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: valium attending: chief complaint: right charcot foot with chronic ulceration major surgical or invasive procedure: 1. complex charcot reconstruction with extensive internal fixation. 2. medial plantar artery based fasciocutaneous tissue flap 3. flexor digitorum brevis muscle flap right foot. 3. split-thickness skin graft. 4. excisional debridement of plantar cuboid ulcer. 5. percutaneous tendon achilles lengthening. 6. placement of external fixator 7. placement of picc 8. epidural 9. arterial line history of present illness: 56f with dm, htn with severe charcot feet admitted post-operatively following right foot charcot reconstruction, medial artery flap and stsg. pt has had a chronic ulceration plantar to her cuboid for approximately two years and states that she had a bump on the bottom of her foot that required surgery after the bump burst about 1.5 years ago. subsequently, she has had numerous treatments including surgery as well as 55 dives in hyperbaric oxygen chamber. she also had an exostectomy and resection of an infected cuboid with application of an external fixator. a bk amputation had been proposed however the patient elects to go forth with a limb salvage procedure and reconstruction. past medical history: mrsa hx ekg with inferior q's 3, avf noted on prior dyslipidemia hypertension dm2 with neuropathy nephropathy gastritis glaucoma previous surgeries 1. left ovarian cystectomy 2. cholecystectomy 3. c-sections x 5 4. toe amputation 5. multiple right foot surgeries social history: denies tobacco, etoh lives with her husband in family history: n/c physical exam: appearance: obese, anxious woman heent: eomi, perlla heart: rrr, ns s1 s2, no murmurs lungs: clear to auscultation bilaterally abdomen: nt/nd, +bs neuro: cn 2-12 grossly intact le: vascular pedal pulses: weakly palpable non-palpable sub-papillary vft: < 3 sec. > 3 sec. immediate extremities: pitting edema non-pitting edema anasarca neurological sensation: intact absent proprioception: intact absent dressings: clean/dry intact since or procedure pertinent results: admission labs: 06:05am blood wbc-9.4 rbc-3.22* hgb-10.6* hct-30.8* mcv-96 mch-32.9* mchc-34.4 rdw-13.0 plt ct-301 06:05am blood glucose-50* urean-16 creat-1.0 na-142 k-4.7 cl-108 hco3-29 angap-10 06:05am blood albumin-2.5* calcium-8.5 phos-4.1 mg-1.7 06:05am blood %hba1c-11.4* discharge labs- wbc- 9.6 h/h- 3.9/28 plts- 469 other labs- glucose urean creat na k cl hco3 angap 05:57am 118* 14 1.5* 142 4.7 104 29 14 source: line-picc 05:29am 133* 17 1.5* 140 4.7 105 30 10 * 25* 2.3* 137 5.3* 105 24 13 alt ast ld ck alkphos 05:13am 10 10 189 115 0.2 hematologic caltibc ferritn trf 05:32am 176* 184* 135* diabetes monitoring %hba1c 06:05am 11.4* pituitary tsh 05:52am 3.5 other endocrine cortsol 05:52am 29.3*1 . 9:40 am tissue bone right foot. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. tissue (final ): reported by phone to @ 1:25 pm. this is a corrected report . reported by phone to dr 1145am. due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. staphylococcus, coagulase negative. rare growth. previously reported as staph aureus coag + (). anaerobic culture (final ): no anaerobes isolated. . 7:42 am swab source: right heel. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. 2+ (1-5 per 1000x field): gram negative rod(s). wound culture (final ): morganella morganii. moderate growth. klebsiella pneumoniae. moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ morganella morganii | klebsiella pneumoniae | | ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- 16 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s anaerobic culture (final ): no anaerobes isolated. . 7:25 am swab source: r foot. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. anaerobic culture (final ): no anaerobes isolated. . ekg: sinus brady vs wandering atrial pacemaker @ 41. nl axis and intervals. q iii, avf, no ischemic st-t deviations. compared with q waves are old and p wave voltage smaller. cxr - since , there is no vascular engorgement. subsegmental retrocardiac atelectasis persists and right basilar atelectasis slightly decreased. heart size is unchanged, seems enlarged. the aorta is mildly tortuous. right picc ends in mid svc. tte - the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. the right atrial pressure is indeterminate. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with normal free wall contractility. there is abnormal septal motion/position. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . v/q scan: poor quality study. matched perfusion and ventilation defects. low prob for pe but cannot exclude. . renal ultrasound findings: the right kidney is normal in size and appearance, measuring 10.0 cm. the left kidney is normal in size and appearance, measuring 10.1 cm. there is no nephrolithiasis or hydronephrosis. limited visualization of the surrounding soft tissues is within normal limits. impression: normal appearance of the kidneys bilaterally. specifically, no hydronephrosis seen. . u/s le bilateral impression: no evidence of dvt. - cxr portable - no significant changes, bilateraly basilar atelecatsis. brief hospital course: # charcot foot reconstruction/wound infection: admitted for right charcot foot reconstruction with external fixation. the patient tolerated the procedures and anesthesia well without complications (see op report for full details). the acute pain service was made aware of this patient for pre & post-op pain management. an epidural was placed and ms contin and msir with a pca. the pca was discontinued on . on the epidural was d/c'ed and the patient had adequate pain control with the ms contin & msir. on the patient had her first dressing change. the skin graft had taken. at discharge her pain was controlled to morphine ir and tylenol with close observation for sedation. podiatry followed patient post operativley. she had been intermittent febrile in excess of 101f daily on /08. she developed a wound infection, started on vanco and zosyn, then culture showed klebsiella and morganella, changed to cipro for 14 day course. also started on clindamycin since second wound culure showed mixed flora. will also need 14 course. podiatry created a drain for wound due to a fluid collection. then recommended every other day dressing changes for wound care. will need podiatry follow up in 2 weeks. sutures removed . # hypotension/bradycardia: developed hypotension on am afer going to commode. hr 40s, bp 62/40. she was bolused with ivf and an ekg was obtained that showed sinus bradycardia without acute ischemic changes. had only transient improvement to the sbp >100s over the next several hours with ivf. her coreg was last given on at 9am. also of note, decreased urine output during this period. she was sent to icu. possible etiologies for bradycardia included primary cardiac event, pneumonia, pe, shock, sick sinus, med side effect, or vagal effect. ep consult felt vagal effect was more likely either from infection, neuropathy, or foot pain. it was felt unlikely to be either an mi or a pe- no significant ischemic st-t changes. v/q scan low probability but poor image. le dopplers negative for dvt. required dopamine drip. on the morning of , she was no longer bradycardic. her rate acutely increased from 40s to 70s and her bp also increased. dopamine was discontinued. this episode is possibly explained by sepsis, since foot culture was growing gnr. patient was initially placed on asa 325 but discharged on 81mg for cardio protection. # acute on chronic renal failure: baseline cr appears ~1 but she was elevated to 2.3 on admission creatinine improved to around 2.0. this was felt to be likely pre-renal +/- post-obstructive (relieved with foley placement). after hypotension episode post-op cr rose again, likely from atn, peak of 2.3. improved by discharge to 1.3-1.5. # hypertension: coreg was stopped during hypotensive event above. once patient became hypertensive to 150-160's again, she was started on ace-i, due to hx of dm. bp was well controlled. this medication dose may need to be adjusted if bp increases again. her lasix was held during her arf, and was not restarted. # anemia: felt to be multifactorial anemia from ckd, anemia of chronic disease, mild blood loss from procedures. normocytic anemia, no evidence of active bleeding. iron studies did not show iron deficiency. # diabetes mellitus type 2 with complication of neuropathy: was continued on lantus and ssi. had blood sugars in 60-100 . lantus was decreased to glargine 30 qhs and placed on less aggressive sliding scale. byetta was given at first and then held after hypoglycemia and patient ran out of this medication (she was taking her own). last aic was 11.4%. # patient was on protonix while in hospital but stopped before discharge. she was on first on heparin sc and then lovenox sc for dvt prophylaxis. , elavil, and phenergan were held. she may need to restart these medications if needed. # hypoxia: during her hospital course the patient had intermittent hypoxia, while in the icu she was ruled out for a pe with a vq scan with low probability and a bilaterally doppler of the lower extremities with no dvt. she was on heparin sc initially then changed to lovenox 40mg sc. she has a known dx of sleep apnea and has been unwilling to use cpap. her oxygen saturation the night before discharge was 91% on 2l, in the am she had saturation in the 80s on ra, but with deep breathing it increased to 98%on ra within 1-2 minutes. patient is asymptomatic during these periods and not sob. appears to have hypoxia hypoventilation, likely worsen by obesity and sleep apnea. she had a cxr before discharge that showed only bibasilar atelecatsis, with some improvment from prior cxr on . she may require oxygen to keep saturations >92%. she needs to continue to use her spirometer 10 times per hour and be encouraged to take deep slow breaths. she may need a further work up as an out patient. she will be discharged to a rehab facility in ny state where she lives. she will have follow up with podiatry and her primary care doctor. medications on admission: carvedilol (6.25 mg twice daily) crestor (rosovastatin) (40 mg daily) elavil (amitriptyline)(25 mg daily) furosemide (20 mg daily) insulin (byetta 10 mg twice daily, lantus 35 units morning and evening, humalog sliding scale) morphine oxycontin 45 mg twice daily phenergan (promethazine 25 mg three times daily) zetia (ezetimibe) (10 mg daily) gabapentin 600 mg three times daily soma 350 mg daily minocycline 100 mg twice daily lortab 75 mg as needed discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever or pain: max 4 grams per day. disp:*qs tablet(s)* refills:*0* 3. lantus 100 unit/ml solution sig: thirty (30) units subcutaneous once a day: give at dinner time. 4. humalog 100 unit/ml solution sig: one (1) subcutaneous three times a day: sliding scale sent from hosptial. 5. enoxaparin 40 mg/0.4 ml syringe sig: one (1) subcutaneous daily (daily): continue while in rehab. 6. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 7. gabapentin 300 mg capsule sig: two (2) capsule po daily (daily). 8. morphine 15 mg tablet sig: one (1) tablet po every four (4) hours as needed for prn pain: hold for sedation. rr<12. 9. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 10. rosuvastatin 20 mg tablet sig: two (2) tablet po daily (daily). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for loose stool. 12. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily): hold for sbp<100 . 13. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day) as needed for constipation. 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 15. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals): start giving when done with cipro (antibiotic). 16. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 17. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days: last day of treatment . 18. clindamycin hcl 150 mg capsule sig: two (2) capsule po q6h (every 6 hours) for 12 days: give for total of 14 days, first day on . discharge disposition: extended care facility: health nursing & rehab discharge diagnosis: -charcot foot repair -diabetes type ii -hypertension -mixed flora wound infection -acute renal failure, secondary to atn from hypotension, resolving -anemia, multifactoral -sleep apnea discharge condition: hemodynamically stable, afebrile, foot in external fixation. discharge instructions: you were admitted to for foot surgery. after your sugery you developed a low blood pressure and slow heart rate this required a stay in the icu. you have an infection in your foot. you are on two antibiotics for this infection. you will need every other day dressing changes for your foot. you will be going to a rehab center to care for your foot. you were started on a new medicaion for your blood pressure. please keep your follow up appointments. you will need to see the podiatrist and your pcp. please take your medications as instructed. several of your medicaions have been changed. if you have chest pain, shortness of breath, fever, increased drainage from your foot, or any other concerning symptom please seek medical attention or go to the er. followup instructions: podiatry, please call to make a follow up appointment with dr. in 2 weeks. ( please call your pcp to make follow-up appointment as soon as you leave the hospital, discuss your stay, she may adjust your lisinopril dose. pcp: , . procedure: venous catheterization, not elsewhere classified arterial catheterization other skin graft to other sites graft of muscle or fascia local excision of lesion or tissue of bone, other bones application of external fixator device, other bones internal fixation of bone without fracture reduction, other bones other change in muscle or tendon length diagnoses: anemia, unspecified other postoperative infection acute kidney failure, unspecified cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled chronic kidney disease, unspecified unspecified sleep apnea atherosclerosis of native arteries of the extremities with gangrene ulcer of heel and midfoot arthropathy associated with neurological disorders equinus deformity of foot, acquired 

Answer: The patient is high likely exposed to