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: bactrim attending: chief complaint: fever, hypotension major surgical or invasive procedure: none history of present illness: mr. is a 41 y/o m with history of recently diagnosed hiv infection (vl > 100,000, cd4 pending), depression/anxiety, and gonococcal infections of pharynx and anus who presents 2 days after discharge from recent admission with recurrent fever up to 103.8. the patient was admitted from to with fevers to 102 and acute renal failure. during that admission, his renal failure resolved with ivf, and his fever workup was remarkable for positive aso titer without symptoms of pharyngitis for which he was discharged on augmentin. he was discharged on at which time he felt fairly well. he continues to have joint pains diffusely for which he is taking oxycodone and tylenol. the patient has been taking his medications, including augmentin, as prescribed. . the morning prior to this admission pt felt somewhat unwell with "red eyes" and missed his augmentin dose. at that time his temperature was 101.2. he thinks that he took one bactrim pill by mistake as well as 6 ibuprofen but continued to feel poorly. his temperature increased to 103.8 at which time he came to the emergency room. patient was reported to have a rash, but on interview in the , patient denied having any rash but thought his skin was somewhat red from his fever. he admitted to a frontal headache located just supraorbitally which has been ongoing since last week; he also had sinus congestion. he denied cough, ear pain or fullness, visual difficulty, sore throat, difficulty swallowing, difficulty breathing, nausea or vomiting, abdominal pain, diarrhea, dysuria, and penile lesions or discharge. he denied neck stiffness as well as numbness/tingling/weakness of the extremities. . in the ed, vs t 102.5 hr 131 bp 110/50 o2 97% ra. his blood pressure did fluctuate from a low of ~ 90 systolic up to 110. he received a total of 7 l of ivf. lactate was 2.8. blood cultures were drawn and an lp was performed which showed 3 wbcs (69% polys, 22% lymphs), 0 rbcs, protein 45, glucose 53. he was treated with ceftriaxone 2 g iv x 1, vancomycin 1 g iv x 1, and acyclovir 800 mg iv x 1; for his rash, he was treated with solumedrol 125 mg x 1 and benadryl. imaging studies revealed normal cxr and ct was negative for incranial hemorrhage or mass effect. . pt was subsequently admitted to the for borderline hypotension. in the , pt was started on azithyromycin for sinusitis. he was continued on ceftriaxone for presumed pneumonia based on rml infiltrate on poor cxr. he had extensive work up for fever during the recent admission and not source has been found at present. his hypotension responded to fluid and stim was adequate. pt was subsequently transferred to the floor. past medical history: 1. anal fissure 2. adjustment disorder 3. urethritis nos 4. depression/anxiety 5. pharyngeal gonococcal infection 6. anal gonococcal infection 7. new diagnosis of hiv, vl > 100k, cd 4 pending; per his report had negative hiv test in social history: pt is involved with a monogamous partner, with whom he lives (). he works as a social worker for the of mass. he reports no recent sexual contact (>6 weeks decreased libido). his partner is monogamous per his report. he drinks glasses of wine on weekends. he denies tobacco use. he does not use heroin or cocaine, but does admit to rare marijuana use. family history: glaucoma (father, . sister and gm with dm. physical exam: pe: t 100.3 bp 106/75 hr 90 rr 18 o2 100% on ra gen: comfortable at rest, no apparent distress. heent: bilateral scleral injection, no discharge, perrl, eomi, no tonsillar exudate. blister-like lesion on right lateral tongue which is not painful per his report. neck: supple, no jvd, no carotid bruit cv: rrr, nl s1+s2, no m/r/g resp: ctab, nl effort abd: mild distention, nl bs, non tender. ext: no peripheral edema/cyanosis/clubbing, dp pulses 2+ bilaterally. neuro: a&o x 3. cn ii-xii intact. strength 5/5 in all four limbs. sensation intact throughout. pertinent results: 07:20pm wbc-8.4# rbc-3.48* hgb-11.4* hct-31.8* mcv-91 mch-32.9* mchc-36.0* rdw-13.5 07:20pm neuts-92.3* bands-0 lymphs-6.2* monos-1.3* eos-0.2 basos-0 07:20pm plt smr-normal plt count-321 07:20pm pt-12.5 ptt-31.7 inr(pt)-1.1 . 07:20pm glucose-122* urea n-12 creat-1.2 sodium-139 potassium-3.5 chloride-100 total co2-27 anion gap-16 alt 33, ast 37, alk phos 63, t bili 0.2, lipase 32, amylase 47, albumin 3.1 . 07:30pm lactate-2.8* . 07:20pm cerebrospinal fluid (csf) wbc-3 rbc-0 polys-69 lymphs-22 monos-0 eos-1 macrophag-8 07:20pm cerebrospinal fluid (csf) protein-45 glucose-53 . csf gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. viral culture: r/o herpes simplex virus (preliminary): no virus isolated so far. fungal culture (pending): cryptococcal antigen (final ): cryptococcal antigen not detected. performed by latex agglutination. (reference range-negative). results should be evaluated in light of culture results and clinical presentation. . 12:00am urine color-yellow appear-clear sp -1.000* 12:00am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg . blood parasite smear: negative g6pd: pending retic count 1.3% cortisol 30.8 legionella urine antigen: negative cmv viral load: pending influenza a/b dfa: negative urine cx: negative urine gonorrhea/chlamydia: negative throat viral cx: no growth to date (strep, gonorrhea cx negative) blood cx: no growth to date . ct head: unchanged exam from previous . no acute abnormality identified. . cxr: 1. limited pa view probably due to technical reason. no acute cardiopulmonary process identified on this study. if clinical concern persists, please repeat the frontal view. 2. opacity overlying the hilum, which can represent hilar adenopathy. further evaluation is recommended. dr. was informed in the monrning of . . cxr: rapid onset interstitial pattern, most likely due to fluid overload, but viral pneumonia cannot be excluded. . cxr: resolution of interstitial edema with persistent small bilateral pleural effusions. brief hospital course: # fever: patient had no focal signs or symptoms of infection. dfa negative for influenza. i suspect his fever is due to acute hiv versus possible lyme disease. known hiv with viral load > 100,000. cd4 count came back during this admission at 180. patient was initially covered with empiric ceftriaxone and azithromycin in the icu without clear source. lp was negative. throat cultures were negative. cxr was most consistent with volume overload (received 7 liters ns in ed alone). urinalysis without evidence for infection and blood cultures remain no growth to date. cmv viral load pending but normal lfts and no diarrhea. recent extensive work-up during his prior admission was unrevealing, however his lyme antibody came back positive. id was consulted and agreed with empiric treatment with doxycycline x 30 day. they also suggested ruling out pcp, low suspicion given his low cd4 count. however, patient denied any cough and was unable to provide sputum, including with induction. bronchoscopy was not pursued given very low suspicion. patient will follow-up with dr. and this can be reconsidered if cxr or o2 sat worsens. . # newly diagnosed hiv: cd4 < 200. given bactrim allergy, patient was started on atovaquone for pcp . g6pd was sent. if normal, could start dapsone for prophylaxis instead given this is pill form and only once daily. he will follow-up with dr. to discuss starting haart. . # hypotension: again, patient hypotensive in the setting of his fever. his blood pressure improved with aggressive hydration. am cortisol was normal. patient has been hemodynamically stable on the floor. . # joint pain: resolved prior to discharge. in conjunction with conjunctivitis, could be reactive due to inflammatory process such as acute hiv or other viral syndrome. also concerning for possible lyme - getting treated with 30 days of doxycycline. and rf negative on last admission. . # conjunctival injection: patient noted to have similar symptoms on his last admission, likely viral conjunctivitis. however, given he is a contact lens wearer, he was started on cipro eye gtt and this symptom significantly improved. he will continue these drops for 5 days total. . # rash: patient was noted to have a diffuse erythroderma which is not concerning to him or causing any symptoms at present. likely secondary to hiv seroconversion rash versus allergy to bactrim which he took prior to admission. could also be related to lyme. it resolved prior to discharge. . # anemia: high ferritin on last admission suggests more likely anemia of chronic disease. iron supplement discontinued. . # depression/anxiety: patient was contined on his home dose celexa, klonopin and temazepam prn. . # dispo: patient discharged to home medications on admission: meds: d/c'd on with 1 week or augmentin for + aso titer. 1. citalopram 30 mg daily 2. temazepam 30 mg qhs prn insomnia 3. clonazepam 0.5-1 mg prn for anxiety. 4. oxycodone 5 mg q4-6h prn joint pain 5. ferrous sulfate 325 mg daily 6. amoxicillin-pot clavulanate 500-125 mg po tid x 7 days discharge medications: 1. doxycycline hyclate 100 mg capsule sig: one (1) capsule po twice a day for 27 days. disp:*54 capsule(s)* refills:*0* 2. atovaquone 750 mg/5 ml suspension sig: five (5) ml po bid (2 times a day). disp:*300 ml* refills:*2* 3. citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). 4. clonazepam 0.5 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for anxiety. 5. temazepam 15 mg capsule sig: two (2) capsule po hs (at bedtime) as needed for insomnia. 6. ciprofloxacin 0.3 % drops sig: two (2) drop ophthalmic every six (6) hours for 3 days. disp:*1 bottle* refills:*0* discharge disposition: home discharge diagnosis: primary: acute hiv lyme disease conjunctivitis secondary: depression and anxiety discharge condition: good: afebrile x 24 hours, clinically looks well discharge instructions: please call your doctor or go to the emergency room if you experience temperature > 101, shortness of breath, headache, or other concerning symptoms. please take all medications, as prescribed. please follow-up as instructed below followup instructions: please follow-up with dr. on monday 26, at 3:20 pm to have a repeat chest xray and to follow-up the lab test that is still pending to determine if you can take a once a day medication, instead of the atovaquone. location: phone: procedure: spinal tap incision of lung diagnoses: iron deficiency anemia, unspecified hyperosmolality and/or hypernatremia asymptomatic human immunodeficiency virus [hiv] infection status lyme disease conjunctivitis, unspecified 

Answer: The patient is high likely exposed to