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: no known allergies / adverse drug reactions attending: chief complaint: fever, abdominal pain, sob major surgical or invasive procedure: hemodialysis history of present illness: the patient is a 43-year-old man with hiv, hep c, cardiomyopathy, hypertension, polysubstance abuse including cocaine in addition to membranous gn (mpgn from hep c) now esrd on hd (t/th/sat, last on saturday), heavy smoker who presented to the ed with abdominal pain, fever, dyspnea. . pt reports he was in his usualy state of health until this morning at 2am when he awoke feeling sob. his bp at that time was "very high." and he had abdominal pain. notes 5 bm yesterday, formed stool with no blood. he reported to the ed. he had missed some of his doses of his blood pressure medications. . in the ed, initial vs were: t 102.9, bp 179/95, hr 110, rr 23, 98% ra. given 1g tylenol, asa 325, 5mg iv morphine, vancomycin 1g, ceftriazone 1g, azithromycin 500mg iv. labs in ed: wbc 10, hct 27, plt 211. inr 1.1, ptt 34. na 142, k 4.5, cl 105, hco3 20, bun 70, cr 7.3, glucose 112. alt 13, ast 19, ap 105, tbilli 0.2, alb 4, lipase 48, ca 8.3, mg 2.2, phos 4. cxr showed rll pna. ct abd performed for abd pain. . the patient was sent directly to dialysis for hd session since he was 4 kilograms above his dry weight. per fellow, he had episode of small hemoptysis, confirmed by rn. however, according to patient, he felt it was from the grape juice he was given earlier in the day. denies any history of hemoptysis. while in hd, patient became suddenly hypertensive up to the 200s/120s and has sudden acute worsening of his dyspnea, rr 40s, hypoxemic satting in 70s on ra. concern for flash pulmonary edema. he continued hd to remove 4-5 l fluid. he was given a nebulizer with no improvement. placed on non-rebreather and satting in 93-95%. he looked uncomfortable, sitting upright, using accessory muscle use to breath. vitals in hd on initial evaluation of patient 226/128, hr 136, rr 40s, satting mid 90s on non-rebreather. while in hd he was given hydralazine 10mg iv (did not improve bp), tylenol 325mg, epo 7600, zemplar 3mcg, topical nitro-paste 1.2 inch, lopressor 5mg iv. then given nitropaste 0.5 inch and bp improved to 160s. vitals prior to transfer to micu: bp 161/102, hr 124. following his dialysis, the patient felt substantially better and was breathing more easily. . in the micu, the patient's vitals were t 98.7 hr 116 bp 179/90 rr 23 98% 3l. he complained of pain in his jaw, neck, hips, and left upper quadrant on exam. the patient did think that he was breathing more freely than the event in hemodialysis. in micu, pt's hypertension was controlled with nitro drip, carvedilol, clonidine, nifedipine, hydral and terazosin. . on transfer to medicine, his vitals are 97.8, 146/86, 102, 21 98% 2l. he reports that he is still having some hemoptysis and he was complaining of continued ruq pain. pt reports that he thinks his pain has been inadequately controlled. he is currently being dialysed. past medical history: 1. hiv - he was diagnosed with hiv in . risk factors included unprotected heterosexual sex as well as intravenous drug use. his nadir cd4 count is 91 and he has no known opportunistic infections. last viral load undetectable, cd4 556 (). 2. hepatitis c. genotype 1b. viral load 187,000 in . 3. cryoglobulinemia 4. cardiomyopathy with an ef of 45-50%. 5. chronic renal insufficiency - mpgn by biopsy in and hypertensive nephrosclerosis 5. gerd. 6. hypertension. 7. gynecomastia; s/p bilateral gynecomastia excision with liposuction . 8. polysubstance abuse, including cocaine and alcohol. 9. anemia, hematocrit 20-24. 10. hypertriglyceridemia - tg 282 in 11. right hydrocele. 12. a subacute infarct in the right caudate head seen on mri in 13. influenza b, . 14. erectile dysfunction. 15. depression 16. inguinal hernia repair in . 17. left ankle orif in . 18. appendectomy in . social history: history of incarceration for 4 yrs. is self-employed, unmarried. he has three children. denies alcohol. reports marijuana use daily, denies tobacco or cocaine. lives with friend . family history: mother and father have hypertension; has 3 brothers, 3 sisters: all healthy, none with htn. there is also a family history of type 2 diabetes mellitus. no family history of sudden death and premature atherosclerotic cardiovascular disease. physical exam: general: alert, oriented, comfortable heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp around 12 cv: s1, s2, no murmurs auscultated lungs: crackles heard at bases abdomen: soft, slightly tender in ruq, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, trace pedal edema. neuro: a+ox3, 5/5 strength in all extremities discharge 98.5 (99.2) 148/87 (120s-190s) 86 18 99%ra fs 112 general: alert, oriented, comfortable heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp 10 cv: s1, s2, systolic murmur over llsb lungs: rhonchorus breath sounds bilaterally abdomen: soft, mildly tender to palpation abdomen, no peritoneal signs gu: no foley ext: warm, well perfused, trace pedal edema neuro: a+ox3, 5/5 strength in all extremities pertinent results: 05:15am blood wbc-10.0 rbc-2.59*# hgb-8.7* hct-27.1* mcv-105*# mch-33.4* mchc-31.9 rdw-13.4 plt ct-211 05:15am blood neuts-89.8* lymphs-5.2* monos-3.6 eos-1.1 baso-0.2 05:15am blood pt-11.4 ptt-34.0 inr(pt)-1.1 05:15am blood glucose-112* urean-70* creat-7.3*# na-142 k-4.5 cl-105 hco3-20* angap-22* 03:52am blood glucose-118* urean-70* creat-6.8* na-136 k-5.0 cl-99 hco3-19* angap-23* 05:15am blood alt-13 ast-19 alkphos-105 totbili-0.2 05:15am blood lipase-48 05:15am blood ctropnt-0.04* 05:15am blood albumin-4.0 calcium-8.3* phos-4.0 mg-2.2 05:24am blood lactate-1.5 cta abd/pelv/chest: impression: impression: 1. no pulmonary embolism or aortic pathology. 2. enlarged main pulmonary artery suggestive of pulmonary arterial hypertension. 3. mediastinal lymphadenopathy. 4. right middle and right lower lobe opacifications concerning for pneumonia on a background of pulmonary edema. 5. small right pleural effusion, periportal and pericholecystic edema as well as hazy mesentery, unchanged compared to and likely due to hiv diagnosis. 6. nonspecific bowel wall thickening in distal ileum likely exaggerated by collapse, though a mild ileitis is a consideration. . echo the left atrium is mildly dilated. the left atrium is elongated. the right atrium is moderately dilated. the estimated right atrial pressure is 5-10 mmhg. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is mildly depressed (lvef= 40-50 %). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). doppler parameters are most consistent with grade ii (moderate) left ventricular diastolic dysfunction. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. no mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is mild pulmonary artery systolic hypertension. cxr there has been interval improvement of pulmonary edema, substantial with only minimal residual kerley b lines demonstrated. right lower lung opacity is still present, consistent with known right middle lobe and right lower lobe infectious process. mild vascular engorgement is still demonstrated. cardiomegaly is moderate to severe, unchanged. no pneumothorax is seen. micro: bcx -: no growth legionella urine is negative discharge 12:45pm blood wbc-6.9 rbc-2.93* hgb-9.2* hct-31.0* mcv-106* mch-31.4 mchc-29.7* rdw-12.7 plt ct-345 12:45pm blood plt smr-normal plt ct-345 12:45pm blood glucose-117* urean-54* creat-6.9* na-140 k-5.3* cl-100 hco3-23 angap-22* 12:45pm blood calcium-8.7 phos-4.5 mg-2.7* 01:30pm blood vanco-12.6 brief hospital course: 43 year old gentleman with hiv (cd4 619 on , hiv-1 rna undetectable ), hcv (viral load 61,900 iu/ml ), mpgn now with esrd on dialysis tues-thurs-sat, history of cryoglobulinemia, who is admitted to hospital for dyspnea and abdominal pain. chest x-ray and ct suggest rll pneumonia. the patient appeared to have an episode of flash pulmonary edema in the setting of hypertensive emergency. # respiratory distress/hcap: (rll/rml) and acute-on-chronic diastolic heart failure. likely flashed in setting of pna and volume overload. in hd in setting of hypertension up to 220/120s. opportunistic infections considered but given recent cd4 count of 422, unlikely. he was started on cefepime, vancomycin, levofloxacin and nebulizers. with this treatment, respiratory status improved to 2l nc requirement. sputum culture, blood cultures, urine culture, c. diff toxin were pending at time of transfer from micu, but all returned negative. pt was dialysed an additional 2 times before discharge and was euvolemic at discharge. he was continued on levaquin and vanco and transitioned to ceftazadime for hd dosing. he was discharged on these medications for his pna until . # abdominal pain: lfts wnl, ct shows ?ileitis? (unchanged from prior) egd in was normal. another possibility considered was hepatic congestion or gut edema in setting of acute on chronic chf. final ct abdomen read was equivocal for ileitis but pt's pain improved over hospital course. pain could have been referred pain from rll pna. he did have constipation that was relieved with aggressive bowel reg. # hypertensive emergency: has history of difficult-to-control hypertension. pts bp 220/120s in hd room in setting of missing his medications. restarted patient's substantial home po regimen, and sbps on discharge improved to 150's-160s. he was discharged on home medication regimen. # hcv/hiv: repeat cd4 count 422, makes opportunistic infection less likelt. continued home regimen of antiretroviral therapies. # ckd, stage v, esrd on hd: received partial hd today, although mainly removed fluid. removed 4l fluid on day of admission. removed an additional 4l over next two days. transitional: home bp monitoring, will need close follow up with pcp or nephrologist for bp control medications on admission: 1. abacavir 300 mg tablet sig: two (2) tablet po daily (daily). 2. carvedilol 25 mg tablet sig: two (2) tablet po twice a day. 3. clonidine 0.2 mg tablet sig: two (2) tablet po tid (3 times a day). 4. efavirenz 600 mg tablet sig: one (1) tablet po daily (daily). 5. emtricitabine 200 mg capsule sig: one (1) capsule po 2x/week (tu,sa): after dialysis, every tuesday and saturday . 6. hydralazine 50 mg tablet sig: two (2) tablet po q8h (every 8 hours). 7. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 8. nifedipine 60 mg tablet extended release sig: one (1) tablet extended release po twice a day. 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 10. prochlorperazine maleate 5 mg tablet sig: one (1) tablet po once a day as needed for nausea: take 30 minutes prior to sustiva/ziagen/epivir 11. terazosin 1 mg capsule sig: three (3) capsule po at bedtime. 12. vitamin c 500 mg tablet sig: one (1) tablet po twice a day. 13. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 14. b complex-vitamin c-folic acid 0.8 mg tablet sig: one (1) tablet po once a day. 15. docusate sodium 100 mg capsule sig: capsules po bid (2 times a day). discharge medications: 1. carvedilol 12.5 mg tablet sig: four (4) tablet po bid (2 times a day). 2. efavirenz 600 mg tablet sig: one (1) tablet po daily (daily). 3. hydralazine 50 mg tablet sig: two (2) tablet po q8h (every 8 hours). 4. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 5. nifedipine 60 mg tablet extended release sig: one (1) tablet extended release po bid (2 times a day). 6. prochlorperazine maleate 10 mg tablet sig: 0.5 tablet po daily (daily) as needed for nausea. 7. terazosin 1 mg capsule sig: three (3) capsule po hs (at bedtime). 8. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 11. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 12. abacavir 300 mg tablet sig: two (2) tablet po daily (daily). 13. emtricitabine 200 mg capsule sig: one (1) capsule po 2x/week (tu,sa). 14. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for pain. 15. trazodone 50 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for insomnia. 16. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 17. clonidine 0.2 mg tablet sig: one (1) tablet po tid (3 times a day). 18. levofloxacin 500 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 6 days: take after dialysis (through ). disp:*3 tablet(s)* refills:*0* 19. ceftazidime 1 gram recon soln sig: one (1) recon soln injection qhd (each hemodialysis) for 6 days: after hd for 6 more days (through ). 20. vancomycin 1,000 mg recon soln sig: one (1) g intravenous per hd protocol for 6 days: continue for six more days (through ). discharge disposition: home discharge diagnosis: healthcare associated pneumonia flash pulmonary edema esrd - requiring emergent dialysis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for hospital acquired pneumonia. your course was complicated by flash pulmonary edema. we treated your pneumonia with iv antibiotics and your pulmonary edema with dialysis and blood pressure control. . we have made the following changes to your home medications: -start levaquin 500mg 1 tab by mouth every 48hrs. take after dialysis. -start ceftazadime and vancomycin to be given iv when you are at dialysis. -continue the remainder of your home medications. . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: please call your pcp to make an appointment within one week of discharge. . also, please resume dialysis at your normal schedule. . below are some additional appointments you have already scheduled department: when: wednesday at 11:00 am with: building: sc clinical ctr campus: east best parking: garage department: advanced vasc. care cnt when: monday at 1 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: cardiac services when: wednesday at 11:30 am with: , np building: sc clinical ctr campus: east best parking: garage procedure: hemodialysis diagnoses: pneumonia, organism unspecified end stage renal disease renal dialysis status anemia, unspecified congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma acute on chronic diastolic heart failure hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease asymptomatic human immunodeficiency virus [hiv] infection status 

Answer: The patient is high likely exposed to