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: tegaderm / prinivil / reglan attending: chief complaint: hyperglycemia major surgical or invasive procedure: debridement of right foot ulcer picc line placement history of present illness: 64 yo male hx of pvd, dm s/p renal transplant . and ulcers. patient states that he has been nauseated with vomiting and diarrhea for the past 2 weeks. he reports having decreased food intake and that he has not been able to take or keep his medications down consistently. he states that in the past when he has been hyperglycemic, he has not had nausea and vomiting like this. he also reports sob and doe for the past 4-5 days. he denies orthopnea and pnd. he reports some edema in his legs bilat which is a chronic problem. came to the er today because his wife finally made him after his temperature spiked to 102. patient also has chronic ulcers. his wife helps care for them and has not noticed any increasing erythema 2 days ago when last she changed the dressing. however, in ed, found to have swollen rle with right ulcers some and surrounding erythema concerning for celluliti. in ed found to be hyperglycemic with bs of 420 and ag 24. they treated him with sq insulin rather than an insulin drip because they were concerned about hypoglycemia. ed with q 1-2 hr fingersticks brought ag down to 16 currently. ed concerned about possible cellulitis started on vanco and unsyn for cellulitis. xray of leg did not show osteomyelitis. cxr clear. was consulted and they took a foot cx. podiatry also saw patient. patient was going go to floor when inr came back at 20.0. patient then given ffp x1 unit and vit k. past medical history: 1. coronary artery disease s/p cabg x 4 in . echo nml lv function 2. type 1 diabetes with complications including retinopathy, neuropathy, end-stage renal disease, and charcot foot 3. end-stage renal disease status post cadaveric renal transplant 4. right lower extremity dvt since requiring life-long anticoagulation on coumadin and ivc filter placement 5. hypertension 6. gerd 7. osteopenia of hip 8. neuropathy rfoot > lfoot 9. bilateral cataract surgery . right foot surgery and charcot foot 11. diverticulosis 12. status post flexible bronchoscopy with biopsy of rul, lingula 13. cryptococcus pneumonia, treated with fluconazole 14. orif left ulna 15. ivc filter placement 16. : abdominal aortogram with rle extremity runoff, angioplasty of popliteal stenosis. social history: he retired from his job as an electrician in the marine corps, which required travel to hi, ca, nc, . he lives at home with his supportive wife. they have 3 children (m36, f34, m26). alcohol: history of up to drinks daily, 5x/wk for many years, only 1-2 beers/ week recently. tobacco: 30 pack years, quit after mi. family history: dm type ii in father and paternal grandfater. mother had "heart disease." physical exam: tmax: 38.4 ??????c (101.2 ??????f) tcurrent: 38.4 ??????c (101.2 ??????f) hr: 82 (82 - 93) bpm bp: 127/52(69) {123/51(68) - 127/52(69)} mmhg rr: 20 (20 - 22) insp/min spo2: 99% heart rhythm: sr (sinus rhythm) height: 65 inch general appearance: well nourished, no acute distress, overweight / obese eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic lymphatic: cervical wnl, supraclavicular wnl cardiovascular: (s1: normal), (s2: normal), no(t) s3, no(t) s4, no(t) rub, (murmur: no(t) systolic, no(t) diastolic) peripheral : (right radial pulse: present), (left radial pulse: present), (right dp pulse: not assessed), (left dp pulse: not assessed), capillary refill wnl respiratory / chest: (expansion: symmetric), (breath sounds: clear : ) abdominal: soft, non-tender, bowel sounds present, no(t) distended, obese extremities: right: 1+, left: trace, no(t) cyanosis, no(t) clubbing skin: not assessed, rash: area of erythema on right lower leg surrounding wound. purpura present on back of hands. neurologic: attentive, responds to: not assessed, oriented (to): person, place & time, movement: purposeful, tone: not assessed pertinent results: admit labs: 134 90 34 ---------------< 420 3.8 20 2.1 d ldh: 296 . wbc: 12.3 hct: 37.8 plt: 243 n:88.9 l:7.5 m:3.5 e:0.1 bas:0.1 . hct: 37 -> 32 -> 29 ag: closed prior to d/c out of icu . cxr: neg ankle: cortical irregularity and soft tissue swelling at the base of the fifth metatarsal are unchanged. stable neuropathic changes in the mid foot. no new areas identified to indicate osteomyelitis. . ekg: nsr, q iii, no acute st-t changes . brief hospital course: mr. is a 64 yo male with a history of t1dm s/p cadoveric renal transplant, chronic rle ulcers, and ivc filter on coumadin, who was admitted with dka in the setting of one week of n/v, diarrhea and fevers. #. dka: thought infection (mrsa bacteremia and c diff colitis found in workup) he received aggressive ivf and iv insulin bolus but no gtt. his gap closed overnight in the icu. ekg without signs of active ischemia. he was restarted on his home insulin regimen once gap closed, with no further incidents. #. r foot ulcer/cellulitis: was previously treated with linezolid and followed by podiatry as out-patient; seen by and podiatry on admission. he was started on vanco and unasyn on admission, and this was narrowed to just vanco after his culture data returned. initial wound swab grew mrsa and was the likely source of mrsa bacteremia. he underwent debridement in or by podiatry on , cultures sent from or and also grew mrsa. id consulted and suggested 6 weeks vancomycin: his wound probes to bone so there was certainly concern for osteomyelitis. pathology eventually confirmed acute osteomyelitis. he will follow up with dr. of podiatry. # mrsa bacteremia: sets on admission. source likely foot ulcer. tte negative. surveillance blood cultures neg to date. treating with 6 weeks vancomycin as above. #. nausea/vomiting, diarrhea, c diff colitis: sx improved with appropriate tx with flagyl. will be treated with 2 weeks flagyl and if diarrhea recurs while on vancomycin, will consider retreating with flagyl. #. sob: sx resolved without further intervention. no signs acs or pneumonia. low suspicion pe. no hypoxia #. right knee pain: there was initially significant concern for possible septic knee in the setting of mrsa bacteremia; however on further evaluation by rheum, they reported that he had no effusion, no fluid for arthrocentesis. their differential included cppd/crystalline disease, other musculoskeletal such as meniscal tear, avascular necrosis (chronic steroids), occult fracture. mri showed no evidence of meniscal or ligamentous injury, non-specific circumferential subcutaneous edema, and only trace joint fluid. his pain improved with conservative management. #. coagulopathy: inr 20 on presentation likely diarrhea and poor po intake over last week; received 1 unit ffp in the ed as well as vitamin k. inr improved to 6. we held coumadin but also gave no further vitamin k in the icu. his inr was allowed to drift down and was 3.7 on discharge. he will follow up with who will determine when he will restart coumadin. #. arf: cr 2.1 on admission; with ivf in ed. likely prerenal as it improved with appropriate hydration. continued prednisone/prograf for renal allograft. on resumption of his outpatient diuretics, his creatinine started rising again. diuretics were held as urine lytes suggested this was again prerenal. given his worsening lower extremity edema and after his creatinine had stabilized around 1.7-1.8, lasix was restarted at 40mg qd and florinef was stopped. #. hx heavy etoh use: ciwa scale and mvi/folate/thiamine; no signs withdrawal so ciwa discontinued. # t1 dm, uncontrolled with complications: as above, dka resolved with appropriate insulin iv in icu and tx of multiple infections. # cad s/p cabg: continued asa, plavix # anemia: he was guaiac negative and iron studies were consistent with acd. procrit was started in-house, to be continued as an outpatient. medications on admission: medications confirmed with pt's wife who has a handwritten list oxycodone - (prescribed by other provider) - 5 mg capsule - as needed for pain ---> wife says most recently he has been using percocet acetic acid (bulk) - (prescribed by other provider) - 3 % liquid - to wash foot wound daily apply dressing after wash amlodipine - 5 mg tablet - 1 tablet(s) by mouth once a day ascensia elite test strips - - use as directed atorvastatin - (prescribed by other provider) - 80 mg tablet - 1 tablet(s) by mouth hs becaplermin - (prescribed by other provider) - 0.01 % gel - as needed clopidogrel - 75 mg tablet - 1 tablet(s) by mouth once a day coumadin - 1mg tablet - one to three tablet(s) by mouth once a day fluconazole - 200 mg tablet - 1 tablet(s) by mouth once a day fludrocortisone - 0.1 mg tablet - 1 tablet(s) by mouth once a day - no substitution furosemide - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth twice a day furosemide - 20 mg tablet - 1 tablet(s) by mouth every other day glucagon emergency kit - 1mg kit - use as directed imdur - 60mg tablet sustained release 24 hr - one tablet every day insulin glargine - (prescribed by other provider) - 100 unit/ml solution - 36 units every noon metoprolol tartrate - 50mg tablet - one tablet twice a day nitroquick - 0.4mg tablet, sublingual - use 0.4 mg under the tongue as needed for chest pain novolog - 100 u/ml solution - sliding scale - os-cal 500+d - 500-200 tablet - one tablet three times a day pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day papain-urea - (prescribed by other provider) - 1.1 million unit/gram ointment - as needed papain-urea-chlorophyllin - (prescribed by other provider) - 521,700 unit/gram-10 %-0.5 % ointment - as needed potassium chloride - (prescribed by other provider) - 10 meq tab sust.rel. particle/crystal - 1 tab(s) by mouth once a day prednisone - 5mg tablet - one tablet(s) by mouth q day risedronate - 35 mg tablet - 1 tablet(s) by mouth once a week take on empty stomach with lots of water, stay upright for 30 min afterwards silver sulfadiazine - (prescribed by other provider) - 1 % cream - as needed tacrolimus - 1 mg capsule - 1 capsule(s) by mouth twice a day travoprost (benzalkonium) - (prescribed by other provider) - 0.004 % drops - 1 drop in the left eye once a day trimethoprim-sulfamethoxazole - (prescribed by other provider) - 400 mg-80 mg tablet - one tablet(s) by mouth mon, wed,fri medications - otc alcohol swabs - pads, medicated - use as directed ascorbic acid - (prescribed by other provider) - 500 mg tablet - 1 tablet(s) by mouth once a day aspirin - (otc) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day calcium carbonate - (prescribed by other provider) - 500 mg tablet, chewable - tablet(s) by mouth as needed colace - 100mg capsule - one tablet twice a day hydrocolloid dressing - (prescribed by other provider) - dosage uncertain hydrocolloid dressing - (prescribed by other provider) - 4" x 4" bandage - as needed lancets - misc - as directed 5 times per day multivitamin - (otc) - tablet - 1 tablet(s) by mouth once a day non-adherent bandage - (prescribed by other provider) - dosage uncertain povidone-iodine - (prescribed by other provider) - 10 % solution - as needed discharge medications: 1. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) g intravenous q48h (every 48 hours) for 5 weeks. disp:*18 g* refills:*0* 2. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. disp:*100 ml(s)* refills:*1* 3. epoetin alfa 10,000 unit/ml solution sig: one (1) ml injection once a week. disp:*4 ml* refills:*2* 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po q 8h (every 8 hours). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po mwf (monday-wednesday-friday). 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. multivitamin tablet sig: one (1) cap po daily (daily). 12. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 13. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours). 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. travoprost 0.004 % drops sig: one (1) drop ophthalmic once a day: in left eye. 16. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 17. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 18. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 19. tacrolimus 1 mg capsule sig: one (1) capsule po q12h (every 12 hours). 20. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 21. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 1 weeks. disp:*21 tablet(s)* refills:*0* 22. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 23. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 24. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 25. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 26. insulin glargine 100 unit/ml solution sig: thirty six (36) units subcutaneous once a day. 27. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: home with service facility: vna discharge diagnosis: methicillin resistant staph aureus bacteremia right foot ulcer infection diabetic ketoacidosis, resolved acute renal failure clostridium difficile colitis secondary: type 1 diabetes mellitus with complications hx of renal transplant coronary artery disease, s/p coronary artery bypass graft peripheral disease bilateral deep vein thrombosis discharge condition: stable, afebrile, ambulating with cane discharge instructions: you were admitted with cellulitis and found to have mrsa bacteremia, likely from a foot ulcer. the ulcer was debrided by podiatry and also grew mrsa. you will need iv antibiotics (vancomycin) for 6 weeks from the date of . visting nurses will draw blood once a week and fax results to the clinic. you should take flagyl for one more week. you should continue to hold coumadin. vna will draw blood for inr and fax the results to the . they will tell you when to resume coumadin. resume your lasix at 40mg daily. depending on your creatinine level, this may be adjusted by dr. or dr. . if you have recurrent fevers, chills, worsening pain, or any other concerning symptoms, call your doctor immediately. if you have recurrent diarrhea, call the clinic, as you may need to restart flagyl. followup instructions: podiatry: follow up with dr. in his office on at 3:10. pcp: up with your primary care physician, . , on at 11:10am. you may call his office at with any questions. : follow up with dr. on at 1pm. renal: follow up with dr. on at 11am. id: follow up with dr. on at 1:30pm. phone: procedure: venous catheterization, not elsewhere classified excisional debridement of wound, infection, or burn diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension acute kidney failure, unspecified infection with microorganisms resistant to penicillins aortocoronary bypass status polyneuropathy in diabetes bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site intestinal infection due to clostridium difficile acute venous embolism and thrombosis of deep vessels of proximal lower extremity diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled cellulitis and abscess of foot, except toes ulcer of heel and midfoot kidney replaced by transplant diabetes with other specified manifestations, type i [juvenile type], uncontrolled 

Answer: The patient is high likely exposed to