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: hypotension, fever major surgical or invasive procedure: left radial arterial line picc removal picc placement bronchoscopy post-pyloric peg advancement ; revision on history of present illness: mr. is a 70m with hiv (cd4 350 in ), scc s/p rll lobectomy complicated by bronchopleural fistula treated with window, as well as empyema and invasive aspergillosis treated with voriconazole referred from for hypotension and fever to 101.8. he was recently admitted from to with aspiration pna, pcp pneumonia and septic shock. his antibiotic course of vanco/cefepime/cipro was completed on . he subsequently developed hypotension to 70/40, refractory to 5l ivf, on the day prior to admission. this morning he was given doses of vanco//cipro. en route from , he was hypotensive, so the ambulance stopped at er. supposedly, no major interventions were done (paperwork is now lost). in the ed here at , vs were hr 110's, sbp 110-120's. he received hydrocortisone 100 mg iv. cannot review ros with patient on arrival due to being on the vent. past medical history: -- trach and peg placed last admission -history of multivessel cad s/p pci of the proximal left circumflex with a bare metal stent w/ dr. ( hospital) -hiv-infection, diagnosed in , well-controlled. currently on truvada and raltegravir. last reported cd4 count 354 (), viral load <48 copies. pt states that his vl has always been undetectable -chronic lv dysfunction last ef 55% -severe migratory polyarthritis, on prolonged high-dose steroid use for presumed "adrenal insufficiency" -moderate mr -herpes labialis -tmj -b/l inguinal hernia repair -scc s/p rll lobectomy complicated by bronchopleural fistula treated with window, as well as empyema and invasive aspergillosis social history: currently residing in rehabilitation. the patient is not married and lives alone. he has a history of 150 pack-year, stopped smoking in . he does not drink alcohol. hiv sexually transmitted. family history: his mother had cva/stroke. physical exam: vitals on arrival to the micu: t 99.2, 113, 116/73, 100% on ps and fo2 general: sitting with eyes closed, trached on vent heent: sclera anicteric, dry mm, poor dentition, left slightly greater tha right, both pupils reactive to light, arcus sensilus pupil (stable) neck: hard to assess jvd, trached, connected to vent lungs: rhonchorus, coarse rales; r-sided chest dressing c/d/i cv: regular fast rate, no murmurs appreciated abdomen: + bs, soft, ntnd, diffuse ecchymoses c/w lovenox shots; old sutures retained in llq (cdi); peg site with minimal erythema and no discharge skin: scattered, diffuse telangiectasias (not spiders) scatter on face/chest/limbs; friable skin with some areas of eschar on chest, do not appear superinfected ext: warm, dry +pp no edema neuro: sleepy, arouses when spoken to ; hard to understand paie witht pmv but he attept to answer questions pertinent results: admission labs: notable for lipase 215, bun10, cr 0.3, wbc 15.7 with 4% bands, hct 25.4, plt 637 lactate 1.0 ast: 97 alt: 76 ap: 170 tbili: 0.2 ua negative imaging: ct torso with contrast: 1. small volume of pneumoperitoneum in the setting of interval recnetly placed percutaneous gastrostomy tube. would correlate to the timing of the tube placement as this is a likely etiology if very recently placed. 2. widespread reticular and ground-glass opacities as well as more dense consolidation in the left lung, progressed from the recent comparison study, concerning for infectious process. 3. increased size and prevalence of multiple mediastinal lymph nodes, possibly reactive given the findings in the lungs. followup upon resolution of symptoms is recommended. 4. endobronchial material partially occluding the right mainstem bronchus, slightly increased since the previous study. 5. trace pelvic free fluid. 6. numerous spinal compression deformities, similar to the recent comparison. bronchial washing: -- negative for malignant cells barium study via peg to evaluate for reflux/aspiration: no evidence of gastroesophageal reflux after injection barium through the patient's peg tube. however, patient cooperation is required for complete evaluation for reflux and due to the patient's waxing and alertness, the study was limited. : bilateral leni's no evidence of dvt in right or left lower extremity. cxr: multifocal consolidation of left lung is stable since . microbiology: blood cultures x 2: negative mycotic blood cultures: negative blood culture: negative blood culture: pending, ngtd urine culture: negative urine legionella: negative bronchioalveolar lavage: respiratory culture (final ): yeast. 10,000-100,000 organisms/ml.. legionella culture (final ): no legionella isolated. potassium hydroxide preparation (final ): no fungal elements seen. immunoflourescent test for pneumocystis jirovecii (carinii): negative fungal culture (preliminary): yeast. of two colonial morphologies. nocardia culture (preliminary): no nocardia isolated. viral culture: r/o cytomegalovirus (preliminary): no virus isolated so far. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): no mycobacteria isolated. beta-glucan: >500 pg/ml beta-glucan: >500 pg/ml * titers requested on on both of these above. levels were pending on discharge. aspergillus galactomannan antigen: 0.1 (negative) aspergillus galactomannan antigen: 0.1 (negative) voriconazole level: added on to am labs from . level penidng at discharge; it is a send out lab. brief hospital course: mr. is a 70 yo m h/o hiv, (cd4 350 in and vl undetect), scc s/p rll lobectomy complicated by bronchopleural fistula involving aspergillosis treated with window- open to air, as well as empyema and invasive aspergillosis treated with voriconazole referred from for hypotension and fever secondary to a recurrent pneumonia. # hypotension/pneumonia: he completed a 10 day course of vancomycin, ciprofloxacin and cefepime at rehab for hap. upon admission, he was started empirically on vancomycin, meropenem and ciprofloxacin, as well as voriconazole given his history of aspergillus infection. he completed an eight day course of vancomycin and meropenem. ct chest showed widespread reticular and ground-glass opacities as well as more dense consolidation in the left lung. a bronchoscopy was performed on that showed no evidence of malignancy or fungus. bacterial cultures were negative, however several bacterial and fungal cultures were preliminary reports. beta glucan test was >500 and galactomanan was negative on two separate measures. given these findings and the patient's history of aspergillus infection, the infectious disease doctors the should remain on life long voriconazole. there is a voriconazole level and b glucan titer pending at time of discharge that will be followed by his id physicians at . pt scheduled to f/u with drs. and in 2 weeks and 6 weeks. . # aspiration: barium study on showed no reflux, though it was a poor study because of inability to cooperate with valsalva manuver. suspicion for recurrent aspiration remained high, especially because nursing staff noted bilious secretions. an ir guided advancement of his gastric tube to post-pyloric positioning was performed without difficulty. unfortunately, this tube broke and had to be replaced by ir on . it is recommended that patient remain on continuous tube feeding through the jejunal tube. . # oral secretions: pt started on scopolamine patch to assist management of oral secretions. would suggest continuing this medication. . # anemia: patient's hematocrit remained in the low to mid-20s. he required one blood cell transfusion for a hematocrit of 20.1. this was not felt to be active bleeding. he was started on iron supplements. his hematocrit should be trended in the rehab facility. hct at discharge was 23.2. # hiv: continued on home haart medications.recommend continuing home haart regimen and following up with dr. () after discharge from rehab. # cad: patient with known history of cad s/p pci. during admission he was continued on aspirin and statin. his metoprolol was restarted at a lower dose of 12.5 q 8 hours as his blood pressure could not tolerate higher doses. # bp fistula/ window: no evidence of infection during hospitalization. dressing changes daily during hospitalization. patient has a follow up scheduled with is thoracic surgeon. he will continue to require daily dressing changes. . # nutrition: nutren pulmonary full strength; additives: banana flakes, 3 packets per day; starting rate: 20 ml/hr; advance rate by 10 ml q4h goal rate: 50 ml/hr residual check: q4h hold feeding for residual >= : 150 ml flush w/ 50 ml water q6h . # respiratory status: would continue to wean off vent support as tolerated. pt reports continued fatigue with prolonged periods of trach collar which likely represents muscle fatigue. . # glycemic control: fsbs qid with sliding scale insulin . # lines: picc on admission removed and new picc placed . tip grew coag negative staph considered a contaminant. . # prophylaxis: - continue lovenox 40 mg sc daily for dvt prophylaxis. - continue ranitidine 150 mg daily for stress ulcer prophylaxis while on ventilator. - continue vap prophylaxis with mouth care while using ventilator # contact: sister # status: dnr (confirmed with sister his hcp) pending issues for follow-up: 1. voriconazole level from was pending at time of discharge. voriconazole dosing should be tailored appropriately. 2. beta-glucan titers from and were pending at time of discharge. these were ordered at the suggestion of the id service consulting on him. they recommended voriconazole 300 mg for lifelong therapy (see above), though this may need to be adjusted pending results of the titers. medications on admission: vancomycin, meropenem, ciprofloxacin --> restarted miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for yeast. enoxaparin 40 mg/0.4 ml syringe sig: one (1) inj subcutaneous daily (daily). ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob/wheeze. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob/wheeze. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). prednisone 2.5 mg tablet sig: three (3) tablet po daily (daily). sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). sulfasalazine 500 mg tablet sig: two (2) tablet po bid (2 times a day). ferrous sulfate 300 mg (60 mg iron)/5 ml liquid sig: five (5) ml po daily (daily). gabapentin 300 mg capsule sig: one (1) capsule po q8h (every 8 hours). escitalopram 10 mg tablet sig: four (4) tablet po daily (daily). ranitidine hcl 15 mg/ml syrup sig: ten (10) ml po daily (daily). tenofovir disoproxil fumarate 300 mg tablet sig: one (1) tablet po daily (daily). emtricitabine 200 mg capsule sig: one (1) capsule po q24h (every 24 hours). raltegravir 400 mg tablet sig: one (1) tablet po bid (2 times a day). atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). acetaminophen 650 mg/20.3 ml solution sig: 1-2 doses po q6h (every 6 hours) as needed for fever. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 2-4 puffs inhalation q6h (every 6 hours) as needed for sob/wheeze. neutra-phos 2 pkt po/ng sliding scale humalog insulin at meals and bedtime discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. enoxaparin 40 mg/0.4 ml syringe sig: one (1) subcutaneous daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 6. sulfasalazine 500 mg tablet sig: one (1) tablet po qid (4 times a day). 7. gabapentin 300 mg capsule sig: one (1) capsule po q8h (every 8 hours). 8. escitalopram 20 mg tablet sig: two (2) tablet po once a day. 9. ranitidine hcl 15 mg/ml syrup sig: one y (150) mg po daily (daily). 10. tenofovir disoproxil fumarate 300 mg tablet sig: one (1) tablet po at bedtime. 11. emtricitabine 200 mg capsule sig: one (1) capsule po at bedtime. 12. raltegravir 400 mg tablet sig: one (1) tablet po bid (2 times a day). 13. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 14. prednisone 2.5 mg tablet sig: three (3) tablet po daily (daily). 15. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for sob, wheezing. 16. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob, wheezing. 17. scopolamine base 1.5 mg patch 72 hr sig: one (1) patch 72 hr transdermal q72hr () as needed for secretions. 18. acetaminophen 500 mg tablet sig: 1-2 tablets po q8h (every 8 hours) as needed for pain, headache. 19. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for sleep. 20. voriconazole 200 mg tablet sig: 1.5 tablets po q12h (every 12 hours). 21. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 22. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 23. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po q 8h (every 8 hours). 24. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day) as needed for cleaning. discharge disposition: extended care facility: - discharge diagnosis: primary: aspiration pneumonia secondary: respiratory failure hiv h/o aspergillus infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. trached on vent discharge instructions: you were admitted for low blood pressure and a fever. you were found to have an aspiration pneumonia. we treated you with antibiotics. we also advance your gastric tube to help prevent aspiration. you tolerated this procedure well. the infectious disease doctors should continue your anti-aspergillus antibiotic, voriconazole for life. your medication changes include: start: 1. voriconazole 300 mg twice per day 2. scopolamine patch every 72 hours as needed for excess secretions 3. trazadone 25 mg every evening as needed for insomnia 4. ferrous sulfate 300 mg daily decrease: 1. metoprolol to 12.5 mg every eight hours followup instructions: provider: , md phone: date/time: 11:00 provider: . (infectious disease) date/time: at 10am phone: , medical office bldg . provider: . (infectious disease) date/time: at 11am phone: , medical office bldg procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances arterial catheterization closed [endoscopic] biopsy of bronchus percutaneous [endoscopic] gastrojejunostomy replacement of tube or enterostomy device of small intestine diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified septicemia severe sepsis personal history of malignant neoplasm of bronchus and lung percutaneous transluminal coronary angioplasty status human immunodeficiency virus [hiv] disease acute and chronic respiratory failure pneumonitis due to inhalation of food or vomitus septic shock hypovolemia glucocorticoid deficiency chronic diastolic heart failure aspergillosis tracheostomy status empyema with fistula attention to other artificial opening of digestive tract 

Answer: The patient is high likely exposed to