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: erythromycin base / biaxin / ciprofloxacin attending: chief complaint: fever major surgical or invasive procedure: central line placement history of present illness: 57-year old man with a history of hiv cd4 373 in , history of asplenia, history of strep viridans septic shock in presents with fevers and rigors, lightheadedness, and elevated wbc who is admitted to the icu for hypotension and fever. he was well until he woke up this morning with rigors and feeling of lightheadedness without syncope. he took a hot shower that did not warm him up and decided to present to the ed given that these symptoms were similar to his prior strep viridans septic shock. he denies any other localizing symptoms including cough, rhinorrhea, nausea, vomiting, diarrhea, myalgias, chest pain/pressure, sob, calf pain, or rash. he recently travelled to and to where he engaged in protected anal and oral sex, ate mussels, but no other changes in diet or habits. no animal exposures other than his pet chihuahua. no known sick contacts. had pneumovax and flu vaccines. in the ed, initial vital signs were: t 98.1 p 122 bp 145/59 r 16 o2 sat 100%. his blood pressure dropped to 80's systolic and had a temperature up to 103f. vanco and zosyn were given in the ed. initial lactate was 2.2, elevated to 2.5 after 2nd liter of ns. wbc was 21.3 with 88% neutrophils. cxr showed l retrocardiac density concerning for pneumonia but later read as subsegmental atelectasis. received total 6l ns, central line was placed. upon leaving the ed, vitals were hr 111 bp: 114/52 o2: 98%2l rr 21 in the , t: 101.5 hr: 108 bp: 117/77 100% ra. review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: hiv, cd4 379 , undetectable viral load and cd4 > 600 2 weeks ago by report, never below 350 since diagnosis per patient. treated initially with trisovir, now on atripla (efavirenz-an nnrti, emtricitabine--a nucleoside rti, and tenofavir--a nucleoside rti). hep b diagnosed . (: negative hep b viral load; had been on atripla which includes emtricitabine and tenofovir, both w anti-hep b activity) s/p septic shock with xigris (activated protein c) administration strep viridans bacteremia c/b acute renal failure and cvvh, respiratory failure and thrombocytopenia in history of splenic abscess s/p splenectomy in dm type 2, on metformin obesity hypercholesterolemia, on lipitor asthma r medial meniscal tear history of severe bronchitis social history: in long term relationship w/ partner x 30 years. works in software quality assurance for . no smoking. very occasional alcohol. no drugs. recently travelled to barcelona with + oral/anal sex, all protected. recent travel also to . ate mussels x 2 in , no unpasteurized cheeses, no animal contacts other than pet chihuahua, no bites, no travel to sw us or tropics, no significant tick exposure. family history: aunt with rheumatic fever, died mother with arrhythmia requiring pacemaker father died of lung ca, 60 year smoking history physical exam: vitals: t: 101.5 hr: 108 bp: 117/77 100% ra general: alert, oriented, no acute distress. interactive and pleasantly conversant. heent: sclerae anicteric, mmm, oropharynx clear without thrush neck: supple, jvp not appreciated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi. cv: tachycardic, regular, normal s1 + s2, grade 2/6 systolic murmur at lusb, no detectable radiation, no rubs or gallops abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. well-healed laparotomy scar noted gu: foley in place ext: +erythema, swelling, and tenderness in left anterior lower leg. there are skin abrasions on dorsal surface of both halluxes as well as onychomycosis of some toe nails. pertinent results: admission labs: 05:56pm lactate-1.8 06:29pm urine hours-random urea n-681 creat-60 sodium-126 05:56pm type- ph-7.36 05:22pm glucose-125* urea n-29* creat-1.4* sodium-140 potassium-4.3 chloride-111* total co2-19* anion gap-14 05:22pm calcium-8.9 phosphate-2.4*# magnesium-1.7 05:22pm wbc-28.1* rbc-3.63* hgb-11.2* hct-34.6* mcv-95 mch-30.9 mchc-32.4 rdw-15.1 12:32pm lactate-2.5* microbiology: blood cx pending as of day of discharge urine cx negative gc / chlamydia negative cdiff negative stool cx negative studies: cxr - mild cardiomegaly with sub-segmental atelectasis in the left lower lobe. brief hospital course: 57 year old asplenic male with hiv (per pt. most recent cd4=600), h/o strep viridans sepsis in /, was admitted with sepsis, most likely secondary to left leg cellulitis. 1. sepsis patient presented with fevers, tachycardia, elevated wbc, and hypotension responsive to fluids. of note, the patient is asplenic, so encapsulated organisms were of concern. there was concern for another episode of strep viridans sepsis as with his previous hospitalization in , but his blood cultures have been negative so far. initial interpretation of cxr was possible pna, but the patient did not have any respiratory symptoms to support it. a left lower extremity cellulitis was the likely source of sepsis. the cellulitis had no induration, but the erythema and swelling appeared to increase slowly in size for a full 24 hours on the intravenous antibiotic regimen before it stabilized. vancomycin and zosyn were continued for treatment of his cellulitis because of his history of mrsa and to cover for encapsulated organisms. gc/chlamydia swaps were negative. id consult recommended transition to po bactrim and augmentin as outpatient therapy. will defer to pcp as to whether or not patient should have penicillin prophylaxis because of his asplenia. 2. acute vs chronic renal insufficiency: mr. creatinine was 1.3-1.4 on presentation. his baseline creatinine is unclear. had acute renal failure during his last hospitalization in , and it is unclear whether his creatinine ever returned to his baseline. 3. hiv per patient, his last cd4 count was greater than 600, and his viral load undetectable. during his hospitalization, he was continued on atripla. 4. type 2 diabetes mellitus he was initially maintained on insulin sliding scale but was then transitioned to his home regimen of metformin. 5. hypertension his lisinopril was initially held during this admission and then restarted once his blood pressure improved. medications on admission: metformin 250mg po bid atripla 1 tab po daily lisinopril 15mg po daily lipitor 10mg po daily asa 81mg po daily ibuprofen 3 tabs tid prilosec 20 mg daily (?) supplements including fish oil, l carnitine, glucosamine discharge medications: 1. metformin 500 mg tablet : 0.5 tablet po bid (2 times a day). 2. atripla mg tablet : one (1) tablet po once a day. 3. lisinopril 5 mg tablet : three (3) tablet po daily (daily). 4. atorvastatin 10 mg tablet : one (1) tablet po daily (daily). 5. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 6. bactrim ds 160-800 mg tablet : one (1) tablet po twice a day for 10 days. disp:*20 tablet(s)* refills:*0* 7. augmentin 875-125 mg tablet : one (1) tablet po twice a day for 10 days. disp:*20 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: 1. cellulitis of the left lower leg. secondary diagnosis: 1. hiv 2. asplenia 3. type 2 diabetes mellitus 4. hypertension discharge condition: stable. patient is ambulating, tolerating oral intake, and has returned to his baseline condition. discharge instructions: you were admitted to the hospital with sepsis thought likely related to your left lower leg cellulitis. you were started on iv antibiotics with improvement in your blood pressure. we have adding the following medications for treatment of your cellulitis: 1. bactrim ds one tablet twice daily for 10 days total 2. augmentin 875mg one tablet twice daily for 10 days total please seek immediate medical attention if you develop fevers, shaking chills, night sweats, light-headedness, dizziness, passing out, worsened swelling in your left leg, shortness of breath, abdominal pain, diarrhea, or cough. followup instructions: provider: , md phone: date/time: 3:15 please follow-up with your primary care physician, . , within the next 10 days. procedure: venous catheterization, not elsewhere classified diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis asthma, unspecified type, unspecified cellulitis and abscess of leg, except foot septic shock carrier or suspected carrier of methicillin resistant staphylococcus aureus methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site obesity, unspecified asymptomatic human immunodeficiency virus [hiv] infection status viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta anomalies of spleen 

Answer: The patient is high likely exposed to