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 / iv dye, iodine containing contrast media attending: chief complaint: leg pain, hypoglycemia, neutropenia major surgical or invasive procedure: central venous line placement lower extremity compartment pressure measurement (left) history of present illness: 57 m esrd on hd, hep c cirrhosis pvd on lovenox and plavix w h/o bilateral le bypass at presents with 1 day of bilateral le pain and edema (lle > rle). patient reports having long history of bilateral lower limb edema, but in the past days has noticed increased swelling and pain bilaterally, but mainly in his left leg. seen at where they were unable to get dopplerable pulses. he was also noted to have chest pain at that time which resolved with nitro, there he was started on heparin drip and transfered to our ed for concern for ischemic limb. osh labs showed wbc 1.2, k 6.2, glucose 30, inr 1.4. he was ordered for insulin/d50/kayexylate though it appears these orders were cancelled. he was noted to be hypoglycemic with fsbg to 30 and was given 2 amps of dextrose. per patient no hx of diabetes. he was given a dose of ceftriaxone. in the ed, initial vs were: 98.6 100 150/88 16 99% 2l. found to have dopplerable pulses bilaterally in lower extremities. however on exam had pain out of proportion to exam. vascular consulted for poor pulses/compartment syndrome, they were also concerned for compartment syndrome in lle and ortho was consulted for assistance with compartment pressure measurement. pressures were performed and were moderate:lateral 19, anterior 22, superficial posterior 33, deep 40, no clear evidence of compartment syndrome. an us was performed of lle with no dvt, noted to peroneal vein not seen. cta neg for necrotising fasciitis and negative for vascular issue, only free air seen from . vascular recommended serial cks (59) repeat compartment pressures. patient was diagnosed with cellulitis in ed and received clinda/levoflox and vanco. in ed patient noted to be hypoglycemic to 11 fsbg 19 on venous blood. given 3 amps of d50 and started on d5 drip at 100 with improvement of glucose to 100s. patient also noted to be neutropenic (wbc 0.9), 30% bands, lactate 2.4, trop 0.1 cr 6.7(but esrd). of note patient also received 125mg of solumedrol in ed for concern for adrenal insufficiency, though his blood pressures were stable throughout his ed course. on arrival to the micu, patient's vital signs were: 97.8f, 86, 100/80 31 99%2lnc. patient was complaining of lle pain. he also noted some dyspnea. he states he has been dyspneic for last 2 weeks and was scheduled for a paracentesis today for symptoms. he also notes some mild chest pain. he also notes some night sweats for last few weeks and subjective fevers. past medical history: pmh: htn, esrd on hd for 10 years, hep c cirrhosis on methadone for opiate addiction psh: bilateral le bypass (based on findings on exam likely a l fem to bk ; r fem->pt) ~ 2 years ago at , left iliac stent social history: - tobacco: 5cig/xday - alcohol: denies etoh use/abuse - illicits: hx of heroin abuse quit 20 yrs ago, on methadone from . lives with girlfriend. . family history: mother with diabetes, kidney disease. physical exam: admission physical exam: general: aox1-2, knows his name and that he's in a hospital, restless heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl, reddish-pink staining around his beard neck: no lad, unable to assess jvd as he is lying flat while receiving dialysis cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation anteriorly, no wheezes, rales, ronchi abdomen: soft, obese, distended, bowel sounds but hypoactive, no organomegaly, no tenderness to palpation, no rebound or guarding gu: foley with small amount of bloody fluid ext: warm, well perfused, 2+ pulses, no clubbing, trace peripheral non-pitting edema neuro: unable to formally assess, able to move all 4 extremities, eomi appear intact . discharge physical exam: pertinent results: admission labs: =============== . 08:32pm blood wbc-0.8* rbc-3.84* hgb-11.8* hct-39.0* mcv-101* mch-30.8 mchc-30.4* rdw-16.9* plt ct-54* 08:32pm blood neuts-28* bands-30* lymphs-25 monos-5 eos-0 baso-0 atyps-0 metas-12* myelos-0 08:32pm blood hypochr-3+ anisocy-1+ poiklo-1+ macrocy-2+ microcy-normal polychr-occasional spheroc-occasional burr-1+ 08:32pm blood pt-19.7* ptt-150* inr(pt)-1.9* 08:32pm blood glucose-19* urean-34* creat-6.7* na-138 k-5.8* cl-95* hco3-23 angap-26* 08:32pm blood alt-25 ast-55* ck(cpk)-59 alkphos-255* totbili-0.8 08:32pm blood lipase-7 08:32pm blood ck-mb-3 ctropnt-0.10* 08:32pm blood albumin-2.5* 10:52pm blood lactate-2.4* 11:21pm blood k-5.1 . pertinent labs: =============== . 08:32pm blood wbc-0.8* rbc-3.84* hgb-11.8* hct-39.0* mcv-101* mch-30.8 mchc-30.4* rdw-16.9* plt ct-54* 02:56am blood wbc-24.5* rbc-2.98* hgb-9.2* hct-26.8* mcv-90 mch-30.9 mchc-34.3 rdw-17.2* plt ct-59* 11:39am blood fibrino-582* 08:32pm blood glucose-19* urean-34* creat-6.7* na-138 k-5.8* cl-95* hco3-23 angap-26* 12:00am blood ck-mb-21* mb indx-25.3* ctropnt-0.25* 04:00am blood ck-mb-22* mb indx-27.8* ctropnt-0.37* 07:59am blood ck-mb-23* mb indx-26.7* ctropnt-0.48* 03:13pm blood ck-mb-15* mb indx-22.4* ctropnt-0.58* 09:32am blood pth-95* 10:30pm blood cortsol-82.7* 09:20am blood cortsol-75.2* 07:44am blood cortsol-43.1* 09:56am blood crp-165.5* 01:44am blood glucose-287* lactate-5.1* na-124* k-3.8 cl-89* calhco3-26 06:17am ascites wbc-205* rbc-80* polys-8* lymphs-18* monos-0 mesothe-2* macroph-72* . discharge labs: =============== . . micro/path: =========== . micro: bc x2 ------------- per report from e coli in 1 of 2 aerobic blood culture: sensitive to ceftazidine, and ceftriaxone, gentamycin, and piperacillin-tazobactam, tobramycin, cefoxitin, cefuroxime, meropenem, cefazolin, resistant to ampicillin levofloxicin, and trimethoprim-sulfam, tetracycline, ciprofloxacin . blood cultures: --------------- blood culture ngtd blood culture ngtd blood culture ngtd blood culture ngtd blood culture ngtd blood culture ngtd blood culture ngtd blood culture ngtd blood culture no growth blood culture no growth blood culture no growth blood culture no growth blood culture no growth : staphylococcus, coagulase negative clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- 4 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s vancomycin------------ 1 s aerobic bottle gram stain (final ): gram positive cocci in clusters. . peritoneal fluid: ----------------- fluid culture in bottles (final ): no growth. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. anaerobic culture (final ): no growth. . mrsa screen (final ): no mrsa isolated. . stool: ------ c. difficile dna amplification assay (final ): negative for toxigenic c. difficile by the illumigene dna amplification assay. (reference range-negative). . imaging/studies: ================ . unilat lower ext veins left : limited study due to patient co-operation. no dvt in both lower extremities. left peroneal veins not seen. . cxr pa/lat : impression: moderate bibasilar opacities may be due to atelectasis, although underlying consolidation and/or aspiration cannot be excluded. low lung volumes. no large pleural effusion is seen, although a trace right pleural effusion is difficult to exclude. . cta aorta/bifem/iliac runoff w/w&wo c and recons : 1. no evidence of vascular compromise. 2. moderate to severe left lower extremity subcutaneous edema with iatrogenic soft tissue gas in the anterior compartment of the calf. no other foci of softtissue gas. . ct pelvis non-con : impression: 1. interval increase in measured density of the peritoneal fluid (from 14 to 25 hus); hemoperitoneum is a consideration and correlated with presentation and examination. 2. interval mild wall thickening of the sigmoid and distal descending colon, nonspecific but possibly due to ischemic colitis. 3. no retroperitoneal or proximal thigh hemorrhage. . tte : impression: lvef >55%. suboptimal image quality. mild mitral regurgitation without discrete vegetation or abscess. normal biventricular cavity sizes with preserved global and regional biventricular systolic function. pulmonary artery hypertension. . ct head non-con : impression: no acute intracranial hemorrhage or mass effect within the limitations of motion artifacts. if clinical suspicion for acute infarction/parenchymal changes is high, mri can be considered if not ci. . ct head non-con : impression: no definite acute intracranial hemorrhage or mass effect. previously noted tiny dense focus in the right lentiform nucleus and the right frontal subcortical white matter likely relate to mineralization given the stability. other details as above. . ct b/l lower extremities non con : impression: 1. diffuse anasarca and extensive ascites, with asymmetric lower extremity subcutaneous soft tissue swelling and subcutaneous edematous changes of the left lower extremity greater than right. absence of iv contrast limits assessment for focal abscess, but no obvious abscess is identified. 2. interval resolution of previously seen foci of gas in the left anterior compartment and left anterior tibialis musculature in comparison to cta examination. no obvious soft tissue or fascial foci of gas identified on this exam to suggest necrotizing fasciitis. however, if there is high clinical concern for necrotizing fasciitis, then this exam should not preclude further assessment. 2. cirrhotic morphology of the liver with splenomegaly and prominent collateral vasculature and extensive ascites/anasarca. 3. diffuse calcified atherosclerotic vascular disease of the abdominal aorta and branch vessels, better assessed on cta examination. aortoiiliac bypass graft again noted. 4. grade 1 anterolisthesis of l5 on s1, stable. no areas of bony osteolysis to suggest osteolmyelitis. . ruq u/s : impression: 1) no evidence of cholecystitis or cholelithiasis. 2) cirrhosis with splenomegaly and ascites. brief hospital course: assessment and plan: 57m with esrd on hd, hep c cirrhosis, h/o bilateral le bypass with lle edema and pain and found to be neutropenic and hypoglycemic. he was ultimately made cmo by his wishes and those of his family and passed away peacefully in the presence of his family. . #goals of care: patient was made cmo on after multiple meetings during which he and his family opted for transition to comfort measures as opposed to life-prolonging measures. his antibiotics were stopped and his dextrose infusions were weaned. he was placed on a dilaudid infusion. he appeared quite comfortable and passed away shortly after. . #gram negative rod bacteremia/sepsis: patient presented with sirs and pan-sensitive e. coli bacteremia (cultures from osh) on admission perhaps from urine, gut translocation, or less likely le??????s. also, he had evidence of hypoperfusion given elevated lactate. he also had a single blood culture bottle grow coag negative staph which was felt to be c/w skin contaminant. pt was started on vanc/cefepime/clinda which was changed briefly to meropenem/tobramycin, and then narrowed to ceftriaxone per id recs following osh culture data. he had no further culture data including peritoneal fluid or blood that was positive. urine cultures were never successfully obtained as he was anuric throughout his admission. . # lle swelling/edema: patient was admitted with worsening le edema which he has at baseline related to his pvd. he initially described havign signficant pain in his left lower extremity which raised concern for compartment syndrome. orthopedics was consulted and performed compartmental measurements which were elevated but not critical and he was found to have dopplerable pulses. he then has leni's of both legs which was negative for dvt. he underwent cta of his lower extremities which showed no vascular issue and no signs of necrotizing fascitis but likely iatrogenic air. vascular surgery also felt this was not an ischemic limb or compartment surgery. he was started on vancomycin/cefepime and clindamycin without significant improvement. he completed a course of vanc and rec'd a few day's worth of meropenem and tobramycin also without significant improvement in the pain he was experiencing. he was narrowed to ceftriaxone after blood cultures from osh returned pan-sensitive e coli. he was evaluated by infectious disease who did not feel his le findings were consistent with infection and by dermatology who suggested mupirocen on open bullae, hydrolatum on cracked skin, and avoidance of heparin and non-paper tapes. . # profound, refractory hypoglycemia: patient had severe hypoglycemia to as low as a fingerstick level of 17 at one time. he remained dependent on continuous dextrose infusion which was uptitrated to d50 given concerns for volume management (anuric, hd-dependent for fluid management). differential included iatrogenic vs liver failure vs adrenal insufficiency vs sepsis vs malnutrition. he had elevated am cortisol levels, was treated for sepsis, and was provided a regular diet although he had poor po intake. endocrinology was consulted and suggested send-outs of proinsulin, c-peptide, insulin, and a hypoglycemic screen which unfortunately was not sent off during a hypoglycemic episode and which yielded an elevated c-peptide level with the rest of the values remaining wnl's. ultimately, it was felt his hypoglycemia was likely caused by a combination of liver disease, kidney disease, severe malnutrition, and poor glucose stores. he was never fully weaned from intravenous dextrose and he and his family were not in favor of enteral tube feeds either by ng ot peg tube. . #neutropenia: patient was neutropenic on admission which was thought to be related to bm suppression from gram negative sepsis. he proceeded to mount a significant leukocytosis with neutrophil predominance to as high as 25. hematology was consulted and felt his hematological abnormalities were secondary to sepsis, steroid administration, and decompensated liver disease with known portal hypertension and recommended management of the underlying conditions. . #acute blood loss anemia from hemoperitoneum: patient was noted to have ascites on admission and as there was concern for dypsnea due to the ascites as well as concern for sbp as a possible infectious source, a paracentesis was performed with removal of almost 5l of peritoneal fluid. this did improve the patient's dyspnea and his peritoneal fluid studies were not c/w sbp with <250 wbc and negative cultures. during his icu stay the patient had a decreasing hct and had a ct concerning for bleed into peritoneum perhaps related to this therapeutic paracentesis. he had no other evidence of bleeding or hemolysis. transplant surgery was consulted who felt the patient did not need further imaging or surgical intervention. patient was monitored with serial crits and rec'd a total of 6 units of prbc's with resultant stabilization of his hematocrit. . #posterior myocardial infarct: during his hospital stay, the patient complained of chest pain and his ce's became elevated with troponin peaking at 0.58 and ckmb at 23. ekg??????s from demonstrated significant std??????s in v2-v4 along with small ste??????s in ii, iii, and avf concerning for posterior infarct with reciprocal changes. he was briefly started on heparin (overall <7 hrs) but given his bleeding risk, it was ultimately felt a heparin drip would cause more harm then benefit. he was placed on aspirin, metoprolol and nitroglycerin drip. during his stay he became chest pain-free off nitro drip. cardiology consulted for possible catheterization but given comorbidities such as sepsis, active intraabdominal bleeding, and severe thrombocytopenia as well as likely small overall area of expected infarct opted for medical management. patient did appear to become fluid overloaded with this ischemic cardiac injury but this improved with dialysis. he had a tte with lvef >55%, mild mr, mild pa htn. this issue remained stable during his micu stay. . #thrombocytopenia with bleeding: patient with chronic thrombocytopenia in the 50's thought to be secondary to liver disease. he rec'd platelets without an appropriate bump and with a mild urticarial reaction that resolved quickly with a dose of benadryl. transfusion medicine investigated and initiated abo-matching of his plt products. he ultimately required 7 units of plt's given his active bleeding which ultimately stabilized. . chronic diagnoses: # esrd: patient was maintained on his home dialysis m/w/f schedule and continued on his home nephrocaps. . #chronic opioid dependence/methadone: he was continued on his home methadone dose of 25mg daily. medications on admission: medications (per records-pt is unsure of medications): methadone 25mg daily lisinopril 40mg metoprolol 10mg norvasc 5mg daily sensipar 60 qhs plavix 75 mg daily lovenox unsure of dosage nexium 40 mg daily minoxidil 20mg nephrocaps . discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired md, procedure: venous catheterization, not elsewhere classified hemodialysis percutaneous abdominal drainage diagnoses: thrombocytopenia, unspecified end stage renal disease renal dialysis status cirrhosis of liver without mention of alcohol chronic hepatitis c without mention of hepatic coma acute posthemorrhagic anemia hyposmolality and/or hyponatremia portal hypertension sepsis true posterior wall infarction, initial episode of care opioid type dependence, continuous hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of anticoagulants other ascites encounter for palliative care do not resuscitate status atherosclerosis of native arteries of the extremities, unspecified other specified hypoglycemia hemoperitoneum (nontraumatic) neutropenia, unspecified nutritional marasmus septicemia due to gram-negative organism, unspecified other specified disorders of skin other pancytopenia 

Answer: The patient is high likely exposed to