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: cellulitis major surgical or invasive procedure: none history of present illness: 59 year old male with h/o type i dm c/b b/l bka (left and right ), neuropathy, retinopathy and nephropathy, htn, copd who was admitted to medical floor with cellulitis of b/l stumps. . the patient was recently admitted on for dyspnea secondary to pna vs cop treated with levoflox x 10days. he was also found to have a enterococcal uti, for which he was started on ampicillin x7 days. the patient left ama with pcp . the prior admission between started with a micu stay for hypoxia, hypercarbia and resultant lethargy. bipap was used intermittently with improvement in mental status and ventilation . after leaving ama during most recent hospitalization, patient reports completing course of levofloxacin and ampicillin for cap/uti. pt notes increasing redness and pain over past week in both stumps. he denied associated fevers/chills, dyspnea, or chest pain. . upon presentation to the ed, he was given vanco and unasyn, was intermittently hypoxic with o2 sats 85% while sleeping and was placed on 2l nc and admitted to floor. he was being treated on broad spectrum abx for cellulitis in the setting of poorly controlled type i dm: vanc/zosyn/clinda, vascular surgery was following. cxr showed improvement of left basilar atelectasis without focal consolidation. . he triggered yesterday for no uop -> 700ml after foley catheter insertion. also with relative hypotension sbp 90s (b/l 130s) with improvement of sbp 110s after 1l bolus ns yesterday. was noted to be intermittently lethargic during day, abg obtained was 7.32/57/68. he underwent a ct scan pelvis/extremities eval for possible fasciitis, and was noted to be more somnolent (arousable only to sternal rub). repeat gas unchanged at yesterday at 9pm: 7.32/58/69. patient was on unchanged methadone maintenance without any additional prn pain medications, and patient has not been able to be setup with bipap at home, has documented osa and received sleep eval during recent hospitalization. currently on 2-3l in low 90s. unable to initiate emergent bipap on floor so he was transferred to the unit overnight to receive bipap. he also received narcan in the unit, which improved his lethargy. . abg following bipap this morning was 7.31/56/73. . currently, the patient notes improved pain control in his stumps. (-)n/v/d/f/c. has not had bm since admission, denies constipation. on ros, does endorse orthonpea, no pnd. (-) abd pain. past medical history: past medical history: 1. diabetes, insulin dependent, with neuropathy, retinopathy, nephropathy, and diabetic foot ulcers. s/p bilateral bkas due to nonhealing ulcers. lbka , rbka 2. h/o ivdu/morphine addiction: on methadone. 3. copd: 1 ppd / 40 years. no pfts on file 4. chronic renal insufficiency: recent baseline 1.2. multiple hospitalizations with bumps into the 2s. 5. htn 6. pvd: h/o recurrent leg ulcers, cellulitis 7. ? hepatitis c 8. gerd 9. h/o mrsa and vre infection 10. h/o decubitus ulcer, now healed social history: lives with his girlfriend, , in , who helps him with adls. has vna care who he says helps wash him, give him medications and prepare his meals. he has spoked 1ppd x 40 years. denies etoh use. denies recreational drug use currently. family history: nc physical exam: pe: t:96.2 bp:120/78 hr:62 rr:18 o2 93% 2l gen: nad/ obese/ unkept/ appears stated age/ pleasant heent: at/nc, perrla, eomi, anicteric, no conjuctival pallor, mmm neck: supple, trachea midline, no lad lung: pt with poor respiratory effort, slight exp wheeze, coarse breath sounds in the left base. no accessory muslce use and speaks in full sentences cv: s1&s2, rrr, no r/g/m abd: soft/+bs/ nt/ nd/no rebound/ no guarding/ obese : no c/c/ 1.5cm ulceration over the left stump, granulation tissue and slight purulence. foul smelling, b/l erythema, warmth and crust over the b/l stumps. erythema extending over up the thigh. ttp fingertips are brown. skin: no lesions, rashes, bruises neuro: aaox3. cranial nerves ii-xii intact. normal bulk, strength and tone throughout. no abnormal movements noted. no deficits to light touch throughout. psych: listens and responds to questions appropriately, pleasant exam at discharge: t 97 hr 58 95% ra 156/82 neck: supple, trachea midline, no lad lung: improved lung exam, rare bibasilar rales, otherwise cta cv: s1&s2, rrr, no r/g/m abd: soft/+bs/ nt/ nd/no rebound/ no guarding/ obese. inguinal folds with erythema, small excoriations, healing well : 1 cm ulceration over the left stump, granulation tissue, healing well. b/l erythema, warmth and crust over the b/l stumps, also improving. skin: no lesions, rashes, bruises neuro: aaox3. cranial nerves ii-xii intact. normal bulk, strength and tone throughout. no abnormal movements noted. no deficits to light touch throughout. psych: listens and responds to questions appropriately, pleasant pertinent results: 03:50am plt count-230 03:50am neuts-79* bands-0 lymphs-15* monos-4 eos-1 basos-0 atyps-0 metas-1* myelos-0 03:50am wbc-8.0 rbc-4.77 hgb-13.9* hct-43.3 mcv-91 mch-29.1 mchc-32.1 rdw-17.3* 04:00am calcium-8.7 phosphate-3.9# magnesium-1.7 04:00am estgfr-using this 04:00am glucose-110* urea n-26* creat-1.9* sodium-141 potassium-4.7 chloride-104 total co2-28 anion gap-14 04:01am lactate-2.1* 04:01am comments-green top 02:17pm lactate-1.2 02:17pm type-art po2-68* pco2-57* ph-7.32* total co2-31* base xs-0 06:17pm urine hyaline-* 06:17pm urine rbc-0-2 wbc-0-2 bacteria-mod yeast-none epi- 06:17pm urine blood-neg nitrite-neg protein-500 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 06:17pm urine color-yellow appear-clear sp -1.015 09:13pm lactate-1.0 09:13pm type-art po2-69* pco2-58* ph-7.32* total co2-31* base xs-1 11:47pm pt-12.7 ptt-35.8* inr(pt)-1.1 11:47pm plt count-210 11:47pm wbc-6.2 rbc-4.08* hgb-11.7* hct-36.9* mcv-91 mch-28.7 mchc-31.7 rdw-17.2* 11:47pm hcv ab-positive* 11:47pm hbsag-negative hbc ab-positive 11:47pm albumin-2.5* calcium-8.0* phosphate-3.9 magnesium-1.6 11:47pm alt(sgpt)-3 ast(sgot)-14 alk phos-59 tot bili-0.2 11:47pm glucose-158* urea n-27* creat-1.9* sodium-142 potassium-4.0 chloride-106 total co2-26 anion gap-14 labs at discharge: wbc rbc hgb hct mcv mch mchc rdw plt ct 5.8 3.73* 11.1* 34.4* 92 29.7 32.1 16.5* 262 glucose urean creat na k cl hco3 angap 69 22 1.7 140 4.6 105 29 11 hb a1c 8.6 hbsag hbcab hepc core ab negative positive positive reports: ecg: artifact is present. sinus rhythm. atrial ectopy. left axis deviation. left anterior fascicular block. non-specific st-t wave changes. compared to the previous tracing the q-t interval is shorter and st-t wave changes are more prominent lenis: no evidence of deep vein thrombosis in either leg chest pa and lateral: in comparison with the study of , there is some decrease in the atelectatic change at the left base. the cardiac silhouette remains at the upper limits of normal without vascular congestion or pleural effusion. mediastinal and hilar contours are normal. ct pelvis/les: impression: findings consistent with right greater than left lower extremity cellulitis. no focal fluid collection or subcutaneous gas to suggest fournier's gangrene. brief hospital course: assessment & plan: 59 yo m with pmhx iddm complicated by b/l bka (left and right ), neuropathy, retinopathy and nephropathy, htn, copd admitted with cellulitis over both bka stumps. . # hypoxia: patient with known copd, baseline pco2 likely around high 40s, found to have pco2 in high 50s associated with lethargy - has recently spent night in icu for bipap. he also had improved ventilation followning narcan administration. hypoxia is likely from chronic hypoventilation from morbid obesity and copd. methadone likely is exacerbating hypoventilation. he has had a recent sleep study suggesting bipap auto sv epapmin=epapmax= 6, pressure support min 3 and pressure support max 6 with back up rate 8. following transfer from the icu to the floor, the patient was continued on bipap overnight, which he tolerated well. he did not require supplemental oxygen to maintain his oxygen saturation. methadone dose was slowly increased for pain control. the patient was discharged with bipap at the above settings. he was ordered an outpatient sleep study in order to qualify for long term bipap, which his pcp, . , follow up with. . #. cellulitis: pt with b/l bka secondary to diabetes and pvd. has been treated with vanc/zosyn/clinda since presentation. did thorough cleaning on arrival to the micu. following transfer to the floor, the patient's antibiotic regimen was simplified from vancomycin and zosyn to bactrim ds alone. local wound care was continued, the cellulitis improved clinically, and the patient was discharged with a full course of bactrim. topical antifungals were also continued. . #. copd: pt with extensive smoking history. no evidence of exacerbation. tiotropium and advair were continued, with albuterol and ipratropium nebs as needed. . #. iddm: pt last documented a1c was 9.2, but was in . will continue home regimen. repeat a1c showed improved control with a1c of 8.6. home insulin regimen was decreased to 20 units of 70/30 in the morning and 10 units of 70/30 at night given pre-breakfast hypoglycemia. the patient had been on 40 units and 20 units, respectively. he was discharged with the lower doses, and will uptitrate as needed. aspirin and statin therapy were continued. . #. ckd: pt with cr 1.9 and at his baseline 1.8-2.0. . #. chronic pain: methadone dose was uptitrated to 60 mg at time of discharge. the patient was informed of the risks of hypoventilation. . # fen: replete lytes prn / diabetic diet . # ppx: heparin sq, bowel regimen . # access: piv, picc . # code: full code . # comm: and medications on admission: 1. nicotine 14 mg/24 hr patch 24 hr 2. aspirin 81 mg daily 3. methadone 10 mg/ml concentrate sig: 90mg 5. ranitidine hcl 150 mg daily 6. simvastatin 80mg daily 7. senna 8.6 mg 8. docusate sodium 100 mg 9. fluticasone-salmeterol 250-50 mcg/dose 10. amlodipine 5 mg daily 11. gabapentin 300 mg q12 12. tiotropium bromide 18 mcg capsule daily 13. insulin nph & regular human 100 unit/ml (70-30): 40u qam 14. insulin nph & regular human 100 unit/ml (70-30): 20u qpm 15. ferrous sulfate 300 mg daily discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. amlodipine 5 mg tablet sig: one (1) tablet po once a day. 8. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day): apply to affected areas. :*1 unit* refills:*2* 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 10. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 11. nicotine 14 mg/24 hr patch 24 hr sig: one (1) transdermal once a day. 12. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: two (2) tablet po bid (2 times a day) for 1 weeks. :*28 tablet(s)* refills:*0* 13. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day): apply to affected areas. :*1 unit* refills:*2* 14. insulin nph & regular human 100 unit/ml (70-30) insulin pen sig: as directed, see attached subcutaneous twice a day: see attached for dosing. 15. methadone 10 mg tablet sig: nine (9) tablet po twice a day. 16. other bipap auto inspiratory maximum 25 mmhg, expiratory minimum 6 mmhg, ips 10 full face medium ( ) discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: cellulitis copd/chronic hypoventilation secondary diagnoses: -diabetes, insulin dependent, with neuropathy, retinopathy, nephropathy, and diabetic foot ulcers. s/p bilateral bkas due to nonhealing ulcers. lbka , rbka -h/o ivdu/morphine addiction: on methadone. -chronic renal insufficiency -htn discharge condition: alert and oriented x 3 wheelchair bound stable and improved discharge instructions: you were admitted to the hospital with worsening stump pain. initially, there was a concern for a deep tissue infection, which a ct scan showed you did not have. you were initially treated with iv antibiotics, which were changed to oral antibiotics, which improved your soft tissue skin infection. you were also noted to sleepy at the beginning of your hospital course, which was thought to be due to sleep apnea, copd, and excessive methadone dosing. you were monitored overnight in the icu and received bipap overnight to help you breathe. the bipap was continued after you left the icu, and it improved both your breathing and sleepiness. your pain was controlled with methadone. you were discharged on in improved condition. please see below for your follow up appointments. the following changes have been made to your medications: please continue taking bactrim ds twice a day for 7 more days please decrease your insulin dosing. take 20 units of 70/30 in the morning, and 10 units of 70/30 in the evening. no other changes were made to your medications. followup instructions: department: when: thursday at 1:40 pm with: , md building: sc clinical ctr south campus: east best parking: garage procedure: venous catheterization, not elsewhere classified non-invasive mechanical ventilation diagnoses: nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere obstructive sleep apnea (adult)(pediatric) other chronic pain esophageal reflux tobacco use disorder chronic airway obstruction, not elsewhere classified unspecified viral hepatitis c without hepatic coma hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified polyneuropathy in diabetes peripheral vascular disease, unspecified opioid type dependence, continuous chronic kidney disease, stage iii (moderate) acute respiratory failure hypotension, unspecified cellulitis and abscess of leg, except foot long-term (current) use of insulin morbid obesity pressure ulcer, lower back diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled infection (chronic) of amputation stump diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled ulcer of other part of lower limb candidiasis of skin and nails pressure ulcer, stage iii amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation 

Answer: The patient is high likely exposed to