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: patient recorded as having no known allergies to drugs attending: chief complaint: bilateral leg pain, productive cough major surgical or invasive procedure: bronchoscopy picc line placement history of present illness: pcp: , , , phone: ( . hpi: 51 m h/o of hiv c/b neuropathy who intially presented to the ed with pain in b/l lower extremities. pt reported that he ran out of his methadone on wednesday, and was not due to get refills in the mail until monday. methodaone and ativan are the only medications he remembers taking. . he is also complaining of a cough for the past 2 days productive of yellow sputum. he denies fevers, chills, nightsweats, dyspnea/sob, nausea, vomiting, hemoptysis or chest pain. . in the ed, the patient was afebrile and satting 100% on ra. he was placed in a negative pressure room for question tuberculosis, and was given 3l of ns iv over 6 hours this am, oxycodone 10mg po x1, ativan 1mg iv x1, morphine 4mg iv x1, oxycodone 15mg po, 2x percocet po x1. a cta was done for tachycardia which revealed groundglass opacities but no pe. . pt was then admitted to the floor given his regular dose of methadone as well as ctx/azithromycin for presumed cap, he was restarted on his antiretrovirals. the patient was started to be ruled out for tuberculosis with one sputum afb negative to date. pcp on this induced sputum was negative as well. the patient continued to spike to 101 on the floor. . on sunday he was noted to have received additional oxycodone from a friend, which resulted in increased somnolence. in the context of this somnolence the patient was also noted to desaturate on ra and was started on o2. his o2 requirement progressed over the next 24 hours to 4l and vancomycin and flagyl were added for possible hospital acquired/aspiration pneumonia. the patient was also started on bactrim for pcp prophylaxis on as his cd count returned as 84. as the patient continued to be progressively hypoxic on , the icu team was consulted as well as the id team. . on evaluation of the icu team, the patient did not complain of sob, cp, abdominal pain, ha, vision changes, n, v. he only complaint of a productive cough. his o2 saturations were apparently in the 70s on ra per report, and 100% on nrb, abg revealed , he was transferred to the micu. . in the micu pt pt was switched to treatment dose bactrim and started on steroids for presumptive pcp, quickly improved from requiring nrb to 94% on ra by morning. he is being called back out to the medical service for ongoing managment of his hypoxic respiratory failure, and hiv. past medical history: 1. hiv+ (duration unknown, cd4 count 201 in , last vl 4600, on haart: norvir, viread and reyataz > non compliant) 2. neuropathic pain due to hiv neuropathy 3. s/p exploratory laparotomy for stab wound social history: patient lives at ., , by himself. he denies having any family or friends. is on welfare, does not work and denies ever having a job. he smokes 1 pack/day, denies any recreational drug use, and drinks 2-3 beers/day last on day prior to admission. family history: noncontributory physical exam: physical exam on admission to micu: vitals: t 98.6 bp 125/80 hr 103 rr 18 sat 100%nrb gen: pt somnolent, a&ox1 to person heent: perrl 3>2mm b/l, eomi, nystagmus b/l when patient more somnolent, oral thrush, dry mm neck: no bruit, no jvd, submandibular ln palpable cv: rrr, nl s1s2 no g/r/m, tachycardic lungs: crackles and rhonchi throughout b/l abd: well healed scar. +bs. nt/nd extremities: no edema. +dp, atrophic leg muscles skin: scaling skin and dermatitis on hands and feet, three healing ulcers on buttocks neuro; aaox1, somnolent, 5/5 strength in upper extremities, contracted in lower extremities with muscular atrophy and 2-3/5 strength b/l > exam limited by compliance. cn exam limited by compliance but no facial assymmetry. no meningeal signs. pertinent results: admission labs: 12:43am wbc-4.3 rbc-4.46* hgb-13.2* hct-37.1* mcv-83 mch-29.5 mchc-35.5* rdw-15.1 12:43am neuts-46.3* lymphs-42.0 monos-7.5 eos-3.2 basos-1.0 12:43am plt count-313 12:43am glucose-90 urea n-13 creat-0.7 sodium-134 potassium-4.0 chloride-98 total co2-20* anion gap-20 12:43am ld(ldh)-205 12:43am asa-neg ethanol-197* acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 06:40pm urine bnzodzpn-neg barbitrt-neg opiates-pos cocaine-neg amphetmn-neg mthdone-neg . discharge/pertinent labs: 10:45am blood wbc-3.2* rbc-3.45* hgb-10.2* hct-29.3* mcv-85 mch-29.7 mchc-35.0 rdw-15.5 plt ct-229 06:12am blood glucose-94 urean-16 creat-0.8 na-129* k-4.4 cl-95* hco3-24 angap-14 06:45am blood alt-39 ast-33 ld(ldh)-368* alkphos-61 totbili-0.2 06:12am blood calcium-7.8* phos-2.6* mg-1.8 07:10am blood caltibc-306 ferritn-484* trf-235 06:50am blood angiotensin 1 - converting -test 01:00pm blood aspergillus galactomannan antigen- test 01:00pm blood b-glucan-test . studies: cxr : the cardiomediastinal silhouette is normal in appearance. the lungs are clear. no effusion or pneumothorax is present. the hilar structures are normal. . cta : no pulmonary embolism. bilateral indistinct ground-glass and soft tissue attenuation with tiny pulmonary nodules, predominantly in a centrilobular distribution. this appearance would be most consistent with an atypical infectious process which spreads along endobronchial pathways, but other causes of infection including mycoplasma and other opportunistic infections including fungal and tuberculosis could also be considered. given the underlying emphysema, an interstitial lung disease such as rbild could also be considered. . micro: . **final report ** blood culture, routine (final ): presumptive peptostreptococcus species. isolated from one set only. anaerobic bottle gram stain (final ): reported by phone to at 2115 on .. gram positive cocci in pairs and clusters. . 5:55 pm immunology **final report ** hiv-1 viral load/ultrasensitive (final ): greater than 100,000 copies/ml. performed by rt-pcr (ultrasensitive). detection range: 50-100,000 copies/ml. . time taken not noted log-in date/time: 12:32 pm blood (toxo) chem# m. **final report ** toxoplasma igg antibody (final ): negative for toxoplasma igg antibody by eia. . 3:50 pm urine source: cvs. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. . 9:47 pm rapid respiratory viral screen & culture source: nasopharyngeal aspirate. rapid respiratory viral antigen test (final ): respiratory viral antigens not detected. . 12:14 am serology/blood source: venipuncture. **final report ** cryptococcal antigen (final ): cryptococcal antigen not detected. . 1:05 pm sputum source: induced. pcp added on at 1252 per fax. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (pending): immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirvovecii (carinii). . 9:47 pm sputum site: induced source: induced. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive rod(s). 2+ (1-5 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): sparse growth oropharyngeal flora. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): reported by phone to crate at 0725 on . specimen not processed due to: quantity not sufficient less than 2 ml received. please submit another specimen. test cancelled, patient credited. fungal culture (preliminary): yeast. of two colonial morphologies. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (pending): . 8:21 am bronchoalveolar lavage bronchial lavage (lingula). gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. legionella culture (final ): no legionella isolated. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirvovecii (carinii). fungal culture (preliminary): yeast. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (pending): brief hospital course: a/p: 51m h/o hiv, hiv neuropathy admitted with le neuropathic pain and productive cough, has had episodic hypoxia requiring admission to micu x2, now stable on room air. . # nosocomial pneumonia: he is being treated for nosocomial (?aspiration given somnolence with narcotic regimen with peptostreptococcal bacteremia) pna as well as pcp pna empirically despite neg. pcp x2, per id recs. tuberculosis negative x3 on admission. bal studies ngtd. b-glucan and galactomanan were neg. legionella neg. cryptococcal antigen neg. ace was wnl. bubble tte negative for intracardiac shunt. he has had intermittent episodes of hypoxia, requiring 2 short micu stays, which may be from mucous plugging. this is now resolved. he was started on a 14 day course of zosyn from to . he has also completed course of bactrim dm and steroids for empiric pcp . he is now back on bactrim ds daily for ppx. pt was followed by id and will follow up with id as outpatient. . # peptostreptococcal bacteremia: pt had 1 anaerobic blood culture positive for peptostreptococcus on . surveillance bcxs with ngtd. this is unlikely contaminant as it is mouth flora. pt was treated with zosyn x 14 days. . # hiv neuropathy with chronic pain: per pharmacy, pt's methadone dose is 40mg tid. when he was placed on this, pt was noted to be somnolent. of note, a visitor had brought him a bottle of oxycodone. pt was placed on methadone 20mg tid with oxycodone 5mg q 4 hr prn for breakthrough. he was also started on gabapentin, titrated to 300mg tid. pt will need monitoring for oversedation. . # hiv: cd4 count is 83. patient has been noncompliant on haart. per id, haart was held. he will follow up with id as outpatient regarding reinitiation of haart. he is back on bactrim ds daily for pcp . he will follow up with his pcp. . # siadh: pt was noted to be hyponatremic. his urine studies suggested siadh, likely pulmonary process. he improved with free water restriction. . # anemia: pt hct ranged from 33-37. upon discharge, discharge, his hct was noted to have an acute drop of 4 points to 30. repeat hct was the same. pt had no obvious bleeding. he was guaiac negative. retic count was noted to be inappropriately low. iron studies were not remarkable. he will follow up with his pcp. . # psoriasis v. ezcema: pt was treated with lachydrin and clobetasol cream. . # etoh abuse: he was initially placed on ciwa scale without issues. he was supplemented with mtv, thiamine, and folate. sw was consulted. . # oral thrush: resolved. pt was treated with nystatin prn. . # fall: pt had a fall on . pt reported that he had tripped. he was possibly sedated from narcotics. he had e/o head trauma and denies hitting head, loc. neuro exam was unchanged. pt was placed on fall precautions. . # full code medications on admission: medications on admission: (pt only remembers two) per pharmacist at specialty scripts: 1- viread (tenofovir) 100mg qd reyataz (atazanavir) 2 caps po qd (300mg?) norvir (ritonavir) 100mg qd lorazepam 1mg qhs methadone 40mg tid prn po fentanyl patch 100mcg q3d (last prescribed ) percocet 5/325 2 tabs qid prn . meds on transfer to micu: metronidazole (flagyl) 500 mg iv q8h acetaminophen 325-650 mg po q6h:prn vancomycin 1000 mg iv q 12h albuterol 0.083% neb soln 1 neb ih q6h ipratropium bromide neb 1 neb ih q6h nystatin oral suspension 5 ml po qid azithromycin 500 mg po q24h ceftriaxone 1 gm iv q24h lorazepam 1 mg po hs @ 1757 view ritonavir 100 mg po daily @ 1757 view atazanavir 300 mg po daily @ 1757 view tenofovir disoproxil fum. 300 mg po daily . allergies: aprenavir > intolerance discharge medications: 1. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for sob/wheeze. 2. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 3. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 4. methadone 10 mg tablet sig: two (2) tablet po tid (3 times a day). 5. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 6. gabapentin 300 mg capsule sig: two (2) capsule po q8h (every 8 hours). 7. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 8. ammonium lactate 12 % lotion sig: one (1) appl topical (2 times a day). 9. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 10. hexavitamin tablet sig: one (1) cap po daily (daily). 11. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 12. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)) as needed for agitation. 13. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 14. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 15. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 16. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po once a day. 17. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: 4.5 gram intravenous q8h (every 8 hours) for 3 days: until . 18. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 19. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 20. acetaminophen 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for fever or pain. discharge disposition: extended care facility: healthcare center - discharge diagnosis: aspiration pneumonia hiv hiv neuropathy discharge condition: good discharge instructions: you were admitted to the hospital worsening of your neuropathy and shortness of breath. you had an extended stay including admission to the intensive care unit for shortness of breath. you are being treated for aspiration pneumonia and pneumocystis pneumonia. you will be discharged to a rehab facility to finish the antibiotic course. please return to the hospital if you have worsening shortness of breath, chest pain or fevers. followup instructions: please follow up with your pcp, . , l. in 2 weeks after discharge from the hospital. please discuss when to restart your hiv medications. . please also keep the following appointments: provider: , md phone: date/time: 9:15 md, procedure: venous catheterization, not elsewhere classified closed [endoscopic] biopsy of bronchus diagnoses: anemia, unspecified candidiasis of mouth human immunodeficiency virus [hiv] disease acute respiratory failure pneumonitis due to inhalation of food or vomitus pneumocystosis bacteremia streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus other disorders of neurohypophysis alcohol abuse, continuous other psoriasis peripheral autonomic neuropathy in disorders classified elsewhere 

Answer: The patient is high likely exposed to