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: history of present illness: this is a 57 year old male with end-stage human immunodeficiency virus, acquired immunodeficiency syndrome with a multi-drug resistant organism and a cd4 count of 59 who presented with epistaxis and altered mental status. the patient was admitted to a hospital in from , to with dyspnea and weakness and found to have an ejection fraction of 25%. it was at that time he was started on lasix and aldactone. he was readmitted in and had a complicated intensive care unit course requiring tracheostomy and hemodialysis for acute renal failure. he was transferred to - on , where he was weaned off of the ventilator. his tracheostomy was removed. he was also treated at that time for vancomycin-resistant bacteremia and pseudomonal pneumonia and a chronic diarrhea without a clear source. his renal failure resolved to the point where he no longer required hemodialysis and he was transferred to on . while at rehabilitation he developed an acute episode of epistaxis and it was unable to be stopped with ice and compression. in addition he had altered mental status which was difficult to assess on top of his baseline human immunodeficiency virus dementia. he was sent to the emergency department for treatment of his acute anemia. while in the emergency department, he developed hypotension with systolic blood pressure in the 70s which did not respond to aggressive intravenous fluid hydration and he was started on dopamine for pressure support and transferred to the intensive care unit. past medical history: end-stage human immunodeficiency virus acquired immunodeficiency syndrome, cd4 count of 59, viral load greater than 100,000. he was diagnosed in , failed multiple heart regimens. he had pneumocystis carinii pneumonia in . type 2 diabetes. acquired immunodeficiency syndrome-related lymphoma, status post chop with six cycles in and intrathecal cytarabine, human immunodeficiency virus cardiomyopathy with an ejection fraction of 25%, pancytopenia, status post appendectomy, status post tonsillectomy, depression, history of fatty liver, history of clostridium difficile colitis, recent history of acute renal failure requiring temporary hemodialysis. allergies: sulfa causes a rash. medications on admission: neurontin 100 mg t.i.d., opium 1 ml t.i.d., ativan 1 mg q. 4 hours prn, neupogen 480 q. day, magnesium oxide 400 q.i.d., loperamide 1 to 2 mg q. 4 hours prn, klonopin 0.25 q. am, azithromycin 1250 mg q. monday, bactrim single strength daily, coreg 50 b.i.d., protonix 40 daily, sodium bicarbonate 250 t.i.d., nph insulin 5 units q. am. family history: mother had leukemia. father died of a cerebrovascular accident. social history: the patient drinks one to two drinks per week, smoked three packs per day for 20 years, quit smoking ten years ago. he has lived with his partner of 40 years. physical examination: temperature 99.3, heart rate 98, blood pressure 80/44, respiratory rate 16, on oxygen saturation 100% room air. general: chronically ill-appearing man, cachectic, frequently screaming, redirectable, though confused. head, eyes, ears, nose and throat: left nares filled with blood and clot, no active bleeding, right nares without evidence of bleeding. pupils, pinpoint bilaterally. extraocular muscles intact. dry mucosal membranes. supple neck, no lymphadenopathy. evidence of prior tracheostomy. chest, crackles at the left base, decreased breath sounds at the right base. left chest, tunnel catheter for hemodialysis without evidence of infection. cardiovascular examination, tachycardiac, loud s2, no murmurs appreciated. abdomen, soft, nontender, nondistended, positive bowel sounds, guaiac negative stool. extremities, no lower extremity edema. calf, muscle wasting, skin, warm and dry. neurological examination, oriented to self, place "" and year. cranial nerves ii through xii grossly intact. positive asterixes, moves all four extremities, but not cooperative with examination. skin, stage 1 decubitus ulcer over the sacrum, no signs or symptoms of infection. laboratory data: white blood cell count 7, hematocrit with a drop to 26 from 29 down to 21, platelets 70, mcv 92, sodium 138, potassium 3.9, bicarbonate 19, bun 34, creatinine 1.3, alt 38, ast 76. chest x-ray showed congestive heart failure, new right upper lobe nodular density. computerized tomography scan of the sinuses revealed no obvious neoplastic source for the epistaxis. hospital course: 1. epistaxis - the patient was seen by otorhinolaryngology in the emergency department. there was no evidence of posterior pharyngeal or posterior nasal bleeding. silver nitrate and topical cocaine were applied in the emergency department, and the bleeding stopped. however, secondary to his acute anemia, the patient required blood transfusion with 3 units of packed red blood cells. he also received six packs of platelets in the emergency department for his acute anemia in the setting of thrombocytopenia. 2. hypertension - the patient was transiently placed on dopamine for pressure support when his hypertension did not respond to fluid resuscitation in the emergency department. he was admitted to the medical intensive care unit over night for hemodynamic monitoring. the patient was quickly weaned off of dopamine the following day and was transferred to the floor. 3. congestive heart failure - several hours after being transferred to the floor the patient developed acute respiratory distress with hypoxia. at that time his oxygen saturation was in the mid 80s on room air. he was tachypneic with a respiratory rate of approximately 50. he had clinical evidence for congestive heart failure and flash pulmonary edema, and appeared to be in a combined cardiogenic and septic shock. the patient was at that time treated for both with a progressive diuresis, nitroglycerin and morphine. in addition he was dosed with zosyn and vancomycin for potential nosocomial infections of either a pulmonary or a gastrointestinal source. after approximately 36 hours, the patient had diuresed and his respiratory status slowly improved. the patient no longer required intravenous lasix and he was started on metronidazole to treat a clostridium difficile infection. 4. clostridium difficile infection - the patient will be discharged on a course of oral metronidazole to treat his clostridium difficile infection. he will take an additional ten days to complete a 14 day course. 5. code status/goals of care - the patient had multi-drug resistant human immunodeficiency virus with human immunodeficiency virus acquired immunodeficiency syndrome-related lymphoma and cardiomyopathy. after multiple discussions with the health care proxy , the medical team, social work and case management, the goals of care were shifted to comfort measures. it was felt that the patient's life expectancy was less than six months at this time and that he would not benefit from aggressive treatment. the patient will be treated with oral morphine and ativan for comfort and agitation, and will complete a course of antibiotic treatment for clostridium difficile infection. he will be discharged to a hospice facility or a skilled nursing facility with hospice benefit. condition on discharge: fair with life expectancy of four to six months. discharge status: to hospice or skilled nursing facility with hospice benefits. discharge instructions: please follow with primary care physician, . , if you have any questions. discharge diagnosis: 1. end-stage human immunodeficiency virus. 2. acquired immunodeficiency syndrome. 3. acquired immunodeficiency syndrome-related lymphoma. 4. human immunodeficiency virus cardiomyopathy. 5. congestive heart failure with an ejection fraction of 25%. 6. pancytopenia. 7. type 2 diabetes. 8. hypertension. 9. human immunodeficiency virus dementia. 10. renal insufficiency. 11. clostridium difficile colitis. medications on discharge: 1. metronidazole 500 mg p.o. t.i.d. for ten days. 2. lorazepam 1 to 2 mg sublingual q. 4-6 hours prn or agitation or anxiety. 3. olanzapine disintegrating tablet, 5 mg p.o. q.h.s. 4. morphine sulfate, oral solution 10 to 20 mg p.o. q. 2-4 hours prn for pain or shortness of breath. dr., 11-378 dictated by: medquist36 procedure: transfusion of packed cells diagnoses: congestive heart failure, unspecified acute posthemorrhagic anemia human immunodeficiency virus [hiv] disease hypotension, unspecified intestinal infection due to clostridium difficile encounter for palliative care cardiomyopathy in other diseases classified elsewhere 

Answer: The patient is high likely exposed to