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: no known allergies / adverse drug reactions attending: chief complaint: wet gangrene of the right foot, hyponatremia, acute renal failure, sepsis, dka, metabolic acidosis. major surgical or invasive procedure: right below the knee amputation history of present illness: ms. is a 79 year old woman with diabetes who presented to the ed on with difficulty walking and was found to have wet gangrene of her right foot. she reports she has had an ulcer on her foot for several months, though for the past 2 weeks the ulcer has gotten much larger and has begun having a foul odor. per her pcps notes, she has been having progressively worsening symptoms of bilateral claudication which her pcp has been evaluating and has suggested she see a vascular surgeon. of note she has not been complaint with her home insulin regimen and has not taken her nph in 1 month. past medical history: hypertension hyperlipidemia diabetes diabetic nephropathy and neuropathy thyroid nodules, benign transient diplopia and left leg weakness with negative mri social history: the patient is a teacher at of music. lives alone. history of tobacco use, quit 20yrs ago, drinks rarely. family history: father died at 76yo from mi, mother died yo, sister and maternal grandfather with dm physical exam: gen: nad, aox3 cvs: rrr pulm: ctab abd: soft, nt/nd ext: rle s/p bka, skin staples in place, dressing c/d/i. lle:femoral: p. popiteal: p. dp: d. pt: d. pertinent results: on admission: 09:00pm blood wbc-40.3* rbc-3.53* hgb-9.9* hct-33.0* mcv-93 mch-28.0 mchc-30.0* rdw-13.5 plt ct-463* 09:00pm blood glucose-937* urean-57* creat-2.0* na-124* k-5.5* cl-83* hco3-17* angap-30* 02:03am blood alt-8 ast-13 alkphos-88 totbili-0.2 06:44pm blood ctropnt-<0.01 02:03am blood albumin-2.3* calcium-8.0* phos-2.3* mg-2.2 10:29pm blood lactate-2.5* on discharge: 05:59am blood vanco-24.6* 05:00am blood wbc-11.2* rbc-3.31* hgb-9.6* hct-29.4* mcv-89 mch-29.0 mchc-32.6 rdw-14.7 plt ct-310 05:00am blood glucose-210* urean-19 creat-1.1 na-140 k-4.9 cl-111* hco3-24 angap-10 05:00am blood calcium-7.3* phos-3.3 mg-1.9 chest xray: findings: in comparison with study of , the swan-ganz catheter has been removed. right subclavian picc line extends to the mid to lower portion of the svc. no evidence of acute cardiopulmonary disease. enlargement of the cardiac silhouette persist. brief hospital course: mrs presented to the ed on with wet gangrene of the right foot, hyponatremia, acute renal failure, sepsis, dka. she was admitted to the micu for aggressive fluid resuscitation, treatment of dka with an insulin drip, and an emergent amputation was performed. she underwent a below the knee amputation (the reader is referred to the operative note for details) and was transferred to the intensive care unit for postoperative care. neuro: the patient received percocet (when tolerating pos) for pain control. neurontin was added on pod2 for phantom pain with good results. cv: the patient remained stable from a cardiovascular standpoint; vital signs were routinely monitored. she received aspirin 325, metoprolol, simvastatin and a pa catheter was placed on pod 1 to assist regulation of volume repletion. the pa catheter was discontinued on pod3. pulmonary: the patient remained stable from a pulmonary standpoint; vital signs were routinely monitored. good pulmonary toilet and incentive spirrometry were encouraged throughout her hospitalization. gi/gu/fen: post-operatively, the patient was made npo with iv fluids and a foley catheter was left in place. diet was advanced when appropriate, which was well tolerated. patient's intake and output were closely monitored, and iv fluid boluses were administered in the early postoperative period to ensure adequate resuscitation and correction of metabolic imbalance. electrolytes were routinely followed, and repleted when necessary. bun and scr were trended and scr improved from 1.7 on the day of admission down to 1. the foley was discontinued on pod 3 and the patient was able to void without problems. id: the patient's white blood count and fever curves were closely monitored. she was started on iv antibiotics on admission (vancomycin, zosyn, cipro, flagyl) and her wbc improved from 40 on the day of admissionn to 11 upon discharge. she will be discharge on vancomycin iv 750 mg q24hours (as adjusted per troughs), cipro po, and flagyl po. these should continue for a total of 2 weeks from the time of amputation, which will complete on . endocrine: the patient's blood sugar was monitored throughout her stay. she was initially placed on an insulin drip to correct her hyperglycemia with resolution of dka. was consulted and an insulin sliding scale along with lantus 18units qhs was administered according to their recommendation and the patient was able to transition from the insulin drip to sc. hematology: the patient received 1u prbc on pod1 for a hct of 26 and remained stable thereafter. prophylaxis: the patient received subcutaneous heparin and h2 blockers. the patient was transferred to the floor on pod2. physical and occupational therapy were consulted. at the time of discharge she was doing well, was afebrile, vital signs were stable. she was tolerating a regular/diabetic diet and her blood glucose leves were well controlled. she was voiding regularly and was able to get out of bed to the chair with assistance. she received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. she will follow-up with dr. in 2 weeks. medications on admission: lisinopril 10 mg daily, simvastatin 40 mg daily, aspirin 325 mg daily, humulin n 25u daily (not compliant) discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 6. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 7. valsartan 80 mg tablet sig: one (1) tablet po daily (daily). 8. gabapentin 100 mg capsule sig: one (1) capsule po tid (3 times a day). 9. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours). 10. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours). 11. senna 8.6 mg tablet sig: 1-2 tablets po daily (daily). 12. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 13. vancomycin 750 mg iv q 24h discharge disposition: extended care facility: - discharge diagnosis: wet gangrene of the right foot hyponatremia acute renal failure sepsis diabetic ketoacidosis discharge condition: stable level of consciousness: alert and interactive. mental status: confused - sometimes. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: please call us immediately for any of the following problems: . redness in or drainage from your leg wound(s). . new pain, numbness or discoloration of your foot or toes. . 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. . 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 followup instructions: provider: , md phone: date/time: 1:45 please call the office to schedule an appointment with dr. in 2 weeks, ( follow up with your pcp weeks after discharge to have your medications reviewed as they have changed. procedure: other amputation below knee diagnoses: acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified polyneuropathy in diabetes personal history of tobacco use chronic kidney disease, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin personal history of noncompliance with medical treatment, presenting hazards to health diabetes with neurological manifestations, type ii or unspecified type, uncontrolled diabetes with ketoacidosis, type ii or unspecified type, uncontrolled diabetes with renal manifestations, type ii or unspecified type, uncontrolled diabetes with peripheral circulatory disorders, type ii or unspecified type, uncontrolled gas gangrene 

Answer: The patient is high likely exposed to