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: reglan / protonix attending: chief complaint: confusion major surgical or invasive procedure: left second toe amputation. history of present illness: 54 year old man with dm1 complicated by gastroparesis/neuropathy, esrd s/p renal transplant in now on pd, cad s/p imi with stent, chf with ef 45% who presents with dehydration, l foot infection, and confusion. the patient was admitted for sepsis in and d/c'd on keflex. he had sudden onset of weakness and chills. he denied fevers cp sob or abd pain. he did have some nausea, that is normal for him following pd. he had been off plavix for 2-3 days for recent nose bleeds. in the , pt's initial vitals were t98.6, p93, bp80/51, rr 23, o2 sat 97%. his blood sugars remained in the 70s/40s with bs 40. his blood pressures did not respond to 2x1l ivf boluses and he was started on levophed. he was cultured and then started on ceftriaxone 1gm iv x 1, vancoymcin 1gm iv x 1. he was later given zosyn for pseudomonas coverage. given his hct drop to 21, he was type and crossed for 4 units. fast ultrasound showed no pericardial effusion, some abdominal fluid. he had a pt was also intubated for airway protection/unresponsiveness. during intubation, wife reported new right-sided tooth fracture. he was ventilated on 550x14, peep 5 with fent/midaz for sedation. a sepsis line was placed in the right ij vein. he had elevated cardiac enzymes and lateral wall st depressions and was given asa 325mg po x 1. he was given 10 mg decadron for h/o adrenal insufficiency. on exam, he had bilateral pitting edema that had been resolving, but his left 3rd toe was dusky. it had no signal on doppler or pleth and vascular was consulted. they will see him in the icu. prior to transfer, vs 98 132/75 (on levo) 86 14 100% (intubated). of note, the patient had been dni, but his wife this in the . he is now full code. . in the icu, he was intubated and sedated. . review of systems: unable to obtain past medical history: # insulin dependent diabetes type i - complications of neuropathy, retinopathy, gastroparesis (somewhat responsive to erthromycin) # renal transplant, , now on pd since - followed by dr # cad - 3vd, des to om , following mi (deferred placing multiple stents d/t excessive dye load in setting of renal insufficiency). # systolic chf: echo from --ef 45-50%, akinesis of basal inferior wall and hypokinese of the mid and basal inferolateral wall. # polycythemia # pvd # htn # h/o osteomyelitis of r 5th metatarsal in # eosinophilic gastritis # stoke in with right hand weakness, resolved on its own social history: patient lives with his wife. is a retired auto mechanic. per wife, no smoking, alcohol, and any illicit drug use. family history: one sister has a congenital problem. mother and another sister with bipolar disorder on lithium. physical exam: exam on admission. vitals: afebrile, 56, 91/42, 16, 100% gen: sedated, intubated eyes: no conjunctival pallor. no icterus. ent: mm. op clear. cv: jvp not assessable. normal carotid upstroke without bruits. pmi in 5th intercostal space, mid clavicular line. rr. distant s1, s2. no appreciable murmurs, rubs, clicks, or gallops. lungs: mechanical breath sounds anteriorly, no obvious wheeze, rhonchi or rales abd: nabs. soft, nd. no hsm. abdominal aorta was not enlarged by palpation. no abdominal bruits. heme/lymph/immune: no cce, no cervical lymphadenopathy. skin: r heel ulcer, l 2nd toe ulcer neuro: sedated, intubated exam on discharge: vs - t 128/77 hr 73 rr 13 o2-sat % ra general - pleasant man in nad, comfortable, appropriate heent - nc/at, perrla, eomi, sclerae anicteric, dry mm, op clear neck - supple, no thyromegaly, no jvd, no carotid bruits lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, no mrg, nl s1-s2, s3 abdomen - nabs, soft/nt, distended, pd catheter in place c/d/i, no rebound/guarding extremities - warm, no c/c/e, s/p 2nd toe amputation with wound vac in place; 3rd nail bed necrotic skin - no rashes or lesions lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, did not test dorsiflexion/plantar flexion, able to wiggle toes, decreased sensation in l4 distribution on left, normal sensation to light touch and proprioception otherwise, did not ambulate patient, dressing to left foot c.d.i. pertinent results: 09:34pm type- temp-36.7 rates-/14 tidal vol-500 peep-5 o2-40 po2-43* pco2-37 ph-7.32* total co2-20* base xs--6 intubated-intubated vent-controlled 09:34pm lactate-1.5 09:34pm o2 sat-70 09:22pm ck(cpk)-380* 09:22pm ck-mb-12* mb indx-3.2 ctropnt-0.95* 09:22pm wbc-7.3 rbc-2.28* hgb-6.6* hct-20.0* mcv-88 mch-28.9 mchc-32.9 rdw-17.7* 09:22pm plt count-208 09:00pm ascites wbc-30* rbc-35* polys-11* lymphs-37* monos-50* mesotheli-2* 06:18pm type-mix po2-128* pco2-29* ph-7.32* total co2-16* base xs--9 comments-green top 06:18pm glucose-100 lactate-2.7* 06:18pm o2 sat-97 05:43pm urine color-yellow appear-clear sp -1.017 05:43pm urine blood-mod nitrite-neg protein-500 glucose-100 ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 05:43pm urine rbc-* wbc-* bacteria-mod yeast-none epi-0-2 trans epi-0-2 05:43pm urine hyaline-0-2 04:15pm glucose-47* urea n-64* creat-6.6* sodium-137 potassium-4.0 chloride-100 total co2-19* anion gap-22 04:15pm alt(sgpt)-14 ast(sgot)-34 ck(cpk)-194* alk phos-87 tot bili-0.2 04:15pm ctropnt-1.0* 04:15pm ck-mb-5 04:15pm albumin-2.8* calcium-7.8* phosphate-5.0* magnesium-2.0 04:15pm cortisol-2.5 04:15pm wbc-6.2 rbc-2.45*# hgb-7.0* hct-21.7*# mcv-89 mch-28.8 mchc-32.5 rdw-17.6* 04:15pm neuts-61.7 lymphs-31.4 monos-3.9 eos-1.9 basos-1.1 04:15pm plt count-192 04:15pm pt-14.3* ptt-28.4 inr(pt)-1.2* 06:10am blood wbc-5.7 rbc-3.27* hgb-9.6* hct-29.2* mcv-89 mch-29.4 mchc-33.0 rdw-17.0* plt ct-189 06:10am blood plt ct-189 06:10am blood glucose-141* urean-41* creat-5.0* na-138 k-3.8 cl-104 hco3-24 angap-14 06:10am blood calcium-7.4* phos-5.4* mg-1.9 . pathology. specimen submitted: left second toe mpj procedure date tissue received report date diagnosed by dr. /ttl previous biopsies: gi bx's. bone distal phalanx & right ulcer. gi bx's. right 5th bone. (and more) diagnosis: left second toe, mpj: - acute osteomyelitis. - skin with ulceration. - bony and soft tissue margins are viable. . foot 1. cortical irregularity and periosteal reaction in the shaft of the proximal phalanx of the great toe, is concerning for osteomyelitis. 2. suspected minimally impacted fracture at the base of the middle phalanx of the left second toe. 3. continued healing of the proximal left metatarsal shaft fracture with callus formation and obscuration of the fracture line. if clinically indicated, a lateral view targeted to the second toe (the current lateral view is of the entire foot) or alternatively a ct or mri may help to better depcit the findings in the second digit. brief hospital course: mr. was admitted with hypotension and intubated in the ed for altered mental status, though there was some report that he had throat swelling after an injection of dexamethasone. he was admitted to the micu intubated on a small dose of norepinephrine. his norepinephrine was weaned off and his lactate/central venous o2 were noted to worsen to 3.2 and 44% so the norepinephrine was restarted. cardiology was consulted for rising cardiac enzyems his ck peaked at 647 and troponin 1.59. cardiology thought that this was most likely secondary to demand and given his 3vd he would not benefit from catheterization, they recommended calling cardiac surgery to redisscuss a cabg as he had been turned down for unclear reasons in the past. he had an infected toe which grew mssa and was amputated by vascular surgery with placement of a wound vac. he was switched from vancomycin to unasyn. his mental status improved and he was extubated 2 days after admission. he was transitioned to the regular floor where he continued to do well. the wound vac was removed and the wound was sutured closed. he received wound care, with a recommendation for dry dressings and his antibioitics were switched to augmentin for a total antibiotic course of 10 days. he was seen by physical therapy, with a plan for weight bearing while wearing a post operative shoe, and continued outpatient physical therapy. he was found to be c.difficile positive in the intensive care unit. he was not having increased stool output, and it was unclear whether this was asymptomatic carriage. given the host context, he was treated with p.o vancomycin for this. he continued to receive peritoneal dialysis. he has follow up planned with vascular surgery as well as his primary care doctor. for his coronary artery disease, his simvastatin was increased to 80mg daily from 20 mg daily for cardioprotective purposes while revascularization surgery continues to be considered. he was a full code during this hospitalization. medications on admission: sevelamer hcl 800 mg tid w/ clopidogrel 75 mg daily prednisone 5 mg daily cyclosporine 25 mg daily metoprolol succinate 25 mg sr daiyl aspirin 81 mg daily simvastatin 80 mg daily calcitriol 0.5 mcg daily lantus 20u qam iss discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. calcitriol 0.5 mcg capsule sig: one (1) capsule po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. cyclosporine 25 mg capsule sig: one (1) capsule po q12h (every 12 hours). 5. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for fungal rash. 6. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 7. simvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 9 days. disp:*45 capsule(s)* refills:*0* 9. epoetin alfa 4,000 unit/ml solution sig: one (1) injection injection qmowefr (monday -wednesday-friday). disp:*30 injection* refills:*0* 10. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain : please do not drink alcohol, or perform activities that require a fast reaction time while taking this medication. cause sedation. disp:*84 tablet(s)* refills:*0* 11. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 12. sevelamer carbonate 800 mg tablet sig: one (1) tablet po three times a day: with . 13. lantus 100 unit/ml cartridge sig: ten (10) units subcutaneous qam. 14. insulin sliding scale sig: dose depends on blood glucose level as needed. 15. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 4 days. disp:*8 tablet(s)* refills:*0* discharge disposition: home with service facility: area vna discharge diagnosis: primary toe osteomyelitis complicated by sepsis . secondary diabetes complicated by gastroparesis/neuropathy end stage renal disease on peritoneal dialysis discharge condition: stable, good, baseline mental status, full weight bearing in post operative shoe. discharge instructions: you were admitted to the hospital because you had sepsis from a toe infection. the toe was amputated, and you were treated with antibiotics for the foot infection with improvement. . the following changes were made to your medications. 1. augmentin 500mg every 12 hours for 4 days 2. vancomycin 125mg four times a day for 9 days. 3. simvastatin 80mg daily . followup instructions: dr office will call you to set up an appointment for the week of . provider: , dpm phone: date/time: 8:15 provider: , .d. phone: date/time: 8:40 provider: , md phone: date/time: 1:00 md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube amputation of toe peritoneal dialysis diagnoses: acidosis end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery congestive heart failure, unspecified severe sepsis polyneuropathy in diabetes peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status methicillin susceptible staphylococcus aureus septicemia hypopotassemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease ulcer of other part of foot acute respiratory failure cardiogenic shock long-term (current) use of insulin septic shock intestinal infection due to clostridium difficile old myocardial infarction chronic systolic heart failure personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits obesity, unspecified glucocorticoid deficiency gangrene diabetes with peripheral circulatory disorders, type i [juvenile type], not stated as uncontrolled background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled kidney replaced by transplant gastroparesis diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled acute osteomyelitis, ankle and foot polycythemia vera diabetes with other specified manifestations, type i [juvenile type], not stated as uncontrolled eosinophilic gastritis, without mention of hemorrhage other hammer toe (acquired) 

Answer: The patient is high likely exposed to