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: cefazolin attending: chief complaint: left lower extremity pain; left lower extremity gangrene major surgical or invasive procedure: left below-knee amputation history of present illness: 77 year-old male with a history of pvd, s/p left bk popliteal to dp with rgsvg (), s/p lue avf () s/p multiple angioplasties, htn, dm, esrd on dialysis m,w,f presenting with gangrene of his left 1st and 4th toes. patient has a recent history of frequent minor accidental trauma to left 1st toe with poor healing and progression of gangrene. the patient presented to on with an unroofed left toe blood blister and left fourth toe gangrene, and lle angiography was done at that time. it was later decided to proceed with a bka. on admission, patient denied cp/sob, f/c, gi or gu complaints. past medical history: esrd on hd mwf, pvd, cad, chf (ef 30-35%), dm, 5.4cm infrarenal aaa, penetrating thoracic aortic ulcerations, mssa bacteremia, carotid stenosis 70%, htn, dvt (), dementia, uc, r adrenal adenoma, gout, prostate ca, nephrolithiasis, fe deficiency anemia, ?cva (aphasic episode), pulmonary htn (2l o2 at home) pm ( pacemaker, sensia sedr01) 3/10 l below-knee popliteal to dorsalis pedis bypass with reversed saphenous vein ( ), multiple lle angios, balloon angioplasty l peroneal ( ), l 2nd toe amputation (), cabg, av fistula (), multiple angioplasties of fistula, pm (), prostatectomy (), l ureteral stent () social history: quit smoking at age 73. retired as a chemical mixer from a leather tannery. no alcohol or illicit drug use. family history: brother: liver cancer. father/mother: cva. paternal grandfather: rectal cancer. physical exam: vss heent: normocephalic, atraumatic. eomi. perrl. nares clear. mucous membranes moist. neck supple without lymphadenopathy. cvs: regular rate and rhythm, without murmurs, rubs or gallops. s1 and s2. resp: clear to auscultation bilaterally without adventitious sounds. no wheezing, rhonchi or crackles. abd: soft, non-tender, non-distended, with normoactive bowel sounds. no masses or peritoneal signs. extr: s/p left bka; rle warm and dry. dopplerable r dp/pt. incision: incision without drainage; mild erythema of amputation site. dressing c/d/i. pertinent results: 07:05pm blood wbc-10.3# rbc-2.76* hgb-8.9* hct-27.6* mcv-100* mch-32.1* mchc-32.2 rdw-19.2* plt ct-86* 06:00am blood wbc-6.6 rbc-2.64* hgb-8.5* hct-26.5* mcv-101* mch-32.2* mchc-32.0 rdw-18.1* plt ct-112* 07:05pm blood glucose-88 urean-27* creat-4.4* na-144 k-3.4 cl-98 hco3-36* angap-13 06:00am blood glucose-70 urean-23* creat-3.6*# na-140 k-4.0 cl-97 hco3-31 angap-16 blood culture : no growth pathology, : leg, right, below knee amputation: a) gangrene. b) severe atherosclerosis. c) resection margins appear viable. upper endoscopy, : nodularity and atrophy of mucosa in the whole stomach (biopsy) multiple nodules were noted at the apex of the duodenal bulb (biopsy) no obvious source of gi bleeding was noted otherwise normal egd to third part of the duodenum colonoscopy, : large pedunculated polyp in the sigmoid colon - not removed given recent gi bleed. (biopsy, injection) diverticulosis of the sigmoid colon and descending colon the ic valve appeared thickened and nodular. dark stool was noted upon intubation of terminal ileum. solid and liquid stool was found at several regions of the colon precluding optimal visualization otherwise normal colonoscopy to cecum and terminal ileum brief hospital course: mr. was admitted on with left lower extremity gangrene. he agreed to have an elective below-knee amputation. pre-operatively, he was consented. a cxr, ekg, labs, and type and cross were obtained. he started a 14-day course of vancomycin, ciprofloxicin, and metronidazole. he was prepped, and brought to the operating room for surgery. intra-operatively, he was closely monitored and remained hemodynamically stable. he tolerated the procedure well. please see the operative report on for further details. post-operatively, he was extubated and transferred to the pacu for further stabilization and monitoring. due to persistent hypotension with sbps in the 70s, he was started on a levophed drip and then transferred to the icu for management while on pressors. his diet was advanced. once he was weaned from levophed and maintaining a map above 60, he was transferred to the vicu for further recovery. while in the vicu he recieved monitored care. when stable his arterial line was discontinued. pt followed the patient. he was then transferred to floor status. on the floor, he remained hemodynamically stable with his pain controlled. he received hemodialysis, per his outpatient regimen, throughout his stay. his vancomycin was admiinstered during hd. he was followed by physical therapy. he was restarted on his home po medications. he continued to make steady progress. on , the patient was noted to have a dark, guiac positive stool. he was changed to ppi, and his hematocrit was watched closely. on , his hematocrit had fallen from 28 (two days prior) to 25.8. a gi consult was obtained, and they recommended upper and lower endoscopy, which was performed on after achieving a bowel prep, revealing the aforementioned findings in the "pertinent results" section. biopsies were taken, which were pending diagnosis at the time of discharge. no active bleeding source was found. the patient is advised to follow up with dr. at gastroenterology as well as with his pcp for further management of his gi nodules and polyp. for the remainder of his hospitalization, the patient's hematocrit remained fairly stable. it is expected that it may drift slightly and this is to be expected. he was discharged on pod#10 to a rehabilitation facility in stable condition, tolerating a regular diet and with good pain control. he was advised to follow up with dr. of vascular surgery, dr. of gastroenterology, and his pcp. medications on admission: toprolxr37.5', simvastatin 10', albuterol sulfate 90 mcg, fluticasone-salmeterol 100-50", glipizide 2.5", lisinopril 40 (not on hd days), calcium acetate 338 (2tid), gabapentin 100', omeprazole 40', triphrocaps', sucralfate 1gm before meals, hydrocodone discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 2. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q6h (every 6 hours) as needed for wheeze. 4. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 5. gabapentin 100 mg capsule sig: one (1) capsule po daily (daily). 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. acetaminophen 650 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. disp:*120 tablet(s)* refills:*1* 8. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*40 tablet(s)* refills:*0* 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*2* 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 11. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 12. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 4 days. disp:*12 tablet(s)* refills:*0* 13. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days. disp:*4 tablet(s)* refills:*0* 14. metoprolol succinate 25 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po daily (daily). 15. lisinopril 20 mg tablet sig: two (2) tablet po on non-hd days (). 16. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) iv sliding scale per hd protocol intravenous hd protocol for 4 days: to be administered during hemodialysis, per protocol, until . disp:*4 * refills:*0* 17. nephrocaps 1 mg capsule sig: one (1) capsule po once a day. 18. glipizide 5 mg tablet sig: 0.5 tablet po twice a day. 19. calcium acetate 667 mg capsule sig: one (1) capsule po three times a day. 20. sucralfate 1 gram tablet sig: one (1) tablet po before meals. discharge disposition: extended care facility: - discharge diagnosis: peripheral vascular disease left lower extremity gangrene discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair; activity per rehabilitation regimen. discharge instructions: this information is designed as a guideline to assist you in a speedy recovery from your surgery. please follow these guidelines unless your physician has specifically instructed you otherwise. please call our office nurse if you have any questions. dial 911 if you have any medical emergency. . activity: . there are restrictions on activity. on the side of your amputation you are non weight bearing until cleared by your surgeon. you should keep this amputation site elevated when resting. . you may use the other leg to assist in transferring and pivots. but try not to exert to much pressure on the amputation site when transferring and or pivoting. please keep knee immobilizer on at all times to help keep the amputation site straight. . no driving until cleared by your surgeon. . exercise: follow the recommendations of the rehabilitation facility . limit strenuous activity for 6 weeks. . do not drive a car unless cleared by your surgeon. . try to keep leg elevated when able. . bathing/showering: . you may shower. no bathing/soaking. a dressing may cover your amputation site and this should be left in place for three (3) days. remove it after this time and wash your incision(s) gently with soap and water. you will have staples, which are usually removed in 4 weeks. this will be done by the surgeon on your follow-up appointment. . wound care: . sutures / staples: an appointment will be made for you to return for staple removal. . if sutures are removed the doctor may or may not place pieces of tape called steri-strips over the incision. these will stay on about a week and you may shower with them on. if these do not fall off after 10 days, you may peel them off with warm water and soap in the shower. . avoid taking a tub bath, swimming, or soaking in a hot tub for four weeks after surgery. . medications: . unless told otherwise you should resume taking all of the medications you were taking before surgery. you will be given a new for pain medication, which can be taken every three (3) to four (4) hours only if necessary. . remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods in your diet. (check with your physician if you have fluid restrictions.) if you feel that you are constipated, do not strain at the toilet. you may use over the counter metamucil or milk of magnesia. appetite suppression may occur; this will improve with time. eat small balanced meals throughout the day. . cautions: . no smoking! we know you've heard this before, but it really is an important step to your recovery. smoking causes narrowing of your blood vessels which in turn decreases circulation. if you smoke you will need to stop as soon as possible. ask your nurse or doctor for information on smoking cessation. . avoid pressure to your amputation site. . no strenuous activity for 6 weeks after surgery. . diet : . there are no special restrictions on your diet postoperatively. poor appetite is expected for several weeks and small, frequent meals may be preferred. . for people with vascular problems we would recommend a cholesterol lowering diet: follow a diet low in total fat and low in saturated fat and in cholesterol to improve lipid profile in your blood. additionally, some people see a reduction in serum cholesterol by reducing dietary cholesterol. since a reduction in dietary cholesterol is not harmful, we suggest that most people reduce dietary fat, saturated fat and cholesterol to decrease total cholesterol and ldl (low density lipoprotein-the bad cholesterol). exercise will increase your hdl (high density lipoprotein-the good cholesterol) and with your doctor's permission, is typically recommended. you may be self-referred or get a referral from your doctor. . if you are overweight, you need to think about starting a weight management program. your health and its improvement depend on it. we know that making changes in your lifestyle will not be easy, and it will require a whole new set of habits and a new attitude. if interested you can may be self-referred or can get a referral from your doctor. . if you have diabetes and would like additional guidance, you may request a referral from your doctor. . follow-up appointment: . be sure to keep your medical . the key to your improving health will be to keep a tight reign on any of the chronic medical conditions that you have. things like high blood pressure, diabetes, and high cholesterol are major villains to the blood vessels. don't let them go untreated! . please call the office on the first working day after your discharge from the hospital to schedule a follow-up visit. this should be scheduled on the calendar for seven to fourteen days after discharge. normal office hours are 8:30-5:30 through friday. . please feel free to call the office with any other concerns or questions that might arise followup instructions: please call dr office for a follow-up appointment, please call dr. at gastroenterology for a follow-up appointment in weeks. please call your primary care physician for visit in about 1 week. procedure: venous catheterization, not elsewhere classified hemodialysis arterial catheterization esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine other amputation below knee diagnoses: other iatrogenic hypotension end stage renal disease renal dialysis status anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease chronic systolic heart failure cardiac pacemaker in situ abdominal aneurysm without mention of rupture hemorrhage of gastrointestinal tract, unspecified ulcerative colitis, unspecified atherosclerosis of native arteries of the extremities with gangrene benign neoplasm of colon diverticulosis of colon (without mention of hemorrhage) 

Answer: The patient is high likely exposed to