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: motrin / lipitor attending: chief complaint: cc: sob, fever, cough major surgical or invasive procedure: none history of present illness: hpi: ms. is a 68 year-old african-american female with a complicated past medical history significant for hiv cd4 986 (), cad s/p mi and ptca, insulin dependent dm2, esrd on hd, diastolic dysfunction, and history of pe on anticoagulation. recently hospitalized in early for sob/pleuritic left-sided chest pain and treated with antibiotics for likely pneumonia. admitted again later in for left-sided chest pain during dialysis and ruled out by enzymes. * patient reports a 3 day history of non-productive cough, ha, sore throat, and fever/chills. no sick contacts at home. she presents today with worsening sob over the last 3 days; denies chest pain. last hd was . ros also significant for decreased appetite, but taking fluids, + n/v ( x in last few days), + racing heart, chronic lq abd pain (unchanged). normal bms. * in pt with t 103.3, bp 150/80, hr 140s. received metoprolol 5mg iv x 1 to slow rate, became hypotensive to sbp 70-80s, started on levophed. also got vancomycin/ctx/flagyl, atrovent nebs, asa/morphine/tylenol, solu-medrol 125mg, 2l ns * currently, patient states that she has some shortness of breath but is feeling better. occ diarrhea. nl urination. still with a decreased appetite. no cp past medical history: past medical history: 1. cad s/p nstemi , s/p ptca/stent lcx . latest catheterization in with 2-vessel disease. persantine mibi without symptoms or ekg changes. mibi images significant for severe fixed inferior defect, ef 58%. 2. dm type 2, on nph. 3. hiv, with last cd4 on = 986 4. esrd on hd since ' 5. history of rul segmental pe, on coumadin anticoagulation () 6. diastolic dysfunction. last echo with 4+mr, +tr and complex aortic atheroma. ef>55%. 7. h/o multiple avf clots, s/p thrombectomies, last in 8. h/o gib in the setting of coagulopathy and nsaids 9. eosinophilic pneumonia diagnosed , on chronic prednisone. 10. anemia crf 11. vulvar intraepithelial neoplasia diagnosed in . 12. . pfts with fvc 0.69 (27%), fev1 0.46 (24%), fev1/fvc 92%. * social history: the patient currently lives in with her daughter aged 50 years old. she was previously a housewife. she denies current alcohol or drug use. she quit drinking >20 years ago. she smoked 2 packs a day for 30 years. family history: non-contributory physical exam: * pe: vitals: t 97.7 tmax: 98.6, bp 110/52 (93-122)/ (34/76), hr 90, rr 20, sat 97% on 2 liters . gen: obese african american woman, in nad, speaking in full sentences. heent: perrl. eomi. clear op. mmm neck: jvp not elevated. resp: distant breath sounds. scattered wheezes bilaterally cv: tachycardic. normal s1, s2. no s3, s4. sys murmur at apex, abd: obese abdomen. bs normoactive. abdomen soft and mild tenderness to palp over lq. no rebound, guarding. no hsm. ext: no pedal edema. pulses difficult to palpate. avf left ue with thrill, nt, no erythema cvl right groin. neuro: cn intact. mae. grossly normal. ao x3 old notes indicate, guiac positive stool * pertinent results: 09:57pm ck(cpk)-723* 09:57pm ck-mb-34* mb indx-4.7 ctropnt-1.34* 02:10pm lactate-2.6* 01:55pm ck(cpk)-585* 01:55pm ctropnt-1.46* 01:55pm ck-mb-28* mb indx-4.8 01:55pm hct-35.1* 08:00am glucose-152* urea n-68* creat-8.6*# sodium-135 potassium-4.4 chloride-89* total co2-25 anion gap-25* 08:00am alt(sgpt)-25 ast(sgot)-44* ck(cpk)-330* alk phos-78 amylase-629* tot bili-0.2 08:00am lipase-18 08:00am ck-mb-11* mb indx-3.3 08:00am calcium-8.6 phosphate-5.0* magnesium-1.8 08:00am pt-20.7* ptt-36.1* inr(pt)-2.7 08:00am urine blood-lg nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-tr 08:00am urine rbc-* wbc-* bacteria-occ yeast-none epi-0 .. ekg: st 114, normal intervals, nl axis. no st-t changes * cxr: no evidence of acute cardiopulmonary pathology * cta: 1. no evidence of pulmonary embolism. 2. mucous impaction in the right upper lobe posterior subsegmental bronchus. 3. there are two (2) patchy areas of air space opacity within the left lung as described above. these probably represent atypical foci of inflammation or infection. however, given slight changes or architectural distortion, ct examination is recommended after appropriate treatment. chest x-ray () - early, mild congestive heart failure * culture data-legionella urinary antigen positive for direct influenza a viral antigen blood cultures - - ngtd c. diff toxin - negative urine cultures- no growth chest x-ray (): , no change since the prior examination. no acute cardiopulmonary pathology. chest ct ()- 1) interval progression of tree-in- opacities, involving all of the right lung (with some apical sparing) and the mid portion of the left lung. there has been no significant interval change of the 2 patchy areas of ground glass opacity within the superior segment of the left upper lobe and within the lingula. diagnostic considerations include atypical infectious agents, such as mycoplasma, mycobacteria, fungus and viral etiology. 2) the ground glass opacities of the left lung should continue to be followed to document complete resolution and exclude malignancy. 3) incidental gallstone. - impression: 1. significant interval resolution of tree and opacities involving the right lung with only a few residual opacities still present. 2. nodular ground-glass opacities within the lingula and left lower lobe are stable. 06:27am blood wbc-12.5* rbc-2.14* hgb-8.2* hct-26.4* mcv-124* mch-38.5* mchc-31.2 rdw-22.0* plt ct-232 06:27am blood neuts-80* bands-0 lymphs-17* monos-3 eos-0 baso-0 atyps-0 metas-0 myelos-0 nrbc-5* 06:27am blood hypochr-2+ anisocy-3+ poiklo-2+ macrocy-3+ microcy-normal polychr-1+ ovalocy-1+ target-occasional stipple-occasional 06:27am blood plt ct-232 06:27am blood glucose-64* urean-93* creat-8.2*# na-134 k-5.6* cl-94* hco3-28 angap-18 04:03pm blood ld(ldh)-399* totbili-0.2 dirbili-0.1 indbili-0.1 07:30am blood ck-mb-notdone 06:27am blood calcium-8.7 phos-3.5 mg-2.6 03:17am blood caltibc-176* vitb12-* folate-11.0 ferritn-1186* trf-135* 11:00am blood genta-0.5* 10:54am blood type-art po2-124* pco2-43 ph-7.45 calhco3-31* base xs-5 comment-hv 10:56am blood lactate-1.9 brief hospital course: * 1. hypotension/sepsis- patient was briefly placed in pressors, and were then weaned. etiology was unclear. perhaps related to adrenal insufficiency and patient was placed on hydrocortisone with improvement, she was switched to prednisone when called out of micu. blood cultures and urine cultures were negative. patient ruled in for flu. patient will need a very slow taper of prednisone given her history of a chronic eosinophilic pna, and perhaps outpatient stim test. patient bp improved as her underlying lung infection (see below) was treated. she was dc'ed on beta-blocker and ace * 2. cv/elevated troponin- likely demand ischemia in setting of tachycardia patient was not having cp. felt to be related to sepsis and renal failure. --patient was continued on asa and beta blocker, ace inhibitor held secondary to hypotension (and was restarted prior to dc) * 3. resp- patient thought to be having flare secondary to flu. patient was given round the clock albuterol, atrovent nebs with inhaled steroids and prednisone. she was very slow to respond. repeat chest x-ray showed no evidence of pna, but given her slowness to respond levoquin was added for question for bacterial superinfection-? tracheobronchitis. a pulmonary consult was obtained, and a chest ct was obtained (see results section). in addition, wbc count began to increase. pulm consulted indicated that likely she has a chronic eosinophilic pna and has been treated with too short courses of steroids in past. they also recommended that she should be placed on bactrim ppx. patient chest ct should a tree in distribution in both the right and left lung; this has a a broad differential including mycobacteria, viral etiology, untreated bacterial infection. it was decided that the patient should be placed on respiratory isolation in order to rule out tuberculosis and to send sputum x 3 for afb, pcp, , bacterial cultures, and cytology (concern for malignancy given smoking history). the sputum cultures grew gram neg rods, and given her history of pseudomonal pna, patient was placed on gentamycin. also, patients sputum grew out stentrophomonas maltophilia that was sensitive to bactrim. at this point, the levoquin was stopped (she had been on levo for 9 days). eventually it was decided that patient would be treated with 14 days of gent and cipro for pseudomonas, and 14 days of bactrim for stentrophomonas maltophilia. patient began to clinically improve, however her aspergillus antigen came back at 3000, but antibodies were negative. pulm was not sure what to make of this info and and id consult was obtained. id recommended repeat ct which showed interval improvement and resending the aspergillus antigen. id recommended that patient be treated only with cipro for pseudomonal infection (gent was dc'ed), and bactrim be lowered to pcp dose (felt that stentrophomonas maltophilia was likely a colonizer). patient was also placed on a 14 days of diflucan for oral thrush. * 4. esrd- on hd mwf. fluid removal helped respiratory status. * 5. dm2- cont home regimen of nph and iss for coverage. * 6. h/o pe- patient was placed on coumadin, and at one point was supratheraputic with an inr of 6.3 (in the setting of starting bactrim and levoquin) and was guiac positive. patient was hemodynamically stable and patient was given some vitamin k. coumadin was held until decreased. eventually coumadin was restarted with heparin bridge until inr was therapeutic. inr will need to monitored daily to assure stability (currently at 3.1, goal - 2 and 3). patient will need outpatient colonscopy * 7. hiv- last cd4 435 in with undetectable viral load. cont outpt antiretrovirals. * medications on admission: meds: 1. metoprolol 25 mg po bid 2. aspirin 325 mg po daily 3. zidovudine 200 mg po bid 4. nevirapine 200 mg po bid 5. lamivudine 50 mg po daily 6. b-complex with vitamin c po daily 7. pantoprazole 40 mg po q24h 8. albuterol-ipratropium 103-18 mcg 1-2 puffs q6h prn sob. 9. isosorbide dinitrate 10 mg po bid 10. lisinopril 5 mg po daily 11. calcium acetate 667 mg po tid w/meals 12. fluticasone-salmeterol 250-50 mcg/dose 13. prednisone 20 mg po qod 14. warfarin 5 mg po daily 15. nph 10 units qam. please also continue your sliding scale as you were prior to admission. 16. ? flagyl discharge disposition: extended care facility: hospital discharge diagnosis: pseudmonas lung infection influenza 1. cad s/p nstemi , s/p ptca/stent lcx . latest catheterization in with 2-vessel disease. persantine mibi without symptoms or ekg changes. mibi images significant for severe fixed inferior defect, ef 58%. 2. dm type 2, on nph. 3. hiv, with last cd4 on = 986 4. esrd on hd since ' 5. history of rul segmental pe, on coumadin anticoagulation () 6. diastolic dysfunction. last echo with 4+mr, +tr and complex aortic atheroma. ef>55%. 7. h/o multiple avf clots, s/p thrombectomies, last in 8. h/o gib in the setting of coagulopathy and nsaids 9. eosinophilic pneumonia diagnosed , on chronic prednisone. 10. anemia crf 11. vulvar intraepithelial neoplasia diagnosed in . 12. . pfts with fvc 0.69 (27%), fev1 0.46 (24%), fev1/fvc 92%. discharge condition: stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet please call your doctor or come to ed if you develop nausea, vomiting, shortness of breath, fevers/chills followup instructions: provider: , m.d. where: cardiac services phone: date/time: 9:30 provider: , m.d. where: center phone: date/time: 10:15 please call your doctor, dr. and make an appointment within one week of dc - number to call is please call and make an appointment with dr. in pulmonary within 1-2 months- # to call is procedure: venous catheterization, not elsewhere classified hemodialysis infusion of vasopressor agent diagnoses: mitral valve disorders long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled obstructive chronic bronchitis with (acute) exacerbation candidiasis of mouth hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease pneumonia due to pseudomonas long-term (current) use of insulin blood in stool pulmonary eosinophilia asymptomatic human immunodeficiency virus [hiv] infection status influenza with pneumonia other acute and subacute forms of ischemic heart disease, other 

Answer: The patient is high likely exposed to