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: mr. is a 51-year-old male with diabetes mellitus and end-stage renal disease (status post renal transplant times two) who presented to the on . mr. also has a history of multiple admissions for diabetic ketoacidosis. on presentation to , he was noted to be lethargic and with an increased blood glucose. he was transferred because his medical care was coordinated at . on admission to , he was noted to have a temperature of 101.4, a heart rate in the 110s, and hypotension reported in the 90s/40s. there was concern for sepsis, and he was treated broadly with antibiotics including vancomycin, ceftriaxone, and levaquin. on transfer to , he was admitted to the medical intensive care unit for management of diabetic ketoacidosis. an initial blood glucose was 370. he was also noted on admission to have a creatinine of 3 (which was well above his baseline of around 1). other findings on admission included a swollen and painful left elbow. on admission, mr. noted general malaise and tiredness. he denied any chest pain, shortness of breath, nausea, vomiting, diarrhea, fevers, chills, dysuria, hematuria, abdominal pain, numbness, weakness, or tingling. past medical history: 1. insulin-dependent diabetes mellitus; complicated by retinopathy, nephropathy, and neuropathy. 2. end-stage renal disease. 3. status post living-related kidney transplant in ; rejection in . 4. status post cadaveric renal transplant in . 5. right index finger osteomyelitis. 6. chronic low back pain. 7. status post transurethral resection of prostate. 8. peripheral vascular disease. 9. status post multiple toe amputations and lower extremity bypass grafts. medications on admission: 1. insulin sliding-scale. 2. aspirin 325 mg p.o. q.d. 3. allopurinol 500 mg p.o. q.d. 4. midodrine 2.5 mg p.o. q.d. 5. lopressor 12.5 mg p.o. b.i.d. 6. heparin subcutaneously. 7. protonix 40 mg p.o. q.d. 8. colace 100 mg p.o. b.i.d. 9. celexa 20 mg p.o. q.d. 10. prograf 3 mg p.o. b.i.d. 11. depakote 500 mg p.o. q.d. 12. lasix 80 mg p.o. b.i.d. 13. zaroxolyn 5 mg p.o. b.i.d. 14. prednisone 10 mg p.o. q.d. allergies: penicillin. social history: he lives in . he denies alcohol or tobacco use. physical examination on presentation: temperature was 101.4, blood pressure was 90s/40s, heart rate was 110, respiratory rate was 15 to 20, oxygen saturation was 96% on room air. in general, lethargic, in no acute distress. alert and oriented times three. head, eyes, ears, nose, and throat examination revealed left pupil was reactive. mucous membranes were dry. the oropharynx was clear. right pupil was not reactive due to retinopathy. the neck was supple. no lymphadenopathy. the lungs were clear to auscultation bilaterally. heart was tachycardic and regular. a 2/6 systolic ejection murmur at the base. the abdomen was obese, soft, and nontender. active bowel sounds. extremities revealed bilateral upper extremity bruising. left elbow with erythema, tenderness, warmth, and swelling. bilateral amputations of multiple toes that were well-healed. pertinent laboratory values on presentation: laboratories on admission revealed white blood cell count was 18, hematocrit was 35.4, and platelets were 207. sodium was 141, potassium was 2.8, chloride was 99, bicarbonate was 12, blood urea nitrogen was 113, creatinine was 3, and blood glucose was 315. serum acetone was large. urinalysis revealed 15 ketones, trace leukocyte esterase, negative nitrites, and 3 to 5 white blood cells. creatine kinases were 1582, 1664, 630, and 441. ck/mb levels were 37, 33, 16, and 11. troponin i levels were 4.1, 3.7, 3.4, and 2.9. radiology/imaging: electrocardiogram showed sinus tachycardia, left atrial dilatation, normal intervals, old q waves in v1 through v3 with no acute changes when compared with an electrocardiogram from . a chest x-ray a was reported as negative for an infiltrate. hospital course: 1. diabetic ketoacidosis: mr. was admitted to the medical intensive care unit for treatment of his diabetic ketoacidosis. he was started on intravenous rehydration given his significant level of dehydration. he was also started on an insulin drip. the insulin drip was stopped after two days, and he was restarted on his home regimen of insulin and a sliding-scale. since being transferred to the floor on , his blood sugars have been well controlled. 2. acute renal failure: he presented with a bump in his creatinine from baseline; most likely resulting from dehydration and a prerenal azotemia. his creatinine normalized with fluid rehydration and was 1.2 on the day of discharge. the renal service followed mr. during his hospital stay and helped with renal dosing of his medications. 3. infectious disease: mr. presented with a fever, hypotension, and an elevated white blood cell count; and there was concern for a sepsis syndrome. he was initially covered broadly with antibiotics. given his left elbow swelling, there was concern for a septic joint. the orthopaedic service saw him and performed an arthrocentesis of his left elbow revealing 12,500 white blood cells and crystals on microscopy. fluid culture were negative, and the joint pain and swelling was most likely attributable to gout. his pain decreased, and he had full range of motion at the time of discharge. he had no erythema. his hypotension and tachycardia were most likely related to dehydration. white blood cell count on discharge was 11.4. he had been afebrile for greater than 24 hours following the discontinuation of vancomycin for a possible cellulitis. 4. cardiovascular system: mr. had a troponin leak but negative creatine kinase on admission. the cardiology service was consulted and asked to see him and recommended a persantine mibi. this test was performed on and revealed no evidence of ischemia or disease. a lipid panel was still pending and can be followed up as an outpatient. folate was started empirically on the recommendation of the cardiology service. 5. hematologic system: mr. hematocrit was stable throughout his hospital stay. 6. kidney transplant: mr. was maintained on his tacrolimus with the dose adjusted for his creatinine clearance. he was initially given stress-dose steroids with intravenous hydrocortisone. this was switched to prednisone, and he will be discharged on a prednisone taper. no evidence of rejection during this hospitalization. 7. prophylaxis: the patient was maintained on protonix and subcutaneous heparin. discharge disposition: mr. was to be discharged back to his facility. physical therapy evaluated him and felt him safe for discharge. discharge status: discharge status was to facility. condition at discharge: condition on discharge was good. medications on discharge: 1. folic acid 1 mg p.o. q.d. 2. prednisone taper 40 mg p.o. one and then 30 mg p.o. on and 20 mg p.o. on and 10 mg p.o. on and thereafter. 3. tacrolimus 0.5 mg p.o. b.i.d. 4. allopurinol 100 mg p.o. q.d. 5. insulin sliding-scale. 6. aspirin 325 mg p.o. q.d. 7. midodrine 2.5 mg p.o. q.d. 8. lopressor 12.5 mg p.o. b.i.d. 9. heparin subcutaneously. 10. protonix 40 mg p.o. q.d. 11. colace 100 mg p.o. b.i.d. 12. celexa 20 mg p.o. q.d. 13. depakote 500 mg p.o. q.d. 14. lasix 80 mg p.o. b.i.d. 15. zaroxolyn 5 mg p.o. b.i.d. discharge instructions/followup: the patient to follow up with dr. as scheduled next week. , m.d. dictated by: medquist36 procedure: arthrocentesis diagnoses: acute kidney failure, unspecified other specified cardiac dysrhythmias hypotension, unspecified cellulitis and abscess of upper arm and forearm diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled acute myocardial infarction of unspecified site, initial episode of care complications of transplanted kidney 

Answer: The patient is high likely exposed to