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: worsening l heel/leg ulcers major surgical or invasive procedure: l bka history of present illness: patient is an 82 year old female who came into vascular clinic for a routine follow up visit. she was examined in clinic today, the bandage was taken down and her left leg wound began bleeding profusely. the bleeding was controlled and the wound was rewrapped and she was admitted to the vascular surgery service. this is an ulcer which has not been healing for many months now, at least 4 months, possibly quite a bit longer. she had 3 months ago, in clinic she was noted to have a 3 x 3 cm ulceration on the lateral aspect of her left tibia. she c/o bilateral foot pain. with the right and the left . both feet throb, non radiating and constant. pain alleviated with tylenol and aggrivated by foot manipulation. past medical history: copd, dm-2, htn, cva, hyperlipidemia, cad, depression, chf, uterine prolapse, pvd, osteoarthritis, and had an appendectomy in the distant past. social history: currently resides at . family history: non-contributory physical exam: 97.4 72 112/70 15 95% ra nad rrr cta b s/nt/nd wounds c/d/i. l bka, staples intact right- staples medially, has hematoma all along the incision line pulses: dopplerable dp and pt signals on right pertinent results: 09:13am blood wbc-9.6 rbc-3.80* hgb-10.9* hct-34.4* mcv-90 mch-28.6 mchc-31.6 rdw-16.5* plt ct-345 09:13am blood plt ct-345 08:24am blood glucose-92 urean-8 creat-0.5 na-140 k-4.3 cl-102 hco3-32 angap-10 cardiology report ecg study date of 5:22:40 am sinus rhythm. low qrs voltage is non-specific but clinical correlation is suggested. since the previous tracing of right axis deviation and early precordial qrs transition are absent and generalized low qrs voltage is now seen. radiology report foot ap,lat & obl left study date of 5:22 pm findings: three views of the left foot demonstrate osteopenia. there is hallux valgus metatarsus and varus with mild degenerative changes of the first mtp. there are mild degenerative changes of the first tmt. there is subchondral sclerosis at both aspects of the tmt joints. there is mild enthesopathy at the dorsal and plantar calcaneal insertions. no frank osteomyelitis is identified in the foot. art dup ext lo uni;f/u left study date of 9:15 am impression: patent left femoropopliteal bypass graft with low, resistive flow. the below-knee popliteal artery appears to occlude not far below the terminus of the bypass graft. art ext (rest only) study date of 9:15 am impression: severe bilateral lower extremity occlusive disease without doppler flow below the knee. pvrs are aphasic in the calf levels distally. cta aorta/bifem/iliac runoff w/w&wo c and recons study date of 12:32 pm impression: 1. occlusion of left fem- bypass at its proximal end. left external iliac stent is patent. occlusion of the left sfa and portions of the left anterior tibial and left posterior tibial arteries. 2. occlusion of the right sfa at its mid portion. areas of occlusion in the mid course of the right anterior tibial and right posterior tibial arteries. 3. indeterminate bilateral low-attenuation adrenal nodules. differential diagnosis includes adrenal adenomata, but they should be monitored on follow up imaging. chest (pre-op pa & lat) study date of 10:53 am findings: since the previous study,the left lower lobe atelectasis is unchanged. the lungs are clear with no mass, consolidation or pneumothorax. cardiomediastinal silhouette is normal. impression: no acute cardiopulmonary findings brief hospital course: patient admitted for worsening lle ulcers. started on braod spectrum antibiotics (vanco, cipro, flagyl). nias requested for le's, foot x-ray, routine wound care. hd1: patient had episodes of hypoglycemia associated with somnolence, with metformin on hold, d/c'd pioglitazone. continued routine wound care, and broad spectrum antibiotics. podiatry consulted re: l heel ulcer- will need lbka if circulation cannot be restored. hd2: no acute events. continued routine wound care, and broad spectrum antibiotics. patient had a cta bilateral lower extremities- demonstrated 1. occlusion of left fem- bypass at its proximal end. left external iliac stent is patent. occlusion of the left sfa and portions of the left anterior tibial and left posterior tibial arteries. 2. occlusion of the right sfa at its mid portion. areas of occlusion in the mid course of the right anterior tibial and right posterior tibial arteries, will need right femoral-to-dorsalis pedis bypass with in situ saphenous vein graft in the future, to be done after l bka. 8/22-24/09 hd3-5: no acute events. continued routine wound care, and broad spectrum antibiotics. booked for lbka on . made npo, pre-oped, iv hydrated and consented for l bka. hd6: day of proposed surgery, patient at the last minute is refusing to have surgery (l bka), procedure was re-booked for . family contact and made arrangements for someone to be in w/ patient prior to going to the or for her l bka. continued routine wound care, and broad spectrum antibiotics. hd7: no acute events. continued routine wound care, and broad spectrum antibiotics. made npo and iv hydrated for l bka the next day. hd8: no acute events. taken to or and underwent l bka. patient tolerated procedure, recovered in the pacu then transferred back to 5 floor. diet and po meds resumed. pain well controlled w/ current medications. hd9/pod1: hct is down to 25.4, transfused w/ 1 unit prbcs. placed on bka pathway. physical therapy referral placed. rehab screening requested. family and patient decided to go ahead w/ plans for right femoral-to-dorsalis pedis bypass to be done during this admission. booked for . /hd10-16/pod6: continued bka pathway. speech and swallow evaluation to evaluate for aspiration and diet recs- continue ground solids and thin liquids. poor po intake calorie count x 3 days, started megase. picc placed for better access, placement confirmed w/ cxr. continued iv antibiotics. lisinopril, mirtazipine and furosemide discontinued for low bp. pre-oped, consented, made npo after mn, iv hydarted for right femoral-to-dorsalis pedis bypass. hd17/pod7: taken to or for right femoral-to-dorsalis pedis bypass with in situ saphenous vein graft. patient tolerated procedure, recovered in the pacu then transferred to vicu 5. routine post bka care. restarted heparin drip post-op. placed lower extremity bypass pathway. hd18/pod7/1: hct down to 27.8 <-31.5, transfused w/ 1 unit prbc's. fluid resuscitated. pain managed w/ iv morphine prn. continued iv antibiotics. resume po meds and diet. continued le bypass pathway. hd19/pod8/2: patient noted to have right unilateral upper extremity swelling, ultrasound was done and ruled out for ue dvt. continued iv antibiotics. continued w/ heparin drip. pain managed w/ iv morphine prn. fluid bolus for low urine output. hd20/pod9/3: hct down to 24.9 <-30.1, transfused w/ 1 unit prbc's. continued on le bypass and bka pathways. continued iv antibiotics and heparin drip. diet advanced. hd21/pod10/4: wbc elevated, pan cultured, cxr taken-possible basilar consilidation. first c-diff came back negative. urine cultures-negative, blood cultures still pending. heparin drip d/c'd. electrolytes repleted. hd22/pod11/5: wbc coming down. poor po intake, reconsulted speech and swallow- recs ground solids and nectar thickened liquids, supplements w/ every meal and calorie counts for 3 days. hct continue to fall now 24.3, transfused w/ 1 unit prbcs. poor urine output since mn, iv fluid bolused after blood transfusion. urine lytes sent fena 0.06%, cr 0.4. hd23/pod12/6: continued le bypass and bka pathways. transfused 1 unit of prbcs. urine poutput remain marginal, good response to low dose lasix. rehab screen requested. hd24/pod13/7: no acute events. given low dose lasix again w/ good response. rehab bed. : patient did well over the weekend. no acute events. discharged to rehab in good consition on . medications on admission: meds: lisinopril 10 mg daily atorvastatin 10 mg qhs atenolol 50 mg daily donepezil 10 mg qhs mirtazapine 30 mg qhs pioglitazone 15 mg daily acetaminophen 500 mg (2) tablet po q 8h prn pain docusate sodium 100 mg capsule ipratropium bromide 17 mcg/actuation aerosol 1-2 puffs inhalation qid aspirin 325 mg po daily oxycodone 5 mg 1 q6h prn pain senna 8.6 mg tablet bisacodyl 5 mg tablet, delayed release (e.c.) 2 po daily prn constipation. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization inhalation q4h prn sob. lasix 20 mg tablet daily. metformin 500 mg tablet po twice a day. namenda 10 mg po daily. humalog insulin sc per fingerstick discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 3. mirtazapine 30 mg tablet sig: one (1) tablet po hs (at bedtime). 4. acetaminophen 500 mg tablet sig: two (2) tablet po q 8h (every 8 hours) as needed for prn pain. 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. ipratropium bromide 17 mcg/actuation aerosol sig: 1-2 puffs inhalation qid (4 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for sob/wheezing. 10. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 11. memantine 5 mg tablet sig: two (2) tablet po daily (). 12. tramadol 50 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain. 13. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 14. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 15. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 16. ipratropium bromide 0.02 % solution sig: inhalation q6h (every 6 hours) as needed for wheezing. 17. atenolol 25 mg tablet sig: three (3) tablet po daily (daily). discharge disposition: extended care facility: rehabilitation & skilled nursing center - discharge diagnosis: pvd w/ ischemic l leg/foot and failed bypass ischemic right leg acute anemia-related to operations-required blood transfusions history of: copd dm-2 htn cva hyperlipidemia cad depression chf uterine prolapse pvd osteoarthritis psh: l femakpop w/nrsvg, l eia stent, s/p appy discharge condition: stable lasix on hold, rehab to determine need to resume discharge instructions: division of vascular and endovascular surgery amputations discharge instructions activities: - no driving till fu - may shower, no tub baths - no stump shrinkers, may ace - no pillows under hip/knee wound: - staples will remain till fu - keep wound dry and clean, call if noted to have redness, draining, swelling, or if temp is greater than 101.5 diet: - diet as tolerated eat a well balanced meal - your appetite will take time to normalize - prevent constipation by drinking adequate fluid and eat foods in fiber, take stool softener while on pain medications - patient will need lots of encouragement to ensure adequate nutritional intake medications: - continue all medications as directed - take your pain medications conservatively - your pain will get better over time followup instructions: call dr. office for fu appointment. phone: follow up in weeks procedure: venous catheterization, not elsewhere classified other revision of vascular procedure other (peripheral) vascular shunt or bypass nonexcisional debridement of wound, infection or burn excision of lesion of other soft tissue other amputation below knee diagnoses: congestive heart failure, unspecified toxic encephalopathy unspecified essential hypertension acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified polyneuropathy in diabetes depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia other complications due to other vascular device, implant, and graft personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diabetes with other specified manifestations, type ii or unspecified type, uncontrolled proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site mechanical complication of other vascular device, implant, and graft gangrene ulcer of heel and midfoot pseudomonas infection in conditions classified elsewhere and of unspecified site diabetes with neurological manifestations, type ii or unspecified type, uncontrolled peripheral angiopathy in diseases classified elsewhere ulcer of ankle diabetes with peripheral circulatory disorders, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to