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: penicillins / cephalosporins / tetracyclines / keflex / propofol / vancomycin attending: chief complaint: fever, toe "darkeness" major surgical or invasive procedure: incision and drainage of right toe hematoma history of present illness: 59 year old female with a history of iddm, ckd, chronic lower extremity edema and morbid obesity who is s/p hammertoe surgery on who presented to the ed on pod #3 with reported fevers at home, increasing right foot pain at the surgical site and "darkness" of the 5th toe. in the ed, she was given a dose of clindamycin. podiatry drained and packed a toe hematoma at the bedside. they did not suspect infection, but sent wound fluid for culture. (wbc and lactate wnl). she was hyperkalemic to 5.6, with no ekg changes. she was given kayexalate x 1. her creatinine was at baseline. she was admitted for iv antibiotics and hyperkalemia. past medical history: past medical history: diastolic dysfunction with well preserved lvef morbid obesity chronic lower extremity edema dyspnea on exertion sleep apnea for which she uses cpap nightly type 2 diabetes mellitus hypertension hypothyroidism hypercholesterolemia chronic kidney disease, (baseline creatinine is approximately 2.3) neuropathy retinopathy past surgical history: s/p arthroplasties of digits 2, 4 and 5 on the right foot on social history: smoked from age 16-22, <1ppd, quit and has not smoked since. no alcohol, no iv drug use. family history: mother- mvp, hypothyroid. father- lung ca, smoker, mets to brain. brother- healthy, lives in , 3 sons, all healthy. physical exam: admission physical exam: vs 97.3 116/76 66 24 98% on ra nad heent ncat, mmm cv distant heart sounds, rrr, normal s1, s2 lungs ctab abdomen obese, + bs, nontender extremities warm, well perfused with 2+ dp pulses; s/p amputation of r 1st and 2nd toes, sutured incision on dorsum of r third toe, necrotic appearing spot on dorsum of r 5th toe; no calf tenderness or edema neuro impaired sensation to light touch over 3 r toes pertinent results: 09:22pm blood wbc-7.6 rbc-3.74* hgb-11.2* hct-33.5* mcv-90 mch-30.0 mchc-33.4 rdw-13.2 plt ct-231 04:09am blood wbc-4.5 rbc-3.99* hgb-12.4 hct-36.0 mcv-90 mch-31.0 mchc-34.3 rdw-13.1 plt ct-251 05:59am blood wbc-11.2*# rbc-3.63* hgb-11.0* hct-31.8* mcv-88 mch-30.3 mchc-34.5 rdw-13.0 plt ct-254 04:09am blood wbc-12.5* rbc-3.67* hgb-10.9* hct-31.7* mcv-86 mch-29.7 mchc-34.4 rdw-13.2 plt ct-286 06:10am blood wbc-9.2 rbc-4.14* hgb-12.1 hct-37.4 mcv-90 mch-29.2 mchc-32.4 rdw-13.1 plt ct-381 09:22pm blood neuts-81.5* lymphs-12.5* monos-4.3 eos-1.6 baso-0.1 04:09am blood neuts-91.9* bands-0 lymphs-5.4* monos-2.7 eos-0.1 baso-0.1 06:10am blood neuts-67.8 lymphs-27.6 monos-4.0 eos-0.4 baso-0.1 swab of toe hematoma drainage: gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. wound culture (final ): staph aureus coag +. heavy growth. clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin-------------<=0.25 s penicillin g---------- =>0.5 r trimethoprim/sulfa---- <=0.5 s . anaerobic culture (preliminary): no anaerobes isolated. . blood culture x 4 - no growth to date urine culture - no growth . foot x-ray (): status post second, fourth and fifth hammertoe surgery, with expected post- surgical soft tissue swelling. no evidence of soft tissue air or definitive finding of osteomyelitis. . chest x-ray (): there are low lung volumes. cardiomediastinal contours are unremarkable. aside from atelectasis in the left base, the lungs are clear. there is no pneumothorax or pleural effusions. . chest x-ray (): as compared to the previous radiograph, there are unchanged bilaterally low lung volumes. as a consequence, the cardiac silhouette is borderline in size. due to motion artifact, the morphology of the lung parenchyma cannot be assessed. there is no evidence of larger pleural effusions. . dopplers of right foot (): not yet read. podiatry should follow this up on her outpatient appointment 06:10am blood wbc-9.2 rbc-4.14* hgb-12.1 hct-37.4 mcv-90 mch-29.2 mchc-32.4 rdw-13.1 plt ct-381 04:09am blood wbc-12.5* rbc-3.67* hgb-10.9* hct-31.7* mcv-86 mch-29.7 mchc-34.4 rdw-13.2 plt ct-286 09:22pm blood wbc-7.6 rbc-3.74* hgb-11.2* hct-33.5* mcv-90 mch-30.0 mchc-33.4 rdw-13.2 plt ct-231 06:10am blood neuts-67.8 lymphs-27.6 monos-4.0 eos-0.4 baso-0.1 09:22pm blood neuts-81.5* lymphs-12.5* monos-4.3 eos-1.6 baso-0.1 04:09am blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-normal polychr-normal burr-occasional ellipto-occasional 06:10am blood pt-12.5 ptt-25.5 inr(pt)-1.1 06:10am blood glucose-60* urean-74* creat-2.5* na-138 k-4.6 cl-103 hco3-24 angap-16 04:09am blood glucose-131* urean-79* creat-2.3* na-135 k-5.1 cl-104 hco3-21* angap-15 04:30pm blood glucose-575* urean-72* creat-2.7* na-132* k-7.0* cl-102 hco3-19* angap-18 06:10am blood calcium-9.6 phos-5.1* mg-2.1 04:56am blood type-art po2-102 pco2-42 ph-7.33* caltco2-23 base xs--3 intubat-not intuba 03:56am blood type-art po2-39* pco2-40 ph-7.35 caltco2-23 base xs--3 04:56am blood lactate-1.1 07:05am urine color-yellow appear-clear sp -1.014 07:05am urine blood-sm nitrite-neg protein-30 glucose-tr ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 07:05am urine rbc-2 wbc-3 bacteri-none yeast-occ epi-<1 07:05am urine casthy-2* 07:05am urine mucous-rare brief hospital course: a/p: 59 yo f with iddm, morbid obesity, s/p arthroplasties of 3 hammertoes on right foot on , admitted to floor with fevers/chills and transferred to micu with resp distress/anaphylaxis after receiving vanco. . #) anaphylaxis to vancomycin: this was likely anaphylaxis to vancomycin with flushing, rash, rigors/fever, change in mental status and resp distress. this is unlikely red man's syndrome as per discussion with floor resident and rn, pt was clearly in resp distress prior to first dose of epi and vanco was given slowly (over 2 hours, pt received <1/2 dose). pt received epi im 0.3 x 2, solumedrol 150 x1, h2 blocker, and benadryl. her respiratory quickly recovered and she had no further issues off of the vancomycin. . #) fevers: likely source is recent surgical site, and wound cx is growing mssa but resistant to clindamycin. wbc has increased in setting of receiving solumedrol. the patient was successfully switched to bactrim, to which to mssa is sensitive. she had no further fevers. podiatry would like her to continue on the bactrim for a total of 7 days. . #) leukocytosis: likely due to both her wound infection and solumedrol 150 mg. resolved with a wbc of 9 on day of discharge. . #) s/p arthroplasty on r foot, mssa wound infection: see above, continue bactrim. outpatient podiatry follow-up. for daily dressing changes. . #) iddm: her blood sugars have been high, likely because of infection and the one dose of solumedrol. pt was initially continued on lantus 40 units twice daily with regular insulin sliding scale while in house. however, pt's glucose were in the 400's in the micu, and she was started on an insulin gtt. pt is a pt at . was consulted and recommended to increase lantus to 45mg and continue insulin drip overnight with goal to eventually titrate off. pt is now off insulin gtt with fs 70s-200s. she has a plan to call her doctor next week to discuss management of insulin. she will continue on the lantus 45 units for now and check her fingersticks at home. . #) hyperkalemia: etiology unclear as creatinine at baseline. it has been on the high side of normal in the past. pt was given kayexalate in ed. in the micu, pt's k peaked at 7.0 with more prominent t waves. pt was treated with calcium gluconate, insulin, and kayexylate. she was monitored on telemetry with no events. her potassium then steadily trended down to 4.6 on discharge. lisinopril is being held. her primary care physician can address whether or not to resume this medication in the future. . #) htn: still elevated off lisinopril. she was switched from toprol xl 75mg to metoprolol 25mg tid in the hospital and continued on hydrochlorothiazine 25mg daily in the hospital. she was told to take the toprol 75mg daily when she left the hospital. her primary care physician should assess her antihypertensive regimen and make adjustments as needed as an outpatient. . #) anemia: fluctuates, currently 34. likely due to chronic renal disease. monitor. . #) sleep apnea: uses cpap nightly, brought her machine with her from home. . #) chronic kidney disease: (baseline creatinine is approximately 2.3), at her baseline during hospitalization. was given a renal diet. . #) hyperlipidemia: contiued simvastatin . #) hypothyroidism: continued levothyroxine . #) neuropathy: continued gabapentin . #) fen/gi - low potassium, low salt, heart healthy diabetic renal diet #) ppx - heparin subcutaneous #) code - full #) dispo - being discharged home , afebrile, ambulating well, pain free. medications on admission: hydrochlorothiazine 25mg daily toprol xl 75mg daily lisinopril 5mg daily levothyroxine 0.25 mg daily gabapentin 100mg qhs lantus 40 units , apidra sliding scale fish oil aspirin 325mg daily topamax 125 mg qhs simvastatin 10mg daily bupropion sr 150mg daily discharge medications: 1. hydrochlorothiazide 12.5 mg capsule sig: two (2) capsule po daily (daily). 2. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 4. gabapentin 100 mg capsule sig: one (1) capsule po hs (at bedtime). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. topiramate 100 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 7. topiramate 25 mg tablet sig: one (1) tablet po at bedtime. 8. bupropion 150 mg tablet sustained release sig: one (1) tablet sustained release po qam (once a day (in the morning)). 9. insulin glargine 100 unit/ml cartridge sig: forty five (45) units subcutaneous twice a day. 10. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day) for 5 days. disp:*10 tablet(s)* refills:*0* 11. apidra 100 unit/ml solution sig: sliding scale subcutaneous sliding scale. 12. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 13. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: anaphylaxis secondary diagnoses: wound infection, hyperkalemia, type 2 diabetes, hypertension, morbid obesity discharge condition: stable, afebrile, able to ambulate without pain discharge instructions: you were admitted for antibiotic treatment of a toe infection after surgery and developed a serious allergic reaction to vancomycin, one of the antibiotics you were given. you were given epinephrine, iv steroids, an iv antacid and benadryl to treat this reaction. the level of potassium in your blood was elevated, but decreased into normal range after treatment. your blood sugars were elevated and you received iv insulin while in the icu and were then transitioned back to subcutaneous insulin. - continue to take your antibiotc as prescribed to treat the toe infection - stop taking your lisinopril, as it can cause high potassium, which you had while you were in the hospital. - continue all other medications as you were taking them prior to your hospitalization, with the exception of increasing your 40 units of lantus to 45 units 2x/day - continue to check your blood sugar at home - please call your doctor if you develop a fever, chills, difficulty breathing, chest pain, nausea, vomiting, confusion or any other questions or concerns. - keep all scheduled doctor appointments followup instructions: provider: . can see you tomorrow anytime after 10am, please call if you would like to schedule a different or definitel appointment time. . provider: , dpm phone: date/time: 1:40 provider: , dpm phone: date/time: 10:40 provider: , : date/time: 2:00 procedure: non-invasive mechanical ventilation other incision with drainage of skin and subcutaneous tissue diagnoses: hyperpotassemia anemia in chronic kidney disease obstructive sleep apnea (adult)(pediatric) other postoperative infection congestive heart failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified hematoma complicating a procedure diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes personal history of tobacco use chronic kidney disease, stage iii (moderate) methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site long-term (current) use of insulin other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation morbid obesity other postprocedural status other specified antibiotics causing adverse effects in therapeutic use diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled chronic diastolic heart failure diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy cellulitis and abscess of toe, unspecified other anaphylactic reaction 

Answer: The patient is high likely exposed to