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: sulfa (sulfonamide antibiotics) / aspirin / levofloxacin / nsaids (non-steroidal anti-inflammatory drug) attending: chief complaint: left great toe gangrene major surgical or invasive procedure: - amputation of the left hallux (), without immediate post procedure complication history of present illness: 88 yo male w/ h/o iddm, ckd, htn, who presented to osh with worsening left foot pain, swelling erythema (started around ). the patient's son notes that 1 day prior to onset of symptoms he was grinding down his father's toenails with a file, slipped and accidentally broke the skin around the left great toe. as per report from osh, "his left le extremity has evidence of extensive cellulitis over the dorsum of the foot. there is ulceration of the left great toe with an eschar formation". pt. was treated with vancomycin (), ancef () and zosyn (). his cellulitis reportedly improved, but the eschar increased in size. he was evaluated by the infectous disease and vascular surgery teams. they felt that there was evidence of gangrene in his left great toe and it would likely need to be amputated. as per report, there was also concern concern for osteomyelitis on plain films. family requested transfer to for second opinion with regards to surgical management. pt. currently reports little pain, and denies fevers/chills. he has significant diabetic neuropathy and little sensation in b/l lower extremities. ros: per hpi, denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain. he does endorse occasional diffuse abdominal pain with bloating which radiates to left groin area. past medical history: diabetes mellitus type 2 - insulin dependent - ? secondary to prednisone (per pt. son) cad s/p stent congestive heart failure polymyalgia rheumatica - on chronic prednisone essential tremor - manifest as frequent spasm-like activity ? factor 11 and 13 deficiency hyperlipidemia h/o rheumatic fever htn diabetic neuropathy diverticulosis bph s/p turp pud s/p partial gastrectomy s/p hiatal hernia repair s/p appendectomy s/p cholecystectomy s/p rectal surgery - secondary to bleeding social history: he completed high school and worked as an electronics technician as well as a meat cutter. he is married, lives with his wife. never smoked and denied any alcohol or drug use. he lives in a 2 family house with his son, dtr in law and 4 children above him. wwii veteran medic who saw active combat in and . never smoked. rare etoh. caregiver of his wife who has dementia and recently fell and admitted to the hospital. son does shopping. he does the bills, meds, cleaning, cooking. has vna. family history: mother- disease. sister - bilateral hand tremor. physical exam: admission: vs - t97.5 bp 110/70 hr 90 rr 20 96% on ra general - well-appearing elderly m who appears comfortable, appropriate and in nad heent - nc/at, perrl, eyes do not face midline together, but movements intact, mmm, op clear neck - supple, no jvd, lungs - lungs are clear to ausculatation bilaterally, moving air well and symmetrically, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, s1-s2 clear and of good quality without murmurs, rubs or gallops abdomen - nabs, soft/nt/nd, regional areas of firmness in abdomen, no rebound/guarding extremities - wwp, no c/c/e, 1+ equal peripheral pulses neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, dtrs 2+ and symmetric discharge: vs - t98.2 bp 135/80 hr 64 rr 20 99% on ra general - well-appearing elderly m who appears comfortable, appropriate and in nad heent - nc/at, perrl, eyes do not face midline together, but movements intact, mmm, op clear neck - supple, no jvd, lungs - fine b/l basilar rales, moving air well and symmetrically, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, s1-s2 clear and of good quality without murmurs, rubs or gallops abdomen - nabs, soft, mild umbilical tenderness, no rebound/guarding extremities - wwp, no c/c/e, 1+ equal peripheral pulses neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, dtrs 2+ and symmetric pertinent results: admission: 09:52pm blood wbc-11.0# rbc-3.39* hgb-11.0* hct-32.5* mcv-96 mch-32.4* mchc-33.8 rdw-14.4 plt ct-233# 09:52pm blood pt-12.9* ptt-26.6 inr(pt)-1.2* 11:10am blood fact -147 fac xii-114 facxiii-pnd 09:52pm blood glucose-139* urean-34* creat-1.6* na-140 k-4.7 cl-105 hco3-25 angap-15 09:52pm blood calcium-9.4 phos-2.4* mg-1.9 09:52pm blood crp-15.7* discharge: 08:10am blood ck-mb-2 ctropnt-0.08* cath report ptca comments: initial angiography revealed a totally occluded mid lad at the proximal portion of the mid lad stent as well as an 80% osital d1 lesion which originated just before the cto in the mid lad. we initially planned to treat the lad and then d1 eith ptca and stenting. bivalirudin was started prophylactically. a 6 french xblad 3.5 guiding catheter provided good support for the procedure. the cto was initially engaged with a wire and was unable to be crossed. multiple wires were attempted (, choice pt es, pilot 200 and confianza). the confienza appeared to cross the cto, but a balloon could not be passed through the lesion, and the wire was never able to move very far into the distal vessel. at this point we chose to not go further in trying to open the cto of the mid lad and instead turned our attention to d1. a wire crossed the lesion with minimal difficulty. the lesion was dilated with a 2.0x12mm sprinter balloon. a 2.5x8mm integrity rx stent was deployed in the ostium of the d1 at 14 atms. the stent was postdilated with a 2.5x6mm nc quantum apex mr balloon at 18 atms. final angiography revealed no residual stenosis at the ostium of the d1, no angiographically apparent dissection and timi iii flow. agniography of the right femoral arteriotomy site showed a site compatible with percutaneous closure. the patient left the lab free of angina and in stable condition. micro: uc pending path: i. big toe, left foot, amputation (a-d): a. gangrene, focally involving skin and soft tissue margins. b. underlying acute osteomyelitis. ii. proximal margin (e): bone with foci of reparative change and intra medullary fibrosis with no significant acute inflammation; multiple levels are examined. studies: abis (): indications: 89-year-old male with dry gangrene of left hallux. findings: bilateral lower extremity abis, doppler waveforms, and pvrs were performed at rest. all of the lower extremity vessels are noncompressible. on the right, the femoral, popliteal, posterior tibial, and dorsalis pedis waveforms are all /triphasic. right-sided pvrs are mildly diminished in the amplitude but at the metatarsal level suggest potential for healing minor tissue loss. the right femoral, popliteal, and posterior tibial waveforms are all biphasic. the dorsalis pedis waveform is monophasic. left-sided pvrs are essentially within normal limits. impression: noncompressible vessels. strong doppler waveforms with pvrs suggest mild tibial disease on the right and mild, non-occlusive tibial disease on the left. heme: factor assays fact facxii facxiii 11:10am 147 114 normal brief hospital course: 89 yo male with history of cad s/p lad stent, iddm2, and pad, admitted for gangrenous l foot s/p left hallux amputation complicated by post-op nstemi, now s/p cardiac catheterization with bms to diag1 transferred to the micu for hypotension with concern for sepsis. # hypotension: on the 10th day of his hospital stay, he triggered for hypotension with sbp to 70, fever to 102 and a lactate of 2.9. most likely septic in origin given fever, leukocytosis, hypotension with elevated lactate. potential sources include gu tract, toe, and scrotum however no clear evidence of disease. also risk for hypotension with blood loss, hct trending down. he was started on vancomycin and meropenem. ct abdomen did not reveal any evidence of acute infection. he was given stress dose steroids which were tapered quickly. a source of infection was never identified and the patient s bp remained stable following transfer from micu. with no source of infection, normal wbc, and no fevers, abx were discontinued on . # scrotal pain: he reports month long duration of pain, with acute exacerbation. no torsion, abcess, or epididymitis on ultrasound. urology was consulted who recommended ice and elevation of scrotum. he was continued on his home ms contin at 30mg with oxycodone and morphine for breakthrough pain. # nstemi: the patient has known cad, and is s/p pci ~7 years prior. he and his family are not entirely sure of the dates or details of his cardiac history. the morning following his amputation (), the patient reported significant nausea and chest tightness. ekg at the time was reassuring with sinus tachycardia with nonspecific and stable lateral st segment changes. cardiac enzymes were monitored and were slightly elevated (peak troponin 0.21, peak ck-mb 5). he was evaluated by the cardiology team who did not feel he required acute intervention, but recommended close follow up with his pcp/cardiologist. he was given a low dose of aspirin and started on a statin to increase his medical management. cp resolved w/ antiemetics. had another episode on , relieved by sl ng. on continued to c/o cp, partially relieved by nitropaste, and on it was decided to send pt for cardiac catheterization to relieve sxs. unstable angina s/p cardiac catheterization with bms placement to diag1. currently on aspirin/plavix and chest pain free. cath complicated by groin ecchymosis without palpable hematoma. he was continued on aspirin and plavix daily and will need to continue these medications without exception until . he was continued on simvastatin and started on metoprolol. his hematocrit was maintained at 30. # diarrhea: has loose stool at home, now with continued diarrhea in the setting of multiple abx. uncertain etiology but most likely abx has pt has no wbc or temp. c diff pcr negative. patient believes its improving. # dysuria: patient complaining of dysuria and increasing frequency following removal of foley on . previous uc showed yeast. ua on showed pyuria with some bacteria. will follow up culture. # gangrene/osteomyelitis of left hallux s/p l hallux amputation: he was treated with zosyn x7d upon transfer (he also received doses of vanco and ancef). his toe worsened and appeared gangrenous upon transfer to . plain films at the osh revealed evidence of likely osteo and vascular surgery at the osh felt that it was going to require amputation. patient and family requested transfer to . vascular surgery was consulted who recommended abis to ensure appropriate blood flow for future wound healing. given the reassuring results, he underwent an amputation of his left hallux on . final result of bone biopsy showed clean tibial margin with gram positive cocci in amputated toe. pt was on vanc/zosyn for 10+ days. the abx were discontinued in setting of clean margins. surgical site looks well on exam. he will need to follow up with podiatry as an outpatient. # peripheral vascular disease: extensive bilateral tibial disease found on noninvasives. he will need to follow up with vascular surgery as an outpatient. # on ckd: baseline creatinine 1.2, peaked at 1.8. fena c/w prerenal etiology and improved with ivf. lisinopril, lasix were held. # abdominal masses: patient with firmness with abdominal palpation and recent pe. new inderminate enhancing soft tissue mass encasing the left renal artery noted on abd ct on . head ct without evidence of mets. as per omr, during his last hospitalization the family and patient reported that they would not like to persue further investigations/treatment of this, however, son also mentioned that they had missed an appointment with an oncologist. the family does not wish to further work up these findings. # incorrect report of factor and xii deficiency: seen by heme/onc, who confirmed pt all factors were normal. he does not have these factor deficiencies. # dm2: he was continued on his home nph with a humalog sliding scale. # pmr: on home prednisone 20mg daily. he was given stress dose steroids during his hypotension. this was rapidly tapered and he was restarted on 20mg of prednisone three days later. he was also started on dapsone 100mg daily for pcp . # htn: currently normotensive. he was started on metoprolol and nitrates. his lisinopril, metoprolol, and nitrates were intermittently held given his blood pressure. # presumed diastolic chf: patient appears relatively euvolemic. he was started on metoprolol and nitrates. his lisinopril, metoprolol, and nitrates were intermittently held given his blood pressure. # anemia: patient is within baseline anemia (low 30s) with normo-macrocytic mcv. likely due to anemia of chronic disease, given ckd. b12 was normal. # gout: continued renally dosed allopurinol. # gerd: continue home pantoprazole. # med rec: continue home vitamin d. transitional issues: -code status: full code, no prolonged measures, would never want to be ventilated -follow up: with primary cardiologist dr. appointment next week for follow up and removal of sutures. -patient given instructions for following up with hospice -follow up urine culture. -please continue plavix. medications on admission: preadmission medications listed are correct and complete. information was obtained from patientfamily/caregiver. 1. prednisone 20 mg po daily 2. vitamin d 800 unit po bid 3. furosemide 20 mg po daily 4. lisinopril 5 mg po daily 5. allopurinol 100 mg po daily 6. potassium chloride 20 meq po tid 7. pantoprazole 40 mg po q12h 8. oxycodone (immediate release) 5 mg po q4h:prn pain 9. nitroglycerin sl 0.4 mg sl prn chest pain call 911 if medication fails to reduce chest pain after 2 doses 10. magnesium chloride *nf* 64 mg oral 11. morphine sr (ms contin) 30 mg po q12h 12. nitroglycerin patch 0.4 mg/hr td q24h 12h on/12h off 13. humulin n *nf* (nph insulin human recomb) 100 unit/ml subcutaneous 24 units qam and 6 units qpm discharge medications: 1. aspirin 81 mg po daily rx *adult low dose aspirin 81 mg 1 tablet(s) by mouth daily disp #*20 tablet refills:*0 2. clopidogrel 75 mg po daily 3. metoprolol tartrate 25 mg po tid hold for sbp < 100, hr < 60 4. simvastatin 40 mg po daily 5. pantoprazole 40 mg po q12h 6. furosemide 20 mg po daily 7. allopurinol 100 mg po daily 8. nph 18 units breakfast nph 9 units bedtime 9. lisinopril 5 mg po daily 10. prednisone 20 mg po daily 11. vitamin d 400 unit po daily 12. oxycodone (immediate release) 5 mg po q4h:prn pain 13. dapsone 100 mg po daily 14. nitroglycerin sl 0.3 mg sl prn chest pain call 911 if medication fails to reduce chest pain after 2 doses 15. morphine sr (ms contin) 30 mg po q12h 16. nitroglycerin patch 0.4 mg/hr td q24h 12h on/12h off discharge disposition: extended care facility: nursing care - discharge diagnosis: primary: - gangrene of the left hallux - osteomyelitis - nstemi secondary: - coronary artery disease 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: dear mr. , it was a pleasure taking part in your care during this hospitalization. you were transferred to for evaluation of the infection in your left toe that required amputation. you were evaluated by the vascular surgery team, who found that while you continue to have good blood flow to your feet, it is diminished. because the infection was also in your bone, you required antibiotics in addition to your amputation. you also reported that you were having chest pains. we performed several blood tests and found that you were having a mild heart attack. the interventional cardiologist interserted a stent into your heart to open up a blockage. following the procedure, you had a low blood pressure and temperature and were transferred to the medical icu. your recovered quickly and were stable the rest of the admission. we hope you continue to feel well. please continue to take all other home medications as directed. followup instructions: department: podiatry when: friday at 3:30 pm with: , dpm building: ba ( complex) campus: west best parking: garage name: , e. when: wednesday at 11:15pm location: medical address: 237a , , phone: procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters left heart cardiac catheterization amputation of toe cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: anemia in chronic kidney disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery polymyalgia rheumatica esophageal reflux congestive heart failure, unspecified long-term (current) use of steroids acute kidney failure, unspecified unspecified septicemia cardiac complications, not elsewhere classified gout, unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes sepsis ulcer of other part of foot other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) other malignant lymphomas, unspecified site, extranodal and solid organ sites diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin diarrhea staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus atherosclerosis of native arteries of the extremities with gangrene other specified antibiotics causing adverse effects in therapeutic use chronic diastolic heart failure hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified acute osteomyelitis, ankle and foot other bone involvement in diseases classified elsewhere cellulitis and abscess of toe, unspecified personal history of pulmonary embolism essential and other specified forms of tremor amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other secondary thrombocytopenia orchitis and epididymitis, unspecified 

Answer: The patient is high likely exposed to