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: ciprofloxacin attending: chief complaint: lower extremity erythema, hypotension, fevers major surgical or invasive procedure: none history of present illness: dr. is an 88yom with a history of aml (s/p 10 cycles azacitadine), bladder cancer s/p transurethral resection, atrial fibrillation, chronic left lower extremity osteomyelitis from a shrapnel injury in wwii, and possible venous thromboembolism who was referred to the ed by his rehab center for increasing erythema of the left lower extremity. . he has a very longstanding history of left lower extremity osteo with a chronic wound draining purulent discharge ever since he sustained a shrapnel injury in in a wwii explosion. he denies any significant change in this condition recently, but his wife notes increasing swelling and erythema of the extremity over the past few days. he had been rehabbing from an early- hospitalization for multifocal pneumonia for which he received a course of ctx/azithro, and was referred to the ed this morning when he became febrile to 104. . in the ed, initial vs were: 99.2 83 115/59 18 92% ra. he was noted to be hypotensive to the 80s-90s, and received 2 l of ns with stabilization of pressures to the low 90s. lle tib-fib films showed chronic osteomyelitis without subcutaneous gas, and a cxr showed stable bilateral effusions from earlier this month. he received 2g cefepime and 1g vancomycin. he had an elevated lactate to 3.5 that corrected with fluids to 2.0. blood cultures drawn prior to antibiotics. given his hypotension, he was admitted to the for possible sepsis. . upon transfer to the icu, his initial vitals were t98.1 bp94/54 p58 rr17 sat94/4lnc. he is comfortable and in no acute distress. he denies any increased pain or fevers recently. he has intermittent shortness of breath, and notes that he sometimes is on oxygen at the nursing home. he has been a resident there for about 2 weeks, and is rehabbing from a recent pneumonia. he has no coughing or sputum production, however. of note, he is in the midst of a azacitidine cycle for his aml, which was diagnosed in . he saw his oncologist yesterday, who's note details a pressure of 94/64. . on review of systems, he denies confusion, weakness, fevers, chills, sore throat, coughing, chest pain, abdominal pain, nausea, vomiting, diarrhea, bloody stools, black stools, dysuria, hematuria, myalgias, arthralgias. past medical history: -bladder ca dxed s/p transurethral surgery (care by dr. with in ). -aml diagnosed (care by dr. at ) , started azacytidine, now s/p 10 cycles, most recent dose . -atrial fibrillation, rate controlled on fundaparinux -htn -chronic left lower ext ulcer with osteomyelitis and cellulitis s/p shrapnel injury in wwii - barrett's esophagus - low back pain - venous thromboembolism? social history: lives with wife. professor emeritus in neuroscience at med and hospital. denies smoking. seven drinks per week. no ilicits. family history: denies history of malignancy. non-contributory physical exam: vitals: t98.1 bp94/54 p58 rr17 sat94/4lnc general: alert and oriented x3, nad heent: sclera anicteric, very dry mm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: crackles at the bases, r>l, otherwise clear to auscultation bilaterally cv: regular rate and rhythm, normal s1 + s2, 3/6 sem at the second rics without radiation, second sem at the apex with radiation to the axilla. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: the left lower extremity has a 3cmx1cm open wound with purulent necrotic discharge at the level of the tibial tuberosity. the entire distal extremity is warm, erythematous with 2+ pitting edema that is tender to touch. no other portals of entry noted. pulses 2+. unaffected extremity is warm and well purfused. neuro: cnii-xii intact bilaterally, strength 5/5 throughout, no sensory limitations to soft touch. labs: see below pertinent results: labs upon admission: 11:40am blood wbc-3.2* rbc-2.97* hgb-10.0* hct-29.5* mcv-100*# mch-33.6* mchc-33.8 rdw-26.3* plt ct-174# 11:40am blood neuts-46* bands-2 lymphs-27 monos-12* eos-2 baso-0 atyps-2* metas-6* myelos-3* 11:40am blood hypochr-occasional anisocy-occasional poiklo-normal macrocy-occasional microcy-normal polychr-normal 11:40am blood glucose-127* urean-31* creat-1.4* na-142 k-4.5 cl-106 hco3-25 angap-16 11:49am blood lactate-3.5* 02:30pm blood lactate-2.0 11:40am urine color-straw appear-clear sp -1.010 11:40am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg labs upon discharge: *********** microbiology : 1/2 bottles of blood culture: staph coag negative, sensitivities pending : blood culture: no growth to date (preliminary) : feces negative for c.difficile toxin a & b by eia. imaging: tib/fib x-ray : findings: in comparison with the study of , there is little overall change. areas of sclerosis and lucency with periosteal reaction is consistent with chronic osteomyelitis. deformity of the adjacent fibula is seen with substantial resorption at its proximal aspect. no definite evidence of gas within soft tissues. cxr : impression: little change except possibly for some small increase in left effusion. brief hospital course: dr. is an 88yom with aml, h/o bladder cancer, chronic lle osteomyelitis, htn, afib who presented with lower extremity cellulitis and septic hypotension. # left lower extremity cellulitis: likely port of entry was non-healing chronic ulcer in left lower extremity. he was treated with intravenous vancomycin and cefepime starting and will continue until follow up appointment with infectious disease on . at that point it will be determined if iv antibiotics can be stopped and whether oral suppressive antibiotics need to be started. his erythema and edema improved over the course of his stay. picc line was placed and can be removed once iv antibiotics are finished. once iv antibiotics are finished, he will start on oral suppressive antibiotics for chronic osteomyelitis. note 1/2 blood cultures grew staph coag negative (sensitive to oxacillin and tetracycline), presumed to be a contaminant rather than actual bacteremia. echocardiogram was deferred due to lack of suspicion for endocarditis and mri leg was not pursued due to clinical improvement on antibiotics and patient resistance to surgical debridement. his chronic non-healing ulcer/chronic osteomyelitis of his left lower extremity is stable in size and without exudate. note weekly labs should be checked including cbc with diff, chem 7, vanco trough and lfts and faxed to infectious disease. additionally, vanco trough will need to be checked on , goal trough is 15-20. # hypotension: initial systolic blood pressure 80-90's prompted icu admission, he received intravenous fluids and improved. his furosemide was restarted on , however his antihypertensives were held. note recent blood pressures prior to admission have been low, so there is a question of whether sbp 90-100 is his baseline. # hypoxia: resolved spontaneously, suspected atelectasis and mild pulmonary edema. no pneumonia was seen on cxr. lasix was resumed once blood pressure was deemed stable. # acute renal failure: pre-renal secondary to infection and hypotension, resolved with intravenous fluids. # aml: azacytidine was held during admission, but may be resumed as an outpatient by dr. . his hematocrit was 24 for several days of admission. we gave 1 unit prbc on and another 1 unit prbc on . he was mildly neutropenic on the day of discharge (anc 961), but he was afebrile. his cbc and anc should be monitored daily for 3 days upon discharge. his other medical problems were managed with his home medications without complications. he was full code for this admission. medications on admission: from recent d/c summary and rehab list 1. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 2. fondaparinux 2.5 mg/0.5 ml syringe sig: 2.5 mg subcutaneous daily (daily). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 5. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 8. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) g po daily (daily). 9. megestrol 400 mg/10 ml (40 mg/ml) suspension sig: four hundred (400) mg po bid (2 times a day). 10. morphine 15 mg tablet extended release sig: one (1) tablet extended release po q12h (every 12 hours). 11. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po tid (3 times a day) as needed for constipation. 12. ocuvite oral 13. multivitamin discharge medications: 1. atenolol 25 mg tablet sig: one (1) tablet po once a day. 2. fondaparinux 2.5 mg/0.5 ml syringe sig: 2.5 mg subcutaneous daily (daily). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 8. megestrol 400 mg/10 ml (40 mg/ml) suspension sig: one (1) po bid (2 times a day). 9. morphine 15 mg tablet extended release sig: one (1) tablet extended release po twice a day. 10. lactulose 10 gram/15 ml solution sig: fifteen (15) ml po three times a day as needed for constipation. 11. ocuvite tablet sig: one (1) tablet po once a day. 12. multivitamin tablet sig: one (1) tablet po once a day. 13. outpatient lab work please check vancomycin trough on saturday please fax results to infectious disease at . please check labs weekly cbc with differential, chem 7, lfts and vancomycin trough, while on intravenous antibiotics. please fax results to infectious disease at fax 14. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours): please continue until appointment with id on . 15. cefepime 2 gram recon soln sig: one (1) intravenous q24h: please continue until appointment with id on . 16. oxycodone 10 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po q12h (every 12 hours). 17. oxycodone 5 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain. 18. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for pruritis. 19. outpatient lab work please check daily cbc with differential for 3 days to monitor his hematocrit, white blood cell count, and absolute neutrophil count. please fax results to . discharge disposition: extended care facility: livingcenter - - discharge diagnosis: left lower extremity cellulitis septic shock acute renal failure chronic left lower extremity osteomyelitis acute myelogenous leukemia anemia atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you came to the hospital because of swelling and redness in your left lower leg which was diagnosed as cellulitis (infection of the soft tissues). you had low blood pressure which responded to intravenous fluids. you were placed on intravenous antibiotics and improved. you will continue to take intravenous antibiotics until your follow up infectious disease appointment on at which time it will be determined whether you will need more antibiotics. please elevate your leg daily to decrease the swelling. we made the following changes to your medications: - start vancomycin 1 gram every 24 hours until id appointment on - start cefepime 2grams every 24 hours until id appointment on - start oxycontin 10mg twice daily for pain - start sarna lotion as needed for itching it was a pleasure caring for you. we wish you a speedy recovery. followup instructions: dr. at 2:00pm location: address: , , phone: fax: department: infectious disease when: thursday at 2:50 pm with: , m.d. building: lm campus: west best parking: garage md procedure: venous catheterization, not elsewhere classified diagnoses: acidosis anemia, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation pulmonary collapse cellulitis and abscess of leg, except foot septic shock personal history of malignant neoplasm of bladder diarrhea neutropenia, unspecified anemia in neoplastic disease ulcer of other part of lower limb acute myeloid leukemia, without mention of having achieved remission chronic osteomyelitis, lower leg 

Answer: The patient is high likely exposed to