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: the patient is a 53 year old man with a history of coronary artery disease, insulin dependent diabetes mellitus for 40 years and a renal transplant in who presented who presented with an increased dyspnea on exertion and shortness of breath at rest, increased over a chronic baseline level. the patient noted symptoms acutely worsened one day prior to admission prompting an emergency room visit. in the emergency room the patient denied chest pain, palpitations, nausea, vomiting or diaphoresis as well as fever and chills. the patient did note that his usual dose of lasix was not working. in the emergency room he was found to be sating high 90s on 2 liters after 80 mg of lasix. he was admitted to the floor he was found to have a low saturation. he was put on 100% nonrebreather, sating in the mid 90s. respiratory rate was 30s to 40s. the patient was given 40 plus 40 of intravenous lasix without any increased urine output. on the nitroglycerin drip and morphine the patient was able to diurese 200 cc. the patient's respiratory rate decreased to the 20s. the patient's examination had improved. the patient was taken to the catheterization laboratory where he was found to be 80% on 100% nonrebreather. the patient was also found to have lateral electrocardiogram changes. he was diaphoretic and not complaining of chest pain but noting paroxysmal nocturnal dyspnea and orthopnea. past medical history: 1. insulin dependent diabetes mellitus for 40 years with triopathy; 2. status post renal transplant ; 3. status post bilateral below the knee amputation; 4. coronary artery disease, with three vessel disease with poor touchdowns, not a surgical candidate with recent in-stent stenosis of the left anterior descending stent treated with brachytherapy; 5. recent admit for right knee ulcer to . allergies: no known drug allergies. medications on admission: pravachol 20 mg p.o. q.d.; aspirin 325 mg p.o. q. day; lasix 60 mg p.o. q. day; enalapril 20 mg p.o. b.i.d.; lasix 75 mg p.o. q. day; isordil 20 mg p.o. t.i.d.; prednisone 10 mg p.o. q.o.d.; sandimmune 100 mg p.o. q. am and 50 mg p.o. q. pm; imuran 50 mg p.o. q. day; ativan 2 to 4 mg p.o. q. 4 to 6 hours prn; nph 20 units subcutaneously in the morning and 14 units subcutaneously in the pm; regular insulin sliding scale; toprol xl 12.5 mg p.o. q. day. social history: the patient is full code. he lives alone. his wife had died recently. the patient quit smoking tobacco 20 years ago. he denied any alcohol use. family history: significant for gastrointestinal and breast cancer. physical examination: the patient's pulse was 95, blood pressure was 125/38 with map 67, respiratory rate 22 and oxygen saturation 97% on 100% nonrebreather. on general examination the patient was a very chronically ill appearing man in no apparent distress who was bolt upright in bed. on head, eyes, ears, nose and throat examination the patient had pupils which were nonreactive. neck examination revealed no lymphadenopathy and a central venous pressure of approximately 10 cm of water. cardiac examination revealed a regular rate and rhythm, normal s1 and s2 with no murmurs, rubs or gallops. there was presence of an s3. pulmonary examination revealed rales up to of the lung fields with bilateral pleural effusions. on abdominal examination the patient's belly was soft, nontender, nondistended with normal bowel sounds. extremity examination reveals bilateral below the knee amputations, 2+ edema. there was a left stage 3 decubitus ulcer of the patella region. laboratory data: pertinent laboratory findings revealed a white blood cell count of 9.4, hematocrit 40, platelets 291. the patient had a bun of 31, creatinine 1.4. the patient's ck was trending downwards. electrocardiogram revealed normal sinus rhythm at 75 with normal axis, left atrial abnormality, st elevations v1 through v4, 1 to 3 mm. there were also small q waves in 3 and f. chest x-ray showed congestive heart failure with bilateral pleural effusions. , stress mibi, the patient with reversible moderate inferior and anterior and septal wall defect. echocardiogram performed , revealed sinus tachycardia with no anxiety, abdominal aortic aneurysm, st increased v2 to v4, the patient also had biphasic t in v6. cardiac catheterization, the patient had ejection fraction of 20 to 30% with 100% proximal right coronary artery lesion, 95% recurrent in-stent mid left anterior descending lesion. this focal lesion was dilated successfully. hospital course: the patient is a 53 year old man with a history of coronary artery disease, myocardial infarction and renal transplant as well as insulin dependent diabetes mellitus and congestive heart failure. 1. cardiovascular - from the cardiovascular standpoint the patient presented in acute decompensated heart failure in the setting of ischemic heart disease. from a coronary artery disease standpoint the patient has severe three vessel disease. multiple interventions including recent percutaneous transluminal coronary angioplasty and brachiotherapy to the left anterior descending now presented with recurrent in-stent left anterior descending stenosis, status post percutaneous transluminal coronary angioplasty. the patient was ruled out for myocardial infarction. he was evaluated by cardiac surgery who felt that the patient was not a coronary artery bypass candidate. he was continued on aspirin, plavix and beta blockers as well as pravachol. from a myocardial standpoint the patient had an ejection fraction of 20% with severe hypokinesis, left ventricular hypertrophy, and diastolic dysfunction. he presented with decompensated heart failure. he ruled out for myocardial infarction, however, his congestive heart failure was felt to be secondary to ischemic heart disease. the patient was diuresed with lasix and eventually a combination of diuril and lasix. the patient was started on natrecor which initially caused some hypotension but then the patient reported improvement in his shortness of breath. he had augmented diuresis while on the natrecor. the patient was considered for aldactone although with his history of hyperkalemia this was deferred. plan was to use bipap if the patient were to have further acute pulmonary edema. post cardiac catheterization the patient had an episode of acute pulmonary edema which was responsive to morphine and lasix. the patient was continued on his outpatient heart failure regimen which included enalapril, isordil, and toprol. from a conduction standpoint the patient remained in sinus rhythm and was continued on his beta blocker. from an endocrine standpoint the patient presented with a history of insulin dependent diabetes mellitus and was maintained on a regimen of nph and regular insulin sliding scale as per his outpatient regimen. from a renal standpoint the patient is status post renal transplant on an immunosuppressant regimen. he presented at his baseline creatinine. however, with fingerstick diuresis the patient's creatinine climbed from 1.4 to approximately 1.8. his cyclosporin level of 113 was within normal limits. the renal transplant team followed the patient. his creatinine gradually began to trend down at the end of the hospital course. infectious disease - the patient presented with a left knee ulcer near the site of the left below the knee amputation. vascular surgery was consulted and felt the patient should be on levofloxacin and flagyl. they debrided the ulcer. the patient was continued on levofloxacin and flagyl for approximately a course of 14 days. the patient had a swab that grew enterobacter as well as stenotrophomonas. infectious disease was contact regarding the treatment of his stenotrophomonas. given the marked clinical improvement in the ulcer, the feeling was that the stenotrophomonas was a colonizer and that there was no need to add additional coverage. vascular surgery recommended the patient follow up with his vascular surgeon at . condition on discharge: good. discharge status: the patient was discharged to follow up with dr. in heart failure clinic in approximately one to two weeks. the patient will also follow up with his vascular surgeon at in approximately one week. due to high likelihood of repeat lad in-stent stenosis, elective relook angiography with standby for ptca will be considered in 4 months. discharge medications: 1. tylenol 650 mg p.o. q. 4-6 hours prn 2. pravachol 20 mg p.o. q. day 3. plavix 75 mg p.o. q. day 4. cyclosporin 100 mg p.o. q. am and 50 mg p.o. q. pm 5. azathioprine 50 mg p.o. q. day 6. metoprolol xl 2.5 mg p.o. q. day 7. colace 100 mg p.o. b.i.d. 8. aspirin, enteric coated 325 mg p.o. q.d. 9. ativan 0.5 to 1 mg p.o. q. 4-6 hours prn anxiety 10. flagyl 500 mg p.o. t.i.d. for nine days 11. levofloxacin 500 mg p.o. q. day for nine days 12. prednisone 10 mg p.o. q.o.d. 13. enalapril 20 mg p.o. b.i.d. 14. lasix 80 mg p.o. q. day 15. isordil 20 mg p.o. t.i.d. prn 16. regular insulin sliding scale, nph 20 units subcutaneously q. am and 14 units subcutaneously q. pm discharge instructions: the patient is to have dry sterile dressings b.i.d. to his left lower extremity ulcer. he will also need daily weights at home with a sitdown scale. case management was contact to obtain a sitdown scale for the patient. services will aid the patient in the dressing changes. discharge diagnosis: 1. congestive heart failure 2. coronary artery disease with three vessel disease status post percutaneous transluminal coronary angioplasty 3. insulin dependent diabetes mellitus 4. sepsis, recent 5. status post bilateral below the knee amputations 6. left knee ulcer 7. renal transplant with chronic immunosuppression. , m.d. dictated by: medquist36 d: 13:33 t: 15:41 job#: procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor implant of pulsation balloon nonexcisional debridement of wound, infection or burn nonoperative removal of heart assist system diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified other complications due to other cardiac device, implant, and graft below knee amputation status diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled legal blindness, as defined in u.s.a. kidney replaced by transplant infection (chronic) of amputation stump 

Answer: The patient is high likely exposed to