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: altered mental status major surgical or invasive procedure: central venous line placement and subsequent removal hemodialysis line removal history of present illness: 70 yo m presented to ed from nursing home w/ altered mental status and low grade fever. per the patient's son, patient's penile gangrene had worsened - prior dry gangrene isolated to glans penis treated conservatively given not operative candidate and followed closely by urology. on evaulation in the ed patient was oriented only to self. in the er initial vs were: t 100.6 hr 53 bp 135/67 rr 14. vs prior to transfer to the icu 86, bp 146/65 98% on 2l rr 12. he rec'd 20u sc insulin in total, he rec'd 500cc of ivf. had a l sc cvl placed. he was transferred to the micu for concern of sepsis. ct groin showed sq air diagnostic for fournier's gangrene. he was treated with vanc/zosyn/cipro and urology was consulted who had a long discussion with son about patient not being an operative candidate and the natural course of fournier's gangrene without surgical intervention. decision made to make patient dnr/dni with no escalation of care. patient was hemodynamically stable throughout micu course. he was transferred to the floor and upon evaluation patient denied pain, cp, sob, abd pain or other ros. past medical history: -5/08 l bka for gangrene - glans penis dry gangrene conservatively managed -dm2 -hypertension -ckd baseline 3.5-4.2, up to 9 in -blindness -neuropathy, possibly demyelinating polyneuropathy -systolic chf ef 50% as of social history: originally from . very remote tobacco use. denies etoh or drugs. wheelchair bound, lives at home with family who are very involved - has nurse visit 3x/day. family history: diabetes, cad in children. one son died of mi. physical exam: vs: 138/67 87 15 98.7 90-98% on ra gen: elderly gentleman, lying in bed,looking straight. heent: r corenal haziness, reduced vision, eomi, no icterus, mmm neck: no cervical lymphadenopathy cv: rrr, no r/g/m pulm: clear to auscultation bilaterally abd: soft, mildy distended, non tender groin: deferred temporarily. ext:warm and well perfused. r foot with dorsal edema, dry ulcer, well circumscribed, no drainage. left bka. neuro: difficult to assess, patient able to verbalize. hard of hearing. can follow some simple commands. could not move feet when asked. unclear if he understood. exam at discharge: t 96 hr 99 158/60 92% ra gen: elderly gentleman, lying in bed, alert and oriented to person, comfortable heent: r corenal haziness, reduced vision, eomi, no icterus, mmm neck: no cervical lymphadenopathy cv: rrr, no r/g/m pulm: clear to auscultation bilaterally abd: soft, mildy distended, non tender groin: gangrene of glans and shaft with some purulence at coronal sulcus. crepitus notable along lenth of penile shaft. urethra with some purulence but appears patent. erythema extending to suprapubic region ext:warm and well perfused. r foot with dorsal edema, dry ulcer, well circumscribed, no drainage. left bka. pertinent results: ct a/p: impression: 1. extensive subcutaneous and soft tissue emphysema involving essentially all compartments of the penis extending its entire length, consistent with fournier's gangrene. emergent surgical evaluation is recommended. 2. extensive diffuse atherosclerotic disease, with possible right proximal superficial femoral artery occlusion as described. please correlate clinically for further evaluation. current study is not tailored for ct angiography. 3. moderate-to-large bilateral pleural effusions with compressive atelectasis, right greater than left. 4. high-density exophytic small lower pole right renal lesion, new since , is not fully characterized. this may be further evaluated by ultrasound on a non-emergent basis. 5. diffuse severe anasarca. 6. fat-containing umbilical hernia. 7. moderate amount of fecal material throughout the colon. ct head: no intracranial hemorrhage, large vascular territory infarct, or large mass. please note mri with gadolinium is superior for evaluation of intracranial mass if not contraindicated. labs: - cbc: wbc-20.9 hgb-8.3 hct-28.3 mcv-80 plt ct-556 - diff: neuts-91.5* lymphs-5.3* monos-2.9 eos-0.2 baso-0.2 - coags: pt-13.3 ptt-28.6 inr(pt)-1.1 - chem 10: glucose-393 urean-80 creat-8.4 na-137 k-5.3 cl-97 hco3-24 angap-21 calcium-8.5 phos-6.6* mg-2.6 - lft's: alt-13 ast-15 ck(cpk)-49 alkphos-363 totbili-0.3 - ctropnt-0.83* - lactate-1.4 labs prior to discharge: wbc rbc hgb hct mcv mch mchc rdw plt ct 30.8* 3.89* 9.6* 30.8* 79* 24.7* 31.2 21.4* 475 brief hospital course: assessment & plan: 70 year old male with h/o dm, htn, esrd on hd and systolic chf ef 30% presented with altered mental status, fever, found to have fourniers gangrene of the groin. he was septic and started on vanco/zosyn/clindamycin in the icu. the patient was a high surgical risk, and any survival and per urology the benefit to be obtained from debridement would likely be small and associated with significant pain and painful dressing changes. he was continued on antibiotics and an aggressive pain regimen. this alleviated his symptoms. his mental status also cleared as his pain control improved. he was hemodynamically stable and he was tranferred to the floor where further discussion regarding goals of care were pursued with the assitance of the palliative care team. during a family meeting, it was made clear that the patient's fournier's gangrene was non-operative and was terminal. following this discussion with health care proxy, son , the decision was made that the patient would want his care to be focused at home with hospice without return to a health care facility if his condition worsened. hemodialysis was discontinued, and his hd line was removed. hospice care was arranged, and the patient was discharged on home with hospice. he had a mid-line placed so that he could continue to receive antibiotics for his non-operative fournier's gangrene. pain control was optimized with a fentanyl patch and sublingual morphine. the patient was comfortable and alert upon discharge. medications on admission: home medications: amlodipine 5 mg daily aspirin 325 mg po daily atorvastatin 40 mg po daily insulin lispro sliding scale metoprolol succinate 25 mg sr daily b complex-vitamin c-folic acid 1 mg po daily acetaminophen 325 mg 1-2 tablets q6hrs prn ranitidine hcl 150 mg po daily insulin glargine 2 units daily docusate sodium 100 mg po bid polyethylene glycol 3350 17 gram/dose po daily bisacodyl 5 mg po daily senna 8.6 mg po bid medications on transfer: acetaminophen 1000 mg po/ng tid artificial tears 1-2 drop both eyes q4 hours hydromorphone (dilaudid) 0.25 mg iv q3h:prn pain clindamycin 600 mg iv q8h piperacillin-tazobactam 2.25 g iv q12h vancomycin 1000 mg iv hd protocol discharge medications: 1. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic q4 hours (). 2. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). 3. zosyn 2.25 gram recon soln sig: one (1) intravenous every eight (8) hours for 1 months. disp:*qs * refills:*2* 4. fentanyl 25 mcg/hr patch 72 hr sig: one (1) transdermal every seventy-two (72) hours. disp:*5 0* refills:*0* 5. clindamycin hcl 150 mg capsule sig: three (3) capsule po q6h (every 6 hours). 6. morphine concentrate 20 mg/ml solution sig: 1-2 mg po q1h (every hour) as needed for breakthrough pain/dyspnea. discharge disposition: home with service facility: hospice care discharge diagnosis: primary diagnosis: forneir's gangrene end stage renal disease type ii diabetes mellitus secondary diagnosis: hypertension discharge condition: mental status: alert and oriented to person level of consciousness: alert activity status: bedrest, out of bed with assist discharge instructions: mr. - it was a pleasure to care for you during your hospitalization. you were admitted due to a very serious infection of the skin and soft tissue of the penis. you were evaluated by urology and surgery was thought to be very dangerous. you were continued on antibiotics. the urologists did not think that you would be able to tolerate a painful surgery to cure the infection, which is a terminal infection. the decision was made by you and your family to treat your pain and other symptoms with pain medications and antibiotics. following a family meeting, arrangements were made for hospice services at home to continue comfort measures. dialysis was discontinued, and your hemodialysis line was removed. you had another iv placed to continue receiving antibiotics at home. you went home on with the intent to continue comfort measures only and not to return to the hospital. see below for a list of medications you will given at home. you will continue to receive hospice care at home. followup instructions: you will continue to receive hospice care at home. procedure: venous catheterization, not elsewhere classified removal of other device from thorax diagnoses: acidosis end stage renal disease congestive heart failure, unspecified unspecified septicemia polyneuropathy in diabetes sepsis systolic heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of insulin vascular disorders of male genital organs encounter for palliative care below knee amputation status diabetes with neurological manifestations, type ii or unspecified type, uncontrolled unspecified visual loss 

Answer: The patient is high likely exposed to