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: history of present illness: this is a 38 year-old male with a history of hiv last cd4 count 134, last viral load greater then 200,000 found to have a temperature of 102.6 while at hemodialysis today. the patient complained at hemodialysis of a headache, which began concurrently with a fever. vancomycin was empirically begun. the patient reports that he was in his usual state of health until hemodialysis on the 28th. he states that he also had mild low back pain, although he denies any low back pain, denies any photophobia and was transferred to the emergency room for further workup. in the emergency room his temperature was found to be 102.7, pulse 88, blood pressure 104/58 and respiratory rate of 28 with an o2 sat of 97% on room air. he received ceftriaxone 1 gram intravenous in addition to the vancomycin he previously received and was noted to have further decline and his blood pressure down to systolic of between 70 and 80 associated with mild lightheadedness. he was given 500 cc of normal saline bolus times two and a further 200 cc of normal saline bolus times one for a total of 1200 of normal saline with transient improvement, but then blood pressures returned to the 70s. a dopamine drip was started in the emergency room. review of systems: notable for diarrhea times one day in the absence of bright red blood per rectum, melena, abdominal pain, dysuria, flank pain or vomiting. past medical history: 1. hiv, the patient was diagnosed in and was started on haart in , which he continued until he self discontinued his regimen one year prior to admission. he has had shingles, but has otherwise had on opportunistic infections. 2. hepatitis c positive. 3. history of shingles. 4. end stage renal disease. he has been hemodialysis dependent times six years. this is thought to be secondary to hiv nephropathy. 5. ppd positive received inh times nine months. medications on admission: 1. trazodone 100 mg po q.h.s. 2. erythropoietin alpha 6000 units subq three times a week with dialysis. 3. nephrocaps one po q day. 4. nystatin oral suspension 5 ml po q.i.d. 5. oxycodone acetaminophen one tab po q 4 to 6 prn. 6. gabapentin 600 mg po b.i.d. 7. testosterone 5 mg patch 1 patch q day. 8. bactrim double strength one tab po q.o.d. monday, wednesday and friday. 9. protonix 40 mg q 24 hours. 10. clonazepam 1 mg po b.i.d. 11. phoslo 4000 and 2 mg po t.i.d. with meals. allergies: penicillin, amoxicillin and ativan and to compazine. social history: he formerly worked at until approximately a year ago. he lives alone and denies any tobacco history, occasional use of ethanol. family history: noncontributory. physical examination on admission: temperature 97.9. pulse 67. blood pressure 91/60. respiratory rate 16. room air sat of 96%. in general, the patient was awake, alert and oriented times three. moving all four extremities in no acute distress. heent pupils 2 mm bilateral and reactive. extraocular movements intact. sclera anicteric. conjunctiva are injected. mucous membranes are moist. no white plaque is present on the patient's tongue. neck supple without any meningismus. full range of motion is present. no jvd. no lymphadenopathy. cardiovascular regular rate and rhythm. normal s1 and s2. no murmurs, rubs or gallops. chest is clear to auscultation bilaterally. no erythema at the hd catheter site. abdomen is soft. the patient has mild right upper quadrant tenderness to palpation, but no rebound or guarding. extremities notable for no rash and no edema. neurological examination mental status examination is normal. strength 5+ in the upper extremities and lower extremities. sensory examination is normal. reflexes are 2+ in the triceps, biceps, patellar and ankle jerks. toes are downgoing. cerebellar examination is normal. laboratories on admission: white blood cell count is 6.3 with 75 neutrophils and 1 band. hematocrit 37, platelets 288, sodium 140, potassium 5.1, chloride 100, bicarb 31, bun 61, creatinine 12.7 and glucose of 67. a chest film revealed no cardiomegaly and no acute cardiopulmonary processes. lp was performed and tube number two had 54 glucose, 39 protein. tube number three had 2 white blood cells, no red blood cells. a ct of the abdomen was obtained and demonstrated a perirectal abscess with fistulization to the left side of the rectum, multiple abdominal and pelvic lymph nodes, all of which were subcentimeter in size were present. hospital course: the patient was admitted briefly to the medical intensive care unit for pressor therapy. the patient was continued on empiric antibiotics and was successfully weaned of dopamine. a transthoracic echocardiogram was obtained and demonstrated left ventricular wall thickness that was borderline hypertrophied with lvef greater then 55%, normal right ventricular chamber size and free wall motion and without any evidence of valvular abnormalities other then trivial mitral regurgitation. in particular, no valvular vegetations were seen and there was no pericardial effusion. the patient was transferred from the micu to the general medical team for further treatment. surgical consult was obtained and the patient underwent ultrasound guided drainage of his perirectal abscess on the . approximately 10 cc of purulent material was drained. gram stain was notable for 4+ gram positive rods, 3+ gram positive cocci in pairs and clusters, 2+ gram negative rods and 1+ budding yeast. culture of the drain material revealed mixed bacterial type with greater then three colony types present and was notable for gram negative rods of two distinct colony morphologies and the anaerobic culture was notable for mixed bacterial flora. the patient's antibiotics were switched from vancomycin, gentamycin and flagyl to ciprofloxacin and flagyl given the patient's allergies to penicillin and amoxicillin. the patient defervesced and remained afebrile for 24 hours prior to discharge. discharge condition: stable. discharge diagnoses: 1. perirectal abscess. 2. hiv. 3. end stage renal disease. 4. hepatitis c. 5. hypertension. 6. fever. discharge medications: same as those prior to admission as well as ciprofloxacin 500 mg q day for a two week course, metronidazole 500 mg by mouth t.i.d. for a total of a two week course and colace 100 mg b.i.d. follow up: the patient will follow up with his primary care physician . on thursday the at 2:00 p.m. in addition, he will return to the for a repeat ultrasound study to monitor resolution of the perirectal abscess on the at 1:30 p.m. and he will then see dr. on the at 10:45 a.m. the patient will also follow up with his nephrologist at regarding removal of his line as discussed with the patient. , m.d. dictated by: medquist36 procedure: spinal tap incision of lung hemodialysis venous catheterization for renal dialysis aspiration of skin and subcutaneous tissue diagnoses: unspecified septicemia human immunodeficiency virus [hiv] disease hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease infection and inflammatory reaction due to other vascular device, implant, and graft other and unspecified coagulation defects acute hepatitis c without mention of hepatic coma abscess of anal and rectal regions anal fistula 

Answer: The patient is high likely exposed to