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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea, productive cough major surgical or invasive procedure: right thoracentesis right video-assisted thoracic surgery (vats) decortication of lung. history of present illness: 52 yo f with history of hiv (cd4 293, vl undetectable ), active heroin user and smoker presents with 4 days dyspnea associated with cough, r lateral and posterior chest pain which started gradually. reports subjective fevers and chills. cough productive of greyish sputum, no blood. no sick contacts, no recent travel. states that she lives home alone. has not had progression of symptoms in the last 4 days. denies sore throat, anterior chest pain, palpitations, dysuria, n/v/d, abd pain. had pneumonia several times in past, most recently 6 months ago and 10 yrs ago. smokes 4 cigs/d x 15 yrs, has not smoked for last 2 days. no recent travel or sick contacts. . patient uses heroin daily, last use this am. buys clean syringes at the pharmacy but uses them 3 times and shares them with her boyfriend. does use rubbing alchol to clean area. injects into legs. . in the ed, initial vitals were 98 101 130/70 18 94% ra. cbc and chem7 were not obtained as patient has poor access. chest x-ray demonstrated pneumonia, so patient was treated with azithromycin 250mg and was admitted to medicine. . on the floor, patient reports sob and right sided lateral chest pain. states this pain came on gradually. no headache, n/v, no dysuria, no abdominal pain, no hematuria, no tenderness at heroin injection sites. past medical history: hiv diagnosed in (cd4 293, vl undetectable ) hcv diagnosed in , now resolved depression social history: lives at home alone, no etoh, smokes 7 cigaretts per day, uses heroin daily, last use this morning. family history: mother is deceased of heart problems. father is deceased with diabetes. one sister, alive and healthy. four children, alive and healthy. physical exam: vitals: t 99.9 bp 145/92 p 100 r 20 o2 95 ra general: pacing up and down the hallway, disheveled, poor hygeine, alert, oriented, yells out in anger when offered tylenol for pain management heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: crackles of the way up r lung, scattered wheezes, right sided anterior rales cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema; left posterior distal extremity with scabs from places of heroin injection, mildly warm surrounding area, no warmth, no tenderness neuro: cns2-12 intact, motor function grossly normal pertinent results: labs on admission: 04:00pm glucose-111* urea n-8 creat-0.6 sodium-138 potassium-3.3 chloride-104 total co2-24 anion gap-13 04:00pm wbc-14.6* rbc-3.21* hgb-9.5* hct-29.3* mcv-91 mch-29.5 mchc-32.4 rdw-14.5 04:00pm neuts-88.3* lymphs-7.6* monos-3.3 eos-0.4 basos-0.3 04:10pm lactate-0.8 . relevant labs: . 06:10am blood ld(ldh)-151 06:10am blood caltibc-208* ferritn-242* trf-160* . microbiology: . 6:18 am urine source: cvs. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. (reference range-negative). . blood culture , : pending . rapid plasma reagin test (final ): nonreactive. reference range: non-reactive. . adenosine deaminase, pleural 15.9 h <9.2 u/l fluid reference interval: adenosine deaminase tuberculosis mean 92.1 u/l metastatic malignancies mean 23.3 u/l mesotheliomas mean 34.9 u/l pulmonary embolism mean 23.8 u/l lymphoma mean 64.3 u/l . 1:25 pm pleural fluid pleural fluid. gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (preliminary): . 1:52 pm sputum site: induced source: induced. gram stain (final ): pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): sparse growth commensal respiratory flora. yeast. sparse growth. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): . 10:00 am sputum source: induced. gram stain (final ): pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (preliminary): sparse growth commensal respiratory flora. immunoflourescent test for pneumocystis jirovecii (carinii) (final ): specimen not processed due to: quantity not sufficient. less than 2 ml received. please submit another specimen. test cancelled, patient credited. reported to and read back by dr. , k () on at 14:42. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. . 1:30 pm pleural fluid gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (preliminary): fungal culture (preliminary): no fungus isolated. afb cultures are still pending although all afb smears are negative from sputum and intra op pleural fluid and tissue. imaging: . chest x-ray: pa and lateral views of the chest. no prior. there is a moderate-to-large right-sided pleural effusion. there is also likely right middle and lower lobe atelectasis. linear opacity at the left lung base suggestive of atelectasis and there is suggestion of left apical calcified granulomas, but there is no confluent consolidation or left effusion. the cardiomediastinal silhouette is within normal limits. hypertrophic changes are seen in the spine. surgical clips in the right upper quadrant suggest prior cholecystectomy. osseous and soft tissue structures are otherwise unremarkable. impression: moderate-to-large right-sided pleural effusion with components of middle and lower lobe atelectasis. . chest ct w/o contrast: 1. large possibly loculated non-hemorrhagic right pleural effusion could be entirely responsible for collapse of the right lower lobe. 2. contents of the right lower lobe indeterminate. since bronchopneumonia is present in the left lung i suspect there is pneumonia in the right also. 3. suggest echocardiography for evaluation of possible tamponade from surprisingly small pericardial effusion. . chest x-ray s/p thoracentesis: marked reduction of right-sided pleural effusion after thoracocentesis, no pneumothorax. . tte: 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 root is mildly dilated at the sinus level. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. impression: preserved biventricular regional and global systolic function. trace aortic regurgitation. mildly dilated aortic root. brief hospital course: 52 yo f with history of hiv (cd4 293, vl undetectable ), active heroin user and smoker presents with 4 days dyspnea associated with cough, r lateral and posterior chest pain which started gradually. . # dyspnea/cough: patient presented with dyspnea and cough as well as right lateral and posterior chest pain of gradual onset for 4 days. cough was productive for grey sputum. patient febrile on admission, right lung with crackles of the way up, scattered wheezes and anterior rales. did have leukocytosis. chest ct with lul and lll pneumonia as well as a right sided pleural effusion, possibly r sided pneumonia as well. initially treated for pneumonia with ceftriaxone, then transitioned to vancomycin/zosyn. pleural effusion also to sob, see below. patient does have hiv, although cd4 293, so not at high risk for opportunistic infection. however, pcp was neg. also, however, tuberculosis on differential. started ruling out for tuberculosis with 3 induced sputums, smears neg, cultures pending. less likely as pleural fluid was 15, not elevated enough for tuberculosis. blood cultures remained neg. id was following, did not think patient needed to be treated empirically. . # pleural effusion: patient with large right sided pleural effusion. thoracentesis done , only 320cc out until patient felt some pain. fluid exudative as ldh > upper limit of normal and pleural fluid total protein >0.5 of serum protein. be exudative secondary to pneumonia vs. tuberculosis. given large amount of fluid in lung, ~1l, and only able to remove 320cc prior to pain, patient may have trapped lung vs. empyema. thoracic surgery was consulted and she was taken to the or on for a right vats decortication. she tolerated the procedure well and returned to the pacu in stable condition. she maintained stable hemodynamics and her pain was well controlled. fluid not transudative, but did obtain tte which ruled out chf as cause of effusion. following transfer to the surgical floor she remained stable without any fevers and her wbc was down to 10k. the infectious disease service followed her closely post op and she continued on vancomycin and zosyn pending new culture results. her intraop cultures remained negative and recommendations were to treat her for two weeks post op with augmentin and levaquin. dr. will continue to follow her as an out patient. her port sites were healing well and her last chest tube was removed on . she was up and walking independently and tolerating a regular diet. she had no signs or symptoms of drug withdrawal post op but continued with a clonidine patch and prn percocet for incisional pain. # hiv: cd4 293, vl undetectable 12/. continued home atripla qhs. at the time of discharge on she remained afebrile, was ambulating frequently and her appetite was good. she will follow up in the thoracic clinic in 2 weeks and call dr. for a follow up appointment in weeks. medications on admission: atripla 600-200-300mg 1 tab po qhs zyprexa 20mg po qhs neurontin 600mg qhs celexa 30mg po qd discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: two (2) tablet po at bedtime as needed for constipation. 3. efavirenz 600 mg tablet sig: one (1) tablet po hs (at bedtime). 4. emtricitabine-tenofovir 200-300 mg tablet sig: one (1) tablet po hs (at bedtime). 5. olanzapine 10 mg tablet sig: two (2) tablet po hs (at bedtime). 6. gabapentin 300 mg capsule sig: two (2) capsule po hs (at bedtime). 7. citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). 8. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 9. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*40 tablet(s)* refills:*0* 10. amoxicillin-pot clavulanate 875-125 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*20 tablet(s)* refills:*0* 11. levofloxacin 750 mg tablet sig: one (1) tablet po daily (daily). disp:*10 tablet(s)* refills:*0* 12. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmon (every monday). disp:*4 patch weekly(s)* refills:*1* discharge disposition: home discharge diagnosis: empyema. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: * you were admitted to the hospital with pneumonia in your left lung and a residual lung infection in the right lung requiring surgery. you are improving daily but will need to stay on oral antibiotics until . * continue to use your incentive spirometer 10 times an hour while awake. * check your incisions daily and report any increased redness or drainage. cover the area with a gauze pad if it is draining. * your chest tube dressing may be removed thursday. if it starts to drain, cover it with a clean dry dressing and change it as needed to keep site clean and dry. * you will continue to need pain medication once you are home but you can wean it over a few weeks as the discomfort resolves. you were given medication in the hospital to prevent withdrawal symptoms. call dr. for a follow up appointment to help you wean them off. * make sure that you have regular bowel movements while on narcotic pain medications as they are constipating which can cause more problems. use a stool softener or gentle laxative to stay regular. * no driving while taking narcotic pain medication. * take tylenol 650 mg every 6 hours in between your narcotic. if your doctor allows you may also take ibuprofen to help relieve the pain. * continue to stay well hydrated and eat well to heal your incisions * shower daily. wash incision with mild soap & water, rinse, pat dry * no tub bathing, swimming or hot tubs until incision healed * no lotions or creams to incision site * walk 4-5 times a day and gradually increase your activity as you can tolerate. call dr. office if you experience: -fevers > 101 or chills -increased shortness of breath, chest pain or any other symptoms that concern you. followup instructions: department: hematology/oncology when: tuesday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage please report 30 minutes prior to your appointmemnt to the radiology department on the of the clinicla center for a chest xray. call dr. from community health center for a follow up appointment in weeks. procedure: thoracentesis thoracoscopic decortication of lung diagnoses: anemia of other chronic disease tobacco use disorder unspecified pleural effusion personal history of other infectious and parasitic diseases depressive disorder, not elsewhere classified opioid abuse, continuous empyema without mention of fistula asymptomatic human immunodeficiency virus [hiv] infection status bacterial pneumonia, unspecified 

Answer: The patient is high likely exposed to