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: right foot ulcer getting worse major surgical or invasive procedure: incision and drainage, right foot with amputation of right hallux. repeat incision and drainage, right foot history of present illness: 65 year old male with type 2 diabetes, htn, hypercholesterolemia, cad and history of remote stroke, current smoker, who was brought to the er by his brother secondary to concern about the state of his r foot. they transferred him to as he gets all of his podiatric care here with dr. . he has had chronic diabetic foot ulcers of both feet, most recently a persistent ulcer on the plantar surface of the 1st metatarsal for the last few months. he has been non-weight bearing on his r foot for at least the last month, however he admits to walking on it recently. his brother says the ulcer has gotten progressively worse, with a foul odor. his r leg has also gotten progressively more swollen over the last week. he was scheduled for pre-operative evaluation with dr. on , with surgery planned for . at his vitals were 102.0, 110, 100/60, 95% on ra. his labs were notable for a wbc of 14 with 9% bands, as well as na of 129, k 5.2, bun 12, creat 0.6. he received vancomycin and zosyn, and was seen by surgery who recommended transfer to for probably surgery. in the ed here his vitals were 101.3, hr 113, 95/palp, 14, 95% ra. he was given vancomycin and clindamycin. a l ij was placed after unsuccessful attempts at a sc, and code sepsis was called. his cvp was 5. he received 6l ns in the ed, and was started on a levophed drip. he was seen by podiatry who are planning on taking him to surgery within the next couple of days pending "medical stability." the patient denies fevers, but thinks he's had some "sweats" over the last week. he says he's been feeling otherwise well. denies any lightheadedness, dizziness, chest pain. he gets shortness of breath when going up a flight of stairs. at baseline he says he can walk around without difficulty and go up stairs without difficulty. he does not exercise. past medical history: 1) type 2 dm, with neuropathy, complicated by chronic diabetic foot ulcers secondary to plantar flexed first metatarsal for which he has multiple antibiotic courses. 2) htn 3) hypercholestremia 4) cad 5) cva years ago, on asa and plavix since 6) carotid enderectomy 7) status post cholecystectomy, appendectomy. social history: patient is separated from his wife for the last 10 years, currently living with his brother. they have 5 children, some of which are in the area. he says he just quit smoking yesterday, but has smoked 1/2-1 ppd x 50 years. he used to drink heavily, about a 6 pack on the weekends, but is in aa and has been sober x 10 years. denies ivdu. family history: mother and father both had dm, both deceased. father with mi at 60 and pvd. mother had a stroke. physical exam: 100.4, 95, 99/69 map 79, cvp 10, rr 22, 94% ra. i/o: 6214/280. gen: overweight caucasian male appearing slightly disheveled. conversant. aao x 3. foul smelling. heent: dry mm. neck: jvp at 10 cm. cor: rr, normal rate, 2/6 systolic murmur at lsb without radiation. lungs: cta b/l, no w/r/r. abd: nabs, soft, large oblique scar in ruq, vertical scar in rlq. extr: 2+ pitting edema of r leg up to mid-tibia. erythema of rle up to ankle. l foot with strong dp/pt pulses, diminished sensation, no active ulcers. on plantar aspect of r 1st metatarsal there is a 2-3 cm ulcer with purulent base, marked surrounding edema and erythema, and foul smelling odor. pertinent results: r foot plain film: two views right foot: deformity and cortical irregularity of the distal first metatarsal is unchanged. well-healed osteotomy of the mid shaft of the second and fourth metatarsals. improved appearance of resected distal third metatarsal. soft tissue abnormality on the plantar aspect of the foot. there is slight hallux valgus deformity. impression: 1. unchanged appearance of cortical irregularity of the first metatarsal head. no adjacent subcutaneous emphysema noted. 2. soft tissue defect noted on the plantar aspect of the foot. . r foot plain film, post-amputation: right foot, three views: comparison with . there has been interval amputation of the first great toe from the distal portion of the first metatarsal. there is accompanying soft tissue loss. the third distal metatarsal is noted to be resected. well-healed second and fourth metatarsal osteotomies again noted. impression: no definite evidence of osteomyelitis after great toe amputation. . pa/lateral cxr: pa and lateral views of the chest: right picc tip is demonstrated within the proximal right atrium. the heart is normal in size. the aorta is tortuous. an opacity is present within the medial right upper lobe, in the right suprahilar region, which appears to have been present dating back to . although this could represent overlapping shadows, an underlying mass cannot be fully excluded. the lungs are otherwise clear. there is no effusions or pneumothorax. impression: 1. right picc tip in the proximal right atrium. findings discussed with the iv nurse at 3:30 p.m., . 2. opacity in the right suprahilar region, which may represent overlapping structures, but an underlying mass cannot be excluded. chest ct is recommended for further evaluation. . chest ct: findings: there is no evidence of significant mediastinal or hilar lymphadenopathy. no pericardial or pleural effusion. coronary arteries are extensively calcified. note is made of aortic wall calcification. in the lung window, note is made of mild paraseptal emphysema. no evidence of consolidation is noted. no nodule or mass is identified. no endobronchial lesion. note is made of somewhat distorted architecture of the right middle lobes as well as major fissure on the right, with atelectasis in the medial aspect. right upper lobe bronchus is not identified. somewhat prominent fat in the mediastinum. these findings may contribute to the opacity seen on prior chest x- ray. pleural calcification on the right. in the visualized portion of the upper abdomen, note is made of calcified granuloma. note is made of bilateral adrenal nodule, measuring 2.3 cm on the right and 1.5 cm on the left, with hounsfield units up to 30, of indeterminate character. there is no suspicious lytic or blastic lesion in skeletal structures. impression: 1. no evidence of mass or consolidation. somewhat distorted appearance of the lung architecture of the right upper chest, which may somewhat contribute to the finding on chest x-ray. right upper lobe bronchus not identified. is this patient post right upper lobectomy? 2. bilateral adrenal nodule as described above, of indeterminant characteristics, probably hypertrophy. please correlate with clinical history, and if necessary, please evaluate by adrenal mri. 3. extensive coronary artery calcification and aortic valve calcification. 4. pleural calcification on the right. . 12:15am blood wbc-11.6* rbc-4.26* hgb-13.1* hct-37.2* mcv-87 mch-30.8 mchc-35.3* rdw-14.0 plt ct-338 12:15am blood neuts-81* bands-0 lymphs-11* monos-6 eos-1 baso-0 atyps-0 metas-0 myelos-1* 06:19am blood wbc-6.1 rbc-3.01* hgb-9.4* hct-27.3* mcv-91 mch-31.4 mchc-34.6 rdw-15.6* plt ct-426 12:15am blood pt-13.8* ptt-28.8 inr(pt)-1.2* 12:15am blood glucose-298* urean-15 creat-0.9 na-132* k-4.1 cl-95* hco3-24 angap-17 06:19am blood glucose-151* urean-10 creat-0.8 na-139 k-3.8 cl-103 hco3-28 angap-12 12:15am blood alt-16 ast-19 ck(cpk)-52 alkphos-55 amylase-27 totbili-0.6 12:15am blood lipase-43 12:15am blood totprot-7.3 albumin-4.1 globuln-3.2 calcium-9.7 phos-3.4 mg-1.8 06:30am blood cortsol-7.1 07:34am blood cortsol-6.6 01:45am urine color-amber appear-clear sp -1.037* 01:45am urine blood-lg nitrite-neg protein-tr glucose-1000 ketone-50 bilirub-neg urobiln-1 ph-6.5 leuks-neg 01:45am urine rbc-21-50* wbc- bacteri-occ yeast-none epi-0-2 . micro: r foot swab: gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): sparse growth mixed bacterial flora ( >=3 colony types) consistent with skin flora. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for pseudomonas aeruginosa, staphylococcus aureus and beta streptococcus). staphylococcus, coagulase negative. sparse growth. staphylococcus, coagulase negative. rare growth. second strain. anaerobic culture (final ): no anaerobes isolated. . r foot tissue culture: gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive cocci. in pairs. tissue (final ): reported by phone to cc7a . due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for pseudomonas aeruginosa, staphylococcus aureus and beta streptococcus). viridans streptococci. moderate growth. of two colonial morphologies. staph aureus coag +. moderate growth. of two colonial morphologies. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. proteus vulgaris. rare growth. work up per dr . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | proteus vulgaris | | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- <=0.25 s clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s <=1 s levofloxacin---------- 0.25 s <=0.25 s meropenem------------- <=0.25 s oxacillin------------- 0.5 s penicillin------------ =>0.5 r piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic culture (final ): bacteroides fragilis group. moderate growth. beta lactamase positive. . r foot swab: gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram negative rod(s). wound culture (final ): due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for pseudomonas aeruginosa, staphylococcus aureus and beta streptococcus). moderate growth mixed bacterial flora ( >=3 colony types) consistent with skin flora. staphylococcus, coagulase negative. sparse growth. of two colonial morphologies. proteus species. sparse growth. staph aureus coag +. sparse growth. sensitivities performed on culture # 208-7582s . anaerobic culture (final ): bacteroides fragilis group. moderate growth. identification performed on culture # . . r foot swab: gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive cocci. in pairs, chains, and clusters. 4+ (>10 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): gram positive rod(s). smear reviewed; results confirmed. wound culture (final ): due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for pseudomonas aeruginosa, staphylococcus aureus and beta streptococcus). moderate growth mixed bacterial flora ( >=3 colony types) consistent with skin flora. proteus species. sparse growth. staph aureus coag +. quantitation not available. sensitivities performed on culture # 208-7582s . anaerobic culture (final ): mixed bacterial flora-culture screened for b. fragilis, c. perfringens, and c. septicum. bacteroides fragilis group. moderate growth. beta lactamase positive. . urine and blood cultures: no growth brief hospital course: 65 year old male with type 2 diabetes, htn, hypercholesterolemia, cad and history of remote stroke, current smoker, who presented with sepsis presumed from foul smelling r foot ulcer. 1) sepsis: patient met criteria with fever, leukocytosis, tachycardia, with suspected source of infection being his right foot. he was admitted to the micu and quickly weaned off norepinephrine. he was started on vancomyin, levofloxacin, and metronidazole per the recommendations of podiatry. after initial fluid resuscitation, he was hemodynamically stable and afebrile. his foot cultures were polymicrobial, growing coag negative staph, strep viridans, mssa, pansensitive proteus vulgaris, bacteroides fragilis. after discussion with id, antibiotic regimen was tailored to nafcillin, to be continued until his appointment with podiatry on (will be 21 days treatment at that point), and total 4 week course of levofloxacin and metronidazole, to stop on . a picc was placed, and he was discharged with home vna for antibiotics, pt, wound care. . 2) foot ulcer: he was seen by podiatry on arrival, who felt that he needed semi-emergent amputation. he went to the or within 18 hours of arrival for incision and drainage, and hallux amputation. the procedure was without complications, and he was taken back to the or on for repeat incision and drainage. he had good healing, and was discharged with home vna for home antibiotics, pt, and wound care. . 4) hematuria: the patient developed grossly bloody urine after foley placement in the er. he described clear symptoms of bph with nocturia, urinary frequency with voiding of small amounts of urine, therefore it was thought likely the he had prostate trauma with foley placement. he was treated with cbi transiently clots and pain at the foley site. he was started on proscar. his hematuria gradually cleared over several days, and he never developed recurrent clots or urinary retention. . 5) adrenal nodules: mr. had several cxr with ill-defined r suprahilar opacity, thought to probably reflect overlapping shadows, but could not r/o mass. a chest ct was done to better characterize. chest ct did not visualize suprahilar mass, but did incidentally visualize bilateral adrenal nodules, most likely reflecting hypertrophy. a dexamethasone suppression test was done, which was inconclusive (am cortisol day prior to dex was 7.1, then 6.6 morning after dex administration). mr. should have these nodules worked up as an outpatient with a dedicated mri imaging study. . 6) diabetes: the patient was significantly hyperglycemic at and on arrival to . he was started on an insulin drip after arrival in the icu, titrated to fs 80-120. his oral hypoglycemics were initially held, but then restarted several days prior to discharge due to hyperglycemia. 6) vascular disease: the patient has had cea and a stroke, and is reported to have cad, though there are no records here and he denies any history of mi or abnormal stress test. he was on asa and plavix for his cea/cva, however these were held in anticipation of surgery and in the context of gross hematuria as above, and were restarted a few days prior to discharge. 7) fen: he recieved a diabetic diet. 8) code: his code was full, discussed with patient. medications on admission: plavix asa glucophage glyburide discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. glyburide 5 mg tablet sig: two (2) tablet po bid (2 times a day). 5. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 6. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 7. nafcillin in d2.4w 2 g/100 ml piggyback sig: two (2) gram intravenous q6h (every 6 hours). 8. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours). 9. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day). 10. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day) as needed. 13. insulin nph human recomb subcutaneous 14. insulin lispro (human) subcutaneous discharge disposition: extended care facility: - discharge diagnosis: infected diabetic foot ulcer sepsis discharge condition: good discharge instructions: you were admitted with an infected ulcer on your foot. you had surgery to address this, and you are being discharged home on iv antibiotics. you should continue to take all of your medicines as directed. you should contact your physician if you experience fevers, chills, worsening pain, inflammation, or pus from your foot, or for any other problems that concern you. followup instructions: you should follow up with dr. within the next 2-3 weeks. you can call for an appointment. you should follow up with dr. in podiatry on friday, at 9:30am - call ( if you have any questions, or need to reschedule. md procedure: venous catheterization, not elsewhere classified amputation of toe excisional debridement of wound, infection, or burn other partial ostectomy, tarsals and metatarsals local excision of lesion or tissue of bone, tarsals and metatarsals diagnoses: pure hypercholesterolemia unspecified essential hypertension unspecified septicemia hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes sepsis personal history of other diseases of circulatory system hypovolemia gangrene cellulitis and abscess of foot, except toes ulcer of heel and midfoot diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled chronic osteomyelitis, ankle and foot 

Answer: The patient is high likely exposed to