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: sulfamethoxazole/trimethoprim / wool alcohols / latex / trimethoprim attending: chief complaint: left foot infection. major surgical or invasive procedure: left foot wound debridement with forgein body removal, . bedside left foot wound debridement, . picc line placement, . history of present illness: this is a 59 year old woman with a h/o cad s/p stenting and dm2 who was admitted from podiatry clinic with purulent discharge from left foot ulcer, also with erythema of surrounding tissue. she subsequently became hypotensive and confused, prompting micu transfer. there she became hemodynamically stable with minimal ivf. she was taken to the or for debridement of her wound and removal of hardware . post-op she has had fevers but remained hemodynamically stable. she also developed hypoxia, requiring up to 6l nc, which has improved with diuresis. she has been confused, espcially when her fever is high, but not aggitated. she has been treated with cipro/vanco/flagyl and has strep virdans from her hardware but other cultures negative to date. she had a repeat debridement at the bedside for an area of loculation with purulent discharge. currently she is complaining of pain from neuropathy which is long standing for her. past medical history: -hyperlipidemia -hypertension -cad s/p stent (ef >55%) des to the lad in -tobacco abuse -hypothyroidism -depression -lumbar laminectomy -iddm for over 40 yrs -diabetic neuropathy and retinopathy -obesity social history: disabled. lives w/ husband at home. best friend visits her regularly. etoh: denies tobacco: 1ppd x20 years illicits: denies family history: postive for dm in mother, father, both grandmothers & both grandfathers. physical exam: vs:t> 98.7 bp 100/58, hr 87, rr 18, sat 95% on ra gen: nad. oriented x3. heent: ncat. sclera anicteric. perrl, eomi. op clear, no exudates or ulceration. neck: supple, jvp not elevated.obese cv: rrr, normal s1, s2. no m/r/g. chest: resp were unlabored, no accessory muscle use. ctab, no rales, wheezes or rhonchi. abd: obese, soft, ntnd. no hsm or tenderness. ext: no c/c/edema. 2+pulses. l.foot in gauze wrap. pertinent results: admission labs: 131 95 49 -----------<204 5.1 26 2.0 estgfr: 26/31 (click for details) ca: 8.2 mg: 2.2 p: 5.3 10.6 17.4>-<260 32.1 %hba1c: 8.0 iron 23* ug/dl iron binding capacity, total 247* ug/dl vitamin b12 415 pg/ml folate 9.8 ng/ml ferritin 222* ng/ml transferrin 190* mg/dl alanine aminotransferase (alt) 22 iu/l asparate aminotransferase (ast) 27 iu/l lactate dehydrogenase (ld) 255* iu/l creatine kinase (ck) 266* iu/l alkaline phosphatase 108 iu/l bilirubin, total 0.4 mg/dl c-reactive protein 168.0* esr: 125 wound swab : gram stain (final ): no polymorphonuclear leukocytes seen. 1+ (<1 per 1000x field): gram positive cocci. in pairs. 1+ (<1 per 1000x field): gram negative rod(s). smear reviewed; results confirmed. 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. foot culture : 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.. viridans streptococci. moderate growth. staphylococcus, coagulase negative. sparse growth. staphylococcus, coagulase negative. rare growth. anaerobic culture (final ): no anaerobes isolated. forgein body : viridans streptococci. wound swab : 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. urine cx : no growth. urine cx : no growth. urine cx : no growth. urine cx : mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. blood cultures x6: no growth. blood cultures : pending blood cultures : pending cxr (pa/lat) : impression: no acute cardiopulmonary process. left foot xray : findings: comparison is made to prior study from . since the previous study, there has been migration of several screws consistent with loosening. there is significant backing out of the distal most screw within the talonavicular joint. the screw is no longer flush with the side plate and has migrated more medially by 1.7 cm. there is prominent soft tissue swelling within the medial aspect of the foot. there has also been some backing out of the more proximal screws within the navicular. no acute fractures are identified. there is some gas within the adjacent soft tissues. there is prominent dorsal soft tissue swelling as well. there are extensive neuropathic changes of the mid foot with inferior tilting of the talus. pathology : medial cuneiform, left: bone with necrosis and focal acute inflammation. tte : the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of the mid- and distal lateral walls (lcx territory). the remaining segments contract normally (lvef = 45-50%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. physiologic mitral regurgitation is seen (within normal limits). there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild regional left ventricular systolic dysfunction, c/w cad. no significant valvular disease. mild pulmonary hypertension. cxr (port) : chf with an element of pulmonary edema. patchy opacity at left base likely relates to this, but an early infiltrate would be difficult to exclude. cxr (port) : pulmonary edema has cleared. residual opacification at the left lung base is mild and may represent persistent edema. followup is needed to exclude developing pneumonia. heart size normal. no appreciable pleural effusion. brief hospital course: assessment/plan: 59 y.o. woman with htn, hl, cad, dm, hypothyroidism with left foot infection. 1) left foot infection: this was noted on arrival at her podiatrist, dr. office on . he noted purulence from an ulcer so admitted her for debridement. she was transferred to the icu oovernight after she became hypotensive and confused. the following day she went to the or for wound debridement, bone and screw removal. she was treated initially with vancomycin, ciprofloxacin, and flagyl, but the cipro was changed to zosyn on transfer to the micu. she was febrile during this time as well with an elevated white blood cell count. the following day, , she was noted by podiatry to have continued purulent discharge requiring bedside debridement. she stabilized hemodynamically and transferred out to the floor on . her antibiotics were changed to vancomycin, ciprofloxacin, and flagyl. she had multiple wound cultures which showed gnr's on gram stain, but growth only of strep virdans and coag negative staph. there was osteonecrosis of the bone noted, esr and crp were both markedly elevated consistent with osteomyelitis. she also had a plate that was left in the foot for the charcot deformity repair. she was followed daily by podiatry for wound care and they recommended a wound vac that was placed . she was discharged to complete a 6 week course of vancomycin and likely a 4 week course of ciprofloxacin. since there was no growth of anaerobic bacteria the flagyl was discontinued after 7 days of treatment. she had no growth in her blood cultures and had a transthoracic echocardiogram that did not show any vegetations so was not thought to have an endovascular infection. she will follow up with dr. after discharge and is to maintain non-weight bearing status on the left lower extremity. she worked with physical therapy to be sure she would be safe with transfers at home and have all assistive devices necessary. 2) hypoxia: she developed hypoxia after volume resusciation in the setting of hypotension in the icu. she required diuresis with iv lasix initially but her hypoxia improved. she was restarted on lasix 20mg po for discharge. this will need to be titrated at home depending on her volume status. 3) anemia: normocytic, related to anemia of chronic disease based on her iron studies, b12 and folate were replete. no bleeding was noted and hct remained stable. 4) kideny disease: she was noted to develop acute kidney injury in the context of hypotension but this improved over her hospital course and she was able to restart lisinopril which was titrated up to her home dose. 5) diabetes mellitus: she was initially continued on her home glargine: 45u q am and 70 q pm but had several mornings of hypoglycemia so her pm dose was slowly titrated down. she related these to not eating her normal home foods/snack so she was discharged to resume home dosing. she was otherwise well controlled so required very little sliding scale insulin. 6) systolic heart failure: she did require diuresis as noted above, and her lisinopril and atenolol were held in the context of hypotension but both were restarted in turn and titrated up to her home dose. this was well tolerated. she was also restarted on a home regimen of lasix orally, 20mg . 7) coronary artery disease: she was continued on aspirin and statin, then resumed slowly lisinopril and atenolol. 8) hypothyroid: she was continued on her home levothyroxine. 9) mood: she was continued on home venlafaxine. medications on admission: lipitor 20mg qd celebrex 100mg , asa 325 mg qd ativan 2mg qhs atenolol 50mg qd lisinopril 20mg qd tramadol 100 q4h synthroid 200mcg qd neurontin 800mg q4h insulin lantus 45units q am and 70units q pm with glulisine insulin sliding scale venlafaxine 150mg daily discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. venlafaxine 75 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po daily (daily). 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 7. tramadol 50 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 8. levothyroxine 100 mcg tablet sig: two (2) tablet po daily (daily). 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever. 10. outpatient physical therapy gait training. 11. wheelchair 12. gabapentin 400 mg capsule sig: two (2) capsule po q6h (every 6 hours). 13. brimonidine 0.15 % drops sig: one (1) drop ophthalmic q12h (every 12 hours). 14. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 15. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 16. insulin glargine 100 unit/ml solution sig: forty five (45) units subcutaneous once a day. 17. insulin glargine 100 unit/ml solution sig: seventy (70) units subcutaneous q evening. 18. insulin glulisine 100 unit/ml solution sig: as directed units subcutaneous five times a day: per home sliding scale. 19. outpatient lab work please draw cbc, bun, creatinine, ast, alt, alkaline phosphotase, total bilirubin, vancomycin trough, esr and c-reactive protein one per week on thursdays and fax the result to dr. , infectious disease, fax: (; phone: (. 20. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 weeks: day 1=. disp:*70 tablet(s)* refills:*0* 21. vancomycin 500 mg recon soln sig: 2.5 recon solns intravenous q 12h (every 12 hours) for 5 weeks: last day of antibiotics is . disp:*qs recon soln(s)* refills:*0* 22. wound care please perform wet to dry dressing changes to left food daily until wound vac applied. discharge disposition: home with service facility: home therapies discharge diagnosis: primary: infected diabetic foot ulcer. secondary: diabetes melitus, hypertension, systolic heart failure, coronary artery disease, hyperlipidemia, neuropathy, depression, tobacco use, hypothyroidism. discharge condition: stable vital signs, alert, on room air. discharge instructions: you were admitted with a left foot infection. you were treated by surgical debridement, removal of hardware, and antibiotics. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: please follow up with dr. within 1 week of discharge. please call for this appointment. please follow up with dr. of podiatry on wednesday, at 11:40 am. please call ( for this questions about this appointment. please follow up with dr. of infectious disease on , at 10:00 am. please call ( with questions about this appointment. md procedure: venous catheterization, not elsewhere classified other incision with drainage of skin and subcutaneous tissue local excision of lesion or tissue of bone, tarsals and metatarsals other incision of soft tissue removal of implanted devices from bone, tarsals and metatarsals diagnoses: anemia of other chronic disease coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status ulcer of other part of foot other and unspecified hyperlipidemia chronic systolic heart failure surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation obesity, unspecified dehydration hypovolemia streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy cellulitis and abscess of foot, except toes unspecified osteomyelitis, ankle and foot other mechanical complication of other internal orthopedic device, implant, and graft 

Answer: The patient is high likely exposed to