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: dyspnea major surgical or invasive procedure: endotracheal intubation. chest ct hemodialyis with additional ultrafiltration sessions. history of present illness: hpi: 69-yo-woman w/ hiv, copd, esrd on hd presents w/ shortness of breath x 2 hours. she reportedly was feeling well until 7pm, when she developed dyspnea at rest. the dyspnea became progressively worse over the next 2 hours, prompting presentation to the ed. the pt did not complain of any fever, chills, increased cough, chest pain, abd pain, melena, or hematochezia. on arrival in the ed, her temp 103, hr 162, bp 230/104, rr 38. she was in acute resp distress and was intubated immediately and placed on cmv ventilation. propofol gtt was started for sedation, resulting in decreased bp to 70/42. propofol was then d/c, and levophed was added, resulting in increased bp to 118/55. initial cxr was concerning for pna w/ diffuse interstitial infiltrates, and the pt was treated w/ levo/vanco/ flagyl/bactrim/hydrocortisone. the micu team was then called for further evaluation. 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, last cd4 count 940 in 4. esrd on hd since ' (m, w, f) 5. chf, with mixed systolic (ef 45-50%) and diastolic dysfunction. 6. severe mitral regurgitation 7. history of rul segmental pe in , on coumadin () d/c'd in 06/. 8. recently diagnosed right popliteal dvt , restarted on coumadin 9. h/o multiple avf clots, s/p thrombectomies, last in 9. h/o gib in the setting of coagulopathy and nsaids 10. eosinophilic pneumonia diagnosed , on chronic prednisone therapy. 11. anemia crf 12. vulvar intraepithelial neoplasia diagnosed in . 13. copd with pfts with fvc 0.69 (27%), fev1 0.46 (24%), fev1/fvc 92%. 14. history of positive galactomannan antigen 15. rul nodules on ct, not fdg avid on pet on . etiology unclear. 16. vulvar squamous cell carcinoma in situ. social history: recently was at the rehab. lives in with her daughter. etoh. ex-smoker (60 pack-year smoking history) family history: non-contributory physical exam: on admission to micu: pe: t 103, hr 112, bp 118/55, o2 sat 100% cmv 500 x 12/40%/5 gen: chronically ill appearing woman lying flat in bed, intubated, moving all 4 extremities in nad. heent: anicteric, eomi, perrl, op clear w/ mmm, no jvd cv: reg s1/s2, no s3/s4/m/r pulm: coarse bs throughout, no wheezes or crackles abd: obese, +bs, soft, nt, nd ext: warm, 2+ dp b, no edema neuro: pt too lethargic to cooperate; moving all extremities spontaneously and follows basic commands pertinent results: initial chest x-ray. 1. endotracheal tube properly positioned with tip at the thoracic inlet. 2. findings consistent with severe pulmonary edema with possibly etiologies including congestive failure or, less likely, ards. chest x-ray. resolution pulmonary edema initial chest ct. there is an endotracheal tube in place. the airways are patent. there is no pericardial effusion. there are no filling defects in the pulmonary arterial vasculature. no pulmonary embolism is identified. some calcifications are seen in the coronary arteries, the aortic arch and descending aorta. otherwise, the heart and great vessels are unremarkable. there is mild bilateral pleural effusion. there is no axillary lymphadenopathy. there is a precarinal 16 x 17-mm lymph node. interval increase in size in the spiculated mass located in the right upper lobe measuring now 34 x 24 mm concerning for lung cancer. new extensive patchy areas of ground-glass opacities are seen throughout the lungs, mostly compromising the upper lobes . limited images of the upper abdomen did not demonstrate significant abnormalities. bone windows: there are no concerning bone lesions. ct reconstructions: confirmed the findings in the axial images. impression: 1. no evidence of pulmonary embolism. 2. diffuse ground-glass opacities through the lung parenchyma, concerning for pcp or pulmonary interstitial lymphoma with underlying probable lung cancer in the right upper lobe. 3. bilateral pleural effusion. brief hospital course: this is a 69 year old woman with hiv on haart (last cd4 940), chf (ef 50%) copd, eosinophilic pneumonia, prior dvt and pe on coumadin, and esrd on hd who presented to this hospital on for 2 dyspnea and was found on arrival to be in acute respiratory distress. she was intubated immediately and placed on cmv ventilation. of note the patient also became hypotensive soon after a propofol drip was started for sedation. propofol was then discontinued, and levophed was added, resulting in increased bp to 118/55. the initial chest x-ray was concerning for pna as diffuse interstitial infiltrates were visualized. the pt was admittted to the micu and was treated empirically with broad spectrum antibiotics along with hydrocortisone for possible copd exacerbation. in the micu the pt was weaned off pressors fairly quickly, extubated by hospital day 2, and was subsequently transferred to the floor. it was believed that her respiratory distresss had a large component secondary to fluid overload which was treated by hemodialysis. she underwent several rounds of ultrafiltration in addition to her regular hemodialysis which resulted in improvement of her volume status as evidenced by her improvement in respiratory status, her physical exam, and by resolution of pulmonary edema on chest x-ray. her course on the medical was complicated only by one episode of chest pain that was not associated with ekg changes and for which she ruled out for mi by cardiac enzymes. as her admission inr was subtherapeutic, she was maintained on a heparin drip along with coumadin for her history of dvt and pe until therapeutic inr was reachieved. her hospital course on the was otherwise unremarkable. she was discharged breathing normally on room air and with instructions to finish her empiric course of antibiotics. of note, review of her chest ct scan with the pulmonary service revealed that a previously noted mass in the right upper lobe had increased in size in comparison to a chest ct performed 3 months ago. this raised concern that this mass may be malignant. she was to follow up with the pulmonary service regarding this finding. in summary, this is a 69 year old hiv positive woman on haart with chf, copd, esrd on hd, and history of dvt and pe on coumadin who was admitted in respiratory failure, intubated briefly and treated empirically for pneumonia with broad spectrum antibiotics, for copd exacerbation with steroids, and with hemodialysis for evidence of chf exacerbation. her respiratory status satisfactorily improved with these treatments and it was felt that her presentation was largely secondary to volume overload from chf exacerbation. issues and plan arising from this hospitalization. 1. pneumonia/resp failure: hypoxic respiratory failure now seems to have been from pulmonary edema from chf exacerbation. contriubtion from pneumonia/reactive airway disease and eosinophilic pna also possible. status post extubation , doing well. - breathing improved well with serial ultrafiltration sessions along with dialysis. pt to continue regular dialysis sessions as outpatient. - question pna; although no source was identified, pan cultures were unrevealing, pt received empiric 10 day course of levofloxacin, flagyl, and vancomycin (start ) - afb smear negative, pcp negative serum cmv igg positive, igm negative suggesting no recent exposure. . 3. copd: has required intubation in past for copd. initially received high dose steroids which were tapered down to her home dose - continue atrovent/albuterol nebulizers. - on prednisone taper to 10 tomorrow. . 4. hypotension: had brief pressor requirement, prior hypotensive episode likely secondary to propofal along with sepsis. now blood pressure nl without pressor requirement. -initially held metoprolol, lisinopril 2.5 q day and isordil 10 . restarted these by discharge. . 5. cad/ episode. pt with known cad s/p p nstemi , s/p ptca/stent lcx . latest catheterization in with 2-vessel disease. cp now resolved, no ekg changes or new elevation in ce, pt was ruled out for mi. -continue asa 325 -restarted metoprolol and titrated up until rate control was optimized -continue imdur and lisinopril as outpatient. . 6. esrd on hd (m,w,f), her chf exacerbation and fluid status were largely managed by hemodialysis and additional ultrafiltration sessions. -pt to continue regular hd schedule as outpatient. . 6. hiv: cdr count 253; previous cd4 count 900s 3 months ago on haart. unclear compliance with meds but pt says she has been taking them. - hiv viral load undetectable - cont zidovudine, nevirapine, lamivudine . 7. eosinophilic pna: ct findings suggestive of infection but different from previous studies. - continued home dose ofsteroids prednisone to taper. . 8. h/o dvt, possible oncompliance given inr was 1 on admission. no pe on cta. - pt was successfully bridged with heparin and discharged on coumadin with therapeutic inr . 9. dm2: controlled with sliding scale with nph while in hospital. . 10. fen: - , heart healthy, renal diet - lytes repleted cautiously given renal status. 11. prophylaxis included heparin/coumadin, protonix . 12. access: r subclavian ij placed , discontinued by discharge. . 13. contact: (daughter) is hcp (h), (w) . code status remains full. medications on admission: bactrim 80-400 mg q m/w/fri prednisone 20 mg qd (to be tapered slowly) b complex-vitamin c-folic acid 1 mg qd zidovudine 200 nevirapine 200 lamivudine 100 qd docusate sodium 100 mg pantoprazole 40 q 24 albuterol q 4 prn albuterol-ipratropium q6 hydromorphone 4 mg q3-4h prn calcium carbonate 500 tid oxycontin 10 mg q12 hr senna 8.6 prn epogen inj coumadin 2.5 qhs paricalcitol 5 mcg/ml solution : as decided at dialysis intravenous 3x/week (mo,we,fr). nph 20 units qam, with regular sliding scale twice a day asa 325 q day metoprolol 25 lisinopril 2.5 q day isordil 10 discharge medications: 1. prednisone 10 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. zidovudine 100 mg capsule : two (2) capsule po bid (2 times a day). disp:*120 capsule(s)* refills:*2* 3. nevirapine 200 mg tablet : one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 4. aspirin 325 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). disp:*30 tablet,rapid dissolve, dr(s)* refills:*2* 6. lamivudine 100 mg tablet : 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. vancomycin in dextrose 1 g/200 ml piggyback : one (1) gram intravenous x1 (one time) for 1 doses: please give one more vancomycin treatment during next dialysis session. disp:*1 gram* refills:*0* 8. nitroglycerin 0.3 mg tablet, sublingual : one (1) tablet, sublingual sublingual q5min x 3 () as needed for prn pain: take 1 pill for chest pain, if no relief after 5 min take another, if still no relief after 5 min take one more; seek medical attention. disp:*30 tablet, sublingual(s)* refills:*0* 9. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 10. warfarin 2.5 mg tablet : three (3) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 11. albuterol-ipratropium 103-18 mcg/actuation aerosol : puffs inhalation q6h (every 6 hours) as needed. disp:*1 solution* refills:*1* 12. metoprolol succinate 50 mg tablet sustained release 24hr : 1.5 tablet sustained release 24hrs po daily (daily). disp:*30 tablet sustained release 24hr(s)* refills:*2* 13. loperamide 2 mg capsule : one (1) capsule po qid (4 times a day) as needed for diarrhea. disp:*120 capsule(s)* refills:*1* 14. ipratropium bromide 0.02 % solution : one (1) inhalattion inhalation q4h (every 4 hours) as needed. disp:*30 inhalattion* refills:*0* 15. trimethoprim-sulfamethoxazole 80-400 mg tablet : one (1) tablet po qhd (each hemodialysis). disp:*30 tablet(s)* refills:*2* 16. metronidazole 500 mg tablet : one (1) tablet po twice a day for 3 days: total course is 10 days, day 1 is . disp:*6 tablet(s)* refills:*0* 17. levofloxacin 250 mg tablet : one (1) tablet po every other day for 3 days: a total course of 10 days, day 1 is . disp:*2 tablet(s)* refills:*0* 18. calcium acetate 667 mg tablet : three (3) tablet po tid w/meals (3 times a day with meals). disp:*60 tablet(s)* refills:*2* 19. calcium carbonate 500 mg tablet, chewable : two (2) tablet, chewable po qid (4 times a day) as needed. 20. acetaminophen 325 mg tablet : one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 21. albuterol sulfate 0.083 % solution : one (1) inhalation inhalation q6h (every 6 hours) as needed. disp:*1 solution* refills:*1* discharge disposition: home with service facility: uphams corner home care discharge diagnosis: hypoxic respiratory failure. congestive heart failure exacerbation. possible pneumonia non cardiac chest pain. fluid overload r middle lobe mass in lung of unknown etiology discharge condition: good, breathing normally on room air. chest pain free. able to tolerate solid food. appropriately anticoagulated. discharge instructions: please return to hospital if you start to experience chest pain or if you feel you it is gettting difficult to breathe. please continue to attend all of your hemodialysis regimen. please continue all medications prescribed in hospital, please note you are taking 7.5 mg of coumadin at night. please note you are now taking 10 mg of prednisone every day. please note you will be taking levoquine and flagyl until . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: please follow up with dr. at the clinic on at 11:15 am. (phone number is ). please follow up with dr. and dr. on , at 4:30 pm their number is . you will receive provider: , md phone: date/time: 1:15 provider: & dr phone: date/time: 4:30 provider: , m.d. phone: date/time: 1:15 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis closed [endoscopic] biopsy of bronchus transfusion of packed cells diagnoses: acidosis anemia in chronic kidney disease end stage renal disease coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified percutaneous transluminal coronary angioplasty status acute respiratory failure malignant neoplasm of upper lobe, bronchus or lung long-term (current) use of insulin old myocardial infarction long-term (current) use of anticoagulants pulmonary eosinophilia diseases of tricuspid valve asymptomatic human immunodeficiency virus [hiv] infection status 

Answer: The patient is high likely exposed to