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: left foot infection, dka major surgical or invasive procedure: mr. underwent podiatric surgery on to for left wound debriment and underwent wound closure on . history of present illness: mr. is a 49 year old male with a history of type ii diabetes, charcot's foot s/p multiple surgeries, and previous mrsa infection who presented to his podiatrist on with two days of nausea, vomiting (clear, non-bilious, non bloody) , productive cough (sputum color not noted), fatigue, and pain and redness of his left foot. he was found to have a draining wound (approximately 1 cm in width x 1 cm in depth) on his left lower leg, just superior to the lateral malleolus with an area of surrounding cellulitis. he was transferred to the emergency department for treatment with iv antibiotics, and observation. of note is that the patient missed his last four doses of lantus insulin, due to running out of medication. . in the ed his vitals were: t 99.3, hr 102, bp 134/74, r 18, and o2 sat 100% on room air. labs were drawn and significant for a glucose of 377, anion gap of 24, lactate of 1.2 and ketones in this urine, consistent with diabetic ketoacidosis. he was given 6 units of insulin, 2 liters of iv fluid, a dose of vancomycin x1 (for cellulitis), and a percocet in the ed and transferred to the micu for further management of his dka and infection. . in the micu he was treated with his 5th liter of normal saline and started on an insulin drip. he was continued on vancomycin and started on zosyn. he was stable with a heart rate of 77 and a blood pressure of 140/66. podiatry reported that plain film imaging showed "interval osteolysis adjacent to the fixation screws that is suggestive of infection or interval losening". blood and swab cultures were obtained, and a urine culture was negative for growth. mr. developed skin reactions in the micu on his back and neck, consistent with a similar exanthem his developed in during his previous admission and was seen by dermatology. he was subsequently admitted to the b service of cc7. past medical history: pmh: -diabetes mellitus type 2 -bilateral charcot foot with multiple surgeries -history of mrsa -left lower extremity dvt () . psh -left charcot foot reconstruction () -right pan-metatarsal resection and () -right foot i& drainage with 2nd metatarsal head resection packed open () -left and right foot debridment () -cataract extraction of right eye () -excision of right foot ulcer () -skin lesion biopsy from sensitivity reaction done by dermatology during micu stay. social history: mr. lives in , ma in an apartment unit alone, however his mother and aunt live in the unit downstairs. he is not married, nor in a relationship and does not have children. he has a brother whom he considers his closest contact and person who would make medical decisions for him. mr. is of irish descent and has a high school education. he worked at an auto dealership until he was fired in . he has not been able to look for a job because of his recent hospitalizations and he states that he may not have medical insurance, but he is not too concerned about it. he smoked 2-3 packs per day but quit over two years ago. he drinks 3-5 beers per day, sometimes more. patient denies illicit drug use. family history: mother has a history of type ii diabetes mellitus. physical exam: exam: vital signs during exam on : t=97.5 hr=18 bp=152/90 rr=18 sao2=97% on room air fingersticks 24h: - . general:no apparent distress skin:raised and erythematous, non-pruritic lesions visible across back and neck. lymph:no occipital, submandibular, cervical, supraclavicular, axillary, epitrochlear, or inguinal lad. heent:normocephalic; no proptosis; anicteric sclera; conjunctiva clear and nonerythematous; moist mucous membranes neck:supple; full rom; no c-spine tenderness to palpation; jvp +1; carotids 2+ w/o bruits; no thyromegaly or nodules; trachea midline back: no t-spine or l-spine tenderness to palpation; no cvat core:ctab; symmetrical air movement bilaterally, no wheezes, rales, or rhonchi; resonant to percussion bilaterally; pmi non-displaced; s1, s2; no murmurs, gallops, or rubs abd:obese; +bs; nondistended; resonant to percussion; soft; nontender; no rebound; no hsm; no ventral hernias gu:deferred (no inguinal hernias) rectal:deferred extr:lateral, lower left foot noted to have erythema, increased warmth, consistent with cellulitis. a small ulceration superior to lateral malleolus that was 1cm in length by 1cm in depth, with slight pus and without odor. 2+ edema of lower extremities bilaterally without cyanosis. femoral, and radial pulses 2+ bilaterally. pedal pulses could not be palpated bilaterally. neuro: ms: orientation: to person, place, date, and purpose for visit attention: repeats 10 digits forwards frontal:follows and repeats 3-step motor pattern with both hands speech:spontaneous; fluent memory:knows current events. patient refused more extensive memory testing. parietal:correctly performs crossed-body, 2-step command cognition:explains proverbs "an apple doesn't fall far from the tree"; good insight; appropriate judgment thought content:no hallucinations; no delusions mood:upset and agitated at the moment. cn: i:not tested ii,iii:perrl, blinks to threat iii,iv,vi:gaze full in all directions; no ptosis. v:sensation symmetric to lt v1-v3 vii:face symmetric w/o weakness viii:hearing symmetric to finger rub ix,x:palate rises symmetrically; no dysarthria or dysphagia; gag reflex intact :scm??????s and trapeziums xii:tongue midline; no gross atrophy or fasciculation motor:normal bulk in upper extremities. lower bulk in lower extremities. normal tone; no spasticity or rigidity. no tremor, chorea, athetosis, hemiballismus, or bradykinesia. no pronator drift. could not stand without assistance or support. ext: 2+ radial pulses bilat, unable to palpate dp, slightly cool le, paler l than right foot, charcot feet, onychomycosis sensory: patient has decreased light touch, vibration, pain and temperature in both feet. patient did not allow for examination of proprioception nor upper extremities. reflexes no clonus or asterixis. coordination / gait: patient would not cooperate with testing. pertinent results: admission labs: 130 93 18 ============< 377 4.8 18 1.0 . ck: 150 mb: 5 trop-t: <0.01 . 12.1 d > 34.1 < 336 n:87.7 l:7.6 m:4.2 e:0.3 bas:0.2 . u/a: trace protein, 1000glucose, 150ketones, neg for infxn . transfer labs: 138 106 5 ============< 196 3.5 23 0.7 ca: 8.4 mg: 1.7 p: 3.2 vanco: 9.5 . 4.7 > 27.3 < 319 . sed-rate: 58 discharge labs: 06:55am blood wbc-4.9 rbc-3.02* hgb-9.2* hct-26.7* mcv-88 mch-30.4 mchc-34.5 rdw-14.5 plt ct-353 06:55am blood glucose-163* urean-8 creat-0.8 na-138 k-4.1 cl-103 hco3-27 angap-12 micro: gram stain (final ): 2+(1-5 per 1000x field):polymorphonuclear leukocytes. no microorganisms seen. . wound culture (final ): klebsiella pneumoniae.sparse growth. . gram stain (final ):1+(<1 per 1000x field):polymorphonuclear leukocytes. no microorganisms seen. . wound culture (final ):staphylococcus, coagulase negative.rare growth. . wound culture (final ): corynebacterium species (diphtheroids). rare growth. . wound culture (final ): beta streptococcus group b. rare growth. anaerobic culture (final ):no anaerobes isolated. . blood culture, routine (final ):no growth. . urine culture (final ): <10,000 organisms/ml. . foot xr : impression: 1. no skin ulcer or focal osteolysis is noted to suggest osteomyelitis. 2. interval osteolysis adjacent to the fixation screws is suggestive of infection or interval loosening. 3. relatively stable neuropathic changes of the foot. . cxr : there are low lung volumes in the semi-upright position. the lung fields appear clear. no failure or pneumonia is identified. impression: no pneumonia. brief hospital course: mr. is a 49 year old male with a history of type ii diabetes, charcot's foot s/p multiple surgeries, and previous mrsa infections who presents with left foot cellulitis, ulceration, and a resolving dka. he developed drug rash allergy on his neck and back while in the ed. . 1. left foot abscess/cellulitis/drug reaction: mr. presented to his podiatrist on with two days of nausea, vomiting(clear, non-bilious, non bloody) , productive cough (sputum color not noted), fatigue, and pain and redness of his left foot. he was found to have a draining wound (approximately 1 cm in width x 1 cm in depth) on his left lower leg, just superior to the lateral malleolus with an area of surrounding cellulitis. he as admitted to the ed for iv antibiotics and observation. in the ed 2 liters of iv fluid, a dose of vancomycin x1 (for cellulitis, first dose ), and a percocet and transferred to the micu for further management. in the micu he was treated with his 5th liter of normal saline. he was stable with a heart rate of 77 and a blood pressure of 140/66. podiatry reported that plain film imaging showed "interval osteolysis adjacent to the fixation screws that is suggestive of infection or interval loosening". blood and swab cultures were obtained, and a urine culture was negative for growth. he was then admitted to the medicine floor for further management. on the floor he was continued on vancomycin 1g and started on zosyn (pip-tazo) 4.5g q8h on . he also developed a allergic reaction on his back, which appeared as erythematous, non-raised target lesions. he was taken by podiatry to the operating room on for surgical debridement of his foot ulcer, and found to have an abscess that was drained. wound cultures grew klebissela pneuomiae with sensitivites to cipro, meropenum, gent, ceftriaxone and less sensitivities to zosyn, amp/sublactam. he was continued on vanc, but the zosyn was stopped and he was started on cipro (500mg po bid) on . wound cultures came back with gram positive cocci, so he was started on keflex po 500mg qid (first dose .)mr. improved with pain management after the debridement, and underwent surgical closure on and was discharged in good condition. . 2. diabetic ketoacidosis: the patient presented to the emergency department with a glucose of 377, anion gap of 24, lactate of 1.2 and ketones in this urine, consistent with diabetic ketoacidosis. of note he also had missed his previous 4 doses of lantus insulin. he was given 6 units of insulin, 2 liters of iv fluid and transferred to the micu where he was started on an inslin drip. his anion gap eventually close, he glucose was controlled in the 150-240's range, and his anion gap closed before he was admitted to the medicine floor. on the medicine floor the patient was followed by the clinic. his lantus dose was reduced to half while he was npo before procedures, and kept at 20mg when eating regularly. his humalog scale was increased 2 units during his stay because of increasing glucose levels. upon discharge his glucose was stable at 163 and his anion gap was 12. . 3. anemia: had a hematocrit of 27.3 on admission, with a range of 24.4 to 28.3, with a discharge hematocrit of 26.7. of note, he loss 300cc of blood during the surgical debridement of his foot ulcer on . two units of blood were cross and matched, but a transfusion was not needed. he was mainted on iron supplementation with ferrous sulfate, 325mg po. his anemia was stable at discharge. . 4. skin lesions: the patient has developed blanching, raised, erythematous lesions with a target like appearance on his back and neck in a similar distribution to a previous admission in . dermatology consulted on the patient, and a biopsy was performed and found to be consistent with a drug reaction, although erythema multiforme could not be excluded. the patient was treated with hydroxyzine 25 mg po prn/q6h, and sarna lotion application prn. the drug allergy improved over the course of the admission and was stable at discharge. a follow up appointment was made with the allergy clinic for the patient. medications on admission: lisinopril 20mg qd lantus 20u (am&pm) humalog ss discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 3. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 4. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for 20 doses: do not exceed 8 tablets in 24 hours. disp:*20 tablet(s)* refills:*0* 5. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 6. clobetasol 0.05 % cream sig: one (1) appl topical (2 times a day) as needed for rash. disp:*qs qs* refills:*0* 7. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for pruritis. 8. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 10 days. disp:*20 tablet(s)* refills:*0* 9. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 10 days: finish all of your antibiotics. disp:*40 capsule(s)* refills:*0* 10. humalog 100 unit/ml solution sig: sliding scale subcutaneous four times a day: please follow new sliding scale and adjust recommendations. disp:*qs qs* refills:*2* 11. syringe bd ultra-fine ii short - syringes 31g 1/2cc as directed use 5x/day. dispense: qs x 1 month, refill 6 12. glucose strips one touch ultra fine strips. qs for one month, 6 refills 13. lancets one-touch lancets for glucose meter. qs one month, 6 refills 14. lantus 100 unit/ml solution sig: twenty five (25) units subcutaneous at bedtime. 15. lantus 100 unit/ml solution sig: twenty (20) units subcutaneous qam. disp:*qs qs* refills:*6* discharge disposition: home discharge diagnosis: primary: diabetic ketoacidosis diabetic foot ulcer infection . secondary: bilateral charcot foot with multiple surgeries drug sensitivy skin rash discharge condition: good . fsbg 85-277 . afebrile, comfortable discharge instructions: you were admitted with diabetic ketoacidosis and a left foot infection. your glucose was at 377 and you were dehydrated, thus you were treated with an insulin drip and iv fluids. you were started on the iv antibiotics piperacillin and tazobactam and vancomycin for your foot infection. your wound culture grew the bacteria klebisella pneumonia and group , you were switched to a 14 day course of the oral antibiotics ciprofloxacin and cephalexin. you were taken to surgery by the podiatry service for debridement of the wound on . your incision was left open for 4 days to heal, and was then reclosed in the operating room on and a wound vaccum was placed as they were not able to close the entire wound. . wound vac will be removed and you will need to perform wet to dry dressings 2 times per day. you will f/u with podiatry next week. . you were also noted to have a rash on your back. you were seen by dermatology who thought that you had a drug sensitivity reaction. your rash appeared to improve after discontinuation of the antibiotics piperacillin and tazobactam, but the exact cause was unknown. you will need to see allergy specialist at . please call the allergy clinic at . . changes in medications: humalog scale adjusted according to print-out ciprofloxacin finish additional 10 day course cephalexin four times a day finish additional 10 day course glargine (lantus) insulin remains 20units in am but now pm dose increased to 25units. . no other changes to your medications were made . please adhere to all of your appointments adn call to reschedule if needed. . if you develop any concerning symtoms such as increased urinary frequency, dizzyness, chills, fever above 101 degrees, light headedness or any other major concerns, please see your doctor immediately. followup instructions: 1)please contact dr. for a pcp follow up within the next week. call (. . 2) clinic with dr. on thursday, at 9:30 am. phone number (. please bring referral from pcp. . 3)podiatry- with dr. , on , at 2:30 pm. phone:. . 4) clinic: please call to schedule an appointment next week. procedure: excisional debridement of wound, infection, or burn other incision with drainage of skin and subcutaneous tissue closed biopsy of skin and subcutaneous tissue other immobilization, pressure, and attention to wound removal of implanted devices from bone, tarsals and metatarsals diagnoses: polyneuropathy in diabetes long-term (current) use of insulin iron deficiency anemia, unspecified dermatitis due to drugs and medicines taken internally cellulitis and abscess of foot, except toes ulcer of heel and midfoot diabetes with neurological manifestations, type ii or unspecified type, uncontrolled diabetes with ketoacidosis, type ii or unspecified type, uncontrolled arthropathy associated with neurological disorders unspecified antibiotic causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to