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 / codeine / clindamycin / zestril / ciprofloxacin / ivp dye, iodine containing / milk attending: chief complaint: ischemic right foot. major surgical or invasive procedure: 1. abdominopelvic arteriogram and selective right lower extremity arteriogram. 2. right saphenofemoral artery to plantar bypass using left greater saphenous vein, angioscopy. 3. a exploration of bypass graft. b thrombectomy of bypass graft. c angioscopy vein graft. d patch angioplasty of graft using greater saphenous vein x4. 4. ligation of the right lower extremity vein graft. history of present illness: this 87-year-old lady has previously had a right superficial femoral angioplasty and stent. she has had recurrent ischemic ulceration of her right foot and is undergoing a diagnostic arteriogram. past medical history: 1. type 2 diabetes mellitus. 2. total right hip replacement in . 3. total abdominal hysterectomy and bilateral salpingo- oophorectomy. 4. cholecystectomy. 5. appendectomy. 6. ddd pacer status post type ii av block. 7. spinal stenosis. 8. chronic lower back pain. 9. hypothyroidism. 10. orthostatic hypotension. 11. recurrent malignant external otitis 12. bell's palsy social history: she is a nonsmoker, and denies alcohol use. the patient is a retired nurse . family history: she has a family history pertinent for diabetes mellitus, coronary artery disease physical exam: 99.5 61 132/50 18 97% no apparent distress, alert and oriented x3 perrla, eomi mmm, slight droop lt droop noted rrr, s1 s2 clear to auscultation soft abdomen, non-tender, non distended left dp palpable, left pt biphasic, right pt and bp monophasic erythema of right foot on dorsal surface extending to ankle ulceration of rt 4th digit pertinent results: 04:00am blood wbc-8.9 rbc-3.05* hgb-9.3* hct-26.4* mcv-87 mch-30.4 mchc-35.0 rdw-14.3 plt ct-173 04:00am blood pt-18.5* ptt-37.2* inr(pt)-1.7* 04:00am blood glucose-97 urean-24* creat-1.1 na-142 k-3.8 cl-101 hco3-34* angap-1106/19/06 calcium-8.5 phos-3.0 mg-1.8 urine color-yellow appear-clear sp -1.020 urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg urine hours-random urean-268 creat-44 na-73 k-34 urine osmolal-331 7:00 pm stool consistency: soft source: stool. final report ** clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. reference range: negative. probable atrial sensed and ventricular paced rhythm with occasional atrial premature beats. since the previous tracing of ventricular premature beats are no longer seen. intervals axes rate pr qrs qt/qtc p qrs t 82 0 136 400/438.42 0 -83 -167 1:15 pm chest (portable ap) history: congestive heart failure. upright ap view of the chest: increasing moderate bilateral pleural effusions, right greater than left are present. additionally, bibasilar opacities reflecting atelectasis persists. rounded opacity within the medial aspect of the right base also may represent right middle lobe collapse. the cardiac contours are obscured by the basilar atelectasis. the mediastinal and hilar contours are unchanged, and there is no evidence of pulmonary vascular engorgement. calcifications of the mitral annulus and aortic knob are unchanged. there is no pneumothorax. right-sided dual chamber pacemaker with leads overlying the right atrium and right ventricle, unchanged. right internal jugular central venous catheter with tip overlying the svc is stable. severe degenerative changes are present within both shoulders. impression: increasing moderate-sized bilateral pleural effusions, right greater than left. bibasilar atelectasis persists. possible right middle lobe collapse. cardiology report echo study date of referring doctor: dr. measurements: left atrium - long axis dimension: *4.5 cm (nl <= 4.0 cm) left ventricle - septal wall thickness: *1.2 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: *1.2 cm (nl 0.6 - 1.1 cm) left ventricle - ejection fraction: 30% to 35% (nl >=55%) aorta - valve level: 1.9 cm (nl <= 3.6 cm) aorta - ascending: 3.0 cm (nl <= 3.4 cm) aortic valve - valve area: *1.3 cm2 (nl >= 3.0 cm2) interpretation: findings: mild diastolic dysfunction with vp velocity is 28cm/sec. left atrium: mild la enlargement. no spontaneous echo contrast in the body of the la. mild spontaneous echo contrast in the body of the la. no mass/thrombus in the laa. depressed laa emptying velocity (<0.2m/s) all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: normal ra size. no spontaneous echo contrast in the body of the ra. a catheter or pacing wire is seen in the ra and extending into the rv. no spontaneous echo contrast in the raa. no asd by 2d or color doppler. the ivc is normal in diameter with appropriate phasic respirator variation. left ventricle: mild symmetric lvh with normal cavity size. normal lv cavity size. moderately depressed lvef. no lv mass/thrombus. lv wall motion: regional lv wall motion abnormalities include: basal anterior - hypo; mid anterior - hypo; basal anteroseptal - hypo; mid anteroseptal - hypo; basal inferoseptal - hypo; mid inferoseptal - hypo; basal inferior - hypo; mid inferior - hypo; basal inferolateral - hypo; mid inferolateral - hypo; basal anterolateral - hypo; mid anterolateral - hypo; anterior apex - hypo; septal apex - hypo; inferior apex - hypo; lateral apex - hypo; apex - hypo; right ventricle: normal rv chamber size and free wall motion. aorta: normal ascending, transverse and descending thoracic aorta with no atherosclerotic plaque. normal aortic root diameter. simple atheroma in aortic root. simple atheroma in ascending aorta. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. mild as. mild (1+) ar. mitral valve: moderately thickened mitral valve leaflets. moderate mitral annular calcification. moderate thickening of mitral valve chordae. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. conclusions: the left atrium is normal in size. no spontaneous echo contrast is seen in the body of the left atrium. mild spontaneous echo contrast is seen in the body of the left atrium. no mass/thrombus is seen in the left atrium or left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). no spontaneous echo contrast is seen in the body of the right atrium. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size. the left ventricular cavity size is normal. overall left ventricular systolic function is moderately depressed. no masses or thrombi are seen in the left ventricle. r. right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. there are simple atheroma in the aortic root. there are simple atheroma in the ascending aorta. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. there is mild aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is moderate thickening of the mitral valve chordae. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. 7:01 pm cta head w&w/o c & recons; cta neck w&w/oc & recons technique: routine noncontrast head ct was followed by mdct imaging of the head and neck following the administration of 90 cc of intravenous optiray. nonionic contrast was administered per protocol. coronal and sagittal reformatted images were obtained. noncontrast head ct: there is no intra- or extra-axial hemorrhage, mass effect, or shift of normally midline structures. there is no specific evidence of major vascular territorial infarction. patchy and confluent hypodensity in bihemispheric subcortical and periventricular white matter, representing chronic micro-ischemic change; the appearance is not significantly changed from prior study dated . the -white matter differentiation is otherwise preserved. the surrounding soft tissue and osseous structures are unremarkable. the imaged paranasal sinuses and mastoid air cells are appropriately aerated. ct angiogram head: the major vessels of the circle of and their major branches are patent. there is no hemodynamically significant stenosis or aneurysmal. within the limits of coverage of this study, no sign of av malformation is apparent. there are moderate mural calcifications of the cavernous and supraclinoid segments of both intracranial internal carotid arteries. ct angiogram neck: there is no evidence of significant stenosis or ulceration, particularly with reference to the carotid bifurcation bilaterally. the left jugular vein is asymmetrically enhancing compared with the right. while this maybe related to the phase of contrast injection, right internal jugular thrombus cannot be excluded. there are large bilateral pleural effusions, reaching the level of the right lung apex, and diffuse atherosclerosis with dense mural calcifications along the aortic arch. impression: 1. no intracranial hemorrhage or major vascular territorial infarction. 2. unremarkable cta of the neck and circle of . 3. asymmetric enhancement of the left internal jugular vein compared with the right. while this may be related to the phase of contrast injection, a right internal jugular thrombus cannot be excluded. 4. large bilateral pleural effusions. 5. atherosclerosis. brief hospital course: 86 female admitted with right 4th toe ischemia and was placed on antibiotics for cellulitis. after resolution of the cellulitis she underwent a right sfa->plantar bpg w/ left nrsvg () and tolerated the procedure well and had a strongly palpable graft pulse. approximately one week later she underwent a toe amputation by the podiatry service. she was noted to be hypotensive to the 80s post-operatively after receiving a dose of morphine and it was noted that her graft had lost its palpable signal and was weakly dopplerable. she was emergently taken back to the or and underwent a graft thrombectomy and patch angioplasties. she had a palpable graft post-operatively. she was progressing well until when she was noted to have a small amount of serous fluid draining from her thigh (medial) incision and some underlying induration and erythema. the wound was opened on and drained of seropurulent fluid. culture revealed e. coli. she was treated with antibiotics accordingly and the wound was packed with wet-to-dry dressings. a vac was placed on . later that evening she was noted to have brisk bleeding from her thigh wound. she was taken immediately to the or where the bleeding vessel was ligated. she bled again in the pacu, this time dropping her pressures. she went again to the or where the vein graft was noted to be macerated from the infection and frankly bleeding. this was ligated and the wound left open. she was transfused multiple units of blood and 2units of ffp. she recovered well with a notably cool right lower leg. she was eventually diuresed and her hematocrit remained stable. a vac was placed on her wound on . she is tolerating a regular diet, out of bed with assist, and continued on iv antibiotics with a right ij central line. she has underlying chf and reactive airway disease which have required diuresis and nebulizer treatments but have remained stable. she currently has rle pain but is refusing an amputation at this time. her blood supply to her right lower leg is poor and her leg should be protected from trauma and pressure ulceration. please follow up with dr. for any antibiotic changes or major changes in her care. medications on admission: coumadin 2'/4'sundays (for paf), lasix 20/10qod, lantus, lisinopril 10', quinine 25', synthroid 75mcg', colchicine 0.6', asa 81' discharge medications: 1. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 2. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 3. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 5. quinine sulfate 260 mg tablet sig: one (1) tablet po hs (at bedtime). 6. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). 7. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q4-6h (every 4 to 6 hours) as needed. 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 9. lasix 40 mg tablet sig: one (1) tablet po three times a day. 10. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed). 11. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day). 12. warfarin 1 mg tablet sig: one (1) tablet po hs (at bedtime): inr goal 2. 13. acetaminophen 500 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 14. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 15. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed). 16. insulin insulin sc fixed dose orders bedtime lantus 20 units insulin sc sliding scale breakfast lunch dinner bedtime humalog glucose insulin dose 0-55 mg/dl 4 oz. juice and 15 gm crackers 56-160 mg/dl 0 units 161-200 mg/dl 2 units 201-240 mg/dl 4 units 241-280 mg/dl 6 units 281-320 mg/dl 8 units 321-360 mg/dl 10 units 361-400 mg/dl 12 units > 401 mg/dl notify m.d. 17. potassium oral 18. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 19. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours). 20. propoxyphene n-acetaminophen 100-650 mg tablet sig: tablets po q6h (every 6 hours) as needed. 21. ceftriaxone 1 gm iv q24h 22. hydromorphone 2 mg/ml syringe sig: one (1) injection q4h (every 4 hours) as needed for breakthru pain. 23. reglan 5 mg tablet sig: one (1) tablet po four times a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: ischemic ulceration of the right foot. acute occlusion of right superficial femoral artery to posterior tibial bypass graft. hemorrhage from the right lower extremity vein graft. discharge condition: stable discharge instructions: routine wound care checks / fevers / chills / discharge from wound/ pain management. please keep right lower extremity clean, dry, moisturized. followup instructions: provider: , m.d. phone: date/time: 1:30. call dr office at . schedule an appointment for 2 weeks. provider: , m.d. phone: date/time: 1:30. call dr office at . schedule an appointment in 2 weeks. procedure: other revision of vascular procedure diagnostic ultrasound of heart arteriography of femoral and other lower extremity arteries amputation of toe other (peripheral) vascular shunt or bypass arterial catheterization control of hemorrhage, not otherwise specified other surgical occlusion of vessels, lower limb veins excisional debridement of wound, infection, or burn aortography transfusion of packed cells transfusion of other serum repair of blood vessel with tissue patch graft other immobilization, pressure, and attention to wound other partial ostectomy, tarsals and metatarsals injection or infusion of oxazolidinone class of antibiotics other excision of joint, foot and toe diagnoses: other iatrogenic hypotension mitral valve disorders cellulitis and abscess of trunk diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) hematoma complicating a procedure other opiates and related narcotics causing adverse effects in therapeutic use accidental puncture or laceration during a procedure, not elsewhere classified ulcer of other part of foot atherosclerosis of renal artery other complications due to other vascular device, implant, and graft long-term (current) use of anticoagulants cardiac pacemaker in situ infection and inflammatory reaction due to other vascular device, implant, and graft atherosclerosis of native arteries of the extremities with gangrene diastolic heart failure, unspecified other alteration of consciousness cellulitis and abscess of foot, except toes hip joint replacement atherosclerosis of autologous vein bypass graft of the extremities 

Answer: The patient is high likely exposed to