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: r great toe abscess major surgical or invasive procedure: kidney biopsy hemodialysis temporary femoral line (discontinued) hemodialysis tunnelled line (internal jugular vein) placed history of present illness: mr. is a 74 yo m with cad, htn, pvd, dm type ii with neuropathy s/p amputation of right first, second, third toes several years ago and underwent recent revision of right hallux amputation due to chronic ulcer/skinbreakdown from bony spur. he had been healing well with no complications from the procedure. however, on the day prior to admission the vna noted a white scab on the surface of the incision. at that time there was no erythema at the site. he was also noted to be weak, lethargic and less interactive over the past three days. he additionally had poor po intake. he did not have any fevers over the three days - despite being checked frequently. he presented to podiatry clinic as he had been having foot discomfort the day of admission. during this appointment he was noted to have pus over his incision site. while at the outpatient clinic, pus and were able to be expressed from the area. he was sent to the ed for further work up. . of note, his daughter has also recently been concerned for a change in his mental status over the past two days, specifically that he was more lethargic and weak than usual. at baseline he ambulates with a walker, however recently he has refused to walk due to weakness and foot discomfort. she noted that he was leaned to the left in his chair which was not typical. she was concerned that he had some right sided weakness, however he was never examined for this. he did not have slurred speech or facial droop. . this year he was admitted in for bilateral pulmonary embolism and in for acute renal failure. . in the ed vs were t 98.7, bp 159-170/60-63, hr 64-71, rr 14, o2 sat 97% on ra, bg 419. exam was notable for right foot with open ulcer with no pus or crepitus, erythema and warmth on dorsum of right foot, normal neurologic exam, cranial nerves intact. labs were notable for lactate of 4.0, cr 1.3, glucose 419. cultures sent in ed. ct head was unremarkable. foot xray suggestive of osteomyelitis. he was treated with 1gm vancomycin and zosyn to cover infection. he received 10u insulin for hyperglycemia and 3l ivf for dehydration. . on arrival to the floor, the patient denies any pain. he is alert and oriented x2 (person, place). . ros as above. he otherwise denies any falls, dizziness, lightheadedness, palpitations, chest pain or shortness of breath. he denies any fevers, chills or night sweats. no change in his bowel and bladder habits. past medical history: type 2 diabetes, managed by (hgba1c 6.8 ) alzheimer's dementia hypertension alcoholic cirrhosis esophageal varices, middle third portal gastropathy cad, s/p mi peripheral vascular disease s/p 3 toe amputations s/p stroke , no residual deficits s/p right cea left cataract surgery right cataract surgery gerd gait abnormality urinary/bowel incontinence social history: he was living up until five months ago with his daughter in . he has been living at a rehab most recently - sunrise. he is now close to some of his family members who live up in this area. positive tobacco use (6 cigars/day), 1-2 beers/week, no drug use. family history: significant for diabetes and heart disease in his immediate family members. physical exam: vs: t 97.8, hr 68, bp 159/58, rr 17, o2sat 100% on ra gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, op without lesions neck: no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g. distant heart sounds. abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e, weakly palpable dp pulses. s/p amputation of the first, second and third toes with small ulcer noted at incision site. no pus, crepitus. minimal serosanguinous drainage. erythema, warmth along dorsal aspect of right foot. skin: no rashes/no jaundice neuro: aaox2 (person, place). cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. no pass-pointing on finger to nose. 2+dtr's-patellar and biceps pertinent results: laboratories on admission: 01:50pm pt-17.1 ptt-31.5 inr(pt)-1.5 01:50pm wbc-8.8 (neuts-82.3 lymphs-11.8 monos-5.1 eos-0.6 basos-0.2) hgb-13.3 hct-39.7 plt count-130 01:50pm sodium-134 potassium-4.7 chloride-97 total co2-25 urea n-24 creat-1.3 glucose-419 02:03pm lactate-4.0 04:22pm urine rbc-0-2 wbc-0-2 bacteria-occ yeast-none epi-<1 trans epi-0-2, -sm nitrite-neg protein-30 glucose-1000 ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg, color-yellow appear-clear sp -1.024 05:13pm lactate-2.9 . laboratories on discharge: 03:30am wbc-7.3 hgb-9.7 hct-28.7 plt ct-192. 11:30am ptt-75.9 03:30am na-135 k-4.2 cl-100 hco3-30 urean-48 creat-4.5 glucose-200 calcium-7.8 phos-4.6 mg-2.0 . other laboratories: 03:30am ld(ldh)-239 03:30am triglyc-175 hdl-19 chol/hd-5.3 ldlcalc-46 cholest-100 06:45am vitb12-1265 11:14am caltibc-208 folate-10.9 ferritn-262 trf-160 11:14am ret aut-3.3 05:29am alt-19 ast-32 ld(ldh)-249 alkphos-351 totbili-0.5 lipase-61 07:07pm ggt-306 03:25pm pth-112 01:30pm hbsag-negative hbsab-positive hbcab-negative 03:48pm anca-negative -negative -negative 12:54am crp-173.0 12:54am esr-38 04:00am c3-52 c4-25 04:50am c3-38 c4-25 06:45am vanco-16.0 01:30pm hcv ab-negative 01:18am lactate-2.0 05:13pm lactate-2.9 02:03pm lactate-4.0 . chem-7 trend glucose-98 urean-7 creat-5.3 na-135 k-4.0 cl-101 hco3-29 glucose-94 urean-97 creat-6.6 na-138 k-4.1 cl-102 hco3-26 glucose-130 urean-108 creat-6.9 na-140 k-4.7 cl-105 hco3-22 glucose-153 urean-109 creat-7.1 na-136 k-5.7 cl-104 hco3-23 glucose-98 urean-103 creat-6.6 na-137 k-5.4 cl-103 hco3-22 glucose-130 urean-108 creat-6.9 na-140 k-4.7 cl-105 hco3-22 glucose-153 urean-109 creat-7.1 na-136 k-5.7 cl-104 hco3-23 glucose-98 urean-103 creat-6.6 na-137 k-5.4 cl-103 hco3-22 glucose-64 urean-99 creat-6.7 na-138 k-5.2 cl-103 hco3-23 glucose-94 urean-95 creat-6.3 na-136 k-4.8 cl-102 hco3-22 glucose-53 urean-90 creat-6.2 na-136 k-5.0 cl-104 hco3-22 glucose-57 urean-76 creat-5.5 na-135 k-4.7 cl-103 hco3-22 glucose-57 urean-66 creat-4.6 na-136 k-4.7 cl-104 hco3-22 glucose-92 urean-53 creat-3.6 na-137 k-4.6 cl-105 hco3-24 glucose-54 urean-42 creat-3.3 na-137 k-3.9 cl-104 hco3-25 glucose-241 urean-32 creat-1.9 na-135 k-4.8 cl-101 hco3-24 glucose-144 urean-21 creat-1.2 na-139 k-3.8 cl-104 hco3-26 glucose-186 urean-14 creat-1.1 na-138 k-4.0 cl-102 hco3-28 glucose-237 urean-14 creat-1.0 na-135 k-3.4 cl-100 hco3-26 glucose-225 urean-19 creat-1.0 na-139 k-3.7 cl-104 hco3-28 glucose-419 urean-24 creat-1.3 na-134 k-4.7 cl-97 hco3-25 . studies: foot (ap & lat) soft tissue right impression: findings are concerning for osteomyelitis involving the distal aspect of the first metatarsal head. if necessary, mri with contrast can further characterize this process. there is no subcutaneous air or acute fracture. . ct head w/o contrast impression: no evidence of hemorrhage or significant change compared to prior study. mri with diffusion-weighted images is more sensitive in evaluation for acute ischemia/infarct and for vascular detail. . foot ap,lat & obl right compared with , there has been additional debridement of the distal first metatarsal. there is some residual bony fragmentation at the resection site, and overlying skin changes. remainder of the right foot is stable. . pathology right toe ulcer: granulation tissue with focal necrosis, acute and chronic inflammation and fragments of bone . chest port. line placement 1. a left picc line catheter has been placed with tip projecting over the atriocaval junction. 2. diminished left lung volume due to the presence of basilar atelectasis with mild elevation of the left hemidiaphragm. 3. the right upper lobe pulmonary opacity has decreased in size on today's examination. . tte (complete) done left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). transmitral doppler and tissue velocity imaging are consistent with grade i (mild) lv diastolic dysfunction. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. physiologic mitral regurgitation is seen (within normal limits). the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , no change. . renal u.s. comparison: . findings: the right kidney measures 12.6 cm. the left kidney measures 12.7 cm. there is no evidence of hydronephrosis or stones. bladder appears grossly unremarkable. impression: no evidence of hydronephrosis. . ecg study date of sinus rhythm. p-r interval prolongation. early r wave progression. compared to the previous tracing of atrial premature beats are no longer seen. rate 63, pr 234, qrs 72, qt/qtc 430/435, p 36, qrs 37, t 38 . portable abdomen supine portable abdominal radiograph: nonspecific gas pattern. stool in the colon limits sensitivity of study. vascular calcifications. impression: somewhat limited study but no gross acute radiographic abdominal abnormality demonstrated. . renal biospy exudative endocapillary proliferative glomerulonephritis with iga dominance, consistent with the post-infectious-type glomerulonephritis that is associated with staphylococcal infection.. diabetic nephropathy. light microscopy: the specimen consists of renal cortex and medulla, containing approximately 20 glomeruli, of which 5 are globally sclerotic. the remainder all show varying degrees of exudative endocapillary proliferation. mesangial matrix is increased; nodule formation is present. basement membranes are overtly thickened, only occasional double contours are seen. no crescents are noted. there is moderate interstitial fibrosis and tubular atrophy. patchy chronic inflammation accompanies the scarring. intact tubulointerstitum shows minimal inflammation. arteries show moderate intimal fibroplasia. arterioles show moderate mural thickening, with prominent hyaline change. immunofluorescence: the specimen consists of renal cortex only, containing approximately 7 glomeruli, of which 1 is globally sclerotic. there is granular peripheral capillary loop and mesangial staining for igg (0-trace), iga (2+), igm (trace), c3 (3+), kappa (+), lambda (1+) and c1q (trace - 1+). albumin and fibrin are non-contributory. electron microscopy: findings will be issued in an addendum. . unilat up ext veins us left normal pulsed doppler waveforms were seen in the left subclavian vein and normal waveforms and normal compressibility was noted in the internal jugular, axillary, brachial, and basilic veins in the left arm. the cephalic vein contains the picc line which extends essentially from wall to wall and no flow could be detected around the picc line which fills the lumen of the cephalic vein. conclusion: left cephalic picc line. no evidence of deep venous thrombosis. . right upper quadrant ultrasound : the study is compared to an ultrasound of the same area from . the penetration is suboptimal. there is no focal hepatic lesion detected though evaluation is limited. the gallbladder is normal without wall thickening or pericholecystic fluid. several small stones are noted layering within its lumen. the patient was not able to move very well, so it was difficult to evaluate whether these are mobile or not. there is no intra- or extra-hepatic biliary ductal dilation. the portal vein was patient with flow in an appropriate direction. there was no evidence of a right-sided hydronephrosis or right upper quadrant ascites. there is a right- sided pleural effusion. impression: 1. cholelithiasis without evidence of cholecystitis. 2. right pleural effusion. . tunnelled cath placement impression: successful placement of a double lumen 19 cm tip-to-cuff tunneled hemodialysis catheter through the right internal jugular vein with tip located in the cavoatrial junction. the catheter is ready to use. brief hospital course: #. acute renal failure the patient was diagnosed with post-infectious glomerulonephritis (c3 deposition in mesangium and somewhat linear iga), s/p renal biopsy (see above report). there continues to be no recovery of renal function thus far with low urinary output. strict ins and outs were monitored with a coude catheter, which was discontinued upon discharge. prior to diagnosis of post-infectious gn, the patient failed a fluid challenge although evaluation of urine lytes were consistent with a prerenal etiology. on admission, the patient had bottles of cultures +mrsa related to his om. although he cleared this infection in 24 hours on iv antibiotics (vancomycin/zosyn), he developed the related acute gn, post-staphylococcus bacteremia. although one would expect full renal recovery with post-infectious gn, mr. is an elderly gentleman with poor renal reserve, with likely subclinical diabetic/hypertensive nephropathy prior to the insult of the post-infectious gn. . hd was initiated () via a temporary femoral catheter, and he received 3 hd sessions while in house; we expect him to recover renal function some time in the coming weeks. as followup, anca, are negative. a hemodialysis ij tunneled catheter was placed and the patient tolerated hemodialysis #3 well on the hd line that same day. vancomycin is planned for a 6 week course (d1= ) and was given with hemodialysis after hd was initiated. vancomycin should continue to be dosed at hd. of note, metformin, lisinopril, glyburide (home regimen) were held when the patient developed arf and hypotension was avoided with sbp goal of 140 to prevent further renal damage. at rehabilitation, his ins and outs should be monitored closely as improving urinary output is a sign of improved renal function. epogen should also be given at hd until mr. recovers renal function. transfusion of was deferred at hd per renal recommendations. at rehabilitation, please continue to monitor his hct for an expected rise with epogen. . # right 1st metatarsal osteomyelitis mr. was s/p right great toe metatarsal debridement in or and closed by podiatry , at the bedside. iv vancomycin and zosyn were begun upon admission. after the culture and sensitivies returned showing mrsa id consultants recommended monotherapy with vancomycin for 6 weeks. a picc line was placed and vancomycin levels were checked daily. as the patient developed arf, the vancomycin became supratherapeutic and was held for ~ 1 week. his levels were checked daily and his vancomycin remained therapeutic during this period of arf. when hd was initiated, vancomycin was dosed at hemodialysis. of note, the patient has a picc line in his left upper extremity. this line may be utilized for iv vancomycin dosing if renal function recovers and hemodialysis (and thus vancomycin dosing at hd) is discontinued. he will complete his 6 week course of intravenous vancomycin (day 1 was ). please consider removing the picc line at rehabilitation depending on the patient's disposition. he is scheduled for outpatient followup with id, dr. . in rehabiliation, please monitor is vancomycin trough prior to each hd adjust dosage as necessary. also, check a cbc and electrolytes weekly. upon discharge, please fax these results weekly to dr. (see post-discharge prescription order). . upon discharge the foot wound appears to be healing well. he is scheduled for outpatient podiatry followup. please continue to elevate right leg, per podiatry. continue oob to chair and rle nwb forefoot. mr. will need aggressive pt due to his extended hospital stay. . # mrsa bacteremia: he had associated +mrsa culture on admission (4/4 bottles of cultures) but survellience cultures are all negative thus far. an echocardiogram was performed to look for any evidence of endocarditis with high grade bacteremia. the patient had no stigmata of endocarditis including no new murmur on physical exam. the echo was technically a poor study but no vegetations were seen on echo; regardless, the patient will be on a 6 week course of iv vancomycin for om which would treat any underlying endocarditis. vancomycin trough on prior to hd #3 was therapuetic (16) for om. . # hypertension lasix and lisinopril were discontinued (2 out of 3 medications of home regimen). lasix was discontinued due to the patient's dehydration on presentation and also will not be effective now secondary to his low uop. lisinopril is also being held in arf. his goal sbp was 140s to prevent renal hypoperfusion. his betablocker was continued at his home dosage. amlodipine 10 mg was begun for renal recommendations. his pressure will also be controlled by volume removal at hd. . # chronic diastolic heart failure: ef 70% on echo from 06/. volume control was provided with hd. lisinopril was held in setting of arf. . # type 2 diabetes mellitus- home regimen of oral hypoglycemics, actos, glyburide, and metformin, were held in the setting of arf. his bs was controlled on lantus to 8 units qhs; humalog insulin sliding scale was also provided. of note the heparin drip can be mixed in d5w or ns. at rehabilitation, please consider a heparin drip with ns to ensure better glucose control. . # anticoagulation/ history of pulmonary emboli (). mr. inr was subtherapeutic upon discharge. he was started on a heparin drip and was administered 7.5 mg coumadin daily, to which he became therapeutic. although, pharmacy in where he fills his coumadin prescription, he has been on coumadin 10 mg daily since . however, coumadin was held in preparation for the renal biopsy and also then hemodialysis temporary and tunnelled line placements. he was also given ffp prior to and subsequently to the renal biopsy. heparin drip was restarted after the renal biospy and held prior to the hd line placement procedures. he is on heparin drip upon tranfer to rehab. the plan is to restart his coumadin upon the evening of discharge () and bridge with heparin drip until the patient is therapeutic on coumadin. per pcp, plan is to continue anticoagulation for a 12 months course of anticoagulation due to extent of multiple pulmonary emboli. . # coronary artery disease mr. is s/p mi in , and he was continued on his home toprol regimen. . # hyperlipidemia consider discontinuing zetia and possibly substituting statin as zetia may have adverse cv effects (preliminary data); see above lipid panel. will defer this to pcp. . # dementia (stable): continued aricept and namenda . # f/e/n: repleted lytes prn. continue diabetic diet. began sevelamer, phoslo for hyperphoshatemia which phosphorus trending down upon discharge. . # ppx: provided bowel regimen (senna), ppi (home regimen), pneumoboots/ heparin drip for dvt prophylaxis . # access: piv x 2 . # code status: full . # communication: daughter, , cell . # dispo: acute rehabilitation for heparin drip, hemodialysis, and physical therapy. iv antibiotics will be dosed at hd; also will need intense pt at rehab with the goal of returning patient to . . medications on admission: actos 15mg daily toprol 25 mg daily prinivil 40 mg daily zetia 10 mg daily lasix 40 mg daily coumadin 7.5 mg daily q m,w,f,sat,sun coumadin 5 mg daily q tues, thurs **although, pharmacy in where he fills his coumadin prescription, he has been on coumadin 10 mg daily since .** glyburide 10 mg aricept 5 mg daily namenda 10 mg daily fiber laxative 1 tbsp powder daily imodium 2 mg prn sl ntg prn calcium and vit d protonix 40 mg daily metformin unknown dose discharge medications: 1. outpatient lab work please fax the following weekly laboratories to your infectious disease specialist, dr. . her fax number is: ( for patients. office number for patients is (. 1. cbc 2. bun/creatinine 3. vancomycin trough 2. outpatient lab work please check vancomycin level on prior to hemodialysis. adjust dosage of vancomycin as per nephrologist at . 3. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 4. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 5. coumadin 7.5 mg tablet sig: 7.5 tablets po once a day. 6. memantine 5 mg tablet sig: two (2) tablet po daily (). 7. donepezil 5 mg tablet sig: one (1) tablet po hs (at bedtime). 8. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 11. insulin glargine 100 unit/ml solution sig: eight (8) units subcutaneous at bedtime. 12. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 13. sevelamer hcl 800 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 14. vancomycin 500 mg iv hd protocol 15. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution sig: one (1) per weight-based dosing guidelines intravenous drip. discharge disposition: extended care facility: - discharge diagnosis: primary acute renal failure secondary to post-infectious glomerulonephritis right toe osteomyelitis, mrsa (methicillin resistant staphylococcus aureus) . secondary type 2 diabetes mellitus dementia hypertension peripheral vascular disease discharge condition: hemodynamically stable, afebrile discharge instructions: you were admitted with right toe osteomyelitis, an infection of the bone with mrsa (methicillin resistant staphylococcus aureus) bacteria. you were treated with intravenous antibiotics, and the plan is to continue those antibiotics for 6 weeks (completion of antibiotic course=). the antibiotics will be given with hemodialysis at rehabilitation. . you also developed renal failure during this admission and were initiated on hemodialysis. the renal failure was due to post-infectious glomerulonephritis (diagnosed by kidney biospy) and was related to the bone infection which was also present in your stream. you quickly cleared the bacteremia ( infection) on intravenous antibiotics. a tunnelled hemodialysis line was placed so that you may continue dialysis as an outpatient. the time course of dialysis is dependent on if you recover kidney function. you may recover some renal function in several weeks. . please keep all followup appointments. . please call your doctor or return to the emergency room if you have any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see or dark/black material when you vomit or have a bowel movement. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. followup instructions: 1. an outpatient appointment has been scheduled on at 10:30 am for you with an infectious disease specialist, dr. . her office is located in the basement of the at . . 2. please followup with your liver doctor at the following scheduled appointment: provider: , md phone: date/time: 10:45 am. . 3. please followup with your primary care doctor at the following scheduled appointment: provider: , .o. phone: date/time: 11:30 am; her office is located at b. . 4. please followup with your podiatrist at the following scheduled appointment: provider: , dpm phone: date/time: 4:40 pm. his office is located at hospital on the of the building, . . 5. please followup with a renal (kidney) specialist at the following scheduled appointment: provider: , md on 10:00 am. you were seen by dr. at hospital while an inpatient. depending the recovery of your renal function at rehabilitation on hemodialysis, you may need outpatient followup with a renal specialist. his office is located in the buidling, medical specialities at . procedure: venous catheterization, not elsewhere classified reconstruction of eyelid with hair follicle graft other local excision or destruction of lesion or tissue of skin and subcutaneous tissue diagnostic ultrasound of heart hemodialysis venous catheterization for renal dialysis excisional debridement of wound, infection, or burn closed [percutaneous] [needle] biopsy of kidney transfusion of other serum other local excision or destruction of lesion of joint, foot and toe diagnoses: other primary cardiomyopathies thrombocytopenia, unspecified nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere abnormal coagulation profile coronary atherosclerosis of native coronary artery esophageal reflux unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension alcoholic cirrhosis of liver acute kidney failure, unspecified infection with microorganisms resistant to penicillins diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes abnormality of gait ulcer of other part of foot methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled calculus of gallbladder without mention of cholecystitis, without mention of obstruction alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance dehydration other specified disorders of stomach and duodenum diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled chronic diastolic heart failure atherosclerosis of native arteries of the extremities with ulceration acute osteomyelitis, ankle and foot other bone involvement in diseases classified elsewhere cellulitis and abscess of toe, unspecified acute alcoholic intoxication in alcoholism, continuous esophageal varices without mention of bleeding chronic osteomyelitis, ankle and foot exostosis of unspecified site acute glomerulonephritis with unspecified pathological lesion in kidney other hammer toe (acquired) 

Answer: The patient is high likely exposed to