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: malaise and nausea major surgical or invasive procedure: debridement of left foot (, ) picc line placement () angiogram () history of present illness: mr. is a 52 year old male with myasthenia , htn, dm, gerd, admitted to podiatry for stable right foot ulcer and left gangrenous heel with fevers and malaise. patient reports over the past week he has been feeling weak overall. he reports intermittent low grade fevers and chills until today when he is found to have a temperature to 102.3. he reports nausea, but denies vomiting, diarrhea, myalgias, rhinorrhea, sore throat, headache or lightheadednes. he denies shortness of breath or cough, but does report that he finds if difficult to walk around although cannot specify if it is related to breathing. no known sick contacts. past medical history: - myasthenia diagnosed in (on prednisone and cellcept on admission). - htn - iddm c/b neuropathy s/p chronic infection, s/p multiple digital amputuations r foot. poor control. - gerd - hyperlipidemia - diabetic foot ulcers on left and right. gangrenous left heel. social history: patient lives in , ma and works in synagogue. he denies tobacco, alcohol, or drug use. family history: non-contributory physical exam: admission physical exam vs: t 102.3, bp 100/50, hr 84, rr 18, 97% on ra gen: ill appearing, lying in bed heent: eomi, o/p with white exudate cv: rrr, no m/r/g pulm: poor inspiratory effort. no crackles, wheezes, or rhonchi. abd: soft, nt, nd, bowel sounds present. no hepatosplenomegaly. ext: no peripheral edema, right and left heels bandaged pertinent results: labs on admission: 129 | 92 | 25 / -------------- 312 5.4 | 92 | 1.6 \ . .. \ 10.9 / 13.9 ----- 420 .. / 34.1 \ . diff: 92%n, 4.4%l, 3.4%m, 0.1%e, 0.1%b sed rate: 125* u/a: urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg rbc-1 wbc-1 bacteria-none yeast-none epi-1 urine culture: negative dfa for influenza a/b: negative mr foot w&w/o contrast left study date of 9:13 pm impression: 1. large soft tissue ulceration abutting the posterior aspect of the calcaneus. minimal edema in the abutting bone is most likely reactive, but early osteomyelitis cannot be entirely excluded. no evidence of intraosseous abcess. 2. muscle edema and enhancement, consistent with myositis, as well as edema in the subcutaneous fat, whoch could reflect cellulitis. no significant soft tissue abcess. a very small (7mm) fluid collection may be present within the substance of the abductor hallucis muscle. 3. peroneal and posterior tibialis tendon tenosynovitis angiogram the left anterior tibial artery occluded approximately 2- 3 cm after the takeoff from the popliteal artery and reconstituted after approximately 10 cm, with in-line flow into the dorsalis pedis artery. the occlusion was crossed successfully with a 0.014 miracle bros wire and a quick-cross catheter and balloon angioplastied with a 2-mm balloon. this resulted in widely patent flow through this region. the left posterior tibial artery was patent, but diffusely diseased with 2 areas of focal stenosis at the ankle. this was successfully crossed with a 0.014 miracle bros wire and balloon angioplastied with a 1.5- mm balloon. this resulted in patent flow with some residual stenosis and disease. the peroneal artery was patent, but diffusely diseased. brief hospital course: mr. is a 52 year old right handed man with a history of predominantly bulbar myasthenia , dm type ii with probable polyneuopathy, hypertension, hyperlipidemia, and chronic foot ulcers with mrsa colonization s/p multiple digital amputations who presented with fever and found to have esbl e.coli/citrobacter freundii bacteremia. 1. gnr bacteremia/fungemia: initial blood cultures grew both esbl resistant e. coli and citrobacter. given these organisms, the gangrenous left heel was the most likely source of infection, especially since cxr, u/a were negative for infection. before the sensitivities were known, broad spectrum antibiotics including flagyl, vancomycin and ceftazidime were started. the patient had a spike in fever to 101 while on these antibiotics. sensitivities revealed that the e.coli was resistant to cephalosporins and aztreonam, so meropenem was initiated on . id was consulted and he it was felt the patient would require a 4 week course of antibiotics for the treatment of the esbl (to be completed with ertapenem on discharge due to daily dosing). a picc line was placed. on , maintenance blood cultures drawn from the picc were noted to be positive for yeast ( parapsilosis). this picc was removed and all subsequent blood cultures were negative. id recommended initial treatment in micafungin which was switched to fluconazole upon discharge. he will need to continue a 2 week course of fluconazole for treatment of his fungemia. at the time of discharge, the patient was afebrile and hemodynamically stable; all surveillance blood cultures subsequent to were negative. 2. left gangrenous heel: mr. was evaluated by podiatry for his left foot ulcer. mri was without evidence of osteomyelitis. the wound was debrided on . during the debridement, there was concern for vascular insufficiency and vascular surgery was consulted to assess the patient's blood supply to his lower extremities. an angiogram and balloon angioplasty of the left anterior/posterior tibial arteries was performed on . this was tolerated well. the patient was started on plavix therapy and should continue which should continue for the next 30 days. he will need to follow-up in the vascular clinic with dr. office next month. 3. myasthenia : mr. had a history of myasthenia and neurology was consulted upon admission. he was initially on cellcept but his was discontinued upon admission given his infections. he was, however, continued on prednisone 15 mg daily. given the patient's history of myasthenic crisis, q4 hr neuro checks and q4 hr nif were in place following his angioplasty and debridement. on , the patient's nif was noted to drop from 80 to 40 and complained of right eye and arm weakness. he was transferred to the icu for concern of worsening mg and plasmapheresis was initiated. after a 24h uneventful observation period, he was felt to be stable and was transferred to the neurology service. he completed 4 rounds of plasmapheresis with good improvement of his symptoms and throughout his remaining hospitalization, the patient had a stable neurologic exam notable only for right eye ptosis and esotropia. he was discharged on 10mg prednisone daily and was scheduled for follow-up in the neuromuscular clinic. 4. diabetes: the patient was noted to have elevated blood sugars during this hospitalization which were felt to be due, in part, to his use of steroids and his infections. he was seen by the consult service and his sugars where monitored throughout his hospital course. with the decreased prednisone prior to discharge, the patient's evening lantus dose was decreased to 65 units per night. he was instructed to continue monitoring his blood sugars at home and to contact his pcp with any concerns or noticeable changes in glucose control. medications on admission: atenolol 12.5 mg daily lantus 80 unit qhs humalog insulin sliding scale lisinopril 5 mg cellcept mg prednisone 15 mg daily pyridostigmine 60 mg x daily prn silver sulfadiazine 1% cream apply to heal daily simvastatin 10 mg daily bactrim dose uncertain calcium 1250 mg daily vitmain d 200 u lansoprazole 15 mg daily discharge medications: 1. ertapenem 1 gram recon soln sig: one (1) gram intravenous daily () for 2 weeks: last dose to be given on . disp:*qs gram* refills:*0* 2. fluconazole 200 mg tablet sig: two (2) tablet po once a day for 2 weeks: last dose to be on . disp:*28 tablet(s)* refills:*0* 3. atenolol 25 mg tablet sig: 0.5 tablet po daily (daily). 4. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily): do not take while you are on antibiotics . 5. plavix 75 mg tablet sig: one (1) tablet po once a day for 20 days. disp:*20 tablet(s)* refills:*0* 6. insulin glargine 100 unit/ml solution sig: sixty five (65) units subcutaneous at bedtime. 7. insulin lispro 100 unit/ml solution sig: five (5) units subcutaneous three times a day: as per your sliding scale. 8. prednisone 5 mg tablet sig: two (2) tablet po once a day. 9. mestinon 60 mg tablet sig: one (1) tablet po four times a day: for myasthenia . 10. lansoprazole 15 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 11. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day). 12. lisinopril 5 mg tablet sig: one (1) tablet po twice a day. 13. calcium carbonate-vitamin d3 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: americare vna discharge diagnosis: primary diagnoses 1. diabetic foot ulcers 2. bacteremia 3. fungemia 4. myasthenia . secondary diagnoses 1. diabetes mellitus, type ii 2. peripheral vascular disease discharge condition: the patient was hemodynamically stable. he had intermittant diplopia but no appreciable weakness on exam. discharge instructions: you came to the hospital after your podiatrist noticed that you were not feeling well at your appointment. at the hospital, you were found to have bacteria in your blood that came into your blood through the ulcers in your foot. you were given antibiotics through your iv. you underwent debridment of your left foot and will need to continue antibiotics for the next 2 weeks as an outpatient. these include iv ertapenem and an oral anti-fungal called fluconazole. . while on these antibiotics, you should not take your simvastatin. you can restart this medication on . you underwent angioplasty of your left leg to help improve blood flow to your wound. you will need to take a blood thinner (plavix) for the next 20 days to help keep this blood flow. you will need to follow-up with your dr. of vascular surgery. please call ( to schedule an appointment at your convenience. during this hospitalization you underwent plasmaphoresis for the treatment of your myasthenia . because of your infection, your cellcept was discontinued and your prednisone dose was lowered. you should now take 10mg of prednisone daily. while on steroids such as prednisone, it is very important to test your blood sugars several times a day. be sure to let your doctor know if your blood sugars are too high or too low. you should be taking 65mg of glargine insulin nightly. please contact your primary care doctor or seek immediate medical attention if you develop fever, shortness of breath or chest pain, muscle weakness, changes in your vision or have bleeding from your foot. followup instructions: pcp: pcp, dr. , call you to set up an appointment. clinic provider: , m.d. phone: date/time: 11:30 podiatry: provider: , dpm phone: date/time: 1:10 infectious disease: id, medical building 02:30p neuro-ophthalmology: dr. 01:30p ( sc clinical ctr, please call to arrange for follow-up with dr. of vascular surgery to evaluate the blood flow in your legs. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries excisional debridement of wound, infection, or burn aortography therapeutic plasmapheresis local excision of lesion or tissue of bone, tarsals and metatarsals application of pressure dressing procedure on two vessels diagnoses: unspecified essential hypertension long-term (current) use of steroids acute kidney failure, unspecified hyposmolality and/or hyponatremia polyneuropathy in diabetes bacteremia long-term (current) use of insulin disseminated candidiasis carrier or suspected carrier of methicillin resistant staphylococcus aureus other and unspecified infection due to central venous catheter diabetes with other specified manifestations, type ii or unspecified type, uncontrolled other toe(s) amputation status gangrene cellulitis and abscess of foot, except toes ulcer of heel and midfoot acute osteomyelitis, ankle and foot diabetes with neurological manifestations, type ii or unspecified type, uncontrolled other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms other bone involvement in diseases classified elsewhere chronic osteomyelitis, ankle and foot diabetes with peripheral circulatory disorders, type ii or unspecified type, uncontrolled myasthenia gravis with (acute) exacerbation 

Answer: The patient is high likely exposed to