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: history of present illness: mr. is a 65 year-old male with end stage renal disease and peripheral vascular disease admitted on originally to the vascular service for elective left below the knee amputation due to nonhealing ulcers. mr. has a history of multiple vascular interventions on his left leg including femoral distal bypass in , but has a chronic pain and a nonhealing ulcer on his left foot, which has failed conservative therapy. with the exception of his pain mr. felt well on admission. he denies fevers or chills, chest pain, shortness of breath. past medical history: remarkable for end stage renal disease secondary to anca vasculitis. the patient was hemodialysis since . the patient has a history of type 2 diabetes since . the patient has a history of peripheral vascular disease as noted above including previously mentioned left leg interventions as well as amputation of fifth metatarsals on his right foot. the patient has a history of congestive heart failure with an echocardiogram in showing a left ventricular ejection fraction of 40 to 45%, right ventricular dilatation and mild pulmonary hypertension, as well as mild global right ventricular hypokinesis. the patient has a history of atrial fibrillation status post cardioversion. the patient has a history of hyperthyroidism, hypertension, history of previous cerebrovascular accident, history of throat cancer status post chemotherapy and radiation therapy, history of mrsa bacteremia, history of gerd. history of chronic aspiration pneumonias status post peg placement. allergies: the patient is allergic to hydralazine to which he developed a vasculitis. cipro to which he gets swelling, ace inhibitors to which he gets swelling and vancomycin to which the patient gets hives. medications on admission: coumadin, which was initially on hold for surgery, subq heparin, levofloxacin 250 mg po once a day, which was begun on for aspiration pneumonia, epogen 1300 units subq once a week, serevent two puffs b.i.d., levothyroxine 200 micrograms po q day, quinine sulfate 325 mg po monday, wednesday and friday prehemodialysis, norvasc 5 grams monday, wednesday, fridays, 5 grams twice a day tuesday, thursday, saturday and sunday. lopressor 25 mg po twice a day. calcium carbonate 4 grams po twice a day. flovent 110 micrograms three puffs b.i.d., claritin 10 mg po once a day and percocet prn. social history: remarkable for a forty pack year smoking history. the patient quit smoking in . laboratories on admission: the patient had a white count of 6.4, hematocrit of 28.7, which is around baseline for the patient. his inr was 1.4. ptt was 36.3 and his bmp was within normal limits. physical examination on admission: the patient was afebrile with a temperature of 98.8, pulse 74, blood pressure 136/62, sating 94% on 2 liters o2. generally, he was cachectic ill appearing male in no acute distress. he had no jvd, but his lungs were remarkable for bibasilar rales. cardiovascular is regular rate and rhythm with no murmurs. abdominal examination was benign with the peg site being clean, dry and intact. extremities left lower extremity was bandage with the bandage being clean, dry and intact. no edema. chronic venostasis changes. right lower extremity had no edema and also had evidence of chronic venous changes. left av fistula had palpable thrill and a good bruit. impression: in short, this was a 65 year-old male with end stage renal disease and peripheral vascular disease and a myriad of other medical problems that was admitted for elective left below the knee amputation secondary to nonhealing ulcer. hospital course: 1. vascular: the patient underwent left below the knee amputation as planned on and was doing well postoperatively until when he began having mental status changes. workup of the mental statue changes is discussed in the endocrine section below. the patient's wound did not heal well and became necrotic, gangrenous and thus the patient was taken back to have his below the knee amputation revised to an above the knee amputation on . postoperatively the patient's wound healed well and at the time of discharge was clean, dry and intact with no erythema and no exudate. 2. endocrine: the patient is a known type 2 diabetic who was taking micronase at home that was discontinued on admission, because the patient was npo for surgery. the patient's sugars were fine postop until he began having mental status changes on the 9th where he became lethargic, noninteractive with his family, narcotics were discontinued without results and blood sugars were noted to be in the low 40s to 70s. review of medications revealed that the patient had been given glyburide due to a nonupdated medication sheet brought from home. blood sugars remained in the 20 to 80 range. the patient despite boluses with d50 was started on a d10 drip. his sugars were maintained within normal limits. unfortunately glyburide does not clear the system with dialysis, so the patient was maintained on a d10w drip with d50 boluses needed throughout the course of the next three days while waiting for glyburide to clear his system. subsequent to weaning the patient off of the d10 drip he was maintained on standing doses of nph insulin and with sliding scale. 3. infectious disease: the patient was afebrile throughout the course of his hospital stay until when he spiked a temperature. subsequent blood cultures grew mrsa. because the patient's allergy to vanco he was started on synercid. the patient underwent a tte to rule out endocarditis, which showed no vegetations. he also had another positive mrsa blood culture on after the placement of a picc line. the picc line was removed after subsequent catheter tip culture grew mrsa positive. the patient remained afebrile with negative blood cultures from mrsa for the remainder of his hospital stay and was sent home for an add two weeks of synercid. the patient also had a positive blood cultures, which grew b fragilis. the source for this was thought to be the sacral decubitus ulcer. the patient was started on flagyl po for this and given a two week course per id recommendation. 4. cardiac: the patient had a history of atrial fibrillation, but was in normal sinus rhythm on admission. throughout the course of his stay he had episodic atrial fibrillation, but remained hemodynamically stable. the patient was restarted on his coumadin prior to discharge with hopes of titrating him back to a therapeutic level. the patient is followed by his nephrologist dr. . 5. sacral decubitus ulcer: during the course of his hospital stay due to his prolonged immobilization postoperative and while being in the intensive care unit the patient developed severe sacral decubitus ulcer stage 3 to 4, which required multiple debridement by plastic surgery while he was in house. because the patient's peripheral vascular disease it was thought that the patient is probably not a good candidate for flap reconstruction. the patient was referred to general surgeon dr. for follow up and further debridement of this wound as an outpatient and continued on wet to dry dressings three times a day. 6. pulmonary: the patient had a history of chronic aspiration pneumonias and had difficulty being weaned from oxygen as an inpatient. thus he was treated with a short course of levofloxacin while in house even though his chest x-ray remained clear without signs of pneumonia during the course of his stay. the patient was also continued on his chronic obstructive pulmonary disease inhalers and oxygen prn. 7. fluids, electrolytes and nutrition: the patient continued g tube feeds throughout the course of his stay. 8. gastrointestinal: the patient had repeated diarrhea following initiation of synercid treatment. he was c-diff negative multiple times and it was thought that the diarrhea was secondary to antibiotic use. discharge condition: the patient was discharged home on in good condition to follow up with dr. regarding treatment of his sacral ulcer, with dr. regarding his atrial fibrillation and cardiac issues, dr. his primary care attending regarding his general care and with dr. for issues surrounding his hemodialysis. discharge diagnoses: 1. peripheral vascular disease status post left below the knee amputation revised to above the knee amputation. 2. end stage renal disease. 3. type 2 diabetes. 4. hypertension. 5. sacral decubitus ulcer status post debridement times two. 6. mrsa bacteremia. 7. b fragilis bacteremia. 8. congestive heart failure. 9. atrial fibrillation. 10. hyperthyroidism. medications on discharge: synercid 500 mg intravenous q 8 times seven days, flagyl 500 mg po q 8 times ten days, zinc sulfate 50 mg po monday, wednesday and friday, nephrocaps one tab po q day, calcium carbonate 1 gram po t.i.d., insulin nph 8 units at breakfast and 6 units at bedtime. reglan 25 mg po q 6 hours, aspirin 81 mg po q day, salmeterol two puffs b.i.d., flovent 110 micrograms two puffs po b.i.d., quinine sulfate 325 mg po monday, wednesday and friday prior to hemodialysis, lopressor 25 mg po b.i.d., synthroid 200 micrograms po q day, ranitidine 150 mg po q day, coumadin 2.5 mg po q day and norvasc 5 mg po q.h.s monday, wednesday and friday and 5 mg b.i.d. tuesday, thursday, saturday and sunday. dr., 12-766 dictated by: medquist36 procedure: enteral infusion of concentrated nutritional substances hemodialysis excisional debridement of wound, infection, or burn amputation above knee other amputation below knee diagnoses: congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation bacteremia infection and inflammatory reaction due to other vascular device, implant, and graft atherosclerosis of native arteries of the extremities with ulceration ulcer of heel and midfoot 

Answer: The patient is high likely exposed to