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: patient recorded as having no known allergies to drugs attending: chief complaint: non-healing ulcer lle major surgical or invasive procedure: lle diagnostic angiogram 6/24 l sfa-->peroneal bpg with r cephalic arm vein history of present illness: 83yo m, h/o iddm, ckd (stage 3) and pvd, who presents for elective angiogram. the patient is a poor historian. he has a history of calf claudication for which he received a right femoral to peroneal bypass with in situ saphenous graft in . he has done well until ~3-4 months ago when he noticed lle pain in the calf and foot with an ulcer developing on the left outer border of the foot. he was seen in the clinic. given his renal insufficiency, he is being admitted pre-procedure for renal protective measures for a scheduled angiogram tomorrow. past medical history: pmh: dm-2, pad, htn, hld, gerd, ckd (stage 3) psh: pacemaker, left hip replacement, l knee arthroscopy, r femoral to peroneal in situ saphenous vein graft (), cabg, appendectomy social history: patient lives with his wife in , ma. he reports smoking a pipe for 20 years but quit 20 years ago. denies any etoh use or recreational drugs. family history: patient was an orphan and thus is not aware of family hx of cardiac diseases. his adult children, however, are healthy and without cardiac diseases. physical exam: afvss gen: nad cv: reg chest: sternotomy incision well healed pulm: no resp distress abd: r sided vertical incision well healed, s/nt/nd ext: bilateral edema r/l. l foot dusky with dry skin and medial aspect of foot with dry eschar ~2.5 cm in diameter tender to palpation, no drainage or fluctuance fem dp pt graft left palp faint dop right palp dop dop palp pertinent results: 09:40pm blood wbc-7.9 rbc-3.29* hgb-10.4* hct-32.4* mcv-98# mch-31.7 mchc-32.2 rdw-14.3 plt ct-204# 09:40pm blood pt-16.0* ptt-32.4 inr(pt)-1.4* 09:40pm blood glucose-197* urean-47* creat-1.7* na-139 k-4.2 cl-104 hco3-27 angap-12 09:40pm blood calcium-8.3* phos-3.4 mg-2.0 05:49am blood wbc-6.7 rbc-3.54* hgb-10.8* hct-33.4* mcv-94 mch-30.6 mchc-32.5 rdw-15.1 plt ct-166 05:49am blood glucose-233* urean-58* creat-1.5* na-141 k-3.9 cl-100 hco3-34* angap-11 05:49am blood calcium-8.2* phos-2.6* mg-2.1 brief hospital course: 83yo m with dm, pvd, was admitted pre-operatively for elective angiogram. renal protective measures included mucomyst and bicarbonate drip. he underwent diagnostic lle angiogram by dr. showing patent pfa, patent sfa with distal occlusion, occluded popliteal throughout, and single-vessel peroneal run-off from pfa collaterals; please see procedure report for details. accordingly he would require a fem-->peroneal bypass. post-procedure he developed midly elevated creatinine (1.7 on admission, 1.3 at nadir, then rose to 1.9), so his diuretic was held. he then developed mild chf, manifested as bl lower extremity edema, and with normalizing creatinine was progressively diuresed over the next several days. cardiology consult reviewed his outpatient cardiac history, a tte was obtained showing lvef 35-40%, mod pulm htn, and increased wedge pressure, and he was eventually cleared medically for surgery. his prior cabg and rle bypass had consumed his leg veins, and vein mapping revealed better vessels in his lue. he therefore underwent a l fem-->peroneal bypass with rue arm vein on by dr. (covering for dr. , who was away at the time and the patient preferred to have the bypass performed asap). he received a r ij cvl due to limited venous access, and was monitored via a r axillary arterial line since further distal access attempts were unsuccessful and the other three limbs being unavailable (two involved in the procedure and the rle having a prior bypass was contraindicated for femoral arterial line placement). procedure proceeded fairly straightforward; please see operative report for details; at the conclusion he had a palpable vein graft pulse medially and dopplerable signal distally. post-operatively he had sustained hypotension, responding to crystalloid volume but requiring neosynephrine drip. cardiac enzymes were cycled and negative and repeat tte was grossly unchanged without any focal wall motion abnormalities. stim test was normal. he eventually turned the corner hemodynamically by pod 2. he was transferred to the vicu on pod 3. due to the ivf volumes given in response to the earlier hypotension, diuresis was later successfully initiated with lasix gtt then lasix 80 for several days. he currently appears dry and is off diuretics, although may need to resume his home dose of bumex shortly. the left lateral foot ulcer was covered with dry gauze. it was initially covered with antibiotics which were discontinued on pod 1. podiatry consult recommended santyl cream, which is being implemented, and a foot xr showed no osteomyelitis. consult managed his diabetes and insulin regimen during his hospital stay. physical therapy evaluated him post-operatively and determined need for rehab placement. he was noted by bedside rn to have difficulty swallowing, was evaluated by swallow consult and video swallow study who approved him for grounds solids, thin liquids, and crushed meds. dvt prophylaxis was maintained with heparin sq, and gi prophylaxis with ppi. by pod 7 he was tolerated a diet, undergoing pt, appeared appropriately diuresed, on his home medications, and deemed suitable for discharge to rehab. medications on admission: prilosec 20'', lantus 5u qam, bumetanide 1', asa 81', coreg 6.25'', mvi', vit c', zocor 40', tums 500 q6h prn, cosopt 1gtt each eye qam, lisinopril 2.5', glipizide 10' discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. omeprazole 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po bid (2 times a day). 4. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic daily (daily). 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for reflux. 9. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 10. oxycodone 5 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for pain. 11. collagenase clostridium hist. 250 unit/g ointment sig: one (1) appl topical daily (daily). 12. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 13. insulin glargine 100 unit/ml solution sig: five (5) units subcutaneous once a day: at breakfast. 14. insulin lispro 100 unit/ml solution sig: per sliding scale below units subcutaneous qac: 71-100mg/dl: 0 units 101-150: 2 units 151-200: 3 units 201-250: 4 units 251-300: 5 units 301-350: 6 units 351-400: 7 units. 15. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) dose inhalation q6h (every 6 hours) as needed for congestion/wheeze. 16. ipratropium bromide 0.02 % solution sig: one (1) dose inhalation q6h (every 6 hours) as needed for congestion/wheeze. discharge disposition: extended care facility: & rehab center - discharge diagnosis: peripheral arterial disease non-healing ulcer bl cad htn hyperchol chronic renal insufficiency, stage iii (baseline cr 1.7) gerd 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: division of vascular and endovascular surgery lower extremity bypass surgery discharge instructions what to expect when you go home: 1. it is normal to feel tired, this will last for 4-6 weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have swelling of the leg you were operated on: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? unless you were told not to bear any weight on operative foot: ?????? you should get up every day, get dressed and walk ?????? you should gradually increase your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 100.5f for 24 hours ?????? bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: follow-up with dr. (vascular surgeon) in 1 week, on , at his clinic in . please call on monday for the specific time. he will remove the staples from your incisions at that time. follow-up with podiatry, dr. , as outpatient. please call for an appointment. procedure: arteriography of femoral and other lower extremity arteries other (peripheral) vascular shunt or bypass aortography diagnoses: esophageal reflux pure hypercholesterolemia congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status ulcer of other part of foot chronic kidney disease, stage iii (moderate) primary pulmonary hypertension pressure ulcer, lower back automatic implantable cardiac defibrillator in situ acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities with gangrene knee joint replacement pressure ulcer, stage ii 

Answer: The patient is high likely exposed to