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: seizure, altered mental status . reason for micu transfer: massive pe, intubated on pressors major surgical or invasive procedure: acls for pulselessness history of present illness: 63 year old female with h/o hiv on haart (cd4 1049) and recent l5-s1 fusion 3 weeks ago who presents with hypotension and seizures. . she was admitted to for l5-s1 fusion that was uncomplicated. she was not discharged on dvt prophylaxis given the surgery. she was at rehab until about 1 week ago. this morning, she complained of palpitations as well as leg pain which was new. then her physical therapist noted a low bp (unclear ) and felt that she may be dehydrated. she also complained of chest pain. later, her vna noted low bp as well. her daughter then witnessed a tonic-clonic seizure where the patient fell back on the bed and her eyes rolled back in her head and her extremities were shaking. she has never had seizures prior. ems was called. bp on arrival by ems was 60/palp which improved to 74/palp after 500cc ivf. in the ed, she was hypotensive and initially given aspirin and morphine. cta showed massive saddle pe. she was hypotensive with sbp in the 30's and was intubated and started on peripheral levophed. also given 6l fluid. tpa was then initiated at 21:39 (100mg iv over 20 minutes). sedated with versed and fentanyl. phenylephrine was started when she maxed out on levophed. sbp decreased to the 50's and she lost a pulse and chest compressions were started, 1mg epi given, pulse returned after 1 minute. cardiology was consulted but declined to take her to the cath lab. her bp's began to improve and sbp was 170's and pressors were weaned. currently sbp in the 90's on neosynephrine only, hr 90's (previously 140-150). thoracic surgery also aware and discussing patient's case. she then received 5000unit heparin bolus plus started on heparin drip at 1000 units/hr. past medical history: recent l4-s1 fusion , planned decompression hiv hepatitis b, suppressed on combivir hepatitis c, never treated, genotype 1 with stage 2 fibrosis htn obesity arthritis benign colon polyps bilateral tubal ligation orif wrist knee arthroscopy h/o tkr social history: daughter is hcp and she has been staying with her. recently discharged from rehab after spine surgery. former smoker. family history: non-contributory physical exam: admission physical exam: vitals: 96.0 92/44 100 24 100% ps 12/5 fio2 100% general: intubated and partially sedated, moving all four extremities and opens eyes to voice and to tactile stimulation heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp difficult to appreciate, no lad cv: regular rate and rhythm with ii/vi systolic murmur heard best at apex and llsb, no longer audible after blood pressure decreased lungs: clear to auscultation bilaterally with ventilated breath sounds abdomen: soft, recent well-healed surgical scar, non-tender, non-distended, bowel sounds hypoactive gu: foley in place ext: warm, well perfused, 2+ dp pulses, no clubbing, cyanosis or edema . discharge physical exam: vitals: t 98.8 hr 64 bp 140/70 rr 20 o2 sat 96% on ra general: patient sitting up in bed in no acute distress. heent: eomi. perrl. sclera anicteric, mmm, oropharynx clear neck: supple, jvp 6cm above the sternal notch, no lad cv: regular rate and rhythm with ii/vi systolic murmur heard best at apex and llsb. prominent s2 on exam. lungs: clear to auscultation bilaterally. no crackles or wheezes on exam. abdomen: obese. soft, recent well-healed surgical scar, non-tender, non-distended, bs+. gu: no foley msk: back incision well-healed without drainage, tenderness, or erythema. ext: warm, well perfused, 2+ dp pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 08:30pm plt count-390# 08:30pm neuts-52.2 lymphs-41.9 monos-4.0 eos-1.6 basos-0.2 08:30pm wbc-9.5 rbc-2.82* hgb-10.3* hct-29.2* mcv-104*# mch-36.5* mchc-35.2* rdw-18.4* 08:30pm calcium-8.6 phosphate-4.1# magnesium-2.0 08:30pm ctropnt-0.20* 08:30pm estgfr-using this 08:30pm glucose-268* urea n-9 creat-0.8 sodium-136 potassium-3.7 chloride-103 total co2-11* anion gap-26* . discharge labs: . 05:10am blood wbc-5.6 rbc-2.46* hgb-8.7* hct-25.1* mcv-102* mch-35.3* mchc-34.6 rdw-20.0* plt ct-317 05:10am blood pt-20.7* ptt-97.2* inr(pt)-1.9* 05:10am blood glucose-92 urean-7 creat-0.5 na-139 k-3.5 cl-107 hco3-25 angap-11 05:10am blood calcium-8.6 phos-3.1 mg-1.8 . microbiology: . blood and urine cultures pending. . imaging: cta: findings: there is adequate opacification of the pulmonary arterial tree. the main pulmonary artery is enlarged, measuring up to 3.0 cm, and there are extensive pulmonary emboli, including a large saddle embolus and additional emboli extending into both the right and left main pulmonary arteries and peripheral pulmonary arterial tree. there is no associated pulmonary infarct. however, there is evidence of right heart strain, including dilation of the right atrium and right ventricle, leftwardbowing of the interventricular septum, and reflux of contrast into the ivc and hepatic veins. the aorta is normal. there is no evidence of acute aortic syndrome. there is no mediastinal or hilar lymphadenopathy. there is no pericardial effusion or pleural effusion. there is atelectasis medially at the right lung base. there is no evidence of pneumonia. there is no pulmonary nodule or mass identified. in the included upper abdomen, there is a single hypodensity within the left lobe of the liver, too small to characterize, though likely a cyst. there is no acute intra-abdominal process identified. bone windows: there are no lytic or sclerotic osseous lesions identified concerning for malignancy. impression: 1. massive saddle pulmonary emboli, extending into both the right and left main pulmonary arteries and all aspects of the pulmonary arterial tree. 2. evidence of right heart strain, including dilation of the right atrium and right ventricle and bowing of the interventricular septum. prominent main pa suggest associated pulmonary hypertension. 3. minor right basilar atelectasis. no evidence of pulmonary infarct. . echo: the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: dilated right ventricle with severe systolic dysfunction. severe functional tricuspid regurgitation. at least moderate pulmonary hypertension. small, hypertrophied left ventricle with preserved global and regional systolic function. . cxr: findings: right lower lung atelectasis and minimal right pleural effusion are no different from prior radiograph dated . mild vascular engorgement is similar to the prior radiograph. moderate cardiomegaly is stable. mediastinal and hilar contours are unchanged. no new lung opacities of concern. left picc line terminates at upper svc. impression: since , the right minimal pleural effusion and lower lung atelectasis are unchanged. brief hospital course: *anticipated stay at rehab facility is less than 30 days.* . 63 year old female with h/o hiv on haart (cd4 1049) and recent l5-s1 fusion 3 weeks prior to admission who presented with hypotension and experienced cardiac arrest while in the ed, found to have massive pe. . # massive pe with hypotension/shock: pe occurred in post-op setting. received tpa in the ed with some improvement in hemodynamics but then became pulseless. she was coded in the ed with return of pulse. she was initially on pressors but was then able to be weaned off in the micu. also had some demand ischemia with elevated cardiac enzymes that trended down afterwards. tte showed global rv dilation/disfunction and severe tr w/ preserved lvef. she was initially treated with iv heparin and was starting to be bridged to warfarin therapy. prior to discharge, the heparin drip was discontinued, and the patient was started on lovenox 100mg subcuntaneously every 12 hours daily. the lovenox was discontinued when her inr was therapeutic. she was discharged on warfarin 3mg orally daily. her inr on day of discharge was 2.4. she will need to be set up with coumadin clinic as an outpatient for inr monitoring. . # hypoxia/tachypnea: patient successfully extubated and upon arrival to the medicine floor was tachypnic breathing in the high 20s, low 30s with 3 liters of supplemental oxygen. she remained stable, and on day of discharge, the oxygen was weaned with a respiratory rate in the 20s. . #altered mental status: there was concern during the admission on the medicine floor that the patient had acutely developed altered mental status. her neurological exam was non-focal and consistent with her exam on presentation to the medicine floor. despite being afebrile without a leukocytosis, an infectios work-up was repeated. so far, this work-up has returned negative. . # anemia: hct had trended down from 29 on admission to 25 at present. an active type and screen was maintained through the entire admission. she required no trasnfusions. she remains hemodynamically stable, with no evidence of active bleeding at present. she did have some mild oozing from ogt while in icu, and she was started on ranitidine out of concern for gi bleed. propton pump inhibitor was contraindicated given the iteraction with nelfinavir (part of harrt regimen). . # transaminitis: during the admission, ast as high as and alt in 700s. while the patient does have h/o hbv and hcv, acute rise was likely secondary to shock liver versus hepatic congestion in setting of severe rv failure. his lfts were trended through the admission and steadily fell during the admission. . # elevated troponin: trop peaked at 1.11 and has since trended down. elevation was in setting of massive pe, shock, right heart strain and delivery of chest compressions. tte showed dilated rv with severe systolic dysfunction. mb remained flat. . #idioventricular rhythm: the patient was monitored on telemetry through her admission. she remained mostly in sinus rhythm during her hospitalization, but she was noted to have times of broad qrs complexes without preceding p waves. these telemetry findings were confirmed on ekg. cardiac enzymes were cycled and were flat. cardiology was consulted and felt her rhythm was from an irritable focus secondary to her ventricular remodeling in the presence of her massive pulmonary embolism. cardiology recommended that the patient's metoprolol be stopped. her metoprolol was discontinued. . # complicated urinary tract infection: patient with fever of 100.4 on day prior to admission to the medicine floor. through her admission on the medicine floor, the patient remained afebrile. fever may be secondary to pe, liver dysfunction. no clear source of infection, as no consolidation on recent cxr; blood cultures remain negative to date. no leukocytosis. on day of discharge, the patient's urine culture returned showing enterococcus in the urine susceptible to ampicillin, macrobid, and vancomycin. she was started on macrobid. unable to give ampicillin secondary to the patient's penicillin allergy. she will be continued on macrobid for a total of 14 days, stop date . the patient will need to have a repeat urine analysis on to determine if the patient is still infected. if her urine analysis returns suggestive of urinary tract infection, send a urine culture and consider starting the patient on vancomycin. if her urine analysis is sterile, complete the full 14-day course of antibiotics. . # recent l4-s1 spinal surgery: no acute surgical issues at present. ortho was followed the patient and recommended that her hematocrit be monitored given her recent surgery and tpa administration. . # seizure: patient reportedly had tonic-clonic seizure at home prior to arrival. have been secondary to hypoxia veresus acidosis from massive pe and shock. no evidence of seizure activity this admission, and no prior history of seizure. infectious work-up negative to date, with negative urine culture, no pna on cxr, and blood cultures negative to date. . # constipation: aggressive bowel regimen with colace, senna, miralax and bisacodyl. . # pain control: patient had pleuritic chest pain secondary to chest compressions done during acls in the emergency department. when patient complained of worsening chest pain, ekgs were done that did not show significant differences from prior ekgs. cardiac enzymes were flat on the day of discharge. her pain was controlled with tramadol 50mg 1-2 tablets every 6 hours as needed for pain. . chronic issues: . # hiv: last cd4 1049 in . her home harrt was continued through this admission. no changes were made. . # hepatitis b: home arv was continued through the admission. no changes were made. . # htn: sbp elevated in 140s-150s. home anti-hypertensives were held initially given the patient's pressor requirement. upon presentation to the floor, the patient's home blood pressure medications were restarted. her pressures remained elevated and thus her home lisinopril was increased to 10mg daily. her home metoprolol was discontinued in the setting of idioventricular rhythm. . #hcv: patient not currently undergoing active treatment for hcv. . transitional issues: . -outpatient inr follow-up to ensure that the patient is therapeutic on warfarin. inr needs to be between 2 and 3. duration of anticoagulation therapy will last at least 6 months. patient will need to have regular inr checks and warfarin titrated to maintain therapeutic inr. . -patient will need outpatient follow-up with her infectious disease doctor in regards to management of her hiv, hbv, and hcv. . -follow-up of pending blood cultures . -patient will need to be on 100mg nitrofurantoin orally twice daily for 14 days for urinary tract infection. . -the patient will need to have a repeat urine analysis on to determine if the patient is still infected. if her urine analysis returns suggestive of urinary tract infection, send a urine culture and consider starting the patient on vancomycin. if her urine analysis is sterile, complete the full 14-day course of antibiotics. medications on admission: lamivudine-zidovudine 150-300mg po bid nelfinavir 1250mg po bid gabapentin 300mg po qhs trazodone 150mg po qhs omeprazole 20mg po daily prn gerd oxycodone 10mg po q4h prn pain metoprolol tartrate 50mg po bid kcl 20meq po daily lisinopril 2.5mg po daily discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 3. trazodone 50 mg tablet sig: three (3) tablet po hs (at bedtime). 4. nelfinavir 625 mg tablet sig: two (2) tablet po bid (2 times a day). 5. lamivudine-zidovudine 150-300 mg tablet sig: one (1) tablet po bid (2 times a day). 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 7. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush for 10 days. 8. methyl salicylate-menthol ointment sig: one (1) appl topical prn (as needed) as needed for discomfort. 9. outpatient lab work please check inr and cbc , , and . 10. warfarin 3 mg tablet sig: one (1) tablet po once daily at 4 pm. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. potassium chloride 10 meq capsule, extended release sig: one (1) capsule, extended release po once a day. 13. albuterol sulfate 0.63 mg/3 ml solution for nebulization sig: one (1) nebulizer inhalation every six (6) hours as needed for shortness of breath or wheezing. 14. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 15. nitrofurantoin monohyd/m-cryst 100 mg capsule sig: one (1) capsule po q12h (every 12 hours) for 14 days: start date . stop date . 16. mirtazapine 30 mg tablet sig: one (1) tablet po hs (at bedtime). 17. tramadol 50 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: pulmonary embolism secondary diagnosis: hiv hbv hcv hypertension s/p recent l4-s1 spinal surgery complicated urinary tract infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , it was a pleasure taking care of you during your hospitalization at . you were hospitalized because of a massive pulmonary embolism (a large blood clot in your lungs). this blood clot likely came after your surgery, and formed in your legs then traveled to your lungs. you were given medications to thin your blood, and will continue treatment for at least 6 more months. . you have been started on a medication called warfarin (aka coumadin). this medication thins your blood. the effects of this medication are checked with a blood test called the international normalized ratio (aka inr). your inr is a number that reflects the "thinness" of your blood, and the goal inr for your treatment is between . your inr will need to be checked frequently in the beginning of your treatment (3-5 times a week), and will gradually be checked less (3-4 times a month) as your medical team helps adjust your medication to keep your inr between . you should anticipate occassional warfarin dose adjustments (maybe more in the beginning), in order to keep your inr in the 2-3 range. warfarin metabolism is affected by the foods you eat, specifically leafy green vegetables. you can eat the same foods you usually eat, but avoid drastically changing your diet and speak with your physician before changing your diet as your warfarin dose may need to be adjusted. while on warfarin, you are at increased risk of bleeding. if you notice severe bleeding, including rectal bleeds, bleeding from the urethra, or nosebleeds, contact your physician. is important that if you suffer a fall or traumatic injury while taking warfarin that you call your doctor or report to the emergency room for evaluation to make sure you are not bleeding internally. . please take all medications as instructed. please note the following medication changes: *new: -warfarin 3mg orally daily (oral blood thinning medication; note that the dose may have to be changed) -nystatin 100,000 unit/ml suspension sig: five (5) ml orally 4 times a day for thrush for 10 days. -ranitidine 150 mg oral daily (acid suppression medication) -senna 8.6 mg tablets 2x a day as needed for constipation (stimulant laxative) -colace 100 mg capsule 2x a day (stool softener) -methyl salicylate-menthol oitnment apply topically as needed for pain -nitrofurantoin 100mg orally twice daily for 14 days -tramadol 50mg pills every 6 hours as needed for pain. . *changed: -increase your dose of lisinopril from 2.5mg to 10mg by mouth daily. -decreased the dose of your potassium chloride pill to 10meq (1 tab) per day. . *stopped: stopped home percocet. please stop your home metoprolol as well. . please arrange with your rehab facility making a hospital follow-up appointment with your primary care physician 2 weeks of discharge. you will need to be followed the clinic for monitoring of your blood inr while you are on coumadin (also known as warfarin) *anticipated stay at rehab is less than 30 days.* followup instructions: department: liver center when: thursday at 2:20 pm with: , md building: lm bldg () campus: west best parking: garage name: , r. location: community health center address: , , phone: ***please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge*** procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube injection or infusion of thrombolytic agent central venous catheter placement with guidance diagnoses: anemia of other chronic disease urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension chronic hepatitis c without mention of hepatic coma acute and subacute necrosis of liver personal history of tobacco use human immunodeficiency virus [hiv] disease acute respiratory failure other specified cardiac dysrhythmias cardiac arrest other shock without mention of trauma iatrogenic pulmonary embolism and infarction other constipation streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] obesity, unspecified acute systolic heart failure knee joint replacement chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta arthrodesis status mixed acid-base balance disorder personal history of colonic polyps arthropathy, unspecified, site unspecified body mass index 39.0-39.9, adult 

Answer: The patient is high likely exposed to