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: patient recorded as having no known allergies to drugs attending: chief complaint: right shoulder pain x 3 days, cough, sob x 6 months major surgical or invasive procedure: left septic wrist debridement and washout on and repeat procedure on . history of present illness: 55 yo lady with multiple medical problems including hiv, pneumonitis, pulmonary htn, esrd on hd, cardiomyopathy and emphysema on o2 at home who presents with right shoulder pain and worsening cough/sob for 6 months. . right shoulder pain: started 3 days ago. sudden onset. not provoked by any activity, no h/o trauma or any other event that may have precipitated this pain. . cough/sob: this has been chronic, apparently at least six months, but the frequency and severity of cough has increased. the patient has a subconjunctival hemorrhage in the left eye from the coughing. cough is productive of white, non-bloody sputum. pt also states "i had pneumonia 3 weeks ago, but i handled it on my own." patient does endorse increasing dyspnea on exertion, and states that she uses several pillows and feels that she has more swelling in her legs than usual. the patient was on prednisone for her lip, but this was discontinued about 6-7 months ago. pt reports chills for the past several days. . denies chest pain, n/v, diarrhea, weight loss. no recent history of incarceration or other exposure risk for tuberculosis although son has been incercerated. no hx of oppotunistic infections. . in , pt with t 101. joint injected with bupicivaine with moderate relief. pt then received hd. on return to the medical floor, she develop severe left wrist pain--contralateral to her original left shoulder pain. plastics was consulted and attempted drainage of the wrist with no success. micu consulted for worsened tachycardia (130 from admission hr of 110 which may be her baseline) and worsening tachypnea. abg surprisingly 7.36/48/86 despite tachypnea. at that time, pt reached her tmax, 102.0. shortly thereafter, 1 of 4 (anaerobic) bottles grew gpc. past medical history: - hiv ( cd4 257, vl <48) - esrd on hd mwf - htn - severe pulmonary htn - cardiomyopathy lvef 31%, severe mr/tr - pneumonitis (lip) followed by dr. at ( #6564 - anemia of chronic disease - avnrt diagnosed at - recent vaginal bleed s/p conization - hcv - untreated - asthma/copd - c-section - r knee surgery - ovarian cysts removed social history: she lives in with her 18 year old son. she has three sons and one daughter. she quit smoking on . she has a 30-40 pack year smoking history. she has used "every drug" including cocaine. last drug use was three years ago. she has never used iv drugs. she has a history alcohol abuse and has been sober for six years. she has a history of homelessness and has lived in shelters, most recently within the past five years. she has never been incarcerated but her son has been. she is currently medically handicapped and unemployed for many years. family history: her mother is living in her 70s and had a stroke, hypertension and diabetes. her uncle died of kidney disease. she never met her father. sister was killed in a motor vehicle crash. her children are healthy. her daughter has a single kidney. physical exam: vitals: 97.6 (98.6), 139/91 (93-160/59-90), 110 (96-110), 22, 98% 2l gen: asleep, easy to arouse, no acute distress heent: left eye with subconjunctival hemorrhage, unchanged; icteric b/l cv: rrr no murmur appreciated pulmonary: cta b/l abd: obese, distended, +bs, mild epigastric tenderness ext: peripheral edema 1+ b/l le, lue with clean wound dressing neuro: aox3 pertinent results: 08:30pm type-art po2-86 pco2-48* ph-7.36 total co2-28 base xs-0 08:30pm glucose-83 lactate-1.1 na+-141 k+-4.1 cl--101 08:30pm o2 sat-94 08:30pm freeca-1.17 01:38am lactate-1.6 01:30am glucose-84 urea n-27* creat-7.8*# sodium-135 potassium-4.5 chloride-98 total co2-26 anion gap-16 01:30am estgfr-using this 01:30am alt(sgpt)-18 ast(sgot)-46* ld(ldh)-311* alk phos-107 tot bili-1.1 01:30am lipase-26 01:30am crp-7.7* 01:30am wbc-4.5 rbc-4.57 hgb-11.3* hct-40.4 mcv-89 mch-24.7* mchc-27.9* rdw-21.4* 01:30am neuts-67.3 lymphs-19.4 monos-7.7 eos-4.6* basos-1.1 01:30am plt count-117* 01:30am pt-17.1* ptt-40.4* inr(pt)-1.5* 01:30am sed rate-23* ---------- c. diff negative and ---------- hida impression: markedly abnormal hepatobiliary scan with no uptake of disida into the liver during 78 minutes of imaging. this finding is compatible with severe hepatic dysfunction. due to the hepatic dysfunction, the biliary system cannot be evaluated. ---------- radiology report chest (portable ap) study date of 11:29 am chest radiograph indication: hemoptysis, evaluation for changes. comparison: . findings: as compared to the previous radiograph, the pre-existing right-sided pleural effusion shows a slightly different distribution but appears to be overall unchanged. the subtle suprabasal opacity in the left lung could have minimally increased in extent. other opacities are not visible. moderate cardiomegaly with signs of mild to moderate pulmonary overhydration. no evidence of left-sided pleural effusion. ---------- radiology report ct abdomen w/contrast study date of 12:47 am conclusion: the findings of adrenal hyperenhancement and renal hypoenhancement are nonspecific but suggest possible infarction or ischemia to these organs. as the proximal arteries appear unremarkable and there is no overt evidence of significant arteriosclerosis, hypotension must be considered. nonspecific dilatation of the small bowel, possibly reflecting ileus. no additional findings. of note, there is joint space narrowing at l4-l5. this is felt secondary to degenerative disc disease rather than discitis. ---------- radiology report ct abd w&w/o c study date of 3:02 pm impression: 1. homogeneous enhancement of the pancreas. 2. mild stigmata of cirrhosis. 3. small fat-containing ventral abdominal hernia. ---------- egd report tuesday, impression: there were no varices seen in the esophagus. abnormal mucosa in the stomach (biopsy, biopsy) otherwise normal egd to third part of the duodenum ---------- pathology examination: diagnosis: gastric mucosal biopsies, two: a. fundus: superficial fragment of fundic mucosa with no diagnostic abnormalities recognized. b. antrum: antral mucosa with regenerative changes suggestive of chemical injury. ---------- endoscopic u/s eus: pancreas parenchyma showed changes c/w moderate chronic . pancreatic duct was normal. bile duct was normal, without stones. brief hospital course: in short, patient is a 55 yo lady with multiple medical problems including hiv (cd4 257), pneumonitis, pulmonary htn, esrd on hd, cardiomyopathy and emphysema on o2 at home who presented initially with right shoulder pain and worsening cough, sob for 6 months. she was initially admitted on and has had a protracted hospital course. . she was found to have mssa bacteremia, for which she was treated with cefazolin. her shoulder pain had improved, but she had developed left wrist pain which was found to be a septic joint and s/p wash out with ortho on . also, during her hospitalization, she had difficulty maintaining her bps, especially for dialysis, and initially it was felt that she potentially had an infection of her avf (imaging did not suggest any thrombus/source of infection there). it is thought that the infection was to her left wrist septic joint - her cultures have since cleared with therapy. she also had difficulty with respirations, and it was thought to be secondary to increased narcotics use, and improved once she was switched from iv to po narcotics. her lfts gradually improved, but she now has a persistently elevated amylase/lipase of unclear etiology. it is thought that this may be secondary to her haart therapy, since her ct of her pancreas did not show any significant abnormalities. mrcp cannot be done given her renal failure. also, during this hospitalization, she had black stool, guaiac positive. . # mssa bacteremia: likely explanation for her fevers. 2 sets of blood cx positive on , not since. risk factors for staph include recurrent hospitalizations, hd, hiv, distant prior staph bacteremia. started on vanco and later switched to nafcillin. gentamycin was added on . neg echo. gent was d/c'd. treating with cefazolin. s/p picc. per id, if tee negative would treat 4 weeks. if no tee would treat 6 weeks (d1= ); however pt. would not cooperate for tee. also outpatient id f/u with weekly cbc, crp, esr, lfts, bmp. id signed off. . # hypotension: was showing septic physiology and was on dopamine, later weaned off, started levophed; weaned off and responded to steroids. after 24 hours off of steroids, they were stopped. intent to try pt. on midodrine but since she refused and bp was stable with it, it was also d/c'd. pt.'s bps were stable when transferred out of icu and continued to be stable on the floor. patient's home sildenafil was held b/c of persistent hypotension episodes. patient normotensive on floor and bp was not much of an issue. . # left wrist pain: felt to be septic joint mssa bacteremia. went to or for debridement and washings on . pain has been well controlled on percocet and with patient in sling/splint during hospitalization. ot reconsulted and saw patient on now that she had improved wrist function. patient still complained of pain and had mild drainage from wound site on , when hand re-evaluated and brought to or for repeat wash-out procedure. pus not visualized during operation however, and site irrigated and closed. . # right shoulder pain. on exam, low suspicion for septic joint and pain resolved fairly quickly. ortho was consulted; managed with sling and pain control. . # cough/sob: resolved quickly. most likely dx seems to be progression of her serious underlying lung pathology. no hx of oppotunistic infections. prelim ct chest c/w emphysematous changes. at this point, low suspicion for tuberculosis as ppd negative. f/u swab negative. was continued on albuterol/ipratropium and resolved and pt. on home oxygen requirement at conclusion of icu stay. patient without symptomatic complaints when on hospital floor. . # esrd: pt was continued on hd three times per week. renal was following and meds were dosed appropriately. . # tachycardia: felt to be a response to infection, but per outpt and inpt notes, she is chronically tachycardic and may have baseline hr in 110s. sinus on 12 lead. plan to restart home beta blocker after hd (toprol xl 25 daily). this had been stopped because of hypotension. restart with renal permission. . # cardiomyopathy/chf, ef 30%: patient's bb was held; should be started on acei/ in the future if bp can tolerate. . # pneumonitits/pulmonary hypertension: sildenafil was held becuse of hypotension; should be restarted when bps more stable. . # asthma/copd: was continued on iprotrop. . # hiv ( cd4 257, vl <48): was continued on haart meds and bactrim ppx. . # coagulopathy: inr elevated in past but not to this range. ? if related to liver enzymes/hcv . # hcv: has not been treated. hepatology has no new recs. stated hcv viral load will not affect current management . # transaminitis: imaging of ruq done increased abd pain and rising t. bili. hida scan ordered and surgery consulted. gent added to abx regimen on but d/c'd per id. bili, amylase still elevated however pt. had refused mrcp and since ast and tuberculosis trending down and renal function would not tolerate dye, with increased amylase to the 1000s, hepatology was consulted, the pt. had a normal ct pancreas study, and id confirmed that such an increase would also affect her lipase. at transfer from icu, still unclear etiology. liver enzymes down trended while on the floor. etiology thought likely due to cholelithiasis causing a brief elevation of liver enzymes. . # erosive gastritis: patient had melena with guiaic positive stool during hospitalization on the floor. egd showed blood collection, questional source but likely erosive gastritis. differential also included epistaxis (hx of epistaxis: risk factors including elevated inr poor liver fx. alt, ast may be normal poor residual fx). egd negative for esophagitis, pud. patient treated with ppi for erosive gastritis with careful monitoring of hct. . # elevated amylase, lipase; : etiology unclear, but patient has risk for gallstone, autoimmune ( pneumonitis, hcv/hiv), and/or drug-induced (haart). gallstone likely given initial elevation of t bili, cholelithiasis. ct pancreas without any obvious abnormalities. mrcp to visualize pancreatic ducts unlikely given renal failure. eus obtained showing changes consistent with chronic but no gallstones. outpatient surgery follow up for elective cholecystectomy is recommended. . # ct suggestive of adrenal infarction. endo stated that adrenal response normal, if relatively adrenal insufficient can try stress dose steroids without fluid bolus or pressors. this was not an issue throughout hospitalization. . # foot pain and leg weakness: unlikely gout given recent steroids. unlikely sepsis given not febrile and no change in wbc and bilateral. actually completely improved as of . put in for pt consult. . # hemoptysis: likely worsened by coagulopathy. had black tarry stools . monitored h/h, inr and sxs and patient was stable. gi endoscope am . . # dispo: because of prolonged bedrest and left wrist mobility will likely need inpatient rehabilitation before she can go home. discharged to rehab medications on admission: metoprolol succinate xl 25 mg acetaminophen 325-650 mg po q6h:prn pain nephrocaps 1 cap po daily calcitriol 0.5 mcg po every other day tues, thurs, sat quetiapine fumarate 25 mg po qmowefr 45 min prior to hd cinacalcet 30 mg po daily raltegravir 400 mg po bid etravirine 200 mg po bid sildenafil citrate 50 mg po tid fexofenadine 60 mg po daily:prn hay fever guaifenesin-codeine phosphate ml po q6h:prn cough sulfameth/trimethoprim ds 1 tab po qmowefr heparin 5000 unit sc tid sevelamer hydrochloride 1600 mg po tid w/meals lamivudine 50 mg po daily discharge medications: 1. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 2. acetaminophen 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. 3. nephrocaps 1 mg capsule sig: one (1) capsule po once a day. 4. sevelamer hcl 400 mg tablet sig: four (4) tablet po tid w/meals (3 times a day with meals). 5. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po qmowefr (monday -wednesday-friday). 6. fexofenadine 60 mg tablet sig: one (1) tablet po daily (daily) as needed for hay fever. 7. etravirine 100 mg tablet sig: two (2) tablet po bid (2 times a day). 8. raltegravir 400 mg tablet sig: one (1) tablet po bid (2 times a day). 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 10. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough . 11. cefazolin 1 gram recon soln sig: two (2) injection qmowe for 4 weeks: please take until last day . 12. cefazolin 1 gram recon soln sig: three (3) injection qfr for 4 weeks: please take until last day . 13. lamivudine 100 mg tablet sig: 0.5 tablet po once a day. 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 15. bisacodyl 5 mg tablet sig: one (1) tablet po daily (daily) as needed for constipation. 16. docusate sodium 100 mg capsule sig: one (1) capsule po daily (daily) as needed for constipation. 17. oxycodone-acetaminophen 5-500 mg capsule sig: one (1) tablet po every 6-8 hours as needed for pain. 18. outpatient lab work please draw cbc, crp, esr, lfts, bmp weekly from (, etc) and fax results to dr at (. discharge disposition: extended care facility: radius of discharge diagnosis: primary diagnoses: - mssa bacteremia - septic wrist at the radial carpal joint and mid carpal joint - erosive gastritis - - transaminitis - esrd on hd - hiv on haart secondary diagnoses: - hiv ( cd4 257, vl <48) - esrd on hd mwf - htn - severe pulmonary htn - cardiomyopathy lvef 31%, severe mr/tr - pneumonitis (lip) followed by dr. at ( #6564 - anemia of chronic disease - avnrt diagnosed at - recent vaginal bleed s/p conization - hcv - untreated - asthma/copd - c-section - r knee surgery - ovarian cysts removed discharge condition: afebrile, in good condition, ambulating, alert and oriented x3, tolerating po intake. discharge instructions: you were admitted to the hospital on for right shoulder pain and shortness of breath. during your hospitalization, we found out that you had an infection in your blood. you are being treated on an antibiotic for this infection (your blood cultures have been negative, but it may be bacteria on your heart valve due to previous drug use, and you will be taking the antibiotic until ). also during this hospitalization, we found that you had bacteria in your left wrist. we took you to an operation on to clean out the wrist. the wrist continued to have infection and you were taken back for a repeat operation on . we also found that you were bleeding from your stools during this hospitalization. we put a scope down your throat to look at your stomach and found generalized inflammation that was likely causing the bleeding. we also found out that the enzymes that we use to monitor for inflammation of the pancreas were elevated. we did procedures including a ct scan and endoscopic ultrasound which showed changes consistent with chronic . changes to your home medications include: calcitriol: we discontinued this medication. cincalcet: we discontinued this medication. sildenafil: we discontinued this medication because of your low blood pressure in the hospital. if you should experience signs of infection such as fever greater than 101, chills, sweats, or chest pain, trouble breathing, palpitations, dizziness, fatigue, or any other medically concerning symptoms, please call your doctor or 911 or go to the emergency room. followup instructions: please keep the following appointments which have been made for you: md: dr specialty: surgery date and time: at 12:30pm location: phone number: special instructions: you are going to see surgery because the gi doctors your was due to the gallstones in your gallbladder. you have been recommended to talk with surgery about an elective cholecystectomy. md: , md specialty: infectious disease date and time: at 9:30am location: community health center phone number: md: dr specialty: gastroenterology- for endoscopy date and time: at 11:30am arrival for 12:30pm procedure location: phone number: special instructions if applicable: instructions will be mailed for endoscopy preparation. please call the hand clinic at . you need to make an appointment for follow-up from your surgery on . please make this appointment to be within 2-3 weeks. procedure: venous catheterization, not elsewhere classified hemodialysis esophagogastroduodenoscopy [egd] with closed biopsy other arthrotomy, wrist other local excision or destruction of lesion of joint, wrist diagnoses: other primary cardiomyopathies end stage renal disease anemia, unspecified congestive heart failure, unspecified acute on chronic diastolic heart failure human immunodeficiency virus [hiv] disease hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site primary pulmonary hypertension other emphysema chronic pancreatitis other specified gastritis, with hemorrhage pyogenic arthritis, forearm human immunodeficiency virus, type 2 [hiv-2] 

Answer: The patient is high likely exposed to