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: severe bilateral foot gangrene requiring prior bilateral guillotine below-knee amputations major surgical or invasive procedure: right above-the-knee amputation and a left below- the-knee amputation history of present illness: mr. presented on the at with severe bilateral foot gangrene. he has had a history of long standing bilateral foot infection and gangrene (wet and dry) extending to his ankle bilaterally. he now presents for revision of his prior below-the-knee guillotine amputations. the remainder of the right bka was non-viable and necessitated above knee amputation. past medical history: cad s/p cardiac cath with diffuse, minor lad disease, om1 80% and rca 70-99%. pvd with 90% right femoral lesion, stented and right posterior tibial s/p ptca. tobacco abuse esrd on dialysis diabetes mellitus chronic hepatitis c (unknown genotype) social history: approx 50 pack year smoking history, currently does not smoke, heavy alcohol use in past but denies current use, denies illicit drug use. family history: no family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. siblings with cabg in their 40s. physical exam: physical examination: vital signs - temp 98.5, bp 119/82, hr 65 bpm, rr 18, o2-sat 100/ra general - well-appearing man in nad, oriented x3, comfortable, mood, affect appropriate. heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear, conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck - supple, no thyromegaly, jvd flat, no carotid bruits lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - rrr nl s1, loud s2, no m/r/g. abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding. abd aorta not enlarged by palpation. no abdominial bruits. extremities - doplerable a. femoralis pulses in both extremities right aka amputation: skin dry over suture, no drainage, no signs of infection left bka: amputation: skin over suture with some bloody serous drainage, neuro - awake, a&ox3, cns ii-xii grossly intact pertinent results: lab results on discharge: blood wbc-10.1 rbc-3.23* hgb-9.3* hct-30.1* mcv-93 mch-28.7 mchc-30.9* rdw-16.4* plt ct-145* glucose-127* urean-33* creat-2.3* na-143 k-4.4 cl-101 hco3-30 angap-16 calcium-8.0* phos-2.2* mg-1.9 cardiology report ecg study date of : sinus rhythm. p-r interval prolongation. probable left atrial abnormality. rightward axis. possible inferior wall myocardial infarction of indeterminate age. modest inferolateral st-t wave changes which are non-specific. compared to the previous tracing of there is no significant diagnostic change. intervals axes rate pr qrs qt/qtc p qrs t 81 /428 73 102 -36 carotid study, : findings: scattered areas of calcific plaque involving the left common, internal and external carotid arteries and the right internal and external carotid arteries. the peak systolic velocities bilaterally, however, are normal as are the ica/cca ratios. there is normal antegrade flow involving both vertebral arteries. impression: scattered plaque as described above; however, no appreciable ica stenosis bilaterally (graded as less than 40% bilaterally). pathology examination name birthdate age sex pathology # , 55 male report to: dr. gross description by: dr. . /dif pathology () diagnosis: i. above knee amputation, right: - gangrenous necrosis of skin and subcutaneous tissue. - acute osteomyelitis and osteonecrosis. - atherosclerosis. - soft tissue and bony resection margins appear viable. ii. below knee amputation, left: - gangrenous necrosis of skin and subcutaneous tissue. - acute osteomyelitis and osteonecrosis. - atherosclerosis. - soft tissue and bony resection margins appear viable. brief hospital course: this patient has a history of peripheral vascular disease with multiple amputations and chronic gangrene (both wet and dry) of his lower extremities bilaterally. he originally presented on after he was seen in hd and his lower extremities were noted to be getting worse. the patient reports that for several weeks, he noted increasing pain, drainage from his bilateral wounds, and worsening smell of the wounds prior to his presentation. he denies any fevers, chills, or sweats. he was taken to the or for a right above-the-knee amputation and a left below- the-knee amputation. given his overall condition with continues drainage and possible infection from his wounds and a dropping blood pressure, the patient required postoperatively multiple blood transfusions. in addition the patient wasn't able to void and initial placement of a foley catheter wasn't successful. thus, urology was consulted and placed a 22fr coudet catheter. a voiding trial is planned after the patient is discharged to rehab (please see follow up instructions, if voiding trial is not successful). the patient was on hemodialysis every third day. he was also complaining of shortness of breath along with an increased white blood cell count. chest x-ray revealed a left lower lobe collapse/consolidation and a pleural effusion. his wound cultures did grow pseudomonas as well as group b streptococcus. several blood cultures were reported as negative. the patient was put on a vancomycin/meropenem/gentamicin regimen for initial coverage of gnr. this regimen has been switched to cefepime according to recommendations of infectious diseases since and should be continued for the next 6 weeks.the patient will require weekly monitoring with cbc, lft's, bun, creatinine as well as follow up. over the course of his hospital stay his condition improved. upon discharge the patient is afebrile and hemodynamically stable. there is still some serosanguinous drainage present on his left stump, no erythema, no pus noted. the patient is on cefepime monotherapy. medications on admission: calcium acetate 667mg 2 capsule prior to meals, cozaar 25mg qd, nephrocaps 1 capsule qd, lasix 20mg , senna qd, colace 100mg , omeprazole 20mg qd, simvastatin 40mg , 81mg qd, carvedilol 6.25mg , lantus 12u qhs, humalog ssi discharge medications: 1. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 4. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. cefepime 1 gram recon soln sig: 0.5 500mg injection q24h (every 24 hours) for 6 weeks. 7. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 8. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 9. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 10. gabapentin 300 mg capsule sig: one (1) capsule po q24h (every 24 hours). 11. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 12. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 13. quinine sulfate 324 mg capsule sig: one (1) capsule po prn (as needed) as needed for hd for cramping . 14. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day). 15. insulin insulin sc sliding scale breakfast lunch dinner bedtime regular glucose insulin dose 0-60 mg/dl 1 amp d50 61-120 mg/dl 0 units 0 units 0 units 0 units 121-160 mg/dl 2 units 2 units 2 units 0 units 161-200 mg/dl 4 units 4 units 4 units 2 units 201-240 mg/dl 6 units 6 units 6 units 4 units 241-280 mg/dl 8 units 8 units 8 units 6 units 281-320 mg/dl 10 units 10 units 10 units 8 units > 320 mg/dl notify m.d. 16. picc care heparin flush (5000 units/ml) 4000- unit dwell prn line flush dialysis catheter (tunneled 2-lumen): dialysis nurse only: withdraw 4 ml prior to flushing with 10 ml ns followed by heparin as above according to volume per lumen. 17. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for congestion. 18. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily): taper s needed. 19. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 20. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) for 5 days. discharge disposition: extended care facility: & rehab center - discharge diagnosis: bilateral foot gangrene requiring right above-the-knee amputation and a left below- the-knee amputation. discharge condition: good, hemodynamicaly stable, discharge instructions: activity: . there are restrictions on activity. on the side of your amputation you are non weight bearing until cleared by your surgeon. you should keep this amputation site elevated when ever possible. please call us immediately for any of the following problems: . redness in or drainage from your leg wound(s) . . 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. 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. . followup instructions: provider: , md phone: date/time: 2:00 urology placed 22fr coudet, leave foley x at least 1 week, then void trial at rehab. he should f/u with urology clinic if unable to void follow up with infectious diseases 10:00am with dr. , phone procedure: venous catheterization, not elsewhere classified hemodialysis transfusion of packed cells other amputation below knee other amputation below knee transfusion of other serum repair of entropion or ectropion with wedge resection revision of amputation stump repair of entropion or ectropion with wedge resection revision of amputation stump repair of entropion or ectropion with wedge resection revision of amputation stump transfusion of platelets diagnoses: other iatrogenic hypotension end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery tobacco use disorder unspecified pleural effusion congestive heart failure, unspecified cirrhosis of liver without mention of alcohol chronic hepatitis c without mention of hepatic coma acute posthemorrhagic anemia acquired coagulation factor deficiency occlusion and stenosis of carotid artery without mention of cerebral infarction hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease ulcer of other part of foot bacteremia long-term (current) use of insulin old myocardial infarction chronic systolic heart failure retention of urine, unspecified diarrhea urinary complications, not elsewhere classified atherosclerosis of native arteries of the extremities with gangrene occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction pseudomonas infection in conditions classified elsewhere and of unspecified site infection (chronic) of amputation stump diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group b amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation aseptic necrosis of bone, other acute osteomyelitis, lower leg 

Answer: The patient is high likely exposed to