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: l. foot infection major surgical or invasive procedure: 1) debridement of left lower extremity fifth toe/ray amputation. 2) serial arteriogram of the left lower extremity. 3) left superficial femoral artery to anterior tibial artery bypass graft using reversed greater saphenous vein, angioscopy, vein inspection and valve lysis. 4) debridement of wound including bone and partial closure of wound over left fifth ray, left foot. history of present illness: this is a 54 y/o male with a known vascular pathology history, who presents with a l. lateral foot infection since 7 days ago. the patient noticed redness and swelling 7 days ago and then noticed the ulcer and odor over the past three days. over the past three days, the pain increased and the patient self-treated the wound with alcohol swabs and bacatracin. the patient states some neuropathy, but has foot sensation. the patient denies chills/fever, constitutional symptoms, nausea/vomitting, rest pain, lle pain on ambulation, or wound drainage. his last vascular procedure was an angioplasty of the rle trifurcation for ischemic pain at this past . past medical history: vascular risk factors: diabetes, hypercholesterol, hypertension, obesity, smoking history. vascular history: stent placement: ? le, cardiac. past medical history: htn, dm, hypercholesterolemia, cad, pvd, psoriatic arthritis past surgical history: cabgx5 cerebral angiogram multiple cardiac and le angioplasties and stents (last angioplasty le ) social history: former is consultant, now on disability. lives with sister. former quite about 9yrs ago 40ppy history; drinks 1-2 drinks/day family history: several uncles on his father's side had strokes in their 50's, father cad physical exam: on admission: vital signs: temp: 98.7 rr: 16 pulse: 96 bp: 162/92 neuro/psych: oriented x3, affect normal, nad. neck: no masses, trachea midline, no right carotid bruit, no left carotid bruit. skin: abnormal: l. dorsum of foot psoriatic lesion, abd psoriatic lesion. heart: regular rate and rhythm. lungs: clear, normal respiratory effort. gastrointestinal: abnormal: obese, nt. rectal: not examined. extremities: abnormal: lle mid-calf 2+ edema. pulse exam (p=palpation, d=dopplerable, n=none) rue radial: p. lue radial: p. rle femoral: p. popiteal: p. dp: d. pt: d. lle femoral: p. popiteal: p. dp: d. pt: d. description of wound: l. lateral foot: 2cm diameter gangrenous eschar over metatarsal head, fluctuant with no drainage, mildly tender, l. lateral foot erythema/swelling, odorous on discharge: afvss gen: nad, aox3 cvs: reg pulm: no resp distress abd: s/nt/nd wound: lle staples intact, c/d/i lle: graft dop, dp dop, pt dop pertinent results: admission labs: 02:01am blood wbc-10.3 rbc-4.06* hgb-11.9*# hct-36.3* mcv-89 mch-29.3 mchc-32.8 rdw-13.9 plt ct-334 10:43pm blood pt-13.0 ptt-27.1 inr(pt)-1.1 10:43pm blood esr-90* 02:01am blood glucose-105* urean-25* creat-1.6* na-139 k-4.1 cl-99 hco3-29 angap-15 02:01am blood calcium-9.5 phos-3.2 mg-1.9 10:43pm blood crp-88.4* discharge labs: 04:29am blood wbc-9.3 rbc-3.28* hgb-9.7* hct-28.4* mcv-87 mch-29.5 mchc-34.0 rdw-16.8* plt ct-315 04:29am blood plt ct-315 01:40am blood pt-13.5* ptt-25.6 inr(pt)-1.2* 04:29am blood glucose-133* urean-23* creat-1.6* na-138 k-3.9 cl-103 hco3-26 angap-13 04:29am blood calcium-8.4 phos-3.7 mg-2.0 path: l fifth toe : - skin and subcutaneous tissue with necrosis, acute and chronic inflammation, abscess formation, and granulation tissue. - bone margin free of acute inflammation. non-invasive arterial studies : on the right, essentially normal study except for noncompressible vessels. on the left, there is significant popliteal/tibial artery occlusive disease. le doppler : patent left greater saphenous vein with suitable diameters. echo : poor technical quality due to patient's body habitus. left ventricular function is probably mildly depressed with global hypokinesis, a focal wall motion abnormality cannot be fully excluded (even after the addition of echo contrast). the right ventricle is not well seen but is probably normal. no pathologic valvular abnormality seen. moderate pulmonary artery systolic hypertension is seen. lvef = 45-50%. stress test : the patient was infused with 0.142 mg/kg/min of dipyridamole over 4 minutes. no arm, neck, back or chest discomfort was reported by the patient throughout the study. there were no significant st segment changes during the infusion or in recovery. the rhythm was sinus with rare isolated vpbs and 1 apb. appropriate hemodynamic response to the infusion. the dipyridamole was reversed with 125 mg of aminophylline iv. impression: no anginal type symptoms or ischemic ekg changes. nuclear report sent separately. cardiac perfusion scan : 1. enlarged left ventricle. calculated lvef 51%. 2. severe fixed perfusion defect in the distal anterior wall. 3. moderate reversible perfusion defect at the apex. l foot xray : there has been amputation of the fifth ray at the mid metatarsal shaft level. brief hospital course: mr. was admitted on with a left lateral foot infection of 1 week duration. he was started on triple antibiotics (vancomycin, cipro, flagyl), and was made npo for a procedure. on , the patient underwent a left 5th toe amputation. pathology showed skin and subcutaneous tissue with necrosis, acute and chronic inflammation, abscess formation, and granulation tissue. the bone margin was free of acute inflammation. the wound was initially managed with wet-to-dry dressings, then a wound vac, and then wet-to-dry dressings again. on , the patient underwent abis/pvrs, which showed an essentially normal study on the right except for noncompressible vessels and significant popliteal/tibial artery occlusive disease on the left. on , the patient underwent a lle angiogram, which showed the following: angiographic findings: 1. normal-appearing distal abdominal aorta without evidence of being aneurysmal or stenotic disease. 2. patent bilateral common iliac arteries. 3. patent bilateral hypogastric arteries. 4. patent bilateral external iliac arteries. 5. the left common femoral and profunda femoris artery were patent. 6. the left superficial femoral artery was patent. 7. the above-knee popliteal artery was patent. however, the below-knee popliteal artery was occluded. there are large geniculate branches and collaterals that reconstituted the anterior tibial artery and peroneal arteries. 8. the anterior tibial artery was occluded proximally, however, it did reconstitute with in-line flow to the foot through the dorsalis pedis artery. the midportion of artery was heavily diseased. 9. the peroneal artery was occluded proximally but reconstituted and proceeded down to the ankle where it provided the posterior branch. 10.the posterior tibial artery was occluded. it was decided to perform a femoral to distal pedal bypass. given the significant psoriatic plaques on the dorsum of the left foot, dermatology was consulted. they recommended applying urea 40% cream over psoriatic plaques at night under occlusion and clobetasol 0.05% ointment to the plaques each morning. there was no contraindication to surgery. this advice was followed with good result. shortly after the angiogram, the patient experienced a gout flare in his right knee. rheumatology was consulted and suggested avoiding colchicine and indomethacin given his arf. the knee was tapped, confirming gout, and intraarticular steroids were administered. the patient was also started on prednisone 30mg po daily with good effect. also following the angiogram, the patient experienced a small rise in his cr to 1.9 from his baseline of 1.1. renal was consulted, and they felt that this was a combination of contrast nephropathy, transient hypotension in the operating room, and intrinsic kidney disease. his vancomycin and cipro doses were adjusted with a decrease in his cr over time. the patient was evaluated by cardiology during this time to assess his candidacy for surgery. echo showed that his left ventricular function is mildly depressed with global hypokinesis and ef 45-50%. the stress test did not show any ischemic changes. a nuclear scan showed the following: 1. enlarged left ventricle. calculated lvef 51%. 2. severe fixed perfusion defect in the distal anterior wall. 3. moderate reversible perfusion defect at the apex. cardiology deemed him a candidate for surgery. on , the patient underwent a left superficial femoral artery to anterior tibial artery bypass graft using reversed greater saphenous vein, angioscopy, vein inspection and valve lysis. he tolerated the procedure well and was taken to the pacu in good condition. his left pt and dps were dopplerable. he received 2 uprbc postoperatively. he was then transferred to the vicu for further recovery. while in the vicu he recieved monitered care. he followed the distal bypass pathway with initial bedrest, followed by activity as appropriate. when he was stabilized from the acute setting of post operative care, he was transfered to floor status. his diet was advanced, which was tolerated well. his foley catheter was removed, and he voided successfully. he experienced arf as described above. after the cr began to fall, the patient's lasix was restarted and he diuresed well. his asa and plavix were restarted on pod1. he required intermittent blood transfusions for hct < 30. there was an ooze from the medial edge of the bypass wound but no large bleed. the ooze was controlled with a stitch. triple antibiotics were continued until the day of discharge. antibiotics were switched to a course of augmentin for 2 weeks upon discharge since the wound culture grew out group b strep. all other cultures were negative. endocrine-wise, his blood glucose was controlled with an insulin sliding scale with good effect. on , the patient underwent a debridement and partial closure of the left foot wound. podiatry cleared him for full-weight bearing on the heel. physical therapy saw the patient throughout his stay and recommended rehabilitation. final consult service recommendations: renal: expect full renal recovery, no additional recommendations. dermatology: continue applying creams as directed. resume enbrel treatment per outside dermatologist after discharge. cardiology: switch amlodipine to imdur for edema. please speak with your cardiologist about this. podiatry: heel weight bear lle; follow up with dr. in 1 week. rheum: decrease dosage of prednisone by 10mg every three days starting today until you are taking no prednisone. on the day of discharge, the patient was in good condition. his pain was well-controlled with po pain medications, and he was eating, voiding, and out of bed with assistance. medications on admission: avandia 4mg po bid, glypizide 5mg po daily, metoprolol 100mg po bid, amlopdipine 7.5mg po daily, moxipril 15mg po daily, lasix 40mg po daily, crestor 10mg po daily, enbrel 50mg sq qweek, plavix 75mg po daily, asa 325mg po qdaily discharge medications: 1. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). 2. amlodipine 2.5 mg tablet sig: three (3) tablet po daily (daily). 3. rosuvastatin 5 mg tablet sig: two (2) tablet po daily (daily). 4. insulin regular human 100 unit/ml solution sig: one (1) sliding scale injection asdir (as directed). 5. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. urea 20 % cream sig: one (1) application topical qpm (). 9. prednisone 10 mg tablet sig: three (3) tablet po daily (daily). 10. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 11. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 12. clobetasol 0.05 % cream sig: one (1) appl topical qam (once a day (in the morning)). 13. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 14. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 15. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 16. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). tablet(s) 17. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 2 weeks. tablet(s) 18. avandia 4 mg tablet sig: one (1) tablet po twice a day. 19. glipizide 5 mg tablet sig: one (1) tablet po once a day. 20. aspirin 325 mg tablet sig: one (1) tablet po once a day. tablet(s) discharge disposition: extended care facility: at discharge diagnosis: left lower extremity ischemia and left foot infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: what to expect when you go home: 1. it is normal to feel tired, this will last for 4-6 weeks ??????you should get up out of bed every day and gradually increase your activity each day ??????unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs ??????increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have swelling of the leg you were operated on: ??????elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ??????avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ??????you will probably lose your taste for food and lose some weight ??????eat small frequent meals ??????it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ??????to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ??????no driving until post-op visit and you are no longer taking pain medications ??????unless you were told not to bear any weight on operative foot: ??????you should get up every day, get dressed and walk ??????you should gradually increase your activity ??????you may up and down stairs, go outside and/or ride in a car ??????increase your activities as you can tolerate- do not do too much right away! ??????no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ??????you may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ??????your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ??????take all the medications you were taking before surgery, unless otherwise directed ??????take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ??????call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ??????redness that extends away from your incision ??????a sudden increase in pain that is not controlled with pain medication ??????a sudden change in the ability to move or use your leg or the ability to feel your leg ??????temperature greater than 100.5f for 24 hours ??????bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: provider: , md phone: date/time: 1:00 please see your private cardiologist within 1 week. discuss the pros and cons of switching amlodipine to imdur. please see your primary care physician 1 week. discuss restarting embrel. procedure: arteriography of femoral and other lower extremity arteries amputation of toe other (peripheral) vascular shunt or bypass aortography arthrocentesis local excision of lesion or tissue of bone, tarsals and metatarsals local excision of lesion or tissue of bone, tarsals and metatarsals diagnoses: pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes personal history of tobacco use percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified ulcer of other part of foot obesity, unspecified atherosclerosis of native arteries of the extremities with gangrene acute gouty arthropathy cellulitis and abscess of foot, except toes diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled peripheral angiopathy in diseases classified elsewhere psoriatic arthropathy 

Answer: The patient is high likely exposed to