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: patient recorded as having no known allergies to drugs attending: chief complaint: cc:. pcp: . at medical group major surgical or invasive procedure: none history of present illness: hpi: mr. is a 48yo m with h/o aids, hep c, prior h/o ugib (esophageal tear per osh records) who initially presented to ed on with hematemesis and ugib. by osh hpi, pt vomited blood x5, ~1 hr after snorting heroin. he was originally hypotensive (though bp there was recorded as 119/78), but his bp responded to ivf. his hct was 35. ng lavage at that time showed brb that did not clear. he was transferred to the icu and his rpt hct came back at 26. he was given several units of prbc overnight. he had a l subclavian placed for better access. egd was performed on that showed a large amount of blood in the stomach and clot was visualized on the gastric side of the ge junction. during the exam, he developed active bleeding at the site of clot. attempts were made at cauterizing the bleeding, but the pt became agitated and was thus intubated for airway protection. egd was continued and the site of active bleeding was again injected with epinephrine and bicap coagulation was performed with achievement of hemostasis. approximately 12h after first egd at osh, egd was repeated for "brisk rebleeding." at that time, the ulcer at ge junction was visiualized w/ clot, but without active bleeding; his duodenum was clear. the ulcer was again treated with epinephrine and bicap. there was concern for perforation given the depth of bicap cauterization. he was continued on protonix iv bid, octreotide gtt, and ancef (for prophylaxis). the decision was transferred here to the sicu on under thoracics care for possible need of surgical intervention. other notable information from the osh: - he required a total of 7units prbcs and 2 units ffp prior to transfer; hct prior to transfer was 30 - post egd/intubation, he had multiple episodes of jerking of shoulders, neck, upper extremities; it was unclear if it was myoclonus vs. seizure so pt was started on ativan gtt. - admission labs at the osh were notable for wbc 2.6, hct 35.5 (but it trended down to 26.4 w/in 3 hrs), plt 90, cr 1.0, bun 10, k 3.3, alt 58, ast 63, tbili 0.5, alb 3.8. pt 10.6, ptt 28.7, inr 1.0. etoh level was negative. he was initially afebrile. . in the sicu here, his temperature was 103.1. his hct was monitored and he remained stable. he had coffee ground ouput (~125cc) from his ngt initially and then it became bilious; he also had black liquid stool via rectal tube (~150cc). he remained intubated and sedated. he was on an ativan gtt, fentanyl gtt and propofol gtt. a ppd was placed on . after evaluation by thoracics, no surgical intervention was felt to be indicated and he was transferred to the micu service on for further management. hct remained stable at 27-29. he was also seen by the gi service who felt that no further intervention was indicated at this time given his high risk of rebleed. differential for his ulcer included hiv ulcer, cmv/hsv, gerd, neoplasia, mw tear, impaction, pill induced. recommendations were for iv protonix and to advance his diet as tolerated to clears. plan is for repeat egd in weeks for biopsy of the ulcer. . at the time of transfer to our micu service his hematocrit remained stable and he was also hemodynamically stable. he has not required any further blood products at . his tmax today was 100.8. he was extubated in the am on and was able to maintain stable o2 sats. his mental status remained lethargic. he is able to follow commands but is unable to provide any additional history. he states that he was otherwise free of symptoms, including fever, chills, ns, weight loss, vision changes, headaches, lh, chest pain, sob, cough, n/v, diarrhea, or urinary symptoms. it is unclear if pt actually understands or is accurately answering these questions. past medical history: # hiv/aids - not on meds; last cd4 28 and vl 136 million ini # hcv - vl not known # anemia # thrombocytopenia # mrsa leg infection in # h/o alcohol abuse # iv heroin use social history: +tobacco, +etoh (amounts not known). last heroin use (snorted, not injected). recently d/c from rehab in , had been there for 7 mos for drugs. since d/c, has been living in shelter in . next of is father who lives in va. . family history: nc . physical exam: vs: tm 100.8, tc 100.1, bp 117/73 (98-167/64-113), hr 90 (64-100), rr 22, sats 98% on 4l nc, i/o 2108/3415 today; yest 3049/3170 gen: somnolent, but arousable. able to answer questions but falls asleep easily. in nad. heent: , pt unable to cooperate w/ eom testing, sclera anicteric, mmm, op without lesions but dentition is poor w/ multiple missing or rotting teeth. neck: no supraclavicular or cervical lymphadenopathy. no jvd. resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: soft, nd. + bs throughout. mild ruq tenderness, no sign. ? liver edge about 2 fingerbreadths below rcm. no masses, no appreciable splenomegaly. ext: no c/c/e, warm, good pulses skin: no rashes/no jaundice neuro: deferred as pt unwilling to cooperate w/ exam. . pertinent results: 11:41pm glucose-114* urea n-22* creat-0.8 sodium-143 potassium-3.7 chloride-113* total co2-24 anion gap-10 11:41pm estgfr-using this 11:41pm alt(sgpt)-24 ast(sgot)-34 alk phos-46 amylase-55 tot bili-0.4 dir bili-0.2 indir bil-0.2 11:41pm alt(sgpt)-24 ast(sgot)-34 alk phos-46 amylase-55 tot bili-0.4 dir bili-0.2 indir bil-0.2 11:41pm albumin-2.8* calcium-6.6* phosphate-2.7 magnesium-1.6 11:41pm wbc-3.0* rbc-3.42* hgb-10.7* hct-29.2* mcv-85 mch-31.3 mchc-36.7* rdw-15.1 11:41pm plt smr-very low plt count-72* 11:41pm pt-13.3 ptt-37.7* inr(pt)-1.1 11:41pm fibrinoge-138* 11:41pm urine color-yellow appear-clear sp -1.019 11:41pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg . cxr:impression: ap chest reviewed in the absence of prior chest radiographs: lungs clear. heart size normal. no pleural abnormality or mediastinal widening. et tube tip at the thoracic inlet is in standard placement, and left subclavian line tip projects over the left brachiocephalic vein. nasogastric tube passes into the stomach and out of view. . cxr:history: hiv, upper gi bleed, extubation. impression: ap chest compared to : ng tube ends in the stomach. endotracheal tube has been removed. left subclavian line ends in the brachiocephalic vein. opacification of the right lung base is probably atelectasis, but should be evaluated clinically for possible aspiration. left lung clear. heart size normal. . ekg:sinus rhythm. low limb lead qrs voltage, is non-specific and could be normal variant. tracing is otherwise, within normal limits. no previous tracing available for comparison. . cxr:impression: very subtle ill-defined opacity right infrahilar region could represent early developing pneumonia. brief hospital course: imp: 48 yo male with history of aids, hepatitis c and polysubstance abuse presented to an outside hospital with an ugib from esophageal ulcer s/p epinephrine and bicap cautherization, transferred to for further management. . # upper gastrointestinal bleed: this was found to be secondary to an ulcer at the gastro-esophageal junction. at the time of admission he was status post two egds at the outside hospital with epinephrine injections and bicap used during both procedures. the patient was followed by our gastro-enterology service while in-house. per their evaluation, the differential diagnosis for his bleed included hiv ulcer, cmv/hsv ulcer, gerd, neoplasia, mw tear, impaction, or pill induced ulcer. his last cd4 count in was <50 (here on cd4 was 32, vl >100,000) so the patient was considered at risk for cmv or hsv. since his transfer to and throughout his hospitalization, his hematocrit remained stable and he required no furher blood products. . # fever: the patient had a temperature to 103.5 on presentation to sicu. originally, this was felt to be transfusion reaction. however, the patient's sputum from grew out coag positive staph and strep pneumo. his cxr has some patchy bibasilar densities (read as atelectasis vs. possible aspiration in the right lower lobe) and pt continues to have low grade temps. given recent intubation, low cd4+ count, and continued fevers, the patient was covered with broad spectrum antibiotics, including vancomycin and ceftriaxone, initially. later he was changed to vancomycin alone given the above sputum cultures. ultimately the patient left against medical advice before sensitivities could return on his sputum. it was recommended that he continue on vancomycin until mrsa could be properly ruled out. linezolid was felt to not be an option for the patient given his globally low complete blood count. the patient refused to stay in the hospital for further evaluation and treatment. he left the hospital ama and was given presciptions for levofloxacin, prophylactic bactrim, and prophylactic azithromycin. . # altered mental status: after extubation the patient had a depressed mental status but otherwise nonfocal neuro exam. this was felt to likely be toxic-metabolic, given the ativan, fentanyl, and propofol he had received prior to extubation. after transfer to the floor his mental status cleared quickly. ultimately, the patient was competent and able to weigh the risks and benefits of his medical decisions at the time of his leaving ama. . # hiv/aids: during this hospitalization, the patient's cd4 count was found to be 32, and viral load greater than 100,000. per records, the patient had been noncompliant with haart in the past. the patient's anc was low during the hospitalization and was 630 at the time of his leaving ama. the dangers of leaving the hospital with this anc without proper evaluation and treatment were explained. he, nonetheless, elected to leave the hospital. . # hepatitis c: the patient has had no known treatment. during this admission his hcv viral load was undetectable. his lfts remained largely within normal limits. . # pancytopenia: this was felt to be likely be multifactorial in the setting of hiv, and alcohol abuse, and liver disease. though his hemtocrit was low throughout the hospitalization, it was stable at the time of discharge as above. . # substance abuse: the patient has a history of alcohol and heoin abuse. he was placed on a ciwa scale once extubated. . # f/e/n: at the time of his leaving ama, the patient was on a full diet. his electrolytes were repleted as needed. . # ppx: the patient was placed on a ppi and pneumoboots. . # code: full medications on admission: meds (on admission): none discharge medications: 1. hydrocortisone 1 % ointment sig: one (1) appl topical qid (4 times a day). disp:*1 tube* refills:*2* 2. hexavitamin tablet sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. azithromycin 250 mg capsule sig: one (1) capsule po q24h (every 24 hours) as needed for mac ppx. disp:*30 capsule(s)* refills:*2* 6. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*2* 8. levaquin 750 mg tablet sig: one (1) tablet po once a day for 1 weeks. disp:*7 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: upper gastrointestinal bleed pneumonia hiv/aids pancytopenia discharge condition: the patient has pneumonia and leukopenia and is leaving before completed treatment against medical advice. discharge instructions: you were admitted to evaluate for gastrointestinal bleeding and fever. your endoscopy at the outside hospital found an ulcer as the source of your bleeding. the bleeding was controlled and you have had no further evidence of bleeding. you have a serious pneumonia requiring an intravenous antibiotic (vancomycin). you are requesting to leave against medical advice before you can complete treatment for the pneumonia. your lungs are infected with two known organisms. given the information available at this stage, there is only one appropriate antibiotic available in pill form (linezolid) to treat one of the organisms. however, this medication is not safe given your platelet count. the other organism is likely susceptible to levofloxacin, but information is incomplete at this time. we will prescribe levofloxacin for you. as the treatment is incomplete, you will likely develop a worsening lung infection and die. we strongly recommend that you remain in the hospital. you also have a worsening white blood cell count. this means your immune system is weakening. your white blood cell count needs to be followed in the hospital. because you are not agreeing to be followed in the hospital, you will likely develop a serious infection and die due to your weakened immune system. you should return to the hospital immediately should you develop shortness of breath, chest pain, heart palpitations, fever, chills, or any other symptom that concerns you. you should take all medications as prescribed. you should make an appointment to be seen by a new primary care doctor as below. followup instructions: you should follow-up with a new primary care physician. may set up a new patient appointment at the clinic here at . the phone number is . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: pneumonia, organism unspecified acute posthemorrhagic anemia unspecified viral hepatitis c without hepatic coma opioid type dependence, unspecified cocaine abuse, unspecified human immunodeficiency virus [hiv] disease chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction personal history of noncompliance with medical treatment, presenting hazards to health drug withdrawal other and unspecified alcohol dependence, unspecified lack of housing alcohol withdrawal 

Answer: The patient is high likely exposed to