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: penicillins / e-mycin attending: chief complaint: diabetic foot ulcer, hypotension major surgical or invasive procedure: i+d of r diabetic foot ulcer history of present illness: 61yo m with h/o dm, dementia, mr admitted to podiatry with diabetic right foot ulcer s/p i+d in or on transferred from pacu to micu for hypotension. per records and ed attending patient was found down at this morning in feces and urine. he was brought to the ed where he had a temp to 101, sinus tach to 150s, wbc 18, and cellulitis on right foot with purulent ulcer and streaking up leg to groin with track. mental status was "alittle out of it" but at baseline per family. got 4l ns in the ed and apap and hr down to 120s. xr foot didnt show evidence of osteo but had track with pus through ulcer. broad spec abx were given (vanc/ctz/cipro/flagyl) and he was evaluated by podiatry and vascular surgery who recommended sending him to the or for i+d. . in the or the patient underwent i+d, received fent (75mg)/midaz (3mg), esmolol and metoprolol for sinus tach in the 150s and neo for hypotension (100s/50s) and 5l drained 10cc pus from right foot, ebl 50ml, packed with saline wet-dry dressing change. per anesthesia he's had tachycardia treated with esmolol and hypotensive (100s/50s). superficial culture taken in ed and deep cultures taken in or as well. will likely need debridement and head of metatarsal removed over the next few days by podiatry. . on the floor, patient is sleeping but arousable. denies pain. denies chest pain and denies palpitations. past medical history: dm2 vascular dementia asthma hypertension barretts esophagus . past surgical history: (per omr) open reduction and internal fixation fracture both bones of the forearm , pheochromocytoma social history: (per omr) smoking: nonsmoker. etoh: social drinking. physical exercise: patient has been moderately physically active. family history: non-contributory physical exam: vitals: t:97.1 bp:91/40 p:140 r:25 o2:97 on 5l nc general: somnolent but arousable, answers questions appropriately but falls asleep mid-interview heent: sclera anicteric, very dry mm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: upper airway snoring sounds but otherwise clear to auscultation bilaterally, no wheezes, rales, ronchi anteriorly cv: tachycardic but regular abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding gu: foley ext: warm, well perfused, no edema, bandage on right foot with marker line on leg and inside marker line no erythema pertinent results: 08:05pm blood wbc-18.1*# rbc-4.26* hgb-11.0* hct-33.0* mcv-78* mch-25.9* mchc-33.5 rdw-16.8* plt ct-269 08:05pm blood neuts-88.5* lymphs-4.4* monos-6.4 eos-0.2 baso-0.5 12:58am blood wbc-6.3 rbc-3.40* hgb-8.8* hct-25.8* mcv-76* mch-25.8* mchc-34.1 rdw-16.7* plt ct-219 08:05pm blood pt-16.4* ptt-29.3 inr(pt)-1.5* 12:54am blood fibrino-640* 08:05pm blood glucose-434* urean-34* creat-1.3* na-127* k-4.6 cl-92* hco3-22 angap-18 08:05pm blood alt-41* ast-49* ld(ldh)-332* alkphos-90 totbili-0.8 12:54am blood albumin-2.4* calcium-7.0* phos-3.2 mg-1.8 12:54am blood hapto-182 08:05pm blood osmolal-296 12:54am blood tsh-0.92 12:58am blood cortsol-13.5 01:05am blood type- po2-56* pco2-50* ph-7.23* caltco2-22 base xs--6 01:40am blood type-art po2-96 pco2-51* ph-7.23* caltco2-22 base xs--6 intubat-not intuba 08:13pm blood glucose-386* lactate-2.1* k-4.6 09:37am blood freeca-1.06* 09:45pm urine color-yellow appear-clear sp -1.023 09:45pm urine blood-lg nitrite-neg protein-75 glucose-1000 ketone-15 bilirub-neg urobiln-neg ph-5.0 leuks-neg 09:45pm urine rbc-2 wbc-1 bacteri-few yeast-none epi-0 . mrsa screen mrsa screen-pending inpatient swab gram stain-final; wound culture-preliminary; anaerobic culture-preliminary inpatient swab gram stain-final; wound culture-preliminary; anaerobic culture-preliminary inpatient urine urine culture-final inpatient swab gram stain-final; wound culture-preliminary; anaerobic culture-final emergency blood culture blood culture, routine-pending emergency blood culture blood culture, routine-pending ecg: narrow complex tachycardia which may be due to sinus tachycardia or an atrial flutter or atrial tachycardia with 2:1 conduction. compared to the previous tracing of the rate has increased substantially and there may be an atrial arrhythmia present. . ct head w/out contrast: 1. no acute intracranial pathology. 2. parenchymal atrophy and small vessel microvascular disease. . r foot ap,lat & obl x-ray: : soft tissue ulceration and swelling at the medial forefoot at the level of the great toe with soft tissue ulceration. markedly limited study for evaluation for osteomyelitis and if clinically warranted, mri may be obtained to further assess. . cxr: no evidence of pneumonia. equivocal evidence of mild congestion. . tee: no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no spontaneous echo contrast is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 40 cm from the incisors. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. . . : xray history: foot ulcer status post debridement. findings: in comparison with the study of earlier in this date, there has been extensive debridement about the first mtp joint with bony resection. area of gas in soft tissues could merely be trapped under the bandage. further information can be gathered from the operative report. brief hospital course: 61yo m with dm2, vascular dementia found down at with infected foot ulcer s/p i+d in or with hypotension likely from sepsis. . # sepsis/ right foot osteomyletis: - resolved following aggressive ivf. lactate normalized and he had improved mentation and urination. covered broadly for infected diabetic foot ulcer with vanc/ceftaz/cipro/flagyl initially. cultures showed multiple organisms. was followed by vascular and podiatry.on wound culture: unable to r/o other pathogens due to overgrowth of swarming proteus.staph aureus coag +=rare growth. anaerobic culture (preliminary):no anaerobes isolated. blood pressures are currently stable. status post podiatric surgery ()-resection of first metatarsophalangeal joint. radical debridement of skin, muscle and subcutaneous tissue, right foot. delayed primary closure, right foot. will be discharged on levofloxacin which will cover the mssa which grew from his wound culture. . # tachycardia: a flutter, s/p d/c cardioversion after amiodarone loading, and beta blocking. tee did not show thrombus. now in sinus with improved bp. pt started on heparin gtt which was transitioned to lovenox and coumadin. has remained in sinus rhythm. currently being rate controlled with metoprolol 75mg tid. lovenox should be dc'd after inr therapeutic between . anticoagulation should be continued until . at that time need for anticoagulation should be reassessed. . # acid/base disturbance: had respiratory acidosis and non gap met acidosis on admission to micu. thought to be secondary to sepsis with procedural sedation. this issue has resolved since and on the floor his acid/base status was stable. . # hyponatremia: hypovolemic hyponatremia likely either tea and toast diet/poor po intake from being on floor for unknown number of days vs adrenal insufficiency vs insensible losses from fevers, infection etc. improved with hydration (normal tsh, random cortisol was 13.2 ?????? equivocal).his sodium level on the floor were normal. . # anemia: hct were 25-26 which is low for his baseline of 30s-40s. guaiac negative, hemolysis labs were negative. continued to trend hct. iron studies were obtained. iron: 25 caltibc: 176 ferritn: 871 trf: 135, suggestive of anemia with chronic disease. this should be followed by the patient's primary care physician. # elevated inr: unclear etiology, patient not on coumadin, heparin. possibly nutritional deficiency but with anemia concerning for hemolysis. inr is now coming down and has been stable at around 1.4. no evidence of hemolysis. started on heparin gtt during stay which was transioned to lovenox and coumadin bridge. . # : likely hypotension/pre-renal given sepsis. now resolved. # conjunctivitis: found to have conjunctivitis on . started on erythromycin drops. resolving. erythromycin stopped prior to discharge. # dementia/mr: sedating meds were being held initially because of low bp. otherwise issue stable during admission. # copd: standing atrovent and prn albuterol nebs while in icu and floor. breathing status has been stable and he is tolerating room air well. continued on home at discharge. . # dm: standing insulin sliding scale. . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ -the patient will need at least 1 month of anticoagulation after having atrial flutter cardioversion. the potential continuation of anticoagulation will have to be assessed as an outpatient. medications on admission: hctz 25', metformin 1000', lisinopril 40', remeron 45'qhs, simvastatin 40', mertazipine 30'qhs, celexa 40', , discharge medications: 1. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 10 days. disp:*10 tablet(s)* refills:*0* 2. warfarin 5 mg tablet sig: one (1) tablet po daily (daily). 3. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 4. lovenox 80 mg/0.8 ml syringe sig: one (1) subcutaneous twice a day. 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 8. diskus 250-50 mcg/dose disk with device sig: one (1) inhalation twice a day. 9. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 10. acetaminophen 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for pain/fever. 11. simvastatin 40 mg tablet sig: one (1) tablet po once a day. 12. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). discharge disposition: extended care facility: rehabilitation & care center - discharge diagnosis: 1.osteomyelitis, right first metatarsophalangeal joint. 2. abscess and cellulitis, right foot. 3. atrial flutter which was cardioverted discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: it was a pleasure to care for you as your doctor. . you were brought to the hospital because of a foot infection. you developed low blood pressure and spent a couple of days in the intensive care unit. after intravenous fluids, antibiotics, and surgery on your foot you improved and were transferred to the regular floor. your admisison was complicated by a abnormal heart rhythm which required electrial conversion to a regular heart rhythm. . we made the following changes to your home medication list: -we added coumadin which is a blood thinner you will need to take because of the irregular heart rhythm you experienced. please take this medication as directed by your outpatient physician. -we added lovenox which is a blood thinner you must take for your irregular heart rhythm you experienced, please take this medication as directed by your physician at rehab. this will be stopped once your inr is between . -we started levofloxacin which is an antiobiotic for your foot infection which you had surgery. - lisinopril and hctz were stopped during admission. . please follow up with the outpatient appointments below: followup instructions: department: podiatry when: thursday at 8:05 am with: , dpm building: ba ( complex) campus: west best parking: garage department: hmfp when: thursday at 2:10 pm with: , m.d. building: ra (/ complex) campus: east best parking: main garage department: when: monday at 9:00 am with: , md building: (, ma) campus: off campus best parking: on street parking md, procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart other electric countershock of heart other excision of joint, foot and toe other tenotomy other local excision or destruction of lesion of joint, foot and toe other local excision or destruction of lesion of joint, foot and toe diagnoses: anemia of other chronic disease abnormal coagulation profile acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis asthma, unspecified type, unspecified atrial flutter ulcer of other part of foot other specified cardiac dysrhythmias diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin other specified septicemias septic shock hypovolemia barrett's esophagus cellulitis and abscess of foot, except toes ulcer of heel and midfoot cerebral atherosclerosis unspecified intellectual disabilities acute osteomyelitis, ankle and foot mixed acid-base balance disorder cellulitis and abscess of toe, unspecified ulcer of calf personal history of traumatic fracture rosacea conjunctivitis, unspecified vascular dementia, with delirium 

Answer: The patient is high likely exposed to