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: abnormal labs major surgical or invasive procedure: picc line placement history of present illness: 47yo m with h/o hiv not on haart presnted to pcp's office and then to our ed with non-productive cough, hiccups, jaundice, and icterus x 4 days. had "flu" about four weeks ago with predominant symptom rhinorrha. this resolved on its own and patient has not felt sweaty at night or febrile. 4 days ago developed a cough and presented initially to pcp's office who noted the jaundice, sao2=97% ra, no desaturation with ambulation and hepatomegaly on exam. labs at pcp notable for wbc (3060 bands), hb/hct 11.8/35.7 esr 119, na 120, cl 86, ca 7.7, alb 2.7, tuberculosis 10.2, db 6.6, sgot 294, sgpt 225. pcp referred him to ed. of note patient was admitted to in with fuo. had a multitude of tests sent including ebv (igm non-reactive, one igg reactive and the other negative), cmv (negative), rmsf (negative) and hiv which returned positive. he has since been followed at health and is not treated with haart per his pcp. in the ed initial vitals: t:100.1 hr:140 bp:117/82 18 o2sat:94%. jaundice on exam but feels fine and wouldnt have come to ed withotu pcp's advice. lll pna on cxr. given 2 ds bactrim tablet to cover pcp and 750mg po. abd us shows splenomegaly but no acute thrombus. lfts elevated. lactate trended down with 2l ns. has also spiked fever to 102.2 and receiving toradol for the fever. ekg: sinus tachy and non specific tw changes and persistent tachycardia to 130s with 3l ns so admission changed from floor to icu. on arrival to the floor patient c/o feeling hot and slightly short of breath. otherwise denied abdominal pain, dysuria, frequency, chest pain, shoulder pain, rash, sick contacts, palpitations. did endorse dark colored urine x 1 day at home. past medical history: hiv not on haart hospitalized for recurrent abcess on his buttocks x 1 night, mrsa cellulitis of arm. immune to hbv and hav in . hcv negative in . social history: single, msm, works at (no exposures to dust particles), lives with roommate and cats that he has had for a long time. previously drank one beer weekly but quit 2 months ago. non-smoker. denies illicit drug use. family history: mother died at age 67-dm,cad. father alive & well. 7 brothers, 8 sisters a & w physical exam: afebrile, vss gen: pleasant heent: perrl, icteric sclera, op without lesions or thrush, flat jvd, resp: decreased breath sounds at bases, egophany left middle lobe cv: rrr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses. ext: no c/c/e skin: no rashes/no splinters neuro: aaox3. slow in answering some questions. pertinent results: admission labs: labs from this admission: lactate 4.0-> 2.3 with 3l ns 120 / 84 / 17 -------------- 4.0 \ 22 \ 1.0 glucose 117 ca: 8.3 mg: 2.3 p: 3.1 alt: 253 ap: 134 tbili: 12.7 alb: 3.0 ast: 329 ldh: 435 dbili: 9.8 tprot: : lip: 61 tox negative (serum) wbc 23 85n, 10 band, 2l, 1meta, 0eos inr 1.3, ptt 26.3 . previous labs from cd4 count 257/22%, wbc 3800 hiv vl hep a ab reactive hbsag non-reactive hbsab reactive hbcab reactive hcv ab non-reactive ekg: sinus tachycardia at 130bpm. no st/tw changes imaging: cxr: patchy right upper and left lower lobe opacities raise concern for multi-focal pneumonia. cxr : findings: as compared to the previous radiograph, there is no relevant change. evidence of a left basal opacity with air bronchograms, extending both behind the heart and in the left lateral and perihilar lung areas. minimal additional overhydration cannot be excluded. borderline size of the cardiac silhouette. no evidence of pleural effusions. no newly appeared parenchymal opacities. cxr : tip of the new left pic line is in the low svc. there is no pneumothorax, pleural effusion or mediastinal widening. heart size is normal. consolidation in the left lower lobe has been present since and could represent either atelectasis or pneumonia. lungs are otherwise clear and there is no appreciable pleural effusion. abd u/s: impression: prominence of the portal triads may be due to acute hepatitis. recommend correlation with serum lfts. splenomegaly. no ascites. patent portal vein. legionella urinary antigen (final ): negative for legionella serogroup 1 antigen blood culture, routine (final ): streptococcus pneumoniae. final sensitivities. note: for treatment of meningitis, penicillin g mic breakpoints are <=0.06 ug/ml (s) and >=0.12 ug/ml (r). note: for treatment of meningitis, ceftriaxone mic breakpoints are <=0.5 ug/ml (s), 1.0 ug/ml (i), and >=2.0 ug/ml (r). for treatment with oral penicillin, the mic break points are <=0.06 ug/ml (s), 0.12-1.0 (i) and >=2 ug/ml (r). sensitivities: mic expressed in mcg/ml _________________________________________________________ streptococcus pneumoniae | ceftriaxone-----------<=0.06 s erythromycin----------<=0.25 s levofloxacin---------- <=0.5 s penicillin g----------<=0.06 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=1 s . mycolytic blood cultures/acid fast cultures pending blood cultures negative 08:05am blood wbc-8.7 rbc-3.88* hgb-10.7* hct-31.6* mcv-81* mch-27.6 mchc-33.9 rdw-14.9 plt ct-422 08:05am blood wbc-8.7 rbc-3.88* hgb-10.7* hct-31.6* mcv-81* mch-27.6 mchc-33.9 rdw-14.9 plt ct-422 08:05am blood pt-13.9* ptt-26.1 inr(pt)-1.2* 04:43am blood wbc-12.3* lymph-6* abs -738 cd3%-69 abs cd3-511* cd4%-17 abs cd4-123* cd8%-45 abs cd8-335 cd4/cd8-0.4* 03:35pm blood na-132* k-4.2 cl-101 08:05am blood glucose-83 urean-10 creat-0.6 na-131* k-4.1 cl-102 hco3-23 angap-10 08:05am blood alt-161* ast-164* totbili-2.5* 05:14am blood alt-114* ast-114* alkphos-95 totbili-3.0* 08:05am blood calcium-7.7* phos-4.1 mg-2.2 04:43am blood caltibc-88* ferritn-2182* trf-68* 08:05am blood osmolal-273* 04:43am blood igm hbc-negative igm hav-negative 02:51pm blood ama-negative 05:14am blood afp-<1.0 02:51pm blood -negative 04:43am blood igg-1512 iga-220 igm-158 brief hospital course: 47yo m with h/o hiv not on haart admitted to the micu with a multifocal pna and with liver injury likely secondary to sepsis, also with bacteremia. # hypoxia/multifocal pneumonia/gram positive cocci bactermia: the patient's presentation of fever, leukocytosis, and tachycardia along with the cxr showing a multifocal pna point towards a lung infection as his underlying process. blood cultures grew out gram postive cocci, later speciated to pansensitive strep pneumo. initially he was broadly treated with vanc, cefepime, levofloxacin (for legionella/atypicals), and bactrim (for pcp). id was consulted and recommended starting steroids, even though pcp was less likely until sputum culture ruled out pcp. he steroids were discontinued when strep pneumo was speciated from the blood. he had no recent cd4 count so this was repeated and returned at 71. once the blood cultures came back his antibiotics were tailored to ctx only. he will need to complete a 14 day course. # hepatocellular injury: patient with acutely elevated bilirubin and inr with a moderate transaminitis. with the preceding viral-like illness would consider ebv/cmv/vzv/influenza as well as bacterial infection with legionella most likely. abdominal ultrasound was consistent with acute hepatitis. liver was consulted and felt his findings were likely from liver-induced injury due to sepsis. several viral serologies, acute hepatitis serologies, autoimmune workup, and iron studies/ceroplasmin were sent for additional workup and did not reveal any cause of liver injury. lfts trended down during stay, although did have a slight bump on the day of discharge. this should be followed as an outpatient to ensure continued resolution. # hiv/aids: last cd4 count in was 257. vl:. cd4 count checked at before admission returned at 71. he will need follow up with his pcp after discharge for initiation of haart. a cmv was also checked and returned with cmv igg positive, but viral load was negative. . # hyponatremia: patient was initally hyponatremic with a na of 120 which improved with volume resuscitation. most likely was hypovolemic hyponatremia. comm: with patient and (roommate) code: confirmed full medications on admission: none discharge medications: 1. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. ceftriaxone 2 gram recon soln sig: two (2) gram intravenous every twenty-four(24) hours for 10 days: last day . disp:*qs * refills:*0* 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*2* discharge disposition: home with service facility: home solutions discharge diagnosis: primary: pneumococcal pneumonia, pneumococcal bacteremia, hiv discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you during your hospitalization. you were admitted with cough and jaundice and found out to have a pneumococcal pneumonia, as well as positive blood cultures for strep pneumoniae. you were treated in the icu with iv antibiotics, and these were continued on the floor. we checked your cd4 count and it came back at 123, so you were continued on a prophylactic dose of bactrim for pneumocystis carinii pneumonia. you need to follow-up with your primary care physician and talk to him about starting antiretrovirals to treat your hiv infection. we made the following changes to your medications: started ceftriaxone 2gm iv every 24 hours for a total of 14 days - last day on . albuterol mdi 1-2 puffs every 4-6 hours as needed for wheeze, shortness of breath please follow up with your pcp as scheduled. you will need to have labs drawn in 1 week after your discharge. followup instructions: name: , r. location: associates of health address: , 2nd fl, , phone: when: tuesday, , 2:30pm please have a cbc with differential and a creatinine and bun drawn at your visit. dr. will follow up with these labs. he should also follow up with the pending liver serology labs. you had a positive cmv (cytomegalovirus) test as an inpatient, the viral load is still pending and dr. should follow this up. do 12-bdu procedure: venous catheterization, not elsewhere classified diagnoses: anemia, unspecified acute and subacute necrosis of liver hyposmolality and/or hyponatremia severe sepsis human immunodeficiency virus [hiv] disease acute respiratory failure pneumococcal septicemia [streptococcus pneumoniae septicemia] pneumococcal pneumonia [streptococcus pneumoniae pneumonia] 

Answer: The patient is high likely exposed to