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: this is a 38-year-old man with aids referred by dr. who has fevers to greater than 104, likely pneumonia or other pulmonary process increasing for one month. he reports increased cough, usually nonproductive, but occasional production of bloody sputum. in addition, he has some dark stool which he states is maroon in color in the last few weeks as well as nausea and vomiting. he states that sometimes he vomits blood. reports left upper quadrant pain times one month with eating. denies dyspnea or chest pain. he states some pain in his chest with cough only and that's resolved, mild headache like a hot plate on his forehead, mild neck pain, positive urinary frequency and dysuria times weeks. today, he has had diarrhea, 30 minutes after meals. he states he has been depressed, not sleeping and wants to die without active suicidal ideation. past medical history: 1. hiv diagnosed in , treated with haart in , viral load was 50,000, went to less than 50, but then patient quit his medications after his rectal abscess. last cd4 count was 1, viral load in was greater than 500,000. 2. kaposi's of skin, oral cavity and lung, status post chemotherapy in . 3. ......... of the skin, buttocks in . 4. history of neutropenia exacerbated by bactrim and resolved with discontinuation. 5. hsv2 resolved , perianal. 6. history of perianal abscess in , status post surgery. 7. left upper lobe pneumonia in , treated with levofloxacin and resolved. 8. recurrent zoster. 9. pancreatitis. 10. oral ulcers and esophagitis. 11. depression. 12. tinea barba. social history: 45 pack year of tobacco. formerly 12-24 beers most recently until five days ago. family history: noncontributory. allergies: bactrim intolerance. medications: patient on only one month in acyclovir 800 t.i.d. times 30 days, then b.i.d., azithromycin 250 times five q. week, dapsone 100 q.d., epivir 150 b.i.d., indinavir 400 b.i.d., paxil 20, prilosec 20, ritonavir 100 times four b.i.d., stavudine 40 b.i.d. review of systems: no rigors, fevers and chills and sweats today only. weight loss 30 pounds in one month. cough. bloody sputum. very weak, appetite is poor, severe watery diarrhea ("like peeing"). left upper quadrant abdominal pain, nausea and vomiting. pain at the site of his spinal tap, insomnia. physical examination: temperature 104.4. heart rate 110. blood pressure 118/68. respiratory rate 18. in general: thin, uncomfortable male with soft voice who looks chronically but not acutely ill. head, eyes, ears, nose and throat: pupils equal, round and reactive to light. extraocular muscles were intact. mucous membranes moist. white patches on cheek and tongue with poor dentition. neck: small lymphadenopathy. cardiovascular: loud s1, s2, no murmurs, tachycardia but regular. pulmonary clear to auscultation bilaterally. abdomen loud bowel sounds, soft, diffusely tender, maximum left upper quadrant, right upper quadrant, suprapubic liver edge down 2 cm, 10 cm total of 10, tender. extremities: no cyanosis, clubbing or edema. skin: brown macules 1 cm scattered on back, right thigh. rectal: heme positive, perianal abscess with scarring. genitourinary: scars on scrotum, papules with ventral dot right inguinal consistent with molluscum contagiosum. psychiatric: depressed mood. neurological: alert and oriented times three, normal bulk and tone. laboratories: white blood cell count 2.3, hematocrit 35.5, platelets 112,000, mcv 90. sodium 130, potassium 3.9, chloride 96, bicarbonate 22, bun 10, creatinine 0.7, glucose 104. urinalysis: ketones 15, protein 100, otherwise negative. cerebrospinal fluid: tube 2 glucose 61, 4 no cells clear. head ct negative. chest x-ray: left upper lobe consolidation consistent with pneumonia. patient admitted to the medical service. hospital course: by system: 1. infectious disease: the patient was spinal tapped which was not consistent with meningitis, however, he was treated empirically with ceftriaxone and noted to defervesce. therefore, ceftriaxone was continued. infectious disease service was consulted. po acyclovir and dapsone were continued. kub was obtained which was negative except for a small amount of pelvic free fluid. numerous microbiology studies were sent. the only one which was positive was a sputum that grew out aspergilloses fumigatus. blood cultures, urine cultures were negative. ova and parasites was negative. stool ova and parasites was negative. stool culture for yersinia, campylobacter, e. coli, vibrio, cryptococcus, giardia were all negative. rpr was negative. sputum ova and parasites was negative. toxicology igg was negative. cryptococcus antigen was negative. sputum for acid fast bacilli times three were negative, however, patient was isolated respiratory until this was obtained. the cerebrospinal fluid from grew one colony on one plate of ..... bacterium which was .......this was thought most likely to be contaminant. patient was continued on ceftriaxone as he defervesced and remained afebrile. also continued on dapsone and acyclovir, however, his white count was noted to drop and the acyclovir was decreased and then stopped. however, after stopping the acyclovir, the patient noted increase in rectal burning and the acyclovir was restarted given the patient's history of herpes and the patient was put on neutropenic precautions. the patient was not restarted on haart during this acute period as he had been off it previously. on , a chest ct was obtained which showed a 1.8 x 1.5 cm cavitary lesion in the posterior left upper lobe surrounded by consolidation and ground glass opacity, as well as scattered emphysema. the patient was started on nystatin for thrush and over the next couple of days, the diarrhea seemed to resolve. the pulmonary service was consulted and on , the patient underwent bronchoscopy. bal grew aspergillus fumigatus, however, it was negative for pcp, cardia, ova and parasites and acid fast bacilli. thoracic surgery was consulted to assess whether the aspergilloma was resectable. they felt that he would need at least four to six weeks of treatment before surgery would be a consideration. therefore, amphotericin was started with a test dose and then at 0.5 mg /kg/iv/q.d. gastrointestinal was consulted given continuing abdominal pain without source, heme positive, and history of skin ........and patient with elevated eosinophils on his white count differential. esophagogastroduodenoscopy was performed on which was noted for friability, erythema and congestion in the antrum consistent with gastritis and abnormal mucosa in the duodenum, but otherwise normal. biopsy was taken. the antrum biopsy showed chronic gastritis with focal intestinal metaplasia. no active gastritis seen. duodenal biopsy showed no diagnostic abnormalities. patient was continued on protonix. 2. gastrointestinal: as above. multiple stool studies were sent and all were negative. 3. respiratory: patient found to have aspergillosis and started on amphotericin. 4. fluid, electrolytes and nutrition: patient noted to have a low sodium on admission of 130 felt consistent with syndrome of inappropriate diuretic hormone. this resolved with fluid restriction. 5. psychiatric: patient continued on paxil. it was discussed with the patient as to whether to have a social worker or psychiatrist and he declined at that time. on , patient was noted to start having nausea and vomiting. after that, he was found later in the morning, after he had tried to get out of bed, next to formed stool and he was unable to get up at that time. head ct was ordered but before patient was sent for head ct it was noted that his systolic blood pressure dropped to the 80s. patient was bolused with one liter of normal saline. blood pressure only responded slightly. medical intensive care unit team was called and was in the room at bedside. patient was vomiting and curled on his side. eyelids were noted to flutter and subsequently patient noted to become rigid, then arms came towards chest in tonic-clonic. patient was nonresponsive. ativan 4 mg given and code team called. patient intubated for airway protection and transferred to medical intensive care unit. in the medical intensive care unit, patient by system: 1. neurologic: he was loaded on dilantin. first lumbar puncture showed protein of 524. other cultures and cytology were negative. he was on acyclovir until hsv, pcr came back negative from cerebrospinal fluid. mri was negative. patient continued to have occasional gaze deviation and facial twitching, so, bedside electroencephalogram was obtained which revealed seizures q. 10 minutes. he was loaded on phenobarbital. he was still having seizures, so induced pentobarbital coma. neurology had been consulted. electroencephalogram flat line using pentobarbital for 72 hours. during this time, he developed central diabetes insipidus, spiked fevers with negative cultures, which was suspicious for ..........dysregulation. the second lumbar puncture showed protein of 226. patient believed to have meningitic process, especially active in basilar regions given central diabetes insipidus and neurogenic fevers of unclear etiology. question of whether this might be partly due to hiv encephalopathy. after three days from to , pentobarbital was weaned to off over 24 hours, continuous electroencephalogram monitoring for 72 hours after started pentobarbital taper with no signs of epileptic activity on electroencephalogram. bedside electroencephalogram was discontinued and patient was followed clinically. he had occasional eye twitch and facial myoclonus believed not to be seizure activity. he was maintained on phenobarbital and dilantin, which will be his anti-epileptic coverage for life. goal levels are 30 for phenobarbital and 17 for dilantin. on the fourth day after pentobarbital was off, patient noted to have brain stem activity, reactive pupils and corneal reflexes. by day seven, off pentobarbital. he became awake and alert, though not interactive over the next two to three days, he became interactive and vocal after extubation, although not at baseline mental status. he was able to follow commands sporadically, although confused often and quite exhausted. mental status will be impeded by his high viral load and his cerebrospinal fluid. central diabetes insipidus resolved but he continued to have fevers, but did not seem to be infectious. at the end of his intensive care unit stay, he appeared to have icu psychosis requiring a sitter and haldol. 2. pulmonary: he was intubated for airway protection. initially acidotic during seizure that resolved quickly on assist control while on pentobarbital, and then quickly weaned to pressure support. he was extubated with ease after the mental status improved and he had no problems with oxygenation or ventilation. he spent 11 days on the ventilator during which time sputum became colonized with e. coli not believed to be a pathogen, developed bilateral effusion from fluid overload that resolved with diuresis. bronchoscopy after mucus plug, off right upper lobe with complete collapse. plug suctioned at bronchoscopy and right upper lobe atelectasis resolved completely. left upper lobe aspergilloma remained unchanged per chest x-ray. patient was maintained on itraconazole as amphotericin had to be stopped after the seizure. 3. cardiovascular: in the beginning, patient was initially septic appearing requiring pressors. the need for pressors increased during the pentobarbital, on dopamine and vasopressin after the pentobarbital was discontinued, pressors easily stopped and patient had good blood pressure, thereafter, echocardiogram was done while in coma with mildly depressed left ventricular function. after, out of his coma, he had no cardiac issues. he initially developed effusions from fluids he received but auto drive receptor-like episode resolved with resolution of the effusions. 4. infectious disease: dapsone prophylaxis was continued. itraconazole for aspergilloma. initially patient on ceftriaxone, levaquin, flagyl because he looked like he might have gram negative rods sepsis, but when cultures were negative, the levaquin and flagyl were discontinued. he was kept on ceftriaxone to complete a 24 day course. he was on acyclovir until hsv pcr was negative, esbl, e. coli and sputum, but no infiltrates, so believed to be a colonizer. cultures were always negative even when spiking q.d. cultures were drawn q. 24-48 hours so fever thought not to be infectious. renal function was good throughout. central diabetes insipidus treated with ddavp and matching out's with resolution of diabetes insipidus. in fact, ddavp was stopped completely because he became hyponatremic and then sodium became normal. fluid status and urine osmolarity were monitored and normal saline or d5 water was given prn. 5. gastrointestinal: initial loss of bowel sounds during the coma with poor motility that improved with reglan. patient was put on tpn during the coma, but after the coma, tolerated tube feeds. patient with good bowel movement after the coma. patient stable and transferred to floor on . this will be his hospital course from to by system: 1. pulmonary: patient with aspergilloma, continued on itraconazole. 02 saturations and respiratory rate remained stable. patient remained on nasal cannula oxygen. 2. infectious disease: patient continued to spike fevers every day. blood cultures and urine cultures were sent. blood cultures were always negative or pending as were urine cultures. infectious disease consult service continued to follow with the discussion that haart might be started when dilantin was weaned off as the two interacted and could not be started reliably concomitantly. another lumbar puncture was obtained for question of possible neck stiffness and photophobia. that night, tube four had white blood cells, 8 red blood cells, 21 polys, 2 lymphocytes, 52 monocytes, 47 in tube 1, 7 white cells, 22 red cells, no polys, 71 lymphocytes, 24 monocytes, protein of 46 and glucose of 67. that night, he got a dose of ceftriaxone, however, the next day with review with infectious disease team, it was felt that this was not consistent with meningitis, and so, ceftriaxone was stopped. patient was started on levaquin for possible coverage of pneumonia as he had some crackles on exam. the following day, oxacillin was also started but this was stopped after one day as lfts were known to elevate. at this time, no source for fevers were definitely discovered. patient with nasogastric tube, no nasal drainage or facial pain to palpation, however, ct at maxillary facial was obtained and is pending at this time. 3. neurology: neurology team continued to follow the patient. dilantin and phenobarbital levels were monitored. patient not noted to have any seizure activity. patient was started on keppra, which will not interact with haart, and after several days of this, dilantin will fully be weaned to off as keppra becomes therapeutic. 4. gastrointestinal: patient followed by nutrition and continued on tube feeds, tolerating well, hold on starting po until swallow study. on , lfts were checked and noted to have risen. alt at 57, ast at 176, alkaline phosphatase at 333, therefore, oxacillin was stopped. these may be due both to oxacillin and dilantin and will be followed. 5. fluid, electrolytes and nutrition: patient noted to have drop in his sodium after three water fluid boluses were increased with his tube feeds. these were held and changed to normal saline intravenous for fluid and sodium fully started to rise. electrolytes were monitored and repleted. 6. cardiovascular: patient noted to be tachycardic, felt secondary to fevers and possibly dehydration, therefore, normal saline boluses were given as needed. 7. prophylaxis: patient was kept on ........and protonix. physical therapy worked with patient. addendum to this dictation will be dictated by new intern, . this dictation is through . , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus esophagogastroduodenoscopy [egd] with closed biopsy venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: other convulsions human immunodeficiency virus [hiv] disease acute respiratory failure other emphysema other disorders of neurohypophysis acute pancreatitis aspergillosis pneumonia in aspergillosis 

Answer: The patient is high likely exposed to