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: dyspnea major surgical or invasive procedure: flexible bronchoscopy egd peg placement and esophageal stent placement percutaneous tracheostomy right bacilic picc line ct-guided drainage rll collection history of present illness: 49 yo m s/p esophageal perf repair at hospital c/b prolonged icu course and persistent leakage, transferred from hospital to in respiratory distress for suspected r thorax emphyema. in pt was immediately intubated for respiratory distress.pt was also in septic shock. admitted to sicu. past medical history: steakhouse syndrome, s/p right thoracotomy with rml wedge biopsy, esophageal repair, mediastinal debridement, pedicled intercostal muscle flap hiv, unknown cd4, on haart htn pneumonia alcohol withdrawal with delirium tremens social history: etoh: prior abuse, h/o dts lives with partner, sister and mother very supportive family history: nc physical exam: t 100.8 p 98 bp 117/68 rr 40s o2 86% on 15l nrb. general all findings normal wn/wd nad aao abnormal findings: intubated, sedated heent all findings normal nc/at eomi perrl/a anicteric op/np mucosa normal tongue midline palate symmetric neck supple/nt/without mass trachea midline thyroid nl size/contour abnormal findings: respiratory all findings normal cta/p excursion normal no fremitus no egophony no spine/cvat abnormal findings: intubated, sedated. diminished breath sounds over r lung field, decreased at l lung base. r thoracotomy incision cardiovascular all findings normal rrr no m/r/g no jvd pmi nl no edema peripheral pulses nl no abd/carotid bruit abnormal findings: gi all findings normal soft nt nd no mass/hsm no hernia abnormal findings: gu deferred all findings normal nl genitalia nl pelvic/testicular exam nl dre abnormal findings: neuro all findings normal strength intact/symmetric sensation intact/ symmetric reflexes nl no facial asymmetry cognition intact cranial nerves intact abnormal findings: intubated, sedated ms all findings normal no clubbing no cyanosis no edema gait nl no tenderness tone/align/rom nl palpation nl nails nl abnormal findings: lymph nodes all findings normal cervical nl supraclavicular nl axillary nl inguinal nl abnormal findings: skin all findings normal no rashes/lesions/ulcers no induration/nodules/tightening abnormal findings: r thoracotomy incision pertinent results: 11:00pm wbc-38.4* rbc-2.99* hgb-8.8* hct-29.2* mcv-98 mch-29.3 mchc-30.0* rdw-16.4* 11:00pm albumin-2.4* calcium-8.5 phosphate-3.0 magnesium-2.5 11:00pm ctropnt-<0.01 11:00pm alt(sgpt)-35 ast(sgot)-72* alk phos-300* tot bili-0.4 11:00pm glucose-120* urea n-26* creat-0.8 sodium-136 potassium-4.0 chloride-103 total co2-23 anion gap-14 03:35am pt-15.4* ptt-29.2 inr(pt)-1.4* test name value reference range units 03:15 complete blood count white blood cells 19.0* 4.0 - 11.0 k/ul red blood cells 2.80* 4.6 - 6.2 m/ul hemoglobin 7.8* 14.0 - 18.0 g/dl hematocrit 26.4* 40 - 52 % mcv 95 82 - 98 fl mch 27.7 27 - 32 pg mchc 29.3* 31 - 35 % rdw 16.8* 10.5 - 15.5 % basic coagulation (pt, ptt, plt, inr) platelet count 1000* 150 - 440 k/ul verified by replicate analysis test name value reference range units 05:35 report comment: source: line-picc complete blood count white blood cells 15.3* 4.0 - 11.0 k/ul red blood cells 2.99* 4.6 - 6.2 m/ul hemoglobin 8.5* 14.0 - 18.0 g/dl hematocrit 28.4* 40 - 52 % mcv 95 82 - 98 fl mch 28.3 27 - 32 pg mchc 29.8* 31 - 35 % rdw 17.6* 10.5 - 15.5 % basic coagulation (pt, ptt, plt, inr) platelet count 802* 150 - 440 k/ul test name value reference range units 05:35 report comment: source: line-picc renal & glucose glucose 112* 70 - 100 mg/dl urea nitrogen 17 6 - 20 mg/dl creatinine 1.0 0.5 - 1.2 mg/dl sodium 135 133 - 145 meq/l potassium 6.0* 3.3 - 5.1 meq/l verified by replicate analysis no hemolysis reported to and read back at 0640 chloride 99 96 - 108 meq/l bicarbonate 29 22 - 32 meq/l anion gap 13 8 - 20 meq/l enzymes & bilirubin alanine aminotransferase (alt) 32 0 - 40 iu/l asparate aminotransferase (ast) 41* 0 - 40 iu/l alkaline phosphatase 233* 40 - 130 iu/l bilirubin, total 0.2 chemistry calcium, total 9.5 8.4 - 10.3 mg/dl phosphate 4.7* 2.7 - 4.5 mg/dl magnesium 2.2 1.6 - 2.6 mg/dl cxr admission confluent opacity involving mid and lower right lung with round lucencies, suggestive of cavitation and/or abscess formation. ground-glass opacification of the left mid lung. small-to-moderate right pleural effusion. findings concerning for infection with cavitary lesions in the right lower lung. correlation with ct exam from the outside hospital, which by report was performed at the osh. egd w/ stent a fistula was found in the lower esophagus. there was a deep fistula at approximately 35cm with upstream ulceration and visible suture material. the ge junction is located at approximately 47cm successful placement of a 20fr traction peg tube using the standard pull technique. successful insertion of a 23mm x 155mm fully covered metal esophagal stent ] under fluoroscopic guidance, with the middle of the stent positioned over the fistula, and the bottom of the stent above the ge junction. the stent was deployed smoothly, and the endoscope was reinserted to confirm appropriate location. otherwise normal upper endoscopy. fluoroscopic images viewable on centricity. cxr findings: multifocal pneumonia including dense right lower lobe consolidation with abscess has not really changed much since . a pigtail catheter in the right lower lobe abscess is unchanged in position and presumably within the abscess cavity. residual stent is present. tracheostomy tube is in standard position ct chest impression: 1. overall similar size of large right lower lobe complex fluid collection. pigtail catheter appears in appropriate position inside the collection. tube patency cannot be assessed. 2. progression of multifocal areas of peripheral lung consolidation consistent with infection. 3. increased fluid and air surrounding esophageal stent. 4. no acute process in the abdomen or pelvis. esophagus 1. no evidence for leak around the esophageal stent, only the distal two-thirds were fully evaluated. 2. smooth narrowing and stricturing at the distal esophagus/gastroesophageal junction, likely related to edema or esophageal dysmotility in the setting of a metallic stent along a large segment of the esophagus. cardiac echo the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. normal biventricular cavity sizes with preserved global and regional biventricular systolic function. pulmonary artery hypertension. liver us : 1. contracted gallbladder, without evidence of cholecystitis. 2. no evidence of biliary obstruction. brief hospital course: mr. is a 49 y/o man with a h/o well controlled hiv on atripla, etoh abuse, and recent esophageal rupture s/p surgical repair on at and osh c/b persistent leak who presented in septic shock to on with large necrotizing lung abscess esophageal-pleural fistula. he was empirically started on vanco//mica and had an esophageal stent placed . he slowly improved, weaning off pressors, though required trachetomy for prolonged ventilation and then weaned to trachmask. surgery for the patient's collection was discussed but due to the parenchymal (rather than pleural) nature of his collection it was felt he may require pneumonectomy but did not likely have pulmonary reserve for this large operation, additionally with risk to re-opening his esophageal perforation or disrupting his pulmonary vasculature. he eventually underwent ir guided drainage with pigtail drain that helped his clinical status somewhat but the fluid was loculated so could not be drained much. he had several bronchoscopies and abscess cultures while on antibiotics, this grew coag negative staph and yeast. his gram stains showed gnrs, gprs and budding yeast. he was transferred to the floor . once on the floor, the patient continued to improve. summary of events: : transferred from hospital, intubated; central line placed and pressors started in ed. admitted to ticu. empiric antibiotics started (vanc//mica--not fluconazole given prolonged qtc); bronchoscopy performed with bal sent. ct chest concerning for necrotizing pneumonia on right in setting of suspected persistent esophageal leak, possible fistula. interventional pulmonology consulted w/ repeat bronchoscopy unrevealing. egd revealed a defect along the right wall of the esophagus at approximately 35cm. gi consult obtained w/ esophageal stenting performed and peg placed. bal gram stain showing 2+ gpr, 2+ gnr; culture pending. pressors weaned slowly overnight with good uop maintained. -: desaturation to 90% w/ mild-moderate improvement following suctioning of copious secretions. id with no change in rx; thoracic with hold tf and conservative management. -: continued copious secretions but stable on vent. vl<20, cd4>400, osh blood:gprs, gpcs, cultures pending. ruled out for tuberculosis. discussed with thoracics, poor surgical prospects. had planned to g-tube study, held meds and tf via peg. re-consider on . cd4 count>400, vl<20. -: given persistent copious secretions, bronchoscopy performed with visualized moderate loose, milky secretions. bal sent w/ gram stain showing gpr, gnr, yeast. culture pending. osh blood cultures reported as: 1 bottle ngtd and 1 bottle w/ diptheria and coag negative staph, suspicious for contaminants. ekg w/ qtc 412. few episodes of desaturation, resolved with suctioning. pan-cultured for fever spike to 101.8. levophed weaning. -: map <65 in afternoon, restarted on levophed (stopped at 23:00) and infused 1uprbc. esophagram study with no extrav of contrast. restarted tfs via peg per thoracic and nutrition recs. tolerated cpap overnight from 4pm - 2am, then tachy. -: given hct of 24 and maps < 65 requiring levophed 0.08, transfused 1uprbc. levo weaned to off, sedation decreased (fent 100->50, midaz off), prn ativan, great improvement in ms. sister and mother in to visit, discussed prognosis with dr. . -: fever to 102.4; blood cultures sent. cdiff toxin x2 negative; 3rd pending. fentanyl discontinued, and pt transitioned to tylenol, dilaudid. given poor sleep/wake cycle and concern for associated delirium, nightly seroquel started. decreased oxygenation in the setting of persistent copious secretions; some improvement seen with increase in peep, continued suctioning. free water flushes started for hypernatremia (na 150), with improvement to 145. -: bronched, bal sent; placed on cmv afterwards due to resp distress w/ goal to wean back to cpap in am, propofol added for intermittent hypertension/tachycardia -: id consulted and agreed with current antibiotics/antifungal although they believe that definitive treatment is right pneumonectomy but patient is not a good candidate surgically; thoracic surgery decided to do bedside trach on ; consents obtained; throughout the day patient would intermittently become agitated/tachypneic resulting in mild desaturation so fentanyl gtt was added to his sedation regimen -: bedside bronch and trach, ct chest, tfs resumed, hliv, weaned levophed; febrile 102.1 - cx sent; -: r picc placed; to ir for drainage of right lung abscess; spiked fever overnight, no new cultures drawn -: ip did not find a safe spot for us guided drainage- would need ct guided drainage, fever to 101.7, not cultured -: went to ct-guided drainage although very little was drained ~20ml, sent for cultures; patient tolerated procedure well; per id consult: sent for b-glucan and aspergillus galactomannan antigen -: d/c'd fent/prop gtt; started oxycodone, ativan, morphine breakthrough; c. diff sent, loperamide d/c'd - : weaned peep to 10; - : afebrile, spent the entire day on trach collar - stable, ambulated with pt/ot, sat in chair - : afebrile, pt/ot oob to chair, id rec'd ct chest and bld cx x 3, continue current abtx and drainage per thoracic. tube flushes, performed daily by thoracic. thorcic to discuss prognosis w/ pt. - : bronched. post-cxr unchanged. decreased o2 after bronch. req recruitment breaths. now back on vent. ct chest showed abscess relatively unchanged since - : stayed on trach collar. out of bed/ambulating. working on rehab placement. ruq u/s for elevated alk phos - no e/o cholecystitis. - : c/o trouble breathing/swallowing in the afternoon, cxr unchanged, thoracic performed bronchoscopy, thick mucus cleaned out, but otherwise clear airways, able to clear secretions well. case management to eval for rehab facility. vanc d/c, continue /mica x 4 weeks per id -: hypona, hyperk -: transferred to 9 following transfer to the surgical floor he gradually progressed. from a gi standpoint he was tolerating his tube feedings but the preparation was changed to nepro as he had persistent elevated potassium in the 6 range. this was effective and over a 5 day period his potassium was in the 4.0 range. a speech and swallow study was done on for placement of a pmv (as he had a cuffless trach tube in place). he tolerated it well and also was started on a diet of thin liquids and pureed solids. unfortunately he appeared to aspirate and was made npo and his trach tube was changed to cuffed. he eventually spiked to 102 and his wbc was 28k. cipro was added to his antibiotic therapy and a chest xray showed some increased opacities in the rul and lll. he has gradually improved with pulmonary toilet and antibiotic therapy and hid trach tube was downsized to a #6 portex, cuffed tube on . the infectious disease service is following him closely and recommends 4 weeks of therapy with micafungin and ertapenum (or meropenum 500 mg q6hrs). the stop date is for those antibiotics and the stop date for the cipro is . please see the page 1 referral for lab tests which need to be done weekly and reported to the clinic. the nutrition service currently recommends changeing his tube feedings to 2 cal hn at 40/hr now that his potassium is in the 4.0 range. his renal function repains stable with a bun/creat of 15/0.9. on his esophageal stent will be removed and he will be admitted to the hospital following that for further management. in the interim he will be transferred to rehab to help increase his strength and mobility. he was discharged on . medications on admission: asa 325 daily atripla 1 tab daily combivent 2-4 puffs q4 prn lisinopril 5 mg qd protonix 40 mg discharge medications: 1. efavirenz 200 mg capsule : three (3) capsule po daily (daily). 2. tenofovir disoproxil fumarate 300 mg tablet : one (1) tablet po daily (daily). 3. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for pain/fever . 4. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). 5. emtricitabine 10 mg/ml solution : two y (240) mg po q24h (every 24 hours). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q3h (every 3 hours). 7. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 8. micafungin 100 mg recon soln : one hundred (100) recon soln(s)mg intravenous q24h (every 24 hours): thru . 9. ertapenem 1 gram recon soln : one (1) gm intravenous once a day: thru . 10. ciprofloxacin in d5w 400 mg/200 ml piggyback : four hundred (400) mg intravenous q12h (every 12 hours): thru . 11. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 12. sodium chloride 1 gram tablet : one (1) tablet po tid (3 times a day). 13. prevacid solutab 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr once a day. 14. aspirin 81 mg tablet, effervescent : one (1) tablet, effervescent po once a day. 15. oxycodone 5 mg/5 ml solution : 10-15 mg po q3h (every 3 hours) as needed for pain. discharge disposition: extended care facility: hospital - discharge diagnosis: right lung empyema and esophageal-pleural fistula bilateral pleural effusions chronic respiratory failure requiring tracheostomy aspiration pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were transferred to on , after complications from esophageal surgery at hospital. you had a large necrotizing lung abscess secondary to esophageal-pleural fistula. you were very sick and required icu management for weeks. your breathing was compromised and you need a tracheostoomy tube along with a feeding tube to maintain your nutrition. you will also need long term antibiotics and for that reason, a picc line was placed. * work hard at rehab to regain your strength. * your trach tube will eventually come out. * you will continue follow up with thoracic surgery, infectiuos disease and gastroenterology. * on the esophageal stent will be removed and you will be admitted to the hospital after the procedure for further management. call dr. office if you experience: -fevers > 101 or chills -increased shortness of breath, chest pain or any other symptoms that concern you. followup instructions: department: infectious disease when: tuesday at 10:00 am with: , md building: lm campus: west best parking: garage infectious disease : dr. department: endo suites when: monday at 9:30 am. report at 8:30am to the , building, , gi unit. you will be admitted to the hospital after the procedure to the thoracic surgery service...dr. . procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus insertion of permanent tube into esophagus diagnoses: pneumonia, organism unspecified hyperpotassemia other iatrogenic hypotension anemia of other chronic disease tobacco use disorder unspecified pleural effusion unspecified essential hypertension unspecified septicemia severe sepsis pneumonitis due to inhalation of food or vomitus septic shock abscess of lung hyperosmolality and/or hypernatremia leukocytosis, unspecified asymptomatic human immunodeficiency virus [hiv] infection status other and unspecified alcohol dependence, continuous empyema with fistula other and unspecified mycoses alcohol withdrawal delirium inhalation and ingestion of food causing obstruction of respiratory tract or suffocation dysphagia, oropharyngeal phase essential thrombocythemia other specified forms of effusion, except tuberculous injury to esophagus with open wound into cavity acute and chronic respiratory failure following trauma and surgery late effect of certain complications of trauma 

Answer: The patient is high likely exposed to