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 / sulfa (sulfonamides) attending: chief complaint: transferred from micu (admitted with arf, mental status changes, pancreatitis, respiratory distress) major surgical or invasive procedure: central line hemodyalisis line intubation history of present illness: 59m with hiv on haart, well controlled cd4 in 400s, who initially presented with fevers to 102f, with associated chills, nausea, and dry heaving. patient initially was seen by his pcp . , who gave patient 2l ivf and pepcid with improvement in his symptoms. laboratory studies at that time were unremarkable. the next day, patient reported decreased oral intake, nausea, vomiting, abdominal pain and headaches. patient also noted epigastric abdominal pain. patient has noted no diarrhea, blood in stool emesis or urine, rash, lymphadenopathy, sore throat, difficulty swallowing, or weight loss. he was compliant with his hiv meds. he denied any recent travel, or any unusual foods. . patient does note that his symptoms started immediately after an arthroscopic knee surgery three weeks prior. patient noted mild nausea at the time, but states that symptoms progressed significantly from then to the point of admission. patient states that his only new medication was the addition of celexa several weeks prior. . on admission, patient had head ct with contrast performed to r/o toxoplasmosis. cr subsequently came back at 12.4. bicarb low, lfts abnormal. had a 7-point hct drop since last tuesday. pt given fluids, bicarb, mucomyst. head ct was normal. mild pulm edema noted on cxr, ms waxing and . in the , pt reported chest pain and had diffuse st changes in anterolateral leads. rec'd aspirin but no bb at the time, and was also given amiodarone for runs of svt vs. vt, which was subsequently discontinued. patient had elevated cks and troponins with negative mb fractions. . renal, hem/onc, and cards were consulted. a peripheral blood smear showed spherocytes but no , ttp was felt to be ruled out. renal placed a line for cvvhd, and patient was subsequently dialysed through the catheter for several days, prior to switch to hemodialysis. past medical history: hiv - last cd4 () - 446, with a vl at that time of 447, on haart hypertension hyperlipidemia type ii diabetes mellitus social history: pt denies tobacco, etoh, or ivdu. is an architectural designer. lives with his partner of 28 years. lives in wooded areas with several dogs. no recent travel. family history: noncontributory physical exam: t 99.9 hr 83 bp 150/86 rr 24 sao2 95% general: wdwn, nad, breathing comfortably on ra heent: perrl, eomi, icteric sclera, conjunctivae pink. no oral ulcers or lesions. neck: supple, trachea midline, no thyromegaly or masses, no lad cardiac: rrr, s1s2 normal, no m/r/g, no jvd pulmonary: ctab abdomen: +bs, soft, nontender, nondistended, no hsm. foley draining clear yellow urine. extremities: warm, 2+ dp pulses, no edema skin: no rashes. neuro: a&ox3, speech clear and logical, cnii-xii intact, moves all extremities pertinent results: hematology: 10:05am wbc-5.3 rbc-3.03* hgb-11.9* hct-32.1* mcv-106* mch-39.2* mchc-37.0* rdw-16.4* 10:05am neuts-74* bands-2 lymphs-21 monos-2 eos-1 basos-0 atyps-0 metas-0 myelos-0 05:10pm pt-13.0 ptt-24.8 inr(pt)-1.1 . chemistry: 10:05am alt(sgpt)-183* ast(sgot)-273* alk phos-64 tot bili-3.6* 10:05am glucose-141* urea n-106* creat-12.4*# sodium-127* potassium-4.9 chloride-91* total co2-15* anion gap-26* 03:05pm haptoglob-469* 03:05pm ck-mb-9 ctropnt-0.15* 03:05pm ld(ldh)-373* ck(cpk)-1299* 05:10pm fibrinoge-418*# 05:10pm asa-neg ethanol-neg acetmnphn-5.1 bnzodzpn-neg barbitrt-neg tricyclic-neg 05:10pm ck-mb-10 mb indx-0.8 05:10pm ctropnt-0.17* 05:10pm ck(cpk)-1201* dir bili-2.3* 05:10pm glucose-113* urea n-102* creat-12.1* sodium-128* potassium-4.7 chloride-95* total co2-17* anion gap-21* 05:22pm lactate-1.3 na+-130* k+-4.7 11:23pm d-dimer-4135* 11:23pm crp-136.0* 11:23pm anca-negative 11:23pm pth-252* 11:23pm cryo-no cryoglo 10:05am blood alt-183* ast-273* alkphos-64 totbili-3.6* 09:50am blood alt-121* ast-108* ld(ldh)-335* alkphos-125* amylase-290* totbili-3.9* 05:22am blood lipase-1396* 09:50am blood lipase-639* 02:59pm blood vitb12-991* folate-9.0 09:37am blood cortsol-19.3 02:52pm blood cortsol-27.3* 02:52pm blood cortsol-29.8* 05:35am blood hbsag-negative hbsab-borderline hbcab-positive 04:20pm blood hbsag-negative hbsab-borderline hbcab-positive 02:59pm blood pep-no specifi 09:37am blood c3-122 c4-23 11:23pm blood hcv ab-negative . cxr (): reason for examination: evaluation of jugular venous line placement. right central venous line double lumen catheter was inserted with its distal tip pointing at the level of distal svc. there is no pneumothorax or pleural effusion. the left subclavian line tip terminates at the junction of brachiocephalic vein. the lungs are essentially clear except for right lower lobe discoid atelectasis. there is no sizeable pleural effusion. there is no evidence of congestive heart failure, marked improvement compared to the previous film. . head ct: no intracranial hemorrhage, abscess, or mass . echo: ef >55%. preserved biventricular function. no rwma. . ct abdomen: 1. no abscesses or loculated collections identified. 2. nonspecific bowel wall thickening with inflammatory changes seen within the ascending colon. diagnostic considerations include colitis (infectious, inflammatory, or ischemic) versus third spacing of fluid. 3. appendix not contrast filled, but not dilated. surrounding inflammatory changes contiguous with those surrounding the ascending colon. it is uncertain which inflammatory process is primary. discussed with dr. following completion of the study. 4. again seen is evidence of pancreatic duct and cbd dilatation, not significantly changed from prior ultrasound. findings are nonspecific, diagnostic considerations including cholangiopathy or ampullitis. 5. small bilateral pleural effusions with associated atelectasis and consolidation. brief hospital course: 59m with hiv on haart presents with f, abd pain, mental status changes, acute renal failure, hypoxic respiratory failure volume overload, now extubated no longer requiring dialysis. unclear etiology of his symptoms, but possibities would include acute chemical pancreatitis, disseminated infection of unclear etiology, serotonin syndrome in setting of recent initiation of ssri, ttp-hus. infectious causes have largely been ruled out, ttp-hus unlikely in the setting of no hemolysis on smear, and patient did not exhibit classic signs of serotonin sx (e.g. no muscle rigidity, clonus) but did initially present with hyperthermia, nausea, abdominal pain, rhabdo, delta ms, and renal failure. likely etiology is pancreatitis, esp with lft abnormalities, elevated pancreatic enzymes, jaundice, and dilatation of pancreatic and cbd seen on ultrasound. . # pancreatitis - patient had an elevated amylase/lipase, and elevated lfts and diffuse abdominal pain leading to this admission. cause was unclear. there were no signs of infection (mycoplasma, cmv, hepatitis, legionella). however, there were liver enzyme elevation nad cbd dilitation. however, mri and ercp did not demonstrate cholelithiasis. therefore it was thought that it may have been secondary to medication side effects or possibly pancreatitis induced by hiv. aids cholangiopathy seems unlikely given lack of obstruction and previous cd4 >100. peak lipase 1396 and amylase 448 prior to ercp. however, pt also developed post-ercp pancreatitis with abdominal pain and elevation of lipase to 10,000. this quickly resolved with iv fluids and the patient did not have abdominal pain and was tolerating food on day of discharge. . # fever. still with unclear etiology. patient has negative cultures to date. continues to spike low grade fevers. resolved without antibiotics. patient cautioned to take temperature and call id fellow or go to the er. . # acute renal failure. pt developed severe renal failure and admission creatinin was 12. patient was admitted to micu and started on cvvh. this was continued only for a few days as the patient's renal function improved and started urinating. evaluation of the urine did not show muddy brown casts, but given the history and rapid improvement of renal function, cause was thought to be acute tubular necrosis secondary to pancreatitis (severe prerenal azotemia) vs. hiv nephropathy vs. multiple nephrotoxic medications. negative renal ultrasound. appears to be in a diuresis phase currently. creatinine continued to decrease throughout hosptial stay and electrolytes were normal. . # htn: as hospital course progressed, patient's blood pressure increased and atenolol was increased to . this should be reevaluated as an outpatient as atenolol typically a qday medcation. . # occult blood positive ogt lavages with clots while in icu. did not have persistent bleeding and no episodes concerning for gi bleeding while on medicine floors. additionally ercp was done with brief exam of upper gi tract and did not have signs of bleeding. . #. delta ms. thought to be in setting of uremia and icu psychosis. improved with dialysis and improvement in overall health. no mental status changes at time of discharge. . # ? nstemi - st depressions in inferolateral leads, pt does have risk factors for cad including dm2, hyperlipidemia, being on haart long-term. elevated troponin to 0.36 but normal mb fractions in setting of severe acute renal failure. s/p amiodarone for svt currently being medically managed with bb alone. echo shows no rwma. need outpatient eval including stress test. . # dm2 - well-controlled. check qid fingerstick, iss coverage. was restarted on actos after renal function improve (okayed with nephrology). patient was recommended to check fingersticks as outpatient in the first days after discharge at least . . # hiv - holding haart for now given that ritonavir can cause acute renal failure as well as the renal and liver side effects possible from hiv meds. will need to readdress this with outpatient dr. . # macrocytic anemia - likely haart - guaiac all stools, follow hct per above . # thrombocytopenia - now resolved. represent generalized bone marrow suppression in the face of systemic inflammatory illness. no recent heparin so would not send hit antibody. ttp has been ruled out as no schistocytes on peripheral smear. dic panel did not show signs of dic. plts trending up after nadir of 70 and now normalized. . # hyperlipidemia - will hold statin for now given elevation in liver enzymes. should restart if liver enzymes normalize. medications on admission: actos 30mg daily acyclovir 400mg aspirin 81mg daily atenolol 100mg daily celexa 20mg qhs loratadine 10mg daily lorazepam prn percocet prn univasc 30mg daily atazanavir 300mg daily ritonavir 100mg daily tenofovir 300mg daily combivir 1 tab discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 2. lorazepam 1 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for insomnia. 3. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 4. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) for 7 days. disp:*140 ml(s)* refills:*0* 5. actos 30 mg tablet sig: one (1) tablet po once a day. 6. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed: do not exceed 2 grams (6 tablets) in one day. 7. one touch test strip sig: one (1) miscellaneous twice a day: please call your doctor if your blood sugar is <60 or >300. disp:*1 box* refills:*2* discharge disposition: home discharge diagnosis: primary: hypotension respiratory failure acute renal failure sepsis pancreatitis . secondary: hiv, hypertension, type ii diabetes, hyperlipidemia discharge condition: fair discharge instructions: you must call the id service or return to the er if you have any fever (>101), abdominal pain, nausea, vomiting, or any concerning symptoms. you must follow up with dr. at 1pm on monday. . you should have only clear liquids today and if your symptoms continue to improve, it is ok to transition very bland diet tomorrow and advance slowly. . please take all medications as prescribed. . new medications: pantoprazole, nystatin . call your doctor or return to the ed immediately if you experience worsening chest pain, shortness of breath, nausea, vomiting, sweating, fevers, chills, bleeding, or other concerning symptoms. followup instructions: you are scheduled for the following appointments. please contact the provider with any questions or if you need to reschedule. . . provider: , m.d. phone: date/time: 1:00 (nephrology) . provider: , m.d. phone: date/time: 1:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis incision with removal of foreign body or device from skin and subcutaneous tissue endoscopic retrograde cholangiopancreatography [ercp] diagnoses: thrombocytopenia, unspecified subendocardial infarction, initial episode of care congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis human immunodeficiency virus [hiv] disease paroxysmal ventricular tachycardia other and unspecified hyperlipidemia acute respiratory failure other shock without mention of trauma hematemesis delirium due to conditions classified elsewhere rhabdomyolysis acute pancreatitis unspecified deficiency anemia diabetes with unspecified complication, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to