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: dyspnea major surgical or invasive procedure: 1. transmetatarsal amputation of left foot 2. intubation 3. arterial line 4. successful initiation of hemodialysis history of present illness: hpi: year old male with dry gangrene of 1st and 2nd left toe, af, htn, cri, pvd s/p recent admission for a left popliteal bypass on whose course was complicated by mssa from toe culture who presented to the ed on with sepsis. the patient's initial hospital visit, on , was complicated by acute renal failure, with creatinine to 6.0 following an angiography with a contrast load. the patient was seen by renal who advised hemodialysis, but based on family wishes the patient was discharged home. on , the patient presented to the ed with a two day history of sob, worsening renal failure, and hyperkalemia. upon exam, he was found to be hypothermic to the mid 95's and hypotensive with pressures between 80-90/50s. his lactate level was 5.7. the must protocol was initiated and the patient was intubated secondary to concerns that he was tiring and sent to the micu. past medical history: pmh: 1. coronary artery disease. 2. aortic valve replacment w/ porcine valve 3. chronic renal insufficiency 4. anemia 5. htn 6. history of prostate cancer 7. history of pacemaker for tachybrady syndrome 8. history of porcine aortic valve placement in 9. history of af psh: patient is s/p aaa repair, s/p turp, s/p aortic valve replacement and s/p pacemaker placement. social history: sh: married, lives in with wife. ( is his son and the health care proxy. one other son. etoh and smoking history unknown, but does not currently smoke or drink. family history: unknown physical exam: t95.2 bp95/50 hr71 rr34 os92%3l gen - mod resp distress. alert. heent - mmm. resp - ctab. cv - no jvd. rrr. nl s1/s2. no mgr abd - s/nt/nd. pos bs. ext - necrotic left 1st-2nd toes and cool, mottled extremities. neuro - a&ox3. pertinent results: 07:15pm blood wbc-25.1*# rbc-3.15* hgb-9.9* hct-32.1* mcv-102* mch-31.4 mchc-30.8* rdw-15.0 plt ct-372# 11:11pm blood wbc-19.9* rbc-2.43* hgb-7.8* hct-24.1* mcv-99* mch-32.2* mchc-32.4 rdw-15.1 plt ct-267 07:15pm blood neuts-93.9* bands-0 lymphs-3.6* monos-2.2 eos-0.2 baso-0.1 02:50am blood neuts-95.7* bands-0 lymphs-1.6* monos-1.7* eos-0.2 baso-0.1 07:15pm blood pt-87.5* ptt-56.6* inr(pt)-48.2 07:15pm blood plt smr-normal plt ct-372# 05:35am blood glucose-82 urean-93* creat-6.3* na-138 k-3.9 cl-98 hco3-19* angap-25* 07:15pm blood glucose-99 urean-109* creat-7.6*# na-137 k-5.4* cl-96 hco3-10* angap-36* 07:15pm blood alt-1 ast-7 alkphos-9* amylase-52 11:11pm blood alt-3 ast-55* ld(ldh)-294* ck(cpk)-947* alkphos-223* amylase-62 totbili-1.0 05:35am blood calcium-8.6 phos-7.2* mg-2.1 07:15pm blood albumin-2.8* calcium-9.0 phos-11.3*# mg-2.8* 04:50pm blood cortsol-32.9* 07:15pm blood redhold-hold 01:00am blood greenhd-hold 08:06pm blood type-art po2-329* pco2-20* ph-7.26* calhco3-9* base xs--15 09:25pm blood type-art rates-/14 peep-5 o2-100 po2-431* pco2-33* ph-7.15* calhco3-12* base xs--16 aado2-261 req o2-50 intubat-intubated vent-controlled 07:18pm blood lactate-5.2* k-5.8* 09:25pm blood lactate-3.4* na-132* k-4.4 11:13pm blood hgb-7.6* calchct-23 o2 sat-70 04:23am blood o2 sat-61 08:37am blood freeca-0.97* brief hospital course: brief hospital course, by issue: 1. sepsis/fungemia in the micu, the patient was placed on broad spectrum sepsis coverage with ceftriaxone, vancomycin, and flagyl. he was also started on pressors. blood cultures subsequently grew out budding yeast that was further confirmed to be albicans. the patient was originally placed on ambisone and was subsequently switched to fluconazole. the flagyl was discontinued secondary to negative anerobic cultures. the patient's toe cultures subsequently grew out resistant proteus and mssa. the patient was weaned from pressors on and a left transmetatarsal amputation was performed on to remove the gangrenous source of his infection. the patient was extubated on without difficulty. of note, the tte performed on demonstrated echogenicity on the right atrial pacer wire that was consistent with either thrombus or vegetation. id was consulted, and they felt that the optimal treatment is to remove the pacer. however, ep predicts 10 to 15 percent mortality from such procedure. the patient is therefore instead be committed to medical therapy per id. in addition, hemodialysis was initiated on , and a hemodialysis catheter was placed on . the patient was subsequently transferred to the floor on an antibiotic regimen of oxacillin, ceftriaxone, and fluconazole. blood cultures from were returned as negative, so the patient's ceftriaxone and oxacillin were stopped on . 2. gi bleed on , the patient had multiple episodes of melena and vomiting of bright red blood. he was found to have a supertherapeutic ptt level (>100) so his heparin was stopped and he was transferred to the micu to be stabilized. following a brief course in the micu the patient returned to the floor on . a subsequent upper endoscopy revealed signs of gastritis and duodenal inflammation, but no focal ulcers. the patient was restarted on coumadin to begin anticoagulation for treatment of af on . 3. infectious disease a ucx from grew , the patient was started on linezolid treatment. two subsequent urine cultures had no growth, so linezolid was stopped. the patient also had signs of erythema and possible infection around the site of his amputation on his foot. as such, he was started on a 14 day course of zosyn beginning on . the patient has negative blood cultures, but the decision has been made to continue him on lifelong fluconazole treatment for candidemia, as his pacemaker with the vegetation on it cannot be removed. a picc line was placed on for long term antibiotic treatment. medical issues upon discharge: #1: id: the patient was found to have albicans via blood cultures, and has been started on flucanazole. based on the negative margins on his amputated foot, his oxacillin and ceftriaxone were discontinued. he had a subsequent increase in his wbc that was most likely caused by a uti that was cultured to grow . he was subsequently treated with linezolid, and a f/u ucx from was negative for bacterial growth, and the linezolid was d/c on . the patient was also started on iv zosyn on per vascular's recommendation secondary to infection of his wound site. he had a picc line placed on for iv access, and will be d/c on iv zosyn and fluconazole. #2: renal faliure: the patient had a temporary femoral dialysis catheter placed. renal followed him throughout his stay and manged his hemodialysis. a tunnel catheter for dialysis was placed on . his pholo was d/c because the patient could not swallow the pills. he received hd on the day of discharge and is scheduled for subseqent hd as an outpatient on . #3: coagulopathy/anemia: the patient had several episodes of bleeding that led to multiple transfusions and treatment with epo along with his dialysis. he is currently on coumadin for anticogulation and will be monitored via inr, with goal of . #4: mitral regurgitation: patient was started on metoprolol 25mg and captopril 6.25mg tid to decrease afterload pressures on the heart and reduce regurgitation. #5: pvd: s/p left metatarsal amputation on . path results demonstrate complete resection of infected material. wound appears slightly infected but improving, will finish 10 day iv zosyn therapy per vascular rec. #6: af: will continue anticoagulation as described above. #7: fen: patient assessed by speech and swallow and determined that he could begin a thin liquid/puree??????d solids diet, and we started oral feeds and medicines without incident. #8: mental status: throughout the course of his stay on the floor, the patient had notable improvements in his mental status. he has baseline dementia and short term memory loss, but the somulence and disorientation that were first apparent have largely resolved, and the patient is close to baseline according to his son. in the two days prior to discharge, the patient began to exhibit increased agitation and mild delirium that was most likely secondary to sundowning complicated by underlying dementia and infection. problem #9: visual changes: patient reports seeing bugs crawling on surfaces. we are not sure if these are actual bugs or secondary to visual pathology. ophthalmology has been consulted and ruled out fungal uveitis on visit. hallucinations did not persist and were not followed further per optho rec. medications on admission: - lasix 40 mg qday - atenolol 25 mg qday - aspirin 325 mg qday - coumadin 5 mg qhs - percocet prn - oxacillin 2g iv q 6 hrs - colace 100 mg - epogen 4000 sl q mon/wed/fri - tums 500 mg tid - mvi - sevelamer 1600 tid - calcitriol 0.25 mg qday - pantoprazole 40 mg qday discharge medications: 1. calcium acetate 667 mg capsule sig: two (2) tablet po tid w/meals (3 times a day with meals). 2. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed) as needed for groin rash. 3. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 4. olanzapine 2.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for agitation. 5. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day): hold for systolic blood pressure < 100. 6. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po qd (once a day). 7. warfarin sodium 2.5 mg tablet sig: one (1) tablet po qd (once a day). 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold for systolic blood pressure < 110 or heart rate < 60. tablet(s) 9. fluconazole 200 mg tablet sig: one (1) tablet po once a day. 10. piperacillin-tazobactam 2-0.25 g recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 10 days. discharge disposition: extended care facility: - discharge diagnosis: 1. sepsis 2. candidemia 3. thrombus versus fungal vegetation on pacer wire 4. end stage renal disease 5. atrial fibrillation 6. peripheral vascular disease 7. gi bleed 8. dementia discharge condition: stable discharge instructions: 1. please take all of your medications as they are prescribed to you. 2. please keep your follow-up appointments as they are outlined below. 3. if you have fevers, chills, lightheadedness, low blood pressure, chest pain, difficulty breathing, nasea, vomiting, abdominal pain, or worsening of redness or drainage from your surgical incisions, please call your physician or return to the emergency room. followup instructions: 1. please follow-up with dr. . please call to make an appointment upon discharge. mr. should be seen by dr. within the next two weeks. (son) is aware to call dr. on monday morning to set up an appointment. ( 2. you have an appointment with dr. from vascular surgery on wednesday, at 1:00 pm. it is important for you to have dr. examine your incisions and your ulcers to make sure there is no infection. 3. your next hemodialysis appointment is on tuesday, at 1pm at hemodialysis center in . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine diagnostic ultrasound of heart hemodialysis amputation through foot transfusion of packed cells diagnoses: anemia, unspecified urinary tract infection, site not specified acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure disseminated candidiasis heart valve replaced by transplant hemorrhage of gastrointestinal tract, unspecified atherosclerosis of native arteries of the extremities with gangrene other and unspecified coagulation defects infection and inflammatory reaction due to cardiac device, implant, and graft 

Answer: The patient is high likely exposed to