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: coreg attending: chief complaint: rle stump wound infection, urinary tract infection and altered mental status major surgical or invasive procedure: debridement, primary closure r bka debridement right bk stump failed lumbar puncture times three history of present illness: mr. is a 56 year-old man with a history of kidney transplant x 2, dm, bilateral bka with rle non-healing ulcer (right bka in ), who presents from rehab with ams. of note, he was recently discharged on after being admitted with a chf exacerbation; at that time, he also had a wound vac placed on his right stump and was treated with two weeks of vancomycin for an enterococcus wound infection. he was doing well at his nursing home until the day prior to admission when he was noted to have worsening mental status. he was also found to have a uti and was started on imipenem. on the day of admission, he was found standing next to his bed on his stumps and was combative and noncooperative with nursing home staff, pulling out both his picc and foley. he was then transferred to the ed for further evaulation. . in the ed, initial vs were: t 99.2 p 51 bp 141/83 r 18 o2 97%ra sat. he was given vancomycin and zosyn, later spiked a temperature to 102.9 rectal which resolved with pr tylenol, and was placed in wrist restraints for combativeness. his right bka was draining purulent material and vascular was consulted, with a recommendation to start broad spectrum antibiotics. he was also noted to have diarrhea and an abdominal ct was performed to rule out colitis or an abdominal process, with an initial read that was negative. because of his history of vre, he was also given linezolid and then ceftriaxone 2g/acyclovir 50 mg x 1 to cover for meningitis. an lp was attempted (3 passes) but was unsuccessful. he was admitted to the micu because of his severe agitation and concern that he would fail management on the floor. . on the floor, he was agitated but intermittently cooperative with interview and exam. past medical history: - chf with known ef 25-35% - pvdf with a right foot nonhealing ulcer s/p right sfa-to-dp bypass graft, a nonreverse saphenous vein in , a left bka in , r bka - esrd secondary to his diabetes s/p failed llrt in , second lrrt in (stable) - cad s/p myocardial infarction, s/p angioplasty with stent placement - htn - cva - type 1 insulin dependent diabetes with triopathy - gerd - hyperlipidemia on a statin - left avf fistula - chronic diarrhea to ? diabetic autnomic neuropathy - recent . enterococcus stump infection, on social history: lives alone, recently in a rehab facility. has an intermittent smoking history of approximately 20-30 packyears. smoked 1 cigarette today. denies etoh or other drug use. family history: m: colon ca f: prostate ca physical exam: vitals: t: 98 bp: 128/70 p: 80 r: 18 o2: 97%ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: 2+ rle edemma, no edema lle. r bka stump with erythema, s/p vac dressing removal, 3 cm ulcerated wound on anterior stump, base of stump also with ulcertation, erythema, and purulent vs fibrinous appearing material. pertinent results: 06:00pm urine comment-sperm seen 06:00pm urine rbc-0-2 wbc-* bacteria-few yeast-none epi-0-2 06:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-15 bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 06:00pm neuts-80.2* lymphs-14.2* monos-4.8 eos-0.7 basos-0 06:00pm wbc-7.2 rbc-3.44* hgb-10.0* hct-30.9* mcv-90 mch-29.0 mchc-32.3 rdw-14.9 06:00pm ck-mb-notdone 06:00pm ctropnt-0.14* 06:00pm lipase-7 06:00pm alt(sgpt)-11 ast(sgot)-24 ck(cpk)-83 alk phos-263* tot bili-0.4 ct head : impression: no acute intracranial pathology including no hemorrhage. ct abdomen pelvis : 1. cardiomegaly, small pericardial effusion and small bilateral pleural effusions, body wall edema. findings likely secondary to volume overload. 2. small amount of gas in bladder, mild bladder wall thickening and perivesical stranding may be seen in the setting of infection. recommend clinicalcorrelation. 3. bilateral atrophic native kidneys are in place. transplanted kidney is noted within the right lower quadrant area. 4. cholelithiasis with no evidence of cholecystitis. 5. extensive atherosclerosis with prior right sfa stenting. knee xray : the patient is status post right-sided below-the-knee amputation. there is soft tissue gas in an ulcer adjacent to the distal tibial stump. however, the cortical margins are unchanged and preserved since the previous study. underlying osteomyelitis is likely given the development of the ulcer extending to exposed bone (best seen on the lateral view). there is increase in the soft tissue swelling since the prior study. vascular calcifications are identified. operative report debridement: preoperative diagnosis: nonhealing right bka stump postoperative diagnosis: nonhealing right bka stump assistant: , m.d. reason for procedure: mr. is a 56-year-old male who underwent right below-the-knee amputation a bout a month ago. he was found standing next to his bed on his bka stumps at rehab, confused and combative and was admitted to for stump infection and ms changes. the decision was made to debide the stump back to viable bone and soft tissue. the procedure was discussed in detail and the patient signed an informed consent prior to the procedure. operative note: the patient was taken to the operating room and the right leg was prepped and draped in the usual sterile fashion. a spinal block was performed and level was confirmed. a ronjour was then used to trim the tibia to healthy, bleeding bone which only required removal of about 1cm of distal tibia. skin and soft tissue was also debrided to healthy tissue. there was a pocket between the anterior and posterior compartments that contained a 20cc fluid collection. this fluid was sent for aerobic and anaerobic cultures. hemostasis was achived and a occlusive negative pressure dressing was placed with continuous suction at 100mmhg. the patient's indwelling foley catheter was removed at the request of the primary team. the patient awoke from mac sedation, tolerated the procedure well, and was taken to the pacu uneventfully. the estimated blood loss of the procedure minimal. complications: none brief hospital course: patient is a 56 year old male s/p kidney transplant x 2, dm1, bilateral bka with rle stump who presented with ams secondary to sepsis from uti and osteomyleitis from stump site infection. patient is s/p multiple debridements and primary closure done by vascular surgery currently on tobramycin. . # right bka stump infection / osteomyelitis - s/p bka procedure in by vascular surgeon, dr. . on previous admission , pt had a wound vac placed on his right stump and was treated with two weeks of vancomycin for an (vse) enterococcus wound infection. previously this infection cultured out vre and required treatment with linezolid, but id not recommending any antibiotics at this time. initially presented with overlying cellulitis, responded well to 5 days of ctx that was given for uti. contributed to altered mental status on initial presentation. was found to have osteo in the stump and underwent surgical debridement on . wound vac was changed on . went to or today for primary clousure. patient is to continue wet to dry dressings. patient had wound vac placed by vascular surgery and to have outpatient follow up. patient is having tobramycin given at 240mg iv, first day on , initially dosed q48h but will be dosed per through levels, <1.0. pain medication regimen adjusted, percocet po and dilaudid po for breakthru pain. id will assist in medication dosing. . # resolved altered mental status: on intial exam and at time of admission to unit and at time of my initial exam on the floor, patient had altered mental status. at ecf, patient was agitated and pulling out lines. patient is calm at this time. ams was thought to be in the setting of infection from uti vs wound infection. other causes were considered including, meningitis less likely given absence of nuchal rigidity and photobia. had failed lp x3, was placed on meningitis ppx with linezolid/ctx/acyclovir until cleared by neuro with exam with no focal deficits. head ct negative. agiation initially required physical and pharmacological restriants. currently, alert and oriented times three and full insight but has waxing and . patient may benefit from outpatient psych. . # resolved urinary tract infection - from rehab had pan-sensitive e coli uti that was being treated with imipeniem for unclear reasons. had foley placed in ed. patient's repeat ua on was clean, iv ceftriaxone was stopped after 5d course. . # stage 2 sacral decubti - stable, not superinfected . # chronic diarrhea - has been worked up throughly by gi in the past. c diff negative again on this admission. symptomatic treatment with loperamide . # kidney transplant/acute renal failure: status post failed llrt in , second lrrt in , and on prednisone, tacrolimus and sirolimus as outpatient. had tacrolimus dose decreased from 4 mg to 2 mg po bid during last admission. transplant team following. cr above baseline of 1.4. function progressively improving. continued tacrolimus and prednisone. renal transplant to follow up as outpatient to determine restarting serolimus. . # chronic schf/cad, ef 25%: had troponin leak on this presentation, but setting of arf. completed romi. echo from shows severe regional left ventricular systolic dysfunction, c/w multivessel cad. mild mitral regurgitation. moderate pulmonary hypertension. had chf ae admission on . cad s/p myocardial infarction, s/p angioplasty with pci. continue aspirin 81, metoprolol, atorvastatin. . # diabetes mellitus, type 1, moderately controlled: continue iss. assisting but not formally consulting since he is dictating his own insulin dosages. . # ? hx of skin ca - unclear diagnosis. patient should have outpatient derm for hx of skin cancers and now off serolimus. . # htn - well controlled on diruetics and metoprolol . # cva in - cont asa 81 . # gerd - on pantoprazole 40mg po daily . # code: dni/dnr, discussed with patient medications on admission: loperamide 2 mg po q8hr flomax 0.4mg po qhs atorvastatin 20mg po daily finasteride 5mg po daily sirolimus 1mg po daily aspirin 81mg po daily metoprolol 12.5 mg po bid isosorbide mononitrate 60mg po daily pantoprazole 40mg po daily furosemide 80mg iv daily furosemide 40mg po daily tacrolimus 2mg po bid morphine 4-8mg iv prn pain prednisone 4mg po daily kcl 20 meq po daily alprazolam 0.5mg po tid percocet q6hr prn glargine 8u sq daily lispro iss pacrelipase 1cap po w/ meals and qhs imipenem 500mg iv q8hr haldol 5mg po q4hr prn discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 3. atorvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 4. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 7. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. tacrolimus 1 mg capsule sig: two (2) capsule po q12h (every 12 hours). 10. prednisone 1 mg tablet sig: four (4) tablet po daily (daily). 11. alprazolam 0.25 mg tablet sig: two (2) tablet po tid (3 times a day) as needed for anxiety. 12. furosemide 40 mg tablet sig: one (1) tablet po once a day. 13. loperamide 2 mg capsule sig: two (2) capsule po tid (3 times a day). 14. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 15. percocet 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 16. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for breakthru pain. 17. insulin glargine 100 unit/ml cartridge sig: twenty (20) units subcutaneous at bedtime. 18. humalog 100 unit/ml cartridge sig: per sliding scale units subcutaneous four times a day. 19. sodium polystyrene sulfonate 15 g/60 ml suspension sig: two (2) mg po once (once) for 1 doses. 20. tobramycin sulfate 40 mg/ml solution sig: one y (180) mg injection q48h (every 48 hours) for 6 weeks: course finishes on . discharge disposition: extended care facility: health care east region discharge diagnosis: primary: r bka stump infection with osteomyelitis and closure resolved urinary tract infection resolved altered mental status . secondary: stage 2 sacral decubti chronic schf ef 25% chronic diarrhea s/p renal transplant diabetes mellitus, type 1, moderately controlled discharge condition: stable, on antibiotics discharge instructions: you were admitted for an infection of your right bka stump and the underlying bone and a urinary tract infection causing altered mental status. you initially were treated in the intensive care unit for your mental status and were given ceftriaxone antibiotic for you urinary tract infection for five days. you underwent two surgical procedures, on debridement right bk stump and debridement, primary closure r bka. you had a wound vac placed to improve wound healing. your blood sugars were better controlled as your insulin regimen was increased. you are to continue tobramyicin as your antibiotic for six weeks for the treatment of your bone infection. . please take all medications as prescribed and go to all scheduled follow up appointments. your dosage of tobramycin will be adjusted based on trough levels. sirolimus was stopped. . please return to the hospital if you develop altered mental status, fevers, or another infection at your stump site. please be compliant with your diabetic diet and take your insulin as per your sliding scale. . follow up: dr. - vascular surgery on at 1:00pm at . suite 5c in . . renal transplant:provider: , md phone: date/time: 9:20 . dermatology:provider: , md phone: date/time: 1:15 . infectious disease: provider: , md phone: date/time: 9:30 followup instructions: dr. - vascular surgery on at 1:00pm at . suite 5c in . . renal transplant:provider: , md phone: date/time: 9:20 . dermatology:provider: , md phone: date/time: 1:15 . infectious disease: provider: , md phone: date/time: 9:30 procedure: repair of entropion or ectropion with wedge resection revision of amputation stump repair of entropion or ectropion with wedge resection revision of amputation stump application of pressure dressing application of pressure dressing diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis other chronic pulmonary heart diseases polyneuropathy in diabetes percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified other and unspecified hyperlipidemia cellulitis and abscess of leg, except foot long-term (current) use of insulin old myocardial infarction chronic systolic heart failure pressure ulcer, lower back personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diarrhea atherosclerosis of native arteries of the extremities, unspecified complications of transplanted kidney below knee amputation status diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled background diabetic retinopathy infection (chronic) of amputation stump ulcer of other part of lower limb pressure ulcer, stage ii unspecified osteomyelitis, lower leg 

Answer: The patient is high likely exposed to