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: the patient is a 46 year old gentleman with past medical history including end stage hiv, placement on hospital. patient also has past medical history significant for polysubstance abuse including cocaine, hepatitis c and cirrhosis. patient was transferred to from an outside hospital for recurrent v-fib arrest in the setting of having an icd placed one week prior to admission. patient was found down on the morning of admission by a neighbor. unresponsive, called ems. when ems came, patient remained unresponsive, but his vital signs were stable. he had a paced rhythm. he had normal blood pressure and normal oxygen saturation. patient was then transferred to an outside hospital in . while there his icd discharged at least two times for episodes of ventricular tachycardia. rhythm strips from the outside hospital were not available at the time of admission. per report patient was given amiodarone 150 mg iv three times and he was given magnesium sulfate 4 gm iv for magnesium level of 1.6. med-flight then transferred patient to as ccu beds were not available elsewhere. en route to the hospital patient experienced another two episodes of v-fib and his icd discharged each time, converting patient back into paced rhythm. during the shocks patient was reported to be alert. he denied chest pain, shortness of breath, had stable blood pressure and stable oxygen saturation. on arrival to the ccu patient experienced two shocks from his icd for torsades. amiodarone was continued at 1 mg per minute. patient went into v-fib arrest two times just after his admission. again the icd converted him back into a stable paced rhythm. again his sats and blood pressure remained stable with these episodes. past medical history: hiv. last cd4 count 438, last viral load less than 50 copies per ml from his outpatient infectious disease physician's notes in his medical record. these levels were from . hiv course is complicated by nonischemic cardiomyopathy and also complicated by candidal esophagitis. hepatitis c and cirrhosis presumed secondary to iv drug abuse. hep a positive as well. nonischemic cardiomyopathy with ef of 20%. patient had cardiac cath in that was negative for coronary artery disease. patient is also status post icd placement on hospital. patient is status post ddd pacer placed four years ago for complete heart block. polysubstance abuse including crack cocaine, heroin and alcohol. patient stated on admission that he had been using crack cocaine for the week prior to admission. most recent use was three days prior to admission. chronic renal insufficiency. uncertain of baseline creatinine. old hospital records from indicate that the renal failure was secondary to diuretic over-use. peripheral neuropathy. b-12 deficiency and macrocytic anemia. stasis dermatitis and eosinophilic folliculitis. asthma. medications prior to admission: abacavir 300 mg b.i.d., saquinavir 400 mg b.i.d., combivir tabs one b.i.d., norvir 400 mg b.i.d., protonix 40 q.day, trazodone 100 q.h.s., lisinopril 10 b.i.d., lasix 80 b.i.d., methadone 250 mg q.d., lexapro 10 mg q.d., digoxin 125 mcg q.d., bactrim one double strength q.d., zyrtec 10 q.d., sublingual nitroglycerin p.r.n., triamcinolone cream, albuterol inhaler p.r.n. review of systems: the patient denied any recent illness. he states that since the icd had been placed, he has felt fatigued, but denies chest pain, shortness of breath. he does admit to recent crack cocaine use, most recently three days prior to admission. social history: the patient states that he was clean and sober for three years until this past week. he states that the stress of his illness and his mother's illness, who is bed bound status post cva, had prompted this use. patient lives alone and states that he has been very depressed at home and felt that his family avoids him because of his hiv status and feels that he cannot take care of himself appropriately. his sister and his niece do look in on him frequently, however. per report of his sister and his niece, his house is disordered and they comment that patient is barely functional. patient has a history of smoking, alcohol abuse and cocaine use as stated previously. physical examination: vital signs on admission included temperature of 98.2, pulse 66, blood pressure 104 to 130 over 54 to 65, respiratory rate 14, sat 100% on 10 liters nasal cannula, weight 74 kg. in general, patient was alert and oriented times two, alert to person and place, but not time. he denied any distress. he appeared disheveled, but otherwise did not appear in any discomfort. heent pupils equal, round and reactive to light and accommodation. oropharynx clear without lesions. heart regular rate and rhythm, s1, s2, prominent s3, to holosystolic murmur at the left upper and left lower sternal borders, does not radiate to carotids, does not radiate to axillae. pmi laterally displaced. right ventricular heave. jvp markedly elevated at 14 cm. lungs bibasilar crackles, left greater than right. abdominal exam soft, nondistended, nontender, hepatomegaly 3 cm beneath the costal margin. extremities no cyanosis, clubbing or edema with good distal pulses. neuro cranial nerves ii-xii intact. strength grossly normal. sensation grossly normal. laboratory data: from the outside hospital data included magnesium of 1.6. tox screen included serum, ethanol, salicylates, acetaminophen and tricyclic levels which were all negative. digoxin level was normal at 0.85, normal being 0.9 to 2.0. ck 226, mb 3.3, troponin i 0.1. hematocrit 30.8, white count 5.4, platelets 155. chem-7 132, 4.0, 92, 26, 16, 1.5, 138. calcium 8.2. chest x-ray from the outside hospital showed cardiomegaly with clear lung fields. head ct at the outside hospital, performed because patient had an unwitnessed fall, was read at the outside hospital as possible evolving left parietal infarct with no evidence of bleed. however, this head ct was read by our radiologists as no evidence of stroke or hemorrhage. ekg showed wide complex rhythm of left bundle morphology, rate 100 with paced beat preceded by a p and followed by a nonpaced ventricular beat, qtc 433. strips from med-flight consistent with polymorphic vt of torsade type. echo one week prior to admission from outside hospital showed moderate mr , left ventricular hypokinesis, ef 20%. lab data from admission to hematocrit 32.8, white count 4.7, platelets 159. chemistry sodium 133, potassium 4.8, chloride 96, bicarb 26, bun 20, creatinine 1.2, glucose 148. calcium 8.6, mag 2.6, phos 4.9, albumin 3.6. serum tox was negative for benzo, negative for barbiturates. urine tox was performed that was positive for cocaine and positive for methadone. ua was negative for uti. hospital course: 1. cardiology. rhythm. for patient's recurrent torsades he was initially continued on an amio drip at 1 mg per minute. as the qt was prolonged, patient was switched from amio to a lidocaine drip as lidocaine decreases the qt interval while amio increases the qt interval. patient's pacer was interrogated on the night of admission and reprogrammed. on interrogation it was revealed that patient had 16 episodes of v-fib with heart rate between 200 to 230 beats per minute, requiring 17 joules and then 31 joules to convert patient back into a paced rhythm. his pacer was a ddd that was originally set for 50 to 120 beats per minute with paced av at 180 msec. the mode was changed by the ep fellow to ddd at 80 to 120 beats per minute with the thinking that increasing the rate of pacing would shorten the qt interval and hopefully prevent recurrent torsade. the pacer was also changed so that the vf zone first shock to patient at 31 joules rather than 17 joules as patient was requiring 31 joules of energy to convert him back to a paced rhythm. patient's magnesium was checked frequently and magnesium after repletion was stable at 2.6. the patient was kept on a lidocaine drip from admission until 5:00 a.m. on the morning of . at this time patient began to experience visual hallucinations and became slightly agitated. therefore, the lidocaine drip was decreased from 3 mg per minute to 1 mg per minute. however, as patient's agitation continued even with the decreased dose of lidocaine, the lidocaine drip was stopped at 7:00 a.m. patient was switched to mexiletine 100 mg p.o. b.i.d. as this is also a class ib antiarrhythmic. patient tolerated this medication much better and his neurological status cleared. he no longer had visual hallucinations and he tolerated the mexiletine dose quite well. patient was also started on labetalol 100 mg b.i.d. this beta blocker was chosen as patient's urine tox was positive for cocaine. he also tolerated this medication well. patient had no repeat episodes of ventricular tachycardia or ventricular fibrillation during his hospital course. pump. patient has dilated nonischemic cardiomyopathy with a low ef of 15% to 20%. patient was continued on lasix during his hospital course as he showed signs of volume overload with an elevated jvp. he was kept on 40 mg b.i.d. throughout his course and tolerated this well. to help with diuresis aldactone 25 mg q.d. was added to his regimen. 2. infectious disease. patient with known hiv, doing well on haart therapy with viral load of less than 50 copies per ml and cd4 count in the 400s. patient's bactrim was held on admission as bactrim is a medication that has been reported to prolong the qt interval. patient's outpatient hiv clinician was contact on the second day of admission to see if he felt patient needed to be continued on bactrim with a cd4 count greater than 200. the clinician, dr. , was not available, but his colleague covering for him was consulted and felt that bactrim could be discontinued. patient was restarted on his outpatient antiretroviral medications after researching that they did not affect the qt interval. he was put back on ritonavir 400 b.i.d., combivir one tab p.o. b.i.d., abacavir 300 b.i.d. and saquinavir 400 b.i.d. 3. because of patient's multiple social issues, a social work consult was obtained. social work together with the case manager set up for patient to have home to help patient with his adls and help him with his medication regimen. patient has multiple supports in his community including an aids project social worker named who was contact during his admission. she maintains close contact with patient on a weekly basis and she spoke to him while he was in-house. she is to follow up with him after his discharge. patient was sent by chair car to his mother's house in where he would stay with his mother and sister until nursing would be able to visit him at his home on thursday, . patient was kept on his methadone dose of 250 mg q.day during his course and this dose was verified through medical records. most recently this dose was confirmed from as to be the appropriate dose. addiction services was also consulted during hospital stay. 4. followup. a followup appointment was made with patient's infectious disease physician who, per patient, also serves as his internist. he was to see dr. in on . patient's cardiologist, dr. in , was also to follow up with patient to follow up on his icd and his new cardiac regimen including mexiletine and labetalol. patient was to call the day after discharge to make an appointment with dr. . , m.d. dictated by: medquist36 d: 17:18 t: 12:39 job#: procedure: other electric countershock of heart diagnoses: cirrhosis of liver without mention of alcohol chronic hepatitis c without mention of hepatic coma alcohol abuse, unspecified human immunodeficiency virus [hiv] disease paroxysmal ventricular tachycardia cardiac arrest ventricular fibrillation cocaine abuse, continuous cardiomyopathy in other diseases classified elsewhere 

Answer: The patient is high likely exposed to