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: penicillins / bactrim / sulfa (sulfonamide antibiotics) attending: chief complaint: dka osteomyelitis major surgical or invasive procedure: debridement of right heel x2 picc line placement history of present illness: 60 yo f with insulin dependent diabetes presented with fatigue, nausea, and vomiting, transferred from osh, admitted for dka requiring insulin gtt. . per report, she ran out of her insulin about 3 months ago because she did not have money to pay for it. she was out of work and husband was on disability. over the course of last week, she has been feeling more tired. she also noticed achy foot but did not recall any injury to it. since sunday, also has been having sternal discomfort that is pressure like, non-radiating. then, over the last 3 days, started to have nausea and non-bilious, non-bloody vomiting. . in the osh, she was given zofran, vanco, clindamycin, ns x 3l, insulin gtt. x ray of the foot showed swelling with specks of air in the soft tissue adjacent to the 5th metatarsal heads, ? infection or penetrating trauma. ekg was sinus tachycardia and left anterior fascicular block . in the ed, initial vitals 100f, hr 124, bp 138/72, rr 18, o2sat 96%. she was noted to have pus from her right foot and erythema. there is diminished sensation but has good pulse on the right foot. no evidence of nacrotizing fasciits per ed resident. blood and urine cultures were sent. she was given cefepime, morphine, and started on insulin gtt with ns/40meq kcl. her blood sugar improved from 303-> 273. per report, she has gotten about 4 l ns from osh & from ed. podiatry is informed of the patient and planning to see her. . on the floor, reports feeling sick to her stomach but otherwise no pain. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, weight gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies weakness. denies diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: per patient - t2dm - htn social history: - tobacco: never - alcohol: denies - illicits: denies - lives at home with husband - has grown children - works 15 hours a week as a duty aid family history: - 2 grandmother with dm - mother and father with mi at old age physical exam: admission physical exam on arrival to micu general: alert, oriented, uncomfortable heent: sclera anicteric, mucous membrane dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic, regular rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, right foot wrapped in kerlex . discharge physical exam vs - tm/c 96.1, 159/81, 85, 16, 95%ra, fs 130 general - well-appearing woman in nad, comfortable, appropriate heent - nc/at, perrl, eomi, sclerae anicteric, mmm, op clear neck - supple, no jvd, no carotid bruits lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, +bandage covering right heel and ankle c/d/i, dressing changes daily as per podiatry. l dp 2+. skin - no rashes or lesions lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, pertinent results: osh: - wound swab: group b strep 01:29am blood wbc-10.8 rbc-4.27 hgb-13.1 hct-37.8 mcv-89 mch-30.7 mchc-34.7 rdw-12.4 plt ct-245 01:29am blood neuts-84.7* lymphs-9.8* monos-5.1 eos-0.1 baso-0.3 01:29am blood pt-12.0 ptt-25.3 inr(pt)-1.0 01:29am blood glucose-296* urean-13 creat-0.8 na-147* k-3.0* cl-110* hco3-12* angap-28* 04:35pm blood amylase-29 05:00am blood alt-15 ast-22 ld(ldh)-216 alkphos-97 totbili-0.2 01:29am blood ck(cpk)-22* 01:29am blood ctropnt-<0.01 01:29am blood ck-mb-2 05:00am blood ck(cpk)-29 05:00am blood ck-mb-1 ctropnt-<0.01 04:35pm blood ck-mb-2 ctropnt-<0.01 04:35pm blood ck(cpk)-20* 05:30am blood %hba1c-12.6* eag-315* 01:29am blood acetone-large 05:00am blood albumin-3.3* calcium-8.8 phos-0.6* mg-1.8 10:00pm blood lactate-1.3 04:28am blood beta-hydroxybutyrate-high 6.4 01:29am urine color-straw appear-clear sp -1.036* 01:29am urine blood-neg nitrite-neg protein-30 glucose-1000 ketone-150 bilirub-neg urobiln-neg ph-5.5 leuks-neg 01:29am urine rbc-2 wbc-<1 bacteri-few yeast-none epi-1 transe-<1 05:00am urine castgr-13* microbiology: stool clostridium difficile toxin a & b test-final-negative swab gram stain-final; wound culture-final {beta streptococcus group b}; anaerobic culture-preliminary blood culture, routine-final-no growth urine culture-final-no growth blood culture, routine-final-no growth tissue-final {beta streptococcus group b}; anaerobic culture-final swab wound culture-final {beta streptococcus group b, staph aureus coag +}; anaerobic culture-final mrsa screen-final blood culture, routine-final-no growth urine culture-final-no growth blood culture, routine-final-no growth r foot wound culture: gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): beta streptococcus group b. sparse growth. identification performed on culture # , . anaerobic culture (preliminary): no anaerobes isolated. 7:16 am swab source: right foot ulcer. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram positive cocci. in pairs, chains, and clusters. wound culture (final ): beta streptococcus group b. moderate growth. staph aureus coag +. sparse growth. | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s anaerobic culture (final ): no anaerobes isolated. imaging: foot x-ray findings: a cutaneous defect is noted at the lateral and inferior aspect of the fifth metatarsal head. there is subcutaneous emphysema tracking around the distal fifth metatarsal along with adjacent soft tissue swelling. there is no periosteal new bone formation or osseous destruction detected. no acute fracture or dislocation is detected. there are hallux valgus and metatarsus varus deformities with hyperostosis along the medial aspect of the distal first metatarsal. degenerative changes are noted at the first mtp joint with joint space narrowing and dorsal spurring. large inferior and posterior calcaneal spurs are also seen. there is a hammertoe deformity at the second digit. degenerative changes are seen in the mid foot at the talonavicular joint. an exaggerated arch is noted. there is patchy osteopenia. a linear radiopaque density is noted in the subcutaneous tissue of the right heel which may represent a foreign body. impression: 1. radiographic findings suggestive of osteomyelitis at the head of the fifth metatarsal. 2. possible foreign body in the right heel. 3. hallux valgus. hammertoe deformity of the second toe. cxr: low lung volumes with bibasilar atelectasis but no findings to suggest pneumonia. bone biopsy: pending brief hospital course: 60 yo f with insulin dependent diabetes presented with dka and right foot pain. # diabetic ketoacidosis. patient's initial anion gap found to be 25 on arrival to the ed. her presentation was most likely secondary to non-compliance and inability to pay for her insulin. she was started on an insulin gtt in the ed, which was continued upon her arrival in the micu. as her gap closed, her iv fluid hydration was adjusted and she was transitioned to glargine with a sliding scale as her consult recommendations. her hemoglobin a1c was found 12.6. she was transferred to the general medical floor on subcutaneous insulin and her blood sugars were primarily well controlled. # right foot osteomyelitis. the patient presented with pus at the plantar surface of her right foot. a deep tissue swab was taken, although after she had already received antibiotics, and blood cultures were sent. a foot x ray suggested osteomyelitis at the head of the 5th metatarsal and possible foreign body in the right heel. podiatry was consulted and she was taken to the or for debridement and wash out with a bone biopsy twice. she was originally started on vancomycin, cefepime and flagyl. the infectious disease team was consulted who recommended that she transition to ceftriaxone and flagyl as her cultures from the osh and in house grew group b strep and mssa. she will require 6 weeks of ceftriaxone from the date of her last debridement/wash out (). she was continued on flagyl due to loose stools, please see below. # htn. sbp was noted to be in the 170s upon arrival. she was initially treated with iv antihypertensives and transitioned to lisinopril in the micu. she continued to be hypertensive during the course of her stay. the patient noted a cough a few days into her course of lisinopril and she was transitioned to valsartan and later losartan for a generic antihypertensive. # loose stools upon arrival to the general medical floor, the patient began to report loose stools. cdiff studies were sent and were negative. the patient continued to report loose stools, although reported they were improving. as the patient was being treated with flagyl, it was not entirely clear if this improvement was due to the flagyl or resolving of her symptoms naturally. a cdiff pcr of the stool was sent and she is to be continued on flagyl po until the results return. . # substernal chest pressure as part of her presentation, the patient reported occasionally substernal chest pressure. she was ruled out for acs, but was noted to have ekg changes, most notably a lafb. while no former ekgs were within our system, this remained stable during her hospital course and her symptoms resolved and her condition improved. # medication noncompliance the patient reported that she had not taken her insulin in three months as she had lost her insurance and was unable to afford medications. she met with both the case management and social work teams who helped her procure insurance so she would be able to afford her medications in the future. # health insurance coverage: application for masshealth was completed, and should hopefully be improved by the time of discharge from rehab to cover home meds including insulin. ============================================================ ============================================================ transitions of care: -patient is to follow up with id for both her duration of flagyl and ceftriaxone -she is to receive ceftriaxone 2 gm iv qday -please monitor weekly labs: cbc, chem 7 (na, k, cl, hco3, bun, cr, glucose), lfts, crp, esr -hydrogel to dry daily dressing changes (wet to dry) to right foot with ace wrapping. -weight bearing as tolerated to right heel all laboratory results should be faxed to infectious disease r.ns. at ( all questions regarding outpatient antibiotics should be directed to the infectious disease r.ns. medications on admission: per patient: - asa 81 mg daily - vitamin c - calcium - mvi - stopped insulin, does not recall dosage . per osh record - metformin 250 mg - lisinopril 10 mg daily - multivitamin - vitamin c 1000 mg daily - caltrate 600 mg daily - asa 81 mg daily - glargin 45 units qpm - unclear dosage of discharge medications: 1. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours): until instructed to stop by infectious disease md. 2. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: two (2) grams intravenous q24h (every 24 hours): 6 week course, last day , unless otherwise directed. 3. senna 8.6 mg tablet sig: one (1) tablet po daily (daily) as needed for constipation. 4. losartan 50 mg tablet sig: two (2) tablet po daily (daily). 5. insulin glargine 100 unit/ml cartridge sig: fifty (50) units subcutaneous qam. 6. insulin lispro 100 unit/ml cartridge sig: as directed by sliding scale subcutaneous qachs. 7. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 8. outpatient lab work please check a weekly chem 7, cbc, crp/ esr, lfts, and fax results to the clinic rns at (. 9. multivitamin tablet sig: one (1) tablet po once a day. 10. vitamin c 1,000 mg tablet sig: one (1) tablet po once a day. 11. caltrate 600 600 mg (1,500 mg) tablet sig: one (1) tablet po once a day. 12. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. discharge disposition: extended care facility: discharge diagnosis: primary: -diabetic ketoacidosis secondary: -right heel osteomyelitis -hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. , it was a pleasure taking part in your care. we hope you continue to feel well. you were admitted because your blood sugars were found to be dangerously high and you were found to have a severe infection in your foot that involved your bone, called osteomyelitis. you were given insulin to decrease your blood sugars and antibiotics for your infection. you were seen by the podiatry team which cleaned your wound in the operating room twice. you were also see by the diabetes and infectious disease specialists. please review the following changes to your medications: diabetes- -insulin lantus (glargine) 50 units at night -insulin 3-16 units as directed by your sliding scale -stop taking metformin high blood pressure- -start losartan 100 mg daily -stop taking lisinopril because it caused a cough antibiotics- -ceftriaxone 2 gm intravenously daily for six weeks unless otherwise directed -metronidazole (flagyl) 500 mg three times a day until you are told to stop it is important to follow up with your primary care physician as well as with the infectious disease and podiatry teams as listed below. followup instructions: you will have regular followup with the infectious disease doctors ( ) to be sure your infection is resolving. your first appointment is on , though your facility will be called with the time and details. please keep the following appointment: department: podiatry when: tuesday at 8:00 am with: , dpm building: ba ( complex) campus: west best parking: garage md procedure: excision of lesion of other soft tissue other partial ostectomy, tarsals and metatarsals other tenonectomy diagnoses: unspecified essential hypertension hypopotassemia ulcer of other part of foot methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site long-term (current) use of insulin personal history of noncompliance with medical treatment, presenting hazards to health diarrhea diabetes with other specified manifestations, type ii or unspecified type, uncontrolled other bone involvement in diseases classified elsewhere unspecified osteomyelitis, ankle and foot streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group b diabetes with ketoacidosis, type ii or unspecified type, uncontrolled dermatophytosis of the body precordial pain inadequate material resources 

Answer: The patient is high likely exposed to