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: bactrim ds / indomethacin / linezolid attending: chief complaint: seizures, mental status changes major surgical or invasive procedure: lumbar puncture history of present illness: the patient is a 48m w/ hiv/aids/hcv/ivda sent from rehab for evaluation of 2 witnessed tonic-clonic seizures. seizures occurred on evening , lasted 30 seconds - 1 minute, resolved spontaneously. first seizure occured while he was being cleaned up, second seizure occured while family member (mother?) was in the room. his nurse reported 'whole body shaking' l>r, not responsive to name or sternal rub, dilated pupils, no loc. patient w/ foley, so not able to assess loss of bladder function, no bowel movement yesterday. patient appeared 'sleepy' afterwards but then seemed to return to his normal self between seizures. hypertensive - received nitropaste. afebrile, t max 99.8, bp 116-120's/86-106, hr 78-129, o2 sat96% on 2l. also found to be hypokalemic with k 2.6, started on ivf @10cc/hrkcl 40 meq x 6 doses. . no nausea/vomiting/diarrhea, no fevers/chills, no seizure history. per brother, patient has had hiv encephalopathy x 1 month, not completely oriented at baseline. his nurse describes his baseline as oriented to self only, spanish speaking with some english, has sensation of pain to minimal stimulus. . ed course: arrived @9pm. never oriented, drowsy --> very agitated. vs 98.5, hr 97, pb 134/89, rr 16, 02 sat 100% on 2l. negative head ct. midnight - noted to have tonic clonic seizure activity lasting 1-2 minutes, post-ictal. o2 sat 100% on non rebreather, weaned easily. given ceftriaxone 2gm, vanc 1gm, ampicillin 2gm, acyclovir 700mg. sedated for lp (2mg versed and 2mg ativan). 200mg iv diflucan for thrush. morphine for pain, received total of 12mg. also received 2 gm iv magnesium, ns w/ 40 meq of k x 2l. hypertensive in 140-150s and tachy up to 130's throughout ed stay, tmax 100.9 (not during seizure). . after arrival to the icu, it was discovered that he had a urine culture positive for acinetobacter at rehab and was started on imipenem. bcx had reportedly been negative after 5 days. . previous hospitalization () for change in ms after being found down and minimally responsive; he was intubated for airway protection; course complicated by r neck hematoma to line placement, alkalosis, hypernatremia, hypercacemia, improved arf, elevated lactate, transaminitis. concern for toxic metabolic encephalopathy, improved somewhat with fluids but did not return to baseline. also with rhabdomylosis - ck peaked at 3996, and improved to normal with ivfs, renal failure also resolved. he was positive for c-diff, had mrsa positive sputum, and sparse pseudomonas growth in sputum. when discharged he needed 6 more days to finish 14 day course of vancomycin, 10 more days to complete 15 day course of meropenem and needed to continue on flagyl for 14 days after all other abx completed. past medical history: 1. hiv/aids - last cd4 105, vl > 100,000 on , off haart because of suicidality and depression, on dapsone ppx for pcp noncompliant. thought to have hiv encephalopathy. 2. hepatitis c: treatment deferred because of depression/suicidality. last viral load was 5,860,000. 3. asthma 4. h/o tuberculosis (, now resolved) 5. h/o pcp x 2 6. h/o pericarditis () 7. h/o pneumococcal pneumonia with bacteremia () 8. h/o lll pneumonia () 9. h/o mac on bal () 10. h/o neuropathy, thought hiv 11. disseminated herpes zoster 12. ? depression. 13. h/o pseudomonal pneumonia (+bal- pan sensitive) social history: patient came to from rehab. smoker (less than 1 ppd x 25 years), + h/o ivda in past, occasional marijuana use. no etoh. sexually active "occasionally" with one partner, same partner for several years. family history: nc physical exam: admission physical exam: vs: temp: 98.1 bp: 142/100 hr: 112 rr: 20 o2sat 100% 2l gen: agitated, crying out, not oriented, cachectic heent: perrl, eomi, anicteric, mm dry, thrush on tongue neck: no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: cta b/l with good air movement throughout cv: tachy, rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, initially with voluntary guarding but later without ext: no c/c/e, warm, good pulses skin: no rashes/no jaundice neuro: aaox0, unable to cooperate with neuro exam at discharge, vitals were stable. the patient was afebrile. the patient was more oriented. he was able to communicate his needs in english. his neck was rotated the left and he had some muscular spasm. his abdomen was benign. the remained of his exam was unchanged. pertinent results: cxr (): cardiomediastinal contours are normal. ng tube tip is in the stomach. there is no pneumothorax or pleural effusion. the lungs are grossly clear. surgical clips projecting over the left supraclavicular area are again noted. left picc remains in place. ekg: sinus tachycardia, rate 115 beats per minute. right atrial abnormality. possible old septal myocardial infarction. possible left ventricular hypertrophy. tracing is compatible with pulmonary disease. compared to the previous tracing of qs complexes in leads v1-v2 are less prominent and there is less suggestion of possible left ventricular hypertrophy. both tracings are compatible with pulmonary disease. ct head (): findings: multiple acquisitions were performed due to patient compliance. despite this, there is motion artifact on the study acquired limiting the evaluation. there again noted is extensive confluent low attenuation throughout the deep white matter of the brain. this is likely related to underlying hiv encephalopathy. there is a advance atrophy for age which is consistently seen in hiv encephalopathy as well. there is no acute interval change or midline shift. no intracranial hemorrhage is evident. impression: stable head ct examination, although the current examination is limited as above. findings most consistent with hiv encephalopathy with no superimposed acute process. ct neck: findings: the patient is rotated to the left side, with the neck being rotated to the left side. hence, this study is limited in acquiring the images in a proper manner, centered onto the midline of the neck. in addition, lack of iv contrast, significantly limits evaluation for any focal infection. within these limitations, there are no large masses noted on the visualized images of the neck. however, subtle areas of increased attenuation in the fat and inflammation cannot be assessed. there is moderate dilatation of the esophagus with small amount of fluid/debris within the esophagus. this finding is new compared to the ct chest on , with interval removal of the nasogastric tube. right-sided picc line is incompletely included on the present study. there are a few surgical clips, noted lateral to the left side of the thyroid, unchanged in position, compared to the prior ct chest on . there is moderate dilatation of the ventricles on the visualized images of the brain, which was noted on the prior mri of the head; however, the brain is incompletely included on the present study. there is a small 4-mm soft tissue density nodule in the upper lobe of the left lung, unchanged. there appears to be resolution of the previously noted pneumothorax in the apices. however, the chest is not completely evaluated on the present study. there is moderate dilatation of the ventricles on the visualized images of the brain, which was noted on the prior mri of the head; however, the brain is incompletely included on the present study. brief hospital course: # seizures: the patient had two witnessed tonic-clonic seizures before presenting to ed and one seizure in the ed. the most likely etiology for patient's seizures is imipenem which was used to treat his urine culture positive for acinetobacter and elavil which was given at high doses for neuropathy. mr. is thought to have hiv encephalopathy and this condition combined with imipenem may have lowered his seizure threshold. patient's amitriptyline was also considered as possible cause of patient's seizures. infectious etiology or mass effect were ruled out by hospital course, benign appearance of csf, and head ct; however, initially the patient was given empiric iv acyclovir, ceftriaxone, and vancomycin because of suspicion of viral or bacterial central nervous system infection. of note, patient has had no seizures since admission and stopping of imipenem and amitriptyline. the patient was started on 500 mg levetiracetam (keppra) as anti-seizure medication. per the neurology service, the patient should be on keppra indefinitely. # mental status changes: the patient's mental status changes are likely due to hiv encephalopathy. ct showed no cns mass effect and no acute cns infectious etiology found. patient's mental status changes date back to admission when patient left hospital ama, never having gone back to baseline mental status s/p presumed fall. patient's cmv viral loads were low (2160) and treatment was deferred since there was no sign end-organ disease. the patient was examined by ophthomaology who did not see any signs of cmv retinitis. # urine: the patient was found to have acinetobacter in his urine sensitive to gentamicin. he was started on a three day course of iv gentamicin on . he will need his final dose today at rehab (). please recheck a ua and culture tomorrow () to confirm his urine has cleared appropriately. the patient has also had urinary retention during this hospitalization. he failed two voiding trials during this stay. as he improves, he can be given another voiding trial or can follow up with urology if needed. # neck position: the patient had head turned to left and was resistant to changing position and has point tenderness bilaterally on sides of neck. neck ct without contrast obtained (could not use contrast as could not obtain peripheral iv access necessary) but study was inconclusive due to patient positioning and lack of contrast. patient continuesd to keep head turned to left with some improvement noted with use of clonazepam. please continue low dose clonazepam to help with muscular spasm. if the patient continues to have neck pain, consider re-imaging the neck. # allodynia: the patient had complaints of allodynia on last admission and reports of neuropathic pain dating back to . this allodynia may be part of the spectrum of his neuropathy which is thought to be secondary to hiv. according to omr, the patient has not had relief of his neuropathy with gabapentin in the past. however, after patient left icu for floor, opiates were held because of worries of sedation affecting mental status. his pain was treated with gabapentin and acetaminophen. we did not restart his opiates during this hospitalization nor his remeron. # hypokalemia/hypomagnesmia: on admission, the patient was hypokalemic (k of 3.0) and hypomagnesemic (1.1). patient's poor nutrition (albumin of 2.6) and no po intake most likely cause. as feeding via ng tube began, lytes were monitored in order to assess refeeding syndrome. at the time of discharge, the patient's po intake was improving. he was able to eat his entire breakfast with help from the nursing staff. please continue to monitor his electrolytes while he is on tpn at least daily replete his electrolytes as needed and change tpn based on electrolytes. once he is able to increase his po intake, please consider discontinuing the tpn. once discontinued, the patient will not need his electrolytes monitored daily. please discontinue his picc line once he no longer needs tpn. # hiv: the patient is not on haart (as he has declined it). id did not recommend haart as haart carries increased risk of toxicity in setting of poor nutrition, and patient is vulnerable to immune reconstitution syndrome with low cd4 count at start of haart and patient has known hepatitis c. id's recommendation was that haart not be initiated until mr. nutritional status improves and that dr. (outpatient id doctor for patient) should make decisions about implementing haart. patient has follow up appointment on at 9:30 am with dr. . please continue his dapsone for pcp . # fluid, electrolytes, nutrion: patient was profoundly cachectic, had not eaten in several days and failed a speech and swallow evaluation. gi did not wish to place peg because of patient's low albumin (which would impede healing) and prominent epigastric surgical scar. patient received ng tube on after neck was imaged with ct. ng tube feeds began at midnight on night of at 10 ml/hr. rate was increased by 10 ml/hr every 12 hours with a goal rate of 50 ml/hour acheived at midnight on sunday . however, tube came out and patient refused replacement. patient did ask for tube to be replaced on but after primary medical team could not place tube, patient refused ir placement of ng tube. patient was begun on tpn on . patient's lytes were repleted prn as mentioned above. the patient is having improved po intake and tpn can be discontinued when patient is taking adequate oral intake. if needed, the patient can be re-evaulated by speech and swallow in the future. despite numerous discussions with the family regarding poor prognosis, the patient remained full code throughout his hospital course. medications on admission: medications at rehab (per rehab notes): primaxin 500mg iv q6 (started ) elavil 100mg po qhs lactinex 1 packet tid zantac peg 150 mg q12 heparin subq 5000u tid senokot atrovent neb 2.5ml q6 prn albuterol 3ml q6 prn tylenol 500mg q6 prn discharge medications: 1. outpatient lab work please check chem-10 if possible, otherwise please check daily electrolytes and replete lytes prn as patient is vulnerable to refeeding syndrome (hypokalemia, hypophosphatemia, hypomagnesiema). 2. nutrition tpn: non-standard tpn for date: volume(ml/d)= 1000; amino acid(g/d) = 0; branched-chain aa(g/d) = 0; dextrose(g/d)= 100; fat(g/d) = 20. trace elements will be added daily standard adult multivitamins nacl = 30; naac = 0; napo4 = 40; kcl = 10; kac = 0; kpo4 = 0; mgs04 = 15; cagluc = 5. total volume of solution per 24 hours. rate of continous infusion determined by pharmacy-see label 3. 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 7. dapsone 100 mg tablet sig: one (1) tablet po daily (daily). 8. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 9. picc line care heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. order was filled by pharmacy with a dosage form of syringe and a strength of 100 u/ml 10. gentamicin gentamicin 60 mg iv q8h duration: 3 days order was filled by pharmacy with a dosage form of piggyback and a strength of 60mg/50ml. pt has had 8 doses. he will need to complete his additional 1 dose today. 11. clonazepam 0.125 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po twice a day: please hold for sedation. 12. keppra 500 mg tablet sig: one (1) tablet po twice a day: please crush in purees. 13. gabapentin 400 mg capsule sig: one (1) capsule po three times a day: please open capsule and give in purees. 14. vitamin b-12 50 mcg tablet sig: two (2) tablet po once a day. 15. outpatient lab work please check a urinanalysis and culture on to ensure the patient has cleared his urinary infection. discharge disposition: extended care facility: hospital discharge diagnosis: primary: # seizures thought due to imipenem treatment # multi-drug resistent acinetobacter uti # hiv/aids # urinary retention requiring foley catheter placement (failed voiding trials x2) # cachexia requiring tpn . secondary: # hiv/aids # hcv # asthma # aids related neuropathy discharge condition: stable discharge instructions: you were admitted to the hospital with seizures. while you were in the hospital we treated you with iv antibiotics for a question of an infection in your spinal column. we also gave you anti-seizure medication. please continue taking this anti-seizure medication. because you were having trouble swallowing, we put a tube from your nose into your stomach and gave you nutrition through this tube. this tube came out and you did not want it replaced. we then gave you nutrition through the iv in your arm. we will continue nutrition through your arm until you are able to keep up with oral nutrition. we also treated an infection in your urine with iv antibiotics. followup instructions: the following appointments have been made for you. please follow up at these appointments. provider: , md phone: date/time: 2:40. please call ahead of time to update address, phone number, and insurance information. provider: , md phone: date/time: 9:30 procedure: venous catheterization, not elsewhere classified spinal tap incision of lung parenteral infusion of concentrated nutritional substances diagnoses: tobacco use disorder urinary tract infection, site not specified other, mixed, or unspecified drug abuse, unspecified unspecified viral hepatitis c without hepatic coma asthma, unspecified type, unspecified depressive disorder, not elsewhere classified candidiasis of mouth hypopotassemia human immunodeficiency virus [hiv] disease cachexia retention of urine, unspecified other diseases of lung, not elsewhere classified other encephalopathy pressure ulcer, heel other specified antibiotics causing adverse effects in therapeutic use disorders of magnesium metabolism mononeuritis of unspecified site other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms spasm of muscle infection with drug-resistant microorganisms, unspecified, with multiple drug resistance generalized convulsive epilepsy, without mention of intractable epilepsy pressure ulcer, hip 

Answer: The patient is high likely exposed to