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: zidovudine attending: chief complaint: dyspnea, cough major surgical or invasive procedure: none history of present illness: 47 yo f with hiv (last cd4 327 ) not on haart, hcv, afib, antiphospholipid ab syndrome, multiple vtes, cm with ef 20%, presents with fever, shortness of breath, cough, headache. she complains of fevers, fatigue and productive cough with green/yellow sputum. she complains of headache on the right side for several days. denies neck stiffness, chest pain, shortness of breath or abdominal pain. no nausea or vomiting. pt denies diarrhea or melena. she denies sick contacts, no recent incarcerations. has lived in homeless shelter in the distant past, not recently. . in the ed, initial vital signs were t 101.6, bp 86/57, hr 108, o2sat 96% ra. her lactate was 1.0. she was given 8l ivf in the ed for low pressures in the 80-90's systolic. hr was 80-90s. rscvl was placed. she was also started on levophed for hypotension. per report, she was mentating normally the entire time. she was given vancomycin for pneumonia on cxr. she was also given levafloxacin, ceftriaxone and bactrim and 60mg prednisone for possible pcp. hcg was negative. positive for trichomonas. . currently, she continues to complain of cough and shortness of breath. no headache currently. no abdominal pain, n/v. past medical history: 1. hiv/aids, diagnosed , last cd4 count 327 . not on art. has self d/c'd art several times. most recently . was not resumed due to poor compliance, - acquired via sexual intercourse. oi: - hcv - pneumonia - - +afb in sputum. was not complaint with rx. - oral thrush - recurrent episodes of pneumococcal pneumonia. last episode - .in each admission pcp and afb's were neg. - lymphocytic pneumonitis - diagnosed by trans-bronchial bx. untreated. tuberculosis risk factors: pt reports negative ppds in the past, does not recall most recent. no hx of exposure to tuberculosis, no incarceration. has lived in homeless shelter in the past ~1 year. 2. dilated cardiomyopathy-ef20-25%, last echo . unclear etiology with clean coronaries . 3. hepatitis c, undetectable vl in the past 4. multiple pnas 5. 6. lv thrombus 7. +anti-cardiolipin antibody 8. lower extremity arterial thrombus 9. asthma/bronchiectasis 10. myocardial infarction , clean coronaries at that time 11. l mca stroke 12. cocaine abuse 13. pulmonary nodules on chest ct 14. chronic lymphoid interstitial pneumonitis social history: smokes < ppd x many years, social alcohol use, denies iv drugs but reports smoking cocaine this morning. lives alone in apartment, was previously living with daugther but no longer. family history: mother has dm. physical exam: exam on admission: vitals: bp 111/82, hr 94, rr 25, 95% 2l nc general: ill-appearing disheavaled woman, moderate distress, tachypneic : anicteric sclera, non-injected. white plaques on tongue. mm appear dry. no lad. cv: rrr, no murmurs, rubs, gallops lungs: using accessory muscles, retractions but able to speak in full sentences. rhonchi throughout. no wheezing abdomen: +bs, soft, non-tender. midline scar from prior hysterectomy well healed. ext: no peripheral edema, no clubbing. neuro: alert and oriented x 3, cn intact ii-xii, muscle strength throughout. pertinent results: labs on admission: 01:45pm wbc-3.9* rbc-3.61* hgb-10.5* hct-30.3* mcv-84 mch-29.1 mchc-34.7 rdw-14.6 plt ct-142* 01:45pm neuts-63.2 lymphs-31.6 monos-4.6 eos-0.2 baso-0.4 01:45pm pt-33.6* ptt-41.8* inr(pt)-3.5* 01:45pm wbc-3.9* lymph-32 abs -1248 cd3%-96 abs cd3-1201 cd4%-15 abs cd4-184* cd8%-80 abs cd8-1003* cd4/cd8-0.2* 01:45pm glucose-89 urean-27* creat-1.4* na-131* k-3.6 cl-102 hco3-19* angap-14 01:45pm alt-18 ast-29 alkphos-56 totbili-0.6 01:45pm cortsol-21.6* 08:03pm ld(ldh)-188 . labs on discharge: 04:55am wbc-2.1* rbc-3.25* hgb-9.5* hct-27.6* mcv-85 mch-29.3 mchc-34.6 rdw-15.4 plt ct-238 04:55am pt-25.0* ptt-34.9 inr(pt)-2.5* 01:45pm wbc-3.9* lymph-32 abs -1248 cd3%-96 abs cd3-1201 cd4%-15 abs cd4-184* cd8%-80 abs cd8-1003* cd4/cd8-0.2* 04:55am ret aut-0.9* 04:55am glucose-83 urean-14 creat-1.1 na-135 k-4.2 cl-110* hco3-20* angap-9 06:06am alt-15 ast-28 ld(ldh)-173 alkphos-51 amylase-154* totbili-0.2 05:19am calcium-7.9* phos-3.6 mg-1.6 04:26am ck-mb-3 ctropnt-<0.01 06:08am ck-mb-notdone ctropnt-<0.01 04:26am caltibc-163* ferritn-369* trf-125* 11:51am cortsol-30.0* 09:33am cortsol-9.4 06:08am b-glucan-pnd 03:50pm rbc-* wbc-21-50* bacteri-mod yeast-none epi-0-2 12:40pm rbc-* wbc-0-2 bacteri-few yeast-none epi-0-2 03:50pm -lg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-4* ph-6.5 leuks-mod 12:40pm -mod nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-neg 03:50pm color-yellow appear-clear sp -1.009 12:40pm color-yellow appear-clear sp -1.010 . microbiology: . culture culture, routine-pending inpatient culture culture, routine-pending inpatient sputum gram stain-final; respiratory culture-preliminary; immunoflourescent test for pneumocystis jirovecii (carinii)-preliminary - pending; . fungal culture-preliminary inpatient stool ova + parasites-final; ova + parasites (final ): no ova and parasites seen. this test does not reliably detect cryptosporidium, cyclospora or microsporidium. while most cases of giardia are detected by routine o+p, the giardia antigen test may enhance detection when organisms are rare. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). . culture culture, routine-pending inpatient culture culture, routine-pending inpatient . sputum gram stain-final; respiratory culture-final; fungal culture-preliminary inpatient - poor sample culture culture, routine-pending inpatient serology/ cryptococcal antigen-negative. . rapid respiratory viral screen & culture rapid respiratory sputum gram stain-final; respiratory culture-final inpatient - poor sample sputum gram stain-final; respiratory culture-final inpatient - poor sample legionella urinary antigen - negative culture-negative culture culture, routine-final {staphylococcus, coagulase negative, staphylococcus, coagulase negative}; anaerobic bottle gram stain-final emergency culture culture, routine-final emergency . labs on discharge wbc rbc hgb hct mcv mch mchc rdw plt ct 07:30am 2.9* 3.51* 10.2* 29.4* 84 29.2 34.8 15.5 277 pt ptt inr(pt) 07:30am 21.2* 33.9 2.0* glucose urean creat na k cl hco3 angap 07:30am 105 19 1.0 136 4.3 105 24 11 . imaging/studies: head ct: no acute intracranial process. stable appearance of cystic encephalomalacia involving the left mca territory. if there is suspicion for acute ischemic insult, mri with diffusion-weighted imaging could be performed for further characterization. . cxr: findings consistent with multifocal pneumonia. . ct chest . extensive rapidly progressive pneumonia in both lungs. although there could be existing fungal infection, the findings are most readily explained by aggressive bacterial pneumonia. small bilateral pleural effusions do not have characteristics of empyema. 2. improving extensive chronic lymphadenopathy. chronic pulmonary micronodulation, attributed to non tuberculous mycobacterial infection. 3. cardiomegaly, anemia. 4. chronic enlargement of right thyroid lobe ct chest 1. resolution of bilateral pleural effusions. 2. bilateral airspace opacities, likely multifocal pneumonia which has dramatically improved. 3. multiple lung cysts which may be due to prior lymphocytic interstitial pneumonitis. echo - (lvef = 25 %). impression: moderate left ventricular dilatation with severe, global hypokinesis and extensive trabeculation suggestive of myocardial non-compaction. moderate pulmonary artery hypertension. mild-moderet mitral regurgitation. compared to the prior study (images reviewed) of , the left ventricular cavity is more dilated with similar systolic function. the severity of mitral regurgitation and the estimated pulmonary artery systolic pressure are higher brief hospital course: micu course: . the patient was admitted to the micu with possible pneumonia and possible sepsis after recieving 8l iv fluids in the ed and a lactate of 1.0. she was quickly weaned off levophed upon arrival to the icu. she was initially treated with broad-spectrum antibiotics with vancomycin, ceftriaxone and levofloxacin. the vancomycin was stopped on due to low suspicion for gram positive pneumonia. she was started on bactrim ds 2 tabs q8 hours for possible pcp. cd4 count was rechecked and was 184. she was given prednisone 60mg po in the ed but steroids were not continued because her o2 sats were high on minimal oxygen and ldh was normal and this was not felt to be severe pcp. was ordered for induced sputum for pcp and nasal aspirate to check for rapid viral antigens. she was continued on fluconazole for oral thrush and nystatin oral rinse was added. . her metoprolol and lisinopril were stopped due to hypotension. she had a repeat echo to assess her chf, which showed lv cavity more dilated from with similar systolic function. the severity of mr and the pasp were higher. she was not felt to be in heart failure on arrival to the icu. she was put on a low-salt diet. . floor course: . pt. was transferred to floor on and she continued to complain of occasional cough and shortness of breath. she denied other sx. her vitals were 96.2f, 102.68, 96, 18, 99% ra. . # fevers/cough/dyspnea. these were felt to be to multifocal cap, or pcp and patient was continued on ceftriaxone, levofloxacin and bactrim ds tid. she underwent a ct of chest which showed extensive rapidly progressive pneumonia in both lungs, small bilateral pleural effusions, improving extensive chronic lymphadenopathy. she was intremittently treated with vancomycin iv x 1d for gpc in bcx from w/ gpc that turned out to be coag negative staph, vancomycin was thus discontinued. her legionella ag was negative and her levofloxacin was thus discontinued on . cryptococcal ag was negative as were respiratory viral rapid screens. patient improved clinically significantly, w/ o2 saturations on ra 94-97% and ambulation of > 50 yards w/o doe. her induced sputums were repeatedly of poor quiality and could not be assessed for pcp . a bronchoscopy was considered, however in consultation with id and pulmonary team it was decided against it due to patient's improvement and hypotension (see below). her repeat ct chest on showed much improved infiltrates b/l consistent w/ improvement. her dyspnea, cough and fatigue continued to improve. she was afebrile throughout the hosptial stay w/ good perfusion on exam. due to progressive leukopenia, anc 580, her bactrim was switched to atovaquone (total 21-day course of 750mg po bid, day 4 on day of discharge, then 1500mg qday for prophylaxis) with subsequent return of wbc count to 2.5 and anc to 1180. on , her ceftriaxone iv was switched to cefpodoxime 200mg po bid. she should complete the course of total of 14days of ceftriaxone/cefpodoxime. repeat induced sputum smear/cx showed oropharygeal flora. pcp smear was pending. beta glucan was pending at time of discharge. pt will require ct within 2 weeks and id f/u within 2 weeks with dr. for re-check of anc. . patient's previously "positive" tst were documented as negative upon chart review with id. she was treated for in the past, but this was felt to be a colonizer. please see note from id staff on for more detail. . # hypotension. patient was triggered for hypotension, sbps 70s/palp on and . she was asymptomatic during this time (no dizziness, lightheadedness, chest pain, shortness of breath, changes in ms). her baseline from op visit was sbp of 90mmhg. she responded to 500cc bolus and maitenance fluids to 90mmhg. patient was signficantly volume negative on i/os, felt to be secondary to post atn diuresis. she was ruled out for adrenal insufficiency w/ a negative cortosyn stimulation test. poor contractility given chf w/ ef 20% and falling off frank-starling curve were considered, but patient was perfusing well and was asymptomatic througout this time. she was also started on low dose digoxin, 62.5mcg to improve forward flow. k was closely monitored and remained wnl throughout hospital stay. upon maintaining fluid balance over next 3 hds w/ ivf boluses and maintenance fluids, her sbps returned to 80-100mmhg. her metoprolol and lisinopril were held throughout this time. these were restarted at metoprolol xl 12.5 and lisinopril 2.5. he was continued on 0.0625 mg of digoxin to aid w/ contractility. culture data as mentioned above were pending at time of discharge. . # leukopenia. patient developed leukopenia 3.8-->1.9->2.1-> 2.5-> 2.9, anc 1170. improved after d/ced bactrim (). wbc from her previous hospitalizations ranged 2.5-4k. this was felt to be likely bactrim, or hiv itself. there were no signs of mac, histoplasma, ebv, hepatitis (which pt has), cmv. her retic count was hypoproliferative. fe studies were consistent w/ acd. folate/b12 were wnl. anc troughed at 580, and improved to 1170 on day of discharge. . # arf. cr elevated to 1.4 on admission, likely sepsis. it improved temporarily and then increased to 1.4 within 5d of admission with increased u/o consistent with post atn duiresis. fena was > 6%. u/a showed no evidence of a glomerular process nor casts. efforts were made to keep patient i/os even. at time of discharge, her cr. improved to 0.9 and her u/o stabilized. . # chronic pulmonary micronodulation on ct. previously attributed to non tuberculous mycobacterial infection. this actually improved on ct scans while hospitalized. lad had also decreased on repeat scans. etiology of these is unclear and outpatient follow up was recommeneded. . # cardiomyopathy. pt. was euvolemic on exam. has chronic, systolic, hiv related vs. cocaine related, non-ischemic chf: ef 20-25%. echo this admission with increased lv dilatation and increased pa pressures. this was likely ivf and increase pulmonary resistance pna. pt. had new inversion of tw in inferior leads and old lateral lead inversions. ce were negative x2. no events noted on telemetry suggestive of ischemia. was initially held to hypotension as was bbk. this as well as metoprolol and digoxin were resumed as bp improved, and continued at time of discharge. patient was maintained on low na diet. . # substance abuse. pt denied cocaine on this interview but had a positive tox screen. social work consult was obtained. she endorsed illusions to sw staff, but denied these to medical staff. she was not interested in discussing this topic further. . # afib hx in chart, but could not locate documentation in omr. patient was in sinus rhythm throughout hospitalization. . # antiphospholipid syndrome. multiple vtes. patient's coumadin was held supratherapeutic inrs, likely fluconazole and levofloxacin. her coumadin was restarted at 5mg qd and titrated to target inr of . she was strongly advised not to miss follow-up appointment for inr re-check. . # hiv/aids. cd4 count 184. vl 254k. patient will likely require haart, but previously not on therapy due to poor compliance. already on fluconazole for ppx. no need for cmv ppx as cd4 > 50. discussed with id, patient will likely start haart as outpatient once adherence to appts can be documented. continued atovaquone and fluconazole. . # depression w/ hx of anxeity sx. per patient, fluoxetine was not helping and she was not currently taking it. continue ativan. pt. is willing to try celexa as outpatient. . # difficulties adhering to care. contributed to by difficult home situation (one daughter jailed) and the other daughter reportedly not supportive at home. in addition, patient reporting difficulties getting to her appointments. after discussion with social work and case managment, pt was set up with transportation assistance. . patient was discharged home in a hemodynamically stable condition with multiple follow-up appointments. medications on admission: bactrim ds 160/800mg 1 tab daily ativan 0.5mg lisinopril 2.5mg daily fluconazole 100mg daily warfarin 10mg daily metoprolol sr 12.5mg daily fluoxetine 20mg daily - pt not taking discharge medications: 1. lorazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 2. fluconazole 100 mg tablet sig: one (1) tablet po q24h (every 24 hours). disp:*30 tablet(s)* refills:*2* 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*30 tablet(s)* refills:*0* 4. digoxin 125 mcg tablet sig: one half tablet po daily (daily). disp:*030 tablet(s)* refills:*2* 5. cefpodoxime 100 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 5 days. disp:*20 tablet(s)* refills:*0* 6. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: please adjust daily dose as directed by clinic. disp:*60 tablet(s)* refills:*2* 7. metoprolol succinate 25 mg tablet sustained release 24 hr sig: 0.5 tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 8. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. outpatient lab work vna services: please draw coumadin level on tuesday, . please draw coumadin level, cbc with differential, and digoxin level on thursday, . please fax coumadin results above to clinic (fax(). please fax cbc with diff and dig level results to clinic, attn: pcp . (fax:(.) 10. atovaquone 750 mg/5 ml suspension sig: 1500 (1500) mg po once a day: please take this medication indefinitely. disp:*qs mg* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: primary: pneumonia, sepsis secondary: heart failure, hiv/aids, coronary artery disease, multiple pulmonary emboli discharge condition: hemodynamically and respiratory stable discharge instructions: you were admitted to with severe lung infection requiring intensive care unit management. you were treated with intravenous fluids and given intravenous antibiotics. with this treatment your lung function improved, including improved breathing and oxygen levels. at time of discharge, you were being given an antibiotic called cefpodoxime. you should continue to take this medication as prescribed. your dose of coumadin was also adjusted, because your levels were high when you came in. please take the coumadin as prescribed. because of your hiv, you were also treated with additional antibiotic that you should continue upon discharge from the hospital. this is called atovaquone. you should continue this indefinitely. in addition, we checked the markers of activity of your hiv virus, and these were elevated, thus you should follow up with an infectious disease specialist upon discharge to discuss initiation of treatment for hiv. you were also continued on fluconazole. you should continue to take this medication. while hospitalized, you had low pressures. while this was the case, your metoprolol and lisinopril were withheld. as your pressures improved, metoprolol and lisinopril were restarted. a new medication, digoxin, was also added to help with your heart failure. your pressures were stable on discharge. because you have a condition called heart failure, your should weigh yourself every morning, and md if weight > 3 lbs. adhere to 2 gm sodium diet. you do not have a fluid restriction. you will be receiving visiting nurse services to help monitor your coumadin levels, digoxin medication level, and your white cell count given your hiv. they will be visiting you tomorrow and thursday to draw your . you will be contact by the clinic regarding how to dose your coumadin based on the levels. should you experience any worsening shortness of breath, fever, chills, productive cough, coughing up , chest pain, leg swelling or any other symptom concerning to you, please call your primary care doctor or go to the nearest emergency room. because of your hiv and other medical conditions, it is very important for you to follow up with your primary care doctor and an infectious disease specialist (please see below for appointments). followup instructions: 1. appointment with nurse practitioner: provider: , phone: date/time: 4:00. - she will follow-up with you for your pneumonia. 2: appointment with pcp, , md phone: date/time: 2:00 - she will follow with you for your pneumonia, digoxin dosing, and hiv. - she will help you to set up a repeat ct scan in 2 weeks. - she will also advise you about your pcp medications once the final results of your pcp culture have returned. 3. appt with infectious disease provider: , md phone: date/time: 8:30am - it is very important that you keep this appointment to establish a plan for treatment of your hiv. 4. please repeat a chest ct scan in 2 weeks. dr. will helping you to set that up. 5. the clinic will be following up with your regarding your coumadin dose. procedure: venous catheterization, not elsewhere classified diagnoses: urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis human immunodeficiency virus [hiv] disease 

Answer: The patient is high likely exposed to