en masse). underlying contribution from copd; question of pcp given no outpatient ppx. the patient was intubated shortly after admission for hypoxia/respiratory failure. he was ventilated per ardsnet protocol, though very difficult to oxygenate. he initially required proning to improve oxygenation. he continued to have difficulty with ventilation eventually requiring paralysis with cisatracurium, and a pentobarbital induced coma. he was eventually taken off the proning bed, and eventually was weaned off paralysis and was maintained on pressure control. he was switched to assist control, and eventually as his oxygenation improved, he was switched to pressure support. he had a tracheostomy placed on as well as a peg tube. he continued to improve from a respiratory standpoint. during his course, he was noted to have a pleural effusion, which was difficult to perform a thoracentesis because of his positioning and difficulty with dysynchronus breathing. he developed a pneumothorax which required chest tube placement by thoracic surgery. he was eventually weaned off of respiratory support fully and his chest tube was removed. . sepsis: source likely legionella. he was initially started on vancomycin, levofloxacin, cefepime, and oseltamivir which was stopped once when the influenza test was negative. he was maintained on the levofloxacin, cefepime, and vancomycin and because of his poor respiratory status, azithromycin was added for double coverage of legionella. he continued to spike very high temperatures (>103) despite antibiotics and despite negative cultures. eventually, it was thought that he was having a drug fever, so all of his antibiotics were stopped, but he did complete a 14 day course of levofloxacin. despite being off antibiotics, he continued to spike fevers. his cultures (sputum, blood, stool, urine) all remained negative. he had viral studies sent which were also negative. he was never hypotensive requiring pressors, though at one point during his hospitalization, he was transiently hypotensive with maps in the 50s-60s which responded to ivfs. he developed acute kidney injury secondary to his sepsis, and he also developed dic. he was given a 96 hr course of activated protein c when he developed these multiple organ failures. during the workup of his ongoing temperatures, he was found to have a dvt in his right leg, for which he had an ivc filter placed given his very tenuous respiratory status and the inability to anticoagulate while on activated protein c and in dic. he was also noted to have pancreatitis based on lab tests, but on ct abdomen, there was no evidence of pancreatitis or hemorrhage. . acute kidney injury: the patient developed acute kidney injury likely in the setting of sepsis and hypovolemia. he was given ivfs with improvement in his renal function. he then had to undergo ct torso with contrast to evaluate for source of fever, which once again increased his creatinine. then, it slowly began to trend towards baseline. he did not require hemodialysis. increasing cr: likely dehydration. . dic: during the early part of his hospitalization, the patient developed discoloration of his fingers and toes. during the workup, he was found to have dic with elevated fdp, decreased fibrinogen, and decreased platelets. he never required blood products for these derangements. his digital cyanosis continued, and vascular surgery was consulted who felt that he would eventually need amputation of his digits, but that it did not need to be done acutely. he was treated with 96 hour of apc, and his dic labs improved. . anemia: the patient's hct was stable during most of his hospitalization, but did begin to decline and at one point, was <21 requriring 1 unit of prbcs. his hct then continued to trend upwards. it was thought that this was likely secondary to his acute illness, and phlebotomizing. his b12/folate were wnl. his ferritin was elevated, but iron and tibc were low, likely from his acute illness. he was started on po iron supplementation via his peg tube. . hiv: patient has a history of hiv and h/o pcp . he was adequately controlled on therapy. it was held during the acute period, but after speaking with his hiv physician, therapy was restarted once he had a peg tube placed. . mental status: since mental status not back at baseline, patient nodding appropriately and would wiggle toes to command. mri brain showing ring enhancing lesions right occipital , suggestive pres. lp performed and sent for flow cytometry, hiv vl, and various viral cultures/pcr. lp was largely unrevealing, except for a leftward shift. he was started on empiric antibiotics for this. ct showed early uncal herniation. the decision was made by the family to make the patient cmo medications on admission: 1. ritonavir 100mg po daily 2. atazanavir 300mg po daily 3. combir 150-300mg tab discharge medications: 1. morphine concentrate 10 mg/0.5 ml solution sig: 1.5-3.0 ml po q2h as needed for pain: =30-60mg for breakthrough pain. . disp:*60 ml* refills:*0* 2. acetaminophen 160 mg/5 ml solution sig: twenty (20) ml po q6h (every 6 hours) as needed for pain. 3. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day) as needed for constipation. 4. fentanyl 100 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours): for pain. disp:*10 patch 72 hr(s)* refills:*2* 5. lorazepam 1 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for anxiety. disp:*12 tablet(s)* refills:*0* discharge disposition: home with service facility: old hospice discharge diagnosis: legionella pneumonia acute respiratory failure septic shock diseminated intravascular coagulopathy pres resulting in uncal herniation discharge condition: comfortable on a fentanyl patch discharge instructions: patient was admitted to the icu for acute respiratory distress. on admission he was intubated for airway support. it was found that he had a legionella pneumonia which was treated with approrpiate antibiotics. patient's course was complicated by sepsis, dic, severe digital ischemia leading to necrosis of fingers and toes, and pres syndrome, unfortunately resulting in uncal herniation. he was made cmo and discharged home with hospice. followup instructions: na procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung parenteral infusion of concentrated nutritional substances insertion of endotracheal tube interruption of the vena cava percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy transfusion of packed cells infusion of drotrecogin alfa (activated) diagnoses: acidosis acute kidney failure with lesion of tubular necrosis hyposmolality and/or hyponatremia severe sepsis chronic airway obstruction, not elsewhere classified human immunodeficiency virus [hiv] disease acute respiratory failure defibrination syndrome other specified septicemias septic shock other encephalopathy diarrhea encounter for palliative care dehydration hypovolemia hyperosmolality and/or hypernatremia other specified anemias acute pancreatitis acute venous embolism and thrombosis of unspecified deep vessels of lower extremity pneumonia due to legionnaires' disease 

Answer: The patient is high likely exposed to