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: no known allergies / adverse drug reactions attending: chief complaint: bleeding from graft site major surgical or invasive procedure: right bka history of present illness: mr is a pleasant 79m who underwent a r fem-pt bypass with what appears to be non-reversed gsv approximately 2 months ago at . he was, by report kept inpatient there for 6 weeks post-operatively, finally discharging home on . he had done well at home until this morning when he had a sudden bout of large volume diarrhea and while in the bathroom noted a substantial amount of bleeding from the r leg distal incision site (which overlies the distal anastomosis). he did not directly visualize the bleeding site as it was obscured by his clothing and not still bleeding when this was removed. he was with a visiting nurse at the time who applied pressure and called ems. per report, he was found hypotensive to the 70's in ems arrival and was disoriented and diaphoretic. he was transported to for further care. in the ed at he was normotensive and neurologically appropriate. no bleeding was noted and he had a hct of 32. he was taking coumadin for a peri-operative dx of afib and his inr was 3.2. wbc at this with was 27 and there was concern that he may be manifesting an early septic picture. he was started on broad spectrum abx (vanco, zosyn) and plans were made to transfer to as his surgeon at hosp was not available. on transfer, my was stable and had no furhter episodes of bleeding. he arrives afebrile, not complaining of pain and completely neuro-motor intact. he states that the index operation was done for caludicaion with sx at 150 yards. he has bee able to achieve an active lifestyle, riding his bike, etc, while at home these last several days. he denies any bleeding episodes prior to today. he notes no history of local trauma of that wound. past medical history: pmh: duodeneal adenocarcinoma, copd, htn, a fib, diverticulosis psh: r fem-pt, (~3yrs ago) social history: 45pkyr smoker, quit 13-14 years ago 1 beer per day no other drug use lives independently family history: non-contributory physical exam: vital signs: temp: 98.1 rr: 16 pulse: 108 bp: 132/74 neuro/psych: oriented x3, affect normal, nad. neck: no masses, trachea midline, thyroid normal size, non-tender, no masses or nodules, no right carotid bruit, no left carotid bruit. nodes: no clavicular/cervical adenopathy, no inguinal adenopathy. skin: abnormal: r subcostal incision - well healed; well healed rle incisions until the ankle . heart: regular rate and rhythm. lungs: clear, normal respiratory effort. gastrointestinal: non distended, no masses, no hepatosplenomegally, no hernia, no aaa, abnormal: mildly tender in the epigastrium. rectal: not examined. extremities: no popiteal aneurysm, no femoral bruit/thrill, no rle edema, no lle edema, no varicosities, no skin changes. pulse exam (p=palpation, d=dopplerable, n=none) rue radial: p. ulnar: p. lue radial: p. ulnar: p. rle femoral: p. popiteal: d. dp: n. pt: d. lle femoral: p. popiteal: d. dp: d. pt: d. description of wound: dehissence of the distal incision site, just posterior to the medial malleolus. there is a shallow ulcerated area with fibrinous tissue and some inflamed granulation. no active bleeding or obviously exposed graft. there is a circumferential area of 1cm of erythema pertinent results: 10:20pm glucose-105* urea n-28* creat-1.8* sodium-139 potassium-3.9 chloride-100 total co2-24 anion gap-19 10:20pm wbc-35.7* rbc-3.51* hgb-10.9* hct-33.5* mcv-95 mch-31.1 mchc-32.6 rdw-15.7* 10:20pm neuts-81* bands-13* lymphs-2* monos-4 eos-0 basos-0 atyps-0 metas-0 myelos-0 10:20pm urine blood-mod nitrite-neg protein-25 glucose-neg ketone-tr bilirubin-sm urobilngn-neg ph-5.0 leuk-neg cxr (): no infiltrate, effusion or enlargement of the cardio-mediastinal sillouhette ekg (): sinus rhythm with atrial premature beats. probable intra-atrial conduction delay. rightward axis is non-specific and may be within normal limits. since the previous tracing of there is probably no significant change. labs on admission: 10:20pm blood wbc-35.7* rbc-3.51* hgb-10.9* hct-33.5* mcv-95 mch-31.1 mchc-32.6 rdw-15.7* plt ct-664* 10:20pm blood pt-31.7* ptt-34.2 inr(pt)-3.2* 10:20pm blood glucose-105* urean-28* creat-1.8* na-139 k-3.9 cl-100 hco3-24 angap-19 03:28am blood alt-52* ast-31 alkphos-78 totbili-0.3 03:44pm blood lactate-2.5* pertinent labs during course: 06:31am blood wbc-26.7* rbc-3.13* hgb-9.9* hct-28.2* mcv-90 mch-31.6 mchc-35.1* rdw-18.5* plt ct-359 09:25am blood wbc-21.2* rbc-3.44* hgb-10.4* hct-33.4* mcv-97 mch-30.2 mchc-31.2 rdw-18.2* plt ct-593* 08:23pm blood wbc-9.0 rbc-2.95* hgb-9.1* hct-27.9* mcv-94 mch-30.8 mchc-32.6 rdw-17.2* plt ct-330 05:02am blood wbc-6.7 rbc-3.59* hgb-10.9* hct-33.1* mcv-92 mch-30.4 mchc-32.9 rdw-17.1* plt ct-110* 02:23am blood wbc-9.5 rbc-2.92* hgb-8.9* hct-27.4* mcv-94 mch-30.4 mchc-32.3 rdw-16.5* plt ct-43* 08:16pm blood wbc-2.1*# rbc-2.87* hgb-9.0* hct-26.1* mcv-91 mch-31.3 mchc-34.5 rdw-16.6* plt ct-53* 12:33am blood wbc-8.7# rbc-3.22* hgb-9.7* hct-30.4* mcv-95 mch-30.0 mchc-31.7 rdw-16.4* plt ct-52* 03:59am blood wbc-9.2 rbc-2.79* hgb-8.7* hct-25.7* mcv-92 mch-31.1 mchc-33.8 rdw-16.4* plt ct-88*# 05:00pm blood wbc-11.0 rbc-3.34* hgb-10.6* hct-31.9* mcv-96 mch-31.7 mchc-33.2 rdw-15.7* plt ct-85* 10:20am blood glucose-176* urean-34* creat-1.5* na-140 k-3.9 cl-105 hco3-23 angap-16 05:26am blood glucose-112* urean-18 creat-0.9 na-141 k-3.7 cl-110* hco3-24 angap-11 04:35am blood glucose-125* urean-12 creat-0.7 na-143 k-3.2* cl-107 hco3-29 angap-10 04:30am blood glucose-107* urean-16 creat-0.6 na-136 k-4.0 cl-107 hco3-22 angap-11 02:30pm blood glucose-122* urean-31* creat-0.9 na-156* k-4.0 cl-120* hco3-27 angap-13 03:59am blood glucose-204* urean-32* creat-1.0 na-150* k-3.7 cl-116* hco3-25 angap-13 04:14pm blood glucose-28* urean-32* creat-1.0 na-149* k-4.0 cl-117* hco3-26 angap-10 12:12pm blood ck-mb-4 ctropnt-0.02* 02:07pm blood ck-mb-4 ctropnt-0.02* 07:47am blood ck-mb-5 ctropnt-0.05* 03:56am blood caltibc-86* ferritn-276 trf-66* 07:56pm blood lactate-6.5* k-3.6 02:34am blood glucose-106* lactate-1.8 k-4.1 12:00am blood heparin dependent antibodies- labs on discharge: na 145, cl 113, bun 31, gluc 88 k 3.9, hco3 23, cr 1.1 ca: 8.1 mg: 2.2 p: 2.4 alt: 41, ap: 84, tbili: 1.2 ast: 32, ldh: 178 wbc 13.8, hb 9.9, plt 141 hct 29.4 pt: 21.7 ptt: 48.1 inr: 2.0 imaging: cxr: findings: single ap upright portable view of the chest was obtained. the lungs are hyperinflated, with flattening of the diaphragms, suggesting chronic obstructive pulmonary disease. apical pleural thickening is seen. there may be calcified pleural plaques overlying the right greater than left lung apices which would suggest prior asbestos exposure. no prior available for comparison. no focal consolidation, pleural effusion, or pneumothorax is seen. cardiac and mediastinal silhouettes are small, in keeping with copd/emphysema. . cxr: findings: as compared to the previous radiograph, there is no relevant change. overinflation, small bilateral pleural effusions, retrocardiac atelectasis. no evidence of focal parenchymal opacity suggesting pneumonia. extensive vascular calcifications along the supra-aortic vessels. . upper ext lenis: impression: superficial thrombophlebitis involving the right basilic vein from the antecubital fossa extending halfway up the arm. no other thrombosis involving the upper extremities veins bilaterally . echo: the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is mild global left ventricular hypokinesis (lvef = 40%). right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. there is a very small pericardial effusion. impression: no valvular vegetations seen. mild global left ventricular systolic dysfunction. mild calcific aortic stenosis. . cxr: findings: ap single view of the chest has been obtained with patient in semi-upright position. comparison is made with the next preceding similar study obtained two hours earlier. at that time an acute complete left-sided whiteout was obtained with mediastinal shift towards the left. now partially re-aeration of the lung is observed indicating clearance of the central airways. there are still some densities remaining and further progress in re-aeration can be expected. no pneumothorax developed. . cxr: findings: as compared to the previous radiograph, the patient has received a tracheostomy tube. this tube is in correct position. the nasogastric tube has been removed. the right picc line is in unchanged position. the pre-existing left apical opacity has markedly decreased in extent. the scars in the right and left upper lung parenchyma, however, are unchanged. also unchanged is the extent of the bilateral moderate pleural effusions, although on today's radiograph the retrocardiac lung parenchyma is better ventilated. no newly appeared focal parenchymal opacity suggesting pneumonia. brief hospital course: 79m with h/o pancreatic adenocarcinoma s/p , here with infected r fem-pt graft, s/p rt bka , infected stump s/p rt aka , multiple intubations for respiratory distress, extremely broad antibiotic treatment for vre bacteremia, xanthomonas baceteremia, and hcap, now s/p trach and peg , with respiratory failure, hypernatremia, hypotension and anemia. see below for discussion of each of his issues. he was transferred to the micu a day prior to discharge for management of his medical issues. goals of care were discussed and he agreed to rehab. he does not want to be rehospitalized if his condition were to change, though. . 1. hypoxic respiratory failure: patient likely has baseline copd/emphysema. he was intubated and extubated once for pneumonia, then failed and had a second intubation requiring tracheostomy placement. he is now with b/l pleural effusions, grossly fluid overloaded, recovering from xanthomonas pneumonia on bactrim per id recs. also likely to deconditioning from prolonged ventilation. the day of discharge, he was weaned off ventilator and placed on trach mask and tolerated well. in a goals of care discussion, he stated he would not want to be ventilated again. he should continue ipratropium and albuterol inhalers as needed. he should have lasix prn as his blood pressure tolerates. . 2. hypernatremia: free water deficit was 1.7l. improved to normal today with free water flushes and d5w. he should continue his current free water flushes and have his labs checked every few days to make sure it remains in a normal range. on discharge his sodium was 145. . 3. bacteremia: his infectious and abx course is as follows: (per id notes) he was started on broad antibiotic coverage on admission with vanco/cipro/flagyl; developed worsening limb ischemia, underwent a right bka on ; developed systemic toxicity on ; had vre bacteremia on with vre wound infection of bka stump; vanco d/ced on and switched to linezolid; po vanco initiated for empiric c diff coverage; stools neg for c diff toxin; repeat bc on re-isolated vre; underwent rt aka amputation on ; resumed cipro, added metronidazole and continued linezolid; blood cultures from and were no growth; picc line d/ced; replaced on ; transferred to floor; noted to have aspiration when eating; formal swallow study on confirmed aspiration; developed abrupt onset respiratory distress on ; required intubation; transferred to the icu, hypotensive; required pressor support; bal performed on demonstrated abundant thick secretions in airways; and white plaque noted on bronchial wall in lll; right lung was normal. bal gram stain: gnr and budding yeast with pseudohyphae; antibiotic regimen revised to cefepime/gent; linezolid changed to daptomycin. he was briefly on meropenem and then switched to bactrim when stenotrophomonas (xanthomonas) maltophilia grew in his blood and his sputum on . he is to complete a 3 week course of bactrim for his bacteremia per id recs. of note, his wbc was rising on the day of discharge to 13. he had no fevers and understood that this was increased today, but he was comfortable with the choice to try rehab at this time and just continue his current antibiotics. . 4. hypotension: patient has had persistent hypotension needing levophed, and albumin boluses throughout his course. likely heart failure and intravascular volume depletion in setting of infection. on discharge, his bps were in the low 100s. he was mentating well. . 5. thrombocytopenia: attributed to linezolid, has recovered from 50 to 88 to 144. hit ab negative, so sq heparin was restarted. seems to be recovering since linezolid was removed. his wbcs also fell, so it was thought to be all marrow suppression. . 6. atrial fibrillation: paroxysmal a fib, during acute illness. he was on coumadin for short period of time, but it was held for various procedures. his platelets dropped and he continued to have a coagulopathy with inr in high 1s to low 2s despite holding coumadin. he was placed on aspirin 81mg daily. he should not start coumadin given that the afib was likely in setting of infection. he is in sinus tach on discharge with occassional runs of afib in low 100s. he is not on any rate control because of his blood pressure. . 7. oliguria: uop poor, cr stable. los 19l +. he should be diuresed with prn lasix as his blood pressure tolerates. . 8. s/p aka: patient was admitted to the vascular surgery service from the ed with thrombosed right femoral-posterior tibial graft and over the first few hospital days his leg demarcated and he was taken to the or for right below the knee amputation. he tolerated this procedure well and was transferred to the vicu post-op. his course was then complicated by bacteremia and he was deemed to need an aka. this was also done without complications. he has a wound that is clean dry and intact, and he should follow up with vascular surgery as scheduled. . 9. goals of care: given patient's highly morbid course, and poor prognosis, we need to discuss with his hcp what his goals of care are. we discussed with him what he would like, and he stated he is firmly dnr/dni. he would not want to be reattached to the vent, and if his status changed dramatically, he would consider changing to comfort care. he does not want to get re-hospitalized in the future. he does want to try and do well at rehab and stated he was not interested in hospice at this time. his contacts are , his son, and presumably his hcp, who is out of town but reachable at . his sister was also , her number is . . 11. hypoglycemia: patient has been intermittently hypoglycemia throughout his stay. not on insulin. perhaps related to , or pancreatic ca. he should stay on finger sticks to monitor his sugars and get dextrose prn. . 12. s/p , has mild abdominal pain, but is likely post gt incisional pain. we continued creon with his tube feeds. . 13. malnutrition: albumin on admission 2.0, cachectic, he was maintained on tube feeds with plan to try rehab . 14. htn: his lisinopril was discontinued on due to hypotension and anuria. medications on admission: b12 1000', dilt cd 120', advair 250/50 1'', lasix 20', klorcon 20meq'; combivent 2puff'''', lisinopril 5', protonix 40', coumadin 2', vitamin b12 1000mg qd discharge medications: 1. lipase-protease-amylase 12,000-38,000 -60,000 unit capsule, delayed release(e.c.) : one (1) cap po qidwmhs (4 times a day (with meals and at bedtime)). 2. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q2hrs as needed for dyspnea. 3. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q4h (every 4 hours). 4. trazodone 50 mg tablet : 0.5 tablet po hs (at bedtime) as needed for sleep. 5. oxycodone-acetaminophen 5-325 mg/5 ml solution : five (5) ml po q6h (every 6 hours) as needed for pain. 6. metoclopramide 10 mg tablet : one (1) tablet po qid (4 times a day) as needed for nausea. 7. heparin (porcine) 5,000 unit/ml solution : one (1) syringe injection (2 times a day). 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr once a day. 9. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 10. normal saline flush 0.9 % syringe : one (1) syringe injection as needed as needed for for picc line flushes. 11. sulfamethoxazole-trimethoprim 200-40 mg/5 ml suspension : thirty (30) ml po every eight (8) hours for 14 days: end date (is a total of 3 week course). discharge disposition: extended care facility: hospital - discharge diagnosis: thrombosed rle graft bacteremia diarrhea atrial fibrillation pneumonia respiratory failure discharge condition: mental status: clear and coherent, although cannot talk well because of tracheostomy, communicated with yes/no and lip . level of consciousness: alert and interactive. activity status: bedbound now, on trach mask, in and out to chair sometimes. discharge instructions: dear mr. , it was a pleasure taking care of you at . you were transferred to from for management of your right foot infection. you were first under the care of the vascular surgeons and your received a right below the knee amputation. you tolerated this surgery well. you subsequently were diagnosed with bacteria in your blood, high sodium levels, low urine output, diarrhea, and atrial fibrillation. you were treated with antibiotics for your bacteremia and diarrhea. you were given blood transfusions and large volumes of intravenous fluids. you then had problems breathing and required a breathing tube. it was hard to improve your breathing enough to remove the breathing tube, you had a tracheostomy. you are now doing well through the tracheostomy without the ventilator. you decided that you wouldn't want to have to use the ventilator again if it was needed. you also had a repeat amputation at your hip for worsening infection. you should follow up with and with the vascular surgeons. you had a second amputation higher on the same leg because of infection and poor healing of the first amputation. for your bacteria in your blood stream, you will need about two more weeks of an oral antibiotic. you are on bactrim for that reason. . discharge instructions following below or above knee amputation from your vascular surgeons: . 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. . 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. . 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. . avoid taking a tub bath, swimming, or soaking in a hot tub for four weeks after surgery. . 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. . you will be helped in the rehab unit to try and regain your strength and improve your breathing as much as possible. followup instructions: please follow up with your doctors at the unit. please also see the vascular surgeons in follow up: procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more temporary tracheostomy closed [endoscopic] biopsy of bronchus amputation above knee percutaneous (endoscopic) jejunostomy [pej] other amputation below knee repair of entropion or ectropion with wedge resection revision of amputation stump diagnoses: acidosis congestive heart failure, unspecified severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonitis due to inhalation of food or vomitus cachexia 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 infection with microorganisms without mention of resistance to multiple drugs other complications due to other vascular device, implant, and graft long-term (current) use of anticoagulants diarrhea infection and inflammatory reaction due to other vascular device, implant, and graft hyperosmolality and/or hypernatremia other and unspecified infection due to central venous catheter streptococcal septicemia personal history of malignant neoplasm of other gastrointestinal tract other specified antibiotics causing adverse effects in therapeutic use arterial embolism and thrombosis of lower extremity infection (chronic) of amputation stump disruption of external operation (surgical) wound other disorders of muscle, ligament, and fascia nutritional marasmus body mass index less than 19, adult amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other secondary thrombocytopenia pneumonia due to anaerobes 

Answer: The patient is high likely exposed to