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: the patient is a hospital transfer to our emergency room who is a diabetic with peripheral vascular disease, hypertension, and hypercholesterolemia who one week ago developed moderate to severe lower back pain. the patient denied any sprain, trauma, falls or lifting. the back pain was without radiation, numbness, weakness, nausea or vomiting. the patient denied dysuria or hematuria. the patient was seen at a local hospital where abdominal ct was obtained that showed a retroperitoneal mass. the patient was given bactrim and discharged. the patient requested evaluation at . past medical history: diabetes mellitus type 2 x 15 years, hypertension, hypercholesterolemia, peripheral vascular disease, chronic renal insufficiency with baseline creatinine of 2.2, history of svt status post surgery, history of hemorrhoids. past surgical history: orthopedic surgery for leg fracture and toe amputations. allergies: the patient has no known drug allergies. medications: zocor 20 mg q.d.; zestril 10 mg q.d.; oxycontin for pain; advil for pain; and insulin. social history: the patient is married and lives with his wife. has occasional alcohol use, occasional cigar use. he is a retired bricklayer. physical examination: vital signs: temperature 98.1, blood pressure 186/94, pulse rate 84, respiratory rate 14, oxygen saturation 97% on room air. general: he was a morbidly obese white male in no acute distress. heent: examination was unremarkable. neck: supple with no lymphadenopathy. cardiac: regular rate and rhythm with normal s1 and s2. lungs: clear to auscultation bilaterally. abdomen: obese, soft and nontender, nondistended, with bowel sounds present. back: no costovertebral angle tenderness or muscle spasm. rectal: normal tone, no masses, guaiac positive. extremities: there was 3+ edema with chronic venous stasis changes with right foot charcot foot changes. femoral pulses were palpable bilaterally. popliteal pulses were palpable bilaterally. pedal pulses were nonpalpable. neurological: examination was unremarkable. laboratory data: white count 14.3, hematocrit 31.6, platelet count 272,000, neutrophils 75, bands 2, lymphocytes 15. pt/inr and ptt were normal. bun 41, creatinine 2.2, k 8.0, recheck 6.2. outside ct scan showed a 7 x 5 x 4 x 4 mass at the level of l2. hospital course: a repeat ct of the abdomen was obtained which demonstrated contained leak in the abdominal aorta, 3 cm distal to the right renal artery, positive node enlargement. multiple blood and urine cultures were obtained which were all no growth and negative abf staining, negative fungal staining, negative to date but not finalized abf and fungal cultures. the patient was transferred to the surgical intensive care unit for continued monitoring and care. he had a foley catheter placed by the urology service. he was placed with two large-bore 18-gauge needles nitroglycerin to maintain his systolic blood pressure at less than 130, n.p.o., intravenous hydration, serial hematocrits. mucomyst was begun. dr. was consulted by consulted by dr. to consider placing a stent graft in the aortic pseudoaneurysm secondary to tumor invasion. the patient underwent endovascular aortic stent placement on . he remained intubated and was stable and was transferred to the surgical intensive care unit for continued care. serial hematocrits were obtained. he was transfused two units of packed red blood cells. post-transfusion hematocrit was 28. the patient's examination remained unremarkable and he continued to require nipride drip and beta blockade to maintain a systolic blood pressure of less than or equal to 130. he was weaned to extubate. on postoperative day two the patient required aggressive diuresis for volume overload secondary to third spacing. the patient was extubated without difficulty. his post-transfusion hematocrit was 33.7, bun 37, creatinine 3.5, k 4.0. abdominal examination remained unchanged and pulse examination remained unchanged. his hematocrit remained stable. the patient was transferred to the vascular intensive care unit for continued monitoring and care. a renal consultation was requested because of continuing elevation in his creatinine. they felt the etiology of the creatinine bump was secondary to acute tubular necrosis which was caused by a combination of contrast-induced hypotension. on the patient returned to ct scan and underwent a ct needle biopsy and aspiration. tissue and fluid were sent for culture. the culture results demonstrated 1+ pmns, abf stain was negative, so far the culture has shown no growth, and the abf is not finalized but no growth. with these results the patient was placed on vancomycin, levofloxacin and flagyl. his medications were renal dosed. the patient required intravenous hydration for low urinary output per renal. infectious disease was consulted to determine length of therapy and antibiotic agents that should be utilized for this patient's care. recommendations were to continue current antibiotic therapy and adjust according to culture results. the patient returned to ct on for further specimens for culture. he tolerated the procedure without complications. his acute renal failure slowly resolved. his peak creatinine was 4.0. he returned to baseline of 1.8. general surgery continued to follow the patient awaiting further anticipation of intra-abdominal surgery. podiatric surgery saw the patient for left foot callus protection. the patient's antihypertensives required redosing with improvement in his renal function. ace inhibitor was restarted, zestril 20 mg q.d. on . discussion ensued regarding intra-abdominal intervention with axillofemoral bypass graft. cardiology consultation was requested for perioperative risk assessment. echocardiogram demonstrated left atrial dilatation mild, right atrial dilatation mild, left ventricular and right ventricular dilatation with global hypokinesis, pulmonary hypertension. valves were without stenosis or regurgitation. ejection fraction was calculated at 20%. although the patient's persantine mibi was negative for ischemic changes, but because of the low ejection fraction and global hypokinesis, cardiac catheterization was recommended. the patient underwent cardiac catheterization on which demonstrated multivessel disease, right coronary artery 40-50% stenosis, main trunk 20% stenosis, left anterior descending coronary artery 20% stenosis, main circumflex coronary artery 30% stenosis. the patient did not require any cardiac intervention or surgery; continue on medical therapy. after rediscussion and reconsideration it was decided that the patient would be at a very high risk for open procedure and that for the present time we would continue conservative treatment with long-term antibiotics, monitor the patient and then determine if any other surgical intervention is required. the following day post catheterization the patient had an episode of vague anterior chest discomfort described as a heaviness/burning. ekg was obtained which showed st depressions in v4, 5 and 6. the patient was transferred to a monitoring unit to rule out myocardial infarction. his cpks and troponin levels were flat. his ekg returned to baseline. general surgery was consulted on to do an open biopsy. the patient underwent exploratory laparotomy, retroperitoneal dissection, phlegmon drainage and biopsy on . he tolerated the procedure well and was transferred to the postanesthesia care unit in stable condition. postoperatively the patient did well. the patient's culture from the operating room on the 31st grew out gram positive cocci. the patient was continued on vancomycin. the patient will require a total of eight weeks of antibiotics. physical therapy and occupational therapy did evaluate the patient for potential rehabilitation. the right picc line initially was felt not to be positioned correctly. after reevaluation it was felt that it was in the correct position and did not require any adjustment. the patient's hematocrit was noted to be 27. recommendations of cardiology to maintain his hematocrit greater than 30 included transfusion. this will be discussed with the attending and decision made before patient discharge, with a repeat hematocrit if transfused. at the time of discharge the patient was afebrile. his wounds were clean, dry and intact. discharge instructions: recommendations were to continue antibiotics for a total of eight weeks, starting from . he would require abdominal and pelvic ct with intravenous contrast at two weeks post discharge and four weeks post discharge. this request will be called to dr. office and arranged for the patient. the patient should have, per infectious disease, weekly complete blood counts, sma-7's and vancomycin troughs. we will clarify with the infectious disease service whether he will require serial esrs to be done on an outpatient basis. the laboratory findings should be called to the infectious disease clinic. the infectious disease clinic number is . follow up: a follow-up appointment in two weeks with dr. and dr. , which is thursday clinics or dr. , which is friday clinics, should be arranged along with his abdominal ct. arrangements should be made for the patient to be seen on follow up by dr. of the renal service at the same time he has his initial follow-up visit with dr. and the infectious disease service. discharge medications: 1. dulcolax tablets 5-10 mg q.d. p.r.n. 2. aspirin 81 mg q.d. 3. vancomycin 1,000 mg intravenous q. 24 hours with trough levels q. week. 4. levofloxacin 500 mg intravenous q. 24 hours. 5. flagyl 500 mg intravenous q. 8 hours. 6. zantac 150 mg b.i.d. 7. metoprolol 50 mg b.i.d., hold for systolic blood pressure of less than 110, heart rate less than 55. 8. lisinopril 10 mg q.d. 9. percocet tablets q. 4-6 hours p.r.n. for pain. 10. epogen 6,000 units subcutaneous q. sunday and wednesday. 11. heparin subcutaneous 5,000 units q. 8 hours. surgical pathology: the periaortic lymph node was reactive with fragments of fibrinous connective tissue with marked chronic and active inflammation and focal abscess formation. the retrocaval phlegmon showed fibrinous and fibroadipose tissue with abscess formation, reactive lymph nodes. there was no malignancy identified in either specimen. discharge diagnoses: 1. retroperitoneal mass, i.e. abscess status post exploratory laparotomy, retroperitoneal approach. 2. abdominal aortic aneurysm, status post aortic endovascular stenting. 3. chronic renal insufficiency with episode of acute tubular necrosis, resolved. 4. coronary artery disease with ejection fraction of 20% status post cardiac catheterization, mild triple vessel disease. 5. left foot deformity, stable. 6. hypertension, controlled. 7. picc line placement for long-term antibiotics. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified left heart cardiac catheterization coronary arteriography using a single catheter incision of abdominal wall endovascular implantation of other graft in abdominal aorta simple excision of other lymphatic structure closed [percutaneous] [needle] biopsy of intra-abdominal mass closed [percutaneous] [needle] biopsy of intra-abdominal mass closed [percutaneous] [needle] biopsy of intra-abdominal mass diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled peripheral vascular disease, unspecified abdominal aneurysm, ruptured 

Answer: The patient is high likely exposed to