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: iodine / paper tape attending: chief complaint: transfer for somnolence, vascular intervention, renal failure major surgical or invasive procedure: : picc placed : tunnelled hemodialysis line history of present illness: 53 yo f with pmhx of chf ef 25%, cdiff, dm2, htn, chronic venous stasis who presented to osh ed for lower ext pain and edema on . she went in from wound care clinic appt and admitted for cellulitis. she was found to have sbp in 80s given ivf. her bnp was >4800 and trop was 0.15. she never c/o cp or sob but was started on a hep gtt. cards was consulted and deemed her not to have acs or chf and hep gtt was stopped. vascular surgery was consulted for leg ulcers and determined that she had irreversible ischemic changes of the left lower extremitiy and determined it is nonviable to pursue revascularization given her underlying vascular anatomy. she has a h/o med noncompliance, which her family confirms is not a recent issues. of note, she had a recent admission from for cdiff, chf and venous stasis. . most of history obtained from osh records. patient received 2mg iv ativan prior to leaving osh. she remarked "ouch" when moving from stretcher to bed and said she knew she was in a hospital. however, mostly only responsive to sternal rub. . ros: could not be obtained due to mental status past medical history: -dm -htn -dl -chronic venous stasis and cellulitis -copd -chf with ef 25% -b/l tubal ligation -recent cdiff colitis -ckd -h/o med noncompliance -personality disorder social history: lives with 5 birds (parakeets, cockatiels) and one dog. -ongoing smoker -no significant alcohol -h/o med noncompliance family history: noncontributory to this presentation. daughter with morbid obesity. 2 other sons living. physical exam: vs: temp:97.6 bp: 125/58 hr:81 rr:18 o2sat 99%2l gen: obtunded, arousable to sternal rub, resp unlabored heent: perrl, eomi, anicteric, drymm, op without lesions, no supraclavicular or cervical lymphadenopathy, jvp 9cm, no carotid bruits, no thyromegaly or thyroid nodules resp: anteriorly decreased bs b/l bases cv: rr, s1 and s2 wnl, no m/r/g abd: obese, and edematous, nd, hypoactive b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c, cool extremities, edema + to mid abdomen skin: multiple ulcers throughout lower ext: right 10x6 cm calf purulent ulcer anteriorly, dorsal foot 4x2 eschar left: calf 10x6cm circumferential ulcer, heel 3x3 eschar, ankle quarter size eschar, big toe 4x2 eschar, neuro: aaox0. cn ii-xii intact.unable to participate in exam rectal: deffered pertinent results: prior to transfer na 124 k 4.4 cl 93 co2 20 glc 159 bun 69 cr 2.7->3.1 cal 7.9 ckmb 5.9 trop 0.1 crp 200.4 wbc 30.9 3% bands hct 31.8 plt 463 . 10:56pm lactate-1.3 10:00pm glucose-164* urea n-73* creat-3.4* sodium-127* potassium-4.8 chloride-95* total co2-19* anion gap-18 10:00pm alt(sgpt)-21 ast(sgot)-21 ld(ldh)-178 ck(cpk)-391* alk phos-86 tot bili-0.5 10:00pm probnp-* 10:00pm albumin-2.6* calcium-8.2* phosphate-5.5* magnesium-2.1 10:00pm vanco-17.7 10:00pm wbc-34.0* rbc-4.61 hgb-9.3* hct-32.0* mcv-70* mch-20.3* mchc-29.1* rdw-17.9* 10:00pm neuts-89* bands-3 lymphs-2* monos-6 eos-0 basos-0 atyps-0 metas-0 myelos-0 10:00pm plt smr-high plt count-534* 10:00pm pt-16.5* ptt-31.9 inr(pt)-1.5* . cxr : the left picc line tip is at the level of mid low svc. there are bilateral large pleural effusions obscuring cardiac silhouette associated with bibasilar atelectasis. the patient is in pulmonary edema, at least moderate. there is no evidence of pneumothorax. . echo: : the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (lvef= 20 %) with global hypokinesis and regional inferior, infero-septal and apical akinesis. no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. there is abnormal septal motion/position. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. lvef 20% . arterial exam: findings consistent with bilateral iliac disease, left to a greater extent than the right. given the history, one must raise the question of left-sided stent occlusion. . ekg: nsr at 86 bpm, na, ni, q waves in v1-v4, std and twi in iii, ii, avf and v6 overall unchanged . renal ultrasound (): impression: no renal pathology. moderate-to-large right pleural effusion. . cta abdomen, lower extremities: impression: 1. severe and extensive vascular disease, which appears longstanding with multiple regions of collateralization. 2. inflow: the most severe abnormalities include a markedly narrowed aorta, near complete occlusion of the distal aorta, with only tenous threads of flow in the common and external iliac arteries, occlusion of the right internal iliac artery, and occlusion of bilateral superficial femoral arteries. collateralization to the popliteal arteries is more robust on the right than left via intramuscular profunda femoral branches. 3. outflow: three vessel runoff with mild right posterior tibial artery disease on the right (anterior tibial and peroneal are patent). widely patent anterior tibial artery on the left, with moderate diffuse disease of the left peroneal and occlusion of the left posterior tibial artery. 4. filling defect within the proximal branches of the sma, which may be embolic in addition to the severe multivessel stenotic disease. 5. extensive third spacing with a large right pleural effusion, small left pleural effusion (both with significant atelectasis), moderate ascites within the pelvis and extensive anasarca. 6. soft tissue ulcers along both calves, however, no definite bony destruction to suggest osteomyelitis. . abdomen x-ray impression: nonspecific bowel gas pattern. large right and small left pleural effusion. brief hospital course: 53 yo f with pmhx of chf ef 20% (echo ), recent cdiff infection, type 2 diabetes mellitus, hypertension, chronic venous stasis/peripheral vascular disease with ulcerations and personality disorder nos who presented to osh ed for lower extremity pain and edema transferred for ongoing care. . #leukocytosis: likely from c.difficile given medical noncompliance and also from ulcers and cellulitis even potentially osteoporosis (nothing probable to bone on exam, though). the patient did not have signs of sepsis (mental status changes, hypotension, lactate normal). the patient was continued on vancomycin iv and cefepime for cellulitis. she was also continued on vancomycin po and flagyl iv (transitioned to po) for cdiff. wound care was consulted for management of her cellulitis, ulcers. . #altered mental status: etiology likely multifactorial given infections, likely cdiff and cellulitis. the patient also received ativan prior to transfer and has history of personality disorder nos. there is history of poor medication compliance and ?comprehension of medical issues. social work was consulted given concerns regarding the patient's ability to care for self at home; the patient required brief soft restraints for deliberate removal of pivs and picc line, making it difficult to provide medical care. the patient's infections were treated per above. . #limb ischemia: appears chronic from records, however severity and progression unclear given she presented with pain and the osh emergency room documented warm extremiteis. pulse dopplerable at right popliteal and bilateral femorals but nothing below on left side. no dopplerable pulses in lower ext with arterial ulcers. abi/pvr testing showed bilateral iliac disease with concern for stent occlusion in left lower extremity. vascular was consulted and recommended cta for possible surgical intervention. they also recommended good wound care, elevating legs, no ace bandages/compression stockings. she was also started on heparin gtt per vascular recommendations. . #acute on chronic renal failure: unclear baseline but likely acute on chronic, with creatinine climbing from 1.8 in early to 2.7 on admission to osh. during hospitalization, cr was 3.5+. etiology includes chronic diabetes (although a1c 8), hypertension, chf with poor forward flow. the patient was initially diuresed with lasix, transitioned to lasix gtt and then trialed on diuril without any improvement in oliguria. renal was consulted and felt her renal disease likely due to long-standing vascular issues and would not resolve. . #chf: eft 20% on echo on , presumed prior ischemic event given q waves on ekg, has lower ext edema which may be partly nutrition and anasarca from volume overload, renal failure. she is likely intravascular dry but total body volume overload given peripheral edema. cxrs are consistent with volume overload. the patient was not hypoxic although intermittently benefited from nasal cannula. . #hyponatremia: hypervolumic, likely from chf and renal failure. . #type 2 diabetes mellitus: on glargine and insulin sliding scale while in-house. . #hypertension: anti-hypertensives were held for initial somnolence (after iv ativan prior to transfer). as the patient remained generally normotensive, medications were not resumed. . # elevated inr: likely nutritional as albumin was 2.6. nutrition was consulted. . once transferred from the icu, her course continued on the medical floor. the patient was able to receive a temporary hd catheter, which further allowed a cta of her aorta and lower limbs, as well as dialysis. the cta demonstrated extensive vascular disease. the vascular surgery team did not believe that any interventions could be completed for revascularization of her lower extremities with these findings. she was noted to have evidence of ischemic injury to her bilateral lower extremities, but surgical intervention was not felt indicated, given the inability to revascularize her legs per the vascular surgery team. her heparin drip was continued. the patient's white blood cell count continued to rise, although her vital signs remained stable. infectious disease was consulted and suggested continuation of broad spectrum antibiotics with the understanding that these were only temprozing measures and only intervention would be definitive treatment. a family meeting was held to discuss the patient's prognosis, and available treatment options, but that as surgery was not indicated, her prognosis was likely days to weeks at most. during that meeting with the patient's sister and daughter, the patient' sister recalled a conversation in which the patient expressed wishes not to be resuscitated or intubated, and the family felt this was in keeping with her known wishes. another family meeting was planned for the afternoon of , to determine the best plan for the patient. the patient was continued on maximal medical therapy, which included broad spectrum antibiotics and hemodialysis, to help with both her renal failure and volume overload. on the morning of , , during dialysis, the patient became unresponsive. her breathing and heartbeat stopped. in accordance with the family's wishes, no resuscitation was attempted. after an examination yielded no breath sounds, no heart sounds, and no corneal reflex, along with a 12-lead ekg yielding asystole, the patient was declared dead at 7:40am. her labs from the morning, which came back following her death, suggested dic, and the likely cause of her death was sepsis secondary to her limb ischemia. medications on admission: medications at home: -lasix 40mg daily -levemir insulin -humalong -lisinopril 5mg daily -vitamin c . meds on transfer: -vit c -lasix 40mg daily -levemir 10 qdaily -humalog prn -lisinopril 5mg -bactroban -vanc 250mg po qid -zosyn 2.25mg iv q6 -flagyl 500mg iv q8 -vanco iv 1g iv q12 -asa 81mg daily -zestril 5mg daily -atenolol on hold -vitamin c -vanc 250mg po qid -arixtra 2.5 mg subq daily . allergies: nkda discharge medications: expired. discharge disposition: expired discharge diagnosis: cardiopulmonary arrest, likely secondary to sepsis limb ischemia. discharge condition: expired. discharge instructions: expired. followup instructions: expired. procedure: hemodialysis venous catheterization for renal dialysis diagnoses: chronic kidney disease, stage v acidosis congestive heart failure, unspecified atherosclerosis of aorta candidiasis of mouth hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease cellulitis and abscess of leg, except foot long-term (current) use of insulin intestinal infection due to clostridium difficile personal history of noncompliance with medical treatment, presenting hazards to health do not resuscitate status pressure ulcer, heel encephalopathy, unspecified acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities with gangrene ulcer of other part of lower limb venous (peripheral) insufficiency, unspecified pressure ulcer, unspecified stage diabetes with renal manifestations, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to