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: diarrhea, abdominal pain major surgical or invasive procedure: tee, external pacemaker implantation. history of present illness: mr. is s 31 yo m with pmh of hiv/aids (cd4= 34, not on haart), hep b + c, and esrd on hd who presents from dialysis with fever and abdominal pain x 3 days. he reports 2-3 days of watery, non-bloody diarrhea up to five times a day. he has had some abdominal pain and nausea, but no vomiting. he c/o some stomach cramps such that he stopped eating food but he did keep drinking fluids. +thirsty. he does not make any urine at baseline. he has had a dry throat but no cough. he describes headaches that come and go as well as some mild photophobia, which is baseline for him. he went to hd today, and was noted to be hypotensive to 80/50 and febrile 101.3. he was then referred to the ed; no dialysis was done. in the ed, vs: 100.5 90 90/49 16 100%ra. tmax in ed was 101.3 and lowest sbp (by report, not recorded), was 63. abdomen was tender in luq. guaiac negative. labs were notable for lactate of 0.6, no leukocytosis. ekg with twi in v2-v3, but no ischemic changes. cxr revealed no acute process. given hypotension, a quick bedside us of chest was performed, which showed no pericardial effusion. 3l ns administered, and bp improved to 100s. a ct abdomen was obtained which showed thickening of descending colon. blood cultures were drawn, and he received levo and flagyl, as well as tylenol and asa. he was then admitted to the icu. renal evaluated the patient and did not think there was an indication for urgent dialysis. most recent vitals 95.1 57 100/56 17 100%ra. past medical history: - hiv dx'd , currently not on haart due to intolerance, h/o pcp - coag negative staph endocardiits s/p mvr and avr in , s/p vanc x 4 weeks - hcv + but has no detectable circulating virus - hbv + but hbc equivocal - esrd hiv nephropathy on hd (though pt reports it was from htn), s/p lue avf revision , . - secondary hyperparathyroidism esrd - chronic lbp; seen in pain clinic; told secondary to oa/nerve impingement - asthma social history: lives with his mother. smokes 1ppd x > 20 years. per chart, used iv drugs as teen, though patient currently denies ever using. family history: family history: - father: hypertension/diabetes - no family hx of kidney disease physical exam: vs 94.8 58 92/60 13 100% ra weight on bed is 71kg. gen: pleasant, nad, lying comfortably in bed. eyes: right eye is somewhat larger than left but both are reactive to light ent: face symmetric, small amount of thrush lining tongue and inner cheek neck: supple, no jvd cv: rrr, sm heard throughout precordium resp: good air movement with some small wheezes throughout as well as squeeks. abd: +bs, soft, minimal generalized tenderness, nondistended, no rebound, liver edge smooth and felt 2cm below costal margin ext: lue av fistula with thrill. no edema, good peripheral pulses, no cyanosis neuro: a&ox3 skin: warm, no rashes psych: appropriate pertinent results: admission labs: 07:03pm glucose-85 urea n-39* creat-9.4* sodium-131* potassium-4.5 chloride-93* total co2-28 anion gap-15 07:03pm ck(cpk)-27* alk phos-351* 07:03pm ck-mb-notdone ctropnt-0.15* 07:03pm calcium-8.2* phosphate-4.6* magnesium-1.7 07:03pm wbc-4.1 rbc-3.22* hgb-10.0* hct-30.3* mcv-94 mch-31.0 mchc-33.0 rdw-16.8* 07:03pm neuts-80.3* lymphs-15.3* monos-3.6 eos-0.6 basos-0.3 07:03pm plt count-100* 07:03pm pt-18.2* ptt-32.0 inr(pt)-1.7* 10:27am lactate-0.6 08:25am glucose-90 urea n-36* creat-9.6*# sodium-131* potassium-4.1 chloride-89* total co2-30 anion gap-16 08:25am alt(sgpt)-9 ast(sgot)-21 ck(cpk)-26* alk phos-412* tot bili-0.7 08:25am lipase-15 08:25am ck-mb-2 ctropnt-0.15* 08:25am wbc-5.4 rbc-3.02* hgb-9.4* hct-28.2* mcv-94 mch-31.2 mchc-33.4 rdw-16.9* 08:25am neuts-78.6* lymphs-15.9* monos-5.1 eos-0.2 basos-0.1 08:25am plt count-107* 08:25am pt-16.6* ptt-31.3 inr(pt)-1.5* discharge labs: 06:55am wbc-4.6 rbc-3.16* hgb-9.9* hct-30.1* mcv-95 mch-31.2 mchc-32.8 rdw-17.9* plt ct-174 06:55am pt-14.6* ptt-29.0 inr(pt)-1.3* 06:55am glucose-76 urean-17 creat-7.2*# na-136 k-3.9 cl-98 hco3-29 06:55am calcium-8.0* phos-3.2 mg-1.9 06:55am vanco-10.7 studies: ekg: sinus rhythm. prolonged p-r interval. compared to the previous tracing no change. cxr - the patient is status post median sternotomy. the cardiomediastinal silhouette is stable. there are no areas of consolidation. the visualized bones appear unremarkable. the previously seen ground glass opacities have resolved. conclusion: no acute cardiopulmonary process. ct abd and pelvis with contrast - conclusion: 1. stable hepatosplenomegaly without any focal lesions. 2. mild thickening of the wall of distal descending and sigmoid colon may be infectious or inflammatory. 3. atrophic small kidneys with maximum craniocaudal measurement of 7 cm. 4. right basal effusion along with atelectasis. echo: the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 40 cm from the incisors. a bioprosthetic aortic valve prosthesis is present. the posterior aortic root is thickened but no definite abscess is idenfitied. trivial intraaortic valvular regurgitation is seen. no masses or vegetations are seen on the bioprosthetic aortic valve. a bioprosthetic mitral valve prosthesis is present. a paravalvular mitral prosthesis leak is present. no mass or vegetation is seen on the mitral valve. moderate (2+) mitral regurgitation is seen. no vegetation or mass is seen on the tricuspid or pulmonic valve. there is no pericardial effusion. impression: no mass or vegetation is seen on the bioprosthetic mitral and aortic valves. there is abnormal thickening of the posterior aortic root without any definitive abscess seen. moderate paravalvular mitral regurgitation. mr without contrast impression: 1. severely limited study shows no acute intracranial process. 2. diffusely low marrow signal, consistent with marrow hyperplasia, which could be secondary to anemia or hiv. left upper extremity doppler - impression: no evidence of septic thrombus in the fistula. cxr - findings: endotracheal tube has been placed terminating 3.8 cm above carina. worsening bibasilar opacities, probably pulmonary edema and less likely aspiration, with adjacent bilateral small pleural effusions. ecg - sinus rhythm. a-v conduction delay. compared to the previous tracing of the t wave abnormalities recorded on are more prominent, now with t wave inversions in lead v3. followup and clinical correlation are suggested. ct t & l spine - final read still pending. discussed with radiologist and no abscess seen. brief hospital course: 31 year old gentleman with h/o hiv not on haart, esrd on hd, and h/o coag neg staph endocarditis s/p mvr/avr admitted with fevers and diarrhea, found to have strep viridans endocarditis. # strep viridans endocarditis: the patient is immunocompromised and has a history of endocarditis. the pt had a recent admission in with similar symptoms. the initial differential for his fevers was broad and included persistent low grade endocarditis (supported by a new pr prolongation on ekg), cmv colitis, viral gastroenteritis, c diff colitis, or . he responded appropriately to volume challenge and his blood pressures were been stable in 90s/50s upon presentation to the micu. a tte on demonstrated "mod-to-severe paravalvular mitral regurgitation without definite vegetations seen, but the new finding of paravalvular mitral regurgitation is consistent with acute infectious endocarditis." there was also concern for cns process given headaches and unequal pupils on exam, although clinical presentation did not suggest bacterial meningitis. of note, lp done was negative. cxr did not show infiltrate. in the icu the pt received vancomycin and gentamicin (50mg) and was continued on flagyl given evidence of colitis. his white count was 5,000 without bands, a cxr showed no evidence of pneumonia or heart failure, an abdominal ct showed mild thickening of the wall of distal descending and sigmoid colon. the patient grew gpc in blood cultures later found to be strep viridans. the patient was intubated to undergo tee which demonstrated (details above) tricuspid valve vegetation with mild tricuspid regurgitation, a thickened region of posterior aortic root consistent with probable abscess and mild to moderate central mitral regurgitation and (at least) moderate eccentric paravalvular leak. ct surgery was consulted, and they did not feel that the patient was a surgical candidate. a ct spine was performed to rule out a paraspinal abscess in the setting of back pain. the patient could not undergo an mri because of a temporary pacemaker that was placed. the patient was followed clinically by observing his fever curves, blood cultures, and pr interval. he was transferred to floor on the evening of and remained afebrile. an id consult was placed to help guide antibiotic therapy as an outpatient. ceftriaxone was felt to be the preferred regimen, however, the patient could not have a picc line placed because of the location of his temporary pacemaker lead and his av fistula. in concert with id it was decided to discharge the patient on vancomycin and gentamycin to be received with hemodialysis. he received these medications after dialysis on the day of discharge. vancomycin and gentamicin will be continued for at least 6 weeks and will follow-up with id as an outpatient. given the possibility of complete heart block, an external pacemaker was placed. he will follow-up with ep as an outpt. # esrd on hd: the patient did not receive scheduled dialysis on arrival as there was not pressing indication for dialysis, and renal reevaluated the pt the morning following admission. the patient lytes were monitored closely and he was continued on nephrocaps, phoslo, cinacalcet, and . he was eventually placed on his regular dialysis schedule of tuesday, thursday, saturday and received dialysis on the morning of discharge. # oral thrush: remained stable and was given nystatin swish and swallow. # hiv. the patient's most recent cd4 count was 14 from : the pt was not on haart do to intolerance to treatment. the patient was continued on dapsone and bactrim. per id, he was discharged on bactrim ss after hemodialysis and dapsone was stopped. # hyponatremia: the patient presented with a serum sodium of 131. this was suspected to be hypovolemic hyponatremia and it improved after iv fluids. the patient was not hyponatremic at baseline but had hyponatremia during past admissions. upon transfer from the icu the pt's hyponatremia had normalized. # anemia: on admission the patient's hematocrit was 28. his baseline hct is 29-34. this was most likely due to esrd and he receives epo with dialysis. his hct remained between 27 and 31 during this admission # thrombocytopenia: platelet count 107 on admission and up to 177 on discharge. his platelet count was likely low in the setting of an acute infection. # elevated troponin: the patient had elevated troponin without any evidence of ischemia, most likely related to chronic kidney disease. # asthma: stable. the patient received albuterol prn # elevated inr: it is unclear if this is nutritional or related to a coagulopathy. his inr remained at his baseline. # hypertension: of note, the patient has had problems with hypertension in the past but his nephrologist reports that his bp has been increasingly easy to control of late. his metoprolol was stopped due to hypotension and did not need to be . # elevated alk phos: chronic. most likely from bone as bone alk phos was elevated when checked in past. nephrologist planning on bone scan. # hcv/hbv: lfts remained at baseline. # chronic pain and h/o opioid dependance: methadone 40mg tid was continued per outpatient regimen. medications on admission: metoprolol 25mg asa 81mg daily nephrocaps po daily oxycodone 5mg for breakthrough pain bactrim ds one tablet q wed cinacalcet 60mg daily methadone 40mg tid 800mg tid phoslo 667mg tid albuterol inh q6h prn dapsone 100mg daily zofran 4mg po q6h prn discharge medications: 1. methadone 40 mg tablet, soluble sig: one (1) tablet, soluble po tid (3 times a day). 2. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 4. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed. 5. gentamicin sulfate (pf) 60 mg/6 ml solution sig: one (1) intravenous qhd. 6. vancomycin 500 mg recon soln sig: per hd protocol recon soln intravenous hd protocol (hd protochol). 7. nystatin 100,000 unit/ml suspension sig: five (5) ml po tid (3 times a day). 8. erythromycin 5 mg/g ointment sig: one (1) application ophthalmic qid (4 times a day) for 7 days. disp:*1 tube* refills:*0* 9. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 10. bactrim 80-400 mg tablet sig: one (1) tablet po after hemodialysis. disp:*12 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: primary: mitral valve endocarditis, strep viridans secondary: hiv/aids chronic hepatitis c hbv+ but hbc equivocal esrd hiv nephropathy on hd chf (ef 40-50%) chronic low back pain discharge condition: afebrile, satting well on room air. discharge instructions: you were admitted with fevers and low blood presure. this was due to an infection of your heart valve. for this, we have started antibiotics that you will get at hemodialysis for at least 6 weeks. there have been changes to your home medication regimen. you should take all your medications as prescribed below. please keep all of your follow-up appointments. please call your doctor or return to the hospital if you experience fevers, chest pain, shortness of breath or any other concerning symptoms. followup instructions: please call to make a follow-up appointment with your primary care doctor/infectious disease doctor within the next 2 weeks. please call to make a follow-up appointment with dr. in electrophyisiology regarding your pacemaker in 1 month. please call to make a follow-up appointment with your nephrologist, dr. . provider: , av care av care phone: date/time: 9:00 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis insertion of temporary transvenous pacemaker system diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease other and unspecified noninfectious gastroenteritis and colitis other chronic pain tobacco use disorder mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension chronic hepatitis c without mention of hepatic coma hyposmolality and/or hyponatremia severe sepsis asthma, unspecified type, unspecified other complications due to heart valve prosthesis candidiasis of mouth human immunodeficiency virus [hiv] disease opioid type dependence, continuous 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 cardiac pacemaker in situ acute and subacute bacterial endocarditis secondary hyperparathyroidism (of renal origin) heart valve replaced by transplant hypovolemia lumbago streptococcal septicemia acute on chronic systolic heart failure diseases of tricuspid valve chronic glomerulonephritis with unspecified pathological lesion in kidney first degree atrioventricular block infection and inflammatory reaction due to cardiac device, implant, and graft blepharitis, unspecified 

Answer: The patient is high likely exposed to