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: penicillins attending: chief complaint: abdominal pain, weight gain major surgical or invasive procedure: none history of present illness: mr. is a 36 year old male with severe biventricular cardiomyopathy, ef 10%, hiv since (not on haart), depression, recent diagnosis of hepatitis presenting with 1 week of progressive dyspnea, abdominal pain/distention, pnd/orthopnea, and tachycardia. he reports that his abdominal pain was persistent ever since his last admission and has been progressively worsening for the past month. mainly located in the epigastrum and ruq, intermittently with right shoulder pain as well. has had nausea today only, no vomiting. he also endorses progressive weight gain since his discharge one month ago when he was 164 lbs, now reportedly 184 lbs. has had looses, yellow stools, /day for the past week. denies any hematochezia/melena. he has had very poor sleep due to the pain and took 2 tylenol pm a night for the past nights. stopped taking his meds on monday and tues and felt much better, resumed meds on wed and symptoms returned. has been feeling dehydrated so stopped following fluid restriction and started drinking 3000-4000 ml daily. also reports increasing abdominal pain and distention and bloating of his face. . of note he was recently admitted from with dyspnea and fatigue and was found to have cardiomyopathy with ef 10%. he was initially admitted to the ccu and treated with lasix gtt for diuresis with improvement of symptoms. cardiomyopathy felt most likely to be toxine from crystal meth vs viral. he was newly diagnosed with hcv however seen by gi and not felt to be acute infection. he had high spiking of fevers to 103 and initially treated with vanc/gent, followed by id however no infection ever identified and abx d/c'd and fevers attributed to viral illness. . in the ed, initial vitals were t 100.4, hr 133, 120/86, rr 24 100%?. he triggered on presentation for tachycardia and tachypnea. he had bedside ultrasound in the ed reportedly showing "ivc full, no resp variation, fluid in pouch, likely ascites. gb difficult to visualize". he was give 37.5mg metoprolol, morphine 4mg iv x2, zofran 4mg iv x2. during ct scan iv infiltrated about 15-20 cc contrast in l arm, ice applied. he was started on ivf at 25 cc/hr. . vs prior to transfer: 97.8 118/82 101 25 100%2l past medical history: 1. cardiac risk factors: none 2. cardiac history: -dilated cardiomyopathy, ef 10% -cabg: n/a -percutaneous coronary interventions: n/a -pacing/icd: n/a 3. other past medical history: # hiv: last cd4: 627, vl: 2,880 copies/ml in -- diagnosed ~ -- mode of transmission: msm -- started on haart at time of diagnosis in ; stopped tx in when insurance ran out #depression #hpv #hepatitis c social history: social history: lives alone, msm with 1 male partner. as dog walker. tobacco: denies ever using tobacco. etoh:denies drinking any etoh recently, no h/o of abuse, drinks socially 1-2x/month. illicit drugs: iv crystal meth user, denies since discharge (). no cocaine or heroin. family history: - mother and many relatives of mother: diabetes - father: cva - no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission pex: vs: t=98.2 bp=105/72 hr=106 rr=32 o2 sat=100% 2l general: wdwn, oriented x3. mood, affect appropriate. speaking in full sentences, occasionally grimacing with pain but no acute distress, cooperative with exam and questions. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple, jvp elevated 4 finger breadths above the clavicle at 30 degrees cardiac: slightly tachycardic, systolic murmur lungs: resp were unlabored, no accessory muscle use. basilar crackles more on the right but otherwise ctab, no wheezes or rhonchi. abdomen: soft, ntnd, + bs, endorses pain with palpation in the epigastrum and ruq, no rebound or guarding. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars. discharge pex: vs: afebrile, 93-100/54-60, 80s, 14@97%(ra) general: wdwn, oriented x3. cooperative with exam and questions. weight: 78kg heent: ncat. sclera anicteric. perrl, eomi. neck: supple, jvp elevated ~9cm (also with tr, so less reliable) cardiac: regular, systolic murmurs at llsb and apex lungs: faint basilar crackles more on the right but otherwise ctab, no wheezes or rhonchi. abdomen: soft, nd, + bs, endorses stable ttp in the epigastrum << ruq, no rebound or guarding. extremities: no c/c/e. skin: no jaundice. pertinent results: relevant and representative labs: cbc: 08:54pm blood wbc-8.8# rbc-5.02 hgb-13.0* hct-41.7 mcv-83 mch-25.9* mchc-31.2 rdw-14.8 plt ct-242 08:44am blood wbc-6.4 rbc-4.33* hgb-11.9* hct-35.2* mcv-81* mch-27.4 mchc-33.6 rdw-15.2 plt ct-210 04:56am blood wbc-5.1 rbc-4.64 hgb-12.2* hct-37.6* mcv-81* mch-26.3* mchc-32.5 rdw-15.0 plt ct-233 coags: 08:19pm blood pt-15.5* ptt-27.2 inr(pt)-1.4* 08:44am blood pt-21.2* inr(pt)-1.9* 04:56am blood pt-15.5* inr(pt)-1.4* chem: 11:00am blood urean-20 creat-1.3* na-139 k-4.5 cl-105 hco3-20* 09:10am blood glucose-71 urean-31* creat-2.0* na-130* k-7.4* cl-102 hco3-14* 04:00pm blood glucose-79 urean-32* creat-2.0* na-137 k-4.2 cl-102 hco3-23 03:15pm blood glucose-153* urean-33* creat-1.5* na-136 k-3.6 cl-99 hco3-30 03:31am blood glucose-112* urean-31* creat-1.2 na-138 k-3.8 cl-101 hco3-31 04:56am blood glucose-97 urean-21* creat-1.0 na-139 k-3.6 cl-102 hco3-31 lfts: 11:00am blood alt-76* ast-56* alkphos-101 totbili-0.9 09:10am blood alt-472* ast-545* ck(cpk)-82 alkphos-102 totbili-2.0* 02:30am blood alt-2750* ast-3943* alkphos-99 totbili-1.9* 03:31am blood alt-* ast-1825* ld(ldh)-871* alkphos-100 totbili-1.3 04:56am blood alt-1519* ast-1117* ld(ldh)-476* alkphos-101 totbili-1.1 misc: 08:19pm blood ctropnt-<0.01 probnp-* 09:10am blood ck-mb-2 ctropnt-<0.01 probnp-* . , ruq u/s impression: 1. collapsed gallbladder with stable-to-minimally decreased wall thickening/edema. 2. mild ascites without pocket large enough to mark for blind paracentesis. if diagnostic paracentesis is still desired, ultrasound guidance is advised. 3. patent hepatic vasculature, including patent main portal vein with hepatopetal flow. . , echo, conclusions the left atrium and right atrium are moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis. the basal lateral wall and apex contract best (lvef = <20 %). the strain pattern suggests significant dyssnchrony. no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. moderate (2+) mitral regurgitation is seen. an eccentric jet of mild to moderate tricuspid regurgitation jet is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. **impression: biventricular cavity dilation and severe biventricular systolic dysfunction c/w diffuse process (toxin, metabolic, etc.) moderate mitral regurgitation. visual dyssnchrony. increased pcwp. compared with the prior study (images reviewed) of , left ventricular cavity size is smaller and the estimated pa systolic pressure is lower. . ct abd/pelv: 1. boderline cardiomegaly with small right simple pleural effusion. 2. opacification in left lung base likely atelectasis vs infection. 3. extensive ascites. 4. gallbladder wall thickened likely gb underdistension and third spacing related. 5. 19 x 16mm exophytic lesion arising from the interpolar region of the left kidney which may represent hemorrhagic cyst vs tumor; mri can be obtained on a nonemergent basis for further characterization. . ruq ultrasound: (wet read) 1. gb less thickened compared to prior. gallbladder is not distended. no pericholecystic fluid. overall appears improved compared to prior from . 2. scant simple perihepatic and the rlq and llq. . ct chest: 1. clear lungs. 2. enlarged cardiac silhouette again seen without pulmonary edema. 3. no evidence of free air beneath the diaphragms. brief hospital course: transition of care: -f/u: , anti-smooth ab -medication changes: start spironolactone 12.5mg qday, start lasix 10-20mg qday, hold lisinopril. -outpatient follow-up for hiv recommended -will have labs drawn prior to pcp f/u ================================================= mr. is a 36 year old male with severe biventricular cardiomyopathy, ef 10%, hiv since (not on haart), depression, recent diagnosis of hepatitis c presenting with 1 week of progressive dyspnea, abdominal pain/distention, pnd/orthopnea, tachycardia found to have pex consistent with fluid overload, elevated cre and lactate concerning for poor forward flow state. . # acute on chronic systolic heart failure with ef of 10%: nonischemic cardiomyopathy thought to be related to methaphetamine use vs viral (hiv, hcv, ) vs hiv or haart therapy. had only been on cardioprotective medications including lisinopril and metoprolol succinate since , so difficult to assess the recovery of lvef compared to one month ago. tte showed elevated left sided filling pressure. elevated bnp on admission, shortness of breath with doe and pnd, and hypoxia were likely due to acute on chronic systolic heart failure. attempted diuresis with lasix bolus on night of admission, but patient had tachypnea and resp distress on hd2. transitioned to lasix gtt given tachypnea and hypoxia, however, patient had hyperkalemia and acute kidney injury (see below). patient was transferred to ccu for management of k = 7.4, hypotension, tachypnea, and tachycardia. able to be aggressively diuresed in ccu on lasix gtt, then transitioned to torsemide 10mg qday. he continued to diurese >2l qday with torsemide 10mg, therefore, discharged on 10-20mg lasix qday depending on weight. also started spironolactone 12.5mg. continued metoprolol 12.5 mg po bid, but held lisinopril in context of . monitored daily weights, i/os. maintained patient on low salt diet and fluid restriction. tachycardia and bps improved after diuresis. of note, patient met with sw to discuss substance abuse and necessity for abstinence. would consider restarting ace-i as outpt if bp will tolerate. also need to evaluate patient for icd if systolic function remains low. weight at time of discharge 78kg. . # acute kidney injury: likely due to cardiorenal syndrome with poor forward cardiac flow along with component of ascites and abdominal wall edema compressing renal vein. continued to make urine. urine lytes indicated pre-renal state, but exam still consistent with fluid overload. as diuresed, cardiac output improved, as did cre and hyperkalemia. lisinopril was held in the setting of , and can consider restarting as outpt if bp will tolerate. . # elevated liver enzymes: patient's alt/ast uptrended from 76/56 (admission) --> 2750/3943, likely related to hepatic congestion from chf exacerbation vs shock liver from poor forward flow vs hepatitis c. ruq us did not show liver or gallbladder pathology, including cirrhosis. diuresed as above, and with diuresis, lfts downtrended. peak t. bili of 2.0; peak lfts 2750 (alt) and 3943 (ast). hepatology was consulted and agreed with plan of action. and anti-smooth pending at time of discharge. . # hyperkalemia: k = 7.4 on hd2, likely due to acute kidney injury. no iatrogenic potassium. was started on lasix gtt, given insulin + d50, cagluc, and kayexalate with resolution. resolved by time of discharge. . # anion gap acidosis: on hd2, patient with ag 15, likely due to acute kidney injury and lactic acidosis from bowel wall edema; resolved with diuresis and improved forward flow. resolved prior to discharge. . # hiv: off haart since secondary to medical insurance issues. most recent cd4 in was 627. will have outpatient follow up. . # hepatitis c: diagnosed during the last visit with hepatitis c viral load. ruq showed no signs of cirrhosis. liver function tests were elevated as indicated above, and downtrended with diuresis and improved forward flow. seen by hepatology. will have outpt follow-up. . # code status: full medications on admission: 1. lisinopril 2.5 mg po daily (pt self-d/cd ) 2. metoprolol 37.5mg po daily (pt self-d/cd ) 3. started on furosemide 20 mg po daily by dr. discharge medications: 1. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*0* 2. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 3. furosemide 20 mg tablet sig: 0.5-1 tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. outpatient lab work chem 7 and mag ast/alt/tbili/alk phos inr discharge disposition: home discharge diagnosis: primary: -congestive heart failure, acute on chronic -acute kidney injury -hyperkalemia secondary: -hiv -hepatitis c discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , you were admitted to with abdominal (belly) pain and shortness of breath. we think the abdominal pain was because your liver wasn't receiving enough blood, and your labs also indicated that your kidneys weren't being getting enough blood. part of the reason for this is that you had so much extra fluid that your heart was having even more difficulty pumping blood than usual. it is critically important that you maintain good fluid status, because even a small amount of extra fluid can result in a heart failure exacerbation with shortness of breath. weigh yourself every morning, md if weight goes up more than 3 lbs. you will need to have your blood drawn on prior to your appointment with your primary physician. can do this at any laboratory with the prescription provided. the following changes were made to your medications: -start spironolactone 12.5mg daily -start lasix 10 to 20mg daily --> take 10mg daily, and if your weight increases more than pounds, call your physician who may direct you to take 20mg or more followup instructions: department: when: friday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac services when: @ 8:30am with: , md building: campus: east best parking: garage md procedure: central venous catheter placement with guidance diagnoses: other primary cardiomyopathies hyperpotassemia congestive heart failure, unspecified acute kidney failure, unspecified acute on chronic systolic heart failure hepatitis, unspecified asymptomatic human immunodeficiency virus [hiv] infection status 

Answer: The patient is high likely exposed to