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 present illness: this is an 81-year-old male transferred from emergency room with a two day history of painful left great toe and ischemic changes of his left forefoot. he has a history of transient ischemic attacks with work up at , unclear if carotid duplex was obtained. denies history of coronary artery disease. has a history of hyperlipidemia. the patient has known end stage renal disease secondary to hypertension. last dialysis was . the patient is inactive and can rarely walk with assistance and does not use a walker. there is no respiratory pain. he was not on aspirin for any medication. he is now admitted for further evaluation and treatment. past medical history: 1. hypertension 2. end stage renal disease on hemodialysis 3. status post right shoulder surgery 4. subdural hematoma two years ago status post fall 5. history of cataracts 6. history of transient ischemic attacks, multiple 7. bilateral vessel visual symptoms 8. drooping of mouth but no residual 9. left av fistula three years ago allergies: he has no known drug allergies. medications: 1. hydralazine 100 mg tid 2. 240 mg 3. lisinopril 40 mg qd 4. phoslo 3 tablets tid 5. avapro 300 mg qd 6. renagel 800 mg tablets 2 3x a day 7. epogen with dialysis physical exam: vital signs: temperature 97.8??????, 64, 180/70, 95% on 2 liters of o2. chest: clear to auscultation bilaterally. heart: regular rate and rhythm with normal s1 and 2 and a 4/6 systolic ejection murmur radiating to the carotids and to the pericardium. there are no carotid bruits. abdomen: soft, nontender, nondistended with a prominent abdominal aorta, but it is not aneurysmal. pulse exam: femoral pulses are palpable bilaterally. popliteals are palpable bilaterally. the right dp is palpable. the right pt is monophasic dopplerable signal. the left dp is palpable, but diminished in intensity. the left pt is a monophasic dopplerable signal. admitting labs: cbc: white count was 7.0, hematocrit 36.0, platelets 130,000, normal differential. bun 19, creatinine 3.3, potassium 3.6. imaging: electrocardiogram normal sinus rhythm, first degree av block, normal axis, no acute changes, left ventricular hypertrophy. chest x-ray unremarkable. hospital course: the patient was admitted to the vascular service. he was intravenous hydrated and began on intravenous heparin. beta blockers were began. carotid ultrasound was obtained which demonstrated 60% to 69% left internal carotid artery stenosis and less than 40% on the right internal carotid artery. renal service was consulted to manage his hemodialysis needs. he was dialyzed on mondays, wednesdays and fridays. he underwent an arteriogram on which demonstrated atherosclerotic changes to the abdominal aorta. there is severe stenosis of the right proximal renal artery. there is multiple stenosis of the left sfa and popliteal artery. there are two focal stenoses severe of the proximal at. there is occlusion of the pt and peroneal. the dp is patent. he was given a mucomyst protocol for this. there was no bump in his bun and creatinine post angio. he continued to be dialyzed. echocardiogram was done to assess a ventricular function for valvular disease. the left atrium was markedly dilated. the right atrium was moderately dilated. there was symmetrical left ventricular hypertrophy. the left ventricle cavity was moderately dilated. there was severe global hypokinesis with relative sparing of the septum. the ................ ventricular systolic function is severely depressed. the right ventricular chamber size is normal. the systolic function appears depressed. the ascending aorta is mildly dilated. the aortic valve three leaflets were mildly thickened. there was mild aortic stenosis and 1+ aortic regurgitation. the mitral valve leaflets are mildly thickened with 1+ mitral regurgitation and 2+ tricuspid regurgitation. there was moderate pulmonary systolic hypertension. there is no pericardial effusion. ejection fraction was calculated at 25%. the patient underwent on a left profunda femoris to anterior tibial bypass with situ saphenous vein. he tolerated the procedure well. he was transferred to the pacu in stable condition with a palpable dp. at the conclusion of the procedure, he required 2 units of packed red blood cells intraoperatively. he was extubated to the sicu for hemodialysis. his pa pressures were 55/18. cardiac output was 6.18, svr 1500, cvp 1. blood pressure was 204/64. he required neomycin during his hemodialysis for low systolic pa pressures. his electrocardiogram postoperatively was unremarkable. his blood gas was 7.27, 58, 125, 28, minus 1. he was continued on a heparin drip and remained in the sicu for continued care. postoperative day #1, there were no overnight events. he was dialyzed, maintained his systolic pressure between 160 and 180. his pa pressure 75/32. cardiac index was 4.3. cardiac output was 7.7. svr could not be measured. o2 saturations were 96%. postoperative hematocrit 33.9 down from 36.5, white count 15.3 up from 13.0. bun 25, creatinine 5.1 which is stable, potassium 5.0. pt/inr were normal with a ptt of 38.1. his physical exam was unremarkable. his graft pulse was palpable. his morphine and benadryl were discontinued because of sedation and he was placed on a fentanyl prn patch. ambien was discontinued. he remained npo on protonix. intravenous fluids were hep-locked. he remained in the sicu. postoperative day #2, he was in the sicu. his swan was discontinued. a triple lumen was placed. he continued on hemodialysis. a knee immobilizer was placed to protect the graft. his postoperative hematocrit was 34.3 up from 33.9. bun 17, creatinine 3.9 which is down from 5.1. his abdomen was with bowel sounds. his lower extremity incisions were clean, dry and intact. the distal pulses were dopplerable. feet were warm. he had good capillary refill. chest x-ray was without pneumothorax. haldol was given for agitation. narcotics, opiates and antilytics were held. protonix was continued and he was transferred to the vicu for continued monitoring and care. postoperative ultrasound of the graft was done which showed an area of high velocity in the upper groin. the patient returned to the operating room on and underwent a venotomy with excision of competent valve. he tolerated the procedure well. he had a 2+ dp pulse and graft pulse at the end of the procedure. he was transferred to the pacu in stable condition. he had ck/mb cycled. electrocardiogram was without changes. his cycled enzyme totals were flat. he continued to be followed by the renal service for dialysis needs. his diet was advanced as tolerated and ambulation was began on postoperative day 4 and 1. he was transferred to the floor. ambulation was begun on postoperative day . kefzol was completed once the patient was .............. the remaining hospital course was remarkable for intermittent episodes of confusion requiring a sitter or small doses of haldol. he did require a blood transfusion on for his hematocrit with improvement of hematocrit of 26.5 to 28.4 post transfusion. case management followed the patient for screening and speech swallow requested to see the patient for bed side swallow evaluation. it was difficult to assess his swallowing mechanisms because of his severe lethargy throughout the trials. their recommendations were to continue diet as tolerated, would recommend small sips versus straw sips when given liquids. encourage po's. do not attempt to feed the patient while he is drowsy. put him at a 90 degree angle upright for all meals. make his medications pureed and will follow for further assessment. diet was tolerated and was advanced to soft solids and thick liquids. on , the patient had a low grade temperature of 102??????. blood cultures and chest x-ray obtained which were both negative. physical therapy strongly recommended that the patient had impaired balance and functional mobility and strength and severely deconditioned, will recommend rehabilitation facility once medically stable. the patient was transferred to rehabilitation. remaining hospital course is unremarkable. awaiting appropriate rehabilitation facility for transfer. the patient was discharged on in stable condition. wounds were clean, dry and intact. the skin sutures removed from the dp incision. the wound was steri-stripped. the patient should follow up with dr. in three weeks. discharge medications: 1. losartan 50 mg qd, hold for systolic blood pressure less than 100 2. nephrocaps 1 qd 3. hydralazine 4. hydrochlorothiazide 100 mg tid, hold for systolic blood pressure less than 120 5. lisinopril 40 mg qd 6. colace liquid 100 mg 7. allopurinol 1 mg , to give the afternoon dose at 3 p.m. 8. allopurinol 0.5 to 1 mg intravenous q4h prn 9. protonix 40 mg qd 10. metoprolol 50 mg , hold for systolic blood pressure less than 110, heart rate less than 50 11. aspirin 325 mg qd 12. thiamine 100 mg qd 13. folic acid 1 mg qd 14. acetaminophen 325 to 650 mg po pr q 4 to 6 hors prn for pain 15. mupirocin cream 2% to rectal area for a total of five days. this was started on and was discontinued on . 16. nitroglycerin ointment 2% 1 inch topical q6h prn for systolic blood pressure greater than 150, wipe off for systolic blood pressure less than 125. 17. calcium acetate 3 tablets tid with meals discharge diagnoses: 1. ischemic left first toe status post left pfa to at bypass with in situ saphenous vein 2. graft stenosis, status post venotomy, valvulectomy 3. postoperative confusion improved 4. end stage renal disease on dialysis 5. hypertension treated and controlled 6. coronary artery disease asymptomatic 7. blood loss anemia corrected , m.d. dictated by: medquist36 procedure: other revision of vascular procedure hemodialysis arteriography of femoral and other lower extremity arteries other (peripheral) vascular shunt or bypass aortography pulmonary artery wedge monitoring arteriography of renal arteries diagnoses: other primary cardiomyopathies hyperpotassemia acute posthemorrhagic anemia peripheral vascular disease, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease delirium due to conditions classified elsewhere atherosclerosis of native arteries of the extremities with rest pain mechanical complication of other vascular device, implant, and graft 

Answer: The patient is high likely exposed to