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: rle wound infection major surgical or invasive procedure: right bka history of present illness: 62m with h/o nash cirrhosis, esrd on hd, non healing right ankle wound open fracture of this year, who was recently discharged on after a prolonged hospital course from to , during which time his right ankle wound was i/d'd 5 times, which grew out vre / galbrata, for which he was put on dapto / micafungin, and vac dressing change q3d. his hospital course was also complicated by cirrhosis encephalopathy, gib esophageal/gastric varices, esrd due to hepatorenal syndrome requiring hd, and hypotension requiring midodrine. patient was discharged to on . . while in , patient continued to make improvements. his mental status was improving, and he had no pain, no more gib. his wounds were stable, and he had no fevers when he was there. he was sent to for lvp yesterday, when paracentesis was done with 4.5-5l fluid removed. his flexiseal was pulled, and he started to use bed pans. he started to eat better as well, but he was found to have some cough and shortness of breath after he ate. he also had dysphagia, and felt that the food was stuck in his throat after he ate. he complained of pain in his mouth, on his tongue and at the back of his throat. because of these issues, he was not getting enough nutrition. scheduled a barium swallow study for him at on this thursday, and per patient's friend , was going to start tpn tonight after his ortho appointment. . pt was seen in the ortho clinic today and found to have frank purulence when the vac dressing was removed. patient was then directed admitted to orthopedic service. since the patient is medically very complicated, patient was then transferred to medicine service with ortho as a consulting service following the patient. . on the floor, patient is alert and oriented x3. pt denied chest/abdominal pain, no shortness of breath, no leg pain, but did complain of tongue/mouth/throat pain. no fever, chills. . ros: denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria. past medical history: - rle infection: pt had a chronic rle cellulitis and osteomyelitis secondary to a traumatic r tibiotalar posterior dislocation and open trimalleolar fracture s/p external fixation , s/p 5 debridements and revisions with non healing r ankle wound during the last admission and was discharged to ltac with vac dressing and on daptomycin and micafungin to treat vre and until . - cirrhosis likely due to steatohepatitis, followed by dr. . last tap when 13l was removed. complicated by encephalopathy and esophageal and gastric varices. pt is not a transplant candidate. - h/o gib due to esophageal and gastric varices - esrd due to hepatorenal syndrome, on hd - type 2 diabetes mellitus with extreme insulin resistence - hypotension requiring midodrine - hyperlipidemia - obstructive sleep apnea on cpap - irritable bowel syndrome - gastroparesis - obesity - rheumatoid arthritis - depression social history: has phd in psychology-retired mass dmh psychologist. no tobacco, no etoh, no other drugs. family history: no h/o clotting disorders. mother died of pna in 80s, also had thyroid disease. father died of heart disease in 70's, had cancer (unknown type), tobacco and alcohol abuse. family h/o t2dm. physical exam: vitals - t:96.0 bp:96/54 hr:65 rr:20 02 sat:95% on room air general: pleasant, well appearing, in nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. systolic murmur best heard at lusb. no rubs or . lungs: ctab, good air movement biaterally when auscultating from anterior. abdomen: obese. nabs. soft, nt, nd. no hsm. extremities: right le has a large deep ulcerated lesion, no pus; dressing in place, c/d/i, no surround erythema. lle has dressing in place, and foot in soft boots. both chronic stasis changes. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. mild asterixis present. psych: listens and responds to questions appropriately, pleasant pertinent results: admission labs: 05:45pm blood wbc-7.0 rbc-3.72* hgb-10.6* hct-36.6* mcv-98 mch-28.5 mchc-29.0* rdw-17.4* plt ct-106* 05:45pm blood neuts-71.6* lymphs-19.4 monos-5.0 eos-3.6 baso-0.3 05:45pm blood plt ct-106* 05:45pm blood esr-34* 05:45pm blood glucose-77 urean-18 creat-4.0* na-141 k-4.2 cl-101 hco3-28 angap-16 05:45pm blood alt-29 ast-69* alkphos-329* totbili-2.0* 05:45pm blood albumin-3.2* calcium-9.4 phos-3.5# mg-2.0 discharge labs: microbiology: - mrsa screen: negative - urine culture: no growth - peritoneal fluid: gram stain - 4+ pmns, no organsims; culture - pending ** - peritoneal fluid (blood culture bottles): esbl e. coli - blood culture: pending ** - c. difficile toxin: negative - stool culture: no salmonella/shigella/campylobacter; no o&p; c. difficile negative - blood culture: pending ** - peritoneal fluid: gram stain - 4+ pmns, no organsims; culture - pending ** - blood culture: pending ** - blood culture: pending ** studies: ecg: sinus rhythm. left atrial abnormality. left anterior fascicular block and possible additional intraventricular conduction delay. non-specific st-t wave abnormalities. since the previous tracing of the rate is faster and further st-t wave changes are present. cxr: there are persistent low lung volumes. small bilateral pleural effusions, left greater than right, associated with adjacent atelectasis are unchanged. there is no evidence of pneumothorax. right hemodialysis catheter is in place. left picc line has been repositioned, the tip is not clearly visualized, likely ends at the cavoatrial junction. cardiac size cannot be evaluated. ct c-spine, t-spine: impression: 1. no obvious evidence of interim diskitis/osteomyelitis on limited evaluation. evaluation for an epidural collection is markedly limited in the absence of iv contrast. mri would be more sensitive, even without iv contrast, if the patient can tolerate mri. 2. no acute cervical fracture or malalignment. unchanged dish and multilevel spondylosis. liver/gb ultrasound: impression: 1. cirrhosis and portal hypertension, with splenomegaly and large ascites. 2. cholelithiasis, without evidence of acute cholecystitis. tte: left ventricular wall thicknesses are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). doppler parameters are indeterminate for left ventricular diastolic function. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is an anterior space which most likely represents a prominent fat pad. impression: hyperdynamic lv function. suboptimal image quality. ecg: sinus tachycardia. left atrial abnormality. left axis deviation. left anterior fascicular block. st-t wave abnormalities. since the previous tracing the rate is faster. bilateral le veins: impression: no definite evidence of lower extremity dvt. however, calf veins were not visualized. cxr: impression: small right and moderately large left pleural effusions are stable. increasing consolidation in the left perihilar region is most likely pneumonia. early followup is recommended. cxr: findings: as compared to the previous radiograph, there is no relevant change. unchanged moderate cardiomegaly, unchanged position of monitoring and support devices. unchanged bilateral pleural effusion, left more than right, unchanged mild-to-moderate pulmonary edema. no newly occurred focal parenchymal opacities. cxr: cxr: brief hospital course: 62m with h/o nash cirrhosis, esophageal/gastric varices, gib, esrd on hd, non healing right ankle wound open fracture who was recently hospitalized was directly admitted today after he was found to have frank pus coming out of his right ankle wound following vac dressing removal in the ortho clinic today. . # rle infection: pt had a chronic rle cellulitis and osteomyelitis secondary to a traumatic r tibiotalar posterior dislocation and open trimalleolar fracture s/p external fixation , s/p 5 debridements and revisions with non healing r ankle wound during the last admission and was discharged to ltac with vac dressing and on daptomycin and micafungin to treat vre and until . he was seen in the ortho clinic on , and after the vac dressing was removed frank pus was seen. he was initially managed on daptomycin and micafungin, orthopedics was also following during his stay. he eventually was taken to the or for a bka on in hopes of removing the source of bacteremia. post operatively his wound healed well, however his mental status failed to improve and his mental status did not improve post operatively. also post-operatively he became more tachycardic, and with an increasing white count and increased work of breathing. he had a blood culture from his hd line that grew out yeast, and there was concern that he was becoming fungemic, on he was made dnr, with the decision not to escalate care any further. that night he became progressively more hypotensive, was on maximum doses of pressors and eventually expired early in the morning on . . # cirrhosis: large volume paracentesis were done on when 13l was removed, and when 4.5l was removed. his liver disease had been complicated by encephalopathy and esophageal and gastric varices/gib during the last admission. patient was not a transplant candidate. he was continued on lactulose, rifaximin, nadolol and ppi throughout his stay. he periodically underwent paracenteses to help with his work of breathing. his mental status deteriorated throughout his stay and post operatively he did not fully recover his mental status, remained intubated and expired early in the morning on . . # esrd: thought to be due to hepatorenal syndrome. patient was continued on hd initially, also continued on calcium acetate and midodrine. however, as he became more progressively hypotensive requiring pressors, he was transitioned to cvvh for renal replacement therapy for a period of time. . # hypotension: patient's blood pressure remained at baseline 80s and 90s initially during his hospital stay however as he became septic requiring icu care he needed pressors for blood pressure support, and was never able to be weaned off pressors. medications on admission: - escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). - rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). - menthol-cetylpyridinium 3 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed) as needed for sore throat. - bupropion hcl 100 mg tablet sig: one (1) tablet po qid (4 times a day). - olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po bid (2 times a day) as needed for agitation. - acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain: please do not give> 2g per day. - lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po tid (3 times a day): titrate to loose bms daily (not watery). this is for hepatic encephalopathy not just simple constipation. - midodrine 5 mg tablet sig: two (2) tablet po tid (3 times a day). - sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). - nadolol 20 mg tablet sig: one (1) tablet po daily (daily). - heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). - calcium acetate 667 mg capsule sig: three (3) capsule po tid w/meals (3 times a day with meals). - ondansetron hcl (pf) 4 mg/2 ml solution sig: eight (8) mg injection q8h (every 8 hours) as needed for nausea. - micafungin 100 mg recon soln sig: one hundred (100) mg intravenous q24h (every 24 hours): last day . - daptomycin 500 mg recon soln sig: nine hundred (900) mg intravenous q48h (every 48 hours): last day . - pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. - folic acid 1 mg tablet sig: one (1) tablet po once a day. - insulin glargine 100 unit/ml cartridge sig: fifty (50) unit subcutaneous at bedtime. - humalog 100 unit/ml cartridge sig: sliding scale subcutaneous qachs: please see the attached sliding scale. discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis percutaneous abdominal drainage percutaneous abdominal drainage local excision of lesion or tissue of bone, tibia and fibula other amputation below knee removal of implanted devices from bone, tibia and fibula diagnoses: end stage renal disease obstructive sleep apnea (adult)(pediatric) cirrhosis of liver without mention of alcohol acute kidney failure, unspecified hepatorenal syndrome unspecified septicemia severe sepsis diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes depressive disorder, not elsewhere classified acute respiratory failure long-term (current) use of insulin septic shock morbid obesity other ascites hypovolemia esophageal varices in diseases classified elsewhere, without mention of bleeding diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled gastroparesis acute osteomyelitis, ankle and foot infection and inflammatory reaction due to other internal orthopedic device, implant, and graft spontaneous bacterial peritonitis arthropathy associated with neurological disorders chronic osteomyelitis, lower leg 

Answer: The patient is high likely exposed to