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: penicillins attending: chief complaint: respiratory failure major surgical or invasive procedure: intubation bronchoscopy history of present illness: this is a 42 year old with a pmh significant for hiv diagnosed in with last cd4 count of 312 and vl of 88,000 on , asthma, who presents with shortness of breath, non-productive cough for the last 4 days. history is limited as patient is intubated upon arriving to the micu. per history obtained by ed physicians, patient has had dyspnea for the last 4 days. has complained of intermittent fevers and chills. was evaluated by dr. at today and referred to ed due to rr 28 and po2 of 88%. he was seen in the ed 3 days prior for similar symptoms and discharged home due to clear chest radiograph; symptoms have worsened since that time. patient was started on advair one month prior and has been recently initiated on atripla antiretroviral therapy. in the ed, initial vital signs were: t: 98.2, bp: 112/88, hr: 91, o2sat: 89%ra. oxygen found to desaturate to the high 80s despite 4l nc. chest radiograph demonstrated right sided diffuse patchy infiltrate concerning for multifocal pneumonia. id service was curbsided in ed, and patient was started on abx for cap and possible pcp. on ceftriaxone 1g iv x 1, azithromycin 500mg po x 1, bactrim ds 2 tabs po x 1, prednisone 40mg po x 1. nebs were given. patient with worsening tachypnea and was electively intubated in the ed. no abg was collected prior to intubation. of note, was recently discharged from prison 1 month prior. past medical history: 1. hiv, patient unsure of current cd4 count. per omr, last cd4 count was 511 on 2. asthma 3. gerd psychiatric history: * panic disorder with agoraphobia * patient cannot remember exat diagnosis, but reports suffering from anxiety and 'inability to leave his house'. these hav been present for the past 6-7 years. * 10 inpatient psychiatric hospitalizations, last one 8 months ago at . reports being hospitalized at , , and . * past med trials: imipramine, klonopin, paxil, zoloft, proza, ativan. * admits to five suicide attempts, all by overdose, some requiring charcoal administration. * denies history of violence * current psychiatrist is dr. at (). social history: substance abuse history: (as per prior omr note). * discharged from prison one month prior (?cocaine possession) * smokes 1.5 ppd of cigarettes * cocaine: used $100 worth in the past, was previously sober for 8 months. first use when teen. * etoh: drank 6 beers, was previously sober for 8 months. denies history of alcohol withdrawal sz, dt's. * denies past or current use of any other illicit substance. denies history of ivdu. social history: (as per prior omr note). patient reports being born in , ma. he is adopted. his adoptive family lives in . graduated high school, worked as a waiter. received ssdi for anxiety and agoraphobia. currently lives in with his partner and two friends. denies current legal history, but admits to prior problems with the law (refuses to disclose information). family history: unknown, as patient is adopted. physical exam: vs: temp: 101.1, bp: 156/88 hr: 118 -> 72 rr: 30 o2sat: 93% on ac gen: intubated heent: perrl, eomi, anicteric resp: rales from the right lateral chest (auscultated from anterior chest) cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: scratch marks located on left arm. neuro: perrl, eomi. pertinent results: admission labs: 10:45am glucose-91 urea n-13 creat-0.8 sodium-138 potassium-3.3 chloride-102 total co2-26 anion gap-13 10:45am calcium-8.8 phosphate-4.0 magnesium-2.1 10:45am wbc-6.2 rbc-4.05* hgb-12.1* hct-34.8* mcv-86 mch-30.0 mchc-34.9 rdw-14.1 10:45am neuts-75.4* lymphs-20.1 monos-3.4 eos-0.2 basos-0.9 10:45am plt count-236 10:45am pt-14.7* ptt-30.6 inr(pt)-1.3* 10:59am lactate-1.6 03:25pm lactate-1.0 03:25pm type-art rates-/20 tidal vol-500 o2-100 po2-110* pco2-65* ph-7.23* total co2-29 base xs--1 aado2-561 req o2-90 intubated-intubated vent-controlled wbc lymph abs cd3% abs cd3 cd4% abs cd4 cd8% abs cd8 cd4/cd8 5.2 5* 260 60 155* 21 55* 37 97* 0.6 labs on discharge: 10:45am 137 104 9 -------------< 117 4.4 24 0.6 ca: 8.5 mg: 2.4 p: 4.2 12.4 5.1 >---< 347 35.8 micro: 10:45 am blood culture negative 5:08 pm mrsa screen negative 4:42 pm bronchoalveolar lavage gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. legionella culture (preliminary): no legionella isolated. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): viral culture: r/o cytomegalovirus (preliminary): no cytomegalovirus (cmv) isolated. 4:42 pm rapid respiratory viral screen & culture specimen pooled with #313-8710b . **final report ** respiratory viral culture (final ): refer to respiratory viral antigen screen and respiratory virus identification test results for further information. test cancelled, patient credited. respiratory viral antigen screen (final ): positive for respiratory viral antigens. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory virus identification for further information. respiratory virus identification (final ): reported by phone to dr . 1115am. positive for influenza a viral antigen. viral antigen identified by immunofluorescence. 4:42 pm bronchoalveolar lavage gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. acid fast culture (preliminary): acid fast smear (final ): no acid fast bacilli seen on concentrated smear. viral culture: r/o cytomegalovirus (final ): please refer to culture # for results. test cancelled, patient credited. fungal culture (preliminary): no fungus isolated. potassium hydroxide preparation (final ): test cancelled by laboratory. patient credited. this is a low yield procedure based on our in-house studies. if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). legionella culture (preliminary): no legionella isolated. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. respiratory viral antigen screen (final ): please refer to culture # 313-8703b for result. test cancelled, patient credited. respiratory viral culture (final ): please refer to culture # 313-8703b for result. test cancelled, patient credited. imaging: - ekg: normal sinus rhythm with rate of 88, normal axis, normal intervals. no st changes or t wave changes concerning for ischemia. - chest radiograph (): impression: multifocal pulmonary opacities in the right lung concerning for multifocal pneumonia. - chest (portable ap) study date of 2:58 pm impression: bilateral pulmonary airspace opacities, more pronounced on the right, concerning for pneumonia. followup chest radiograph following treatment is recommended. endotracheal tube in situ as outlined above. - chest (portable ap) study date of 3:57 am moderate right pleural effusion has developed since , accompanying mediastinal vascular engorgement, so this could be a reflection of volume overload, but would need to be evaluated clinically to exclude empyema. the fusion overlies and partially obscures the right lung, but there does seem to be some improvement in the extent of what was severe right lung consolidation. left upper lobe shows mild vascular congestion and heart size is larger today than it has been on this admission. with the chin down, the tip of the endotracheal tube is at the upper margin of the clavicles and can safely be advanced to 0.5 cm. nasogastric tube passes into the stomach and out of view. no pneumothorax. - ecg study date of 2:38:12 pm sinus rhythm. findings are within normal limits. compared to the previous tracing of there is no significant diagnostic change. - chest (portable ap) study date of 3:30 am as compared to the previous radiograph, the nasogastric tube and the chest tube are in unchanged position. improving right lung opacities. unchanged left perihilar opacity. presence of a small right pleural effusion cannot be excluded; on the left, there is no evidence of pleural effusion. brief hospital course: # hypoxic respiratory failure: likely secondary to right sided multifocal pneumonia. initially covered broadly given hiv status with vanc, ctx, azithro and bactrim (for pcp). also received prednisone 40mg for treatment of severe pcp. the day after admission the patient's flu swab came back positive and he was started on tamiflu. he underwent bronchoscopy on , which revealed the presence of influenza a, but did not came back positive for pcp, treatment doses of bactrim and steroids were discontinued. his respiratory status slowly improved with lower fio2 requirements until he was successfully extubated on . he remained stable on 4 liters nasal cannula for the rest of the time he was in the micu. upon transfer to the floor, the patient was continued on ctx, azithromycin, and oseltamivir. he completed a total 7 days course of ctx and azithro, and completed a 5 day course of oseltamivir while in the hospital. upon discharge, he was satting well on room air. we started him on bactrim ds daily for pcp prophylaxis given his cd4 count of 55. # hypotension: felt sepsis from his mf pna and increased insensible losses from diaphoresis/fevers. responsive to ivf boluses with resultant improvement in uop. # hiv: patient was on haart therapy prior to admission however cd4 count here was only 55. bactrim ds daily ppx for pcp was started. he was continued on atripla. # asthma: no wheezing on exam. patient was written for nebs prn. # psych history: initially while intubated difficult to assess but did cont sertraline. held klonopin and seroquel initially in setting of intubation and fentanyl/versed gtt, however these were restarted with hopes of weaning his sedation. upon extubation, the patient made reference to suicidal ideation, and wish to leave the hospital. psychiatry was consulted, who said that the patient did not require 1:1 sitter on transfer to the floor, but that he could not leave ama without repeat psychiatric evaluation. upon arriving to the floor, the patient once again voiced his desire to leave the hospital ama, saying that the hospital had stolen his jacket and shoes, and that he would not stay in a place where things were stolen from him. psychiatry was called to evaluate again, and again said that the patient did not understand his medical illness and did not have capacity to leave. we treated him with iv antibiotics as best we could as he would take po medication intermittently while in-house. his mood improved, and he ultimately ended up being compliant with his medications. # code: full # pending studies - none # pcp issues: - please reassess cd4/vl in a setting where the patient is not acutely ill - consider the need for pcp prophylaxis based on current cd4 count - consider sending toxo serologies given that the patient is approaching the need for oi prophylaxis for mac medications on admission: (per records) - albuerol 2 puffs po qid prn - verapamil cr 240mg po daily - claritin 10mg po daily - klonapin 1mg po 5 times per day - seroquel 100mg po qid; 400mg po qhs - sertraline 200mg po qhs - benadryl 25mg qam and 75mg qhs - advair diskus take 1 puff - omeprazole 40mg po daily - flonase - bentropine 0.5mg po daily - atripla (efavirenz/emtricitab/tenofovir) 1 tab po daily - zofran 8mg po q8h prn - ibuprofen 800mg po qid discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation four times a day as needed for shortness of breath or wheezing. 2. atripla mg tablet sig: one (1) tablet po once a day. 3. quetiapine 100 mg tablet sig: one (1) tablet po qid (4 times a day). 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 5. zofran 8 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. 6. quetiapine 200 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 7. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. clonazepam 1 mg tablet sig: one (1) tablet po five times per day (). 9. sertraline 100 mg tablet sig: two (2) tablet po at bedtime. 10. ibuprofen 800 mg tablet sig: one (1) tablet po four times a day. 11. bentropine sig: 0.5 mg once a day. 12. flonase 50 mcg/actuation spray, suspension sig: one (1) nasal once a day. 13. advair diskus 250-50 mcg/dose disk with device sig: one (1) inhalation once a day. 14. benadryl 25 mg capsule sig: one (1) capsule po qam. 15. verapamil 240 mg cap,24 hr sust release pellets sig: one (1) cap,24 hr sust release pellets po once a day. 16. claritin 10 mg tablet sig: one (1) tablet po once a day. 17. benadryl 25 mg capsule sig: three (3) capsule po at bedtime. discharge disposition: home discharge diagnosis: primary diagnosis: - influenza a - pneumonia secondary diagnosis: - hiv/aids discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you came to the hospital because of cough and trouble breathing. you were found to have a serious infection in your lungs called pneumonia and required mechanical ventilation (a breathing tube) to help you breathe. you were treated with antibiotics and medications for hiv. additionally, you were found to be positive for influenza a meaning you have the flu. you were treated with an anti-flu medication called tamiflu. you required oxygen and were asked to stay in the hospital while we treated you until the point at which you no longer needed oxygen. you had sought to leave against medical advice, and we explained to you the serious consequences of leaving against medical advice, with a life-threatening illness, oxygen requirement and hiv/aids with a very low cd4 count. our psychatrists evaluated you, and thought that you did not have the capacity to make decisions regarding your own health in this circumstance. after two more days, you completed your course of both the antibiotics as well as the flu medicine, and you did not have an oxygen requirement, and so we felt safe discharging you home. when you leave the hospital: 1. start sulfamethoxazole-trimethoprim 800-160 mg tablet: take one (1) tablet po daily (daily) we did not make any other changes to your home medications, so please continue to take them as you normally do. followup instructions: you have an appointment with dr. at health on wedneday at 10:30 am. do 12-bdu procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube arterial catheterization diagnoses: hyperpotassemia esophageal reflux tobacco use disorder asthma, unspecified type, unspecified human immunodeficiency virus [hiv] disease acute respiratory failure major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior other alteration of consciousness influenza with pneumonia agoraphobia with panic disorder 

Answer: The patient is high likely exposed to