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: doxycycline / ciprofloxacin / linezolid attending: chief complaint: syncope major surgical or invasive procedure: cvl placement history of present illness: 49m w/hx of hiv, cd4=1294 on arvs. patient has a past medical history significant for cardiomyopathy status post vsd repair, amoebic abscess. found at home down on the ground and bathroom for an unknown period of time. per family baseline mental status is crystal clear, alert and oriented. patient has had gradual decline in mental status, history of recent falls. patient says that he has had decreased p.o. intake for nonspecific reasons. he is generally without somatic complaints, no headache or vision change, no neck pain, chest pain or shortness of breath, abdominal pain, no rashes, no change in medications. the only thing i can elicit from the patient is that he is reporting insomnia, for which he has intermittently taken benadryl for the past week. in the ed, initial vs were: hr 64 bp 79/55 rr 14 spo2 92% patient received vanco, unasyn, bactrim, for presumed pneumonia 2l ns given for bp support. blood cultures sent. patient had cxr, ct head negative for acute process. cvl was attempted, patient given 1mg lorazepam before hand. right subclavian obtained first pass, wire threaded to 3 dots, and patient had instances of ectopy. wire was withdrawn back to 2 dots, then back to 1 dot, and ectopy increased 5 beats, then run of pulseless v tach. cpr was initiated, patient recieved 1mg epinephrine, 150mg amiodarone, shocked w/ 200j back to sinus rhythm with bigeminy. downtime <1min. groggy afterwards, but remaines alert and oriented. now w/ r femoral in place. abg; ph 7.33, pco2 59, po2 43, hco3 33 ast: 182 alt: 85 lactate: 2.5 bun 66, creat 2.2 ck: 5026 trop-t: 0.03 transfer vs: hr 53 bp 91/47 rr 15 o2 94% on arrival to the micu, patient states he does not remember exactly the events that brought him into the ed, although he does remember falling today. does not recall events of the code. currently his only complaint is of feeling tired. denies cp, sob, cough, sputum production, palpitations, abdominal pain, or any musculoskeletal pain. past medical history: - hiv on haart - hpv with anal cancer and microinvasion s/p chemo/radiaiton () - amoebic liver abscess - hypothyroidism - hypertriglyceridemia - spinal stenosis - peripheral neuropathy - vsd s/p repair in - pvd - bph - depression - hyperhydrosis - folliculitis - lipodystrophy - hypogonadism - strabismus - s/p cholecystecomy social history: social history: lives with his mother - : history, denies currently - alcohol: drinks per month - illicits: denies ivda family history: father with first in 50s, uterine ca in mother, breast in side, grandfather with colorectal cancer, cousins with diabetes physical exam: admission physical exam vitals: t: 98.4 bp: 98/77 p: 70 r: 18 o2: 99%2lnc general: alert, oriented, no acute distress although speaking very slowly, chronically ill in appearance heent: sclera anicteric, mucous membranes dry, oropharynx clear, eomi although with rightward fast beating nystagmus with right lateral gaze and leftward fast beating nystagmus with right lateral gaze, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, ii/vi systolic murmur lungs: fine bibasilar crackles abdomen: distended, soft, non-tender, bowel sounds present gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, finger-to-nose intact pertinent results: admission labs 08:00pm blood wbc-8.6 rbc-3.11* hgb-11.3* hct-32.1* mcv-103* mch-36.4* mchc-35.3*# rdw-12.4 plt ct-238# 08:00pm blood neuts-67.8 lymphs-23.0 monos-6.2 eos-2.6 baso-0.4 08:00pm blood pt-11.0 ptt-27.7 inr(pt)-1.0 02:28am blood wbc-9.8 lymph-14* abs -1372 cd3%-76 abs cd3-1049 cd4%-43 abs cd4-594 cd8%-32 abs cd8-440 cd4/cd8-1.4 08:00pm blood glucose-93 urean-66* creat-2.2* na-133 k-3.9 cl-94* hco3-28 angap-15 08:00pm blood alt-85* ast-182* ck(cpk)-5026* alkphos-61 totbili-0.2 08:00pm blood ck-mb-39* mb indx-0.8 ctropnt-0.03* 02:28am blood calcium-7.5* phos-2.3* mg-2.7* 08:00pm blood osmolal-293 08:31pm blood ammonia-24 02:28am blood tsh-3.1 02:28am blood hbsag-negative hbsab-positive hbcab-negative 08:00pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 02:28am blood hcv ab-negative 08:48pm blood po2-43* pco2-59* ph-7.33* caltco2-33* base xs-2 comment-green top ekg: 69 sr, ra, 1st degree avb, pvc microbiology: blood cultures negative from onward 9:56 pm blood culture source: line-tlc. **final report ** blood culture, routine (final ): staphylococcus epidermidis. final sensitivities. coag neg staph does not require contact precautions, regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. staphylococcus epidermidis. second strain. final sensitivities. coag neg staph does not require contact precautions, regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus epidermidis | staphylococcus epidermidis | | clindamycin----------- =>8 r =>8 r erythromycin---------- =>8 r =>8 r gentamicin------------ <=0.5 s <=0.5 s levofloxacin---------- =>8 r <=0.12 s oxacillin------------- =>4 r =>4 r rifampin-------------- <=0.5 s <=0.5 s tetracycline---------- 2 s <=1 s vancomycin------------ 2 s 1 s 1:21 am blood culture source: line-piv. **final report ** blood culture, routine (final ): staphylococcus epidermidis. coag neg staph does not require contact precautions, regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. final sensitivities. staphylococcus epidermidis. second strain. coag neg staph does not require contact precautions, regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus epidermidis | staphylococcus epidermidis | | clindamycin----------- =>8 r =>8 r erythromycin---------- =>8 r =>8 r gentamicin------------ =>16 r <=0.5 s levofloxacin---------- =>8 r =>8 r oxacillin------------- =>4 r =>4 r rifampin-------------- <=0.5 s <=0.5 s tetracycline---------- 2 s =>16 r vancomycin------------ 2 s 2 s cxr: impression: slight prominence of the central pulmonary vasculature is compatible with pulmonary venous hypertension. no overt pulmonary edema or other acute cardiopulmonary process. cxr: comparison: radiographs dating between and : marked cardiomegaly is accompanied by pulmonary vascular engorgement and combined alveolar and interstitial edema as well as a small right pleural effusion. no visible pneumothorax. nchct: findings: there is no evidence of hemorrhage, edema, large mass, mass effect or acute infarct. ventricles and sulci are normal. no fracture identified. the mastoid air cells, middle ear cavities and visualized paranasal sinuses are clear. no soft tissue swelling identified. echo the left atrium is dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. overall left ventricular systolic function is severely depressed (lvef= 15-20 %). the right ventricular cavity is mildly dilated with borderline normal free wall function. the aortic root is mildly dilated at the sinus level. the aortic arch is mildly dilated. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: severely dilated left ventricle with severe global left ventricular hypokinesis. the right ventricle is not well seen but is probably mildly dilated and borderline hypokinetic. mild to moderate mitral regurgitation. compared with the prior study (images reviewed) of , overall left ventricular systolic function has substantially worsened. the right ventricle appears dilated and hypokinetic on the current study. pulmonary artery pressures could not be estimated on the current study. leni: 1. within the limitations of this exam, there is no deep vein thrombosis seen within the right or left extremity. 2. nonvisualization of the left peroneal veins. cxr : findings: in comparison with study of , the patient has taken a much better inspiration. there is still mild asymmetry of the mid portion of the lungs with more opacification on the right. this could still represent a focus of clearing consolidation in the appropriate clinical setting. the remainder of the study shows continued enlargement of the cardiac silhouette with basilar atelectatic or fibrotic streaks. no vascular congestion. densely calcified lesion in the right upper quadrant is seen as on the ct examination of . cxr : findings: the right picc is no longer curled in the svc. the tip now terminates in the upper svc. again noted is mild bibasilar atelectasis and mild pulmonary edema. there is no pleural effusion or pneumothorax. the cardiomediastinal silhouette is unchanged. impression: right picc terminates in the upper svc. brief hospital course: 49m w/ ho of hiv, cd4=1294 on arvs, cardiomyopathy status post vsd repair, hypothyroidism pw report of progressive altered mental status per his family and hypotension. ed course complicated by pulseless v-tach during attempted central line placement with return of spontaneous circulation within 1 minute, found to have staph epidermitis bacteremia. active issues: # s/p v-tach arrest: most likely due to guidewire within the right atrium or right ventricle, causing an event of ectopy which self-propagated to v-tach. brief pulseless interval before rosc, and the patient was mentating well afterwards. post-arrest team consulted; as he was adequately mentating, there was no role for cooling. icd considered by cardiology consult given his arrest, however deferred at this time at the recommendation of the patient's personal cardiologist, dr. . he had no further episodes of ectopy or dysrhythmia during his hospital course. # staph epi bacteremia: cultures positive and for coagulase negative stapholococcus. thought less likely a contaminant given consecutive positive cultures (both with 2 species of staph epi). id consulted, recommended 14 day course of vancomycin. picc line was placed and patient discharged on vancomycin 1250mg # hypotension: most likely multifactorial, possible etiologies including infection, medication-induced/polypharmacy (patient on a number of sedating medications, with possible confusion about dosing), hypovolemia from poor po intake. given the patient's hiv status, there was concern for infection, although there was no fever, leukocytosis, or any focal process of cxr or ua. given the presence of bradycardia with his hypotension raises the possibility of a drug induced etiology, where he cannot mount a physiologic tachycardia in response to his hypotension. the patient denies any recent ingestions or medication noncompliance, however he is on a large number of medications, a number of which are sedating. urine and serum tox screens both negative. patient was briefly on norepinephrine for bp support, which was initiated just prior to coming to micu, however this was titrated off on hd#1. antibiotics were intitiated to treat the patient as presumed cap. lenis were obtained to rule out dvt. at the time of transfer to the floor, the patient was normotensive and he continued to be normotensive for the remainder of his stay. # elevated ck, mb: likely in the setting of being found down today. resolved with iv fluids. # : presented with creatinine of 2.2 (baseline 0.8-0.9). most likely hypovolemia and pre-renal in the setting of poor po intake. creatinine back to baseline on discharge. # elevated lactate: likely in the setting of his hypotension, poor po intake, hypovolemia. receieved ivf in the ed and iit had normalized by the time he was called out to the floor. # transaminitis: likely due to hypotension. last had negative hepatitis serologies in . given his abdominal distension which is new within the past year, as well as hiv status, there was concern that potentially he may have developed hepatitis in the interim. hepatitis serologies were obtained which were negative. # hiv: patient was continued on his at home haart regimen. transitional issues: - blood cultures pending on discharge (returned all negative) - patient will need vancomycin 1250mg until medications on admission: the preadmission medication list is accurate and complete. 1. emtricitabine-tenofovir (truvada) 1 tab po daily 2. raltegravir 400 mg po bid 3. androgel *nf* (testosterone) 1 % (25 mg/2.5 g) transdermal daily 4. pravastatin 20 mg po daily 5. finasteride 0.5 mg po every other day 6. fish oil (omega 3) 1000 mg po bid 7. methylphenidate (ritalin) 20 mg po qam 8. methylphenidate (ritalin) 10 mg po qpm 9. valacyclovir 500 mg po q24h 10. lorazepam 0.5 mg po tid anxiety 11. lisinopril 5 mg po daily 12. carvedilol 6.25 mg po bid 13. cyclobenzaprine 10 mg po tid:prn spasm 14. thyroid 45 mg po daily 15. acidophilus *nf* (l.acidoph & sali-b.bif-s.therm;<br>lactobacillus acidophilus) 175 mg oral tid 16. amiodarone 200 mg po daily 17. fluticasone propionate nasal 2 spry nu daily 18. ibuprofen 600 mg po q8h:prn pain 19. pregabalin 200 mg po bid 20. multivitamins 1 tab po daily 21. clopidogrel 75 mg po daily 22. tizanidine 10 mg po tid 23. tramadol (ultram) 50 mg po bid 24. oxycodone sr (oxycontin) 30 mg po q12h 25. oxycodone (immediate release) 5-10 mg po q6h:prn breakthrough pain 26. varenicline *nf* 1 mg oral 27. -d 12 hour *nf* (fexofenadine-pseudoephedrine) 60-120 mg oral discharge medications: 1. amiodarone 200 mg po daily 2. clopidogrel 75 mg po daily 3. cyclobenzaprine 10 mg po tid:prn spasm 4. emtricitabine-tenofovir (truvada) 1 tab po daily 5. fexofenadine 60 mg po bid 6. finasteride 2.5 mg po every other day 7. fish oil (omega 3) 1000 mg po bid 8. ibuprofen 600 mg po q8h:prn pain 9. lisinopril 5 mg po daily 10. lorazepam 0.5 mg po q8h:prn anxiety 11. multivitamins 1 tab po daily 12. oxycodone (immediate release) 5-10 mg po q6h:prn breakthrough pain 13. oxycodone sr (oxycontin) 30 mg po q12h 14. pravastatin 20 mg po daily 15. pregabalin 200 mg po bid 16. raltegravir 400 mg po bid 17. thyroid 45 mg po daily 18. tramadol (ultram) 50 mg po bid 19. docusate sodium 100 mg po bid 20. acidophilus *nf* (l.acidoph & sali-b.bif-s.therm;<br>lactobacillus acidophilus) 175 mg oral tid 21. androgel *nf* (testosterone) 1 % (25 mg/2.5 g) transdermal daily 22. fluticasone propionate nasal 2 spry nu daily 23. methylphenidate (ritalin) 20 mg po qam 24. methylphenidate (ritalin) 10 mg po qpm 25. valacyclovir 500 mg po q24h 26. -d 12 hour *nf* (fexofenadine-pseudoephedrine) 60-120 mg oral 27. varenicline *nf* 1 mg oral 28. vancomycin 1250 mg iv q 12h rx *vancomycin 750 mg 1250mg twice a day disp #*21 unit refills:*0 rx *vancomycin 500 mg 1250mg twice a day disp #*21 unit refills:*0 29. metoprolol succinate xl 25 mg po daily rx *metoprolol succinate 25 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 30. outpatient lab work please draw bun/creatinine on and call results to md on call, at 31. tizanidine 10 mg po tid discharge disposition: home with service facility: home solutions discharge diagnosis: primary: - bacteremia - ventricular tachycardia arrest - human immunodeficiency virus secondary diagnoses: - benign prostatic hyperplasia - hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital after being found on the floor by your family. your blood pressure was low in the emergency department and placement of a central line was attempted. you had a ventricular tachycardia (abnormal heart rhythm) during placement and required cpr. you were admitted to the intensive care unit, and your heart rhythm was normal for the rest of your hospitalization. you received 5 days of antibiotics for pneumonia. you had 2 blood cultures which were positive for bacteria and were started on iv vancomycin (an antibiotic), which you should continue until . other changes to your home medications are: - stop carvedilol. start metoprolol succinate 25mg daily in its place. -you should continue your other home medications as previously prescribed. you should have blood drawn for labwork on . weigh more than 3 lbs. it was a pleasure taking care of you during your hospitalization and we wish you the best going forward. followup instructions: name: , d. location: address: , 2nd fl, , phone: appointment: wednesday 12:20pm department: otolaryngology (ent) when: monday at 1 pm with: , au.d. building: lm campus: west best parking: . garage md procedure: cardiopulmonary resuscitation, not otherwise specified central venous catheter placement with guidance central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified other primary cardiomyopathies anemia, unspecified tobacco use disorder congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism cardiac complications, not elsewhere classified peripheral vascular disease, unspecified depressive disorder, not elsewhere classified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) paroxysmal ventricular tachycardia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure cardiac arrest bacteremia chronic systolic heart failure encephalopathy, unspecified hypovolemia other and unspecified infection due to central venous catheter staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus rhabdomyolysis asymptomatic human immunodeficiency virus [hiv] infection status personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus shock, unspecified 

Answer: The patient is high likely exposed to