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: transfer from nursing home hypoglycemia and unresponsiveness major surgical or invasive procedure: - angioplasty and stent of left external iliac artery. - right femoral to plantar artery bypass graft history of present illness: ms. is an 80 year-old female with a past medical history remarkable for dm type 2, chronic renal insufficiency (baseline unknown), hypertension, and chronic anemia, brought to the ed from after being found unresponsive and hypoglycemic. per report, the patient was found unresponsive this am at 0545 at the nursing home. the blood sugar at that time was reportedly 23, and she was given 3 mg of glucagon. ems called, upon arrival blood sugar 53. a peripheral iv was placed, and she was given 1 amp of d50 with rise in blood sugar to 309. the patient then became awake and alert, and she was brought to the ed for further evaluation. per nursing home notes, she had a similar episode of hypoglycemia the day prior, which was treated with glucagon. in the ed, t 94.8, bp 240/108, hr 92, sat 98% on room air. blood sugar stable. she was given hctz 12.5, lasix 29, and coreg 6.25. on examination, she was noted to have bilateral foot ulcers, and a right foot x-ray showed probable osteomyelitis, and received unasyn 1.5 gm iv. she is being admitted for further management. upon further questionning, ms. reports poor appetite over the past few days. no uri symptoms, no chest pain, no sob, no gi or gu complaints. she notes that she has had the right heel ulcer since , and does not recall previous therapy. + pain, no fever or chills. past medical history: 1. diabetes mellitus type 2, on glipizide, with triopathy. per report, multiple prior episodes of hypoglycemia. 2. hypertension 3. congestive heart failure, ef unknown 4. chronic renal insufficiency, baseline creatinine 2.3 in 5. chronic anemia, with normocytic indices, hct 36 in 6. peripheral neuropathy 7. diabetic retinopathy and bilateral cataracts. she is legally blind. social history: she was previously in , and recently moved to in . she has been at since . she has 4 children in the area. she is a non-smoker, no etoh, no illicit drug use. family history: non-contributory. physical exam: deceased pertinent results: on admission ekg: nsr, normal axis, normal intervals, lvh by voltage criteria with nsstt changes. p pulmonale. no prior for comparison. cxr : increased thickening of septal lines, with cardiomegaly, suggestive of chronic chf. markedly tortuous aorta. degenerative changes of the left shoulder, with previous avascular necrosis of the proximal humeral head. right foot x-ray: bony alignment is satisfactory. no fractures are identified. there is a soft tissue defect seen in the lateral aspect of the calcaneus. there is a large amount of associated soft tissue swelling. additionally, the cortical border of the calcaneus demonstrates loss of cortical uniformity in that region, suggesting osteomyelitis in this region. pvr/abi: pulse volume recording showed amplitudes of 35, 18, 14 and 7 mm in the right low thigh, calf, ankle and metatarsal. on the left, these amplitudes were 24, 12, 7 and 15 mm. noninvasive measurement showed a systolic pressure of 157 mmhg in the left brachial artery. the segmental limb pressure indices dropped from 1.30 in the right distal thigh to 0.75 in the right calf and _____ in the right ankle. on the left side, the index was 0.73 in the distal thigh, 0.61 in the calf and 0.52 in the dorsalis pedis artery. conclusion: significant peripheral arterial obstructive disease, starting at the aortobiiliac level, and likely associated with superimposed bilateral infrapopliteal disease (left worse than right). renal u/s: slightly echogenic kidneys, consistent with medical disease. 4 mm nonobstructing stone within the left kidney. small simple cyst of the right kidney. echo: mild symmetric left ventricular hypertrophy with moderate global hypokinesis. mild mitral regurgitation. ef 35%. pmibi summary of the preliminary report from the exercise lab: dipyridamole was infused intravenously for 4 minutes at a dose of 0.142 milligram/kilogram/min. two minutes after the cessation of infusion, tc-m sestamibi was administered iv. the image quality is adequate. the left arm is suboptimally positioned. left ventricular cavity size is normal. resting and stress perfusion images reveal normal tracer uptake throughout the myocardium. gated images reveal mild global hypokinesis. the calculated left ventricular ejection fraction is 48%. impression: normal myocardial perfusion. mild global hypokinesis with lvef 48%. 12:37 am gb drainage,intro perc tranhep; guidance perc trans bil draina reason: acute cholecystitis in septic pt in icu. please place perc medical condition: 80 year old woman with pvd, sepsis, arf reason for this examination: acute cholecystitis in septic pt in icu. please place perc chole tube indication: septic patient with suspected cholecystitis clinically and by ultrasound. radiologists: dr. and dr. . dr. , the attending radiologist, was present for the entire procedure. description of procedure: the procedure, its indications, risk, benefits and alternatives were discussed at length with the patient's daughter-in-law, . verbal consent was obtained by telephone. a preprocedure timeout was performed. the patient was prepped and draped in sterile fashion. 1% lidocaine was used for local anesthesia. initial limited ultrasound of the right upper quadrant demonstrated a distended gallbladder with wall thickening, as seen in the formal right upper quadrant ultrasound earlier in the day. there was no active patient cooperation with the procedure, and patient motion made the procedure more difficult. ultrasound guidance was used to place an 8- french catheter into the gallbladder, yielding bilious fluid by aspiration. after attempt at deployment of the catheter, there was irregular return of fluid suggestive of malposition. a second attempt was used using a tla needle and guidewire. after successful aspiration of fluid, there was difficulty deploying the wire within the gallbladder lumen. a third attempt was made with a single stick technique using an 8-french catheter. while fluid was aspirated, this third attempt was also unsuccessful in deployment of the catheter and the catheter coiled in adjacent ascites. some of the bilious fluid was sent to the lab for analysis. the technical challenges of this procedure including patient motion and inability to keep the catheter deployed within the gallbladder lumen were discussed with the surgical services caring for the patient. at this time, it was decided to await results of the fluid analysis and then clinically decide whether additional intervention is needed. there were no immediate complications to the procedure, although the patient's blood pressure remained relatively low throughout the procedure. impression: technically unsuccessful percutaneous cholecystostomy placement under ultrasound guidance. liver or gallbladder us right upper quadrant ultrasound: the gallbladder is markedly distended with wall thickening and edema. the wall gets very thin at areas raising the possibility of wall necrosis. there is sludge layering within the gallbladder. there is ascites and pericholecystic fluid. there is a right- sided pleural effusion. impression: distended gallbladder with wall thickening and edema, consistent with cholecystitis. 2:44 pm carotid series complete reason: stroke. findings: duplex evaluation was performed of both carotid arteries. minimal plaque was identified. on the right, peak systolic velocities are 65, 139, 279 in the ica, cca, and eca respectively. the ica to cca ratio is 0.5. this is consistent with less than 40% stenosis. on the left, peak systolic velocities are 87, 109, 115 in the ica, cca, and eca respectively. the ica to cca ratio is 0.8. this is consistent with less than 40% stenosis. there is antegrade flow in the right vertebral artery. the left vertebral artery was not visualized. impression: minimal plaque with bilateral less than 40% carotid stenosis. brief hospital course: 80 year-old female with long-standing dm with triopathy, admitted with hypoglycemia and bilateral diabetic ulcers with probable right foot osteomyelitis. her hospital course will be reviewed by problems. pt deceased. . 1) bilateral foot ulcers osteomyelitis: physical examination on admission was remarkable for bilateral foot ulcers with dry gangrene, with one ulcer on the left hallux and a larger ulcer on the right heel, with monophasic pedal pulses and poor vascular supply. a foot x-ray was obtained which revealed probable osteomyelitis of the right calcaneus. vascular surgery / podiatry was consulted. she was started on broad antibiotic coverage with unasyn iv and vancomycin for coverage of polymicrobial infection +/- mrsa, with the latter dosed for level <15. a wound swab was sent to evaluate the patient's skin flora and returned positive for mrsa, prompting continuned use of vancomycin. pt taken to the or for is schemic infected right heel wound, status post a femoral to plantar artery bypass graft. pt wound was debrided, a vac was placed. this was followed by non-invasive vascular studies (), it showed an abi 0.58 and 0.52 on the right and left respectively. an mra was also done, this showed diffuse disease. patient was transferred to the vascular surgical service on . pt then underwent a an angiogram. pt was given mucomyst and bicarb to protect the kidneys. this showed severe deseased distally to the prior graft site. it was thought that the patient could not benefit from another lower extremity bypass graft. the patient then underwent a debridement of right foot soft tissue and calcaneus by podiatry. pt tolerated the procedure well. there were no complications. after this procedure pt had a graft survellance which indicate a widely patent right lower extremity bypass graft. there was, however, moderate-to-severe disease within the native distal vessel, as exemplified by a peak systolic velocity of over 300 cm/sec. vascular surgery then considered a bka at this point, after all efforts were exhausted to save the leg. . 2) dm type 2: per report, ms. has had multiple episodes of hypoglycemia, likely secondary to glipizide and poor po intake. glipizide was discontinued in hospital, and she was placed on a regular insulin sliding scale. bs were stable throughout her hospital stay. . 3) hypertension / hypotension: ms. was hypertensive in the ed, with sbp up to 200. she also has evidence of lvh on ekg. lasix and hctz were both held on admission given her acute renal failure. blood pressure was modestly controlled using increased titrations of coreg, imdur and hydralazine and fluid bolus for bout's of hypotension. pt, required vasopressors / max levophed s/p gb drainage,intro perc tranhep, and guidance perc trans bil drainage for sbp less then 60. pt deseased following this procedure. . 4) congestive heart failure: clinically, she appeared euvolemic to hypovolemic on admission, with normal jvp and clear breath sounds. a tte was obtained on , which revealed ef 35%, symmetric lvh and global lv hypokinesis, felt secondary to mixed ischemic and hypertensive cardiomyopathy. she was continued on coreg, and lasix was held given her acute renal failure as noted. she had a p-mibi prior to transfer to surgery which estimated lv ef at a much higher 55%. 5) acute renal failure on chronic renal insufficiency: per report, her creatinine was 2.3 in . her creatinine on admission was 4.4. she was given gentle hydration, with minimal improvement in her renal function. urine lytes were sent and revealed fena 2% and feurea 55%, not suggestive of a pre-renal etiology. urine microscopy was without casts. a renal u/s was also obtained on , which revealed echogenic kidneys consistent with medical disease and a small non-obstructing stone in the left kidney. renal was consulted, and the etiology of her severe renal disease remains unclear. /upep were negative. creatinine was monitored and patient was gently hydrated with isotonic bicarnbonate as well as ns. her creatinine steadily climbed out the hospital course to a high of 4.8. pt kidney function was a problem the hospital course. strict guidlines were adhered to. renal was consulted. there guidelines were used. pt did end up recieving hd. for arf. . 6) anemia: per report, hematocrit was 36 in 03/. iron studies were sent in hospital with iron 28, tibc 163 and ferritin 893, with iron/tibc >16% not suggestive of iron deficiency but rather consistent with anemia of chronic disease. tsh normal at 1.0. her hematocrit slowly trended down in hospital, and she was transfused 1 unit of prbcs on for hct 24.8, with a good response. stools guaiac negative on . per renal, she was started on epo units 3x/week. her hct was monitered with serial blood tests. . 7) leukocytosis: wbc count 28 on admisson, presumed secondary to osteomyelitis. as noted above, and infectious work-up was otherwise unremarkable with negative u/a, negative cxr and blood/urine cultures negative to date. her wounds were cx as mentioned above. she was treated with iv antibiotics. these were tailored toward her sensitivities. . 8) nuero: pt mental status began to wax and . nuerolgy was consulted. it was thought that the pt had suffered from a stroke. a ct scan was obtained which showed multiple low density areas, including left frontal lobe, right occipital lobe, and left caudate head, these may have represented multiple infarctions or metastatic lesions with edema. this evaluation was limited on this non-contrast head ct, and therefore, further evaluation by brain mri with diffusion-weighted images and gadolinium was obtained. unfortunantly the mri was virtually uninterpretable study due to gross patient motion. she had several episodes of twitching post mri, which may have been seizure activity. alternatively, this muscle twitching could have been myoclonus. given her multiple reasons to seize: focal lesions on ct (?stroke vs infection vs mass lesions), metabolic abnormalities, ongoing infection, medications which lower seizure threshold (i.e. flagyl), one has to assume that these events were likely epileptic in nature were treated accordingly. pt recieved a eeg. this was an abnormal eeg due to the focal slowing in the left anterior quadrant with associated sharp waves as well as left temporal sharp waves, a slow background, and bursts of generalized slowing. the last two abnormalities indicate a widespread encephalopathic process affecting both cortical and subcortical structures. carotid us were done, these showed <40% bilateral carotid stenosis. . 9) increase lft's: pt c/o abdominal pain, pt did have an increase in , pt undwent a gb drainage,intro perc tranhep, and guidance perc trans bil drainage - this was a technically unsuccessful percutaneous cholecystostomy placement under ultrasound guidance. they did send cx's, these were negative. pt did not tolerate this procedure. she required iv vasopressors and levophed post procedure for sbp 60's. it was thought that the pt would benefit from open cccy. the family was contact. the prefered not to intervene. pt deceased. . medications on admission: glipizide 2.5 mg po qd hctz 12.5 mg po qd mvi 1 tab po qd coreg 6.25 mg po bid colace 100 mg po bid lasix 20 mg po bid oscal 250/vit d 2 tabs po tid ferrous sulfate 325 mg po qd ultram 25 mg po bid ? bactrim ds 1 tab po bid x 10 days? discharge medications: n/a pt deceased discharge disposition: extended care discharge diagnosis: n/a - pt deceased discharge condition: n/a - pt deceased discharge instructions: n/a - pt deceased followup instructions: n/a - pt deceased procedure: venous catheterization, not elsewhere classified hemodialysis angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries other (peripheral) vascular shunt or bypass excisional debridement of wound, infection, or burn insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) monitoring of cardiac output by other technique transfusion of packed cells percutaneous aspiration of gallbladder transfusion of platelets other immobilization, pressure, and attention to wound local excision of lesion or tissue of bone, tarsals and metatarsals injection or infusion of oxazolidinone class of antibiotics infusion of vasopressor agent diagnoses: acute kidney failure with lesion of tubular necrosis toxic encephalopathy unspecified septicemia severe sepsis accidental puncture or laceration during a procedure, not elsewhere classified systolic heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin acute cholecystitis atherosclerosis of native arteries of the extremities with gangrene diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled legal blindness, as defined in u.s.a. cellulitis and abscess of foot, except toes ulcer of heel and midfoot acute osteomyelitis, ankle and foot plantar fascial fibromatosis 

Answer: The patient is high likely exposed to