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: right heel ulcer major surgical or invasive procedure: right heel debridement egd with sclerotherapy orif right hip history of present illness: this unfortunate 70 year-old gentleman, with peripheral vascular disease, liver cirrhosis and cancer has developed ischemic related gangrene of his right heel. he was transferred from another hospital with infection. he has been treated with antibiotics for 48 hours and is now undergoing debridement. past medical history: pmh: glaucoma, mi (), dm1, hepatitis nos, cirrhosis, small cell lung ca s/p chemo/xrt psh: a0-bifem (, ), b cataract, r hand surgery social history: pt lives with his wife and other dtr, in their own home in . dtr, , lives nearby and is very involved and supportive. son also lives in ma and is supportive. wife is wheel chair bound secondary to polio, but is very independent and has essentially been caretaker for pt in more recent years as his health/mobility has declined. dtr,, is currently rennovating her home and plan is for parents and sister to live with her and her family by the end of the summer. previous drinker denies tobacco family history: non contributary physical exam: general - pale cachectic male laying in bed, good spirits, freindly heent - ncat / perrl / eomi, neg lesions nares, oral pharnyx, auditory supple / farom neg lymphandopathy, supra clavicular nodes resp - cta b/l upper lobes, crackles at bases cardiac - rrr 1/6 sem at apex abd - tympanic, distened, nttp, pos bs, neg cva tenderness bruits - non noted ext - doppler pt/dp/at b/l right heel - excised, clean, dry. minimal erythema around debridement site, good granulation pertinent results: wbc-10.2 rbc-3.17* hgb-9.7* hct-29.2* mcv-92 mch-30.7 mchc-33.3 rdw-16.7* plt ct-183 pt-13.6* ptt-32.2 inr(pt)-1.2 fibrino-530* glucose-42* urean-15 creat-1.0 na-133 k-3.7 cl-107 hco3-22 angap-8 alt-9 ast-25 alkphos-86 amylase-23 totbili-2.2* caltibc-103* trf-79* %hba1c-7.0* -done -done triglyc-44 freeca-1.28 radiology final report ct chest w/contrast; ct 100cc non ionic contrast indication: history of lung cancer, now with ulcer in the esophagus. evaluate for cancer recurrence. soft tissue window images demonstrate abnormal esophageal wall thickening in the distal esophagus with multiple lymph nodes which are at the upper limits of normal in size, but given its proximity to the abnormal esophagus, are also likely abnormal. additionally, there are moderate to large bilateral pleural effusions, greater on the left. the left pleural effusion is loculated with a moderate supbulmonic component. additionally, there is subtle linear enhancement of the posterior surface of the left pleura. there is bibasilar atelectasis, left greater than right, associated with the bilateral pleural effusions. the entire left lower lobe is collapsed/consolildated. in both upper lobes, there are geographic areas of opacity with traction bronchiectasis and scarring, likely relating to prior radiation therapy. an ill-defined 5mm ground glass nodule is seen in the right middle lobe. there are diffuse emphysematous changes in both lobes. at the base of the right lung, there is an irregular area which likely represents atelectasis/scarring. the heart, pericardium, and great vessels are normal. in the visualized portion of the upper abdomen, again seen is ascites, a hiatal hernia, and right hydronephrosis. the visualized portions of the spleen and left kidney are normal. bone windows: no suspicious sclerotic lesions are seen. impression: 1. abnormal thickening of the distal esophagus with adjacent lymphadenopathy, worrysome for malignancy. 2. geographic areas of opacity in both upper lobes, consistent with prior radiation. 3. subtle linear enhancement of the left posterior pleural surface. while this could be due to radiation, given the history of lung cancer, pleural based metastatic disease is of high concern. 4. 5 mm ground glass nodule in right middle lobe. the nodule is somewhat ill- defined, and is nonspecific, but given the history of lung cancer, a 3 month follow- up chest ct is reccommended. 5. bilateral moderate to large pleural effusions and associated bibasilar atelectasis. the left pleural effusion appears loculated, with a moderate subpulmonic component, and there is associated complete collapse/consolidation of the left lower lobe. 6. unchanged ascites, right hydronephrosis, and a hiatal hernia. radiology final report abdomen (supine & erect) port medical condition: 70 year old man with +ntg, dark blood, h/o partial bowel obstruction indication: history of partial bowel obstruction with dark blood in the ng tube. decubitus and supine view of the abdomen: dilated loops of small bowel are present in the right abdomen measuring up to 5 cm in transverse diameter. air- fluid levels are demonstrated on the left lateral decubitus view. the degree of dilatation of small-bowel loops appears slightly decreased compared to the study of . ct abdomen w/contrast; ct pelvis w/contrast indication: 70-year-old man with history of lung cancer, now with nausea and vomiting, and loose stools. small pleural effusions are seen bilaterally. there is a small hiatal hernia. a nasogastric tube descends below the diaphragm and terminates in the stomach. there are diffuse coronary artery calcifications, and atherosclerotic disease within the aorta. there is a large amount of intraperitoneal ascites. the liver is cirrhotic, without nodules or masses. the gallbladder is not visualized. the pancreas, spleen, both adrenals are normal. there is mild hydronephrosis of the right kidney, with delayed contrast excretion. the abdominal aorta is diffusely calcified with good contrast opacification of the intraabdominal vessels. there is diffuse dilatation of the intraabdominal loops of small bowel, measuring 4.6 cm in cross sectional diameter with multiple air fluid levels. there is fecalization of the small bowel within the terminal ileum, within the right lower quadrant. no focal masses are seen within this area. distal loops of small bowel and colon are decompressed with minimal contrast opacification of the ascending colon. there is no evidence of pneumatosis, or pneumobilia. ct of the pelvis with oral, with intravenous contrast: dense calcification of the intra-abdominal aorta increases in to bilateral iliac arteries. a foley catheter is seen within a collapsed bladder. minimal gas and stool are seen within the sigmoid and rectum. bone windows: degenerative changes are seen throughout the lower thoracic and lumbar spine. there are no suspicious lytic or sclerotic osseous abnormalities. there is diffuse subcutaneous edema. impression: 1) small-bowel obstruction with a possible transition point in the distal ileum, within the right lower quadrant. no focal masses are identified at this area. 2) delayed right renal nephrogram with mild hydronephrosis consistent with distal obstruction. 3) cirrhotic liver. 4) bilateral pleural effusions. 5) dense diffuse atherosclerosis of the coronaries, and intraabdominal aorta. 6) small hiatal hernia. hip unilat min 2 views right reason for this examination: please assess r femur fracture again, demonstrated is a fracture of the right femoral neck with angulation at the fracture site. there is also some degree of impaction with foreshortening of the femoral neck. the projection is slightly different than the previous study. allowing for this factor, the fracture is likely unchanged. no additional fractures are identified. extensive vascular calcifications are present. pelvis portable reason: low pelvis to view arthroplasty the patient is status post right total hip replacement procedure with satisfactory postoperative alignment on a single projection. immediate postoperative changes are noted including soft tissue gas and superficial skin staples. extensive vascular calcifications are again observed. l-spine (ap & lat) reason for this examination: new-onset loss of l5 motor function, please assess for compression fx. indications: recent onset of loss of l5 motor function. question compression fracture. the bones are diffusely demineralized. there is a mild compression deformity at the l4 vertebral body level. very minimal loss of height is noted at l5 as well. the remaining lumbar vertebral bodies show preservation of normal height. the disk spaces are relatively well preserved with some mild narrowing noted at l3-l4. degenerative changes are noted posteriorly in the facet joints. extensive vascular calcifications are seen throughout the abdominal aorta and its branches. regarding the decreased height at l4, it was likely present at the time of the recent abdominal radiograph as well, but difficult to compare due to lack of the lateral view at that time. within the abdomen, note is made of multiple air filled loops of dilated bowel, which were also present on a recent ct of the abdomen of , which described a small-bowel obstruction. there is also a suggestion of ascites. impression: 1) compression deformity at l4 and very minimal compression at l5. 2) dilated loops of small bowel, concerning for small-bowel obstruction. please note that recent abdominal ct of described a small-bowel obstruction. probable ascites. ct head w/o contrast indication: fall. head trauma. noncontrast head ct: there is no acute intra- or extra-axial hemorrhage, hydrocephalus, shift of normally midline structures, or evidence of major vascular territorial infarction. there is a generalized prominence of the sulci and ventricles consistent with brain atrophy. small likely lacunar infarcts are present in the periventricular white matter bilaterally. there is no skull fracture. visualized paranasal sinuses are clear. there are dense carotid siphon calcifications. impression: no acute intracranial hemorrhage. cardiology report ecg sinus rhythm. first degree a-v delay. prior inferior wall myocardial infarction. probable prior anteroseptal myocardial infarction. borderline low voltage. since the previous tracing of atrial ectopy is absent. intervals axes rate pr qrs qt/qtc p qrs t 92 250 86 378/427.71 64 34 46 chest (pre-op pa & lat) chest x-ray, pa and lateral views: the study is compared to . the heart size is normal. the mediastinal and hilar contours are essentially unchanged with prominent opacity again seen at the left hilum. the pulmonary vascularity is unremarkable. the lungs show similar prominent interstitial markings, but the appearance is unchanged allowing for differences in technique. there are no pleural or pericardial effusions. the lungs are clear. the osseous structures are unremarkable. impression: no significant change since the prior study, or acute cardiopulmonary process. sputum site: expectorated **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): budding yeast. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. smear reviewed; results confirmed. respiratory culture (final ): oropharyngeal flora absent. staph aureus coag +. sparse growth. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ =>16 r levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin------------ =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s vancomycin------------ <=1 s r heel/superficial wd. **final report ** wound culture (final ): due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for pseudomonas aeruginosa, staphylococcus aureus and beta streptococcus). probable enterococcus. moderate growth. gram negative rod(s). rare growth. staph aureus coag +. moderate growth. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ =>16 r levofloxacin---------- =>8 r oxacillin------------- =>4 r penicillin------------ =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s vancomycin------------ <=1 s urine **final report ** urine culture (final ): no growth. brief hospital course: pt had a difficult hospital course pt admitted on for heel ulcer pt wound is swabbed, blood cx taken, pt is stared on iv antiotics - pt stable - pt taken to the or for debridement of the right heel, he had a right heel block. he tolerated the procedure well. there were no complications. transfered to the pacu in stable condition. there was extensive debridemnt in th or, infection to the bone, discussed bka with patient. blood cx are positive for septecemia, pt followed with surveillance cultures. iv antibiotics adjusted accordingly. - pt experiences decrease u/o. foley placed. minimal urine output noted. urine lytes orderd. pre renal. pt treated with fluids. because of the pts known cirrohsis, minimal n/v, distention of the abdomen not usual for the pt. a kub was ordered. it was found that the pt had a sbo. ct scan obtained. pt was made npo/po meds were changed to iv/ngt placed. tpn started. nutrition labs ordered. general surgery consult obtained. they recommended treating conservativley. diagnosis partial sbo. - ng tube removed, pt diet was advanced. pt doing well. - pt fell trying to got to the bathroom. a stat ct scan was ordered. which was negative for an acute bleed. the following day pt still c/o right hip pain. plain films were ordered. showed a fracture of the right hip. a trauma consult was obtained. ortho consult was obtained for the right femoral neck fracture. pt started on levonox for enbolis precations. pt taken to the or for orif of the right hip. - pt undergoes right bipolar hip replacement. ( tolerated the procedure well. there were no complications. pt transfered to the pacu in stable condition. pt transfered to vicu in stable condition. it was noticed that the patients hct was steadily decreasing after the procedure. he was transfused appropriatly. on pt has an episode of coffee ground emesis. ng tube replaced. 300 cc of coffee ground emmesis evacuated. pt stool was guiac positive. because of the decreasing hct and the obvious gi bleed from the ngt and the stool. a gi consult was obtained. before gi saw the pt the pt became hypotensive, tachycardic. the pt had to be emergently transfered to the icu. pt had to intubated for airway protection. the levonox was dc'd, protonix was started. labs were ordered. it was found that the pt had an increase of inr/pt - secondary to cirrohsis. ffp was given. fluid resusitation was started. pt taken for emergent egd - found to have active variceal bleeding. treated with scleropathy. pt started on octreotide drip. levo started for prophalaxsis. a heptology consult was obtained. repeat egd performed. pt stabalized. - pt transfered to the regular floor. a podiatry consult was obtained to gather information on conservative treatment given the patients difficult course. they recommended continuation of ns w to d dsg changes. c/w mp boots. egd performed - pt stable. recommended f/u egd in one month for obliteration of varices and f/u in liver clinic here or with pcp. because of pt poor intake of food consult obtained. saw pt, recommended ssi of humulog and to decrease lantus to 8 units. on discharge pt is doing well. taking po, urinating, bm, oob to chair. - dc medications on admission: metformin 1000", paxil, folate, lantus 32u, spironolactone 100" discharge medications: 1. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours). 2. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 3. spironolactone 25 mg tablet sig: two (2) tablet po daily (daily). 4. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 5. vancomycin hcl 1000 mg iv q24h if random level <15 already approved -- changed frequency because of vanco trough; 6. morphine sulfate 2 mg/ml syringe sig: one (1) injection q3-4h () as needed. 7. picc line care sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 8. insulin breakfast glargine 16 units insulin sc sliding scale - humulog breakfast, lunch, dinner and bedtime glucose insulin dose 0-60 mg/dl 4 oz. juice 61-120 mg/dl units 0 121-160 mg/dl units 2 161-200 mg/dl units 4 201-240 mg/dl units 6 241-280 mg/dl units 8 > 280 mg/dl notify m.d. 8 units 6 units discharge disposition: extended care facility: lifecare of discharge diagnosis: dry gangrene of right heel partial sbo, fracture of right hip after falling at bedside, gib from esophageal varices, esophageal ulcer concerning for possible cancer - egd discharge condition: stable discharge instructions: please do wet to dry dressing changes on the right heel. pt is on vancomycin. please adjust vanco level according to blood draws. picc line care followup instructions: please call dr office and schedule an appointment for two weeks after discharge, call him at . when you call he may schedule you for an amputation. you may not need to see him. call dr (orthopedics) and schedulae an appointment for two weeks after discharge, call him at . please call gastroenterology and schedule an egd for one month after discharge, call the gastroenterologist at . please call dr. at . he works in heptology. make f/u in one month. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine other endoscopy of small intestine percutaneous abdominal drainage partial hip replacement endoscopic excision or destruction of lesion or tissue of esophagus endoscopic excision or destruction of lesion or tissue of esophagus transfusion of packed cells excision of lesion of other soft tissue insertion of (naso-)intestinal tube local excision of lesion or tissue of bone, tarsals and metatarsals diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver unspecified viral hepatitis c without hepatic coma infection with microorganisms resistant to penicillins malignant neoplasm of bronchus and lung, unspecified methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site esophageal varices in diseases classified elsewhere, with bleeding hydronephrosis atherosclerosis of native arteries of the extremities with gangrene fall from other slipping, tripping, or stumbling unspecified intestinal obstruction personal history of irradiation, presenting hazards to health cellulitis and abscess of foot, except toes acute osteomyelitis, ankle and foot ulcer of esophagus with bleeding dermatophytosis of foot closed fracture of base of neck of femur dermatophytosis of nail 

Answer: The patient is high likely exposed to