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 the present illness: the patient is a 76-year-old male with a past medical history significant for diabetes mellitus, end-stage renal disease, on hemodialysis secondary to diabetes, bilateral below knee amputations, and congestive heart failure, who noted, on the morning of admission, pink discoloration of his left fifth fingertip. in the area, he had an old crusted eschar. the patient denied trauma and the patient did not know how the finger got discolored. the patient has peripheral neuropathy and did not feel anything knew. the patient denied fever, chills, rashes, nausea, vomiting, diarrhea. the patient has stable dyspnea on exertion but no chest pain. in the emergency department, the eschar was unroofed with minimal purulence. the patient was given ancef 1 gram iv times one. past medical history: 1. diabetes mellitus times 50 years. 2. end-stage renal disease, on hemodialysis tuesday, thursday, and saturday. 3. gerd. 4. peripheral vascular disease, status post bilateral bka. 5. atrial fibrillation. 6. history of chf. 7. depression. 8. hypothyroidism. 9. hepatitis b. 10. peripheral neuropathy. allergies: the patient has no known drug allergies. admission medications: 1. proamatine 5 three times per week. 2. amiodarone 200 q.d. 3. aspirin 81 mg q.d. 4. coumadin 1 mg q.d. 5. epogen 5,000 units three times a week. 6. humulin . 7. levoxyl 150 micrograms q.d. 8. lopressor 100 mg b.i.d. 9. metamucil. 10. nephrocaps 400 mg q.d. 11. peri-colace 100 mg q.d. 12. prilosec 20 b.i.d. 13. zoloft 75 q.d. 14. renagel 800 t.i.d. 15. phoslo two tablets t.i.d. 16. b6 50 b.i.d. 17. b12 one q.d. family history: significant for diabetes mellitus. the patient's mother died at 81, history of an ulcer. father died at 88 due to heart problems. social history: the patient lives with his sister and nephew. : smoked 50 years, a pack and a half, quit ten years ago. alcohol: one to two beers per week. physical examination on admission: vital signs: temperature 97.6, bp 152/60, pulse 72, respiratory rate 24. general: the patient was a pleasant man, looking his stated age, in no apparent distress. heent: the pupils were equal, round, and reactive to light. the oropharynx was clear. the mucous membranes were moist. neck: supple. no lymphadenopathy. no jvd. lungs: clear to auscultation bilaterally. heart: regular rate and rhythm. normal s1, s2, iii/vi systolic ejection murmur at the right upper sternal border. abdomen: soft, nontender, nondistended with active bowel sounds. extremities: bilateral bkas without edema. left fifth finger with redness and warmth at tips with open ulcer, nonpurulent, nondraining, 2+ radial pulse. laboratory/radiologic data: white count 14.0, 81% neutrophils, 11% lymphs, hematocrit 31.4, platelets 472,000. pt 14.1, inr 1.3. sodium 138, potassium 3.6, chloride 98, bicarbonate 27, bun 27, creatinine 4.5, glucose 281. left fifth finger swab gram's stain negative for polys or micro-organisms, culture pending. left fifth digit film: no osseous destruction suggesting osteomyelitis. tte in showed an ejection fraction of greater than 55%, trace ar and mild mr. dobutamine echocardiogram in without inducible ischemia. hospital course: this is a 76-year-old man with insulin-dependent diabetes mellitus, end-stage renal disease on hemodialysis with a history of atrial fibrillation and history of chf who presents with left fifth fingertip ulcer and cellulitis. there was no evidence of osteomyelitis and no obvious evidence of acute infection, although the patient was started on zosyn 2.25 grams iv q. eight to cover for pseudomonas. blood cultures were sent and the patient was treated with wet-to-dry dressings q.d. all diabetes and medications for his end-stage renal disease were continued. the patient was noted to be subtherapeutic for his atrial fibrillation and thus was given an additional dose of coumadin. goal inr was . of note, during the hospital course, the patient was noted to have elevated blood pressures and his metoprolol was increased to 125 mg b.i.d. otherwise, issues remained stable. the following day, the patient had an episode of nausea and vomiting times one but no abdominal pain. a chest x-ray and a kub were ordered. the kub did not demonstrate obstruction or free air. the chest x-ray demonstrated a new left pleural effusion with probable increase in heart size, pleural plaques, and calcification. since the pleural effusion did not have any obvious etiology, it was determined that eventual thoracentesis would be needed, but at this time there was still concern that the finger ulceration could be due to an emboli, thus an echocardiogram was ordered and the patient was continued on zosyn. the plastic surgeons who specialize in hands were consulted. in addition to concern for embolic phenomenon, transplant surgery was consulted because of possible vascular steal phenomenon in the setting of his av fistula in that arm, although it has been present for years. the patient also had upper arterial dopplers performed on . the patient continued to be asymptomatic at this time, and antibiotics and local management were continued. a ct of the chest was ordered to further evaluate the pleural effusion. the ct suggested question of a left hilar mass as well as a layering pleural effusion as well as known pleural plaques that remained stable. transplant surgery, after reviewing the duplex of the left arm which showed a stenotic proximal avf just distal to the arterial anastomosis, determined that the patient would go to the or on for perma-cath placement as well as ligation of the av fistula because this was resulting in a steal syndrome and arterial insufficiency. the patient went to the or on and was noted to have a complicated course. following the av fistula ligation and the perma-cath insertion under mac anesthetic, the patient had airway obstruction and hypoxia. thus, he was converted to general anesthesia. at this time, his rhythm changed from sinus rhythm to atrial fibrillation with hypotension requiring boluses of neo-synephrine. the patient was also given lopressor 50 mg and esmolol 50 mg for rate control. at the end of the case, the patient was breathing spontaneously, but it was determined that the patient should be kept intubated. he was transferred to the pacu and was stable. at that point, a neo drip was started. cardiology and the medicine team were contact and it was decided to cardiovert the patient at the bedside in the pacu since it was a controlled situation. he was given one shock at 200 joules, and promptly converted to sinus rhythm. a chest x-ray done in the pacu demonstrated a large pleural effusion but there was concern for hemothorax since ,000 units of iv heparin was given intraoperatively. a chest tube was placed by the surgeons and 850 cc of slightly serosanguinous fluid was drained. the patient was then transferred to the sicu for monitoring following his av ligation, perma-cath placement, dc cardioversion for atrial fibrillation as well as chest tube placement. by , the patient was off neo-synephrine and the patient was extubated without difficulty. at this point, surgery recommended the discontinuation of the zosyn and he was transferred to the floor. the chest tube was discontinued on . the patient eventually received a bed on on the floor, continued to do well without complaints but was noted to be back in atrial fibrillation on the ekg, but had no symptoms and was maintaining his blood pressure. at this point, the pleural effusion had been drained via the chest tube by the surgeons, cytology results were still pending. the patient continued hemodialysis and was being continuously anticoagulated for his atrial fibrillation. the patient did remain on zosyn, although thought he could be switched to p.o. antibiotics at this point. otherwise, the patient remained stable. by , the patient continued to feel fine and was just anxious to go home. at this point, he remained on his aspirin and beta blocker, as well as coumadin for anticoagulation with a goal inr of . he was also continued on his amiodarone and remained in sinus. cytology from the pleural effusion remained pending, but the workup was deferred to outpatient. the patient was continued on dialysis tuesday, thursday, and saturday, continued his midodrine prior to dialysis as well as his other renal medications. regarding diabetes, he was continued on his q.i.d. fingersticks with fixed and sliding scale insulin. he was also continued on his levothyroxine. since the patient remained stable and all issues could be deferred to outpatient, the patient was discharged home on . discharge diagnosis: 1. av fistula steal syndrome, status post av fistula ligation with perma-cath placement. 2. left pleural effusion of unknown etiology. 3. atrial fibrillation, status post dc cardioversion. 4. diabetes mellitus with end-stage renal disease requiring hemodialysis. 5. congestive heart failure. 6. left pinky ulceration. discharge instructions: the patient is to follow-up with pcp, . , in one to two weeks; had an appointment on at 12:10 p.m. the patient was instructed to continue dialysis as usual on tuesdays, thursdays, and saturdays. condition on discharge: stable. discharge medications: 1. amiodarone 200 mg q.d. 2. aspirin 81 mg q.d. 3. insulin fixed and sliding scale. 4. levothyroxine 150 micrograms q.d. 5. multivitamin. 6. disanthrol/docusate b.i.d. 7. sertraline 75 mg q.d. 8. sevelamer 800 mg t.i.d. 9. calcium acetate 667 mg t.i.d. with meals. 10. midodrine 5 mg three times a week with dialysis. 11. dulcolax two tablets q.d. as needed. 12. metoprolol 75 mg b.i.d. 13. warfarin 1 mg q.o.d. 14. epogen 5,000 units three times a week. 15. prilosec 20 mg b.i.d. , m.d. dictated by: medquist36 procedure: insertion of intercostal catheter for drainage hemodialysis venous catheterization for renal dialysis atrial cardioversion removal of arteriovenous shunt for renal dialysis diagnoses: unspecified pleural effusion congestive heart failure, unspecified atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease iatrogenic pneumothorax surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to renal dialysis device, implant, and graft diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled cellulitis and abscess of finger, unspecified 

Answer: The patient is high likely exposed to