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: propoxyphene / methadone / pseudoephedrine / peanut / adhesive bandage / banana attending: chief complaint: fever, chest pain, hypotension major surgical or invasive procedure: temporary l femoral line placement temporary l femoral line removal incision and drainage of l axillary fluctulant mass removal of rle femoral hd catheter placement of lle femoral hd catheter placement of lue brachial midline venous line (unsuccessful attempted picc line placement) history of present illness: 40yom with hiv on haart (cd4 411 on ), esrd on hd with multiple graft complications s/p r forearm amputation and infections (including h/o esbl sepsis) presented with fever noted at dialysis center. pt was recently hospitalized () for pain at r groin tunnel cath and (as per pt) fever. pt was empirically rx'd with vanc. pt was in usoh until thursday , when he noted throbbing pain (radiating to l chest wall) after l axillary ln biopsy. since then, he reports progressive pain at site. on am of admission, pt reported noting a fever of 103.4 and at dialysis center, fever of 102.1 was noted. pt reports feeling chills and vomited x 1 (non-bloody, non-bilious). pt also had 1 episode of non-bloody diarrhea (no abd pain). at dialysis center, pt received received 1g vanc, 125 gent ed vitals: 103.4, 110, 116/49, 16, 97%ra vs 99.5, 113/55, 97, 15, 96%ra patient was hypotensive to 80's/60's and received 1.5l iv ns and meropenem 1g on transfer to micu. pt remained stable in micu. on transfer to floor, pt complains of l chest pain (ekg shows no changes). past medical history: -- esrd on hd since 4 years due to htn/dm -- r tunneled groin cath placed -- av graft failure sp r forearm amputation for recurrent infxn -- hiv (cd4 411 in , vl undetectable) -- h/o esbl sepsis last year -- c diff colitis -- htn -- dmii -- asthma -- gerd -- chronic phantom limb pain -- retinal detachment social history: - incarcerated - tobacco: denies - alcohol: denies - illicits: endorses marijuana approximately 7 years ago family history: hypertension, cad, copd, bone cancer physical exam: physical exam on admission: vitals: t98.2 bp: 123/49 p:85 r: 12 o2: 96% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, r submandibular lad, rubbery, nontender cv: regular rate and rhythm, normal s1 + s2, ii/vi systolic murmur lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, ruq tenderness, no rebound, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, peripheral edema bilat r>l, fluctuant mass on r antecub, nontender, non erythematous, dystrophic nails with crusting, 4 toes on l foot, no ulcers access: r groin line- no erythema, purulent discharge, induration; l femoral line in place neuro: cnii-xii grossly intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred physical exam on discharge vs: 98.7, bp 134/79, p 85, rr 21, o2 sat 100% on ra general: pt appears intermittently uncomfortable but mostly laying calmly in bed heent: +l prosis (baseline), sclera anicteric, mmm, ulcerative oral lesions (clean base) on palate; perrl neck: supple, submandibular r posterior neck lad palpable (rubbery, nontender) cv: regular rate and rhythm, normal s1 + s2, +systolic murmur () lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: +ruq tender hepatomegaly (slight), no rebound, non-distended ext: l wound sp i+d, clean edges, packed with dressing, draining serous discharge. peripheral le non-pitting edema r>l. r antecubital fluctulant mass (non-tender, non erythematous), 4 toes on l foot. lines: l groin hd catheter in place: bloody discharge, tender to palpation, no erythema, no induration lue midline catheter (tender to palpation, with significant fluctulance in area of line entry, no erythema or warmth). neuro: cnii-xii grossly intact, 5/5 strength upper/lower extremities, grossly normal sensation. pertinent results: admission labs: 07:35pm blood wbc-14.8*# rbc-4.55* hgb-10.5* hct-31.7* mcv-70* mch-23.0* mchc-33.0 rdw-19.6* plt ct-291# 03:53am blood wbc-14.0* rbc-4.47* hgb-10.3* hct-31.6* mcv-71* mch-23.1* mchc-32.7 rdw-19.6* plt ct-292 07:35pm blood neuts-88.4* lymphs-7.1* monos-3.5 eos-0.7 baso-0.4 07:35pm blood plt ct-291# 03:53am blood pt-13.2* ptt-34.3 inr(pt)-1.2* 07:35pm blood glucose-103* urean-35* creat-6.8*# na-141 k-4.3 cl-95* hco3-34* angap-16 03:53am blood glucose-121* urean-39* creat-7.6* na-138 k-4.6 cl-94* hco3-33* angap-16 07:35pm blood alt-68* ast-112* alkphos-269* totbili-0.5 03:53am blood alt-87* ast-131* alkphos-261* totbili-0.5 07:35pm blood ctropnt-0.16* 03:53am blood ctropnt-0.18* 03:53am blood albumin-4.3 calcium-9.4 phos-4.7*# mg-2.2 pertinent labs: 07:35pm blood neuts-88.4* lymphs-7.1* monos-3.5 eos-0.7 baso-0.4 06:10am blood neuts-72.9* lymphs-15.6* monos-7.5 eos-2.9 baso-1.1 07:35pm blood alt-68* ast-112* alkphos-269* totbili-0.5 03:53am blood alt-87* ast-131* alkphos-261* totbili-0.5 06:10am blood alt-59* ast-57* ld(ldh)-162 ck(cpk)-83 alkphos-267* totbili-0.3 06:10am blood alt-49* ast-47* ld(ldh)-164 ck(cpk)-51 alkphos-295* totbili-0.4 08:05am blood alt-38 ast-32 ld(ldh)-176 ck(cpk)-55 alkphos-281* totbili-0.4 07:35pm blood ctropnt-0.16* 03:53am blood ctropnt-0.18* 06:10am blood ck-mb-2 ctropnt-0.15* 06:10am blood ck-mb-1 ctropnt-0.17* 08:05am blood ck-mb-2 ctropnt-0.16* 07:30am blood ck-mb-1 ctropnt-0.16* 10:20am blood pth-307* 06:15am blood pth-291* 07:18am blood pth-309* 03:53am blood hcv ab-negative 07:35pm blood lactate-2.0 microbiology: blood cultures from clinic: vre blood cultures : negative catheter tip cx : negative bcx : pnd bcx : pnd throat viral cx : prelim negative c diff assay : negative wound cx from l axillary wound : gram stain: no polymorphonuclear leukocytes seen. no microorganisms seen. wound culture (final ): staphylococcus, coagulase negative. rare growth of two colonial morphologies. anaerobic culture (final ): no anaerobes isolated. discharge labs: 07:57am blood wbc-5.0 rbc-4.47* hgb-10.1* hct-31.7* mcv-71* mch-22.7* mchc-31.9 rdw-20.1* plt ct-236 07:57am blood glucose-119* urean-60* creat-8.6* na-143 k-5.6* cl-99 hco3-30 angap-20 07:57am blood alt-16 ast-19 ld(ldh)-147 alkphos-182* totbili-0.3 07:57am blood calcium-10.1 phos-8.0* mg-2.5 radiology: lue us (preliminary): 1. no son evidence for left upper extremity dvt with picc in one of four left brachial veins. 2. left upper extremity graft, incompletely evaluated, likely thrombosed. rle us : impression: no son evidence for right lower extremity deep vein thrombosis. enlarged right inguinal lymph node as seen on previous ct. ct abd/pelvis (to assess for hematoma in lle): impression: no acute hematoma. a left femoral approach central venous catheter terminates at lower cavoatrial junction. r neck us : single non-specific non-pathologically enlarged lymph node in the right side of the neck. no fluid collection or soft tissue mass is identified. echo : impression: no valvular vegetations seen (good-quality study). symmetric lvh with normal global and regional biventricular systolic function. mild mitral regurgitation. moderate pulmonary hypertension. lue us : mixed echogenic left axillary mass, predominantly hypoechoic, could represent phlegmon versus hematoma. tiny ring-down artifacts may represent foci of gas or surgical packing material. ruq us : impression: mild intrahepatic bile duct dilation within the left lobe. normal cbd. no ultrasound evidence for acute cholecystitis. ct abd/pelvis : limited evaluation due to lack of iv contrast and paucity of intra-abdominal preliminary reportfat. within these limitations, no acute intra-abdominal process is noted. no acute intra-abdominal process is noted on this limited exam. cxr : no acute process brief hospital course: mr. was admitted for treatment of sepsis. he was treated for the following acute conditions: active issues: # pain at midline catheter site on , pt was noted to have lue pain at midline catheter site. there was no warmth, erythema or evidence of extravasation. lue ultrasound showed no son evidence for left upper extremity deep vein thrombosis, a left upper extremity graft not well evaluated but likely thrombosed, and a mid-line catheter in one of 4 left brachial veins. # vre sepsis: as per records from prison, paitnet had vre bacteremia based on blood cultures drawn at that time. the source was most likely the r femoral hd catheter (although tip culture negative). blood cx from , , and were negative. pt had originally been treated with vancomycin but this was discontinued on and linexolid was started on . linezolid was later changed to ampicillin iv q12h on , on recommendation of the infectious disease consulting team. pt underwent removal of the r hd femoral line . r femoral site was tender to palpation but nothing was draining and pain resolved prior to discharge. to facilitate hemodialysis, a l femoral hd tunnel catheter placed on succesfully with no evidence of infection. pt is also sp midline catheter () on lue (ir team unable to place picc) for administration of ampicillin in his prison facility. - continue ampicillin 2g iv q12h (2 week course intended; - ) #esrd: pt was on hd three times/wk (mwf). last succesful dialysis (dialysis on was unsuccesful patient inability to tolerate it). hd tunnel catheter (l femoral) placement in succesful on as per i/r team. - please check ca x phosphate product, if >55, hold activated vit d supplementation to prevent calcium phosphate crystal deposition #left axillary lymphadenopathy s/p ln bx on and developed swelling and pain thereafter. acute care surgery was consulted and did i/d () and pt feeling better. culture growing coag-negative staph (likely s. epidermitis). later, wound noted to be draining serous material and surgery was re-consulted to evaluate sufficiency of packing and possibility of closure by secondary intention/further i+d. surgery recommended continued wound packing with dry gauze. #ulcerative oral lesions/r neck pain on , lesions were noted on upper gums, raised, hypopigmented and reported tender. likely hsv. pt continued to have mouth pain lesions, which have expanded to l side of mouth and are stable now. pt reporting jaw and neck pain (neck pain likely reactive ln from oral infxn), which is now improving. prelim hsv culture negative. - lidocaine mouth wash - fu final hsv culture - pt completed 7d coutse of acyclovir 200mg po q8h ( - ) inactive issues: # hd reaction/chest pain on , pt reported myalgias, chest pain and began to shake while undergoing dialysis. he reported a "tingling" feeling in his extremities. there was no evident explanation for this reaction. be pt's electrolyte changes (pt hyperkalemic in recent past). pt not febrile and cp reproducible on palpation/no ekg changes. pain resolved spontaneously. # l groin pain on , pt noted pain in the l femoral region, around site of tunnel catheter placement. pain was radiating to back as per pt. there was concern for retroperitoneal hematoma given pt's complicated vascular anatomy. non-contrast ct of pelvis was negative for hematoma and back pain resolved. # discomfort while receiving iv antibiotics on , pt reported a "funny" sensation associated with abx. it was described as a chill on his l chest wall. this was likely feeling of abx entering through catheter. rrr on heart exam and no ekg changes. pt received amp iv x 5d so allergic reaction unlikely. no pruritis, urticaria, sob, laryngeal sx to suggest allergic rxn. ampicillin infusion was completed succesfully at a slower rate. # hyperkalemia when not on dialysis, pt had episodes of hyperkalemia (i.e. on , pt persisted with elevated k despite metolazone, lasix and kayexelate) above what renal team would expect given pt's diet. although no ekg changes, review of pt's meds revealed that pt was on lisinopril during this admission. it was previously dc'd by renal causing pt to have hyperkalemia. lisinopril was dc'd but pt remained hyperkalemic. pt was placed on a low k diet. - please continue low k diet. # le edema r>l - no evidence of dvt on us #transaminitis (resolved) hep b negative and hep c negative. unlikely direct infectin of hepatobilliary tract given mostly negative us/ct findings. now at baseline. the elevation was likely sepsis. #hiv: last cd4 411 () - on haart: emtricitabine, abacavir, efavirenz #anemia: most likely renal failure hx. - on epo with hd and ferrous gluconate and folic acid supplements #dm: fsg well-contolled. will continue humalog iss. on diabetic diet and iss during current admission. #htn: home meds: labetalol 800 three times daily, amlodipine 10 mg daily, minoxidil 10 mg daily. held during admission due to sepsis/hypotensive episode. home meds restarted slowly. dc'd lisinopril due to hyperkalemia. on amlodipine, minoxidil, and labetalol per home bp regimen. dialysis as scheduled will help in management of htn episodes. please consider titrating up bp meds as necessary or restarting lisinopril with careful potassium monitoring. #gerd: hx of omeprazole use for gerd put was not on active medication list from prison. - please re-assess for need to continue omeprazole #seizure disorder on keppra transitional issues: - please follow up hsv viral culture for oral lesions - please follow-up lfts, may need to review medications including haart medications if transaminitis recurs - please provide regular lower extremity monitoring for worsening of swelling and/or diabetic ulcers. - please follow-up on pathology from l ln biopsy - please monitor progression or improvement of l axillary wound and continue thorough dry packing at least two times per day - please arrange to follow-up with nephrology and transplant to plan for graft/fistula establishment in proximal rue, tentatively set for . - please note, pt complains of a throbbing, reproducible pain at the anterior chest wall, if this pain recurs, please compare his ekg at time of pain with a baseline ekg (no ekg changes have been noted during this admission). - please note, pt had elevated troponin levels on admission (0.16 - 0.18, stable on several repeat draws). given pt's renal failure and low ck-mb fraction, this was not thought to be due to cardiac ischemia. - please note lymphadenopathy noted in r neck, rue, lue and l axilla (sp biopsy and i+d) - please monitor lymphadenopathy to resolution after completion of treatment for vre sepsis. - please check ca x phosphate product, if >55, hold activated vit d supplementation to prevent calcium phosphate crystal deposition medications on admission: preadmission medications listed are correct and complete. information was obtained from patientfamily/caregiver. 1. levetiracetam 1000 mg po bid 2. sevelamer carbonate 4000 mg po tid w/meals 3. doxercalciferol 2.5 mcg po mwf with hd 4. hydroxyzine 50 mg po mwf hd protocol 5. labetalol 800 mg po tid 6. docusate sodium 100 mg po bid 7. senna 2 tab po hs 8. aspirin 81 mg po daily 9. amlodipine 10 mg po daily 10. minoxidil 10 mg po bid 11. diphenhydramine 25 mg po tid 12. epoetin alfa 20,000 unit sc mwf start: hs with hd 13. emtricitabine 200 mg po mf 14. folic acid 1 mg po daily 15. abacavir sulfate 300 mg po bid 16. albuterol inhaler 2 puff ih q4h:prn sob 17. efavirenz 600 mg po qhs 18. ferrous gluconate 325 mg po daily discharge medications: 1. abacavir sulfate 300 mg po bid 2. albuterol inhaler 2 puff ih q4h:prn sob 3. amlodipine 10 mg po daily 4. aspirin 81 mg po daily 5. diphenhydramine 25 mg po tid 6. docusate sodium 100 mg po bid 7. efavirenz 600 mg po qhs 8. emtricitabine 200 mg po mf 9. ferrous gluconate 325 mg po daily 10. folic acid 1 mg po daily 11. labetalol 800 mg po tid 12. levetiracetam 1000 mg po bid 13. minoxidil 10 mg po bid 14. senna 2 tab po hs 15. sevelamer carbonate 4000 mg po tid w/meals 16. ampicillin 2 g iv q12h on hd days, please dose after hd rx *ampicillin sodium 1 gram iv every 12 hours disp #*16 bag refills:*0 17. lidocaine viscous 2% 20 ml po tid:prn mouth pain. rx *lidocaine hcl 20 mg/ml oral three times per day disp #*1 container refills:*0 18. epoetin alfa 20,000 unit sc mwf with hd 19. hydroxyzine 50 mg po mwf hd protocol discharge disposition: extended care facility: discharge diagnosis: primary diagnosis: sepsis secondary diagnosis: left axillary abscess, end stage renal disease, hypertension, diabetes type ii discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted with fever from your dialysis center. your blood pressure dropped and you were transferred to the intensive care unit. you were found to have an infection of the blood (your outside hospital records showed that you had bacteria in your blood during the dialysis). we think that the infection most likely came from your right groin dialysis catheter. unfortunately, this catheter is very important for you to continue to undergo dialysis. it was removed and another hemodialysis catheter was placed in your left groin. you were treated with antibiotics for your blood infection and a midline venous line was placed in your left arm to allow you to receive these antibiotics. you also underwent incision and drainage of the left underarm lymph node (which was previously biopsied). the wound is now healing. finally, you were found to have oral lesions, which are likely caused by a virus (hsv), which we have treated with antibiotics. again, it was a pleasure to take care of you at . we made the following changes to your medications: - please start taking ampicillin iv until - pleast stop taking vitamin d. followup instructions: department: transplant center when: thursday at 1 pm with: , md building: lm bldg () campus: west best parking: garage procedure: hemodialysis venous catheterization for renal dialysis other incision with drainage of skin and subcutaneous tissue incision with removal of foreign body or device from skin and subcutaneous tissue phlebography of other specified sites using contrast material central venous catheter placement with guidance diagnoses: hyperpotassemia anemia in chronic kidney disease end stage renal disease other postoperative infection cellulitis and abscess of trunk severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure long-term (current) use of insulin long-term (current) use of other medications infection with microorganisms without mention of resistance to multiple drugs epilepsy, unspecified, without mention of intractable epilepsy kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure seroma complicating a procedure streptococcal septicemia enlargement of lymph nodes diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled asymptomatic human immunodeficiency virus [hiv] infection status diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled arthropathy associated with neurological disorders non-healing surgical wound herpetic gingivostomatitis bloodstream infection due to central venous catheter below elbow amputation status 

Answer: The patient is high likely exposed to