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: augmentin / oxycodone attending: chief complaint: fever, swelling, pain and drainage from l bka stump major surgical or invasive procedure: operation performed: 1. ultrasound-guided puncture of right common femoral artery. 2. contralateral second-order catheterization of left external iliac artery. 3. abdominal aortogram. 4. serial arteriogram of the left lower extremity. 5. debridement of massive soft tissue infection of the left lower extremity. right heart catheterization/ left heart catheterization/ coronary catheterization. procedure: re-exploration of below-knee amputation and above- knee amputation. history of present illness: patient is a 70f with severe pvd s/p left bka by dr. with pain, redness, and discharge in left stump since sunday. fever to 101f. pt was in usual state of health until saturday when the 1 cm ulcer that appears intermeittently on the bottom of her otherwise well-healed stump opened up and began to drain purulent fluid. on sunday the stump became firey red and warm to touch which prompted her to present to the ed today. no n/v/c/d. all other ros negative. past medical history: pmh: vascular history as below, cad s/p angioplasty 92, htn, high lipids, s/p appy, s/p colon resection, s/p lumpectomy, gi bleed vascular procedures: : l bka : angio - occlusion of the l and peroneal art, unable to reenter the distal limb : left second toe amputation : angio - dx abd aortogram & l lower extrem arteriogram, pta of the tibioperoneal, and sfa and stenting of the tibioperoneal bk- and ak- art for residual stenosis. social history: neg drinker neg smoker family history: unknown physical exam: pe: 96.8 74 128/42 18 100%ra pain gen: nad, appears comfortable pulm: ctab chest: rrr. no murmurs abd: soft, nt/nd lle: purulent discharge along medial well healed incision of bka stump; significant ttp from stump to proximal knee; significant blanching circumferential erythema from stump to proximal knee; pain with active and passive rom of knee; no significant edema appreciated rle: 3+ pitting edema to knee pulses fem dp pt r 1+ d d d l 1+ d - - pertinent results: 07:00pm blood wbc-25.0*# rbc-3.58* hgb-11.1* hct-32.8* mcv-91 mch-30.8 mchc-33.7 rdw-18.9* plt ct-358 03:05am blood wbc-12.7* rbc-3.18* hgb-9.8* hct-27.6* mcv-87 mch-31.0 mchc-35.7* rdw-18.1* plt ct-174 03:27am blood wbc-10.0 rbc-2.84* hgb-8.7* hct-24.8* mcv-87 mch-30.5 mchc-34.9 rdw-18.1* plt ct-113* 03:30am blood wbc-13.0* rbc-4.33# hgb-12.9# hct-38.4# mcv-89 mch-29.7 mchc-33.5 rdw-17.5* plt ct-107* 07:26pm blood wbc-30.1*# rbc-2.85* hgb-8.6* hct-25.9* mcv-91 mch-30.1 mchc-33.2 rdw-17.5* plt ct-341 04:20am blood wbc-16.3* rbc-3.44* hgb-10.4* hct-29.8* mcv-86 mch-30.3 mchc-35.0 rdw-17.5* plt ct-259 04:07am blood wbc-11.8* rbc-3.54* hgb-10.4* hct-30.3* mcv-85 mch-29.5 mchc-34.5 rdw-17.0* plt ct-217 08:10am blood pt-15.0* ptt-47.7* inr(pt)-1.3* 06:50am blood pt-11.9 ptt-30.6 inr(pt)-1.0 07:00pm blood glucose-183* urean-44* creat-1.4* na-135 k-5.0 cl-102 hco3-18* angap-20 06:56pm blood glucose-194* urean-26* creat-0.8 na-144 k-3.8 cl-120* hco3-17* angap-11 03:27am blood glucose-96 urean-18 creat-0.6 na-143 k-3.7 cl-114* hco3-23 angap-10 04:20am blood glucose-85 urean-13 creat-0.5 na-138 k-4.0 cl-108 hco3-24 angap-10 04:07am blood glucose-79 urean-14 creat-0.4 na-140 k-3.6 cl-109* hco3-27 angap-8 03:05am blood alt-9 ast-23 alkphos-51 amylase-200* totbili-0.8 04:20am blood alt-4 ast-18 alkphos-62 totbili-1.0 06:56pm blood ck-mb-7 ctropnt-0.02* 10:49pm blood ck-mb-notdone ctropnt-0.08* 03:35am blood ck-mb-notdone ctropnt-0.10* 10:38am blood ck-mb-notdone ctropnt-0.13* 06:12pm blood ck-mb-notdone ctropnt-0.09* 04:20am blood ctropnt-0.02* portable tee (complete) done at 2:33:04 pm the left atrium is moderately dilated. overall left ventricular systolic function is normal (lvef>55%). transmitral and tissue doppler imaging suggests normal diastolic function, and a normal left ventricular filling pressure (pcwp<12mmhg). transmitral doppler and tissue velocity imaging are consistent with grade ii (moderate) lv diastolic dysfunction. moderate to severe (3+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mitral regurgitation is seen. brief hospital course: admitted from home to vascular surgery, fever, pain w/ l below knee amputaion stump erythema and drainage. x-ray showed-likely a deep ulcer extending to the cortical surface of the remnant tibial stump. started broad spectrum antibiotics. remained febrile 101.5. pre-oped for exploration and drainage of infected l bka stump. npo post mn and iv hydration. remained febrile t 102- blood cultures sent. triggered for hypotension sbp down to 60's and desaturation down to 88%. given ns boluses, responded briefly but continued to become hypotensive. transferred to the vicu, more fluid boluses given, given o2/nc 4l- o2 sats came up to 98-100%. persistently hypotensive. foley inserted, additional preipheral iv access, central line, a-line placed. started on dopamin to keep sbp>90's. taken to or for exploration and drainage of infected l bka stump. post-operatively, remained intubated and sedate, transferred to cvicu. presumed to have necrotizing fascitis- started on meropenem, clindamycin and gentamycin. post-operatively the id team was consulted who recommended continuing therapy with clindamycin and meropenem, vancomycin was added in addition. cultures taken from the operating room were followed. daily wound care was performed with wet->dry dressings tid. dopmaine was required to maintain adquate sbp's. pressors were weaned off, 1 u prbc transfused and a plastic surgery consult was obtained. the patient was weaned from mechanical ventilation, transitioned from ac to cpap, a wound vac was placed over the left bka stump. the patient was extubated without incident, began spiking fevers, c-diff was sent along with blood cultures. wound cultures from the or were positive for beta-hemolytic strep and mssa. pt with increasing sob, desaturations, cxr consistent w/volume overload, diuersis initiated. t-wave inversions noted on ekg persistently increasing troponins, cardiac cath, negative for significant flow limiting coronary lesions. pt transfered to vicu - the patient was progressively diuresed, nutrition recommendations were obtained and implemented, tte was repeated showing improved systolic function (50-55%) pt cleared by cardiology to return to or for completion aka pt returned to operating room for above knee amputation with primary closure. the procedure was without complication. chronic pain service continued to follow 2 units prbc were transfused for a drop in hct, no obvious source of bleeding aside from oozing at the amputation site. enzymes were cycled to r/o for mi, negative x3. antibiotics were continued the dressing was taken down, amputation site appeared in good condition, meropenem was discontinued. pt was deemed fit for discharge. at the time of discharge pain was well controlled with oral medications, pt was voiding without difficulty, tolerating a regular diet and working with physical therapy. cvl d/c'd physical therapy continued to work with patient for transitioning to chair. medial aspect of left aka wound slightly opened in multiple subcentimeter areas with no evidence of infection or necrosis, pt kept in house for wound monitoring. incision closing appropriately with dry dressing changes. no sign of infection. medications on admission: atenolol 25', folic acid 1', lasix 20', vicodin prn, lisinopril 10', methotrexate 17.5 mg q week, methyprednisolone 4', omeprazole 20', opium tincture 10mg/ml 2 drops , simvastatin 20', mvi, calcium 500", imodium 80' discharge medications: 1. methylprednisolone 2 mg tablet sig: two (2) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. simethicone 80 mg tablet, chewable sig: 0.5-1 tablet, chewable po qid (4 times a day) as needed for distension. 5. quetiapine 25 mg tablet sig: 0.5 tablet po qhs (once a day (at bedtime)). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 9. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 10. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 11. insulin regular human 100 unit/ml solution sig: as directed injection asdir (as directed). 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 13. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 14. methotrexate sodium 2.5 mg tablet sig: four (4) tablet po 1x/week (fr). 15. methotrexate sodium 2.5 mg tablet sig: three (3) tablet po 1x/week (sa). 16. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 17. gabapentin 100 mg capsule sig: two (2) capsule po tid (3 times a day). 18. opium tincture 10 mg/ml tincture sig: two (2) drop po bid (2 times a day) as needed for diarrhea. discharge disposition: extended care facility: discharge diagnosis: infected l bka stump sepsis hypotension non stemi chf- left ventricular systolic dysfunction, ef 30% discharge condition: improved discharge instructions: discharge instructions following below or above knee amputation . this information is designed as a guideline to assist you in a speedy recovery from your surgery. please follow these guidelines unless your physician has specifically instructed you otherwise. please call our office nurse if you have any questions. dial 911 if you have any medical emergency. . activity: . there are restrictions on activity. on the side of your amputation you are non weight bearing until cleared by your surgeon. you should keep this amputation site elevated when ever possible. . you may use the other leg to assist in transferring and pivots. but try not to exert to much pressure on the amputation site when transferring and or pivoting. please keep knee immobilizer on at all times to help keep the amputation site straight. . no driving until cleared by your surgeon. . please call us immediately for any of the following problems: . redness in or drainage from your leg wound(s) . . 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. . exercise: . limit strenuous activity for 6 weeks. . do not drive a car unless cleared by your surgeon. . try to keep leg elevated when able. . bathing/showering: . you may shower immediately upon coming home. no bathing. a dressing may cover you??????re amputation site and this should be left in place for three (3) days. remove it after this time and wash your incision(s) gently with soap and water. you will have sutures, which are usually removed in 4 weeks. this will be done by the surgeon on your follow-up appointment. . wound care: . sutures / staples may be removed before discharge. if they are not, an appointment will be made for you to return for staple removal. . when the sutures are removed the doctor may or may not place pieces of tape called steri-strips over the incision. these will stay on about a week and you may shower with them on. if these do not fall off after 10 days, you may peel them off with warm water and soap in the shower. . avoid taking a tub bath, swimming, or soaking in a hot tub for four weeks after surgery. . medications: . unless told otherwise you should resume taking all of the medications you were taking before surgery. you will be given a new prescription for pain medication, which can be taken every three (3) to four (4) hours only if necessary. . remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods in your diet. (check with your physician if you have fluid restrictions.) if you feel that you are constipated, do not strain at the toilet. you may use over the counter metamucil or milk of magnesia. appetite suppression may occur; this will improve with time. eat small balanced meals throughout the day. . cautions: . no smoking! we know you've heard this before, but it really is an important step to your recovery. smoking causes narrowing of your blood vessels which in turn decreases circulation. if you smoke you will need to stop as soon as possible. ask your nurse or doctor for information on smoking cessation. . avoid pressure to your amputation site. . no strenuous activity for 6 weeks after surgery. . diet : . there are no special restrictions on your diet postoperatively. poor appetite is expected for several weeks and small, frequent meals may be preferred. . for people with vascular problems we would recommend a cholesterol lowering diet: follow a diet low in total fat and low in saturated fat and in cholesterol to improve lipid profile in your blood. additionally, some people see a reduction in serum cholesterol by reducing dietary cholesterol. since a reduction in dietary cholesterol is not harmful, we suggest that most people reduce dietary fat, saturated fat and cholesterol to decrease total cholesterol and ldl (low density lipoprotein-the bad cholesterol). exercise will increase your hdl (high density lipoprotein-the good cholesterol) and with your doctor's permission, is typically recommended. you may be self-referred or get a referral from your doctor. . if you are overweight, you need to think about starting a weight management program. your health and its improvement depend on it. we know that making changes in your lifestyle will not be easy, and it will require a whole new set of habits and a new attitude. if interested you can may be self-referred or can get a referral from your doctor. . if you have diabetes and would like additional guidance, you may request a referral from your doctor. . follow-up appointment: . be sure to keep your medical appointments. the key to your improving health will be to keep a tight reign on any of the chronic medical conditions that you have. things like high blood pressure, diabetes, and high cholesterol are major villains to the blood vessels. don't let them go untreated! . please call the office on the first working day after your discharge from the hospital to schedule a follow-up visit. this should be scheduled on the calendar for seven to fourteen days after discharge. normal office hours are 8:30-5:30 monday through friday. . please feel free to call the office with any other concerns or questions that might arise division of vascular and endovascular surgery lower extremity angioplasty/stent discharge instructions medications: ?????? take aspirin 325mg (enteric coated) once daily ?????? if instructed, take plavix (clopidogrel) 75mg once daily ?????? continue all other medications you were taking before surgery, unless otherwise directed ?????? you make take tylenol or prescribed pain medications for any post procedure pain or discomfort what to expect when you go home: it is normal to have slight swelling of the legs: ?????? 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 ?????? it is normal to feel tired and have a decreased appetite, your appetite will return with time ?????? drink plenty of fluids and 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: ?????? when you go home, you may walk and go up and down stairs ?????? you may shower (let the soapy water run over groin 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 or band aid over the area that is draining, as needed ?????? no heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) ?????? after 1 week, you may resume sexual activity ?????? after 1 week, gradually increase your activities and distance walked as you can tolerate ?????? no driving until you are no longer taking pain medications ?????? call and schedule an appointment to be seen in weeks for post procedure check and ultrasound what to report to office: ?????? numbness, coldness or pain in lower extremities ?????? temperature greater than 101.5f for 24 hours ?????? new or increased drainage from incision or white, yellow or green drainage from incisions ?????? bleeding from groin puncture site sudden, severe bleeding or swelling (groin puncture site) ?????? lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. if bleeding stops, call vascular office . if bleeding does not stop, call 911 for transfer to closest emergency room. followup instructions: provider: , md phone: date/time: 11:00 provider: , md (vascular surgery):( - 11:00 am building procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters parenteral infusion of concentrated nutritional substances angiocardiography of left heart structures arteriography of femoral and other lower extremity arteries excisional debridement of wound, infection, or burn aortography repair of entropion or ectropion with wedge resection revision of amputation stump diagnoses: other primary cardiomyopathies systemic lupus erythematosus thrombocytopenia, unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery other postoperative infection urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified personal history of malignant neoplasm of breast pneumonitis due to inhalation of food or vomitus cellulitis and abscess of leg, except foot bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site intestinal infection due to clostridium difficile other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use iatrogenic pulmonary embolism and infarction pressure ulcer, lower back accidents occurring in other specified places streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] accidents occurring in residential institution atherosclerosis of native arteries of the extremities with gangrene combined systolic and diastolic heart failure, unspecified other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria infection (chronic) of amputation stump disruption of external operation (surgical) wound ulcer of other part of lower limb other specified retention of urine nutritional marasmus takotsubo syndrome necrotizing fasciitis pressure ulcer, unstageable other specified bacterial infections in conditions classified elsewhere and of unspecified site, clostridium perfringens amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation gas gangrene streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group a 

Answer: The patient is high likely exposed to