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: amlodipine attending: chief complaint: chest pain major surgical or invasive procedure: left lower extremity below the knee amputation history of present illness: 72 yo with hx of dm2, htn, hld, afib, dchf (ef 70%), pvd, recent admit for lle ulcerations to vascular service discharged on p/w constant cp since 6pm after dinner. she describes cp as nonradiating gas-like bubble, mid sternal. mylanta was without relief and pt vomited clear sputum. vs were 98.9, 100, 18, 188/100, 96%/ra. nitro x3 was given without relief. . during her recent hospitalization on she became agitated, hypertensive and bradycardic. during that time she had a troponin elevation to a max of 0.31 and was evaluated by cardiology. this was felt to be related to demmand and it was advised to perform a tte and possible f/u stress vs cath. . in the ed, initial vitals were 98.3, 75, 184/86, 18, 100%/ra. labs significant for trop <0.01, creatinine 1.9 (basline 1.7), bnp 4887 (without prior), wbc 5.4, hct 27, inr 1.2. ua with few bact, epis. urine culture was sent. cxr showed cardiomegaly and pulmonary edema with resolved pleural effusion compared to prior (im ho read). ekg showed afib at 63, twi i, avl, v5 v6 similar to prior. she was given 325mg asa, magic mouthwash, lidocaine viscous, morphine, pantoprazole. nitro did not work. . cp resolved spontaneously vs on transfer: 145/73, 64, 17, 100%/2l . on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, black stools or red stools. s/he denies recent fevers, chills or rigors. all of the other review of systems were negative. . cardiac review of systems is notable for absence of current chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . patient reports that she does not have current chest pressure. she is unsure what made it resolve in the ed. she denies dysuria and states that she is on the antibiotics for her leg only. . of note, review of the discharge instructions reveals that the patient was discharged on multiple blood pressure medications including lisinopril and increased dose of lasix. past medical history: 1. cardiac risk factors: +diabetes, +dyslipidemia, +hypertension 2. cardiac history: - diastolic dysfunction - atrial fibrillation not on warfarin given recent admission for epistaxis () taking asa 325mg 3. other past medical history: - acute renal failure (baseline cr 1.0 -> 4.7), discharged with cr 2.5 - cataract surgery social history: pt moved to from 40 yrs ago, currently lives with daughter who works at the . denies past or current history of tobacco use, alcohol use, or other ilicit drug use. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: 98,154/83, 72, 22, 99%/3l general:obese woman in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of approx 6cm though difficult to assess. cardiac: pmi located in 5th intercostal space, midclavicular line. irregularly irregular. normal s1, s2. iv/vi sem. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no wheezes. abdomen: soft, distended but no ttp. no hsm or tenderness. extremities: 2+ pitting le edema with skin dryness/breakdown. wound vac in place lle. pulses: monophasic dp/pts b/l, not palpable pertinent results: 05:25pm ck(cpk)-138 05:25pm ck-mb-1 ctropnt-0.01 09:55am glucose-110* urea n-25* creat-1.6* sodium-139 potassium-4.2 chloride-100 total co2-28 anion gap-15 09:55am ck(cpk)-177 09:55am ck-mb-2 ctropnt-0.02* 09:55am calcium-8.7 phosphate-4.0 magnesium-2.3 09:55am wbc-5.4 rbc-3.62* hgb-8.9* hct-29.0* mcv-80* mch-24.5* mchc-30.6* rdw-19.0* 09:55am plt count-266 09:55am pt-14.5* ptt-26.6 inr(pt)-1.3* 05:08am urine hours-random urea n-517 creat-82 sodium-55 potassium-33 chloride-49 02:35am urine color-yellow appear-clear sp -1.011 02:35am urine blood-neg nitrite-neg protein-25 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-tr 02:35am urine rbc-0 wbc-0-2 bacteria-few yeast-rare epi- 02:35am urine hyaline-0-2 11:55pm glucose-203* urea n-28* creat-1.9* sodium-135 potassium-3.8 chloride-98 total co2-27 anion gap-14 11:55pm ctropnt-<0.01 11:55pm probnp-4887* 11:55pm iron-23* 11:55pm caltibc-248* vit b12-620 folate-10.0 ferritin-102 trf-191* 11:55pm wbc-5.4 rbc-3.47* hgb-8.6* hct-27.0* mcv-78* mch-24.8* mchc-31.8 rdw-18.7* 11:55pm neuts-81.1* lymphs-14.3* monos-3.3 eos-0.7 basos-0.6 11:55pm plt count-188 11:55pm pt-14.3* ptt-28.6 inr(pt)-1.2* . 06:30am blood crp-113.6* 10:50am blood crp-96.8* . discharge labs: . 11:25am blood wbc-5.0 rbc-3.76* hgb-9.3* hct-30.1* mcv-80* mch-24.7* mchc-30.9* rdw-20.3* plt ct-319 11:25am blood glucose-229* urean-22* creat-1.5* na-137 k-4.5 cl-98 hco3-28 angap-16 11:25am blood calcium-8.4 phos-2.5* mg-1.7 . labs/studies ekg: afib rate 65, lad, twi i, avl similar to prior and mild increase in inversion/flattening in v5, c6 . . tte moderate concentric left ventricular hypertrophy with preserved regional and global biventricular systolic function. mild right ventricular dilation. moderate pulmonary hypertension. moderate tricuspid regurgitation. mild aortic stenosis. elevated estimated pcwp. ef 70-75%. compared with the prior study (images reviewed) of , the right ventricle now appears mildly dilated. aortic valve stenosis has slightly progressed (but is still mild). . ct head : images are slightly limited by patient motion artifact. within this constraint, there is no intracranial hemorrhage, edema, mass effect, or vascular territorial infarction. ventricles and sulci are normal in size and configuration. punctate basal ganglia calcifications are bilateral. there is no fracture. mastoid air cells are clear. brief hospital course: the patient is a 72 year old female with a history of dm type 2, dchf, hl, htn, and atrial fibrillation with a complicated hospital course during this admission. . she was previously admitted to from through for management of lle venous ulcers. during that admission had multiple triggers for hypertensive urgency, a-fib with rvr, dyspnea. non invasive le vascular studies demonstrated venous and arterial disease not amenable to percutaneous intervention. wound cultures grew pseudomonas, klebsiella, and enterococcus. she was treated initially with vancomycin and zosyn then discharge to rehab with ciprofloxacin + augmentin. on she was re-admitted to the cardiology service for chest pain. mi was ruled out. she then became febrile and was taken to or for left bka as source was presumed to be distal lle infected ulcer. she continued her care in the vascular service. she remained febrile after surgery upto 103.0. vancomycin and zosyn were started on then switched to vanc + cefepime + metronidazole. in addition fluconazole was started for yeast in the urine. on she became somnulent and difficult to arouse and was transferred to the medicine service for further management. a ct was obtained which ruled out an acute intracranial process. her ams change was attributed to medication effect including prazocin, clonidin, morphine and oxycodone in the context of reduced renal clearance due to acute on chronic renal failure. the offending medications were stopped and somnulence subsequently resolved. her renal failure was treated with administration of ivf and prbc and her renal functions improved. her fever subsequently resolved, bcx remained negative and operative tissue histology demonstrated clean margines without signs of infection. abx were discontinued and she remained afebrile. she is now discharged for rehabilitation. . the following is a brief re-cap of her problems during this admission: . # cad: admitted for chest pain. mi ruled out per negative ce and non dynamic ecg. chest pain resolved soon after admission and did not recurr. aspirin, lisinopril simvastatin are continued. metoprolol was replaced by labetolol. . # lle nonhealing infected ulcer: this was secondary to pvd. pt had been previously assessed with angiography and had no target vessels appropriate for revascularization. she underwent bka . . # ams change : to drowsing medication including oxycodone, morphine, prazocin and clonidin in the context of reduced renal clearance. completely resolved after offending medications were withdrawn. clonidin was subsequently restarted. . # renal failure: pre-renal failure to over-diuresis. resolved with ivf and prbc. . # fever: had fever which did not initially resolve after bka for a non healing lle infected ulcer. was treated with vanco+cefepim+ flagyl. infectious workup after her operation did not reveal source. blood and urine cultures were negative except for urine yeast which were treated with 8 day course of oral fluconazole. fever subsequently resolved and wide-spectrum antibiotics were discontinued after she remained afebrile for > 72 hours. . # anemia: stable hct at 25 microcytic with increased rdw consistnet with iron def. no obvious bleeding source. got 1x prbc d/t backround heart disease as well as for volume expansion in the context of dehydration. hct subsequently remained stable and was 30 at discharge. furhter f/u of hct and anemia work-up is advised in the outpatient setting. . # htn: has history of uncontrolled htn and hypertensive urgencies. underwent work-up for secondary htn during previous admission which was unrevealing except for elevated urine metanephrines at about twice normal level. she did not however have any other symptoms or signs suggestive of pheochromocytoma. during this admission she required repeated dosing of iv anti-hypertensive and was finally stablized on p.o. clonidin, labetolol, lisinopril and furosamide. metoprolol and prazocin were discontinued. bp should continue to be carefully monitored in the outpatient setting . # caf: this was stable with no rvr during this admission. patient continues to decline coumadin given her history of epistaxis. her chads2 score = 3 (htn, chf, dm). she is continued on labetolol for rate control and a full dose aspirin daily. . # dchf: had dchf exacerbation during her previous admission which was treated with duresis. during this admission was stable in terms of her heart failure. she was discharged on furosamide, labetolol and lisinopril. . # dm: continued fixed dose + iss medications on admission: medications (reconciled with facility list): senna 8.6 mg tab 1 tablet(s) by mouth twice a day . heparin (porcine) 5,000 unit/ml injection 1 solution(s) three times a day . aspirin 325 mg tab 1 tablet(s) by mouth daily (daily) . clonidine 0.1 mg tab 1 tablet(s) by mouth twice a day . acetaminophen 325 mg tab 2 tablet(s) by mouth every six (6) hours . furosemide 80 mg tab 1 tablet by mouth twice a day . prazosin 5 mg cap 1 capsule(s) by mouth twice a day . lisinopril 20 mg tab 2 tablet(s) by mouth daily (daily) . simvastatin 40 mg tab 1 tablet by mouth at bedtime . isosorbide dinitrate 20 mg tab 3 tablet(s) by mouth three times a day . ciprofloxacin 750 mg tab 1 tablet(s) by mouth every twenty-four(24) hours . metoprolol tartrate 50 mg tab 2 tablet(s) by mouth three times a day . amoxicillin-pot clavulanate 500 mg-125 mg tab 1 tablet(s) by mouth every twelve (12) hours . docusate sodium 100 mg cap 1 capsule(s) by mouth twice a day . oxycodone 5 mg tab 1 tablet(s) by mouth every four (4) hours as needed for pain . bisacodyl 5 mg tab, delayed release 2 tablet(s) by mouth daily (daily) as needed for constipation . humalog 100 unit/ml sub-q subcutaneous sliding scale starting at 71-100 with 1u, increasing by 1u every 50 for breakfast, lunch, supper . insulin glargine 100 unit/ml sub-q subcutaneous 4u qhs, 12u qam. discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. clonidine 0.2 mg tablet sig: one (1) tablet po bid (2 times a day). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever or pain. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 7. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day). 8. bisacodyl 5 mg tablet, delayed release (e.c.) sig: tablet, delayed release (e.c.)s po daily (daily) as needed for constipation. 9. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 10. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 11. labetalol 200 mg tablet sig: two (2) tablet po bid (2 times a day). 12. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). 13. insulin glargine 100 unit/ml (3 ml) insulin pen sig: twelve (12) units subcutaneous qam. 14. insulin glargine 100 unit/ml (3 ml) insulin pen sig: four (4) units subcutaneous at bedtime. 15. insulin humalog please continue to take according to attached sliding scale 16. lisinopril 40 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: peripheral vascular disease infected left lower extremity ulcer s/p left below knee amputation htn acute on chronic renal failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. : . you were initially admitted to the hospital because of chest pain. you had tests that confirmed that you did not have a heart attack. you then developed a fever which was likely due to an infection of your left lower leg ulcer. you underwent amputation of your left lower leg as this was the only way to prevent the infection from spreading and becoming life threatening. after the operation you had some trouble including anemia, dehydration which injured your kidneys and some drowsiness due to medications you recieved to treat your pain and high blood pressures. you were given fluids and blood transfusion as well as antibiotics for a likely infection and your medication regimen was adjusted. you subsequently regained full consciousness and your kidney function improved. your fever also finally resolved and you are now ready for discharge to a rehabilitation facility. . the following changes were made to your medications: . prazocin, metoprolol, isosorbide dinitrate, oxycodone, ciprofloxacin and amoxicilline-calvulanate were stopped. . lisinopril was increased to 40mg by mouth daily. . ranintidine 150mg tablet was added. take one tablet twice daily to prevent heart burn. . labetolol 400mg was added. take one tablet twice daily for blood pressure control. . isosorbide mononitrate 60mg was added. take two tablets once daily. . clonidine 0.1mg was changed to clonidin 0.2mg. take one tablet twice daily for blood pressure control followup instructions: you have the following appointments: 1. department: - pcp : wednesday at 1:30 pm with: , m.d. building: campus: east best parking: garage 2. department: vascular surgery when: thursday at 10:30 am with: , md building: lm campus: west best parking: garage md, procedure: other amputation below knee diagnoses: anemia in chronic kidney disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified toxic encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified candidiasis of other urogenital sites hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other opiates and related narcotics causing adverse effects in therapeutic use chronic kidney disease, unspecified other and unspecified hyperlipidemia chest pain, unspecified chronic diastolic heart failure atherosclerosis of native arteries of the extremities with ulceration chronic total occlusion of artery of the extremities ulcer of calf venous embolism and thrombosis of superficial vessels of lower extremity 

Answer: The patient is high likely exposed to