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: sulfamethoxazole/trimethoprim / lisinopril attending: chief complaint: fever to 103 degress, chills, fatigue, vomiting x 1 day major surgical or invasive procedure: none history of present illness: hpi: 39 year old man with aids, cd4 of 4 in , vl not done, who presented to the ed with 1 day of fevers to 103 degrees at home, rigors and chills. on day of admission, he also had 1 episode of nausea, vomited up food (non-bilious/ non-bloody) that has resolved. pt. notes chronic cough he associated with his thrush. also had episode of diarrhea 5 days ago that resolved. otherwise, the patient denies headache, visual changes, neck pain/stiffness, confusion, chest pain, sob, pleuritic cp, abdominal pain (has chronic tenderness epigastrically), urinary changes, new rash or joint pain. . on arrival to the ed he was found to have a temperature of 102.9 degrees, hr in 130s, sbp 106/61. also was found to have a lactate of 7.7, bicarb of 15 (normally in 20s), arf with cr of 2.5 (baseline 1.1-1.4). he was put on the must protocol and a left subclavian line was placed. his initial cvp was 4. mixed venous sat was 85%. blood cultures were drawn which grew bottles gram negative rods. he received doses of vanc/levo. his bp dropped to 70/30, and he received 5 l of ns, levophed started after 3 l and sbp 85. a-line placed - abg - 7.40/26/137, and the lactate improved to 1.5. he started making urine with up to 60 cc per hour. he was admitted to the micu. he was continued on the sepsis protocol in the micu and transfused with 2 units of blood for a hct of 18. he was weaned from levophedrine around 4 am and has since had a stable bp in the 110's. patient was then transferred to floor on , at that time he reported feeling much improved, but not quite at his baseline. he denies continued fevers or chills, abdominal pain, diarrhea, nausea, vomiting, or other concerns. he says he is currently almost blind from the cmv retinitis, and detect some light in his left eye. past medical history: 1. hiv since ', now with aids, cd4 of 4, complicated by klebsiella oxytoca pna with pos. bcx (pan-), bacteremia in , cytomegalovirus retinitis currently , oroesophageal candidiasis, oral hairy leukoplasia, toxo in , anal warts, lipodystrophy. 2. dermatitis. 3. hypertension. 4. hemorrhoids. 5. anemia. 6. leukopenia. 7. angioedema. 8. ulcerations. 9. herpes simplex. 10. shingles. 11. hepatitis b. 12. bacterial meningitis. 13. ef of 45% 14. peripheral neuropathy social history: lives in jp with his male partner. denies current alcohol use. smoked 1 ppd for 15 years, quit in . used to use marjuana, now on marinol. no ivda. family history: father had mi at age 41 mother had salivary cancer in her 60's physical exam: v: tm 102.9 tc 97.7 p 85 bp 109/69 r20 99% ra gen: cachectic, blind, pleasant man in no apparent distress skin: molluscum contagiosum over face. port-o-cath r chest nontender, no erethema heent: pupils 3mm and equal but not reactive to light. op with thrush over palate and tongue resp: ctap b cv: rrr nl s1s2 ii/vi sem at rusb abd: soft ntnd +bs ext: no edema 2+ dp pulses neuro: cn 2-12 intact except for unreactive pupils. pertinent results: 8:50p ca: 7.7 mg: 1.0 p: 1.0 d other blood chemistry: cortsol: 37.5 normal diurnal pattern: 7-10am 6.2-19.4 / 4-8pm 2.3-11.9 7:12p lactate:7.7 comments: verified 6:30p 133 101 34 / agap=21 -------------183 3.6 15 2.5 \ alt: 44 ap: 461 tbili: 0.6 alb: 3.1 ast: 46 ldh: dbili: tprot: : 69 lip: 44 91 6.3 \ 7.1 / 213 / 23.8\ n:90 band:6 l:2 m:1 e:0 bas:0 metas: 1 nrbc: 1 comments: verified by replicate analysis notified dr. in er @ 19:20 pm hypochr: 2+ anisocy: 1+ poiklo: 1+ macrocy: 1+ ovalocy: 1+ pencil: occasional tear-dr: occasional comments: manual plt-est: normal pt: 13.3 ptt: 40.0 inr: 1.1 micro: 13. immunology (cmv) cmv viral load-pending; 14. blood culture ( myco/f lytic bottle) blood/fungal culture-preliminary; blood/afb culture-preliminary; 15. blood culture aerobic bottle-final {klebsiella oxytoca}; anaerobic bottle-final {klebsiella oxytoca}; 16. urine urine culture-final {enterococcus sp., enterococcus sp.}; 17. blood culture aerobic bottle-pending; anaerobic bottle-final {klebsiella oxytoca}; 18. catheter tip-iv wound culture-final; cxray: focal patchy opacities in the right mid zone and probably in the right lower and left lower zones. given the history, these most likely represent infectious infiltrates. no chf or gross effusion. renal, abdominal u/s: impression 1. contracted gallbladder with thickened wall, likely related to postprandial state. 2. small amount of ascites. 3. echogenic, enlarged kidneys, consistent with hiv nephropathy. no evidence of hydronephrosis. brief hospital course: a/p: 39 year old man with hiv cd4 4 in with gnr bacteremia and fever. 1) presumed line infection - patient had gram negative bacteremia, kelbsiella ocitoca sensitive to levo in blood cultures. follow up blood cultures negative. most likely source is the patient's port-o-cath though it is not clinically infected. id consulted and made recommendation to remove port. the patient was evaluated by surgery (dr. who states that if the line is taken out, it would be next to impossible to place another port-o-cath in. in consultation with dr. and the patient the decision is made to attempt to treat though the line with a 14 day course of levofloxacin and monitor for signs of infection. of not a cxray showed a rml diffuse infiltrate. sputum showed 4+ year and normal oral flora. gi stool cultures were negative to date. cmv viral load is pending at time of discharge. also, urine was positive for enterococcus sensitive to levo. 2) - pt. has baseline transaminase elevation, but alk phos has increased from 200s in to > 400. ggt elevated to 497 but down from past results. ruq showed contracted gall bladder and small amount of ascitis. 3) acute on chronic renal failure - possibly related to sepsis vs med related or hiv nephropathy. baseline cr 1.5 in , now elevated to 2.5. renal u/s showed no hydro but enlarged kindeys consistent with hiv nephropathy. no casts were noted. fena was 4.4 without diuretics, which suggests that it is most likely hiv nephropathy at new baseline . creatinine improved to 1.6 on dicharge. patient will follow up with renal as outpatient. 4) hisstory of hypotension, resolved - patient was admitted on the must protocol: in the icu, his cvp was kept with 1 l ivf boluses, uo > 30 cc/ hr with prn 1 l ivf boluses; monitor svo2, random cortison was normal. he was weaned off levophed after a few hours. his hypovolemia may have been partially due to hypovolemia and parially due to sepsis. . 5) anemia - patient withchronic anemia, likely related to bone marrow suppression from hiv or related meds. he has required transfusions in the past and had 2 units in-house. . 6) hiv - haart therapy was discontinued during hospitalization it will be restarted as outpatient. in house patient was maintained on clarithromycin for prophylaxis, and dapsone for pcp . patient was maintained on clindamycin and pyrimethamine for history of toxoplasmosis. patient maintained on clotrimazole troche for thrush. patient placed on posaconazole (study drug) qid for refractory oral thrush. . 4) cmv retinitis - on discharge the decision was made to hold foscarnet therapy until patient's creatinine remains stable. the plan is to continue foscarnet as maintenance therapy (rather than treatment therapy as patient has already suffered visual loss from the disease.) the treatment plan is to prevent extrocular manifestations of cmv. . 5) prophylaxis - patient maintained on ppi, heparin sq and colace. . 6) access - during hospitalization a l subclavian placed , patient will be discharged with portacath. . 7) fen - normal diet, boost tid . 8) code - full code - of note, patient says "short course of intubation" acceptable and plans to discuss with his partner. 9) dispo - home with services. of note, patient receives approximately 6 hours of vna services (from 10:00-4:30) patient reported sometimes being alone from 4:30-8:00 p.m. until his partner came home for which he requested some companionship, especially given his recent blindness. however, the patient did not feel unsafe during these time. we will discharge the patient with his current services in place and attempt to find additional support through community assistance and care-for-the-blind programs. we also make recommendations through his vna to provide additional support for education for the blind. medications on admission: according to omr and patient aldara 5%--apply to molluscum contagiosum twice a day as needed atarax 25mg--take one by mouth three times a day as needed ativan 0.5mg--one by mouth q 6 hrs as needed for anxiety boost --drink one can three times a day calcium carbonate 500mg--one by mouth three times a day clarithromycin 500 mg--take one by mouth twice a day clindamycin hcl 300mg--take one by mouth three times a day clotrimazole 10 mg--one dissolved in your mouth four times a day as needed dapsone 100mg--take one by mouth every day dronabinol 2.5mg--take one by mouth twice a day epogen u/ml--40,000 units sq weekly (prn in the past) foscarnet sodium 24mg/ml--4186 mgs iv q 12 hrs imodium a-d 2mg--take one by mouth four times a day as needed for diarrhea kaletra 33.3-133.3--take three by mouth twice a day ketoconazole 2%--apply topically twice a day to affected areas lamivudine 150mg--take one by mouth twice a day leucovorin 5 mg--take two by mouth every day loratadine 10mg--take one by mouth every day (?) neupogen 300mcg/ml--300 mcg sq every day as directed (in past) neurontin 100mg--one by mouth three times a day normal saline 0.9%--1000 cc infusion before each foscarnet dose; two week supply pyrimethamine 25 mg--take three by mouth every day ritonavir 100mg--take one by mouth twice a day tenofovir 300 mg--take one by mouth every day trazodone hcl 50mg--take one by mouth at bedtime as needed zyrtec 10mg--one by mouth every day discharge disposition: home with service facility: uphams corner home care discharge diagnosis: kleibsiella sepsis, enterococcus uti, arf discharge condition: stable discharge instructions: please return if you experience fever, chills, chest pain, shortness of breath followup instructions: follow up with nephrology, (, in weeks for possible biopsy. provider , rn,ms,: dermatology phone: date/time: 12:30 provider , .d. where: phone: date/time: 9:30 provider , rn,ms,: dermatology phone: date/time: 1:45 procedure: venous catheterization, not elsewhere classified transfusion of packed cells diagnoses: anemia of other chronic disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere urinary tract infection, site not specified acute kidney failure, unspecified severe sepsis human immunodeficiency virus [hiv] disease hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other septicemia due to gram-negative organisms infection and inflammatory reaction due to other vascular device, implant, and graft cytomegaloviral disease viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta chorioretinitis, unspecified 

Answer: The patient is high likely exposed to