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: fever and mental status changes major surgical or invasive procedure: 1. lumbar puncture 2. percutaneous gastric jeujonstomy tube placement history of present illness: patient is difficult to obtain history from and therefore most was obtained from chart, partner, and notes. patient is a 58 y/o male with a history of hiv (cd4 36, vl 14,700 on ), t2dm, and htn s/p recent admission with brain lesions who presented with confusion and fevers. he was recently admitted from for mental status changes. he was found to have a new lesion on brain mri and new seizures. brain biopsy was non-diagnostic and he had a post-op sub-arachnoid hemorrhage that was stable on serial ct scans. he was thought to be doing better at home and his partner went away for a couple days. when she returned, she found him to be lethargic, slow to respond, febrile and non-compliant with his meds. he was brought in on the day of admission with temp to 102 and worsening confusion/lethargy. no focal neuro defecits per neuro on admission. . in the ed: he was febrile to 100.7. he received ceftriaxone and vancomycin. he had a head ct that showed a new large region of hypodensity of the left frontal white matter adjacent to the previously identified subcentimeter lesion near the left frontal . patient was initially sent to the floor for further work up but was minimally responsive, febrile, tacchycardic and shaking and was sent to the micu. the shaking was thought to be due to fever and rigor and not seizure activity. . in the micu, neurology and id were consulted. lumbar puncture was eventually done (see below for results). patient treated with vancomycin, ceftriaxone and acyclovir empirically while the cultures were pending, but those were stopped. mri was also done while in the micu showing multiple new enhancing lesions and t2 abnormalities are seen in both cerebral hemispheres as well as the right inferior cerebellum. . on transfer from the micu to the floor, patient was in sinus tacc with sbp 140s and afebrile. he was slow to respond to questions but would eventually answer most of them. the patient did not remember why he was admitted. he knew his name, he knew this was a hospital when we gave him choices and he knew if was but thought it was . patient denied ha, vision changes, nausea, chest pain, shorntess of breath, abdominal pain. past medical history: -hiv diagnosed : cd4 count 17 in , vl<50; started on haart earlier this year, with reduction in vl -history of pcp pna /hav -history of knife wound in montserrat in . -diabetes mellitus -hypertension social history: he was born in montserrat and moved to in , back to montserrat in , then in since . he has also traveled to , , , and new . he formerly worked as a welder. two cats at home. currently lives with female partner of many years and two children (aged 13 and 15), planning on getting married. family history: non-contributory. physical exam: t 98.1 p 110 bp 142/76 r 18 o2 sat 98% ra, fsbg 120 gen- lethargic, slow to respond heent- ncat, anicteric, no injections, pupils small and symmetrical, equally round and reactive to light, op +thrush- scrapes off with tongue blade, mmm cor- 3/6 sem heard best at lusb, rr, tacchycardic lungs- poor insp effort, clear anteriorly abd- +bs, soft, nt, nd, no masses or hsm extrem- no cce, pedal pulses 2+ b/l neuro- difficult to assess due to patient cooperation, cn 2-12 intact although patient reports decreased sensation on left side of face, right arm and leg strength 3/5 vs on left. pertinent results: : ct head w/out contrast: impression: 1. new large region of hypodensity of the left frontal white matter adjacent to the previously identified subcentimeter lesion near the left frontal . these findings are nonspecific but are likely in part due to edema possibly from progression of the lesion at this site. alternatively, this could indicate superimposed infection. this appearance would be unusual for infarction as it does not conform to a vascular territorial distribution. further evaluation with gadolinium enhanced mr is suggested. 2. no evidence of acute intracranial hemorrhage. 3. stable ct appearance of hypodensity near the right frontal lesion and of the left cerebellar hemisphere. 4. resolution of bleeding at the right-sided biopsy site. . mri/mra : mri impression: multiple new enhancing lesions and t2 abnormalities are seen in both cerebral hemispheres as well as the right inferior cerebellum. differential diagnosis includes toxoplasmosis, tuberculosis, or cryptococcus infection. previously noted inferior left cerebellar atrophic changes and signal changes are again identified. mra of the head: the head mra demonstrates normal flow signal within the arteries of anterior and posterior circulation. no evidence of vascular occlusion, stenosis or an aneurysm greater than 3 mm in size are seen. impression: normal mra of the head. mrv of the head: head mrv demonstrates normal flow signal in the superior sagittal and transverse sinuses. normal flow signal is also seen in the deep venous system. impression: normal mrv of the head. : ct head w/out contrast impression: 1. unchanged appearance of hypodensity extending from the left frontal white matter to the left basal ganglia, with associated effacement of the frontal of the left lateral ventricle. 2. hypodensity in the region of the right thalamus. although this area did not enhance on previous mri, there was significant flair abnormality in this region. differential considerations include evolving infectious process such as toxoplasmosis, tuberculosis, or cryptococcus. . : ct head w/out contrast impression: 1. unchanged confluent areas of hypodensity within the frontal lobes with associated effacement of the frontal of the left lateral ventricle. unchanged rounded hypodensities within the right frontal subcortical white matter, right thalamus, and left basal ganglia. as previously mentioned, the differential includes infectious processes such as toxoplasmosis, tuberculosis or cryptococcus. 2. two new hyperdense rounded foci within the left frontal subcortical white matter/ matter. these may reflect the patient's underlying infectious process. other differential diagnoses would include hemorrhagic metastases and septic emboli. small parenchymal hemorrhages are less likely but cannot be excluded. . laboratory results: 04:31a source: line-picc sodium 133 chloride 103 bun 18 glucose 83 agap=13 potassium 4.3 hco3 21 crt 1.8 ca: 9.9 mg: 1.9 p: 3.2 source: line-picc wbc 4.1 hemoglobin 8.5 platelets 131 hct 24.5 brief hospital course: the patient is a 58 year old man with hiv/aids (cd4 count 34) who presented to the emergency room with fevers and change in mental status, with imaging and microbiology results most consistent with cerebral toxoplasmosis. . 1. brain lesions most consistent with toxoplasmosis: . during the hospital stay the lumbar puncture was performed (6wbc (1% polys, 78%lymphocytes, 21% monocytes; 0atypicals) 0 rbc; elevated protien: 135; glucose 79; opening pressure: 33cm h20). csf fluid was negative for virus (by pcr), hsv 1&2 (pcr), syphillis vdrl, cmv and toxoplasmosis igg/igm. however, toxoplasmosis dna was found in the csf via pcr. . treatment for presumed cerebral toxoplasmosis was started in the hospital. he was started on intravenous bactrim in the micu but was switched to oral pyrimethamine/sulfadiazine once nasogastric tube was placed due to concern over rising creatinine and worsening renal function. throughout the hospital stay, the patient pulled out his nastrogastric tube several times and would spit up or vomit medications; therefore, treatment was changed from oral pyrimethamine/sulfadiazine to iv bactrim several times depending on his renal function and ability to tolerate oral intake. as a result, the patient did not initially receive consistent treatment of for toxoplasmosis. consistent therapy was initiated with iv bactrim, with stable creatinine, and was switched to po pyrimethamine/sulfadiazine, with leucovorin calcium, on once gj-tube was placed. the patient is now on day 8 of consistent treatment for toxoplasmosis, and should complete a total of 14 days. . of note, ebv dna in the csf via pcr was found to be "equivocal" meaning that the test was neither definitively positive or negative, and trace monoclonal igg kappa was found in the csf fluid. this could be suggestive of possible pcnsl, although the nature of the cereberal lesions are more suggestive of toxoplasmosis than a lymphomatous process. a repeat image of his brain after completing treatment for toxoplasmosis will be helpful to futher evaluate this, and has been scheduled for at in the clinical center of the at 7am in the basement. . imaging was repeated a various times throughout his stay due to lethargy, waxing and mental status, as well as vomiting and nausea, all of which subsequently improved greatly. the imaging showed new lesions, however it was felt that this was not yet a failure of treatment for his toxoplasmosis, given he had not consistently been getting medications. . at the time of discharge to rehab, the patient's mental status and motor function had been improving on the consistent toxoplasmosis therapy. after about 2 weeks of consistent toxoplasmosis therapy, the patient's brain will be re-imaged via mri w/ gadollinium. if the patient's lesions have not improved after therapy, primary cns lymphoma may be re-visited as a possibility. the patient will be followed by hiv/aids neurologist dr. and infectious disease team at , dr. . . seizure prophylaxis was continued with keppra. . 2. cryptococcus antigen was detected in the blood stream, but not in the csf. the patient was started on iv ambisome, but therapy was switched to fluconazole after the patient's renal function worsened. the patient remained on fluconazole throughout the hospital stay, and should continue until advised to stop by infectious disease doctors an outpatient. . 3. hbv. during the hospital stay, the patient's serum hbv viral load was measured as 2,460,000 iu/ml. his liver enzymes were also initially elevated, likely in part to the hepaitis b, but they trended down to the normal range. . 4. hiv/aids (cd4: 36, vl 14,700 in ) during the hospital stay, patient was on truvada/kaletra. these medications were stopped partway through the hospital course because of increasing creatinine and inability to administer po medications consistently ( patient refusal or vomiting). truvada/kaletra were were started with renal dosing. * his creatinine should be monitored closely, every one to two days, now that his haart medications have been restarted. . patient also has been receiving prophylaxis weekly on wednesdays with azithromycin 1200 mg. . 5. acute renal failure patient's cr rose during the hospital stay from 1.5 on admission to as high as 2.3. cr on discharge was 1.8. it was thought that the rise was most likely secondary to drug effect, especially ambisone, and to a less degree truvada and bactrim. * his creatinine should be monitored every day or every other day since he has just recently restarted his haart medications--their dosing may need to be adjusted accordingly. . 6. blood pressure patient was continued on medications for his hypertension, and has been titrated up to 100mg metoprolol , now that he can reliably get po medications. he may need further titration of his medication or additional , such as amlodipine. . 7. diabetes patient's blood sugars were under good control- 100's to 140's range, however he was taking very little po during most of his stay. he was kept on a sliding scale of insulin, however may need a baseline insulin or additional as he restarts his tube feeds. . 8. poor appetite speech and swallow have evaluated patient due to poor intake, as there was concern he was having dysphagia or other neurological problems with eating. it was found that he does not appear to have any risk of aspiration or other difficulties eating or swallowing--however, he does not appear to be interested in eating many of the hospital foods. given his other medical co-morbidities, we deferred initiating any appetite stimulant, however this is something that may be considered in the future. another option would be to decrease the rate of his tube feeds to stimulate hunger, although patient denies feeling hungry all of the time. . a gastric-jeujonostomy tube was placed on , and tube feeds were initiated, working up to a goal of 95ml/hr with replete with fiber, full strength, and he was at 75ml/hr at time of discharge, going up by 10ml/hr every 6 hours as tolerated. he was receiving 50ml of free water for flushes as well every 6 hours. reglan and a ppi was continued to assist with reflux, bowel motility and any nausea. . for the gj tube site, intraventional radiology recommended changing dressing daily. gently cleanse around the skin entry site of the catheter with dilute hydrogen peroxide. dry and apply sterile gauze dressing. an abdominal binder is being used to keep it in place. . 9. anemia: his anemia has been stable. iron studies were consistent with anemia of chronic disease, and it was also thought that a number of his medications, especially bactrim, were contributing to his anemia. . 10. health care proxy: his health care proxy was determined to be long time partner, , and the hcp form was signed. . 11. vascular access: picc line was left in for ease of daily lab draws. medications on admission: (per last discharge, patient did not know medications and per family had not been taking them.) 1. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). disp:*180 tablet(s)* refills:*2* 2. levetiracetam 500 mg tablet sig: one (1) tablet po qam. disp:*30 tablet(s)* refills:*2* 3. levetiracetam 500 mg tablet sig: two (2) tablet po hs (at bedtime). disp:*60 tablet(s)* refills:*2* 4. nifedipine 30 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). disp:*30 tablet sustained release(s)* refills:*2* 5. emtricitabine-tenofovir 200-300 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. lopinavir-ritonavir 200-50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily) as needed for pcp . discharge disposition: extended care facility: hospital discharge diagnosis: primary diagnosis: - toxoplasmosis secondary diagnoses: - hiv/aids - hepatitis b - hypertension - diabetes mellitus, type 2 discharge condition: stable. discharge instructions: you were admitted due to fever and decreased mental status. a number of tests were done, including blood test, tests on your cerebral spinal fluid, and imaging, which demonstrated it was likely you had an infection in your . you should continue to take all of your medications as prescribed in order to treat the infection, as well as your underlying medical conditions and other illnesses. during your stay, you had difficulty eating enough and taking your medications, so a tube was placed to assist with getting you medications and nutrition. . you will need a follow up mri of your brain to assess how well the treatment is working. this has been scheduled for you on on the of , at 7am in the basement. you can call ( (#1) if you need to reschedule. you will need to follow up with neurology to discuss these results: neurology appointment: dr. at 3:30pm, 330 building, , , , ma. . follow up appointments with your primary care provider's covering physician (dr. ) and your infectious disease doctor, dr. , have also been set up: - , 11:30 am with dr. , community health center at , , ma. - , 9:00 am with dr. , community health center at , , ma. . please contact your primary care doctor or go to the emergency room if you experience fever, chills, drowsiness, new weakness, numbness, or tingling, chest pain, shortness of breath, abdominal pain, or other concerning symptoms. followup instructions: primary care physcian: dr. at community health. phone: . date/time: at 11:30am. , , ma. . infectious disease physcian: dr. , at community health. phone: . date/time at 9:00am, , , ma. . mri appointment: , of , 7:00 am, basement level. . neurology appointment: dr. at 3:30pm, 330 building, , , , ma. md procedure: venous catheterization, not elsewhere classified spinal tap incision of lung enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrojejunostomy diagnoses: acidosis anemia of other chronic disease unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified protein-calorie malnutrition candidiasis of mouth human immunodeficiency virus [hiv] disease chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta cryptococcosis antifungal antibiotics causing adverse effects in therapeutic use toxoplasmosis of other specified sites 

Answer: The patient is high likely exposed to