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: the patient is a 59 year old caucasian woman with a past medical history significant for diabetes, chronic arachnoiditis, metastatic thyroid cancer who presents with right lower extremity cellulitis times two days. the patient has had an ulceration on the right lateral ankle and has noticed that it has been worsening in appearance over the last few days with increasing erythema. the patient also complained of nausea. she stated that her temperature at home was 102. she denies any vomiting, constipation or diarrhea. she denies any headaches, chest pain, shortness of breath or abdominal pain. the patient also complains of pain at the dorsum of her right foot and anterior aspect of her lower leg. she denies any trauma. she denies any change in activities. the patient has been on augmentin 375 mg b.i.d. for one day prior to admission. past medical history: 1. metastatic thyroid cancer, status post resection and radiation. 2. diabetes, type 2. 3. hypertension. 4. chronic arachnoiditis. 5. chronic back pain. 6. lower extremity and upper extremity muscle spasms. 7. anemia. 8. obstructive sleep apnea. 9. anxiety. 10. history of colon adenoma. medications on admission: 1. synthroid .175 mg q. day. 2. catapres .1 mg b.i.d. 3. catapres patch tts 3 patch q. week. 4. glucophage 500 mg b.i.d. 5. baclofen 20 mg t.i.d. 6. k-dur 20 meq q. pm. 7. quinine 325 mg b.i.d. prn. 8. coumadin 5 mg alternating with 6 mg each day. 9. protonix 40 mg q. day. 10. celexa 40 mg q. day. 11. vioxx 50 mg q. pm. 12. amitriptyline 20 mg q.h.s. 13. zanaflex 1 mg t.i.d. and 2 mg q.h.s. 14. lisinopril 40 mg b.i.d. 15. klonopin .5 mg q.h.s. 16. colace 100 mg t.i.d. 17. zofran prn. 18. nubain 10 to 30 mg q. 3-4 hours prn for pain. 19. humulin sliding scale. 20. trazodone 150 mg q.h.s. 21. miralax 2 capsules prn. allergies: 1. compazine causes rash. 2. methylprednisolone causing gastrointestinal bleed. 3. pepcid causing mental status changes. 4. intravenous nitroglycerin causes mental status changes. physical examination on admission: vital signs reveal a temperature 99.1, pulse 105, blood pressure 233/97, respiratory rate 20, oxygen saturation 90% on room air. in general the patient was alert and oriented times three in mild discomfort. head, eyes, ears, nose and throat examination shows pupils equally round and reactive to light. extraocular muscles intact with moist mucous membranes. there is no lymphadenopathy and no neck tenderness. the lungs are clear to auscultation bilaterally. cardiovascular, tachycardiac, no murmurs, rubs or gallops. abdomen, soft, nontender, nondistended with good bowel sounds. there is no organomegaly, no rebound or guarding. neurological examination shows cranial nerves ii through xii intact. the patient has no sensation to light touch below the thighs on both lower extremities, and below the elbows in both upper extremities. she has 4 out of 5 muscle strength in the lower extremities, 4+/5 muscle strength in the upper extremities. extremity examination, dorsalis pedis and posterior tibial pulses were not palpable bilaterally. on the left heel there is a superficial ulceration on the medial aspect. on the right lower extremity there is a superficial closed ulceration of the second toe. the lateral malleolus had a superficial ulceration with fibrotic center and mild serous drainage. there is no pus or purulence. there is no exposed base. there is no tracking of the wound. there is warmth of the lower extremities. there is a descending cellulitis on the right side to the mid anterior shaft, no calf vein, mild tenderness directly adjacent to the ulceration of the lateral malleolus. laboratory data: on admission white count was 13.1, hematocrit 35.5, platelets 236. coagulation screen shows pt of 19.5, inr 2.5. chem-7 within normal limits except for glucose of 263. the patient's creatinine is 1.0 which is her baseline. lactate is normal. magnesium is 1.5, calcium and phosphorus are normal. hospital course: (by issue) 1. right lower extremity cellulitis and ulcerations - the patient was admitted to the podiatry service on for the cellulitis of the right lower extremity. on admission she was started on vancomycin, levaquin and flagyl for broad coverage. blood cultures and wound cultures were taken. both grew out escherichia coli. in order to more specifically cover, the patient's antibiotics were changed to oxacillin and ceftriaxone. the patient has also had hardware in her right ankle and because of the possibility that this was seated, the patient required surgery. her coumadin was discontinued and once her inr had decreased close to baseline, she was taken to the operating room for hardware removal. this was done on . postoperatively the patient is stable on oxacillin and ceftriaxone until two days after the operation. then due to concern for pneumonia her antibiotic coverage was changed to zosyn and vancomycin. she continued this for three days and then was only on zosyn. her right lower extremity was in a vacuum-assisted closure dressing and continued to improve, healing by secondary intention. she has been followed by podiatry. her left lower extremity ulcer also continued to improve. x-rays showed an old fracture without any changes in the left foot. the patient did not have any further signs of worsening cellulitis or infection of her extremities. 2. respiratory - on , the patient developed hypoxia with an oxygen saturation of 80% on room air and hypertension with systolic blood pressure in the 190s. she was also complaining of a new productive cough. chest x-ray done on that day was consistent with congestive heart failure and the patient was given lasix. there is also question of a right lower lobe infiltrate on the chest x-ray, so azithromycin was initially added to her regimen of ceftriaxone and oxacillin. on the same day, the patient also developed mental status changes which was possibly thought to be related to her hypoxia. at this point, due to concern for pneumonia and respiratory compromise, the patient's antibiotic coverage was changed to vancomycin and zosyn and she was transferred to the intensive care unit for closer monitoring. she was never intubated. she was continued on zosyn and vancomycin and a sputum culture was obtained. the sputum culture showed and did not grow out any bacteria. the patient's respiratory status improved with decrease in oxygen requirements. once the sputum culture was negative for any bacteria and there was no evidence of methicillin-resistant staphylococcus aureus her vancomycin was discontinued. she was continued on zosyn for treatment of possible aspiration pneumonia and for her cellulitis. 3. congestive heart failure - the patient required lasix intermittently for mild hypoxia and crackles on lung examination indicative of congestive heart failure. she was also on zestril 20 mg b.i.d. initially and then titrated up for afterload reduction. her blood pressure was labile but was controlled with catapres, lopressor, and zestril. 4. anticoagulation - the patient's coumadin was discontinued as was previously mentioned in order to be taken to the operating room. while off coumadin the patient was on a heparin drip for her history of deep vein thrombosis and pulmonary embolism. once it was decided that no further procedures would be done by podiatry she was restarted on coumadin. her heparin drip was continued until her inr would be in the goal range of 2 to 3. 5. chronic back pain - the patient had chronic back for which she had been on nubain at home. while in the hospital she was started on a morphine pca. initially there was no basal rate, however, the patient was not using the pca and therefore basal rate was added. plan was for the patient to have a morphine placed by neurosurgery once her active acute issues are cleared. this will probably be done after discharge. she was also on baclofen, tizanidine and vioxx for her pain. 6. hypothyroidism - the patient was continued on levoxyl. 7. psyche - the patient was on celexa and klonopin. 8. dysphagia - the patient had a swallowing study previously done in , in order to evaluate symptoms of dysphagia. this showed a possible offer for esophageal sphincter dysfunction, no further workup was done at the time. on this admission there is a question of aspiration pneumonia and the patient was re-evaluated by the swallowing service. again there was no evidence of aspiration but evidence that there was upper esophageal dysfunction. the patient will require a gastroenterology follow up for workup and possible dilatation. for now, she will be on a soft diet with frequent liquids when eating. 9. anemia - the patient has a history of chronic anemia requiring blood transfusions. while in the hospital she also had periods of time when her hematocrit was below 30. there were no signs of active bleeding. the iron studies showed a mixed picture with decreased iron and tibc and elevated ferritin. the patient's iron to tibc ratio was low suggesting a possible combination of iron deficiency anemia, anemia of chronic disease and possibly anemia related to the patient's hypothyroidism. the patient was given blood transfusions as needed to maintain her hematocrit greater than 30, given her history of congestive heart failure. 10. diabetes type 2 - the patient was continued on a sliding scale of insulin. her metformin was held when she was not eating. it will be restarted when she is eating more stabilely. code status: the patient is full code on admission and discharge. discharge condition: the patient is in good condition. discharge status: the patient is to be discharged to an acute rehabilitation facility. discharge diagnosis: 1. aspiration pneumonia. 2. cellulitis. 3. hypertension. 4. congestive heart failure. 5. obstructive sleep apnea. 6. chronic anemia. 7. history of deep vein thrombosis and pulmonary embolism. 8. diabetes type 2. 9. chronic back pain. 10. arachnoiditis. 11. anxiety disorder. 12. dysphagia. discharge medications: discharge medications will be listed in a discharge summary addendum as they are to be decided at this time. there will be an addendum to this discharge summary at a future date. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified excisional debridement of wound, infection, or burn transfusion of packed cells removal of implanted devices from bone, tibia and fibula application of pressure dressing diagnoses: congestive heart failure, unspecified iron deficiency anemia secondary to blood loss (chronic) ulcer of other part of foot pneumonitis due to inhalation of food or vomitus bacteremia acute diastolic heart failure secondary malignant neoplasm of mediastinum cellulitis and abscess of foot, except toes 

Answer: The patient is high likely exposed to