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: bactrim attending: chief complaint: rash major surgical or invasive procedure: intubation and mechanical ventilation central line placement picc line placement () history of present illness: (pt is intubated and sedated on arrival to the , the history is provided by his significant other, ). mr. is a 42 year-old male with a history of hiv infection and lyme disease who presents w/ a diffuse erythematous rash which started today at 11am. the rash was first noticed last week. he went to his pcp's office on when he first noted the rash. it was described as a generalized, macular papular rash on his torso and extremities. it was thought to be due to dapsone (which was being used for pcp ) and it was recommended that he d/c dapsone. he had been on dapsone since mid-. for pcp prophylaxis, he was then given inhaled pentamidine (on ) without any problems. the patient was advised to use benadryl for symptom relief. the following weekend (), the patient continued to have what his partner described as an erythematous, "spotty" rash all over his body. it was not itchy, but the patient took benadryl and claritin rtc to help with the rash, without much improvement. he also stopped taking atripla (his previous haart medication) and began taking kaletra and truvada (the new haart regimen which had been prescribed by his pcp ). he was noted to have intermittent fevers to 101 and "heart palpitations". his partner denied any symptoms of night sweats, chills, sob, chest pain, cough, uri sx, nausea, vomiting, abdominal pain, diarrhea. he was noted to be fatigued and his partner states that the patient "slept for the last 3 days". by tuesday (), the patient's rash had resolved and he went to work without any complaints. he was noted to have more energy that evening and slept well. however, upon waking on , he noted to his partner that he felt poorly but tried to go to work. he also told his partner that he was beginning a new medication today for pneumonia but it was unclear what medication this was. the patient then presented to the er for further evaluation. . in the er, initial vs were t 98.6, bp 103/51, hr 110, rr 18, sats of 99% on ra. his initial complaint was of an allergic reaction at work -he noted that his skin was warm, dry, flushed and his eyes were red and itchy. he quickly then dropped his bp to 74/41. he was bolused w/ ivf and started on vancomycin. his temp started to rise and he was given ibuprofen. ivf were continually bolused and ctx was given. his sbp remained in the 70s so he was put on dopamine through a peripheral iv while a central line was placed. he was then switched to levophed. he then became hypoxic with increasing o2 requirement and was intubated in the er using etomidate/succinylcholine. he received a total of 5.5l of ns and had 80cc uop (a foley had been placed). dermatology was consulted in the er and had a ddx of drug hypersensitivity, viral exanthem, or infection. they did not feel that this was sjs. . per the pcp notes at , the patient had stopped atripla on due to a rash and had begun on kaletra/truvada on . the rash was felt to be self-limited as it resolved with discontinuation of atripla. he also noted that he had continued on the dapsone up until . he commented on resolution of the rash, but did note a ha over the weekend that was . given pt's intubated status and conflicting story from his partner, it is unclear what meds the patient was receiving and when he had discontinued others. . of note, the patient was admitted with a similar chief complaint in . he presented with fever, acute renal failure, anemia and joint pain. he was diagnosed with acute hiv infection (vl >100,000k, cd4 of 180) and the remainder of the infectious w/u was negative. aso titer was positive and complement levels were negative, but the patient was treated with a full course of augmentin anyways. anemia was felt to be due to iron deficiency and outpatient workup was recommended. he then presented 2 days after discharge with fever to 103.8, "red eyes", and rash. he had a lactate of 2.8 at the time. he was initially treated with ctx, vanco and acyclovir, had an lp (neg for meningitis), head ct (neg for bleed), and cxr (no infiltrate). his abx were initially switched to ctx and azithromycin. lyme antibody was positive so his antibiotics were switched to doxycycline for a 30 day course. he was discharged on cipro eye drops and atovaquone for pcp . past medical history: 1. anal fissure 2. adjustment disorder 3. urethritis nos 4. depression/anxiety 5. pharyngeal gonococcal infection 6. anal gonococcal infection 7. new diagnosis of hiv, vl > 100k, cd 4 pending; per his report had negative hiv test in social history: pt is involved with a monogamous partner, with whom he lives (). he works as a social worker for the of mass. he reports no recent sexual contact (>6 weeks decreased libido). his partner is monogamous per his report. he drinks glasses of wine on weekends. he denies tobacco use. he does not use heroin or cocaine, but does admit to rare marijuana use. family history: glaucoma (father, . sister and gm with dm. physical exam: vs - t 101.8, tmax 102.8, bp 98/62, hr 129, rr 20, sats 96% ac 500x20, peep 10, fio2 100% weight - 75kg pre-ivf; 83kg on admit gen: wdwn middle aged male intubated and sedated. . heent: sclera injected but anicteric. perrl (3->2mm bilaterally). op clear around mouth (could not assess posterior pharynx as pt intubated, ogt in place, pt not opening mouth). no jvd but prominent visible carotid pulsations. cv: hyperdynamic precordium, prominent pmi in mid l clavicular line. tachycardic, regular. normal s1, s2. no m/r/g. lungs: clear anteriorly at apices. rhonchorous, vented breath sounds throughout remainder anterior lung fields. abd: firm, distended. minimal bs. no rebound or guarding. ext: warm, erythematous, 2+ pt, dp, radial pulses bilaterally. r ij. r art line. gu: penis w/o any lesions. rectal exam in ed guaiac negative. neuro: pt intermittently sedated and awake. when awake, follows commands and answers questions appropriately. can respond by shaking head, writing. using all 4 extremities spontaneously. downgoing toes bilaterally. skin: diffuse, erythematous, fine, maculopapular confluent, blanching rash that is extensive over his face, neck, torso, extremities (upper and lower bilaterally) and palms, but spares his soles. not pruritic, no excoriations, no skin lesions, no bullae or vesicles. pertinent results: ct chest/abdomen/pelvis w/contrast 10:23 am ct chest with intravenous contrast: there is dramatic improvement in the bilateral effusions with minimal residual bilateral atelectasis when compared to the previous study. the central airways are patent to segmental levels bilaterally. there is a small hyper attenuated lesion in the right middle lobe of the lung, which is likely a tiny calcified granuloma. there are small axillary lymph nodes under 1.5 cm as seen in the previous study. there are no pathologically enlarged mediastinal lymph nodes. there is no pericardial effusion. ct of the abdomen with intravenous contrast: the liver, spleen, adrenal glands, pancreas, abdominal loops of small bowel are unremarkable. there is resolved ascites when compared to the last study. there is minimal gallbladder wall thickening likely due to third spacing. tiny paraortic lymph nodes noted, not significantly enlarged by strict ct criteria. pelvis: mild thickening of the right colonic wall, likely due to third spacing. a comparison with a prior examination is difficult due to the lack of contrast filling in the previous study. lower left ureter dilation with no evidence of obstruction as seen in the previous study. no mass is identified in and around the bladder. no significant lymphadenopathy within the pelvis. impression: 1. improvement of effusion and ascites when compared to previous ct. 2. no abscess or fluid collection seen. 3. mild right colonic wall thickening, possibly due to third spacing. a comparison with a previous exam is difficult due to the lack of opacification from oral contrast in the previous study. 4. dilated left lower ureter seen previously, possibly due to reflux or ureterocele <br> cd4 count () - 250. esr ()- 58 crp ()- 20 <br> <b>micro data:</b> blood cx () - coag negative staph x 2 bottles all other blood/urine cultures negative throat strep culture () - negative toxo culture () - negative pending cultures/serology: blood (, , x 2), fungal (), paracoccidio (), histo () <br> eeg: "this is an abnormal portable eeg due to the presence of frontally predominant generalized delta frequency slowing suggestive of deep midline or subcortical dysfunction. no clear epileptiform features were seen." head mri: "area of encephalomalacia in the right inferior frontal lobe. no abnormal enhancement, mass effect, or hydrocephalus. no evidence of slow diffusion to indicate acute infarct or signs of encephalitis." head ct: "no acute intracranial process. specifically, no evidence of hemorrhage, mass, or abnormal enhancement." 12:00pm plt smr-normal plt count-335 12:00pm hypochrom-normal anisocyt-2+ poikilocy-normal macrocyt-1+ microcyt-normal polychrom-1+ ovalocyt-1+ 12:00pm neuts-38* bands-39* lymphs-17* monos-3 eos-0 basos-0 atyps-0 metas-3* myelos-0 12:00pm wbc-1.5* rbc-3.26* hgb-11.0* hct-32.0* mcv-98 mch-33.8* mchc-34.4 rdw-16.0* 12:00pm estgfr-using this 12:00pm glucose-96 urea n-17 creat-1.4* sodium-139 potassium-3.7 chloride-101 total co2-29 anion gap-13 12:37pm lactate-2.8* k+-3.9 12:37pm comments-green top 01:44pm hgb-9.1* calchct-27 o2 sat-78 carboxyhb-1 met hgb-3* 04:30pm urine hyaline-0-2 04:30pm urine rbc-0-2 wbc- bacteria-few yeast-none epi-0-2 04:30pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-sm urobilngn-neg ph-5.0 leuk-tr 04:30pm urine color-yellow appear-clear sp -1.017 04:30pm urine uhold-hold 04:30pm urine hours-random 08:54pm o2 sat-94 08:54pm lactate-2.5* 08:54pm type-art temp-38.8 rates-20/6 tidal vol-500 peep-10 o2-90 po2-315* pco2-43 ph-7.30* total co2-22 base xs--4 aado2-302 req o2-55 intubated-intubated 09:08pm plt smr-normal plt count-301 09:08pm hypochrom-normal anisocyt-normal poikilocy-occasional macrocyt-2+ microcyt-normal polychrom-normal ovalocyt-occasional 09:08pm neuts-87* bands-12* lymphs-0 monos-0 eos-1 basos-0 atyps-0 metas-0 myelos-0 09:08pm wbc-4.8# rbc-2.73* hgb-9.4* hct-26.9* mcv-99* mch-34.6* mchc-35.0 rdw-15.4 09:08pm calcium-6.2* phosphate-2.1* magnesium-1.2* 09:08pm alt(sgpt)-75* ast(sgot)-77* ld(ldh)-426* alk phos-54 tot bili-0.4 09:08pm glucose-98 urea n-18 creat-1.4* sodium-139 potassium-4.4 chloride-110* total co2-19* anion gap-14 09:16pm pt-14.9* ptt-35.8* inr(pt)-1.3* 09:16pm plt count-319 09:16pm wbc-6.4 rbc-2.58* hgb-8.8* hct-25.7* mcv-100* mch-33.9* mchc-34.1 rdw-15.2 09:16pm calcium-6.3* phosphate-2.8 magnesium-2.4 09:16pm alt(sgpt)-99* ast(sgot)-106* ld(ldh)-458* alk phos-46 tot bili-0.4 09:16pm glucose-140* urea n-23* creat-1.9* sodium-136 potassium-5.3* chloride-112* total co2-15* anion gap-14 09:18pm wbc-6.3 lymph-6* abs lymph-378 cd3-69 abs cd3-263* cd4-21 abs cd4-79* cd8-47 abs cd8-179* cd4/cd8-0.4* 09:18pm fibrinoge-298 d-dimer-4843* 09:18pm fdp-10-40 09:18pm pt-13.1 ptt-28.6 inr(pt)-1.1 09:18pm plt count-363 09:18pm wbc-6.3 rbc-2.84* hgb-9.7* hct-28.6* mcv-101* mch-34.3* mchc-34.0 rdw-15.7* 09:18pm cortisol-17.0 09:18pm calcium-6.7* phosphate-2.8 magnesium-1.4* 09:18pm alt(sgpt)-87* ast(sgot)-90* ld(ldh)-503* alk phos-62 tot bili-0.4 09:18pm glucose-118* urea n-20 creat-1.6* sodium-138 potassium-5.2* chloride-108 total co2-20* anion gap-15 09:19pm urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:19pm urine color-yellow appear-clear sp -1.015 09:56pm o2 sat-76 09:56pm type- temp-38.8 rates-20/8 tidal vol-500 peep-10 o2-60 po2-61* pco2-64* ph-7.15* total co2-24 base xs--7 -assist/con intubated-intubated 10:36pm urine bnzodzpn-pos barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 10:36pm urine osmolal-350 10:36pm urine hours-random urea n-196 creat-117 sodium-91 10:36pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 10:36pm cortisol-16.3 10:36pm albumin-2.6* 10:36pm lipase-20 11:19pm o2 sat-94 11:19pm o2 sat-94 11:19pm lactate-1.6 11:19pm type-art temp-39.7 rates-20/6 tidal vol-500 peep-10 o2-60 po2-193* pco2-54* ph-7.17* total co2-21 base xs--9 -assist/con intubated-intubated <br> <b>discharge labs:</b> chem panel: na-141 cl-100 bun-13 gluc-111 agap=15 k-3.8 hco3-30 cr-1.1 ca: 9.2 mg: 1.8 p: 2.6 alt: 52 ap: 81 tbili: 0.3 alb: 4.1 ast: 29 mcv:99 wbc-4.5 hb-11.3 plt-260 hct-33.4 n:60.3 l:32.2 m:3.8 e:3.2 bas:0.5 brief hospital course: is a 42-year-old male newly diagnosed with hiv in who presented to the ed on with fever, nausea, headache, and a whole body erythematous skin rash that had started earlier in the day. in the ed, his skin was noted to be warm, dry, and flushed. his blood pressure, initially 103/51, dropped to 74/41. fluid boluses failed to improve his blood pressure and so pressors were started. when he became hypoxic, he was intubated using etomidate and succinylcholine. one dose of ceftriaxone and one dose of vancomycin were given in the ed. he was admitted to with a diagnosis of distributive shock of unknown etiology and started on zosyn, vanco, and clindamycin. . mr. continued to be hypotensive in the icu. he received large amounts of iv fluid and was placed on three pressors, dopamine, levophed, and epinephrine, and still remained hypotensive. when -stim test showed adrenal insufficiency, hydrocortisone was added as well. over the next few days, pressors were slowly weaned as his blood pressure recovered. urine, stool, sputum, throat, eye, and blood cultures all failed to grow significant pathogens. a nares staph aureus swab was negative as well. hiv viral load measured to be fairly low at 17,000 copies/ml, making acute hiv superinfection/exacerbation unlikely. a 2d echo on showed normal ventricular function. it was felt that the patient had distributive shock from one of the following three etiologies: . 1. dapsone hypersensitivity syndrome: consistent in that the patient had recent use of dapsone, elevated methemoglobin, fever, erythematous rash with subsequent exfoliative rash, and elevated liver enzymes. inconsistent in that the patient had no jaundice or eosinophilia. "sulfa/sulfone" drugs, including lasix, were avoided during the patient's stay to avoid the risk of re-inciting a hypersensitivity reaction. the patient was given stress doses of hydrocortisone. . 2. toxic shock syndrome: consistent in that patient had fever, hypotension, intense erythoderma, blanching, conjunctival injection, and elevated liver enzymes. inconsistent in that the patient had no significant renal involvement, thrombocytopenia, convincing desquamative rash, or known source of bacterial infection. the patient was examined and cultured extensively (including throat, eyes, and nose) for streptococcus or staph aureus, but no source was identified. spotty fever and leptospira antibodies were sent as they are in the differential of tss. the patient was maintained intially on broad spectrum antibiotics. . 3. bacterial sepsis: consistent with the patient's presentation of 39% bandemia, but inconsistent in that no source of infection was ever identified. as noted above, extensive culturing offered no source of bacterial infection. the patient was maintained initially on broad spectrum antibiotics. . of note, the patient required heavy sedation with fentanyl and midazolam drips to keep him sedated while intubated. pressure support trials were initially unsuccessful as the patient had prolonged periods of apnea. the trials improved and he was ultimately extubated on successfully. . following extubation, the patient initially appeared to be his normal self. the next day, however, he began to appear agitated and confused. after being given a dose of haldol, he displayed symptoms consistent with antipsychotic-induced dystonia (lip/tongue smacking, grimacing, etc.). haldol was discontinued and benadryl/cogentin given. the following morning, while still agitated and confused, he had a tonic clonic seizure lasting less than one minute followed by lethargy/confusion interspersed with 3 or 4 short moments of terror and accompanying screams. he calmed with 2 mg of iv ativan. . the seizure was felt to be due to benzo withdrawal as the patient had a long standing history of benzo use and had been on large doses of midazolam while sedated. while he was being maintained on 1 mg ativan for anxiety prior to the seizure, this may not have been sufficient. other etiologies that could not be ruled out included levofloxacin reaction, neurological hiv, and infectious meningitis or encephalitis. the patient never exhibited autonomic lability, however, as would be expected with a benzo withdrawal. a head ct with contrast immediately after the seizure failed to show any acute pathology. . the patient remained agitated, confused, and confrontational. in order to obtain the appropriate tests for his mental status change, he was again sedated and intubated on . a head mri showed "encephalomalacia in the right inferior frontal lobe," but no acute process. csf fluid from lp was sent for the following tests: protein, glucose, cytology, gram stain, hsv, hiv viral load, virus, cryptococcus, ebv, lyme disease, toxoplasma, varicella, vdrl, wnv, and cultures. his serum was tested for toxoplasma, rpr, cryptococcus, b12, folate, and urea. an eeg was done on . . following the completion of tests on , the patient was weaned from sedation and extubated. he was placed on standing doses of ativan (2mg tid) and zyprexa for agitation and prevention of opioid withdrawal. he remained much calmer than previously and his mental status returned to . on , he was discharged to the floor. no pcp prophylaxis was given during his stay because he had received pentamidine nebulizer treatment on (dosed every 30 days). . on arrival to the floor, the patient was noted to be calm and in no respiratory distress. he was afebrile and hemodynamically stable. he was increasingly ambulatory, and was eating and drinking well. he did not need any prn zyprexa for sedation, so this was discontinued. he did not require insulin, so this was discontinued. he was ambulatory on the floor, so subcutaneous heparin was discontinued. he continued to have low grade fevers in the 99 degree range, and blood cultures off of his central line drawn on showed 2/2 bottles from the line positive for coagulase-negative, staph. aureus. peripheral cultures drawn at the same time showed no growth of bacteria. the catheter tip culture was negative. surveillance cultures were drawn. he continued to look and feel clinically well, and had no subjective complaints. however, he subsequently had intermittent fevers. he was restarted on vancomycin on . fevers on and were as high as 102.5. on , he had a fever of 101. on , tmax was 100.6. all cultures were ngative except culture from . preference was to have patient monitored until he was consistently without fevers, however patient reported increased anxiety with staying in hospital and very strong desire to leave. given no other clear souce, pt is being discharged to complete 2-week course of antibiotics (vancomycin) for possible line infection. . id team was following him in the hospital, recommended holding antiretroviral therapy during this hospitalization until outpatient id care arranged and acute illness resolved. this discharge, cd4 count was in 250s, so haart and prophylaxis not acutely restarted. pt can f/u as outpatient for consideration of these therapies. . psychiatry was also following along and recommended institution of celexa and taper of benzodiazepines at 25% per day. this was completed. he was discharged on celexa 20mg (had briefly been on 60mg which was home dose, but this was thought to be too high for him given that he had been off this dose for some time). . at the time of discharge, he was culture negative with the exception of studies off of central line as mentioned above, and the following studies are outstanding and will need to be followed up on by his primary care doctor and or his id physicians. . pending studies: blood cultures (, , x 2) fungal culture () histo serology () paracoccidio serology () medications on admission: meds: (per records) celexa 60mg po qhs acyclovir (? prolonged course) kaletra 200-50 2tabs po q12 (lopinavir-ritonavir) truvada 200-300mg 1 tab po qd (emtricitabine-tenofovir) pentamidine inhaled - first dose on . meds that patient had available to him: seroquel 50mg po qhs prn insomnia truvada 1 tab po qd - filled atripla 1 tab po qd - filled smz-tmp 400-800mg po qd (also has ds tabs 2tabs po bid ) dapsone 100mg po qd - filled acyclovir 800mg po tid x10d - filled celexa 60mg po qhs fluoxetine 20mg po qd kaletra 50-200mg 2tabs po bid - filled clonazepam 1mg po qhs - filled fluconazole 100mg po qd x7d - filled ambien 10mg po qhs triamcin/orabas 0.1% apply to affected area . meds identified by pharmacy as free pills pt had in bag: ibuprofen acyclovir vicodin hydrocodone percocet vicoprofen diazepam clonazepam lorazepam discharge medications: 1. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. disp:*30 tablet(s)* refills:*0* 2. vancomycin 1,000 mg recon soln sig: one (1) g intravenous twice a day for 9 days: last dose on . disp:*18 solution bags* refills:*0* 3. picc line care sig: as directed as directed: picc line care per protocol. disp:*qs picc care* refills:*0* 4. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). disp:*600 ml(s)* refills:*2* 7. multiple vitamin tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: home therapies discharge diagnosis: primary: shock, circulatory (sepsis vs. anaphylactic) dapsone hypersensitivity syndrome acute renal failure coag negative staph infection thrush secondary: hiv/aids discharge condition: t-100.6. vital signs otherwise stable. no complaints. discharge instructions: take all medications as prescribed. you will need to take vancomycin for 9 more days to complete a 2-week course (last dose on ). follow up appointments as indicated below. you were advised to remain in hospital for further monitoring of your temperature, however since you insisted on leaving, you are asked to monitor your temperature at home (ideally every hours). . return to the emergency room or call your doctor for: temperature of 101 or more shortness of breath worsening headaches followup instructions: new pcp: : , md phone: date/time: 2:00 new id specialist: provider: . blood phone: date/time: 3:30 psychiatrist: triangle program. 9am. . , ma. you are also welcome to continue primary care with dr. at the center (i have discussed this with him). call him to arrange an appointment with him for within two weeks of leaving the hospital should you elect to continue your primary care with him. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube diagnoses: pneumonia, organism unspecified unspecified septicemia other, mixed, or unspecified drug abuse, unspecified other convulsions depressive disorder, not elsewhere classified human immunodeficiency virus [hiv] disease anxiety state, unspecified hypoxemia drug withdrawal viral exanthem, unspecified lyme disease anal fissure cerebral artery occlusion, unspecified without mention of cerebral infarction unspecified adjustment reaction streptococcal sore throat sedative, hypnotic or anxiolytic dependence, continuous toxic shock syndrome alopecia, unspecified 

Answer: The patient is high likely exposed to