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 66 year old female with a past medical history for diabetes mellitus type 2, peripheral vascular disease status post left below the knee amputation and right above the knee amputation in , chronic renal insufficiency, coronary artery disease, status status post stent, and gout. the patient presented to with chest pain and shortness of breath. states that commonly has angina but yesterday had chest pain radiating to her neck and worsening anginal symptoms with low exertion. the patient's ekg showed st changes with st depression in i and avl, a ck at the outside hospital of 1000, mb of 89 with troponin of 24.8. the patient was transferred for cardiac catheterization which showed a ra pressure of 9, pa pressure of 34/18, with a mean of 25 and a wedge pressure of 15. the patient had left main coronary artery mild disease, left anterior descending diffuse disease, totally occluded left circumflex, non-dominant with diffuse disease, right coronary artery dominant with mid-segment total occlusion. catheterization was technically difficulty. no interventions were done. cardiothoracic surgery was consulted. the catheterization was greatly unchanged from a cardiac catheterization in which showed left main disease with focal area of 80% in left anterior descending, left circumflex 80% occluded, right coronary artery with diffuse disease. evidently, in , the patient was evaluated for coronary artery bypass graft but it was not done because of being a poor surgical candidate with co-morbidities. review of systems: no history of cerebrovascular accident, no amaurosis fugax, no claudication in the arms. history of syncope several years ago but could not recall events surrounding this. the patient is having worsening of general symptoms. the patient used to be able to transfer from bed to wheelchair and would get chest pain after approximately ten feet. now patient was getting chest pain strictly on transfer from bed to wheelchair. medications on admission: 1. lopressor 100 twice a day. 2. imdur 60 mg q. day. 3. insulin 70/30, 56 units twice a day. 4. lasix 40 mg q. day. 5. aspirin 81 mg q. day. 6. allopurinol 100 mg q. day. 7. pravachol 40 mg q. day. allergies: the patient has allergy to ace inhibitor; she is intolerant with an increased creatinine. medications on transfer from catheterization: 1. integrilin drip. social history: the patient lives in with her husband. she is independent. she had a 15 pack year history of smoking which she quit. no alcohol use. she was a former nurse. physical examination: the patient was afebrile on admission. heart rate 95 to 100; right arm blood pressure 80, left arm blood pressure 120; 99% on two liters nasal cannula. generally, comfortable, obese, lying in bed, slightly cushingoid in appearance. heent: showed sclerae are anicteric. oropharynx clear. no jugular venous distention, no bruits. pupils are equal, round, and reactive to light and accommodation. mucous membranes were moist. lungs clear to auscultation laterally and occasional expiratory rhonchi anteriorly. heart: regular rate and rhythm, positive s1, s2, with ii/vi holosystolic murmur at apex. point of maximal impulse difficult to palpate. abdomen with positive bowel sounds, nontender, no ecchymosis. groin: right groin without hematoma. venous groin sheath in place. extremities with left below the knee amputation, right above the knee amputation. scar along medial portion of left below the knee amputation. laboratory: on admission, white blood cell count 9.0. hematocrit 26.7, platelets 166, inr 1.7, pt 15.7, ptt 37.2. sodium 142, potassium 3.8, chloride 108, bicarbonate 22, bun 42, creatinine 2.0, glucose 148, magnesium 1.5, calcium 7.8. ck 2187, mb fraction was 223, mb index 10.2. ekg on , showed sinus tachycardia, pr interval of 154 with qrs interval of 110 milliseconds, st depressions in i and avl, v5 through v6. rwp was normal. q's in ii and f. on , status post catheterization, sinus rhythm at 92 beats per minute, lad, pr interval 166, qrs interval 106, st depression in i, avl and v5 through v6 with 1 millimeter q's in iii and f. no real change from previous pre-catheterization ekg. assessment and plan: 66 year old female with type 2 diabetes mellitus with vascular complications including coronary artery disease, chronic renal insufficiency and renal artery stenosis, status post catheterization with extensive coronary artery disease. 1. coronary artery disease: continue integrilin, restart heparin without bolus. cardiothoracic surgery will be consulted. ct surgery is not an option. interventional could consider stenting right coronary artery, consider functionality of this. continue aspirin and beta blocker; oral nitrates, consider changing them to three times a day for titration. pump: no signs of decompensation. use hydralazine with nitroglycerin for symptomatic relief. no mortality benefit per v-hef trial. rhythm: sinus; will monitor. 2. type 2 diabetes mellitus: continue nph and sliding scale insulin. check urine protein and creatinine. continue blood sugar checks four times a day. 3. chronic renal insufficiency: hold on lasix for now. prerenal component. watch creatinine closely post catheterization. 4. hematology: hematocrit decreased. baseline creatinine 29.6, microcytic. possible causes, chronic gastrointestinal loss or chronic renal insufficiency, guaiac stools. will transfuse now. check on her studies, reticulocyte count, goal hematocrit is greater than 30. 5. pulmonary: stable. 6. fluids, electrolytes and nutrition: continue with diabetic diet. replete electrolytes as needed. 7. code status: to discuss with patient. contact is her husband, , . 8. prophylaxis: the patient getting ppi and heparin. hospital course: 1. cardiovascular: the patient with congestive heart failure exacerbation status post myocardial infarction with no intervention. the patient was seen by cardiothoracic surgery and not deemed to be a surgical candidate. the decision was made that no catheterization intervention was needed as well and right coronary artery stent was not placed. the patient was continued on her current medications as well as the patient's amiodarone was decreased from 400 twice a day to 400 q. day; isordil was added. the patient put on hydralazine titrated up to 40 four times a day. the patient had complication status post cardiac catheterization which turned out to be an extra-peritoneal bleed with a pseudo-aneurysm. the patient received blood transfusion for a hematocrit as low as 27.8. the patient then had thrombin injection/thrombin plug of pseudo-aneurysm, which was successful. the patient's plavix, heparin were both held in light of the retroperitoneal bleed and have not been restarted. the patient's hematocrit has successfully stabilized status post thrombin injection of the pseudo-aneurysm. the patient is stable. while in coronary care unit the patient also developed severe abdominal pain. ct scan of the abdomen and pelvis in , made no mention of gallbladder issues but did mention that gallbladder was distended with sludge but no edema or pericholecystic fluid around the gallbladder. since that time, the patient did subsequently develop severe abdominal pain and was sent for an abdominal ultrasound which showed a grossly distended gallbladder with stones, edematous gallbladder wall and some pericholecystic free fluid with no biliary dilatation. the result was a percutaneous cholecystomy tube under ultrasound guidance; 400 cc. of bile fluid was removed and drained and the gallbladder was left in place to gravity bag. the bile fluid showed heavy growth of gram negative rods. subsequent cultures showed klebsiella sensitive to levofloxacin. the patient has been on levofloxacin since the gallbladder drainage was placed. the patient has been afebrile with no real issues with her white blood cell count which is now slightly elevated. the patient did have blood cultures drawn for a temperature spike which, on , was shown to have staphylococcus coagulase negative in one bottle; subsequently no growth to date on other cultures. the patient was started on vancomycin 750 mg q. 24 hours due to her renal clearance. this will be for a seven day course only. the patient was also put on metronidazole (flagyl), 500 mg three times a day, for further coverage. the patient's echocardiogram on , showed overall left ventricular systolic function severely depressed, global hypokinesis to akinesis in the inferior posterior wall, right ventricular systolic function was good, two plus mitral regurgitation. no definite pericardial effusion. due to the patient's retroperitoneal bleed, the patient's plavix and heparin has not been restarted. the patient does have a right subclavian line as well as a right picc line for long-term antibiotic use. since the patient has left the coronary care unit she has been stable, but the right subclavian line is still in place on , which will be pulled, and the picc line will be left in place. the patient's inr is elevated at 1.9, therefore, vitamin k 5 mg subcutaneously was given. inr will be rechecked before subclavian line is pulled. the patient will have gallbladder drainage left in place for approximately up to six weeks while the gallbladder has a chance to quiesce. once the gallbladder inflammation has resolved, the drain will removed per surgery. the patient now has restarted p.o./oral medications and eating. the patient is going well with regards to intake. the patient is now without abdominal pain, resting comfortably. physical therapy will see the patient to get the patient out of bed and back to functioning status of transferring to wheelchair. disposition: the patient will be discharged to a rehabilitation center for further intravenous antibiotics and rehabilitation status post non-q wave myocardial infarction. discharge plan: the patient's plan will be to return to home, not yet with hospice care but with continued plan that she will be titrated up on her medicines for blood pressure and heart rate control as well as anginal control, and that she will at some point require hospice care for her failing condition that is not amenable to surgery. the patient's blood pressure medications will be titrated as tolerated. discharge instructions: 1. the patient will follow-up with surgery regarding drainage of gallbladder tube and removal of gallbladder tube. 2. the patient will need to be restarted on her anti-coagulation, heparin and coumadin, once it is deemed safe status post her retroperitoneal bleed. 3. the patient will need her subclavian line pulled once inr is stable. 4. the patient will be continued on her procrit and her creatinine has been trending down. 5. the patient will need continued vancomycin until . 6. the patient will need levaquin and flagyl for a klebsiella, gram negative in her bile which is sensitive to levaquin and will be continued to be deemed the course via infectious disease input. 7. the patient will be screened for rehabilitation and sent to rehabilitation as soon as she is clinically stable. code status: the patient's code status is "do not resuscitate". medications as of : 1. atrovent nebulizers for wheeze. 2. hydralazine 40 mg p.o. four times a day. 3. percocet one to two tablets p.o. q. six hours p.r.n. 4. insulin sliding scale. 5. lopressor 50 mg p.o. twice a day. 6. amiodarone 400 mg p.o. q. day. 7. robitussin ac 10 cc., four times a day p.r.n. 8. aspirin 325 mg p.o. q. day. 9. allopurinol 100 mg p.o. q. day. 10. protonix 40 mg p.o., twice a day. 11. procrit 3000 units subcutaneously three times a week. 12. iron 325 mg p.o. three times a day. 13. colace 100 mg p.o. three times a day. 14. isordil 30 mg p.o. three times a day. 15. lipitor 40 mg p.o. q. day. 16. levaquin 250 mg intravenously q. 24 hours. 17. vancomycin 750 mg intravenously q. 24 hours to be discontinued on . 18. metronidazole 500 mg intravenously three times a day. 19. nph is at 40 units in a.m. and 40 units in p.m. the patient's blood sugars have been stable. condition on discharge: stable and approved. discharge diagnoses: 1. coronary artery disease status post non-st elevation myocardial infarction and status post cardiac catheterization with no intervention. 2. diabetes mellitus type 2. 3. hypertension. 4. chronic renal insufficiency. , m.d. dictated by: medquist36 d: 16:12 t: 18:07 job#: procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of other therapeutic or prophylactic substance arterial catheterization pulmonary artery wedge monitoring percutaneous aspiration of gallbladder diagnoses: subendocardial infarction, initial episode of care acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified atrial fibrillation accidental puncture or laceration during a procedure, not elsewhere classified cardiogenic shock iron deficiency anemia, unspecified diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled calculus of gallbladder with acute cholecystitis, without mention of obstruction 

Answer: The patient is high likely exposed to