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: bactrim attending: chief complaint: ankle pain major surgical or invasive procedure: intubation by micu team self-extubation history of present illness: mr. is a 49 year old man with past medical history of type 2 diabetes (complicated by nephropathy and neuropathy) and peripheral vascular disease status post right superficial femoral artery stent with dry gangrene of the right 5th metatarsal and subsequent amputation 2 months ago, who presented on with nontraumatic acute pain of the right ankle and fevers. when he was in the ed he had fevers to 103, and was admitted given concern for septic arthritis. at the metatarsal site, he had noticed intermittent increased drainage of the wound with mild odor. an ankle arthrocentesis was attempted; however an appreciable amount of fluid could not be obtained. lower extremity ultrasound was negative for deep venous thrombosis. orthopedics was consulted who recommended iv vancomycin/ceftazadime for empiric coverage of probable cellulitis given hyperpigmentation of right lower extremity. on , the patient awoke from a nap with chest discomfort, acute tachycardia, and new onset acute hypoxia. saturations were reported to be as low as 70% on room air, with increase to low 90's on 100% nonrebreather mask. pulmonary exam was not significant for wheezes or crackles. ekg showed new sinus tachycardia to 127, with lateral st depressions in v5/6 but otherwise no other evidence of acute ischemic changes. chest x ray was not concerning for new pulmonary effusions, pneumothorax, or pneumonia. troponins were positive at 0.28. with ck-mb of 5. he was started on an empiric heparin drip and transferred to the icu for further monitoring. past medical history: type 2 diabetes complicated by retinopathy, nephropathy, neuropathy chronic kidney disease hypertension hyperlipidemia peripheral vascular disease tobacco abuse history of tibial fracture right superficial femoral artery stent and angioplasty social history: he is not currently working. he has worked as a painter in recent years. he is actively smoking and has done so for 20 years. he drinks alcohol in moderation. married, lives with wife. independent in adls family history: his mother is in the 70s, has "problems with her legs". his father is in good health. he has 3 sisters and 2 brothers who are in good health. he has one daughter 28 and one son 15, who are in good health. physical exam: admission exam vitals: t:102.6 bp: 145/74 p:124 r:34 o2:92% nrb general: alert, oriented, respiratory distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple,no lad cv: tachycardic with sinus rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses. rle with missing 5th metatarsal. granulation tissue and mild purulence present at site. tenderness to palpation up to mid calf. rle appears hyperpigmented compared to left. neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact. discharge exam 98.3 136/68 71 18 100 ra general - well-appearing man in nad, comfortable, appropriate lungs - no adventitious sounds heart - nl s1-s2, no murmurs. abdomen - nontender, nondistended, no masses or hsm, no rebound/guarding extremities - r ankle swollen compared to left, hyperpigmented compared to left. some limitation in movement of r ankle pain. prior amputation site on r 5th toe w/o any drainage. pertinent results: admission labs: 08:00pm wbc-11.6*# rbc-3.13* hgb-9.8* hct-29.4* mcv-94 mch-31.3 mchc-33.3 rdw-13.5 08:00pm crp-15.5* 08:00pm glucose-98 urea n-50* creat-2.2* sodium-141 potassium-4.5 chloride-106 total co2-22 anion gap-18 08:20pm lactate-1.4 08:30pm urine rbc-7* wbc-1 bacteria-few yeast-none epi-0 08:30pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 08:30pm urine color-straw appear-clear sp -1.007 11:07pm lactate-1.0 relevant labs: 08:00pm blood wbc-11.6*# rbc-3.13* hgb-9.8* hct-29.4* mcv-94 mch-31.3 mchc-33.3 rdw-13.5 plt ct-288 07:05am blood wbc-9.0 rbc-3.19* hgb-9.6* hct-29.9* mcv-94 mch-30.2 mchc-32.2 rdw-13.8 plt ct-479* 08:00pm blood neuts-90.5* lymphs-5.1* monos-3.4 eos-0.7 baso-0.2 07:05am blood neuts-71.2* lymphs-18.9 monos-5.5 eos-4.0 baso-0.3 07:05am blood glucose-162* urean-49* creat-2.5* na-141 k-4.8 cl-104 hco3-29 angap-13 03:13pm blood ck-mb-5 ctropnt-0.28* 09:10am blood ck-mb-1 ctropnt-0.06* 06:15am blood caltibc-215* hapto-442* ferritn-843* trf-165* 08:30pm urine color-straw appear-clear sp -1.007 08:30pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-neg 08:30pm urine rbc-7* wbc-1 bacteri-few yeast-none epi-0 discharge labs 07:05am blood wbc-9.0 rbc-3.19* hgb-9.6* hct-29.9* mcv-94 mch-30.2 mchc-32.2 rdw-13.8 plt ct-479* 07:05am blood neuts-71.2* lymphs-18.9 monos-5.5 eos-4.0 baso-0.3 07:05am blood plt ct-479* 07:05am blood glucose-162* urean-49* creat-2.5* na-141 k-4.8 cl-104 hco3-29 angap-13 07:05am blood calcium-9.1 phos-4.4 mg-2.0 microbiology: blood cultures 8/4, , , : no growth. lyme serology negative urine culture negative wound swab from r amputated toe : no growth, no microorganisms on gram stain imaging: tte the left atrium and right atrium are normal in cavity size. the patient is mechanically ventilated. the ivc is small, consistent with an ra pressure of <10mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: normal biventricular cavity sizes with preserved regional and low normal global left ventricular systolic function. no valvular pathology identified. dilated ascending aorta. compared with the prior study (images reviewed) of , global left ventricular sysotlic function is now slightly reduced with preserved systolic function. the heart rate is also now tachycardic. ct chest : findings: normal appearance of the visualized thyroid. no lower cervical adenopathy. heart size within normal limits. limited, non-contrast evaluation of the upper abdomen reveals no gross abnormality. blood pool is hypodense relative to myocardium suggesting anemia. evaluation of the lungs demonstrates normal overall parenchymal pattern with focal areas of scattered ground-glass opacity in the bilateral upper and lower lobes, most prominent in the left upper lobe. confluent opacification in the bilateral lower lobes in a dependent distribution with small bilateral pleural effusions are noted. in the right lower lobe subpleural space, there is a 7-mm calcification which along with mediastinal lymph node calcifications suggests granulomatous disease. no acute osseous abnormality. vasculature is normal in caliber. impression: 1. scattered ground-glass opacities with consolidations in the bilateral lower lobes. appearance is nonspecific, but in the appropriate clinical setting likely represents pneumonia. 2. anemia. 3. stigmata of old granulomatous disease. 4. lack of iv contrast prevents evaluation of the pulmonarey vessels for embolus. mri mr of the left ankle without the intravenous administration of contrast findings: diffuse prominent subcutaneous edema is present throughout the distal left lower extremity and imaged portions of the left foot. trace tibiotalar joint effusion. prominent edema is also present within fat pad. edema is also present with the sinus tarsi. edema is present within the plantar musculature of the mid and hindfoot. no evidence however for edema extending along fascial planes within the foot and distal left lower extremity. no subcutaneous or intramuscular abscess. anterior and posterior tibiofibular ligaments are intact and normal in signal. anterior and posterior talofibular ligaments are intact. calcaneofibular ligament appears grossly intact. deltoid and spring ligaments appear intact. extensor tendons are normal in signal. trace fluid is present with the tendon sheath of the intact tibialis anterior. small amount of fluid is present within the tendon sheath of the intact posterior tibialis. small amount of fluid is present within the tendon sheaths of the intact peroneal brevis and longus. achilles tendon is normal in thickness and signal. no evidence for discrete fracture nor significant bone marrow edema. no evidence for osteomyelitis. impression: 1. prominent subcutaneous edema of the distal left lower extremity and foot. although nonspecific, this finding can be due to cellulitis. edema also present in the plantar musculature and could reflect an element of myositis. 2. no mr evidence for osteomyelitis or fasciitis. no focal fluid collection to suggest abscess. 3. trace left ankle effusion. 4. mild tenosynovitis of otherwise intact anterior tibialis, posterior tibialis, and peroneus longus and brevis tendons. exam: mri of the right foot without contrast. findings: there are expected post-surgical changes from prior amputation of the fifth toe and mid-to-distal fifth metatarsal bone. there is mild soft tissue edema and enhancement surrounding the amputated fifth toe, as well as subcutaneous edema (mild) surrounding the entire forefoot. however, there are no obvious fluid collections to suggest abscess. the visualized residual fifth metatarsal bone as well as the rest of the visualized bones demonstrates no gross abnormal bone marrow edema and no cortical destruction to suggest osteomyelitis. there are diffuse abnormal t2 signal involving the intrinsic muscles of the foot. evaluation of the extensor and flexor tendons as well as limited evaluation of the intrinsic ligaments of the foot demonstrates no acute abnormality. limited evaluation of the mid foot also demonstrates no acute pathology. impression: 1. post-surgical changes involving previously amputated fifth metatarsal and toe, without evidence of osteomyelitis. 2. assessment for abscess limited by absence of iv contrast, but no obviuos soft tissue abscess identified. 3. diffuse subcutaneous soft tissue edema (mild), likely due to cellulitis. 4. diffuse intrinsic muscle edema, nonspecific in appearance. the differential diagnosis includes changes secondary to neurogenic disease from underlying diabetes and myositis. brief hospital course: 49 y/o man with dmii who initially presented with ankle pain consistent with cellulitis, with hospital course complicated by sepsis, acute hypoxia requiring intubation in the medical icu, progression of chronic kidney disease, and troponinemia. active issues: # right lower extremity pain due to leg cellulitis. upon admission, mr. was empirically started on vancomycin and ceftazadime on for coverage of a presumed infection. although initial concern was for septic arthritis, tap by orthopedics only showed a few drops of bloody fluid that was not sent for lab evaluation. he had minimal improvement in symptoms, so decision was made to obtain right ankle mri to look for deep wound infection on that was negative for osteomyelitis, although did show edema that could be evidence of cellulitis. reportedly in the micu he was still spiking fevers to 103 at night before being transferred to the medicine floor on . after being transferred to the floor however, patient remained afebrile. flagyl was started on per infectious disease recommendations. another mri was obtained on that included all portions of the right foot, as parts of the foot, notably the amputated 5th metatarsal, were not obtained on the prior mri, which was again negative for osteomyelitis. rheumatology was also consulted who did not believe that his right lower extremity pain was due to a rheumatological issue. mr. pain improved by time of discharge and all antibiotics were discontinued on . he remained afebrile after discontinuation. blood cultures 8/4, , , and and urine culture showed no growth. lyme serology was also negative. # acute hypoxemia: soon after admission, mr. was saturating in mid to high 90s on nasal cannula; however, on , patient was reported to have desaturations to mid 80s, and placed on non-rebreather without improvement in o2 saturation. he was tachypneic and tachycardic, and decision was made to intubate and provide mechanical ventilation. his presumed cause is likely flash pulmonary edema (secondary to sepsis) as he responded well to diuresis with iv lasix. he self extubated on , and required minimal supplemental o2 afterwards, ultimately transferred to the floor on . of note while he was intubated and sedated, he required vasopressor support with norepinephrine, however this was discontinued as he was extubated and weaned off sedation. # ckd stage 3: mr. has underlying chronic kidney disease that has been acutely worsening over the past few months. his creatinine level was around ~1.7 a few months ago, but hovered around ~2.5 for much of his admission. renal team was consulted, and felt that his declining kidney function was simply a natural progression of his chronic kidney disease. of note mr. also had a low hematocrit throughout much of admission (~29). his labs were consistent with anemia of chronic disease, with no evidence of hemolysis. renal did not believe there was any role for inpatient management of his anemia. # elevated troponin (not nstemi): while in the micu, mr. cardiac enzymes revealed a mildly elevated tn-t in the setting of ckd, but his cm-mb was normal. cardiology was consulted, and believed this was consistent with some "demand" ischemia in the setting of the patient's acute illness. a tte was performed that demonstrated normal lv function without any regional wall motion abnormalities. chronic issues: # type 2 diabetes controlled with complications: mr. was started on insulin sliding scale while in house, and did not have any complications. he was continued on his home glipizide after discharge. # superior femoral artery stent/peripheral vascular disease: vascular surgery was consulted for possibility of vascular optimization for healing purposes as well as a question of an infected right superior femoral artery stent. they did ankle brachial index measurements and an ultrasound of his right superior femoral artery stent which showed satisfactory bloodflow. # benign hypertension: patient was continued on his home amlodipine. labetolol was added to help with his blood pressure control. # hyperlipidemia: home simvastatin was continued. transitional issues: - follow up final read of ultrasound of right superior femoral artery graft from and final read of ankle brachial index studies from . these were reviewed with primary team in conjunction with vascular surgery, but the final report has not been updated yet. - patient will have close follow-up with vascular surgery. - due to progression of chronic kidney disease, dialysis or transplant may need to be pursued within the next year. mr. is currently transitioning outpatient renal providers, who will continue to follow closely. - full code medications on admission: preadmission medications listed are correct and complete. information was obtained from patientwebomr. 1. vitamin d 50,000 unit po 1x/week () 2. clopidogrel 75 mg po daily 3. collagenase ointment 1 appl tp daily 4. viagra *nf* (sildenafil) 100 mg oral prn 5. amlodipine 10 mg po daily 6. glipizide 5 mg po daily 7. simvastatin 10 mg po daily 8. torsemide 20 mg po daily discharge medications: 1. amlodipine 10 mg po daily 2. clopidogrel 75 mg po daily 3. collagenase ointment 1 appl tp daily 4. simvastatin 10 mg po daily 5. torsemide 20 mg po daily 6. labetalol 300 mg po bid hold for sbp<100 or hr<60 rx *labetalol 300 mg 1 tablet(s) by mouth twice daily disp #*60 tablet refills:*0 7. oxycodone (immediate release) 5-10 mg po q4h:prn pain rx *oxycodone 5 mg tablet(s) by mouth every four hours disp #*12 tablet refills:*0 8. polyethylene glycol 17 g po daily:prn constipation rx *polyethylene glycol 3350 17 gram 1 packet by mouth daily disp #*30 packet refills:*0 9. glipizide 5 mg po daily 10. viagra *nf* (sildenafil) 100 mg oral prn 11. vitamin d 50,000 unit po 1x/week () discharge disposition: home discharge diagnosis: primary diagnosis: cellulitis secondary diagnoses: peripheral vascular disease s/p right sfa stent diabetes hypertension chronic kidney disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , you were admitted for infection on your right leg. we treated your infection with intravenous antibiotics. while you were here, you were transferred to the intensive care unit for trouble breathing secondary to fluid in your lungs. this improved with removing fluid with diuretic medications. medications started: oxycodone (for pain) labetolol (for blood pressure) miralax (for constipation) medications stopped: none please see below for your follow-up appointments. followup instructions: location: community health center address: , , phone: **appointment tuesday at 1:15 pm** department: west clinic when: monday at 4:00 pm with: , rn building: de building ( complex) campus: west best parking: garage department: vascular surgery when: thursday at 2:45 pm with: vascular lab building: lm campus: west best parking: garage department: vascular surgery when: thursday at 3:30 pm with: vascular lab building: lm campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube arterial catheterization arthrocentesis diagnoses: anemia in chronic kidney disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere tobacco use disorder acute kidney failure, unspecified unspecified septicemia severe sepsis diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) acute respiratory failure other specified cardiac dysrhythmias cellulitis and abscess of leg, except foot diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled other toe(s) amputation status diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified acute edema of lung, unspecified diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled peripheral angiopathy in diseases classified elsewhere other acute and subacute forms of ischemic heart disease, other 

Answer: The patient is high likely exposed to