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: chief complaint: shortness of breath major surgical or invasive procedure: none. history of present illness: 42f w/ hiv (off and on haart, currently off, last cd4 53 and vl 129,000 copies/ml on ) also with esrd on hd, and presenting with 3-4 days of gradual onset shortness of breath. pt reports that middle of this past week she started getting sob with exertion. denies cough, fevers, chills, night sweats, weight changes, chest pain, le swelling, wheezing over that time. she gets dialysis monday wednesday friday and then was scheduled for an extra session today (sat) due to the doe and hope that taking off extra vlume would help. her symptoms here were worse afterwards and she complained of lightheadedness, dizziness, feeling very weak. found to have bp of 80/50 and brought to the ed. no chest pain at any point or pain in neck arm back or jaw. no lower extremity pain or swelling. she does not make urine in the ed, initial vs were: 98.5 69 82/40 20 100%. briefly on peripheral pressors and given small fluid bolus. pressors quickly titrated off. attempt made to palce ij but unable to thread wire and pt reporting history of central venous clots. trop found to be above baseline (0.15-0.25) at 0.43 so cardiology was consulted. in setting of no cardiac symptoms and unchanged ekg, they recommended getting ck and ckmb with no further workup if not elevated as likely mild stress trop leak in setting of lowish bps. ck/ckmb were flat. r groin line is dialysis access and this was accessed in the ed. got cta before went to floor which showed no pe and no evidence of lung paranchyma abnormalities. on arrival to the micu, bp stable in 90s systolic. pt reports baseline bp around 100 systolic. comfortable, no increased rr or wob. no longer lightheaded/dizzy. complains of baseline chronic headache. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies rhinorrhea or congestion. denies cough, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: 1. hiv. diagnosed (heterosexual intercourse with hiv positive partner). hx pcp x3 (last >10y ago). last past medical history: 1. hiv. diagnosed (heterosexual intercourse with hiv positive partner). hx pcp x3 (last >10y ago). last cd4 59. noncompliant w/haart many times in past. never restarted in . 2. varicella zoster right scalp and v1 distribution complicated by loss of vision r eye + postherpetic neuralgia (on neurontin in the past without relief). takes percocet with good relief. 3. hiv associated esrd on hd since . l hd line now; s/p 3 failed fistulas (both arms, r leg). 4. cervical dysplasia. 5. fibroids s/p ablation. 6. post-hd presyncope and hypotension (diltiazem stopped). 7. coag-negative staph bacteremia/hd line infection . 8. secondary hyperparathyroidism social history: she lives at home with her 17-year-old daughter; sister also lives in . originally from . unemployed, on welfare. she denies alcohol, illicits or tobacco. family history: sister- dm, other sister - in 50s physical exam: admission exam: general: alert, oriented, no acute distress, blunted affect heent: sclera anicteric, mmm, oropharynx clear, perrl neck: supple cv: rrr, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: no focal deficits, moving all ext, intact sensation, has no sight in r eye (baseline) discharge exam: exam unchanged from admission pertinent results: admission labs: 09:00am blood wbc-3.1* rbc-3.61* hgb-11.8* hct-36.7 mcv-102* mch-32.8* mchc-32.3 rdw-14.4 plt ct-127* 09:00am blood neuts-58.5 lymphs-21.9 monos-5.7 eos-13.3* baso-0.6 09:00am blood alt-18 ast-30 ld(ldh)-297* alkphos-104 totbili-0.2 11:40am blood lipase-104* 11:40am blood ck-mb-4 ctropnt-0.43* 11:40am blood albumin-4.4 calcium-10.0 phos-5.4*# mg-2.1 - chest (portable ap) -- impression: no acute intrathoracic process - ct cta chest w&w/o c&recons, non-coronary: impression: 1. no evidence for pulmonary embolism. 2. stenosis of the left subclavian vein and bilateral brachiocephalic veins with patency of the svc resulting in multiple thoracic collateral vessels. . ekg: bigeminal pacs, normal intervals, qtc 420, no st ischemic changes, sr studies: echo: the left atrium and right atrium are normal in cavity size. an atrial septal defect or patent foramen ovale is present with premature appearance of prominent contrast in the left heart after intravenous injection of agitated saline. color flow doppler does not identify a discrete defect. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels 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. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is high normal. there is no pericardial effusion. impression: atrial septal defect. mild mitral regurgitation with normal valve morphology. normal biventricular cavity sizes with preserved global and regional biventricular systolic function. if clinically indicated, a tee would be better able to assess the interatrial septum to identify the site of the intracardiac shunt. discharge labs: 07:30am blood wbc-2.2* rbc-3.27* hgb-10.6* hct-33.9* mcv-104* mch-32.5* mchc-31.4 rdw-15.1 plt ct-108* 07:30am blood glucose-59* urean-51* creat-6.2*# na-139 k-5.1 cl-100 hco3-27 angap-17 10:57am blood alt-16 ast-24 ld(ldh)-225 ck(cpk)-127 alkphos-87 totbili-0.1 07:30am blood calcium-7.9* phos-4.4# mg-2.2 10:57am blood pep-polyclonal b2micro-72.4* igg-* igm-710* brief hospital course: 42f w/ hiv (off and on haart, currently off, last cd4 53 and vl 129,000 copies/ml on ) also with esrd on hd, and presenting w/ 3-4 days of gradual onset sob of unclear etiology and hypotension that seems to be fluid taken off by extra hd session. # hypotension: it was likely that the patient's hypotension occurred in the setting of taking off too much volume at hd. the patient was in the low 80s on arrival to ed, initially admitted to the micu and was briefly on pressors with lactate initially of 4.2. she improved quickly with a small fluid bolus and soon titrated off pressors. the patient received one dose of vanc/zosyn in the ed out of concern for infectious etiology, but infectious work up in the micu was all negative. on transfer from the micu to the , the patient continued to remain normotensive. she was continued on her home dialysis schedule. # shortness of breath: the etiology of the patient's shortness of breath is unclear. she was ruled out for pe with cta, and there were no signs or symptoms of heart failure. the patient had elevated ldh in the setting of low cd4 count; however, she reports taking her bactrim ppx and was never hypoxic, making pcp very unlikely. an echo was done to evaluate for any underlying pulmonary hypertension which was remarkable for asd and mild mr. possible that the patient's shortness of breath was in the setting of being volume overloaded and did resolve after her initial hd session, but then led to resultant hypotension after taking off too much fluid. upon discharge, the patient was not having any shortness of breath. # elevated ldh: the patient was noted to have elevated ldh and in the setting of having a borderline calcium, elevated eosinophils, and relatively new thrombocytopenia, the work up for lymphoma/malignancy was started while the patient was in the intensive care unit. an u/s was done showing a borderline increased spleen compared to a study from . the patient was also found to have elevated b2 microglobulin, igg and igm, and pep was c/w polyclonal hypergammaglobulinemia. # thrombocytopenia: the patient has new thrombocytopenia since /. her platelets were trended during this admission. uncler , but could be secondary to bone marrow suppression in the setting of her active hiv disease. # esrd on hd: the patient was continued on her home hd schedule while in patinet. she was continued on her home cinacalcet and sevelamer, which was increased at discharge. # hiv: the patient is not taking her haart medications, with last cd4 of 53 and vl 129,000 copies/ml on . the patient was not started on haart while in patient, as she has not been taking the medications at home. she was continued on her bactrim and azithro ppx, which she reports taking at home. the patient has follow up with her id doctor, dr. . transitional issues: - the patient was found to have elevated b2 microglobulin, igg and igm, and pep was c/w polyclonal hypergammaglobulinemia. this will need to be followed up as an oupatient. - the patient had echo which was notable for asd and mild mr. - the patient is currently not taking her haart. medications on admission: cinacalcet 60 mg daily hydroxyzine 25 mg tid prn percocet 5mg-325mg qid sevelamer 3200 qmeal, 1600 qsnack vitamin d 50,000 units qweek bactrim 800-160 3x/week discharge medications: 1. azithromycin 600 mg tablet sig: two (2) tablet po 1x/week (). 2. cinacalcet 30 mg tablet sig: two (2) tablet po daily (daily). 3. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po three times a day as needed for itching. disp:*10 tablet(s)* refills:*0* 4. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 5. sevelamer carbonate 800 mg tablet sig: five (5) tablet po tid w/meals (3 times a day with meals). disp:*150 tablet(s)* refills:*0* 6. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po qhd (each hemodialysis). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 9. folic acid 1 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: primary diagnosis: shortness of breath hypotension secondary diagnosis: human immunodeficiency virus end stage renal disease on hemodialysis 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 while you were hospitalized at . you were admitted to the hospital because you were having shortness of breath, then later developed low blood pressures during dialysis. you were initially admitted to the intensive care unit where your blood pressures were stabilized. on transfer out of the icu, your shortness of breath had also resolved. you had blood tests and an ultrasound to look for complications of your hiv including lymphoma, which were generally unrevealing; you had elevated levels of immunoglobulins in your blood, which is a non-specific finding. we changed the following medications: please increase sevelamer to 4000 mg three times daily, with meals please follow up with dr. . see below for appointment details. followup instructions: department: when: wednesday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: obstetrics and gynecology when: wednesday at 2:30 pm with: clinic building: campus: east best parking: garage procedure: hemodialysis diagnoses: thrombocytopenia, unspecified end stage renal disease human immunodeficiency virus [hiv] disease kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypotension of hemodialysis herpes zoster with other nervous system complications polyclonal hypergammaglobulinemia other fluid overload 

Answer: The patient is high likely exposed to