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 / hayfever attending: chief complaint: heel ulcer r osteo left major surgical or invasive procedure: none history of present illness: cc: past medical history: - iddm - pvd - cad (no mi) - hyperlipid - hypertension - cri (baseline cr 1.5-1.7) - s/p l ak -dp spliced bpg () - s/p lrkt (') - s/p cabg/mech.(') - s/p excise l metatarsal head - s/p l av fistula (') - s/p excise colon polyp (') social history: non-contrib family history: non-contrib physical exam: a/o nad rrr cta abd - benign left palp graft / fem left palp dp right palp fem dop pt / dp pertinent results: 09:00am blood wbc-6.2 rbc-3.24* hgb-9.5* hct-26.6* mcv-82 mch-29.4 mchc-35.7* rdw-15.8* plt ct-177 09:00am blood pt-22.4* ptt-33.2 inr(pt)-2.2* 09:00am blood calcium-8.6 phos-4.1 mg-2.7* 07:30pm blood %hba1c-9.0* renal transplant u.s. reason: eval for incr cr, please eval transplanted kidney only, plea history: 72-year-old man with end-stage renal disease and transplanted kidney in with rising baseline creatinine. doppler ultrasound examination: the transplanted kidney is in the right lower quadrant. no renal stones or hydronephrosis is seen. it measures 12.2 cm in length. no renal masses are seen. a small 6 mm cyst is seen in its interpolar region. the resistive indices in the upper pole are 0.81, and in the lower pole are 0.81 as well. increased resistance is demonstrated in the mid pole arterials with low to no diastolic flow. the main renal artery and in the renal hilum are patent. images of the bladder are limited as the bladder is not fully distended. impression: increased resistance to flow demonstrated in the mid pole arterioles of the transplant kidney as described above foot ap,lat & obl left 7:00 pm history: 72-year-old man with transmetatarsal amputation and sinus wound. findings: comparison is made to previous study from . the patient is status post transmetatarsal amputation. there is a prominent ulcer along the stump of the fifth metatarsal, which appears to extend to the cortical surface. the underlying bones demonstrate some lucency and osteomyelitis is suspected. calcifications as well as clips are seen. brief hospital course: pt admitted for angio increase creat / renal transplant consulted dc avapro sacrolimus level stable c/w lasix follow-up with dr as outpt angio canceled high blood sugars / consult started on insulin drip increases lantus to 30 from 18 bs stable on dc ulcers on right foot accuzyme ointment osteo left met head / probe to bone confirmed by x-rays f/u as out pt with dr / need removal bone cx's taken left foot ulcer pseudomonas home on renal dose levo sensitivities pending medications on admission: : lantus 18 units qhs, rapamune 3, prednisone 5, omeprazol 20, metoprolol 50 "', zyvox 600 , lasix 120 am / 80 qpm, metolaone 2.5, myfortic 720 ", pravochol 20, avapro 300, coumadin 5, norvasc 10 (noon),fosamaxx 35 weekly, gemfibrizole 600 " discharge medications: 1. sirolimus 1 mg tablet sig: three (3) tablet po daily (daily). 2. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 5. pravastatin 20 mg tablet sig: one (1) tablet po daily (daily). 6. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 7. gemfibrozil 600 mg tablet sig: one (1) tablet po bid (2 times a day). 8. alendronate 70 mg tablet sig: 0.5 tablet po qthur (every thursday). 9. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 14 days. disp:*14 tablet(s)* refills:*0* 10. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. disp:*20 tablet(s)* refills:*0* 11. mycophenolate sodium 180 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day). 12. insulin take as directed by your pcp 13. papain-urea 1,100,000-100 unit-mg/g ointment sig: one (1) appl topical (2 times a day) for 3 weeks: until wound is debrided right heel. disp:*1 papain-urea (topical) 1,100,000-100 unit-mg/g ointment* refills:*1* 14. glargine take 30 units at night / if you are on ss please take as directed by your pcp 15. warfarin 5 mg tablet sig: one (1) tablet po daily (daily): have your inr followed. you must get this done early next week. 16. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: extended care facility: discharge diagnosis: b/l gangrenous foot / pad left 5th met head osteo increase creat 2.9 - transplant kidney hypercoagable on admission hyperglycemic on admission pvd dm type 2 esrd - transplant cad hyperlipidemia htn discharge condition: good discharge instructions: wound care: please call us immediately for any of the following problems: redness in or drainage from your wound(s). new pain, numbness or discoloration of your lower or upper extremities (notably on the side of the incision). watch for signs and symptoms of infection. these are: a fever greater than 101 degrees, chills, increased redness, or pus draining from the incision site. if you experience any of these or bleeding at the incision site, call the doctor. general: diabetic foot care: diabetes is a disease in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. diabetes can also lead to decreases in the body's ability to fight infection. when diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. foot problems can develop and quickly become serious. with damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. normal sweat secretion and oil production that lubricates the skin of the foot is impaired. these factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. sores may develop. damage to blood vessels and impairment of the immune system from diabetes makes it difficult to heal these wounds. bacterial infection of the skin, connective tissues, muscles, and bones can then occur. these infections can develop into gangrene. the ultimate result may be the amputation of the foot or leg. if the infection spreads to the bloodstream, this process can be life threatening. people with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur. although treatment for diabetic foot problems has improved, prevention, including good control over blood sugar, remains the best way to prevent problems. diabetics should learn how to examine their own feet and how to recognize the early signs and symptoms of diabetic foot problems. they should also learn what is reasonable to do at home as far as routine foot care, how to recognize when to call the doctor, and how to recognize when a problem has become serious enough to seek emergency treatment. risk factors: these risk factors increase your chances of developing foot problems and diabetic infections in your legs and feet if you are diabetic. footwear: poorly fitting shoes are a common cause of diabetic foot problems. if you have red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing your shoes, you need to get new, properly fitting footwear as soon as possible. if you have common foot abnormalities such as flat feet, bunions, or hammertoes, you may need prescription shoes or shoe inserts. nerve damage: people with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. the medical term for this is peripheral neuropathy. because of the nerve damage, you may be unable to feel your feet normally. also you may be unable to sense the position of your feet and toes while walking and balancing. with normal nerves, you can usually sense if your shoes are rubbing on your feet or if one part of your foot is becoming strained while walking. the diabetic may not properly perceive minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. normally, people can feel if there is a stone in their shoe and remove it immediately. a diabetic may not be able to perceive a stone. its constant rubbing can easily create a sore. poor circulation: diabetes, especially when poorly controlled, can lead to accelerated hardening of the arteries or atherosclerosis. trauma to the foot: any trauma to your foot can be a risk factor for a more serious problem to develop. infections: athlete's foot can lead to more serious bacterial infections and should be treated promptly. ingrown toenails should be handled right away by a foot specialist. toenail fungus should also be treated. smoking: smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. this damage can disrupt the healing process and is a major risk factor for infections and amputations. signs and symptoms: persistent pain can be a symptom of sprain, strain, bruise, overuse, improperly fitting shoes, or underlying infection. redness can be a sign of infection, especially when surrounding a wound, or of abnormal rubbing of shoes or socks. swelling of the feet or legs can be a sign of underlying inflammation or infection, improperly fitting shoes, or poor venous circulation. other signs of poor circulation: pain in your legs or buttocks that increases with walking and improves with rest (the medical term is claudication) hair no longer growing on the lower legs and feet hard shiny skin on the legs localized warmth can be a sign of infection or inflammation, perhaps from wounds that won't heal or are slow to heal. any break in the skin is serious and can be from abnormal wear and tear, injury, or infection. calluses and corns may be a sign of chronic trauma to your foot. toenail fungus, athlete's foot, and ingrown toenails may lead to more serious bacterial infections. drainage of pus from a wound is usually a sign of infection. persistent bloody drainage is also a sign of a potentially serious problem. a limp or difficulty walking can be sign of joint problems, serious infection, or improperly fitting shoes. fever or chills in association with a wound on the foot can be a sign of a limb- or life-threatening infection. red streaking away from or redness spreading out from a wound is a sign of a progressively worsening infection. new or lasting numbness in your feet or legs can be a sign of nerve damage from diabetes and increases your risk for leg and foot problems. home care: foot examination: examine your feet daily and also after any trauma, no matter how minor, to your feet. report any abnormalities to your physician. moisturizer to prevent dry skin and cracking. wear cotton or wool socks. avoid elastic socks and hosiery because they may impair circulation. eliminate obstacles: move or remove any items you are likely to trip over or bump your feet on. keep clutter on the floor picked up. light the pathways used at night??????indoors and outdoors. toenail trimming: always cut your nails with a safety clipper, never a scissors. cut them straight across and leave plenty of room out from the nailbed or quick. if you have difficulty with your vision or using your hands, let your doctor do it for you or train a family member how to do it safely. footwear: wear sturdy, comfortable shoes whenever feasible to protect your feet. to be sure your shoes fit properly, see a podiatrist (foot doctor) for fitting recommendations or shop at shoe stores specializing in fitting diabetics. your endocrinologist (diabetes specialist) can provide you with a referral for a podiatrist or orthopedist who may also be an excellent resource for finding local shoe stores. if you have flat feet, bunions, or hammertoes, you may need prescription shoes or shoe inserts. exercise: regular exercise will improve bone and joint health in your feet and legs, improve circulation to your legs, and will also help to stabilize your blood sugar levels. consult your physician prior to beginning any exercise program. smoking: if you smoke any form of tobacco, quitting can be one of the best things you can do to prevent problems with your feet. smoking accelerates damage to blood vessels, especially small blood vessels leading to poor circulation, which is a major risk factor for foot infections and ultimately amputations. diabetes control: following a reasonable diet, taking your medications, checking your blood sugar regularly, exercising regularly, and maintaining good communication with your physician are essential in keeping your diabetes under control. consistent long-term blood sugar control to near normal levels can greatly lower the risk of damage to your nerves, kidneys, eyes, and blood vessels. when to call the doctor: write down your symptoms and be prepared to talk about them on the phone with your doctor. following is a list of common reasons to call your doctor if you have a diabetic foot or leg problem. for most of these problems, a doctor visit within about 72 hours is appropriate. any significant trauma to your feet or legs, no matter how minor, needs medical attention. even minor injuries can result in serious infections. persistent mild-to-moderate pain in your feet or legs is a signal that something is wrong. constant pain is never normal. any new blister, wound, or ulcer less than 1 inch across can become a more serious problem. will need to develop a plan with your doctor on how to treat these wounds. any new areas of warmth, redness, or swelling on your feet or legs are frequently early signs of infection or inflammation. addressing them early may prevent more serious problems. pain, redness, or swelling around a toenail could mean you have an ingrown toenail??????a leading cause of diabetic foot infections and amputations. prompt and early treatment is essential. new or constant numbness in your feet or legs can be a sign of diabetic nerve damage (neuropathy) or of impaired circulation in your legs. both conditions put you at risk for serious problems such as infections and amputations. difficulty walking can result from diabetic arthritis (charcot's joints), often a sign of abnormal strain or pressure on the foot or of poorly fitting shoes. early intervention is key to preventing more serious problems including falls as well as lower extremity skin breakdown and infections. constant itching in the feet can be a sign of fungal infection or dry skin, both of which can lead to infection. calluses or corns developing on the feet should be professionally removed. home removal is not recommended. fever, defined as a temperature greater than 98.6??????f, in association with any other symptoms or even fever alone should prompt an immediate call to your doctor. the degree of fever does not always correlate with the seriousness of infection. you could have no fever or a very low fever and still have a serious infection. people with diabetes need to be especially cautious of fever. when to go to the hospital: if time and your condition permit, write down your symptoms, a list of your medications, allergies to medicines, and your doctor's name and phone number prior to coming to the hospital's emergency department. this information will greatly assist the emergency physician in the evaluation and treatment of your problem. following are some common reasons to seek immediate medical attention for diabetic foot and leg problems. severe pain in your feet or legs is often a sign of acute loss of circulation to the leg, serious infection, or may be due to severe nerve damage (neuropathy). any cut to your feet or legs that bleeds significantly and goes all the way through the skin needs proper cleaning and repair to aid healing. any significant puncture wounds to your feet (for example, stepping on a nail or being bitten by a dog or cat) carry a high risk of becoming infected. wounds or ulcers that are more than about 1 inch across on your feet or legs are frequently associated with limb-threatening infections. redness or red streaks spreading away from a wound or ulcer on your feet or legs are a sign of infection spreading through the tissues. fever higher than 101.5??????f in association with redness, swelling, warmth, or any wound or ulcer on your legs may be a sign of a limb or life-threatening infection. if you have diabetes and you simply have a fever more than 101.5?????? f, and no other symptoms, seek immediate emergency care to determine a source and treatment plan. because the degree of fever does not always correlate with the seriousness of the illness, people with diabetes should take even low-grade fevers (less than 101.5??????f) very seriously and seek medical attention. alteration in mental status (confusion) may be a sign of life-threatening infection that could lead to loss of a leg or foot, when associated with a leg wound or foot ulcer. it may also be a sign of either very high or very low blood sugars, which are more common when there is infection present. prevention: prevention of diabetic foot problems involves a combination of factors. good diabetes control regular leg and foot self-examinations knowledge on how to recognize problems choosing proper footwear regular exercise, if able avoiding injury by keeping footpaths clear follow-up read any instructions from the doctor while you are still in the emergency department or doctor's office. ask questions about any instructions you don't understand. follow all of your doctor's or nurse's instructions. let your doctor know if your condition is not improving within a reasonable time. other info: less pain, swelling, redness, warmth, or drainage are generally all signs of improvement in an infected wound. shrinkage of the wound or ulcer is a good sign. absence of fever is also generally a good sign. generally, some improvement should occur within the first 2-3 days. let your doctor know if you are not improving as expected. be especially vigilant about your diabetes care while you are healing a foot or leg infection. good glycemic control is not only good for healing an ulcer you already have, it is good for preventing future ulcers. check your blood sugar regularly and let your doctor know of any pattern of lows or highs. followup instructions: , j . make an appointment aand see him immediatly after dc. please call your renal doctor. have him follow your creatinine. you have a transplanted kidney. call yopu cardiologist and have your inr followed. on dc your inr is 2.1. take your coumadin tonight call dr office and schedule an appointment for two weeks. his number is . you were seen by dr , the podiatrist. you should follow up with him in at the same time you see dr . his office number is . procedure: venous catheterization, not elsewhere classified hemodialysis angioplasty of other non-coronary vessel(s) venous catheterization for renal dialysis other partial ostectomy, tarsals and metatarsals other partial ostectomy, tarsals and metatarsals reconstruction of eyelid with tarsoconjunctival flap radical excision of skin lesion other change in muscle or tendon length procedure on single vessel other tenotomy diagnoses: anemia in chronic kidney disease end stage renal disease congestive heart failure, unspecified acute kidney failure, unspecified polyneuropathy in diabetes hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure intestinal infection due to clostridium difficile atherosclerosis of native arteries of the extremities with gangrene diastolic heart failure, unspecified complications of transplanted kidney other complications due to renal dialysis device, implant, and graft acute osteomyelitis, ankle and foot diabetes with neurological manifestations, type ii or unspecified type, uncontrolled other amputation stump complication 

Answer: The patient is high likely exposed to