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: erythromycin base / biaxin / ciprofloxacin attending: chief complaint: fever, chills major surgical or invasive procedure: mechanical ventilation arterial line placement hemodialysis line placement internal jugular central line placement history of present illness: 57m with hiv (last cd4 525 with vl undetectable ~2 months ago) presents with acute onset of fever, chills, and extreme weakness several hours prior to presentation. he was at his office working feeling in his usual state of health until about 9pm last night. at that time, he developed abrupt onset of fever, chills, hot flashes. +nausea. no vomiting. no cough, sob, chest pain. no urinary symptoms. no sick contacts. had episode like this before. no recent travel. . in the ed, initial vitals were t 102.5, bp 118/65, hr 116, rr 20, 94% ra. his bp dropped to 70/30s at one point but improved with ivf. bp then dropped again. r ij was placed. levophed was started. he remained persistently tachy to 120-130s. labs notable for lactate of 2.5, no leukocytosis, hct 49. ua neg. cxr unremarkable. admitted to micu for closer monitoring. . on arrival to the micu, the patient's main complaint is feeling very thirsty. he also has severe back and knee discomfort chronic arthritis pain and lying flat on his back. sbp dropped again to as low as 60s. vasopressin and neosynephrine were added to bring up bp. . ros: as above. otherwise negative in detail. past medical history: hiv hep b, never been treated obesity hypercholesterolemia asthma r medial meniscal tear dm type 2 hx splenic abscess s/p splenectomy in social history: in long term relationship w/ partner. smoking. no alcohol. no drugs. family history: noncontributory physical exam: vs - t 100.9; bp 90/44; hr 120; rr 12; o2sat 92% on 4l gen: anxious appearing, obese male, diaphoretic, alert and interacting appropriately heent: perrl, eomi, dry mm, op clear cv: distant hs, chest: face tent, ctab, no w/r/r abd: obese, soft, nondistended, mild tenderness at ruq/mid-epigastrium ext: no le edema skin: no rash neuro: a+o x 3 pertinent results: 10:30pm blood wbc-9.4 rbc-5.26# hgb-16.2# hct-49.1 mcv-93# mch-30.8# mchc-33.0 rdw-14.3 plt ct-432 03:42pm blood wbc-24.9* rbc-4.68 hgb-14.3 hct-43.9 mcv-94 mch-30.5 mchc-32.6 rdw-14.6 plt ct-247 04:03am blood wbc-48.3* rbc-4.06* hgb-12.4* hct-37.1* mcv-91 mch-30.7 mchc-33.5 rdw-15.1 plt ct-23* 03:53pm blood wbc-45.6* rbc-3.29* hgb-10.4* hct-30.0* mcv-91 mch-31.6 mchc-34.6 rdw-16.4* plt ct-72* 04:10am blood wbc-17.4* rbc-2.59* hgb-8.2* hct-24.4* mcv-94 mch-31.6 mchc-33.5 rdw-17.1* plt ct-355# 06:30am blood wbc-8.2 rbc-2.53* hgb-8.0* hct-26.0* mcv-103* mch-31.6 mchc-30.8* rdw-19.2* plt ct-811* 06:00am blood wbc-9.5 rbc-3.04* hgb-9.6* hct-29.7* mcv-98 mch-31.5 mchc-32.3 rdw-19.5* plt ct-738* 06:30am blood wbc-8.2 lymph-20 abs -1640 cd3%-81 abs cd3-1333 cd4%-23 abs cd4-373 cd8%-58 abs cd8-953* cd4/cd8-0.4* 10:30pm blood glucose-133* urean-27* creat-1.0 na-137 k-4.4 cl-99 hco3-25 angap-17 03:00am blood glucose-79 urean-80* creat-6.6* na-147* k-5.1 cl-109* hco3-19* angap-24* 03:12am blood glucose-89 urean-73* creat-6.1* na-150* k-4.7 cl-110* hco3-18* angap-27* 06:40am blood glucose-86 urean-39* creat-3.1* na-145 k-4.1 cl-107 hco3-24 angap-18 10:45pm blood lactate-2.5* 12:17pm blood lactate-6.1* 10:21am blood lactate-2.0 03:53pm blood lactate-0.8 abdomen u.s. (complete study) study date of 8:29 am impression: 1. limited examination shows no gross intrahepatic biliary dilatation. 2. markedly edematous gallbladder, without stones or distension. the appearance of the wall can be seen in patients with underlying liver disease or hypoproteinemia. 3. fluid within the left upper quadrant, of uncertain etiology or location. differential considerations include a fluid-filled, distended stomach, vs. post- operative fluid within the splenectomy bed. 4. small amount of ascites. portable tte (complete) done at 11:43:53 am: left ventricle - ejection fraction: >= 55% the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. trace aortic regurgitation is seen. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. there is no pericardial effusion. impression: no vegetations seen (suboptimal-quality study). normal global and regional biventricular systolic function. in presence of high clinical suspicion, absence of vegetations on transthoracic echocardiogram does not exclude endocarditis. brief hospital course: mr is a 57 year old man with history of hiv, splenectomy, presented with acute onset of fever, chills and nausea. patient was evaluated in the ed where he spiked fever to 102.5 and developed acute hypotension requiring rapid escalation of care with 3 pressors and large volume resusitation for septic shock. . patient was in micu from where his course included xigris administration, cvvh for massive volume overload and treated with broad spectrum antibiotics. eventually the patient was weaned off of pressors, received one dose of ivig, and subsequently placed on pcn g for strep viridans culture but had one episode of hypotension and fever during which time 1 time doses of vanc/zosyn were given. today is day 18/28 as per id of pcn g course. in addition, the patient had unexplained transaminitis during his stay, history of hbv infection and hbv core antigen positive, negative hcv ab. transaminitis resolved as patient was weaned from ventilation and pressures stabilized -- on transfer ast/alt have normalized and alk phos trending down. amylase and lipase elevated on , continues to be elevated -- there was an initial concern for pancreatitis and abd. ct done showing mild pancreatitis; however lipase now trending down and no signs of infection (fever, leukocytosis) is present at transfer. pt. also suffering from arf likely atn from septic shock, received several rounds of cvvh after massive fluid resuscitation, now auto-diuresing with up to 3l uop/day, though cr still above 5 on transfer. in addition, pt. had a transient drop in plt's to a nadir of 10 requiring plt transfusion -- heme/onc consulted, reviewed smear, and believed pathogenesis to be bone marrow suppression in light of overwhelming sepsis, and not dic. plt levels have since returned to normal. . on transfer to the floor, pt. was alert and talkative. was seen by physical therapy and was able to transfer from bed to chair and back with assistance. continued to have good urine output, so renal concluded no need to place hd line. cr trended downward to 3.1 the day prior to discharge, and patient was tolerating adequate po's. will be discharged on day 23 of 28 of his pcn g as per id. in addition, was having diarrhea, c.diff negative x 2. . follow up: --------- - please follow up microsporidia stain, cyclospora stain, and cryptosporidium/giardia dfa stool samples - when cr is under 1.5, please resume original haart medications micu course =============== events : - bcx gpcs in pairs - zosyn changed to ceftriaxone and clindamycin - given ivig - ruq u/s showed edematous gallbladder -climbing wbc -renal put in hd cath -f/u cxr shows decreased pulm edema, effusions, but ?aspiration, l retrocardiac opacity -standing tylenol -started iv hydrocortisone - 25g albumin x2 - ivfs w/ bicarb -platelets to 10k, 1 bag of platelets given, increased to 39 -d/c'ed ceftriaxone per id given interaction with calcium gluconate on cvvh -dic labs -heme/onc does not believe plt drop is dic, believes it is suppression of marrow due to sepsis -dopamine weaned off, on cvvh . events: -peep decreased to 16 -cultures growing strep viridans events: d/c-ed vanc, clinda. started pcn with one dose of , id recs -weaned off levophed and vasopressin! -please bring up with nephrology whether patient can get dialysis now that pressures are stable. events -patient with labored breathing, peep was increased to 20, pt. placed back on midazolam sedation. -ip, saw free flowing fluid with no loculations, performed diagnostic thoracentesis, transudative pleural fluid -tee to be done tomorrow, tube feeds restarted, npo past midnight -ruq ultrasound being done- prelim read -> interval decrease in gb wall edema, gb not distended, no gstones, no cholecystitis, small amount of free fluid adj to liver - level 0.7, given per id recs -hit ab negative -bronch done, demonstrated esophageal balloon in lung, extracted -plt increasing . events: -tee showed no vegetations -labs show pancreatitis, plan to obtain ct abd after off cvvh -hypotensive to 70s with 500 ccs negative per hour, given 1000 cc bolus, changed cvvh to run at even, held versed -hepatitis panel sent -amylase level of pleural fluid added on -started acyclovir -need to ask id in am about iv vs topical acyclovir, need for , and when to restart haart events: d/c-ed per id recs -wanted to continue po acyclovir for now -considering starting haart soon, not quite yet -they did not comment on whether or not to start broader abx coverage for pna. so we started levofloxacin for pna. i/os: -4.2l events: -two episodes of hypotension with sbp below 100, given two 500cc boluses of fluid -temp to 101, pan cultured, given 1x dose of zosyn and vancomycin -peep @ 12 -hcv and hbv negative -increased cr to 2.1 -ebv igg positive . events: -hd -hd line removed, tip for culture -abx d/c'd -ct abd completed- no abscess or fluid collection, mild pancreatitis, b/l pleural effusions c/ atelectasis, l opacity . events: patient more arousable +2l . events - renal recs to make patient npo for tomorrow for possible tunneled cath hd line placement; however, if patient's urine output is picking up (last uop decidedly more than prev. at 100-110 every 2 hours) - holding heparin - patient sitting up, responsive to questions - abg pristine on ps ventilation (7.42/40/90) =================================== medications on admission: metformin 500mg po bid atripla 1 tab po daily lisinopril 5mg po daily lipitor 10mg po daily discharge medications: 1. white petrolatum-mineral oil 42.5-56.8 % ointment : one (1) appl ophthalmic prn (as needed). 2. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 3. miconazole nitrate 2 % powder : one (1) appl topical prn (as needed) as needed for pannus fungal infection. 4. lactulose 10 gram/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed for constipation. 5. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation q6h (every 6 hours) as needed for wheezing. 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 7. olanzapine 5 mg tablet : one (1) tablet po bid (2 times a day) as needed for aggitation. 8. lorazepam 0.5 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for anxiety. 9. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day) as needed for constipation. 10. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : 1-2 puffs inhalation q6h (every 6 hours) as needed for wheezing, sob. 11. penicillin g pot in dextrose 3,000,000 unit/50 ml piggyback : 3,000,000 units intravenous q4h (every 4 hours) for 6 days: please stop on . 12. insulin glargine 100 unit/ml solution : eight (8) units subcutaneous qam. discharge disposition: extended care facility: - discharge diagnosis: primary: septic shock acute renal failure secondary: hiv on therapy hepatitis b, untreated obesity hypercholesterolemia asthma diabetes mellitus type 2 history of splenic abscess status post splenectomy in discharge condition: stable, eating, drinking, voiding, and having bowel movements, conversant, can get from chair to bed with assistance. discharge instructions: you were admitted initially for a severe infection and severe inflammation. upon arrival you were promptly taken to the intensive care unit where you were given antibiotics and resucitated with fluids. after you stabilized in the icu, you were transferred to the floor where you were recovering very well. you are being sent to a rehabilitation facility where you will work with physical therapy to recover your strength. you will also complete your course of antibiotics there. upon discharge from the rehab facility, please set up an appointment with your primary care physician 1 to 2 weeks of discharge. please take all medications as prescribed. the most notable medication that we are continuing you on is your penicillin, for which you have 1 more week to complete. if you experience any sudden chest pain, shortness of breath, nausea, vomiting, diarrhea, constipation, lightheadedness, or loss of consciousness, please contact your primary care provider . followup instructions: provider: , md phone: date/time: 1:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis thoracentesis arterial catheterization infusion of drotrecogin alfa (activated) diagnoses: thrombocytopenia, unspecified abnormal coagulation profile diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis asthma, unspecified type, unspecified human immunodeficiency virus [hiv] disease acute respiratory failure septic shock obesity, unspecified streptococcal septicemia acute pancreatitis viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] pneumonia due to other streptococcus 

Answer: The patient is high likely exposed to