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: penicillins / vancomycin / acyclovir attending: chief complaint: blurry vision bilaterally major surgical or invasive procedure: picc line placement. lumbar puncture. history of present illness: 47 yo m with a history of hiv (last cd4 () 81, vl 48) who restarted haart 3 weeks ago who presented to the ed from clinic with a complaint of worsening vision loss. his symptoms started in mid-, when he suddenly developed some mild pain at the back of his left eye. his left eye then started to produce tear-like clear fluid. the vision in his left eye started to deteriorate over the course of the next week. his left eye had blurry vision, he had floaters in front of his eyes, and he noted central vision loss. he denied headache. these symptoms prompted him to present to his pcp and ophthalmologist, and he was prescribed predforte drops q1 h and scopolamine drops , which initially provided relief of the symptoms. however, in , he developed similar symptoms in his right eye (pain, central vision loss, blurry vision) and he saw his ophthamologist again. he continued to use the eye drops in both eyes, but he still intermittently had blurry vision. during the week prior to admission, he started to experience exacerbation of his visual changes, and he may not have been compliant with using the eye drops. he reports the vision loss is worse in his left eye, and he can only see shadows. . he was seen by ophthalmology on the day prior to admission, and was diagnosed with bilateral panuveitis. ophtho recommended that he be admitted for further workup. . of note, per logician notes, he was recently informed by the doh that he had sexual contact with a person who was diagnosed with syphilis. past medical history: 1.hiv, diagnosed in . but possibly acquired the infection in . he didn't take any anti-retroviral drugs for 4 years, but restarted 3 weeks ago. (last cd4: 81 cell/ul (); last viral load 48.01*hi () 2.shingles , no more incidence ever since 3.left meniscus tear s/p knee surgery 4.arthritis, especially of knees b/l 5.hyperlipidemia 6.acute gingivitis 7.viral warts 8.nonspecific skin rash 9.cryptosporidiosis 10.pityriasis versicolor 11.hepatitis a 12.oral aphthae 13.depression 14. deviated septum . allergies: penicillin causes itchy hives and rash (received pcn once as child and once in 20s-30s), vancomycin (red man syndrome), acyclovir (itchiness), seasonal allergies social history: 10 pack-year smoking history, quit 15 years ago. social etoh use. recreational illicit drug use in the past, but has not been using drugs during the past several years. works part-time at mistral restaurant as a server; also started to work as a photographer, had a photography show recently. family history: dm (mother), colon ca (father, at 88 ), kidney problems, stroke, htn, gi problems. physical exam: vs: temp 99.8, bp 120/60, hr 89, rr 20, sao2 100% ra general: awake, alert, nad heent: ncat. mmm. op clear, no oral thrush. sclera anicteric. no supraclavicular, submandibular, or anterior cervical lad. patchy alopecia of hair and beard. cv: regular rate, nl s1, s2. no murmurs/rubs/gallops. pulm: cta bilaterally. no wheezes/rhonchi/rales abd: positive bowel sounds, soft ntnd abdomen. no hsm. no masses ext: no lower extremity edema skin: no rashes neuro: pupils dilated to 6 mm bilaterally, not reactive to light. patient unable to cross eyes to check for accomodation. patient could count fingers at 1 foot. patient can not make out details in visitor's face at bedside. eomi. fundoscopic exam on r revealed normal vasculature, no obvious abnormalities of optic disc. unable to visualize fundus/vessels on the l. normal facial sensation and strength. tongue protrudes in midline. moving all extremities spontaneously. pertinent results: 04:55am blood wbc-4.1 rbc-3.92* hgb-11.3* hct-33.7* mcv-86 mch-28.8 mchc-33.5 rdw-18.2* plt ct-331 11:55am blood pt-12.4 ptt-23.8 inr(pt)-1.1 06:45am blood wbc-6.4 lymph-10* abs -640 cd3%-73 abs cd3-467* cd4%-13 abs cd4-80* cd8%-56 abs cd8-358 cd4/cd8-0.2* 04:55am blood glucose-110* urean-13 creat-0.7 na-141 k-4.6 cl-104 hco3-28 angap-14 06:12am blood calcium-8.6 phos-3.8 mg-2.5 04:55am blood alt-13 ast-13 ld(ldh)-111 alkphos-93 amylase-87 totbili-0.1 04:55am blood lipase-35 04:55am blood albumin-3.3* iron-133 04:55am blood caltibc-322 vitb12-324 folate-5.9 ferritn-218 trf-248 04:55am blood ret aut-1.4 06:45am blood osmolal-272* 08:15am urine hours-random urean-407 creat-48 na-43 08:15am urine osmolal-308 06:45am blood rheufac-<3 hiv-1 viral load/ultrasensitive (final ): 1,390 copies/ml. blood tests: rpr reactive fta-abs reactive vzv ab igm, eia negative ace normal hla-b27 pending lyme by western blot: lyme disease ab, conf. igg western blot 1 band <5 igg bands detected 41 kda igm western blot 0 band <2 igm bands detected none detected kda interpretation -------------- nonconfirmatory lyme serology (final ): eia result not confirmed by western blot. equivocal by eia. negative by western blot. varicella-zoster igg serology (final ): positive by eia. cmv igg antibody (final ): positive for cmv igg antibody by eia. 312 au/ml. reference range: negative < 4 au/ml, positive >= 6 au/ml. cmv igm antibody (final ): negative for cmv igm antibody by eia. toxoplasma igg antibody (final ): negative for toxoplasma igg antibody by eia. 0.0 iu/ml. reference range: negative < 4 iu/ml, positive >= 8 iu/ml. toxoplasma igm antibody (final ): negative for toxoplasma igm antibody by eia. interpretation: no antibody detected. 6:45 am blood culture ( myco/f lytic bottle) blood/fungal culture (preliminary): no fungus isolated. blood/afb culture (preliminary): no mycobacteria isolated. blood culture: ngtd x2 csf studies: 3:41 pm csf;spinal fluid source: lp. added cryptococcal ag and mycology cx per add on requisition. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. viral culture (preliminary): no virus isolated so far. fungal culture (preliminary): no fungus isolated. cryptococcal antigen (final ): cryptococcal antigen not detected. (reference range-negative). performed by latex agglutination. results should be evaluated in light of culture results and clinical presentation. acid fast culture (preliminary): the sensitivity of an afb smear on csf is very low.. if present, afb may take 3-8 weeks to grow.. analysis wbc rbc polys lymphs monos 03:41pm 190 5 72 24 4 2 clear and colorless 03:41pm 110 400 47 42 11 source: lp 2 clear and colorless chemistry totprot glucose 03:41pm 113 29 vdrl pending treponema antibody pending herpes simplex virus detection and diff, pcr hsv 1 dna not detected hsv 2 dna not detected - virus (ebv) dna, pcr result: detected studies: ct head (): impression: no evidence of intracranial mass or hemorrhage. cxr (): impression: no acute cardiopulmonary process. brief hospital course: 47 yo male with hiv and recently diagnosed bilateral panuveitis who presents from ophthalmology clinic with worsening vision loss. . #vision loss: the patient was admitted with bilateral vision loss, central scotoma, and a recent exposure to syphilis. infectious disease was consulted, and followed him throughout his hospitalization. he was afebrile during the admission without an elevated wbc. he was initially empirically started on vancomycin 1 gm iv q12hr for possible staph uveitis and acyclovir 10 mg/kg iv q8hr for possible cmv/hsv infection. the patient developed diffuse urticaria and rash after receiving vancomycin, thought to be red man syndrome. his symptoms improved with premedication with diphenhydramine prn and ranitidine . mri of the orbits was unable to be completed secondary to the patient's claustrophobia. head ct showed no evidence of intracranial mass or hemorrhage. lp showed opening pressure of 8, elevated wbc, increased protein, decreased glucose. csf showed no bacteria, no virus isolated so far, no fungus, and no cryptococcal antigen. the csf was negative for hsv 1 and 2 but positive for ebv. csf vdrl and treponema antibody were pending at the time of discharge. serum rpr was reactive, pending confirmation from the state. serum fta-abs was reactive. the patient was thought to have neuro-ocular syphilis and was started on penicillin g 4,000,000 units iv q4 hours after pcn desensitization in the micu. vancomycin was discontinued on hospital day 3 as staph uveitis was a less likely diagnosis. acyclovir was discontinued on hospital day 5 when csf viral culture showed no virus isolated so far. a picc line was placed on , and the patient was sent home with an infusion pump for penicillin g 4,000,000 u iv q4 hours for 14 day course (last day ). he was sent home with an epinephrine pen in case he develops an anaphylactic reaction. the patient will have follow up with id, ophthamology, and his pcp. the patient may need an mri brain as an outpatient to look for lymphoma as his csf was positive for ebv. - other positive blood tests: vzv igg, cmv igg - other negative blood tests: vzv ab igm, cmv igm, toxoplasma igg/igm, lyme disease, blood/fungal culture, blood/afb culture, ace, rf <3, ppd negative - pending blood tests: blood cx x2 ngtd, hla-b27 - pending csf tests: afb cx, vdrl, treponema antibody . #penicillin allergy: the patient reported a history of non-anaphylactic allergy to pcn, and had developed hives and a rash after receiving it once as a child and once in his 20s-30s. the patient's vision loss was due to neurosyphilis, and pcn-g iv is the recommended treatment. the patient was transferred to the micu for pcn desensitization protocol, with 7 doses of increasing penicillin over 3 hours. the patient did not have any adverse reactions. if patient's pcn doses are separated by greater than 12 hours, he will need repeat desensitization. . #bilateral panuveitis: the patient was seen in clinic on the day prior to admission and was found to have os synechiae/irregular pupil and no evidence of retinitis ou. per their report, he had bilateral panuveitis and vision loss threatening ou. they recommended for him to continue pred forte 1 gtt q1hr ou and scopolamine 0.25% 1 gtt ou, which had been prescribed to him a few months earlier. these drops were continued during his hospitalization. ophthamology followed him during his hospital stay, and he will follow up with them as an outpatient. . # hiv: the patient was diagnosed with hiv in ) 81, vl 48]. he stopped taking antiretroviral medications 4 years ago, but was restarted on haart 3 weeks prior to admission. his outpatient antiretroviral regimen was continued during the hospitalization (darunavir, emtricitabine-tenofovir, ritonavir, and zidovudine). he also was continued on bactrim ds daily for pcp . the patient had a cd4 count of 80 and cd4% of 13, and his hiv viral load was 1,390 copies/ml. a cxr showed no acute cardiopulmonary process. . #hyponatremia: the patient presented with a na of 134, which decreased to 131 on day 2 of admission. serum osm 272, urine osm 308, urine urea 407, urinecr 48, urinena 43. the patient was thought to have siadh, and was started on a 1 l free water restriction. na improved to 141, and the patient was taken off of the free water restriction. . #anemia: hct upon admission was 37.9, but dropped to 31.1 on hospital day 2. the patient had guaiac negative stools, iron studies normal, normal reticulocyte count, and normal b12 and folate levels. his coags were all within normal limits. his hct improved to 33.7 at the time of discharge, and his anemia was possibly due to hemodilution from siadh. . #arthritis: the patient has chronic arthritis especially in his knees bilaterally. he can follow up with his pcp upon discharge. . # depression: the patient has been experiencing depressive symptoms intermittently. he was seen by social work while in the hospital, and was encouraged to follow up with his pcp upon discharge. medications on admission: 1.ritonovir 100mg po bid 2.truvada 200-300 mg po daily 3.retrovir 300mg q12h 4.prezista 600mg po bid 5.bactrim ds 800-160mg po daily 6.androgel pack 50mg/5gm po daily 7.predfort 1% 1 drop ou q1h 8.scopolamine 0.25% 1 drop ou . allergies: penicillin discharge medications: 1. ritonavir 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. epinephrine hcl 0.1 mg/ml syringe sig: one (1) injection as needed as needed for anaphylaxis. disp:*1 syringe* refills:*2* 3. emtricitabine-tenofovir 200-300 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. zidovudine 100 mg capsule sig: three (3) capsule po q12h (every 12 hours). disp:*180 capsule(s)* refills:*2* 5. darunavir 300 mg tablet sig: two (2) tablet po bid (). disp:*120 tablet(s)* refills:*2* 6. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. testosterone 1 %(50 mg/5 gram) gel in packet sig: one (1) packet transdermal daily (). 8. prednisolone acetate 1 % drops, suspension sig: one (1) drop ophthalmic q1h (every hour): 1 drop to each eye every hour. disp:*1 bottle* refills:*2* 9. scopolamine hbr 0.25 % drops sig: one (1) drop ophthalmic (2 times a day): 1 drop to each eye twice a day. disp:*1 bottle* refills:*2* 10. diphenhydramine hcl 12.5 mg/5 ml elixir sig: five (5) ml po q4-6h () as needed for allergic reaction, itchy, hives. disp:*1 bottle* refills:*2* 11. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day) for 12 days. disp:*24 tablet(s)* refills:*0* 12. penicillin g potassium 1,000,000 unit recon soln sig: () units injection every four (4) hours for 12 days: end date . disp:* units* refills:*0* 13. picc supplies picc line care per ccs protocol 14. outpatient lab work please draw cbc, bun, cr, lfts (ast, alt, alk phos, amylase, lipase, t bili, ldh) on . these results should be faxed to in clinic at (). discharge disposition: home with service facility: homecare discharge diagnosis: primary: 1. bilateral panuveitis 2. neurosyphilis 3. hiv 4. penicillin allergy secondary: 1. depression 2. arthritis discharge condition: stable, vision improving. discharge instructions: 1. if you develop a fever >101.5, increased vision loss, severe headache, rash, shortness of breath, chest pain, or any other symptoms that concern you, contact your primary care physician or come to the emergency department. 2. take all of your medications as prescribed and on time. 3. attend all of your follow up appointments. followup instructions: you have an appointment on at 12:00 with dr. at . you have an appointment on at 8:45 with dr. love () in infectious diseases at , basement id west. you have an appointment on at 10:30 with dr. love () in infectious disease at , basement id west. you have an appointment with dr. () in ophthamology on at 9:00 at center, floor 5. you will need a follow up mri brain done for ebv in your csf done in the outpatient setting, follow up about this with your primary care physician. procedure: venous catheterization, not elsewhere classified spinal tap incision of lung immunization for allergy diagnoses: anemia, unspecified hyposmolality and/or hyponatremia human immunodeficiency virus [hiv] disease need for desensitization to allergens neurosyphilis, unspecified panuveitis 

Answer: The patient is high likely exposed to