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: history of present illness: this is an 80 year-old gentleman with right first toe ischemic gangrenous changes post trauma for duration of 5 to 6 months. initially saw his podiatrist who did a nail clipping and since then the wound has progressed. the patient has been on antibiotics po regimen. medication and length of therapy he does not remember. patient denies right calf hip claudication. he does admit to right first toe pain with walking. patient underwent an arteriogram at where they felt that the patient was not a surgical candidate. patient was referred to dr. for a second opinion. patient now is admitted for elective surgery. last dose of coumadin was . allergies: no known drug allergies. medications on admission: lantus 20 units every a.m., renal vit every day, lopid 600 mg b.i.d., coreg 25 mg b.i.d., prevacid 30 mg every day, diovan 320 mg every day, lasix 80 mg every day hold on dialysis days. renagel 2400 mg t.i.d., zoloft 50 mg every day, lisinopril 20 mg b.i.d., aspirin 81 mg every day, albuterol puffs multidose inhaler 2 q.i.d., spiriva puff 1 every day, advair discus 100/50 puff 1 b.i.d., digitek 0.125 mg every day, norvasc 5 mg every p.m., coumadin 2 mg every p.m., procrit at dialysis, lasix 160 mg every a.m. wednesday, thursday, saturday, sunday and 80 mg of lasix every p.m., which is to be held on hemodialysis days. social history: patient is widowed for the last 5 years. lives with his daughter. is retired. had been self employed. he is a former 3 pack per day smoker for 20 years. has not smoked for 10 years. does admit to alcohol use, but has discontinued alcohol for the last 15 years. past medical history: coronary artery disease with history of myocardial infarction in . denies any congestive heart failure, type 2 diabetes with neuropathy and nephropathy insulin dependent for the last 10 to 12 years, history of hypercholesterolemia, history of aortic valvular disease, history of carotid disease, history of c diff in of 99, pneumonia in of 99. echo showed an avr prosthesis with ejection fraction of 45%, left ventricular hypertrophy and mr with mitral valve prolapse. patient has a history of hematochezia, which was worked up at , which was negative. past surgical history: he is status post avr and cabg in in , . left av fistula in . bilateral carotid endarterectomies in 97. hemodialysis is at marymac dialysis center . physical examination: general appearance, alert white male in no acute distress. heent exam shows bilateral transmitted murmurs versus bruits. carotid pulses are 1+ bilaterally. there is no jvd. there is no thyromegaly. lungs are clear to auscultation. heart is a regular rate and rhythm with 2/6 systolic ejection murmur at the base, which radiates to the apex and carotids. abdominal exam is soft, nontender, nondistended. bowel sounds x 4. no masses. epigastric and iliac bruits. peripheral vascular exam shows right first toe with ischemic color changes and the nail tip gangrene. patient has bilateral femoral bruits. he has underwent a left greater saphenous vein harvest. pulses are on the right radial 2+, femoral 1+, popliteal, dp and pt absent. on the left the radial pulse is 1+, femoral 1+, absent popliteal, dopplerable dp and absent pt. left av fistula in the upper arm has a thrill and neurological exam patient is oriented x 3, nonfocal. hospital course: patient was admitted to the vascular service. renal was consulted for hemodialysis needs. the patient was continued on augmentin renal dosing and he was placed on bed rest in the vascular position. iv heparinization was instituted once the patient's inr was less then 2.0. patient's echocardiogram demonstrated moderate left atrial enlargement, right atrium and interatrial septum was moderately dilated and with an aneurysmal interatrial septum. the left ventricular showed symmetrical left ventricular hypertrophy mild, the left ventricular cavity size was normal. the suboptimal technical quality of focal wall motion abnormality could not be fully excluded. overall ejection was greater then 55%. there is a false lv tendon, which is (normal variant). the aortic valve was by a prosthetic aortic valve. there is thickened avr leaflets and increased avr gradient with a mild aortic insufficiency of 1+. the mitral valve showed moderate mitral anular calcification with mild thickening of the mitral valve cordae and calcifications at the tips of the papillary muscles. there was no mitral stenosis. the mitral regurg is 1+. due to the acoustic shadowing the severity of the mitral regurg may be significantly underestimated. the tricuspid valve was not well visualized. it was indeterminate pa systolic pressure. the pulmonic valve was not well seen. there was no pericardial effusion. admitting chest x-ray showed cardiomegaly without acute cardiopulmonary process and left pleural thickening. ultrasounds of the carotids were obtained for a history of carotid endarterectomy, which demonstrated less then 40% right internal and left internal carotid artery stenosis. patient was evaluated by renal who felt that patient would require more then just twice a week hemodialysis. he was begun on a monday, tuesday, thursday, saturday schedule. also followed the patient for his diabetes care. the patient underwent on a right axillary bifemoral bypass. he tolerated the procedure well. he was transferred to the pacu in stable condition. postoperatively he remained hemodynamically stable and was transferred to the vicu for continued monitoring and care. postoperative day one he did require fluid boluses overnight for low urinary output. heparin drip was begun. he complained of right shoulder pain. an ultrasound was obtained, which showed a right subclavian dvt. his feet were warm and well perfuse. his medications were converted to po pain medications. he was restarted on his preoperative medications. ambulation to chair was begun. patient was transferred to the icu, required a need for neo- synephrine support. postoperative day 2 his neo was slowly weaned. he remained afebrile. blood gas 7.31, 38, 126, 21, - 6. the graft was dopplerable. anticipated to transfer patient to the vicu once weaned off of his neo. postoperative day 3 the patient continued on triple antibiotic therapy. he continued on neo-synephrine. he was extubated and the neo was weaned and he was transferred to the vicu for continued care. because the patient remained on the neo-synephrine the patient required to be transferred to the sicu for continued care. dialysis was continued by the renal service. by postoperative day 5 the neo was weaned. hematocrit was stable at 29.4. bun 40, creatinine 2.5. patient was adequate control with dilaudid for pain. he continued on his preoperative medications. his swan was discontinued. ambulation was begun. his diet was advanced as tolerated. patient was transferred to the vicu for continued monitoring and care. patient continued to do well and was transferred to the regular floor on . heparin drip was continued with a goal ptt of 60 to 70. vancomycin was continued. mrsa screen was negative. vre screen was negative. patient had blood cultures done, which were negative. his hematocrit drifted to 26.9. they felt this was related to volume and he required aggressive hemodialysis over the next 72 hours on a daily basis for volume overload. vancomycin was discontinued on . his central line was converted to a peripheral line. he is beginning screening and physical therapy assessed the patient for discharge planning. patient was dialyzed on . there was difficulty with accessing the av fistula. it was noted on physical exam only the proximal 1 mm of the av fistula had a good thrill. an av fistulogram was recommended. at the time of dictation this was ordered and pending scheduling. the remaining hospital course prior to discharge will be dictated at the time of patient's discharge. , dictated by: medquist36 d: 14:05:27 t: 14:56:26 job#: procedure: venous catheterization, not elsewhere classified hemodialysis angioplasty of other non-coronary vessel(s) other (peripheral) vascular shunt or bypass transfusion of packed cells diagnoses: pure hypercholesterolemia acute posthemorrhagic anemia aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes mitral valve insufficiency and aortic valve insufficiency hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease heart valve replaced by other means atherosclerosis of native arteries of the extremities with gangrene other complications due to renal dialysis device, implant, and graft diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to