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: history of present illness: this is a 47-year-old male with a history of long-standing type 1 diabetes mellitus, severe peripheral vascular disease, s/p multiple amputations, renal failure s/p renal transplant ten years ago, coronary artery disease, status post coronary artery bypass grafting, admitted for fever and left lower extremity cellulitis. the patient reported the onset of fever the evening prior to admission to 104?????? at home with rigors, as well as nausea and vomiting. the patient noticed redness and swelling of the left lower extremity which started the night prior to admission. this was very painful to touch. fevers were not relieved by tylenol. he denied cough, shortness of breath, chest pain, palpitations, or abdominal pain. he has had regular bowel movements. he was urinating well. no dysuria. he denied sick contacts. past medical history: kidney transplant on . diabetes since age 11. right bka on . coronary artery disease status post bypass in . multiple finger amputations. left foot metatarsal amputation in . history of shingles. hypertension. neuropathy. gout. gastroparesis. anemia. congestive heart failure. medications: aspirin 325 q.d., insulin lantus 48 u at dinner, humalog at dinner and bedtime, allopurinol 150 mg q.d., rapamune 2 ml q.d., lopressor 100 b.i.d., zantac 150 q.d., prednisone 5 q.d., cellcept b.i.d., advicor 1000 mg q.h.s., neurontin 100 t.i.d., lasix 40 q.d., reglan 10 q.d., epogen 4000 2 tab a week, methadone 10 b.i.d., diovan 80 q.d., compazine p.r.n., oxycodone 5 mg p.r.n., nitrostat 0.4 mg p.r.n., zaroxolyn 2.5 mg p.r.n. allergies: erythromycin, protamine. social history: the patient lives with wife. previously worked as a mechanic. he stopped working about a year ago. history of tobacco; however, he is not currently smoking. he has social alcohol. physical examination: vital signs: temperature 103.9??????, heart rate 108, blood pressure 130/70. general: the patient was a well-developed, well-nourished male. he was tired and uncomfortable. he was warm to touch. alert and oriented times three. heent: normocephalic, atraumatic. oropharynx clear. dry mucous membranes. pupils equal, round and reactive to light. extraocular movements intact. neck: supple. no jugular venous distention. no lymphadenopathy. cardiovascular: heart sounds normal. s1 and s2. no murmurs appreciated. old cabg scar. lungs: clear to auscultation bilaterally. back: no cva tenderness. abdomen: distended, soft, no tenderness to palpation. right lower quadrant scar (kidney transplant). extremities: right bka. no erythema or swelling. left lower extremity foot partially amputated at the metatarsals. positive swelling. redness. positive tenderness to palpation. his erythema extends 3 cm below the patella. no crepitus. able to flex ankle and knee. he had chronic dry left heel ulcer. laboratory data: white count 19.3, hematocrit 35.3, platelet count 333, 84% neutrophils, 5% bands; coags within normal limits. ultrasound of the lower extremities negative. chemistries with a sodium of 138, potassium 3.6, chloride 98, bicarb 26, bun 75, creatinine 2.6, glucose 176. hospital course: 1. left lower extremity cellulitis: the patient was initially started on oxacillin; however, the fevers persisted over the next 24-48 hrs and white cell count continued to escalate. the patient was switched to vancomycin and zosyn empirically as a result. shortly thereafter, the patient developed delirium and the patient's white blood cell count continued to climb to 30,000, and he was clinically worsening. he developed worsening renal function and increase in transaminases as well. blood tests showed elevated d-dimer and fibrinogen consistent with sepsis. the patient was taken to the operating room with vascular surgery on , for exploration and debridement. postoperatively the patient was taken to the medical intensive care unit where he was stabilized and was transferred to the floor on . in the medical intensive care unit, a central venous line was placed, and fluid status was titrated to cvp. ct of the leg did not demonstrate any abscess but the study was done without contrast due to renal impairment. mri was unable to be performed given that the patient had a surgical clip in the ethmoid sinus. a le ultrasound was done which did not any focal fluid collections and a gallium scan was also done which confirmed these findings. on transfer to the floor on , the patient's mental status was improving. surgical culture eventually grew oxacillin resistant staph aureus. antibiotics were narrowed to vancomycin alone. he was afebrile for the remainder of his hospital course. his white blood cell count slowly trended down and was 11,000 on . vancomycin was dosed for levels less than 15. on , a picc line was placed, and his vancomycin is to be continued until . the vascular surgery service followed the patient throughout the hospital course and recommended that the patient continue on antibiotics until the cellulitis had improved. he may still need a left bka in the near future depending on his future course. 2. acute on chronic renal failure: the patient's creatinine began to trend up on admission and peaked at 4.0. this was in the setting of sepsis from the leg infection but with careful fluid management and supportive treatment, his creatinine improved back to 2.0 on close to his baseline. the patient initially had his immunosuppressants held except for the prednisone given that he had an acute infection. rapamune was restarted to its prior level of 2 mg prior to discharge; however, the cellcept continued to be held per renal service. further management per dr. , his nephrologist. 3. diabetes: initially the patient's blood sugars were difficult to control, and the patient was placed on an insulin drip while he was in the medical intensive care unit. on transfer to the floor, the patient lantus dose was increased to 54, and his humalog insulin sliding scale was tightened with improvement and control of his blood sugars. 4. herpes labialis: the patient had herpes lesions around his mouth, and given his immunocompromised state, he was started on acyclovir for a 14-day course. the lesions continued to improve throughout the hospitalization. 5. delirium: the patient's delirium was attributed to a combination of uremia and infection and had improved to near baseline at the time of discharge. 6. elevated lfts: the patient had transaminases which elevated to the low 1000s after going to the operating room. this was thought to be either due to shock liver secondary to hypertension or possible secondary to his anesthetic when he went to the operating room. the lfts continued to trend down throughout his hospital course without specific intervention. disposition: the patient needs two additional weeks of intravenous vancomycin, and a picc line was placed for this purpose. physical therapy and occupational therapy evaluated the patient and determined that he would benefit from a short stay of rehabilitation, and he was transferred to a rehabilitation facility for skilled nursing care and physical therapy. discharge diagnosis: 1. left lower extremity cellulitis, culture positive for mrsa. 2. acute on chronic renal failure. 3. delirium from sepsis. 4. diabetes mellitus. 5. status post renal transplant. 6. history of severe peripheral vascular disease with multiple amputations. 7. coronary artery disease, ef 35-40%. follow-up: the patient will follow-up with his primary care physician, well as renal and vascular services. discharge instructions: instructions were given to the patient on discharge. procedures: left lower extremity debridement on . discharge medications: allopurinol 150 mg q.d., metoprolol 100 mg b.i.d., zantac 150 mg q.d., reglan 10 mg q.d., epogen 4000 u b.i.d., niacin 1000 mg q.d., heparin 5000 u subcue b.i.d., rapamune 2 mg q.d., prednisone 5 mg q.d., silvadine 1% creme to left lower extremity b.i.d., lantus insulin 52 u subcue q.h.s., humalog insulin per sliding scale, morphine 2 mg q.2 hours p.r.n., acyclovir 150 mg iv q.24 hours, discontinue on , vancomycin 1000 mg iv q.24 hours, discontinue on . need to check vancomycin levels periodically to assure levels < 15. activity: out of bed to chair with assistance at least t.i.d. physical therapy to work with strength and functional mobility. diet: diabetic renal diet. condition on discharge: stable. , m.d. dictated by: medquist36 d: 13:58 t: 14:00 job#: procedure: venous catheterization, not elsewhere classified excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn open biopsy of soft tissue diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia cellulitis and abscess of leg, except foot cellulitis and abscess of foot, except toes ulcer of heel and midfoot diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled fasciitis, unspecified 

Answer: The patient is high likely exposed to