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 / percocet / iodine; iodine containing attending: chief complaint: right lower extremity claudication. major surgical or invasive procedure: 1. right superficial femoral artery to anterior tibial bypass graft with nonreversed left arm vein. 2. angioscopy with valve lysis. 3. thrombectomy of right superficial femoral artery. 1. right leg graft disruption and thigh hematoma. 2. thrombosed right superficial femoral artery to anterior tibial graft. r - bka history of present illness: the patient is a 52-year-old female, with peripheral disease, who has undergone several previous percutaneous procedures on her right lower extremity, including atherectomies and stents to her distal sfa and popliteal artery, which have occluded. past medical history: 1. severe peripheral disease status post right femoral-popliteal bypass in , now found to be occluded. 2. status post thoracic aortic replacement. 3. copd. 4. cad with 90% rca and 60% lad lesions by recent catheterization. 5. severe hyperlipidemia, cholesterol level of about 600 and triglycerides of approximately 3,000. 6. insulin dependent diabetes. 7. hypothyroidism. 8. hypertension. 9. pancreatitis. 10. degenerative joint disease status post laminectomy. 11. status post cholecystectomy. 12. status post right femoral embolectomy. 13. obesity. social history: she admits to a 45 pack year history of tobacco. she is still smoking. pt lives alone. she has 3 children. family history: noncontributory physical exam: obese female, nad ncat / perrl / eomi neg lesions nares, oral pjharnyx, auditory supple / farom neg lymphandopathy, supra - clavicular nodes rrr cta b/l soft ntnd, pos bs, neg cva gu defered right aka - c/d/i left triphasic at, biphasic dp; 2+ radial pertinent results: wbc-7.0 rbc-3.21* hgb-8.9* hct-27.1* mcv-85 mch-27.8 mchc-32.9 rdw-15.5 plt ct-590* pt-17.3* ptt-27.3 inr(pt)-2.0 glucose-59* urean-13 creat-0.7 na-140 k-4.3 cl-103 hco3-22 angap-19 alt-17 ast-26 alkphos-87 amylase-27 totbili-0.2 calcium-9.1 phos-4.1 mg-2.0 type-art po2-179* pco2-39 ph-7.36 calhco3-23 base xs--2 10 glucose-186* lactate-1.1 na-135 k-4.4 cl-107 hgb-10.2* calchct-31 freeca-1.17 urine: color-yellow appear-clear sp -1.014 blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg rbc-0-2 wbc- bacteri-few yeast-none epi-0 blood cx: **final report ** aerobic bottle (final ): no growth. anaerobic bottle (final ): no growth. ekg sinus rhythm. normal ecg. compared to the previous tracing of no diagnostic interim change. intervals axes rate pr qrs qt/qtc p qrs t 66 140 86 31 chest (pre-op pa & lat) indication: preoperative assessment prior to bka procedure. the patient is status post prior median sternotomy. the heart is upper limits of normal in size and stable. pulmonary vascularity is normal. the lungs are clear, and there are no pleural effusions. mild degenerative changes are seen within the spine. finally, note is made of a right picc line, terminating in the superior vena cava. impression: no evidence of acute cardiopulmonary process. cath study brief history: 52 yo woman with a long well-documented history of peripheral arterial disease, s/p many percuateneous interventional procedures on her right lower extremity including, most recently, directed thrombolytic therapy and throbectomy for an occluded recent bypass graft to her rle. she now returns to the lab with probable re-occlusion of her graft. indications for catheterization: limb threatening peripharal arterial disease ptca comments: initial angiography demonstrated a total occlusion of the sfa at just proximal to the proximal graft anastamosis. heparin was started prophylactically. a stiff angled glidewire was advanced though the native sfa into the distal popliteal artery were angiography demonstrated the at and pt to be totally occluded and the peroneal artery to be patent as the main blood suppy to the foot but with moderate diffuse disease. the glide wire was exchanged for a mircale bros 6 wire and atherectomy of the distal sfa into the distal politeal artey was performed. a wire was passed into the at and distal injection confirmed that there was no distal runoff via the at and flow did not improve with atherectomy of the origin of the at. we were unable to cross in to the pt with a wire. we then turned our attention to the peroneal artery where atherectomy was performed on the proximal and mid vessel with restoration of flow into a large distal collateral, however the pt never filled. a distuption was noted in the mid peroneal artery at this point with diminished flow into the distal artery. in spite of thrombectomy with an excisor catheter and several balloon inflations with 2.0 mm balloons. the case was terminated due to excess flouro time and contrast load. final angiography revealed no significant impprovement in blood flow to the foot. comments: 1. arterial access was obtained in retrograde fashion via the lfa with a 6 french short sheath. 2. selective angiography of the right lower extremity revealed the sfa to be totally occluded just proximal to the anatamosis of the graft. 3. failed percutaneous intervention on the right lower extremity. final angiography revealed no restoration of flow into the infrapapliteal vessels (see pta comments). final diagnosis: 1. total occlusion of the right sfa. 2. failed intervention on the right sfa and infrapopliteal vessels. picc w/o port medical condition: 52 year old woman with r sfa-at bypass with l arm v. graft reexploration and thrombectomy. reason for this examination: please place a midline in rue. unable to get piv on floor. unable to get midline on floor. we want to d/c her r ij. history: status post right sfa-at bypass with graft reexploration and thrombectomy. needs iv access. procedure and findings: the right upper arm was prepped and draped in the usual sterile fashion. since no suitable superficial veins were visible, ultrasound was used for localization of a suitable vein. the basilic vein was patent and compressible. after local anesthesia with 2 cc of 1% lidocaine, the basilic vein was entered under ultrasonographic guidance with a 21 gauge needle. a 0.018 nitinol guidewire was advanced under fluoroscopy into the superior vena cava. it was determined that a length of 37 cm would be suitable. the picc line was trimmed to length and advanced over a 4 french introducer sheath under fluoroscopic guidance in the superior vena cava. the sheath was removed. the catheter was flushed. final chest x-ray was obtained demonstrating the tip to be in the superior vena cava. the line is ready for use. a stat-lock was applied and the line was heplocked. impression: successful placement of 37 cm long right basilic single lumen picc line with tip in the superior vena cava. the line is ready for use brief hospital course: pt had difficult hospital course. chart thinned. pt admitted on pt underwent the below procedure. she tolerated the procedure well. there were no complications. pt extubated in the or, tansfered to the pacu in stable condition. after recovery from the anesthesia. pt transfered to the vicu in stable condition. procedures: 1. right superficial femoral artery to anterior tibial bypass graft with nonreversed left arm vein. 2. angioscopy with valve lysis. 3. thrombectomy of right superficial femoral artery. /- pt was doing well. she started to c/o pain in her right leg. it was decided that the pt had a clot in her graft. she was taken back to the or immediatly. pt underwent the below procedure. she tolerated the procedure well. there were no complications. pt extubated in the or, tansfered to the pacu in stable condition. after recovery from the anesthesia. pt transfered to the vicu in stable condition. procedure: 1. re-exploration of right superficial femoral artery to anterior tibial graft and graft thrombectomy. 2. evacuation of thigh hematoma. pt started on heparin iv / coumadin started. - pt was doing well. pt was ready for discharge. pt recieved pca / picc line placement. inr / ptt monitered. pt goal achieved. pt again started to experience pain. another angiogram was done. showed occluded graft, despite being on anticogulation. post pvr were done showed flat metatarsal b/l. at this time it was decided to amputate the leg, for failed graft x 2. pt underwent the below procedure. she tolerated the procedure well. there were no complications. pt extubated in the or, tansfered to the pacu in stable condition. after recovery from the anesthesia. pt transfered to the vicu in stable condition. procedures: r-bka. - pt recooperated from the aforementioned surgery. anticoagulation was dc'd post operatively. on discharge pt taking po, oob to , urinating without difficulty, pos bm. medications on admission: asa 325', plavix 75', atenolol 50', lisinopril 10', atorvastatin 80', gemfibrozil 600'', niacin 250', roglitazone 4'', protonix 40', ntg prn, propoxyphene 65', lantus 90', riss discharge medications: 1. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. atorvastatin calcium 80 mg tablet sig: one (1) tablet po daily (daily). 3. gemfibrozil 600 mg tablet sig: one (1) tablet po bid (2 times a day). 4. niacin 100 mg tablet sig: one (1) tablet po q 24h (every 24 hours). 5. rosiglitazone maleate 4 mg tablet sig: one (1) tablet po bid (2 times a day). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day) as needed. 8. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 9. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical daily (daily) as needed. 10. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 11. hydromorphone 4 mg tablet sig: 2-3 tablets po q3-4h (every 3 to 4 hours) as needed for pain. 12. quetiapine fumarate 25 mg tablet sig: one (1) tablet po hs (at bedtime). 13. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for pruritis. 14. quetiapine fumarate 25 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for anxiety/racing thoughts. 15. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed. 16. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 17. gabapentin 400 mg capsule sig: three (3) capsule po q8h (every 8 hours). 18. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 19. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours): dc . 20. picc line heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift 21. insulin change insulin sc sliding scale & fixed dose fingerstick qachs insulin sc fixed dose orders bedtime glargine 90 units insulin sc sliding scale q6h regular glucose insulin dose 0-60 mg/dl 1 amp d50 61-159 mg/dl 0 units 160-199 mg/dl 4 units 200-239 mg/dl 7 units 240-279 mg/dl 10 units 280-319 mg/dl 13 units > 320 mg/dl notify m.d. discharge disposition: extended care facility: hospital - discharge diagnosis: right lower extremity claudication. discharge condition: stable 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 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 followup instructions: call dr at and schedulae an appoiintment for 2 weeks. call dr at and schedule an appointment in four weeks. ( on an off clinic day ) keep the following appointments: provider: study where: cc clinical center radiology phone: date/time: 11:00 provider: , m.d. where: cardiac services phone: date/time: 1:00 procedure: other revision of vascular procedure other (peripheral) vascular shunt or bypass transfusion of packed cells other amputation below knee transfusion of other serum endarterectomy, lower limb arteries percutaneous angioscopy diagnoses: urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism hematoma complicating a procedure diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes other and unspecified hyperlipidemia other and unspecified angina pectoris surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of insulin other complications due to other vascular device, implant, and graft chronic obstructive asthma, unspecified atherosclerosis of native arteries of the extremities with rest pain 

Answer: The patient is high likely exposed to