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: gangrene of the left heel major surgical or invasive procedure: left lower extremity arteriogram and unsuccessful attempt of crossing left anterior tibial occlusion with a wire. . left below-knee popliteal to dorsalis pedis artery bypass with non-reversed saphenous vein and angioscopy. history of present illness: this 60-year-old gentleman with longstanding diabetes, peripheral vascular disease, status post a kidney transplant has a gangrenous ulcer involving a good portion of his left heel. he had extensive tibial disease on his arteriogram not amendable to catheter-based intervention with reconstitution of a calcified dorsalis pedis artery distally. past medical history: diabetes mellitus type 2 with triopathy hypertension perpheral vascular disease s/p right belowknee popliteal artery by pass graft to anterior tibial artery with reversed lesser saphenous vein s/p right ray amputation of first toe s/p right panmethead resection s/p right plantar foot ulcer debridment s/p left renal cadaveric transplant s/p right femoral artery bypass graft to dorsals pedis s/p right toe amputation s/p ou laser for retinal detachment s/p permcath placement x2 s/p left avf social history: married 5 grown children ambulates independently nonsmoker /drinker family history: non-contributory pertinent results: on admission: 04:20pm blood wbc-9.9 rbc-3.66* hgb-10.5* hct-31.9* mcv-87 mch-28.7 mchc-32.9 rdw-16.1* plt ct-241 03:49am blood pt-12.8 ptt-29.0 inr(pt)-1.1 04:20pm blood glucose-83 urean-51* creat-1.9* na-139 k-4.9 cl-107 hco3-23 angap-14 04:20pm blood calcium-8.4 phos-4.6*# mg-2.6 03:40am blood fk506-13.8 . on discharge: 04:42am blood wbc-7.2 rbc-3.13* hgb-9.1* hct-26.8* mcv-86 mch-29.0 mchc-33.9 rdw-16.1* plt ct-239 01:54am blood pt-12.4 ptt-34.5 inr(pt)-1.1 04:42am blood glucose-70 urean-56* creat-1.9* na-141 k-4.9 cl-110* hco3-23 angap-13 09:53pm blood ck(cpk)-28* 09:53pm blood ck-mb-notdone ctropnt-0.14* 04:42am blood calcium-8.9 phos-4.1 mg-2.8* . 10:50 pm catheter tip-iv source: rij cvl. **final report ** wound culture (final ): no significant growth. . cardiology report stress study date of exercise results resting data ekg: sinus brady, laa, rbbb, low voltage limb, st-t abnls heart rate: 58 blood pressure: 142/80 protocol / stage time speed elevation heart blood rpp (min) (mph) (%) rate pressure i 0-4 .142mg kg/min 61 total exercise time: 4 % max hrt rate achieved: 38 symptoms: none interpretation: 60 yo man (h/o abnl ecg and pvd) was referred for pre-op risk stratification prior to vascular surgery. the patient was administered 0.142 mg/kg/min of persantine over 4 minutes. no chest, back, neck or arm discomforts were reported. in the presence of baseline st-t wave abnls, no additonal changes were noted during the procedure. the rhythm was sinus with rare isolated vea noted. the hemodynamic response to the persantine infusion was appropriate. three min post-mibi, the patient received 125 mg aminophylline iv. impression: no anginal symptoms or ecg changes from baseline. nuclear report sent separately. . radiology final report chest port. line placement 4:26 pm chest port. line placement reason: r/o ptx and check new rij line tip medical condition: 60 year old man with left leg bypass reason for this examination: r/o ptx and check new rij line tip chest, single ap film history of cv line placement. a jugular cv line is in distal svc. no pneumothorax. there is cardiomegaly and bilateral calcified pleural plaques as previously demonstrated. the right cpa is partly cut off the film. . radiology final report chest port. line placement 11:52 pm chest port. line placement reason: please assess for line placement / ptx medical condition: 60 year old man with left leg bypass s/p swan ganz placement reason for this examination: please assess for line placement / ptx indication: swan-ganz placement. chest, one view: comparison with . right internal jugular vein line with swan-ganz catheter in the right pulmonary artery. calcified pleural plaques as previously demonstrated. cardiomegaly and pulmonary hilar fullness indicate a degree of cardiac failure. osseous structures appear grossly unchanged. impression: 1. successful right swan-ganz catheter placement. no pneumothorax. 2. mild to moderate cardiac failure. . radiology final report renal transplant u.s. port 7:14 pm renal transplant u.s. port reason: eval flow medical condition: 58m c lt heel gangrene/ulcer : l bk -dp bpg w nrgsv from l thigh reason for this examination: eval flow clinical history: 58-year-old male complaining of left heel gangrene and ulcer. evaluate transplanted kidney. renal transplant ultrasound: transplanted kidney is seen within the left lower abdomen and measures 13.7 cm, uniformly larger than prior measurement of 12.1cm, likely representing further compensatory hypertrophy. its overall echogenicity and corticomedullary differentiation is unchanged. no hydronephrosis, perinephric fluid collection, mass or stone is identified. the bladder is collapsed. doppler evaluation demonstrates uniform vascular flow. normal waveforms are seen within the main renal artery and vein. pulsed doppler interrogation demonstrates arterial resistive indices ranging from 0.78-0.82, which are all within normal limits. small amount of fluid is seen within the left lower quadrant. impression: normal doppler evaluation of the transplant kidney. small amount of fluid within the left lower abdomen. . radiology final report scrotal u.s. port 8:49 am scrotal u.s. port reason: portable; eval enlarged left testicle medical condition: 58y/o w lt heel gangrene/ulcer. admit for lle angio on s/p : l bk -dp bpg w nrgsv from l thigh with enlarged left testicle reason for this examination: portable; eval enlarged left testicle indication: enlarged left testicle. scrotal ultrasound: reference is made to a renal ultrasound from . the right testicle measures 3.8 x 2.2 x 2.2 cm, and the left measures 3.9 x 2.8 x 2.6 cm. testicular size and echogenicity are symmetrical, without focal mass. there is a massive left hydrocele. there is no evidence of varicocele. a tiny right hydrocele is also present. doppler assessment of blood flow shows symmetrical flow to both testicles and epididymal heads. impression: large left hydrocele. no evidence of testicular mass. . cardiology report echo study date of patient/test information: indication: reassess lv function s/p vascular surgery. height: (in) 69 weight (lb): 276 bsa (m2): 2.37 m2 bp (mm hg): 168/64 hr (bpm): 67 status: inpatient date/time: at 16:30 test: portable tte (focused views) doppler: limited doppler and color doppler contrast: none tape number: 2007w025-0:18 test location: west sicu/ctic/vicu technical quality: suboptimal referring doctor: dr. measurements: left ventricle - ejection fraction: 60% to 70% (nl >=55%) tr gradient (+ ra = pasp): *39 to 46 mm hg (nl <= 25 mm hg) interpretation: findings: right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. dilated ivc (>2.5cm) with no change with respiration (estimated rap >20 mmhg). left ventricle: overall normal lvef (>55%). right ventricle: rv hypertrophy. dilated rv cavity. borderline normal rv systolic function. aortic valve: mildly thickened aortic valve leaflets (3). no as. mitral valve: mildly thickened mitral valve leaflets. no mvp. mild mitral annular calcification. mild thickening of mitral valve chordae. calcified tips of papillary muscles. trivial mr. tricuspid valve: normal tricuspid valve leaflets. normal tricuspid valve supporting structures. no ts. mild tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. normal main pa. no doppler evidence for pda pericardium: no pericardial effusion. general comments: suboptimal image quality - poor echo windows. suboptimal image quality - poor parasternal views. suboptimal image quality - poor apical views. conclusions: the estimated right atrial pressure is >20 mmhg. overall left ventricular systolic function is normal (lvef 60-70%). the right ventricular free wall is hypertrophied. the right ventricular cavity is dilated. right ventricular systolic function is borderline normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study of (images reviewed) of the right ventricle now appears somewhat dilated and borderline hypocontractile. . radiology final report chest (portable ap) 12:58 pm chest (portable ap) reason: please assess for line placement / ptx medical condition: 60 year old man with left leg bypass s/p replacement of cvl over a wire reason for this examination: please assess for line placement / ptx history: 60-year-old man with left leg bypass status post central venous line exchange. comparison: . chest ap: there is stable moderate cardiomegaly. the aorta is calcified and tortuous. there is decreased pulmonary vascular congestion and interstitial abnormalities. bilateral pleural plaques are again noted. right ij cvl tip is in the svc. there is no evidence of pneumothorax. osseous structures are unremarkable. impression: right ij cvl tip in svc. no pneumothorax. improving chf. . radiology final report foot ap,lat & obl left port 8:10 am foot ap,lat & obl left port reason: eval for osteo medical condition: 60 year old man with chronic dry gangrene of l heel reason for this examination: eval for osteo three views, left foot history: ulcer. findings: three views of the left foot are submitted. there are no prior examinations. soft tissue defect is present overlying the posterior and plantar aspect of the calcaneus. underlying calcaneus demonstrates normal density without sclerosis or focal area of lucency. degenerative change is present at the first metatarsophalangeal joint. there is also a small plantar calcaneal spur. bones are otherwise unremarkable. there is marked vascular calcification as well as mild soft tissue swelling of the dorsum of the foot. impression: ulcer overlying the posterior and plantar aspect of the calcaneus without evidence of underlying calcaneal abnormality. brief hospital course: the patient was admitted to dr. vascular surgery service on for a gangrenous left heel. he underwent a left below-knee popliteal to dorsalis pedis artery bypass with non-reversed saphenous vein and angioscopy on . for details of the operation, please refer to the operative report. in the operating room, he was noticed to have a diffusely enlarged left scrotum and urology was consulted post-operatively. a scrotal ultrasound showed a simple left hydrocele and urology recommended follow-up as an out-patient. immediately post-op, the renal transplant servic was consutled for his prior history of a renal transplant and helped to manage his immunosuppression medications. on pod 1, he was afebrile and tolerating a regular diet. his urine output was adequate. podiatry was consulted for evaluation of his gangrenous heel for possible surgical management and recommended accuzyme and follow-up as an outpatient for possible intervention in the future. in the evening of pod 1, he became oliuric and hypotensive and was trasnferred to the csru for a more acute level of care. a swan- catheter was placed for fluid management and a renal transplant ultrasound was performed, which demonstrated good flow to his transplant kidney. he continued to remain stable in the csru and his graft remained strongly palpable. on pod 3, he had improving urine output mostly likely due to atn from his hypotension. his craetinine continued to improve daily from a peak of 2.8 and he was stable for transfer to the floor on pod 4. his graft continued to function and he remained afebrile. renal continued to make adjustments to his immunosuppression and he was stable for discharge on pod 7. physical therapy evaluated and worked with hims and appproved him for home with vna and pt. he will follow-up with dr. . medications on admission: lasix 80', predisone 5', bactrim ds mwf, prograft 2", cellcept ", lisinopril 20', imdur 120', glipizide 20", prandian 2 ac/hs, lopressor 75", vit b complex, nph 44am/36pm ,reg insulin 14am/8pm, riss, metolazone 2.5 mwf, allopurinol 100', lipitor 40' discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po mwf (monday-wednesday-friday). disp:*30 tablet(s)* refills:*0* 5. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 7. repaglinide 2 mg tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*0* 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*0* 9. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 10. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po daily (daily). disp:*45 tablet sustained release 24 hr(s)* refills:*0* 11. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 12. insulin nph human recomb 100 unit/ml suspension sig: as directed subcutaneous as directed: 44 units before breakfast and 39 units before dinner. disp:*qs 1 month supply* refills:*0* 13. insulin sliding scale insulin sc sliding scale breakfast lunch dinner bedtime regular regular regular regular glucose insulin dose insulin dose insulin dose insulin dose 0-80 mg/dl 4 oz. juice 4 oz. juice 4 oz. juice 4 oz. juice 81-100 mg/dl 10 units 0 units 6 units 0 units 101-150 mg/dl 14 units 0 units 8 units 0 units 151-200 mg/dl 16 units 4 units 10 units 0 units 201-250 mg/dl 22 units 10 units 16 units 4 units 251-300 mg/dl 24 units 12 units 18 units 8 units 301-350 mg/dl 26 units 14 units 20 units 10 units 351-400 mg/dl 28 units 16 units 22 units 12 units 14. tacrolimus 1 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* discharge disposition: home with service facility: care group home care discharge diagnosis: gangrene of the left heel discharge condition: stable discharge instructions: what to expect when you go home: 1. it is normal to feel tired, this will last for 4-6 weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have swelling of the leg you were operated on: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? unless you were told not to bear any weight on operative foot: ?????? you should get up every day, get dressed and walk ?????? you should gradually increase your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 100.5f for 24 hours ?????? bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: please call dr. office(vascular surgery) at ( to schedule a follow-up appointment for 10-14 days from your date of discharge. . please call dr. (renal) at ( to schedule a follow-up in weeks from your date of discharge. . please call dr. (podiatry) at ( to schedule a follow-up appointment in weeks from your date of discharge. . please call dr. (urology) at ( to schedule a follow-up appointment if you would like to have your left hydrocele evaluated. procedure: venous catheterization, not elsewhere classified other (peripheral) vascular shunt or bypass diagnoses: unspecified essential hypertension acute kidney failure, unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes atherosclerosis of native arteries of the extremities with gangrene complications of transplanted kidney diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled hydrocele, unspecified 

Answer: The patient is high likely exposed to