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: transfer from osh for liver and renal failure major surgical or invasive procedure: liver biopsy dialysis catheter placement history of present illness: this is a 39 yo male with hiv diagnosed in but was only recently started on haart therapy about 2 months ago in . he also has hepc and disseminated mac with liver biopsy in demonstrating afb positive granulomas and was subsequently started on ethambutol/azithro/rifabutin. he has had several recent admissions this past month at osh for pna, neutropenia and left renal calculus with hematuria. . his current course started on when he presented to hospital with fever, left flank pain and ruq pain. the workup for his pain was difficult because he has chronic abdominal pain requiring narcotics. workup includes multiple problems: increased lfts, pericholecystic fluid, coagulopathy, hyperkalemia and arf. the differential for his liver failure at this time included hiv cholangiopathy vs. drug induced hepatitis vs. reactivation mac infection from starting haart therapy. the differential for his renal failure included hiv nephropathy vs. membranoproliferative glomerulonephritis hepc vs. chronic renal calculi vs. reconstition syndrom from haart therapy. . because of the concern for reconstitional syndrome, his haart as well as mac therapy were stopped. he was put on ceftriaxone for unclear reasons. . his potassium was as high as 7.2 and there were reports of a pericardial rub. he was urgently dialyzed on and with resolution of hyperkalemia. . given his liver failure, renal failure and complex infectious history including hiv, hepc and disseminated mac, he was transferred to for tertiary care. . currently his chief complaint is left sided abdominal pain and ruq pain. he denies fevers currently but reported having fevers at osh. he denies chest pain or shortness of breath. he has been passing gas and moving his bowels. he is making urine and has no dysuria. past medical history: # hiv/aids, diagnosed in , off haart "on religious grounds", cd4 count 2 and vl 350,000 on . # hcv with cirrhosis, (?)genotype 1, viral load 7 million # liver biopsy : afb positive granulomas, started on ethambutol/azithro/rifabutin for mac (rifabutin later d/c'd for unclear reasons) # longstanding right-sided abdominal pain of unclear etiology: distended with pericholecystic fluid, however hida normal, surgeons do not feel this is cholecystitis # prior ct demonstrating hypoechoic splenic lesions, (?)lymphoma vs infection # admitted , found to be in new renal failure secondary to glomerulonephritis (?)hiv/hcv-associated. at that time started on anti-retrovirals - kaletra and trizivir. # bilateral renal stones # polysubstance abuse # penile warts and perianal warts social history: lives in home called new challenge (home for rehab for polysubstance abusers with other residents). he contracted hiv from a woman in . moved from 1.5 years ago but frequently returns for visits. has extensive history of illicit drug use for 20 years in the past that included cocaine, heroine, lsd, marijuanna, tobacco and alcohol. he is married with 2 children in . family history: father died of colon cancer. mother died with diabetes and depression. physical exam: vitals: 99.0 145/80 100 16 95%ra gen: a+ox3, nad, coughing, no respiratory distress, well nourished male heent: perrl, eomi, sclera icteric, mmm, op clear neck: no lad cv: tachycardic, regular, pericardial rub heard best at lrsb, no murmurs or gallops, pmi at left nipple pulm: scattered rhonchi with bilateral faint crackles, no wheezes, good air movement abd: soft, tender at epigatrum, nondistended, +bs. no costovertebral tenderness. + warts on penis ext: 2+ pedal edema up to lower legs bilaterally neuro: grossly nonfocal, mobilizes all extremities pertinent results: osh : -- bun 18, cr 1.2. -- ast 265, alt 108, alk phos 188, tuberculosis 1.6 -- ua: 2+ protein, 3+ blood, 250 rbc per hpf . osh : -- bun 70, cr 3.3 -- tuberculosis 16.7, db 13.7 . osh : -- cr 3.3 -- inr 6.0 . osh : -- chem 7 134, 4.7, 101, 22, 58, 2.8 -- tprot 5.6, alb 1.8 -- cal 7.9 -- tbili 8.3, ap 153, ast 152, alt 87 -- cbc: 3.1, 2.73, 24.8, 75, mcv 91 -- inr 2.3 (down from 3.4 yesterday) . studies: # osh ct abd : 2-3mm stone at ureterovesicular junction. . # osh mri : hepatosplenomegaly . # osh ct abd c contrast : liver pancreas normal contours. spleen slightly enlarged. gallballder nl in diameter, however an attenuated ring surrounds the gallbladder. no intraluminal stones. kidneys normal in size shape and positive. no hydronephrosis. no stones. adrenal glands normal. no retroperitoneal adenopathy. no upper abd areas of ascites. impression: 1. splenomegaly 2. pericholecystic fluid suggestive of acalculus cholecystitis. . . cxr: no acute cardiopulmonary process. . ruq usn: minimal gallbladder wall edema, without significant distension, or evidence of cholelithiasis. acalculous cholecystitis cannot be excluded. if there is concern for cholecystitis, further evaluation with a hida scan could also be considered. . renal usn: no hydronephrosis. medical renal disease. . tte: the left atrium is normal in size. the estimated right atrial pressure is 0-5mmhg. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). transmitral and tissue doppler imaging suggests normal diastolic function, and 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 regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. no mitral regurgitation is seen. there is normal pulmonary artery systolic pressure. there is no pericardial effusion. . impression: no pericardial effusion. preserved global and regional biventricular systolic function. . ct chest: 1. mild dependent peribronchial ground-glass opacities are suggestive of aspiration, either subclinical or due to early aspiration pneumonitis 2. minimal right upper lobe bronchiolitis may be due to aspiration or focal small airways infection. localized distribution is not typical of mac, which is usually more diffuse. follow-up ct after treatment for bacterial infection may be considered, if warranted clinically. 3. trace ascites 4. probable splenomegaly and 4 mm nonobstructing right renal stone. . . ct sinus: mild-moderate degree of mucosal thickening is seen within the maxillary sinuses bilaterally, sphenoid sinuses, and ethmoid sinuses, with aerosolized secretions in the left maxillary sinus. minimal mucosal thickening noted within the frontal sinus. right ostiomeatal complex appears patent. left ostiomeatal complex is opacified by mucosal thickening. nasal septum is midline. right cribriform plate is approximately 1-2 mm lower than the left. no evidence of osseous destruction seen. likely 3mm bone island is noted in the left orbital roof. . . ct abd/pelvis: 1. enlarged liver with perihepatic ascites. nonspecific fat stranding along the anterior right retroperitoneum and right pericolic gutter extending about the cecum is nonspecific, may be related to hepatic dysfunction. 2. distended gallbladder without disproportionate surrounding fat stranding. if there is clinical concern for acute cholecystitis, hepatobiliary nuclear medicine scan could be performed. 3. bilateral nonobstructing renal calculi. 4. appendix not definitely visualized. fat stranding and fluid along the right pericolic gutter extends from the liver edge into the pelvis obscures its visualization. if there is clinical concern for acute appendicitis, mri could be performed in this patient who cannot have intravenous contrast. 5. splenomegaly. no lymphadenopathy. . . hida: 1. limited study. 2. no evidence of acute cholecystitis. 3. normal biliary to bowel transit time. 4. poor hepatic tracer uptake, compatible with the stated history of mac hepatitis. . . ercp: four fluoroscopic spot images were obtained during ercp procedure by gastroenterologist without a radiologist present. cholangiogram demonstrates opacification of a mildly dilated biliary tree. a filling defect is seen within the distal cbd consistent with stone. final image demonstrates placement of a biliary stent. . . transjugular liver biopsy: 1. marked lobular regeneration with scattered apoptotic hepatocytes and moderate cholestasis. 2. localized areas of bile duct proliferation surrounded by fibrosis, highly suggestive of cirrhosis. 3. trichrome stain shows prominent sinusoidal fibrosis (see note). 4. no granulomas are seen. 5. no stainable iron seen. . . bone marrow biopsy: flow cytometry report: flow cytometry immunophenotyping: the following tests (antibodies) were performed: hla-dr, fmc-7, kappa, lambda, and cd antigens: 2, 3, 5, 7, 10, 19, 20, 23, 45. . results: three-color gating is performed (light scatter vs. cd45) to optimize lymphocyte yield. . b-cells are scant in number (4% of lymphoid gated events), and do not express aberrant antigens. clonality could not be reliably assessed due to scant numbers and cytophilic staining. . t-cells comprise 47% of lymphoid gated events and express mature lineage antigens. . interpretation: non-specific lymphoid profile; b-cells are scant in number and clonality could not be reliably assessed. t-lymphocytes do not show any antigenic aberrancy. . correlation with clinical findings and morphology (see separate report) is recommended. flow cytometry immunophenotyping may not detect all lymphomas due to topography, sampling or artifacts of sample preparation. . . usn guided paracentesis: successful 1 liter diagnostic paracentesis via the right lower quadrant under ultrasound guidance. negative for sbp. . . rus usn: gallbladder wall thickening is secondary to contracted state and third-spacing. . vein mapping upper extremities: thrombophlebitis in right cephalic vein. patent bilateral basilic with diameters as noted. there is no left cephalic vein. patent bilateral subclavian veins and brachial arteries. . . ct abd/pelvis: 1. small nonobstructing renal calculi bilaterally. 2. no dilated loops of small bowel seen. evaluation of the colon is limited as it is not filled with oral contrast, and surrounding pericolonic fat is obscured by ascites. 3. interval development of large amount of ascites. 4. hepatosplenomegaly unchanged. . . brief hospital course: # comfort measures only. this is a 39 yo man with hiv/aids and hep c cirrhosis not a candidate for interferon or haart with progressive liver and renal failure. in accordance with the patient's and his family's wishes, the patient is comfort care only. . below is a detailed history of his recent hospitalization. . # id. the patient has hep c and hiv not previously on medication until late (per conversation with dr. , id at osh). upon admission to osh, he was noted to have cd4=4, vl undetectable, (cd4=2, vl 350,000 in ). hep c viral load 55,000,000. per osh records, his haart was held upon admission to osh concern for reconstitution syndrome in addition to concern that haart regimen could be causing liver failure (pt was briefly treated with solumedrol for reconstitution at osh, but this was discontinued upon his admission). his pcp prophylaxis and mac treatment were also held because of concern that these could be causing his elevated lfts. . upon presentation, the patient was febrile daily with temps 100-102, however serial blood, urine, sputum and stool cultures were generally unremarkable, with the exception of sputum culture which showed 2+ gpc, gpr, however sample quality was poor, and culture was negative. the patient was ruled out for tuberculosis with sputum cx x 3. pcp smears were negative. cmv and ebv viral load were negative. hepc viral load was 55 million. . the patient was treated with a 7 day course of zosyn upon presentation because of coarse breath sounds, and fever, however ct chest revealed only ground glass opacification at bases, but no clear infiltrate. . id consult was obtained. given his elevated bilirubin and alkaline phosphatase, concern was for a biliary source of infection, however ruq usn showed minimal gallbladder wall edema, without significant distension, or evidence of cholelithiasis. the patient underwent hida which showed no evidence of acute cholecystitis. given a high concern for biliary infection (ruq pain, fever, elevated tbili), the patient undwerwent ercp on , at which time mildly dilated biliary tree was visualized with filling defect in distal cbd consistent with a stone, thus stent was placed. . the patient's lfts continue to rise after stent placement, and give his immunocomprimized state, fungal etiologies were considered. liver biopsy was performed on via transjugular approach. koh prep revealed budding yeast, and pathology specimens demonstrated yeast, however culture data was unremarkable. given elevated lfts, and clinical suscpicion for fungal infection, the patient was started on ambisome on . . bone marrow biopsy was obtained on which was unremarkable. serum crypto, urine histo, and fungal blood cultures were negative. galactomannan and beta glucan were negative. . lfts began improving on . he was without elevated wbc throughout admission (indeed was neutropenic as below). he continued to have low grade temperatures (99-100.6) until . he was restarted on azithromycin for pcp prophylaxis on (dosed qweekly), however his tbili began rising again, and this was discontinued on . . the patient was not felt to be a candidate for hep c treatment given his comborbidities. on repeat hiv viral load was >100,000, decision was made to continue to defer restarting haart, while awaiting hiv genotype information (pt's prior hiv regimen of trisovir/kaletra was felt to be atypical). in close consultation with the infectious disease team, the patient was ultimately felt to not be a candidate for haart therapy out of concern for further liver toxicity and inability to tolerate the therapy. after the patient's decision to be comfort only, all antibiotics were discontinued. . # gi/liver. the patient presented to an osh with fever and ruq pain. the patient had known hepatitis c, viral load on this admission was 55,000,000. the patient had been started on mac treatment liver biopsy in which was afb positive on smear, however no cultures had been sent. mac treatment (ethambutol, rifabutin, azithromycin) were held upon admission at osh. upon admission to osh, pt had ast 265, alt 108, ap 188, tuberculosis 1.6. his lfts continued to rise, and peaked after transfer to on alt 150 ast 223, but then trended down alt 50s, ast 120s by . tbil peaked on @ 22.1, s/p ercp with stent placement on . upon presentation, to his inr was 2.0. . presentation was primarily a cholestatic picture. ruq usn, hida scan and ercp were as above. there was no evidence of hiv cholangiopathy. . hepatitis serologies were hepbsag, hepbsab negative, bepbcab positive. anca negative. weakly positive (1:40), c3 43, c4 10. hepc viral load 55 million. hsv igg and igm positive. . given elevated lfts after ercp with stent placement, pt underwent liver biopsy on which revealed fibrosing cholestatic hepatitis, with cirrhosis. lfts began trending down shortly after biopsy, however, thus pt's hepatic failure was felt more likely to be the result of medication (most likely azithromycin or hiv medications), superimposed upon hepatitis c infection and underlying fibrosing cholestatic hepatitis. . on , pt's hct droped from 22-24 ->20 -> 17 requiring transferred to the icu. . # renal. the patient presented without a history of renal disease, however creatinine 1.2 upon presentation to osh up to 3.3 upon transfer to . his osh course was complicated by hyperkalemia for which he underwent hemodialysis on and . . upon presentation to pt was not felt to require urgent dialysis. renal consult was obtained. his temporary dialysis catheter was discontinued on , the tip was sent for culture which was unremarkable. . the patient did apparently have complicated history of bilateral renal calculi and he was admitted at osh recently for renal calculi and hematuria. abd ct at osh showed no hydronephrosis. ua and ucx were unremarkable, and ct abd/pelvis this admission was negative for calculi, or hydronephrosis. . the patient developed progressive renal failure. etiology was ultimately felt most likely to be hepc induced mgpn. biopsy was deferred as he was relatively high risk for the procedure and the relevance to management options in this patient (as he was already known to not be a candidate for interferon therapy) were limited. the patient's renal failure continued to progress and in accordance with the patient's wishes he had a temporary dialysis catheter placed and 2 cycles of hemodialysis in able to prolong his life to allow his family to see him. after his family's arrival - and in accordance with the patient's and his family's wishes - his dialysis catheter was removed and the patient had no further dialysis. . # heme/onc. the patient presented with anemia and thrombocyopenia. the etiology was initially felt most likely hiv, hepc, renal disease. bone marrow biopsy was performed which revealed hypercellular marrow with mild erythroid and megakaryocytic hyperplasia and left-shifted myelopoiesis. . medications on admission: medications at home: # mepron # zithromax # ethambutol # diflucan # kaletra # triziver . medication on transfer: # reglan prn # flonase # protonix # zofran prn # ambien prn # ms 30mg # oxycodone ir 15mg q6prn # morphine 5mg iv q4h prn # solumedrol 40mg iv bid # tylenol prn # procrit40,000 quweek starting # ceftriaxone 1gram q24 (last dose 4/28) discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 3. docusate sodium 50 mg/5 ml liquid sig: po twice a day as needed for constipation. 4. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas pain. 5. lorazepam 1 mg tablet sig: 0.5-1.0 tablet po q4-6h (every 4 to 6 hours) as needed for nausea or anxiety. 6. oxycodone 20 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 7. oxycodone 5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. discharge disposition: extended care facility: radius discharge diagnosis: primary: aids hepatitis c disemminated mac acute renal failure acute liver failure secondary: longstanding right-sided abdominal pain of unclear etiology bilateral renal stones polysubstance abuse penile warts and perianal warts discharge condition: hemodynamically stable, afebrile discharge instructions: you were admitted because of liver and kidney failure secondary to hiv, hepatitis c and complications of these diseases. the goals of care are your comfort. you will be further cared for at a hospice facility in , . followup instructions: a hospice nurse will be available to answer any questions for you and to obtain and provide medical care. procedure: other endoscopy of small intestine hemodialysis closed (percutaneous) [needle] biopsy of liver venous catheterization for renal dialysis percutaneous abdominal drainage percutaneous abdominal drainage biopsy of bone marrow endoscopic insertion of stent (tube) into bile duct transfusion of packed cells transfusion of other serum transfusion of platelets endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct diagnoses: acute kidney failure with lesion of tubular necrosis cirrhosis of liver without mention of alcohol acute and subacute necrosis of liver human immunodeficiency virus [hiv] disease other specified disorders of biliary tract disseminated candidiasis calculus of kidney calculus of bile duct without mention of cholecystitis, with obstruction other specified disorders of liver abdominal pain, right upper quadrant unspecified viral hepatitis c with hepatic coma disseminated due to other mycobacteria other specified viral warts nephritis and nephropathy, not specified as acute or chronic, with lesion of membranoproliferative glomerulonephritis 

Answer: The patient is high likely exposed to