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: history of present illness: the patient is a 55-year-old gentleman with a history of peripheral vascular disease and recently diagnosed acquired immunodeficiency syndrome who was transferred from an outside hospital for further evaluation. the patient was originally admitted to an outside hospital on with complaints of vomiting, weakness, and weight loss. he was found on admission to be pancytopenic. a computed tomography scan revealed a fatty liver. he subsequently developed a right upper lobe infiltrate. he was ruled out for tuberculosis with sputum cultures times three, but he remained febrile and was started on ceftriaxone and azithromycin. a bronchoscopy done at the outside hospital on showed erythema in the left main stem bronchus of unclear significance. also, at the outside hospital, the patient was found to be human immunodeficiency virus positive with a cd4 count of 2. he was also hepatitis b positive. the patient was started on bactrim for pneumocystis carinii pneumonia prophylaxis. a bone marrow biopsy done at the outside hospital showed a myelodysplastic pattern of cells. the patient was transferred to for further evaluation. past medical history: (the patient also has a past medical history of) 1. cholelithiasis. 2. peripheral vascular disease; status post two femoral-to-popliteal bypass grafts on the right lower extremity. medications on transfer: (his medications on transfer from the outside hospital included) 1. azithromycin 500 mg by mouth every day. 2. bactrim double strength one tablet by mouth every day. 3. protonix 40 mg by mouth once per day. 4. simethicone. 5. vancomycin 1 gram twice per day. 6. diflucan. 7. prednisone 20 mg by mouth once per day. 8. nystatin swish-and-swallow. allergies: social history: the patient has smoked one-third of a pack of cigarettes for the past 35 years. no current alcohol use, but heavy alcohol use 20 to 30 years ago. no drug abuse. the patient denies any homosexual contact. has a history of unprotected heterosexual contact years ago. family history: his father died of a myocardial infarction at the age of 49. his mother had breast cancer. physical examination on presentation: the patient's physical examination on admission revealed his temperature was 99.6 degrees fahrenheit, his heart rate was 120, his blood pressure was 120/64, his respiratory rate was 22, and his oxygen saturation was 91% to 93% on 3 liters. his head, eyes, ears, nose, and throat examination revealed temporal wasting. he had some erythema around the nose. he had some thrush in the oral cavity. his pupils were equal, round, and reactive to light. his extraocular muscles were intact. the neck was supple. the patient had no lymphadenopathy. jugular venous distention was not appreciated. he had no wheezes on pulmonary examination. he did have some diffuse crackles on the right greater than left. cardiovascular examination revealed tachycardia. normal first heart sounds and second heart sounds. no murmurs, rubs, or gallops. the patient's abdomen was soft and nontender. the abdomen was mildly distended. extremity examination revealed he had 2+ pitting edema in the right lower extremity and 1+ on the right side. the dorsalis pedis pulses were 2+ on the left and 1+ on the right. on neurologic examination, the patient was alert and oriented times three. his cranial nerves ii through xii were intact. his motor strength was in the upper extremity. motor strength was 4+/5 in the lower extremity. pertinent laboratory values on presentation: the patient's laboratory values revealed his white blood cell count was 1.6, his hematocrit was 24.9, and his platelets were 57. the patient's sodium was 135, his potassium was 4.3, his chloride was 109, his bicarbonate was 21, his blood urea nitrogen was 15, his creatinine was 0.4, and his blood glucose was 106. his liver function tests revealed a normal alanine-aminotransferase of 36, his aspartate aminotransferase was 86, his lactate dehydrogenase was 446, his alkaline phosphatase was 112, and his total bilirubin was 0.7. his calcium was 7.5, his magnesium was 1.9, and his phosphate was 3.9. the patient's thyroid-stimulating hormone was 2.5. he was hepatitis b surface antigen positive. his hepatitis b core antibody was positive. his hepatitis b surface antibody was negative. his human immunodeficiency virus test was positive while here. he had urine cultures which did not grow out any bacteria. his blood cultures did not grow out bacteria. his rapid plasma reagin was nonreactive. his cryptococcal antigen was undetectable. pertinent radiology/imaging: the patient's chest x-ray on admission showed diffuse ground-glass opacities throughout the right lung and in the left lower lobe. no definite pleural effusion. this was most likely consistent with pneumocystis carinii pneumonia. he had a computed tomography scan on admission of the chest which showed diffuse areas of consolidation involving both lungs as well as sparing of the left upper lobe; again consistent with pneumocystis carinii pneumonia. he had a moderate right pleural effusion. he also had ascites in his abdomen. concise summary of hospital course by issue/system: impression revealed a 55-year-old gentleman with newly diagnosed human immunodeficiency virus and a history of peripheral vascular disease who now presented hypoxic, requiring a significant amounts of oxygen, and also with pancytopenia, and most likely with a pneumocystis carinii pneumonia infection. 1. human immunodeficiency virus issues: initially, the patient was started on highly active antiretroviral therapy treatment for his advanced human immunodeficiency virus/acquired immunodeficiency syndrome. his highly active antiretroviral therapy was started on hospital day two; including efavirenz 600 mg by mouth at hour of sleep and lamivudine/zidovudine one tablet by mouth twice per day. on hospital day three, the lamivudine/zidovudine was discontinued, and lamivudine by itself was added on at 150 mg by mouth twice per day, and stavudine 30 mg by mouth q.12h. was added to the regimen. a discussion ensued regarding whether or not the patient had a possible immune reconstitution reaction worsening his pneumocystis carinii pneumonia, and it was decided that his highly active antiretroviral therapy treatment would be temporarily placed on hold until his opportunistic infections improved. subsequently, his highly active antiretroviral therapy treatment was discontinued on hospital day twelve and had not been restarted at the time of this dictation. 2. pneumocystis carinii pneumonia issues: the patient was essentially diagnosed with pneumocystis carinii pneumonia on admission via a chest x-ray, elevated lactate dehydrogenase, and computed tomography scan. a pulmonary service consultation was obtained on hospital day two. a bronchoscopy which they performed showed a normal oropharynx and a normal larynx. in the airway, there was mild erythema and a discrete erythematous area seen in the left main stem bronchus of unclear significance. subsequently immunofluorescence test for pneumocystis carinii pneumonia performed from the bronchial lavage was positive for pneumocystis carinii. the patient was started on treatment level dosage of bactrim for his pneumocystis carinii pneumonia which was 250 mg intravenously q.8h. for 21 days. he was also started on prednisone for a 21-day course with a taper in place. 3. cytomegalovirus issues: the patient had a cytomegalovirus viral load sent on hospital day ten which came back with 57,000 copies. the test was repeated on hospital day eighteen and came back 21,000 copies. in the interim, the patient was being treated with ganciclovir at 250 mg intravenously q.12h. the latest cytomegalovirus viral load performed on hospital day twenty-four revealed a viral load of 7000. the patient is currently still being treated with treatment doses of ganciclovir at 250 mg intravenously q.12h. the patient will need to have his white blood cell count and red blood cell count monitored while being on this medication, as it can cause pancytopenia. 4. nutritional issues: the patient was found to be very cachectic and wasted on admission. he was started on boost plus supplements three times per day on hospital day two and was continued on that throughout the course of his admission. on hospital day twenty-four, a nasogastric tube was placed and the patient was begun on tube feeds with promod with fiber with a goal rate of 55 cc per hour. the patient is currently still being treated with the tube feeds. of note, his albumin on admission was 1.6. 5. mycobacterium avium-intracellulare prophylaxis issues: mycobacterium avium-intracellulare prophylaxis was started with azithromycin 1200 mg by mouth every week on hospital day eleven. 6. functional status issues: physical therapy worked with the patient since he was admitted and felt that he was significantly deconditioned and would benefit from continued physical therapy as an inpatient. 7. congestive heart failure issues: the patient had an echocardiogram several days after admission which revealed an ejection fraction of approximately 35%. the patient was begun on a low-dose ace inhibitor as management. throughout the course of his hospitalization, he was diuresed as needed for decreases in his oxygen saturations and clinical appearance of volume overload. 8. hyponatremia issues: the patient had a persistent hyponatremia with serum sodium levels frequently in the range of 120. he was treated with 500-cc boluses of normal saline as needed. urine studies were drawn on him that were somewhat equivocal but were consistent with a syndrome of inappropriate secretion of antidiuretic hormone picture and also slight hypovolemic state. toward the end of his hospital stay, the patient's sodium did trend up. on the day of discharge, his sodium was 134. 9. oral thrush issues: the patient was found to have oral thrush on admission and was placed on nystatin oral suspension swish-and-swallow. clinically, the thrush did improve throughout the course of his admission; however, it was still present, and the treatment will need to be continued. 10. major events: on hospital day six, the patient was transferred to the medical intensive care unit for persistent hypotension with a systolic blood pressure down to the 70s. the cause was thought to be overly aggressive antihypertensive treatment with an ace inhibitor. the patient was volume resuscitated and was transferred back out to the floor two days later. on hospital day nine, the patient was again transferred to the medical intensive care unit for hypotension and slight hypoxia. he was again volume resuscitated with approximately four liters of fluid and was transferred back to the floor two days later. condition at discharge: condition on discharge was stable; normotensive and slightly tachycardic (with heart rates generally between 100 and 110). his oxygen requirement was approximately 99% on 4 liters. he had minimal strength likely due to poor nutritional status and deconditioning. he was able to walk approximately 10 feet without assistance. discharge status: discharge status was to hospital for further care. discharge diagnoses: 1. acquired immunodeficiency syndrome. 2. cytomegalovirus pneumonitis. 3. pneumocystis carinii pneumonia. 4. malnutrition. 5. hospital-acquired pneumonia. medications on discharge: 1. bactrim double strength one tablet by mouth every day. 2. triamcinolone cream 0.025% one application to the forehead once per day. 3. sarna lotion to the forehead once per day. 4. ganciclovir 250 mg intravenously q.12h. 5. insulin as per sliding-scale. 6. azithromycin 1200 mg by mouth every week (on tuesday). 7. multivitamin one tablet by mouth every day. 8. nystatin oral suspension 5 mg by mouth four times per day as needed. 9. protonix 40 mg by mouth q.24h. discharge instructions/followup: the patient was instructed to follow up in the infectious disease clinic upon discharge from the outside hospital. , m.d. dictated by: medquist36 procedure: spinal tap incision of lung enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: congestive heart failure, unspecified candidiasis of mouth human immunodeficiency virus [hiv] disease pneumocystosis viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta nutritional marasmus pneumonia in cytomegalic inclusion disease 

Answer: The patient is high likely exposed to