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: mrs. is a 54-year-old white female with the past medical history significant for diabetes mellitus, insulin dependent for the last 34 years, as well as coronary artery disease, congestive heart failure, and end-stage renal disease status post renal transplant times one year ago. the patient presents with a nonhealing ulceration of her right lower extremity on the plantar surface of her right foot for approximately the last six months. she has a severe history of neuropathy. it is felt that this is most likely a neuropathic ulcer, as she does not admit to any trauma to the area. the ulcer is approximately 3-mm x 3-mm in size with a hyperkeratotic lesion on the plantar aspect of the right first phalangeal joint. she is status post multiple bypass surgeries, which ultimately resulted in a left lower extremity below-the-knee amputation, times two years ago with a right femoral-popliteal bypass in . she was admitted to the vascular surgery service for further evaluation, as well as angiography and surgical correction. past medical history: 1. insulin dependent diabetes mellitus for the last 34 years with triopathy and gastroparesis. 2. coronary artery disease status post myocardial infarction in . 3. hypertension. 4. 70 pack per year history of nicotine use, which continues today. she admits to 2?????? pack per day for the last 34 years. 5. hyperlipidemia. 6. the patient admits to having two cerebrovascular accidents with residual defect on the left, both occurring in , as well as anemia, and end-stage renal disease status post kidney transplant in 9/. social history: the patient has a 70 pack per year history of nicotine use, which continues today. she admits to 2?????? pack per day for the last 34 years. she denies any history of alcohol abuse. past surgical history: history is significant for multiple bypass procedures of the lower extremities; left below knee amputation in ; kidney transplant 9/. medications on admission: 1. insulin pump with a basal rate of 0.7 units, 12 midnight to 12 noon, 0.9 units 12 noon to 6 p.m. and 0.7 units 6 p.m. to 12 midnight. 2. aspirin 325 mg p.o.q.d. 3. lasix 80 mg p.o.q.d. 4. neurontin 200 mg p.o.q.d. 5. lopressor 25 mg p.o.b.i.d. 6. prograf 2 mg b.i.d. 7. cellcept mg p.o.b.i.d. 8. prednisone 7.5 mg p.o.q.d. 9. bactrim single strength p.o.b.i.d. for pcp . 10. ms contin 60 mg p.o.q.d. 11. dilaudid 2 mg p.o.t.i.d. 12. moban 50 mg p.o.q.h.s. 13. dulcolax. physical examination: examination revealed a well-developed, somewhat cachectic white female appearing in no apparent distress, but appearing older than her stated age of 54. neck: neck was supple without evidence of carotid bruits. heart: heart: heart revealed regular rate and rhythm, 2/6 systolic ejection murmur. lungs: lungs were clear to auscultation bilaterally. abdomen: abdomen was soft, nontender, and nondistended with positive bowel sounds and a palpable kidney transplant in the right lower quadrant. extremities: examination revealed positive femoral pulses bilaterally with only dopplerable popliteal and pedal pulses on the right. there is a below the knee amputation present on the left. the ulcer was very superficial on the plantar aspect of the right lower extremity approximately 3 -mm x 3-mm in size. hospital course: the patient was admitted to , where she was evaluated by dr., who felt that she would need an angiogram to assess her lower extremity vasculature as she was not healing the ulcer and it was felt that the bypass, which was performed in the past, was either closed or severely diseased. this was performed on and revealed a narrowed distal aorta without significant focal stenoses; normal iliac system; and right transplanted kidney. the right femoral popliteal bypass was not visualized and the native artery was severely diseased and diffusely narrowed. there was a very high-grade stenosis in the above knee popliteal arteries as described. a single vessel anterior tibial runoff to the foot supplies a patent dorsalis pedis artery, which reconstitutes to the plantar arch. based on these findings, it was decided that she would need a distal revascularization and a vein mapping of her arms, which were performed. this revealed that she had a patent left basilic and cephalic vein and this was used for her bypass procedure. prior to the operation she was evaluated by the renal transplant service who recommended switching her prograf and cellcept over to iv, while she remained npo. consultation was also sought, as she is a very brittled diabetic, and she was managed on the insulin pump. she was subsequently taken down the operating room on , where a right common femoral to popliteal-anterior tibial bypass performed with left arm vein graft. details of this procedure are dictated in a separate operative note. the patient was transferred up to the vascular intensive care unit. she was maintained with a cvp catheter. she did fairly well. however, she did have a slightly low urine output for which she was given maintenance iv fluids with lactated ringer at 125 an hour. she was started on an insulin drip for sugars well into the 300s. it was managed by the unit. she was doing quite well from a hemodynamic standpoint until postoperative day #3, when she went into congestive heart failure and became shortness of breath with desaturations down into the 80s. she was closely managed by the vascular team. she was given iv lasix 20 mg times three doses. she had a very minimal response to this and she diuresed approximately one liter. the electrolytes were evaluated and subsequently repleted appropriately. a swan-ganz catheter was introduced and did reveal that she had high filling pressures. it was noted that her weight was approximately 7-kg over her baseline. she continued to respond slowly to the lasix and she was stable. however, it was noted that she did desaturate and had a period of confusion. it was felt that she may be intubated. so, she was subsequently transferred to the surgical intensive care unit. at this point, the aggressive diuresis kicked in and she continued to diurese quite well. intubation of the patient was avoided and she remained stable with evidence of decreased shortness of breath and improving o2 saturations. she was maintained in the intensive care unit for three days, at which time she was continued on her insulin drip. she was then subsequently transferred back up to re-vascular intensive care unit where she was monitored. she was started back on her insulin pump on postoperative day #10. it should be noted that while she was in the intensive care unit consultation was sought by the department of cardiology to facilitate her healing. they recommended aggressive diuresis with loop diuretics, as well as continuing the lopressor to decrease the heart rate with a successful treatment plan. she eventually began to take off some of the fluid, which was present. at this time she is up on the floor. she is doing quite well. chest x-ray has improved. however, there is still evidence of some mild congestive heart failure present. the patient is essentially asymptomatic and is without any problems at this time. she denies any symptoms of shortness of breath, chest pain, or dyspnea. she is afebrile. she is back on her insulin pump. she did have an increase in her basal rate to 1.8 units. she has been shown, by the learning center, how to bolus herself should her sugars be elevated. she has been seen by the department of physical therapy and she has been cleared for discharge to home. it is felt that rehabilitation is not necessary at this time. visiting nursing association will be set up for wound care, as well as to monitor for infections or recurrent congestive heart failure. physical examination at the time of discharge revealed the patient to be in no apparent distress. she is afebrile. vital signs were stable. neck was supple without evidence of carotid bruits. heart revealed regular rate and rhythm. lungs are clear to auscultation bilaterally without wheezes, rubs, or rhonchi. abdomen was soft, nontender, and nondistended with palpable kidney transplant. extremities revealed a well healed left arm incision, as well as slowly healing incisions of the right lower extremity. the foot is warm and there is good dopplerable signals in her foot. at this point there was no change in her wound. however, we expect to see a change in the next several weeks. laboratory data: studies at the time of discharge are as follows: white blood cell count of 10.7, hemoglobin 10.2, hematocrit 30.8, platelet count 240,000, glucose 89, bun 21, creatinine 0.8, sodium 139, potassium 4.3, chloride 97, bicarbonate 35, calcium 8.6, phosphorus 2.7, magnesium 1.5. wound cultures from the foot revealed coagulase negative staphylococcus aureus in sparse growth. the chest x-ray from , revealed persistent pattern of interstitial and alveolar opacities representing mild congestive heart failure. disposition: stable, progressing well. she will go home with vna services. the staples in the left groin are to be removed by dr. in the followup visit in days. dry sterile dressing is to be placed to the right heel, as well as to the right plantar wound. she is to be followed by the podiatry department in approximately 7-10 days. she will be discharged. she is advised to followup closely with the clinic for further management of her diabetes, as well as the renal transplant service on a routine basis for continued evaluation, as well as monitoring of her immunosuppressive medications. discharge medications: 1. prograf 2 mg p.o.b.i.d. 2. cellcept mg p.o.b.i.d. 3. bactrim single strength, p.o.q.d. 4. neurontin 300 mg p.o.t.i.d. 5. sliding scale of regular insulin. 6. lasix 40 mg p.o.b.i.d. 7. lopressor 25 mg p.o.b.i.d. 8. zantac 150 mg p.o.q.d. 9. prednisone 7.5 mg p.o.q.d. 10. insulin pump with a basal rate of 1.8 cc per hour. 11. dilaudid 2-4 mg p.o.q. h.p.r.n. discharge diagnoses: 1. nonhealing ulceration of the right lower extremity status post right femoral to popliteal bypass graft with left arm vein. 2. brittle diabetic female with insulin dependent diabetes mellitus for the last 24 years, currently controlled at this time with an insulin pump. 3. congestive heart failure currently resolved on oral diuretics. 4. end-stage renal disease status post kidney transplant with no active issues at this time. 5. hypertension, managed on oral beta blockers. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified other (peripheral) vascular shunt or bypass diagnoses: congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified polyneuropathy in diabetes diabetes with peripheral circulatory disorders, type i [juvenile type], uncontrolled diabetes with neurological manifestations, type i [juvenile type], uncontrolled ulcer of heel and midfoot kidney replaced by transplant peripheral angiopathy in diseases classified elsewhere 

Answer: The patient is high likely exposed to