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: nonhealing ulceration on right heel major surgical or invasive procedure: right heel incision and drainage dx aortogram & r le angiogram right below knee amputation history of present illness: patient with known perpheral arterial diseas and venous stasis skin changes with a nonhealing rt. heel ulceration since feburary .patient has been followed by a podiatrist in new . vna services have been following patient for wound care. recently started on home ceftriaxone. was evaluated by vna after recieving a call that he had been experiencing increasing right foot pain. patient denies any constutional symptoms. patient evaluated in the er and now admitted for further care. past medical history: historyof dm2 w neuropathy historyof coronary artery disease s/p mi history of chroinc systolic chf with excerbation--treated history of atrial fibrillation,anticoagulated history of polyarthritis rheumatica,predisone dependant social history: pt and wife live at home in , . pt retired in from his work as a manager in auto sales. he states he hopes to return to his previous work part-time in the future. he has a close family. etoh:denies tobacco: former use family history: n/c physical exam: vital signs: 97.0-64-16 b/p 96/p gen: drowsy, aaox3, no acute distress pulm: basalar crackles heart: irregular,irregular abd:bengin ext: bilateral edema 3+r>l,pitting with hyperpigment changes to lower extermities. right lower extermity blaanching erythema. right punched out heel ulceration.with underminding if surrounding tissue. no frank purulence but some seropurulent drainage on dressing pulses: palpable femoral 1+ bilateral,dp triphasic dopperable signals bilaterally pt dopperable triphasic signal left, rt. pt absent. neuro: nonfocal pertinent results: 05:03pm blood wbc-14.7* rbc-3.66* hgb-10.6* hct-33.1* mcv-91 mch-29.0 mchc-32.1 rdw-15.8* plt ct-411 01:50am blood wbc-17.2* rbc-3.48* hgb-9.9* hct-32.0* mcv-92 mch-28.5 mchc-31.0 rdw-15.8* plt ct-355 02:42pm blood wbc-10.3 rbc-3.52* hgb-9.9* hct-32.2* mcv-92 mch-28.2 mchc-30.8* rdw-16.1* plt ct-380 04:49am blood wbc-14.3* rbc-3.62* hgb-10.4* hct-32.9* mcv-91 mch-28.7 mchc-31.6 rdw-16.6* plt ct-390 04:38am blood wbc-8.9 rbc-3.32* hgb-9.6* hct-30.1* mcv-91 mch-29.1 mchc-32.0 rdw-17.0* plt ct-398 05:03pm blood pt-19.9* ptt-64.7* inr(pt)-1.9* 01:45pm blood ptt-62.4* 06:44am blood pt-16.3* ptt-66.6* inr(pt)-1.5* 04:49am blood pt-26.2* ptt-49.7* inr(pt)-2.6* 07:56am blood pt-16.0* ptt-54.8* inr(pt)-1.4* 04:38am blood pt-19.9* ptt-61.4* inr(pt)-1.9* 05:03pm blood glucose-93 urean-45* creat-1.4* na-126* k-4.7 cl-87* hco3-30 angap-14 09:04am blood glucose-90 urean-42* creat-1.4* na-126* k-5.2* cl-93* hco3-23 angap-15 06:30am blood glucose-49* urean-21* creat-1.0 na-135 k-4.2 cl-99 hco3-31 angap-9 06:44am blood glucose-55* urean-15 creat-0.9 na-137 k-4.5 cl-98 hco3-35* angap-9 03:24am blood glucose-119* urean-11 creat-0.7 na-135 k-4.0 cl-101 hco3-28 angap-10 04:38am blood glucose-137* urean-13 creat-0.8 na-134 k-4.1 cl-99 hco3-29 angap-10 05:06am blood ck(cpk)-165 04:49am blood alt-16 ast-47* ck(cpk)-341* alkphos-304* totbili-0.6 05:03pm blood probnp-* 05:06am blood ck-mb-4 ctropnt-0.12* 03:53pm blood ck-mb-3 ctropnt-0.13* 07:59pm blood ck-mb-notdone ctropnt-0.02* 10:14am blood probnp-* 04:49am blood ck-mb-4 ctropnt-0.03* 03:53pm blood tsh-2.0 03:53pm blood t4-6.5 t3-56* 05:03pm blood crp-256.7* 07:51pm blood vanco-22.0* 07:33am blood vanco-15.5 05:52pm blood vanco-26.5* 09:35am blood vanco-14.2 08:53pm blood vanco-7.7* 06:30am blood digoxin-0.6* 04:04am blood digoxin-1.2 04:49am blood digoxin-1.1 01:59pm blood type-art po2-77* pco2-37 ph-7.43 caltco2-25 base xs-0 intubat-not intuba 10:29pm blood po2-72* pco2-25* ph-7.58* caltco2-24 base xs-2 02:22am blood ph-7.48* comment-green top 12:50am blood type-mix po2-35* pco2-38 ph-7.43 caltco2-26 base xs-0 01:59pm blood lactate-1.3 02:22am blood glucose-254* k-4.4 01:21am urine color-yellow appear-clear sp -1.020 01:21am urine blood-sm nitrite-neg protein-30 glucose-neg ketone-tr bilirub-sm urobiln-1 ph-5.0 leuks-neg 01:21am urine rbc-* wbc-0-2 bacteri-few yeast-none epi-0-2 01:21am urine casthy-* 09:57pm urine color-yellow appear-clear sp -1.016 09:57pm urine blood-mod nitrite-neg protein-tr glucose-neg ketone-15 bilirub-neg urobiln-neg ph-7.0 leuks-neg 09:57pm urine rbc-* wbc-0-2 bacteri-few yeast-none epi-<1 01:21am urine hours-random urean-435 creat-135 na-less than uric ac-21.7 8:05 am tissue right heel tissue. **final report ** gram stain (final ): reported by phone to at 1125 on . 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive cocci. in pairs and chains. 2+ (1-5 per 1000x field): gram negative rod(s). tissue (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. streptococcus anginosus (milleri) group. sparse growth. staph aureus coag +. quantitation not available. sensitivities performed on culture # (). anaerobic culture (final ): no anaerobes isolated. swab right heel wound. **final report ** wound culture (final ): due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. staph aureus coag +. moderate growth of two colonial morphologies. penicillin sensitivity available on request. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. streptococcus anginosus (milleri) group. sparse growth. identification performed on culture # (). sensitivities: _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin-------------<=0.25 s trimethoprim/sulfa---- <=0.5 s 9:12 am swab source: instep right foot. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram negative rod(s). 2+ (1-5 per 1000x field): gram positive cocci. in pairs. wound culture (final ): streptococcus anginosus (milleri) group. sparse growth. identification performed on culture # (). anaerobic culture (final ): bacteroides fragilis group. moderate growth. beta lactamase positive. prevotella species. moderate growth. beta lactamase positive. 5:48 pm stool consistency: soft source: stool. **final report ** clostridium difficile toxin a & b test (final ): reported by phone to @ 0528 on -cc7c . clostridium difficile. feces positive for c. difficile toxin by eia. (reference range-negative). a positive result in a recently treated patient is of uncertain significance unless the patient is currently symptomatic (relapse). 12:40 am stool consistency: formed **final report ** clostridium difficile toxin a & b test (final ): reported by phone to @ 5:12a . clostridium difficile. feces positive for c. difficile toxin by eia. (reference range-negative). a positive result in a recently treated patient is of uncertain significance unless the patient is currently symptomatic (relapse). 6:48 am stool consistency: loose source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). 9/1308 ecg: atrial fibrillation with rapid ventricular response. right bundle-branch block. prior anteroseptal myocardial infarction. no previous tracing available for comparison. echo: the left atrium is elongated. the estimated right atrial pressure is 10-15mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated with moderate to severe regional hypokinesis with severe hypokinesis of the distal 2/3rds of the left ventricle (lvef = 25 %). the basal segments contract best. the estimated cardiac index is normal (>=2.5l/min/m2). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets are severely thickened/deformed. there is moderate to severe aortic valve stenosis (area 0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. an eccentric jet of mild to moderate +] is seen directed the interatrial septum. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: left ventricular cavity enlargement with extensive regional systolic dysfunction c/w multivessel cad or other diffuse process. moderate to severe aortic valve stenosis. moderate pulmonary artery systolic hypertension. mild aortic regurgitation. cxr: the cardiomegaly is severe, unchanged since prior study. there is overall improvement in pulmonary edema with still present residual opacities in the lower lobes that might represent residual of edema although atelectasis cannot be excluded. there is no appreciable pleural effusion although note is made that the left costophrenic angle was excluded from the field of view. the left picc line catheter tip is in proximal svc. rx stress test: interpretation: 65 yo man (h/o cad, chf and atrial fibrillation) was referred for evaluation 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 by the patient during the procedure. in the presence of baseline abnls and digoxin therapy, no additional st-t segment changes were noted from baseline. the rhythm was atrial fibrillation with occasional isolated vpds noted during the procedure. by doppler, the patient was hypertensive at baseline with an appropriate blood pressure response to the persantine infusion. three min post-myoview, the patient received 125 mg aminophylline iv. impression: no anginal symptoms or significant ecg changes from baseline. nuclear report sent separately. nuclear: interpretation: the image quality is adequate but limited by motion. left ventricular cavity size is dilated at stress and rest. rest and stress perfusion images reveal fixed moderate/severe inferior and apical defects but otherwise uniform tracer uptake throughout the left ventricular myocardium. gated images could not be obtained due to atrial fibrillation. impression: fixed moderate to severe defect involving inferior wall and apex. dilated lv at rest and stress. cxr: findings: there has been interval increase in pulmonary vascular congestion. bibasilar atelectasis is unchanged. there is a very small right-sided pleural effusion. mild cardiomegaly is unchanged. mediastinal contours are obscured by the overlying metalic body. a left picc is seen projecting in good position, though its tip is obscured by the foreign body. there is a new right internal jugular swan-ganz catheter with tip ending in the main pulmonary artery. impression: 1. interval worsening in pulmonary vascular congestion. 2. new right ij swan-ganz catheter ending in the region of the main pulmonary artery. ecg: atrial fibrillation, mean ventricular rate 94. right bundle-branch block. compared to the previous tracing of no major change. cxr: findings: as compared to the previous radiograph, the swan-ganz catheter has been removed; however, the introduction sheath is still in place. there is a picc line inserted over the left upper extremity, the tip of the picc line projects over the mid svc. as compared to the previous radiograph, there is slightly improved ventilation of the retrocardiac lung areas. otherwise, the lungs are unremarkable and show no evidence of newly occurred focal parenchymal opacity potentially suggestive of pneumonia. moderate cardiomegaly without signs of overhydration. no pleural effusions, no pneumothorax. brief hospital course: admitted right heel debridment.transfered to cvicu for rapid af rvr and hypotension requiring dilt gtt. and nep gtt. cardology consulted.cardiac enzymes cycled.dig added to regment for rythmn control.cardiac enzymes ck 15-14, troponins 0.03-.04 : echo obtained, results attached : pt tested c. diff positive : dx angio performed showing limited options for revascularization. given pt's poor cardiac status, the pt was given the option of r bka vs bypass with the understanding that bka presented his best chances for early healing and ambulation and also provided less overall risk given his poor health. pt and family decided to pursue r bka and he was medically managed to optimize pre-op cardiovascular status. : r foot debridement at bedside. dilt drip weaned : pre-op persantine stress test was performed and the decision was made with recommendation from cardiology to postpone r bka two days to achieve a further 2l diuresis. : pt was taken to the or after it was determined he was in adequate condition from a cardiovascular standpoint. swan-ganz catheter & brachial arterial line were placed by anesthesia and femoral/sciatic nerve block was administered. r bka was performed without complication. pt tolerated the procedure well and was transfered to the vicu postoperatively in stable condition. : pt tolerated a regular diabetic/cardiac diet, pain was well controlled. : swan-ganz catheter was removed : pt fell on amputation site while getting oob to chair with pt. stump was evaluated serially and felt to be intact. : pt is discharged to rehab in stable condition with a foley catheter in place. medications on admission: coumadin 7.5mg po 6/7 days, plavix 75mg po daily, asa 81mg po daily, citalopram 20mg po daily, crestor 2.5mg po daily, prednisone 6mg po daily, coreg 6.25mg po daily, lasix 80mg po bid, lisinopril 1.25mg po daily, lantus 35/35, humalog hs ss, spironolactone 12.5 qod, bisocodyl 10mg daily, prn colace, oxycodone/apap 10/650 prn, vit d 400 daily, vit b12 daily, calcium 1200 daily, ceftriax 1g daily discharge medications: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 3. rosuvastatin 5 mg tablet sig: 0.5 tablet po daily (daily). 4. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed. 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 7. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. prednisone 1 mg tablet sig: six (6) tablet po daily (daily). 9. carvedilol 6.25 mg tablet sig: 0.5 tablet po bid (2 times a day). 10. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 11. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: please check pt's inr . he was admitted on 7.5 mg po 6 out of 7 days. however, he has become therapeutic quickly on 5 mg po daily. adjust dose as necessary tp keep inr 2.0-3.0. he may need to revise his dosing schedule after his course of flagyl has ended. 12. sodium chloride 0.65 % aerosol, spray sig: sprays nasal prn (as needed). 13. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily): this is a new medication started during this admission. last dig level was 1.1. 14. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed. 15. spironolactone 25 mg tablet sig: 0.5 tablet po every other day (every other day). 16. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 17. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 18. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 19. insulin regimen insulin sc: sliding scale & fixed dose fingerstick qachs breakfast: glargine 25 units insulin sc sliding scale: breakfast lunch dinner bedtime humalog humalog humalog humalog glucose insulin dose insulin dose insulin dose insulin dose 0-60mg/dl amp d50 amp d50 amp d50 amp d50 61-140mg/dl 0units 0units 0units 0units 141-160mg/dl 4units 5units 4units 0units 161-180mg/dl 6units 6units 6units 0units 181-200mg/dl 8units 7units 8units 0units 201-220mg/dl 10units 9units 10units 2units 221-240mg/dl 12units 11units 12units 4units 241-260mg/dl 14units 13units 14units 6units 261-280mg/dl 16units 15units 16units 8units > 280mg/dl notify md notify md notify md notify md 20. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 12 days: continue through , which completes fourteen days after neg c diff toxin test. 21. lisinopril 2.5 mg tablet sig: tablet po once a day: please start med friday . 22. lasix 40 mg tablet sig: one (1) tablet po twice a day: please weigh pt daily. when he gains 2lbs or more in one day please start lasix at 40mg po bid. he was admitted on 80 mg lasix but we have found he responds very well to smaller doses. discharge disposition: extended care facility: st. hospital rehabilitation unit discharge diagnosis: non healing rt. heel ulceration history of perpheral vascular disease s/p angiogram with stenting ? vessels history of chf,with excerbation,compensated history of coronary artery disease,s/p mi history of atrial fibrillation,anticoagulated history of polymyalgia rheumatica, steroid dependant discharge condition: stable discharge instructions: incision care: keep clean and dry. -you may shower, and wash surgical incisions. -avoid swimming and baths until your follow-up appointment. -please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. -if you have staples, they will be removed during at your follow up appointment. . please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * new or worsening cough or wheezing. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. * signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or not gone within 24 hours. call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. * please resume all regular home medications and take any new meds as ordered. * do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. please get weights daily. when he gains 2lbs or more in one day please start lasix at 40mg po bid. he was admitted on 80 mg lasix but we have found he responds very well to smaller doses. please check pt's inr . he was admitted on 7.5 mg po 6 out of 7 days. however, he has become therapeutic quickly on 5 mg po daily. adjust dose as necessary tp keep inr 2.0-3.0. he may need to revise his dosing schedule after his course of flagyl has ended. it was necessary to start digoxin on this admission, please continue. followup instructions: please call to make a follow-up appointment with dr. in 2 weeks. **please follow up with your cardiologist in 3 weeks.** procedure: arteriography of femoral and other lower extremity arteries aortography pulmonary artery wedge monitoring other amputation below knee other myectomy removal of other device from thorax diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery congestive heart failure, unspecified atrial fibrillation aortic valve disorders diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes long-term (current) use of insulin right bundle branch block other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation old myocardial infarction rheumatoid arthritis acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities with ulceration cellulitis and abscess of foot, except toes ulcer of heel and midfoot paroxysmal supraventricular tachycardia chronic total occlusion of artery of the extremities 

Answer: The patient is high likely exposed to