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: cool lower extremity, dehydration major surgical or invasive procedure: bilateral thrombectomies bilateral b/l fasciotomy diagnostic angiogram r bka / l fasciotomy closure angioplasty of l cfa and angioplasty of l fem-at bpg history of present illness: this is a 50 year old gentleman with a past medical history of l fem-at bypass with ptfe graft , left common femoral artery to above-knee popliteal artery bypass graft ', right common femoral artery to above-knee popliteal artery bypass graft with 8 mm ringed ptfe ', kidney transplant in ', pancreas transplant ', pancreas explant ', now presents with acute onset of mental status changes, hypotension, and b/l cool extremities. the patient had a recent prostate biopsy on , was in his usual state of health on am, experienced nausea and vomitting the remainder of , and on the morning of admission, was unresponsive. the patient was started on a heparin gtt at osh and was med-flighted to . the patient was hypotensive enroute, had 2.5l ivf, and was started on levophed. besides the vomitting on , there were no reports of fever/chills, rest pain, or evidence of claudication. the patient did injure his right third toe and took percocet for the pain. the patient is on asa and plavix, which has been held for recent colonoscopy and prostate biopsy. past medical history: 1)cabg x 3 ' 2)living related kidney transplant coplicated by wound exploration ' 4)cadaveric pancreas transplant ' 5)l cea ' (), 6)right common femoral artery to above-knee popliteal artery bypass graft with 8 mm ringed ptfe ' 7)right second toe amputation ' 8)cataracts ' 9)r wrist ' 10)left common femoral artery to above-knee popliteal artery bypass graft with 8-mm ringed ptfe ' 11)repair of incisional hernia ' 12)l fem-at bypass with ptfe graft 13)pancreas explant ' 14)vitrectomy ' social history: he was a past smoker but has quite several times with the latest time being six months ago. alcohol use on a social level. no drug use. family history: significant for cad. physical exam: vs: t: 100.2 hr: 97 bp: 167/52 (0.9 mcg/min levophed) 25 100% fm gen: combative, non-verbal heent: at/nc, no icterus heart: rrr chest: cta b/l abd: soft, nt, nd, kidney graft palpated in rlq ext: warm thighs b/l, cool calves b/l, cold feet b/l, b/l surgical scars (well-healed), r. second toe amp, r. third toe with circumferential eccymosis, calves mottled b/l, >4 second capillary refill b/l feet, patient spontaneously moves b/l feet, calves soft b/l, no edema pulse: dp pt fem rad l - - - 2+ 2+ r - - - 2+ 2+ neuro: non-verbal, moves all 4 extremities pertinent results: labs on admission: 12:20pm blood wbc-8.9 rbc-3.80* hgb-11.4* hct-34.3* mcv-90 mch-30.0 mchc-33.3 rdw-14.0 plt ct-139* 12:20pm blood neuts-90* bands-5 lymphs-3* monos-1* eos-1 baso-0 atyps-0 metas-0 myelos-0 12:20pm blood pt-14.9* ptt-108.9* inr(pt)-1.3* 12:20pm blood glucose-137* urean-57* creat-3.7*# na-140 k-5.8* cl-106 hco3-21* angap-19 12:20pm blood ck(cpk)-113 05:49pm blood lipase-7 12:20pm blood ck-mb-2 12:20pm blood ctropnt-<0.01 05:49pm blood ck-mb-2 ctropnt-<0.01 03:07am blood ck-mb-3 ctropnt-<0.01 05:49pm blood albumin-3.5 calcium-8.5 phos-1.6*# mg-1.7 08:15pm blood type-art temp-38.4 rates-20/ tidal v-550 peep-12 fio2-80 po2-301* pco2-39 ph-7.42 caltco2-26 base xs-1 aado2-253 req o2-48 -assist/con intubat-intubated 12:29pm blood lactate-3.0* . labs prior to discharge: 08:00am blood wbc-8.5 rbc-2.78* hgb-8.3* hct-24.8* mcv-89 mch-30.0 mchc-33.6 rdw-14.7 plt ct-823* 08:00am blood pt-16.3* ptt-30.4 inr(pt)-1.5* 08:00am blood glucose-164* urean-26* creat-1.6* na-129* k-4.5 cl-94* hco3-24 angap-16 08:00am blood mg-2.1 08:10am blood tacrofk-4.6* 08:00am blood tacrofk-pnd imaging: ct head noncont: negative cta torso : 1. thrombosis of the right femoral-popliteal, and left femoral-anterior tibial grafts with minimal reconstitution at the level of the tibioperoneal trunks bilaterally via collaterals. the profunda arteries are patent bilaterally. 2. unchanged plaque/thrombus within the sma which attenuate the vessel, however, not significantly changed since . no evidence of bowel ischemia. 3. unremarkable right lower quadrant renal transplant. 4. anterior mediastinal soft tissue which may represent thymic rebound. close interval followup is recommended. 5. bibasilar atelectasis. art duplex u/s : widely patent left common femoral to popliteal bypass graft. monophasic waveforms indicate presence of some baseline underlying ischemia of the left lower extremity distal to the popliteal artery. cxr : left lower lobe atelectasis significantly improved. left pleural effusion cleared. no new consolidation. brief hospital course: summary of major hospital events: hd #1. upon arrival on the patient was critically ill with an elevated potassium and an acute renal failure. the patient was admitted to the intensive care unit after a ct angiogram showed that the left profunda was widely opened, but his femoral anterior tibial artery bypass was occluded. he did have distal flow. on the right side he had a small clot in the proximal profunda with good distal flow and flow in the leg. on exam the patient initially had cool legs which were mottled, but as his blood pressure began to resolve, the only cool part of his legs were the feet below the ankles. he had no signals. he had palpable femorals only. extensive discussions were held with the family and the decision was made to observe on heparin and try to resuscitate him to get him in a more stable condition for the operating room. his initial ck was 110. over the course of the evening, the patient began to do better and had controlled blood sugars with a potassium in the normal range and his creatinine came down to the 2 range. his ck started to rise and his feet did not improve, so he was taken urgently to the operating room on hd #2. hd #2. on he underwent bilateral graft thrombectomies, bilateral leg fasciotomies, right common femoral atherectomy with bovine pericardial patch angioplasty, and angiogram demonstrating no flow through the right femoral-popliteal bypass graft with insufficient runoff through the right popliteal supplied by the right profunda. hd #4. on he had an right lower extremity angiogram via the left brachial artery showing showing a patent profunda with branches supplying a small peroneal artery with no outflow. based on these findings we concluded that he will most likely require a below-knee amputation in the near future. hd#10: patient underwent a r bka. please see dr. operative note for details. patient tolerated the procedure well, transferred to the pacu and then to vicu. aps was consulted. dilaudid pca and ketamine drip was started post op and continued to pod4. pain medication transitioned to po ms contin and dilaudid on pod4. pain controlled prior to discharge. diet was advanced. pt consulted to assist in strength training and mobility. hd#12: patient underwent angioplasty of left common femoral artery and angioplasty of left femoral to anterior tibial bypass graft. received perioperative hco3 infusion. pt tolerated the procedure well, transferred to pacu and then to vicu in stable condition. again, diet was advanced and pain controlled with first ketamine drip and iv pca and then po dilaudid ms contin. hospital course summary by systems: neuro: please see above for details. acute pain service was consulted. started on ketamine drip and dilaudid pca. po ms contin and dilaudid controlling pain reasonably well prior to discharge. patient is comfortable. strongly recommend that he follow up with chronic pain service for continued evaluation and treatment. cv: the patient was stable from a cardiovascular standpoint; vital signs were routinely monitored. routine beta blockade and statin therapy was continued. plavix was continued. no symptoms or signs of acs, negative set of cardiac enzymes started on admission. pulmonary: the patient was stable from a pulmonary standpoint; vital signs were routinely monitored. good pulmonary toilet, early ambulation and incentive spirometry were encouraged throughout this hospitalization. cxr on showed improvement of left lower lobe atelectasis and resolution of pleural effusion. no s/s of pe during stay. gi/gu: pt is s/p renal kidney tx on prograft and predinose. renal tranplant service actively followed patient. creatine was closly monitored. tacrolimus levels were routinely monitored. tacro dosing was recently changed from 1.5 to 2 on . he should continue on this regimen until he follows up with renal as an outpatient. renal agrees with discharge to rehab, and does not have any active issues requiring medical management at this time. labs should be closely followed while at rehab. on his foley was removed. patient subsequently was voiding with good u/o but did have relatively high pvr volumes ranging from 300-600cc. he was asymptomatic. it was decided to hold off on inserting a foley at this time, but his pvrs and signs of worsening urinary retention should be closely monitored at rehab. fen: the patient's diet was advanced when appropriate, which was tolerated well following multiple procedures. the patient's intake and output were closely monitored, and ivf were adjusted when necessary. the patient's electrolytes were routinely followed during this hospitalization, and repleted when necessary. patient had mild hyponatremia likely from pain induced siadh per the renal transplant medical team. all infusions were changed to only ns solutions. his sodium stabilized in low 130s and high 120s prior to discharge. id: the patient's white blood count and fever curves were closely watched for signs of infection. patient was dignosed with uti by ciprofloxicin-sensitive enterobacter. treated by full 7 day course. subsequent urine culture showed no growth. patient received routine perioperative antibiotics. patient was started on keflex for some mild new erythema around stump suture line. recommend 7 day course of keflex. endocrine: the patient's blood sugar was monitored throughout this stay; insulin dosing was adjusted accordingly. was contact. please see medication list for insulin regimen prior to discharge. hematology: the patient's complete blood count was examined routinely; no transfusions were required during this stay. hct was stable in mid 20s priors to discharge. he was asymptomic with stable vss prior to discharge. patient was anticoagulated with heparin drip, often requiring up to u/hr to reach therapeutic ptt levels. patient was switched to therapeutic lovenox (80mg ) on . 7.5mg of coumadin also started on . five mg of coumadin given on . inr prior to discharge 1.5. we recommend 2.5mg coumadin for his pm dose. inr goal . prophylaxis: see hematology. at the time of discharge, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a regular diet, ambulating, pt was straight cathed for urinary retention which will need to be followed up on at rehab for possible foley placement, and pain was controlled reasonably well. discharge medications: 1. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 7 days. disp:*28 capsule(s)* refills:*0* 2. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). 5. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 7. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 11. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 12. gabapentin 300 mg capsule sig: three (3) capsule po q8h (every 8 hours). 13. docusate sodium 100 mg capsule sig: one (1) capsule po tid (3 times a day). 14. enoxaparin 80 mg/0.8 ml syringe sig: one (1) subcutaneous (2 times a day). 15. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 16. morphine 30 mg tablet sustained release sig: one (1) tablet sustained release po q8h (every 8 hours). 17. tacrolimus 1 mg capsule sig: two (2) capsule po q12h (every 12 hours). 18. hydromorphone 4 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed. 19. warfarin 2.5 mg tablet sig: one (1) tablet po once (once) for 1 doses. discharge disposition: extended care facility: hospital of & islands - discharge diagnosis: bilatetal occluded bypass grafts (pre-op) fluid deficit htn dm hyponatremia pvd discharge condition: stable discharge instructions: discharge instructions following below or above knee amputation . this information is designed as a guideline to assist you in a speedy recovery from your surgery. please follow these guidelines unless your physician has specifically instructed you otherwise. please call our office nurse if you have any questions. dial 911 if you have any medical emergency. . activity: . there are restrictions on activity. on the side of your amputation you are non weight bearing until cleared by your surgeon. you should keep this amputation site elevated when ever possible. . you may use the other leg to assist in transferring and pivots. but try not to exert to much pressure on the amputation site when transferring and or pivoting. please keep knee immobilizer on at all times to help keep the amputation site straight. . no driving until cleared by your surgeon. . please call us immediately for any of the following problems: . redness in or drainage from your leg wound(s) . . watch for signs and symptoms of infection. these are: a fever greater than 101 degrees, chills, increased redness, or pus draining from the incision site. if you experience any of these or bleeding at the incision site, call the doctor. . exercise: . limit strenuous activity for 6 weeks. . do not drive a car unless cleared by your surgeon. . try to keep leg elevated when able. . bathing/showering: . you may shower immediately upon coming home. no bathing. a dressing may cover you??????re amputation site and this should be left in place for three (3) days. remove it after this time and wash your incision(s) gently with soap and water. you will have sutures, which are usually removed in 4 weeks. this will be done by the surgeon on your follow-up appointment. . wound care: . sutures / staples may be removed before discharge. if they are not, an appointment will be made for you to return for staple removal. . when the sutures are removed the doctor may or may not place pieces of tape called steri-strips over the incision. these will stay on about a week and you may shower with them on. if these do not fall off after 10 days, you may peel them off with warm water and soap in the shower. . avoid taking a tub bath, swimming, or soaking in a hot tub for four weeks after surgery. . medications: . unless told otherwise you should resume taking all of the medications you were taking before surgery. you will be given a new prescription for pain medication, which can be taken every three (3) to four (4) hours only if necessary. . remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods in your diet. (check with your physician if you have fluid restrictions.) if you feel that you are constipated, do not strain at the toilet. you may use over the counter metamucil or milk of magnesia. appetite suppression may occur; this will improve with time. eat small balanced meals throughout the day. . cautions: . no smoking! we know you've heard this before, but it really is an important step to your recovery. smoking causes narrowing of your blood vessels which in turn decreases circulation. if you smoke you will need to stop as soon as possible. ask your nurse or doctor for information on smoking cessation. . avoid pressure to your amputation site. . no strenuous activity for 6 weeks after surgery. . diet : . there are no special restrictions on your diet postoperatively. poor appetite is expected for several weeks and small, frequent meals may be preferred. . for people with problems we would recommend a cholesterol lowering diet: follow a diet low in total fat and low in saturated fat and in cholesterol to improve lipid profile in your blood. additionally, some people see a reduction in serum cholesterol by reducing dietary cholesterol. since a reduction in dietary cholesterol is not harmful, we suggest that most people reduce dietary fat, saturated fat and cholesterol to decrease total cholesterol and ldl (low density lipoprotein-the bad cholesterol). exercise will increase your hdl (high density lipoprotein-the good cholesterol) and with your doctor's permission, is typically recommended. you may be self-referred or get a referral from your doctor. . if you are overweight, you need to think about starting a weight management program. your health and its improvement depend on it. we know that making changes in your lifestyle will not be easy, and it will require a whole new set of habits and a new attitude. if interested you can may be self-referred or can get a referral from your doctor. . if you have diabetes and would like additional guidance, you may request a referral from your doctor. . follow-up appointment: . be sure to keep your medical appointments. the key to your improving health will be to keep a tight reign on any of the chronic medical conditions that you have. things like high blood pressure, diabetes, and high cholesterol are major villains to the blood vessels. don't let them go untreated! . please call the office on the first working day after your discharge from the hospital to schedule a follow-up visit. this should be scheduled on the calendar for seven to fourteen days after discharge. normal office hours are 8:30-5:30 monday through friday. . please feel free to call the office with any other concerns or questions that might arise followup instructions: provider: , md phone: date/time: 10:40 provider: lab phone: date/time: 8:00 provider: lab phone: date/time: 9:00 patient should make an appointment with chronic pain service for managment of chronic pain. needs apt ms in 4 weeks. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other revision of vascular procedure insertion of endotracheal tube angioplasty of other non-coronary vessel(s) angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries arteriography of femoral and other lower extremity arteries fasciotomy arteriography of other intra-abdominal arteries closure of skin and subcutaneous tissue of other sites other amputation below knee procedure on two vessels diagnoses: hyperpotassemia esophageal reflux tobacco use disorder urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified hyposmolality and/or hyponatremia coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status polyneuropathy in diabetes surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of insulin other complications due to other vascular device, implant, and graft atherosclerosis of native arteries of the extremities with rest pain background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled kidney replaced by transplant diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled nontraumatic compartment syndrome of lower extremity transplanted organ removal status 

Answer: The patient is high likely exposed to