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: left lower extremity calf pain major surgical or invasive procedure: none history of present illness: mr. is a 32 year old male with hiv/aids not on anti-retroviral therapy(last cd4 5 on ), history of coagulase negative staph endocarditis status post aortic valve replacement and mitral valve replacement in , strep viridans prosthetic valve endocarditis in complicated by aortic root abscess (medically managed), and end stage kidney disease on hemodialysis who presented with chief complain of left lower extremity pain. he reported a sharp pain in the back of his calf that began three days prior to presentation associated with this he reported worsening of his bilateral lower extremity edema over several weeks prior to presentation. regarding other issues he reported that his baseline dyspnea on exertion that he had for months had worsened over the previous few weeks. he reports that he has dyspnea when walking only a few steps. overall, he reported being very sedentary and spending the majority of his day in bed due to his multiple medical problems. uses oxygen at home as much as possible. he denied cough, chest pain, increased sputum, or pleuritic chest pain. he reported chronic orthopnea and denied paroxysmal nocturnal dyspnea. in addition, he reported nausea/vomiting over the past few days prior to admission. he reported non-bloody, non-bilious emesis after each meal. he also had diarrhea with 6-7 loose stools per day over the three days prior to admission without blood. on presentation he was denying abdominal pain but said he had had it over the past days. in the ed, vitals were t96.5, bp 100/71, hr 116, rr 20o2 sat 100% on 3l. patient was given vancomycin, levoflaxcin, and pipercillin-tazobactam due to question of right lower lobe infiltrate and new effusion. he was given 1lns. initial labs revealed lft's elevated from baseline so a ruq u/s was performed that showed no acute biliary pathology but findings consistent with cirrhosis. review of systems: ==================== positives are per hpi. he denied fevers, chills, or night sweats. denied headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied constipation or abdominal pain. no dysuria. denied arthralgias or myalgias. past medical history: 1. hiv/aids, cd4 count of 5 in . not on harrt. 2. history of native valve bacterial endocarditis with coagulase negative staph in requiring mitral and aortic valve replacements and four weeks of vancomycin 3. prosthetic valve endocarditis in fall of with strep viridans, medically managed with prolonged vancomycin and gentamicin therapy complicated by partial dehiscence of prosthetic aortic valve (also had pacemaker placed temporarily for symptomatic 1st degree av delay but this was removed due to pocket infection) 3. chronic hepatitis c though no circulating virus 4. hepatitis b infection + but hbc equivocal 5. end stage renal disease (hemodialysis dependent) secondary to hiv nephropathy and focal sclerosing glomerulonephritis 6. secondary hyperparathyroidism secondary to esrd 7. chronic low back pain reportedly to osteoarthritis & nerve impingement 8. asthma social history: he reports a short period of ivdu during his teens but denies any use since then. per his report he acquired hiv through sexual contact. to his multiple medical problems and poor physical condition he lives with his mother. smoked 1 ppd for 20 years and currently smoking 6 cigarettes/day. family history: notable for dm and htn in his father. physical exam: at presentation: vitals: bp 104/70, hr 95, rr 19, 100% on 3lnc general: cachectic, somnolent heent: sclera icteric, dry mucous membranes with evidence of thrush and oral ulcers, neck: supple, elevated jvp lungs: diminished breath sounds at right base, otherwise clear cv: regular rate and rhythm, loud systolic murmur at apex and at base with trill at base abdomen: mild tenderness diffusely, guarding, no rebound, unable to assess for hepatosplenomegaly ext: b/l le swelling with pitting edema to knees, cool hands and feets. dopplerable lle pulse. lle calf with erythema and tendernss. darkness of skin in hands and toes. pertinent results: laboratory results: ====================== on presentation: wbc-4.7 rbc-4.53* hgb-14.4 hct-44.7 mcv-99* rdw-21.9* plt ct-35* ----neuts-58 bands-5 lymphs-12* monos-25* eos-0 baso-0 atyps-0 metas-0 myelos-0 nrbc-47* rbc morph: hypochr-3+ anisocy-3+ poiklo-2+ macrocy-3+ microcy-normal polychr-1+ spheroc-occasional target-1+ schisto-1+ tear dr pappenh-1+ ellipto-1+ pt-29.3* ptt-33.5 inr(pt)-3.0* fibrino-144* fdp-10-40* hapto-<20* glucose-166* urean-69* creat-5.8* na-137 k-4.8 cl-92* hco3-25 angap-25* alt-95* ast-247* ld(ldh)-583* ck(cpk)-149 alkphos-542* totbili-3.9* dirbili-2.7* indbili-1.2 ck-mb-10 mb indx-6.7* ctropnt-0.49* albumin-3.2* calcium-9.4 phos-6.1*# mg-2.6 blood tox: asa-neg ethanol-neg acetmnp-neg bzd-neg barbitr-neg tricycl-neg on transfer to floor: blood wbc-6.5 rbc-4.58* hgb-13.9* hct-44.5 mcv-97 rdw-21.3* plt ct-20* pt-27.9* ptt-37.2* inr(pt)-2.8* glucose-117* urean-49* creat-4.5*# na-139 k-4.5 cl-95* hco3-29 alt-88* ast-150* ld(ldh)-424* alkphos-387* totbili-5.8* microbiology: ============= blood culture : pseudomonas aeruginosa. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | amikacin-------------- 4 s cefepime-------------- 2 s ceftazidime----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem------------- 4 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ =>16 r hbv viral load: hbv dna not detected. hcv viral load: hcv-rna not detected. other studies =============== ecg : sinus rhythm. right axis deviation. left atrial enlargement. left ventricular hypertrophy with st-t wave change. compared to the previous tracing of no diagnostic interim change. chest radiograph : impression: right lower lobe pneumonia with pleural effusion. cardiomegaly with vascular engorgement. ruq ultrasound - no acute cholecystitis. right upper quadrant ultrasound : impression: 1. presence of gallbladder wall thickening and right upper quadrant ascites is likely related to liver disease. no definite signs of acute cholecystitis. 2. right pleural effusion. bilateral lower extremity ultrasounds : impression: no evidence of dvt in either lower extremity. transthoracic echocardiogram : conclusions: the estimated right atrial pressure is 10-20mmhg. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef= 45-50 %). the right ventricular cavity is markedly dilated with moderate global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. a bioprosthetic aortic valve prosthesis is present. the prosthetic aortic valve leaflets are thickened. motion of the aortic annulus is abnormal and suggestive of partial dehiscence. there is a probable vegetation on the aortic valve. mild to moderate (+) aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the prosthetic mitral valve leaflets are thickened. the gradients are higher than expected for this type of prosthesis. there is small vegetation on the mitral valve. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , aortic valve ring motion is now more prominent consistent with worsening dehiscence, aortic regurgitation is now present and there is a new mobile echodensity on the aortic valve consistent with vegetation. tricuspid regurgitation is now more prominent. the right ventricle is now dilated with more depressed systolic function. left ventricular systolic function appears slightly more vigorous. ct abdomen and pelvis : impression: 1. colon is decompressed and is unremarkable. 2. new moderate ascites. 3. stable moderate right pleural effusion. 4. new trace left pleural effusion. 5. new anasarca. ct left lower extremity : impression: 1. nonspecific but marked edema involving the subcutaneous fat of the calf and extending to the dorsum of the foot. 2. edema noted in the soleus muscle, but no evidence of muscle abscess. 3. degenerative change at the tibiotalar joint. non-invasive resting lower extremity arterial studies : impression: mild-to-moderate bilateral outflow arterial disease in the lower extremities. brief hospital course: mr. was a 32 yo male with hiv/aids, cd4 of 5 who presented with left lower extremity pain as well as worsening dyspnea on exertion and found to have another episode of pseudomonas prosthetic valve endocarditis. 1) prosthetic valve endocarditis: soon after presentation a tte was performed that showed new vegetations on the patient's mitral and aortic valves as well as persistent partial dehiscence of the aortic valve. id consult was obtained and recommended vancomycin/pipercillin-tazobactam/and gentamicin so these were started. eventually, the patient's regimen was simplified to ceftazidime with id guidance as blood cultures grew out pseudomonas sensitive to ceftazidime. the patient was on ceftazidime through the day of his death. 2) left lower extremity swelling/pain: the patient presented with three days of left lower extremity pain of unclear etiology. at presentation this did appear larger than the other side and therefore lower extremity ultrasound was obtained and showed no dvt. a ct was also obtained in order to evaluate and found generalized subcutaneous edema consistent with a cellulitis. primary concern was for a possible septic embolic lesion from what had been found to be new vegetations. the patient was kept on broad spectrum antibiotics and vascular consult was obtained to rule out major vascular compromise. non-invasive vascular studies did not show this. eventually, the patient's generalized reddened area became a discreet purple area, then a bulla, and then it spontaneously drained. wound care was consulted to suggest management strategies for this wound. given the patient's general goals of care were leading toward a maintenance of current management without new invasive procedures no biopsy was performed for definitive diagnosis. 2. dyspnea on exertion. the patient has chronic dyspnea on exertion but denies any chest pain, cough, or sputum production. this responds well to supplementary o2 and morphine therapy and the patient was denying any dyspnea at baseline at the time of discharge. 3. end stage renal disease: the patient was maintained on hd per nephrology throughout his hospitalization. 4. nausea/vomiting: the patient reported persistent nausea and heartburn symptoms thorughout his hospitalization patient has history of nausea/vomiting, abdominal pain and diarrhea. given cd4 count of 5, concern for multiple infectious etiologies. as the patient had visible thrush at presentation he was empirically treated with fluconazole and clotrimazole. still, despite this treatment he continued to have considerable symptoms. there was some concern that he could continue to have etiologies like cmv esophagitis or another viral etiology. as reported above, however, goals of care were not favoring invasive etiologies at that time and risk/benefit ratio did not favor empiric treatment with ganciclovir. therefore, treatments were symptomatically offered with empirically increased pantoprazole, sucralfate, and maalox-lidocaine-diphenhydramine. with these treatments symptoms initially improved prior to patient's final decompensation (description below). 5. coagulopathy: on presentation the patient had elevated inr's as well as pt and ptt. fibrinogen and fdp were also decreased. as ptt was only slight decreased dic was considered a less likely process and progressive liver failure was considered a more likely etiology. as goals of care were changing however after being given fdp no further treatments were offered. 6. thrombocytopenia: the patient had considerable thrombocytopenia at presentation around the 20's. the most likely etiology of this thrombocytopenia was considered to be most likely his cirrhosis and splenomegaly consuming platelets. 7. hiv/aids: the patient has recently not been treated with haart and has a most recent cd4 count of 5. for this cd4 count tmp/sulfa prophylaxis was continued. 8. lactic acidosis. the patient had persistent lactic acidosis on presentation and was later noticed to have hypothermia. most likely etiology was considered a chronic sepsis or infection. 9. hypertension: the patient was initially hypertensive on multiple medications for this. he slowly became hypotensive to normotensive over the course of his hospitalization presumedly due to sirs and active infectious process. 10. volume overload: the patient was initially volume overloaded and then mild fluid removal was accomplished by hd. unfortunately, as blood pressures fell throughout hospitalization no more volume removal was possible. 11. goals of care: the patient initially chose to go back to being full code during this hospitalization. the intensivist had a discussion with the patient, however, about his very poor prognosis and the ultimate incurability of his endocarditis. therefore, he became dnr/dni once again. as the hospitalization continued further discussion with the patient and his health care proxies as well as the health care team continued to address the patient's extremely poor prognosis and minimal salvage options should he decompensate. therefore, goals of therapy gradually shifted toward comfort based care and no further new invasive therapies, though no therapies were discontinued. the plan was made to transfer the patient to a with plan to continue antibiotics and hd as long as these were desired by the patient and his proxies with probable eventual transition to comfort care. unfortunately, shortly after a was found to accept the patient between the evening of and the morning of the patient developed severe worsening of his abdominal pain with guarding. his pain was so severe as to require large doses of opioids and he slipped into unconsciousness. given his precipitous worsening abdominal exam and our knowledge of large valvular vegetations the treating teams assumption was that the patient had an embolic event to his gastrointestinal vasculature. this was discussed with the family as well as the dire prognosis associated with it. given the patient would not be a candidate for surgery even were this verified and his overall very poor prognosis no further diagnostic modalities were pursued. the patient was given analgesics, anti-emetics, and other symptomatic therapies and made cmo. he died on the morning of with his family in attendance. medications on admission: 1. nystatin po qid prn 2. hydroxyzine hcl 25 mg qid 3. oxycodone 5 mg po q6h 4. lidocaine 5 % patch 5. nitroglycerin 0.2 mg/hr patch 24 6. lorazepam 0.5 -1 mg prn anxiety 7. roxanol concentrate prn pain 8. methadone 40 mg q8 hours 9. camphor-menthol 0.5-0.5 % lotion prn 10. erythromycin 5 mg/g ointment 1 inch ophthalmic qid 11. omeprazole 20 mg daily 12. trimethoprim-sulfamethoxazole 160-800 mg q hd 13. captopril 50 mg tid 14. acetaminophen 650 mg prn pain 15. hcl 800 mg po tid with meals 16. hydralazine 25 mg po tid 17. amlodipine 10 mg daily discharge medications: not applicable discharge disposition: expired discharge diagnosis: primary diagnoses: aids esrd prosthetic valve endocarditis discharge condition: expired discharge instructions: not applicable followup instructions: not applicable procedure: hemodialysis diagnoses: pneumonia, organism unspecified acidosis thrombocytopenia, unspecified end stage renal disease tobacco use disorder congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma severe sepsis disruption of internal operation (surgical) wound acute on chronic diastolic heart failure asthma, unspecified type, unspecified other chronic pulmonary heart diseases candidiasis of mouth human immunodeficiency virus [hiv] disease surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other sequelae of chronic liver disease acute and subacute bacterial endocarditis secondary hyperparathyroidism (of renal origin) other ascites acute vascular insufficiency of intestine other and unspecified coagulation defects diseases of tricuspid valve viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta infection and inflammatory reaction due to cardiac device, implant, and graft septicemia due to pseudomonas septic arterial embolism 

Answer: The patient is high likely exposed to