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: codeine / fentanyl / sulfa(sulfonamide antibiotics) / penicillins / zithromax / cephalexin / levaquin / zocor / cipro / darvon / zovirax / septra attending: chief complaint: cold right foot major surgical or invasive procedure: angiography, right external iliac artery stent placement, right superficial artery stent placement x3 history of present illness: year old female with history dementia and pvd s/p lle bypass 2 years ago, now being transferred from hospital with a painful cold right foot for the past 2 days. she started with right foot pain 2 days ago and then started to look progressively worse with cyanosis and cold. she had a similar situation on the left foot 2 years ago and underwent a lle bypass at hospital. has a history of paroxysmal a.fib, but has been on sinus rythm here and at . she walks with a walker at baseline and also uses wheelchair when she goes to church. she has been able to move her toes with mild weakness and feels mild numbness as well. past medical history: past medical history: pvd, cad s/p cardiac stents , htn, dementia, recent gi bleed, h/o r hip fx 3 years ago, h/o colonic polyps, diverticular disease, hypothyroidism, hyperlipidemia, chronic constipation, chf, h.o gastric angioectasias, h/o ischemic colitis, osteoporosis, gerd, arf, paroxysmal a.fib past surgical history: left carotid stent, tah, open ccy, tonsillectomy, lle bypass 2 years ago social history: social history: retired, lives at home with husband across the street from his son's house. denies any tobacco or etoh use. family history: nc physical exam: at admission: physical exam: vitals: t 99.2 hr 101 bp 149/119 rr 18 so2 95% gen: a&ox3, nad heent: no scleral icterus, mucus membranes moist cv: rrr, no m/g/r pulm: clear to auscultation b/l, no w/r/r abd: soft, nondistended, nontender, no rebound or guarding, normoactive bowel sounds, no palpable masses dre: normal tone, no gross or occult blood ext: no le edema. right foot cyanotic, colder than left foot, with mild weakness and numbness. no signals. pulses: fem dp pt graft left 2+ 1+ 1+ dop 2+ right 1+ dop - - discharge exam: general: waking; oriented to person, slightly tachypneic but overall improved work of breathing heent: sclera anicteric, dry mm, oropharynx clear neck: supple, jvp elevated above clavicle though difficult to assess with mask on cv: irreg irreg, normal s1 + s2, 3/6 systolic murmur lungs: decreased bs at bases bilaterally with crackles, good aeratin abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, faint dp pulses bilaterally with 1+ edema to midshin, no calf tenderness, groin sites without hematoma neuro: moving all extremities, toes downgoing pertinent results: admission labs: 08:30pm blood wbc-8.0 rbc-4.53 hgb-14.0 hct-40.9 mcv-90 mch-30.9 mchc-34.3 rdw-14.1 plt ct-308 08:30pm blood pt-11.7 ptt-31.9 inr(pt)-1.1 08:30pm blood glucose-102* urean-35* creat-1.3* na-139 k-5.0 cl-106 hco3-21* angap-17 03:43am blood wbc-10.1 rbc-3.95* hgb-12.4 hct-35.6* mcv-90 mch-31.3 mchc-34.8 rdw-13.9 plt ct-257 12:25pm blood glucose-149* urean-24* creat-1.4* na-139 k-3.7 cl-104 hco3-26 angap-13 . discharge labs: 06:34am blood wbc-8.2 rbc-3.44* hgb-10.5* hct-31.2* mcv-91 mch-30.5 mchc-33.7 rdw-15.3 plt ct-289 04:57am blood glucose-89 urean-31* creat-1.5* na-144 k-3.3 cl-105 hco3-28 angap-14 04:57am blood calcium-7.9* phos-3.0 mg-1.9 05:55pm blood triglyc-243* hdl-26 chol/hd-7.7 ldlcalc-126 ldlmeas-134* 06:34am blood %hba1c-6.2* eag-131* . tte: the left atrium is normal in size. the estimated right atrial pressure is at least 15 mmhg. there is mild-moderate symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef>75%). the right ventricular cavity is mildly dilated with borderline normal free wall function. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is severe mitral annular calcification. there is mild-moderate functional mitral stenosis (mean gradient 6 mmhg) due to mitral annular calcification. moderate tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: mild-moderate symmetric left ventricular hypertrophy with hyperdynamic left ventricular function and no lvot gradient at rest. mild aortic stenosis and regurgitation. mild-moderate functional mitral stenosis. severe pulmonary artery systolic hypertension. left pleural effusion. brief hospital course: ms. is a yo f with extensive pvd, cad, dchf (ef~75%), paroxysmal a-fib (not on coumadin), and ckd who presented with an ischemic rle pod from angiography, angioplasty, and stenting on transferred to the icu in setting of afib with rvr. patient was found to have pulmonary edema and was subsequently diauresed to euvolemia with return of nsr. . # ischemic right foot the patient was admitted to the vascular surgery service under dr. on after being transferred from an osh with a cold right foot. the patient was premedicated for angiography that was performed on . the patient was found to have an occluded right external iliac artery that was then stented. the patient's right superficial femoral artery was also stented x3. the patient's sedation was lightened on pod 1 and the patient was extubated. the patient tolerated the extubation well. the patient was then transferred to the vicu for continued monitoring. the patient was started on plavix and kept on her home dose full aspirin. . # acute on chronic kidney failure on pod 3 the patient's foley was removed. the patient failed to void and replacement of foley catheter yielded 40 cc of urine. patient was bolused with ivf and urine lytes showed a fena of 0.2. on pod 4 the patient was oliguric despite fluid boluses. ddx includes atn vs. cin vs poor forward flow in setting of volume overload. pt was hypotensive post-op predisposing to atn and also received dye load in setting of angiography making cin possible. the fluid boluses likely exacerbated patient's underlying heart failure leading to poor forward flow, evidenced by the fact that patient's kidney injury improved with aggressive diuresis. patient was diuresed and had improvement in her creatinine near her base line of 1.4-1.6. . # respiratory distress: micu was consulted for respiratory distress that developed on pod 5 with oxygen saturations dropping into the high 80s, and using accessory breathing muscles. an echo was performed that showed severe pulmonary hypertension but no evidence of right ventricular strain. the patient was stablizied on a face mask at fio2 35% with oxygen saturations in the mid 90s. there was strong suspicsion for pe given her s1q3t3, troponin elevation, new chest x ray findings demonstrating pulmonary arterial hypertension though v/q scan was very low likelihood. her respiratory distress was ultimately felt to be from pulmonary edema and patient's hypoxia resolved with diuresis. patient responded well to 80 mg torsemide which was held at the time of discharge as the cause of her edema was felt to be largely iatrogenic and did not respresent a need for on-going diuresis. . # afib with rvr patient developed afib with rvr on pod 5 with pressures transiently in the 60s. the rhythm did not respond to iv lopressor so patient was transferred to the micu for further management. trigger for dysrrhytmia likely enlarged right atrium in the setting of heart failure as well as beta-blocker withdrawal. additional etiology could have been pe, however patient had been systemically anticoagulated peri-procedure and placed on ppx sq heparin post-procedure. patient was successfully rate controlled on a diltiazem drip and gradually transitioned to an oral regimen. she spontaneously converted to sinus and was restarted on her home dose of labetalol. she will not be discharged on coumadin in agreement with family goals of care as the patient has had gi bleed requiring transfusion in the past. stroke prophylaxis will be aspirin and plavix which she will require for her femoral stent. . # urinary tract infection: ua and urine culture revealed evidence of an infection later found to be e.coli sensitive to ceftriaxone. patient completed a three day course of ceftriaxone on . . # nutrition: speech and swallow evaluated patient and initially she seemed to lethargic to safely swallow. a dobhoff was placed to initiate tube feeds but patient self-discontinued this. she subsequently passed repeat speech and swallow evaluation so her diet was advanced to thickened liquids and soft foods. . # dementia/delirum: responded well to low-dose zyprexa. benzos and sedating medications were avoided. . # cad: continued on asa. imdur and labetolol initially held for low blood pressures but gradually restarted. lisinopril was held in the setting of . this may be restarted as an outpatient. . # hypothyroidism: - continue levothyroxine . # code: full . transitional issues -anticoagulation: per vascular, patient will need to be on aspirin and plavix for her right foot. whether patient would benefit from coumadin for her paroxysmal atrial fibrillation/flutter should be addressed with her pcp. does have diverticula and a history of gi bleeds, so the risks and benefits should be weighed. -patient is currently a full code, given her comorbidities this issue should continue to be readdressed with her family. -if hypoxic would restart torsemide 80 mg. - lisinopril is being held secondary to acute kidney injury. this may need to be restarted as an outpatient. medications on admission: vicodin q4hrs prn nitroquick 0.4 mg ativan 0.5 qhs and prn cymbalta 20 daily senna daily prn constipation acidiphilous 1 tab qd tylenol 650 prn pain fish oil isosorbide mononitrate 60 daily lisinopril 10 daily mvi calcium-vit d 600-200 labetalol 50 synthroid 75 daily prilosec 20 discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po tid (3 times a day). 2. isosorbide mononitrate 60 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 3. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 4. duloxetine 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. aspirin 325 mg tablet sig: one (1) tablet po once a day. 7. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 8. methyl salicylate-menthol ointment sig: one (1) appl topical (2 times a day) as needed for back pain. 9. labetalol 100 mg tablet sig: 0.5 tablet po bid (2 times a day). 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 11. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: eagle rehabilitation center - discharge diagnosis: primary right lower extermity ischemia pulmonary edema acute on chronic diastolic heart failure urinary tract infection atrial fibrillation with rapid ventricular response secondary: -peripheral vascular disease -coronary artery disease -hypertension -dementia -hypothyroidism -hyperlipidemia -gastric angioectasias -ischemic colitis -osteoporosis -gerd discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it was a pleasure taking care of you while you were in the hospital. you were initially admitted to vascular surgery for stenting and angioplasty of your right leg. you tolerated this procedure well and had improvement in your circulation. post-operatively you had worsening kidney function and were given fluids due to the poor function of your heart you developed a syndrome called pulmonary edema which means fluid in the lungs. you were then transfered to cardiology for treatment of your heart failure and abnormal heart rhythm. your heart rhythm ultimately returned to and you were discharged to a rehab hospital to continue to regain your strength. the following changes were made to your medications: -start aspirin 325 mg daily -start clopidogrel 75 mg daily -stop lisinopril 10 mg daily -continue tylenol 650 mg three times a day as needed for pain -continue bengay as needed for back pain -continue atorvastatin 80 mg daily -continue duloxetine 20 mg daily -continue isosorbide mononitrate 60 mg daily -continue levothyroxine 75 mcg daily -continue labetalol 50 mg twice daily -continue omeprazole 20 mg daily -continue calcium-vit d 600-200 mg twice daily division of vascular and endovascular surgery lower extremity angioplasty/stent discharge instructions ?????? you make take tylenol or prescribed pain medications for any post procedure pain or discomfort what to expect when you go home: it is normal to have slight swelling of the legs: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated ?????? it is normal to feel tired and have a decreased appetite, your appetite will return with time ?????? drink plenty of fluids and eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? when you go home, you may walk and go up and down stairs ?????? you may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? no heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) ?????? after 1 week, you may resume sexual activity ?????? after 1 week, gradually increase your activities and distance walked as you can tolerate ?????? no driving until you are no longer taking pain medications ?????? call and an appointment to be seen in weeks for post procedure check and ultrasound what to report to office: ?????? numbness, coldness or pain in lower extremities ?????? temperature greater than 101.5f for 24 hours ?????? new or increased drainage from incision or white, yellow or green drainage from incisions ?????? bleeding from groin puncture site sudden, severe bleeding or swelling (groin puncture site) ?????? lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. if bleeding stops, call vascular office . if bleeding does not stop, call 911 for transfer to closest emergency room. followup instructions: please call dr. office ( to a follow up appointment in weeks. please call you primary care doctor a follow up appointment about a week after you are discharged from rehab. ,cormac f. procedure: enteral infusion of concentrated nutritional substances angioplasty of other non-coronary vessel(s) aortography procedure on two vessels insertion of four or more vascular stents central venous catheter placement with guidance insertion of drug-eluting stent(s) of superficial femoral artery diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases atrial flutter percutaneous transluminal coronary angioplasty status accidental puncture or laceration during a procedure, not elsewhere classified constipation, unspecified other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure arteriovenous fistula, acquired hypotension, unspecified osteoporosis, unspecified hyperosmolality and/or hypernatremia accidents occurring in residential institution atherosclerosis of native arteries of the extremities, unspecified chronic total occlusion of artery of the extremities other and unspecified escherichia coli [e. coli] dissection of other artery acute kidney failure with other specified pathological lesion in kidney dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to