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: ultram / vicodin attending: chief complaint: stemi major surgical or invasive procedure: cardiac catheterization with stenting of the rca history of present illness: hpi: 62 y/o male with htn, dm, dyslipidemia, pvd presents from hospital after an inferior mi. he presented there this am from a nursing home with one day of chest pain. pain was located across the chest without raditation to arms, jaw, or back. it was associated with sob, nausea, diaphoresis. pain was at its worst. pain did not resolve until he underwent catherization. ecg on presentation revealed an inferior stemi. bp was 80/40. temp 101.5. patient was taken to cath lab where ptca was performed on mrca. timi iii flow was achieved, however stent could not be deployed. patient was transfered to . on arrival, patient c/o chest discomfort. he denied sob, n/v, abd pain. he complained of left elbow pain. past medical history: dm h/o cardiomyopathy - resolved htn rheumatoid arthritis anxiety depression pvd b/l non-healing elbow, heel ulcers h/o cardiac catherization - no cad social history: lives in has sister involved in care denies etoh, ivda, tobacco use family history: n/c physical exam: exam: t96.7 bp 93/64 hr 103 rr28 95%3l n/c gen: chronically ill appearing male nad heent: perrl, anicteric, mmm neck: supple, no jvd cv: rrr no m/r/g lungs: cta anteriorly abd: soft, nt, nd +bs groin: no hematoma ext: no edema, pulses non-palpable b/l. right pt dopplered. left elbow wound with copious purulent material right heel - necrotic ulcer left heel - exposed masticated bone neuro: a/a ox3 pertinent results: wbc 18.6 hct 34.7 plt 261 bun 22 cr .5 ck 835 mb 144 trop 1.24 mg 1.5 . ecg: (osh) 11:38 - complete heart block, stemi iii>ii, avf, v3-v6, st depressions i,l,v2 (osh) 11:40 - right side leads - 1/2mm ste v3-v5 (osh) 14:53 - post-angio - sinus tach at 100, q-wave iii, avf, st depression i,l, v5-v6 () 18:48 - sinus tach at 100, q-wavw iii, avf, twi v4-v6 () 19:01 - right side leads - qwave v4-v6 cath report ptca comments: initial angiography showed an 80-90% stenosis of the distal rca. we planned to treat this lesion with ptca and stenting. eptifibatide was given prophylactically. a 7 french jr4 guide provided suboptimal support (an al0.75 and a mp guide would not engage). a prowater wire crossed the lesion with ease and was positioned in the distal vessel. pre-dilation was performed with a 3.0x15 mm maverick balloon for multiple inflations at 6-8 atm. angiography showed a type iib dissection at the proximal edge of the lesion. we then attempted to deliver a 3.0x18 mm and subsequently a 3.0x8 mm vision stent but could not advance either stent beyond the mid rca. the wire was then exchanged for a choice floppy wire, which facilitated the delivery of the 3.0x8 mm vision stent to the dissection site and the stent was deployed at 14 atm. attempts to deliver a second 3.0x8 mm vision stent further distally to completely cover the lesion failed due to vessel tortousity and poor guide support. final angiography showed a <20% residual stenosis, no dissection and timi 3 flow. the patient left the lab in stable condition. final diagnosis: 1. one vessel coronary artery disease. 2. successful stenting of the rca. echo conclusions: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is severely depressed (severe global hypokinesis with akinesis of the inferior wall). no masses or thrombi are seen in the leftventricle. right ventricular systolic function appears depressed. the aortic root is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. there is no aortic valve stenosis. the mitral valve appears structurally normal with mild mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is a small pericardial effusion. feet plain films right foot, two views: there are extensive vascular calcifications noted. an extensive soft tissue defect is noted on the plantar surface of the heel. there is an overlying dressing, which obscures fine bony detail. there are no fractures, dislocations, bony destruction, or periosteal reaction. note is, however, made of diffuse increased density in the posterior calcaneus, which appears to be due to thickened and ill- defined trabeculae, more prominent in the left foot. the joint spaces are grossly preserved. left foot, two views: extensive vascular calcifications are noted. there is a smaller soft tissue defect seen on the plantar surface of the heel. note is made of diffuse increased density in the posterior calcaneus, which appears to be due to thickened and ill- defined trabeculae. no fractures, dislocations, bony destructions or periosteal reaction is identified. the joint spaces are grossly preserved. impression: 1. bilateral soft tissue defects on the plantar surfaces of the heel. 2. bilateral trabecular thickening, left greater than right, within the calcaneus. this finding can represent chronic infection though given that these findings are not specifically in the area of the posteroinferior calcaneus where the soft tissue lies this is less likely; neuroarthropathy or healing insufficiency fracture are also in the differential. impression: severe left ventricular systolic dysfunction (multivessel cad vs toxic/metabolic state). brief hospital course: a/p: 62 y/o male with multiple cardiac risk factors who presents with inferior stemi associated with heart block, now s/p cardiac catherization with ptca of mrca but without stent deployment. pt now intubated, in hf, ?septic with long standing ext wounds. . 1) stemi: the pt received a cath with balloon angioplasty of the rca. however, a stent was unable to be placed. the pt's presenting symptoms resolved during cath. he was transferred to with plans of having a repeat cardiac cath for a further attempt at opening the lesion. at the pt was placed on asa, plavix, lipitor 80mg, and lopressor, titrated up as tolerated by his blood pressure. he was kept on these medications throughout his hospitalization. he was placed on integrillin for 18 hours. upon admission he was also placed on stress dose steroids as the patient was on chronic steroids for arthritis. initially the pt was planned for an elective cardiac cath 3 days after admission (). however, given the fact that he spiked a temperature as high as 103.2 and was frequently tachycardic with low blood pressures, it was felt that the pt was questionably septic. the pt's chronic b/l heel and left elbow wounds were felt to be a likely source of sepsis. the ccu team felt that given the possibility of sepsis, a stent would not be warranted given its potential as a nidus of infection. the pt was planned for balloon angioplasty of his rca rather than stenting. during this period a swan ganz catheter was placed. his swan readings were followed and did not indicate a septic physiology. also, the pt's blood cultures never demonstrated the growth of any organism. therefore the pt was again felt to be a candidate for stenting. the pt was intubated during a period of respiratory distress (discussed below). once stable the pt was kept intubated and was taken to cath where the pt received successful stenting of his mid rca with less than 20% residual flow. post cath pt had some sinus tachycardia which was treated with increase in bb. pt also had one episode of chest pain along with some abdominal pain and distention. ecg was unchanged and pt's pain improved with maalox and simethicone and did not recur. - asa, plavix, lipitor 80mg, toprol xl 100mg qd. lisinopril was held given sbp in the 90s-100s. would consider restarting as bp tolerates given benefits of acei in a post mi patient and pt with known cad. - initially stress dose steroids as patient is on chronic steroids for arthritis, now tapering down home dose 5mg. - goal hr<80 and sbp<120, so can adjust bb accordingly. . 2) chf: the pt had an echo performed which demonstrated an ef of 25% with inferior wall ak. throughout his hospitalization, the pt was diursed with lasix as needed. an ace-i has been held as his bp has been low and would not tolerate another antihypertensive in addition to bb. 3) rhythm: the pt was intermittently in sinus tach for periods of time. the ddx was post-mi arrythmia vs. pain associated with extremity wounds vs. anxiety. the pt's sinus tach was controlled with with increased bb as his bp tolerated as well as pain control with fentanyl and percocet. 4) respiratory distress: a few days into his hospital course the pt experienced labored breathing with a rr in the 40s. he maintained this rate for a period of hours and appeared to betiring he was intubated and kept intubated until post cath at which time he was extubated without difficulty. the etiology of the pt's resp distress was unclear though was likely related to chf/volume overload. however, during his distress the pt, though diuresed was non-responsive symptomatically to lasix. follwoing his extubation he experienced no further episodes of dyspnea. 5) infection/ext wounds: the pt has long-standing left elbow wound and b/l feet wounds. the elbow wound had been debrided in the past, but was grossloy purulent. his feet both have necrotic ulcers, the ulcer on the left extending down to the calcaneus. plain films of feet show no apparent osteomyelitis, though given pt with exposed bone on right le, it was clinically felt felt that the pt had om. as above, the pt was questionably septic given tachy and low bp, though had nml svr's by swan and never had positive blood cxs. the pt has been followed by vascular, podiatry and ortho. ortho drained, debrided, and packed the left elbow. for the pt's ext wounds, both podiatry and vascular recommended future surgical intervention after the pt had stabilized from a cardiopulmonary standpoint. in the meantime the services recommended an eight week course of zosyn and vanc. the pt's course began on . he will be followed for his wounds by the ortho team at upon discharge. while admitted, the pt's pain was controlled by fentanyl, percocet, and/or oxycodone. he remained afebrile on antibiotics and the antibiotics should be continued. after speaking with podiatry consult, antibiotics were changed to unasyn on the day of discharge given pt's diahrrea, see below. pt will follow up with podiatry clinic, where wound care and antibiotic coverage can be readdressed should any changes occur. 6) diabetes: the pt is on metformin as an outpatient. during the admission, the pt's metformin was held and he was covered with iss. now restarted on metformn. he was and should continue to be given tight glucose control given infection, mi. . 7) rheumatoid arthritis: the pt was placed on stress dose steroids (fludro/hydro) given his long-standing out-pt steroid treatment. his pain was controlled as above. . 8) adrenal insufficiency: given the pt's long-standing steroid administration, he was presumed to be adranally insufficient in mounting a stress response to the mi. he was maintained on stress dose steroids and is being tapered down to his out-pt dose 5mg daily. . 9) diarrhea/abdominal pain--the pt experienced loose stools following cath. ddx included included c diff on abx vs. rxn to abx themselves. the pt was c diff negative x3. therefore the pt's diarrhea was felt to be to abx instead of infection. he was srted on immodium for control. the following morning pt complained of bloating and distention. he had not had a bm in >12 hrs. ecg was done which showed to changes. pt was given simethicone and maalox which relieved the pressure. his pain was thought likely secondary to gas and bloating. he was given immodium, metamucil and keopectate were also added. this helped intermittently, however pt continued to have diahrrea and antibiotics were changed as above. . 10) depression/anxiety: the pt was continued on wellbutrin, risperdol. . 11) f/e/n: the pt was maintained on a low na/cardiac healthy, diabetic diet. he was npo prior to his cath. his lytes were repleted as necessary. . 12) ppx: the pt was maintained on sq heparin. . 13) dispo: to rehab. medications on admission: lisinopril 5 daily lipitor 10 daily mvi omeprazole 20 daily percocet b4 dressing changes risperdal 1.5 daily toprol xl 200 daily welbutrin 100 iss methylprednisolone 4mg daily arava (leflunomide) 20 daily metformin 500 vitamin c 500 daily motrin prn augmentin discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. risperidone 1 mg tablet sig: 1.5 tablets po hs (at bedtime). 4. bupropion 100 mg tablet sig: one (1) tablet po bid (2 times a day). 5. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 7. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 8. therapeutic multivitamin liquid sig: five (5) ml po qd (). 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 10. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. metoprolol succinate 100 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 13. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed): insulin sliding scale with meals as indicated. 14. oxycodone 5 mg tablet sig: one (1) tablet po q2-3h (every 2-3 hours) as needed for pain. 15. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 16. furosemide 20 mg tablet sig: two (2) tablet po daily (daily). 17. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed. 18. zinc oxide-cod liver oil 40 % ointment sig: one (1) appl topical prn (as needed). 19. psyllium 1.7 g wafer sig: one (1) wafer po bid (2 times a day). 20. prednisone 10 mg tablet sig: one (1) tablet po daily (daily): until and then change to 5mg daily (patient on maintance dose of 5mg). 21. potassium chloride 10 meq capsule, sustained release sig: four (4) capsule, sustained release po daily (daily): continue until pt stops having diahrrea. hold for k>4.5. 22. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 23. bismuth subsalicylate 262 mg/15 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for diarrhea. 24. unasyn g piggyback sig: one (1) intravenous every six (6) hours for 7 weeks. discharge disposition: extended care facility: hospital - discharge diagnosis: stemi bilateral heel ulcers. respiratory distress elbow wound discharge condition: stable discharge instructions: pt or ecf staff should contact physician if pt: experiences chest pain shortness of breath temp >101 has bleeding, pain or swelling at cath site. pt has been having diahrrea, his stool was negative for c. diff x 3 and was given some immodium, metamucil and keopectate was ordered as well. this should be monitored to make sure that the diahrrea is under control. . please follow up with podiatry for your heel ulcers and apporpriate antibiotic therapy as listed below. followup instructions: pt to be followed by dr. at rehab. pt will be followed by his orthopedic physicians there for his extremity wounds. provider: , dpm phone: date/time: 3:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of non-drug-eluting coronary artery stent(s) injection or infusion of platelet inhibitor insertion of endotracheal tube pulmonary artery wedge monitoring nonexcisional debridement of wound, infection or burn transfusion of packed cells aspiration of bursa cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: other primary cardiomyopathies coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified septicemia cardiac complications, not elsewhere classified sepsis acute myocardial infarction of other inferior wall, initial episode of care cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure rheumatoid arthritis pressure ulcer, heel accidents occurring in residential institution atherosclerosis of native arteries of the extremities with gangrene proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site ulcer of heel and midfoot unspecified osteomyelitis, ankle and foot diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled dissection of coronary artery other anxiety states 

Answer: The patient is high likely exposed to