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: latex / fentanyl / risperidone attending: chief complaint: headache major surgical or invasive procedure: lumbar puncture, blood patch . history of present illness: this is a 23 year old biologically female who identifies as a male, with pmh significant for hiv (recently started ), untreated hep c, recent admission to for zoster, but never filled acyclovir script after he was discharged now presents with fever, nausea and vomiting, dizzyness and lightheadedness. . the pt reports that he "can't keep anything down," and feels like head is "being squeezed," and has a history of tension headaches and migraines. he says this head pain "does not feel like the usual migraine." of note, the pt started (truvada, reyataz, norvir) on . the pt denies photophobia, meningismus, endorses fever to 102 at home. he endorses cough, sore throat, no chest pain or palpitations. he endorses diarrhea "for a long time," nausea and vomiting for the past two days. labs on showed hiv vl: 931 cd4: 318. . in the ed, initial vs were: t 98.1, p 71, bp 130/79, rr 16, pox 100%. ct head was unremarkable. patient had an lp (opening pressure was 15) and pt received: ondansetron, morphine, acetaminophen, lorazepam, dilaudid, ceftriaxone, ibuprofen, acyclovir, vancomycin. during lp pt became more tachycardic, got morphine as hr increased to 140. tmax in ed was 103 with rigors. ekg at pulse of 160 showed sinus tachycardia. on transfer to the icu the pt had received 4l ns, with pulse in the 130's. on exam pt has faint rash over the left deltoid. pt still uncomfortable, with headache. after arriving in the icu the patient appeared uncomfortable and was tachycardic and tachypnic. past medical history: -cerebral palsy, s/p multiple achilles tendon surgeries, no residual deficits per patient, mild urinary retentiona at times. -hiv (not on ), dx approx 2 yrs ago. took pmtct 1 yr ago successfully. () cd4 = 412, vl 2400 -asthma, mild intermittent: has received flu vaccine -prior thrush due to advair for asthma -hepatitis c diagnosed in , no ifn therapy, last hep c vl not detected -s/p appendectom -depression: sees dr. at health center, prozac tapered off 1 week ago, was to begin cymbalta per her report. -history of suicide attempts: last sa was in , requiring icu admission at hospital. pt overdosed on his medications at that point (prozac, trileptal, seroquel). pt -reports hx of 2 sa by od, and 2 sa by cutting. first sa at age 13-14. self cutting, last circa , self reports near fatal cut and has stopped anorexia/bulimia, currently with active behaviors including restricting and purging -ptsd - rape survivor -adhd - on concerta -ocd -trauma/abuse: last time this occured that patient is willing to acknowledge is but will not discuss incident. h/o + ua/utis social history: complicated social history. female-to-male gender, has all female organs, does not take hormones. currently lives in with 1 yo son. hx of crystal meth per his report today -- states has been clean for 4 years, though past records indicate more recent use and prior use of heroin, cocaine use. occasional etoh, last drink 1 wk ago (40oz beer daily). ppd tobacco. family history: grandmother: gallbladder issues aunt: diabetes mother cervical, ovarian, uterine physical exam: vitals: bp: 119/69 p: 106 r: 18 o2: 97% ra general: alert, oriented, appears uncomfortable heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad, unable to cooperate to assess meningismus lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic, otherwise normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: no evidence of vesicles, erythema or crusting. areas on left upper extremities that may be former vesicles, now bland appearing with no erythema neuro: a+ox3, cn ii-xii intact motor: upper and lower extremities sensation: intact gait assessment deferred pertinent results: laboratory data: complete blood count: 03:10pm blood wbc-5.0# rbc-4.46 hgb-11.6* hct-35.8* mcv-80* mch-26.1* mchc-32.6 rdw-12.7 plt ct-272 03:32am blood wbc-11.8*# rbc-3.93* hgb-9.9* hct-30.8* mcv-79* mch-25.2* mchc-32.1 rdw-12.6 plt ct-157 08:05am blood wbc-4.6# rbc-3.92* hgb-10.0* hct-30.9* mcv-79* mch-25.5* mchc-32.4 rdw-12.9 plt ct-135* 08:30am blood wbc-3.3* rbc-3.98* hgb-10.0* hct-31.3* mcv-79* mch-25.2* mchc-32.0 rdw-12.8 plt ct-104* 07:50am blood wbc-3.4* rbc-3.98* hgb-10.1* hct-31.6* mcv-79* mch-25.2* mchc-31.8 rdw-13.1 plt ct-154 08:05am blood wbc-3.8* rbc-4.06* hgb-10.6* hct-32.2* mcv-79* mch-26.2* mchc-33.1 rdw-13.0 plt ct-215 07:40am blood wbc-4.4 rbc-4.52 hgb-11.2* hct-35.6* mcv-79* mch-24.8* mchc-31.5 rdw-13.0 plt ct-252 03:10pm blood neuts-69.3 lymphs-25.9 monos-3.3 eos-0.6 baso-0.9 . coagulation profile: 07:40am blood pt-12.5 ptt-30.1 inr(pt)-1.1 . basic metabolic profile: 03:10pm blood glucose-93 urean-5* creat-0.7 na-138 k-3.4 cl-103 hco3-26 angap-12 07:40am blood glucose-89 urean-6 creat-0.6 na-139 k-3.7 cl-103 hco3-27 angap-13 03:32am blood calcium-7.5* phos-3.8 mg-1.3* 07:40am blood calcium-8.8 phos-4.8* mg-1.9 . liver function tests: 03:10pm blood alt-31 ast-34 ld(ldh)-146 alkphos-76 totbili-2.9* dirbili-0.4* indbili-2.5 08:05am blood alt-21 ast-29 ld(ldh)-162 alkphos-67 totbili-3.4* . 03:32am blood hapto-143 03:10pm blood tsh-0.67 07:05pm blood lactate-1.5 . urine: 03:45pm urine color-yellow appear-hazy sp -1.008 03:45pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-tr 03:45pm urine rbc-* wbc- bacteri-mod yeast-none epi- . microbiology: 08:05am blood aspergillus galactomannan antigen-test negative 08:05am blood b-glucan-test negative 10:16am blood herpes simplex (hsv) 2, igg-test name negative 10:16am blood herpes simplex (hsv) 1, igg-test positive 10:16am blood herpes simplex virus 1 and 2 antibody igm-test negative . blood culture: : no growth to date. . csf analysis: : gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. cryptococcal antigen (final ): cryptococcal antigen not detected. (reference range-negative). performed by latex agglutination. results should be evaluated in light of culture results and clinical presentation. fungal culture (preliminary): no fungus isolated. . csf viral culture: : no virus isolated thus far. . urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. . monospot test: : monospot (final ): negative by latex agglutination. . - virus vca-igg ab (final ): negative by eia. - virus ebna igg ab (final ): negative by eia. - virus vca-igm ab (final ): negative <1:10 by ifa. interpretation: no antibody detected. in most populations, 90% of adults have been infected at sometime with ebv and will have measurable vca igg and ebna antibodies. antibodies to ebna develop 6-8 weeks after primary infection and remain present for life. presence of vca igm antibodies indicates recent primary infection. . cmv viral load : cmv dna not detected. . hcv viral load (final ): 558,000 iu/ml. . ecg (): narrow complex tachycardia which is likely sinus tachycardia. compared to the previous tracing of the rate has increased. . ecg (): sinus bradycardia with atrial premature beats. compared to the previous tracing of the rate has decreased. st-t wave changes are not seen on the current tracing. . ct head (): impression: no acute intracranial process. . cxr (): impression: no acute pulmonary process. brief hospital course: 23 year old biologically female who identifies as male gender with a history of hiv, hepatitis c, and recent admission for zoster presents with fever, tachycardia and headache a few days after initiation of . . # headache: presented to ed with fever, tachycardia, and mild headache. the initial differential for headache in this patient included viral meningitis given recent history of zoster infection and incomplete acyclovir course, bacterial meningitis, and reaction to meds. head ct was without acute pathology. patient was empirically started on vancomycin, ceftriaxone, and acyclovir, which were discontinued after csf did not suggest bacterial meningitis. acyclovir was empirically continued due to persistent headache until csf hsv pcr was negative. pain control was provided initially with iv dilaudid which was transitioned to po morphine. iv caffeine and fiorocet were both attempted without success. due to suspicion that worsening headache was secondary to lumbar puncture, pain service was consulted and blood patch was placed on with good effect. patient was discharged home with short supply of po morphine. medication was held upon admission and per pcp, held at the time of discharge. pcp to have discussions with patient in regards to her medication. . # fever: unknown etiology, but possible secondary to to viral syndrome, nos. blood, csf and urine cultures did not yield any organisms to date. chest xray was unremarkable. head ct and lp wnl. have also been a hypersensitivity reaction to meds. empiric antibactial antibiotics were discontinued as fevers resolved and no clear source of infection could be identified. . # tachycardia: the patient was tachycardic on presentation. sinus tachycardia seen on ekg. likely secondary to pain, headache, or viral syndrome. pt denied chest pain, palpitations, shortness of breath. the patient did endorse a fire-like pain over l ue, which may be secondary to post-herpetic neuralgia. the patient was maintained on telemetry overnight, given iv hydration and pain control as above. . # hyperbilirubinemia: no evidence of jaundice on exam. mild tenderness to palpation over abdomen on exam. ldh was normal, and anemia was at baseline, so unlikely elevated bili due to hemolysis. likely due to current regimen. possibly secondary to syndrome in the setting of poor po intake. lactate is 1.5 which made cholangitis less likely. no further imaging was performed. . # hiv: the patient was diagnosed with hiv several years ago, and had not been on until this past week. most recent labs showed vl: 931, cd4: 318. given fever, tachycardia and headache, which may all be secondary to side effects, was held on admission. after discussions with pcp, was discontinued at the time of discharge. . # hepatitis c: never treated. hepatology follow up is in place. . # history of anorexia/bulemia: monitored intake and electrolytes. medications on admission: truvada (emtricitabine nrti, tenofovir nrti) reyataz (atazanavir protease inhibitor) norvir (ritonavir protease inhibitor) cymbalta adderall trileptal discharge medications: 1. oxcarbazepine 150 mg tablet sig: one (1) tablet po bid (2 times a day). 2. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever, pain. 3. morphine 15 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for headache. disp:*15 tablet(s)* refills:*0* 4. duloxetine 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. medication adderall - please continue taking the dose that you were previously taking. discharge disposition: home discharge diagnosis: primary: - viral syndrome, nos - post lumbar puncture headache secondary: - cerebral palsy - hiv 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 because you developed a severe headache, nausea, vomiting and fevers. we performed a lumbar punture as we were concerned that this was due to bacterial meningitis, however it did not appear to be the case. you were initially started on antibiotics, but these were discontinued after we confirmed that you did not have meningitis. your symptoms improved, fevers resolved and you are ready to go home. you had a blood patch done on to help relieve your headache. we made the following changes to your medications: we started you on morphine 15mg every six hours as needed for pain. please do not drive or drink alcohol while taking this medication. please arrainge for assistance to care of your child when taking this medication. we stopped your medications for hiv. please follow up with dr. before resuming these medications. please continue to take all your other medications as prescribed. please follow up with your primary care doctor as shown below. followup instructions: you have the following follow-up appointments: please follow up with dr. on at 2pm. his phone number is . hepatology: please follow up with: department: liver center when: thursday at 9:15 am with: , md building: lm campus: west best parking: garage procedure: spinal tap incision of lung spinal blood patch diagnoses: tobacco use disorder urinary tract infection, site not specified chronic hepatitis c without mention of hepatic coma asthma, unspecified type, unspecified depressive disorder, not elsewhere classified unspecified viral infection other acquired absence of organ attention deficit disorder with hyperactivity alcohol abuse, continuous asymptomatic human immunodeficiency virus [hiv] infection status infantile cerebral palsy, unspecified leukocytopenia, unspecified obsessive-compulsive disorders disorders of bilirubin excretion posttraumatic stress disorder personal history, urinary (tract) infection reaction to spinal or lumbar puncture history of physical abuse phenothiazine-based tranquilizers causing adverse effects in therapeutic use trans-sexualism with unspecified sexual history 

Answer: The patient is high likely exposed to