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: bactrim ds attending: chief complaint: this 49-year-old lady with severe peripheral vascular disease and diabetes, as well as renal insufficiency, has previously had a right below-the-knee amputation. she has developed gangrene and rest pain of her left forefoot. major surgical or invasive procedure: l tma history of present illness: this 49-year-old lady with severe peripheral vascular disease and diabetes, as well as renal insufficiency, has previously had a right below-the-knee amputation. she has developed gangrene and rest pain of her left forefoot. past medical history: 1. raynauds 2. dm type 1 complicated by peripheral neuropathy 3. htn 4. cri 5. cva 6. uc 7. r partial hallux amputation 8. laparoscopic distal pancreatectomy for neuroendocrine tumor 9. r 2nd toe amputation social history: occasional alcohol former tobacco (15 pack years) family history: non contributory physical exam: a/o x3 nad cta rrr abd - benign rle amp site bk c/d/i lle tma positve erythema / sutures intact / negative drainage palp fem b/l lle slight dop pt and dp pertinent results: 04:51am blood wbc-8.2 rbc-2.53* hgb-8.8* hct-26.2* mcv-104* mch-34.7* mchc-33.5 rdw-14.2 plt ct-245 04:51am blood plt ct-245 02:10am blood pt-14.6* ptt-35.5* inr(pt)-1.3* 04:51am blood glucose-135* urean-14 creat-1.0 na-143 k-4.1 cl-108 hco3-31 angap-8 04:51am blood calcium-9.0 phos-2.8 mg-1.8 brief hospital course: this 49-year-old lady with severe peripheral vascular disease and diabetes, as well as renal insufficiency, has previously had a right below-the-knee amputation. she has developed gangrene and rest pain of her left forefoot. an arteriogram showed no options in terms of bypass or endovascular interventions. she is now undergoing a tma in hopes of salvaging part of her foot. pt underwent tma with out difficulties. transfered to the vicu in stable condition. pod # 1 pt had acute respiratary failure secondary to sepsis. pt intubated on the floor and sent to the sicu. she spent 4 days in the sicu. she was weaned from vent and pressors. after her stay in the sicu. she was transfered to the floor in stable condition. she remained on ab hospital stay. on dc she is stable nwb lle tma site medications on admission: asa 81 qd, lantus 20 qhs, hiss, asacol 400 qd, lisinopril 40 qd, neurontin 800 tid, nicotine patch 21 qd, ms contin 30 po qid, dilaudid 4 prn, prednisone 10 qd, hctz 50 qd, calcium c vit. d 600 folic acid qd, lopressor 25 qd, simvastatin 20 qd, nifedical 30 qd celexa 10 qd discharge medications: 1. cilostazol 50 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. mesalamine 400 mg tablet, delayed release (e.c.) sig: four (4) tablet, delayed release (e.c.) po tid (3 times a day). 5. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 6. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 7. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. disp:*30 tablet(s)* refills:*0* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. nifedipine 30 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 11. gabapentin 400 mg capsule sig: two (2) capsule po q8h (every 8 hours). 12. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed). 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 14. prednisone 5 mg tablet sig: three (3) tablet po daily (daily). 15. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 16. hydromorphone 2 mg tablet sig: 1-2 tablets po every hours as needed: prn. 17. morphine 30 mg tablet sustained release sig: one (1) tablet sustained release po q6h (every 6 hours). 18. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 19. hexavitamin tablet sig: one (1) cap po once a day. 20. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed. 21. hydrochlorothiazide 50 mg tablet sig: one (1) tablet po daily (daily). 22. insulin lunch dinner bedtime humalog 3 units humalog 3 units humalog 3 units bedtime glargine 20 units insulin sc sliding scale breakfast lunch dinner bedtime humalog glucose insulin dose 0-60 mg/dl amp d50 61-120 mg/dl 0 units 0 units 0 units 0 units 121-140 mg/dl 2 units 2 units 0 units 0 units 141-160 mg/dl 4 units 4 units 2 units 2 units 161-180 mg/dl 6 units 6 units 4 units 3 units 181-200 mg/dl 8 units 8 units 6 units 4 units 201-220 mg/dl 10 units 10 units 8 units 5 units 221-240 mg/dl 12 units 12 units 10 units 6 units >240 mg/dl 14 units 14 units 12 units 7 units discharge disposition: extended care facility: hospital @ mentrowest discharge diagnosis: ischemic left foot acute sepsis / needing intubation / bp resusitation for hypotension dm cri discharge condition: stable discharge instructions: discharge instructions following transmetatarsal 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 transmetatarsal amputation you are non weight bearing for weeks. you should keep this amputation site elevated when ever possible. you are non weight beariing on your left lower extremity 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). 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. do not drive a car unless cleared by your surgeon. no heavy lifting greater than 20 pounds for the next 14 days. 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: call dr and schedule an apoointment for tweo weeks. he can be reached at . call clinic and make an appointment in one to two weeks to see your diabetic doctor procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube amputation through foot diagnoses: other iatrogenic hypotension unspecified septicemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified polyneuropathy in diabetes sepsis chronic kidney disease, unspecified long-term (current) use of insulin atherosclerosis of native arteries of the extremities with gangrene raynaud's syndrome below knee amputation status diabetes with peripheral circulatory disorders, type i [juvenile type], not stated as uncontrolled diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled peripheral angiopathy in diseases classified elsewhere 

Answer: The patient is high likely exposed to