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: methadone / dilaudid attending: chief complaint: elective toe amputation and ulcer debridement major surgical or invasive procedure: procedure performed: 1. amputation of the first and second digits of the right foot. 2. debridement of right lower extremity anterior ulcer. . picc line placement history of present illness: 66 yo m with esrd on hd, chf, copd and severe pvd originally admitted for right 1st and 2nd toe amputation with pre-op pneumonia, and post-op loculated pleural effusions and a fib with rvr. . the patient initially was admitted to the surgery service for right 1st and 2nd toe amputations as well as right lower leg ulcer debridement with vac dressing placement on on pre-op testing the patient was found to have a right middle lobe pneumonia. subsequent ct chest on revealed bilateral loculated pleural effusions and pneumonia. he received multiple antibiotics including nafcillin, clindamycin, vancomycin and levofloxacin. the patient had a ct guided thoracentesis with pigtail catheter placement on . cultures on this fluid to date are without growth. sputum culture has growth only from with moraxella. the patient was transitioned to vancomycin and zosyn and is now on approximately day 6 of an expected 10 day course of zosyn monotherapy. . on post-op day #2 the patient developed a fib with rvr with a rate to the 130-150's. he developed hypotension to the systolic 70-80's and required transfer for the medical icu. the patient transiently required pressors. he was started on an amiodarone load on . . on the day of transfer from the icu to the floor, the patient underwent picc line placement which failed and ended in midline placement. he is scheduled to undergo revision by ir tomorrow. in addition, he made his code status dnr/dni by icu team report. . currently the patient complains of persistent shortness of breath and lower extremity pain. past medical history: esrd on hd (on tue-thurs-sat schedule) pvd htn chf sys/diastolic(ef 55%) copd crohn's chronic anemia hyperlipidemia cad/mi/pci in 's paroxysmal afib . psh: left axillary-bifem bpg (rest pain), l bka trauma, l aka for ischemia gangrene, right avf with revision, right cfa-bk with nrsvg in with 4 compartment fasciotomy in , appendix, rotator cuff repair, bladder surgery social history: see previous d/c summeries family history: mother died of gastric cancer in her 80's. father died at 85 from esrd. # siblings, one died of liver disease. married with 4 children. physical exam: in icu: vitals: 95.8 84/50 68 20 95% 2l nc gen: nad, appearing older than stated age heent: eomi, perrl. mm dry. lungs: diffuse rhonchi with bronchial breath sounds in the r middle lung field. heart: rrr s1, s2, no mrg abdomen: soft nt, nd, l-sided axillary-fem bypass palpable aka 2+ edema at ankle, necrotic toes, open wound of dorsal foot, open wound with moderate purulence of anterior shin . on transfer from the icu: pe 95.6-96.2 68-104 84-110/40-60 13 99% 2l nc i/o: +315 in 24 hrs, 6.5l length of stay gen: nad, comfortable. heent: perrl. cv: systolic ejection murmur loudest at the right sternal border. regular rate and rhythm. pulm: coarse crackles in bilateral lung fields. abd: soft, nontender, no organomegaly. ext: s/p left bka, vac dressing in place in right shin. surgical wound dressing in place over right 1st and 2nd toes. large bullae. . pertinent results: 05:45pm blood wbc-12.2* rbc-3.54* hgb-8.9* hct-29.0* mcv-82 mch-25.1* mchc-30.6* rdw-17.8* plt ct-300 12:04am blood wbc-10.6 rbc-3.32* hgb-8.4* hct-27.8* mcv-84 mch-25.2* mchc-30.1* rdw-16.5* plt ct-226 03:52am blood wbc-23.6*# rbc-4.30* hgb-10.4*# hct-38.5*# mcv-89 mch-24.1* mchc-26.9* rdw-16.1* plt ct-388# 04:20am blood wbc-39.5*# rbc-3.86* hgb-9.2* hct-33.0* mcv-86 mch-24.0* mchc-28.0* rdw-16.6* plt ct-296 04:52am blood wbc-23.5* rbc-3.78* hgb-9.2* hct-32.4* mcv-86 mch-24.3* mchc-28.4* rdw-16.8* plt ct-302 04:09am blood wbc-9.3 rbc-3.52* hgb-8.6* hct-30.8* mcv-88 mch-24.4* mchc-27.8* rdw-17.0* plt ct-222 06:50am blood wbc-10.4 rbc-3.63* hgb-9.1* hct-30.7* mcv-85 mch-25.1* mchc-29.7* rdw-18.9* plt ct-250 06:00am blood wbc-9.7 rbc-3.75* hgb-9.3* hct-32.3* mcv-86 mch-24.7* mchc-28.7* rdw-17.9* plt ct-254 06:30am blood wbc-10.3 rbc-3.69* hgb-9.3* hct-31.2* mcv-85 mch-25.2* mchc-29.8* rdw-19.8* plt ct-281 04:07am blood wbc-14.3* rbc-3.61* hgb-9.1* hct-30.7* mcv-85 mch-25.3* mchc-29.8* rdw-19.7* plt ct-347 05:45pm blood neuts-84.9* lymphs-7.6* monos-5.8 eos-1.6 baso-0.2 03:52am blood neuts-83* bands-0 lymphs-13* monos-2 eos-2 baso-0 atyps-0 metas-0 myelos-0 06:00am blood neuts-70 bands-0 lymphs-13* monos-9 eos-2 baso-1 atyps-0 metas-2* myelos-3* 08:33pm blood pt-16.4* ptt-45.2* inr(pt)-1.5* 06:30am blood pt-18.6* ptt-34.5 inr(pt)-1.7* 04:07am blood pt-15.2* ptt-32.3 inr(pt)-1.3* 05:45pm blood glucose-142* urean-26* creat-4.7* na-141 k-3.7 cl-98 hco3-28 angap-19 07:01pm blood glucose-108* urean-19 creat-3.6*# na-141 k-4.0 cl-105 hco3-22 angap-18 04:07am blood glucose-88 urean-21* creat-4.9*# na-140 k-4.3 cl-100 hco3-29 angap-15 04:07am blood alt-31 ast-17 ld(ldh)-172 alkphos-277* totbili-0.7 04:20am blood lipase-58 06:00am blood ggt-238* 01:10am blood ck-mb-notdone ctropnt-0.79* 09:10am blood ck-mb-notdone ctropnt-0.74* 04:10pm blood ck-mb-notdone ctropnt-0.38* 11:40pm blood ck-mb-notdone ctropnt-0.40* 06:00am blood ck-mb-notdone ctropnt-0.45* 09:48am blood totprot-6.1* albumin-3.0* globuln-3.1 04:20am blood totprot-6.1* albumin-2.9* globuln-3.2 calcium-9.4 phos-7.5* mg-2.0 06:00am blood albumin-2.9* calcium-10.1 phos-4.6* mg-1.7 04:07am blood calcium-10.0 phos-4.6* mg-1.6 07:00am blood anca-pnd 04:09am blood vanco-13.8 04:20am blood vanco-5.2* 07:01pm blood holdblu-hold 10:37pm blood lactate-1.4 imaging: preop pa and lateral chest, impression: 1. dense right middle lobe consolidation, new since , likely pneumonic. 2. chf with interstitial edema; new small right pleural effusion may relate to either process. . ct chest w/o contrast 4:23 am impression: bilateral loculated pleural effusions, right more than left. right lower lobe and middle lobe _____ pneumonia. moderate apical emphysema. moderate mediastinal adenopathy. . impression: ct thoracentesis w/tube placment 2:49 pm 1. successful ct-guided subcutaneous catheter drainage placement. 2. incidental 6 mm right middle lobe pulmonary nodule and emphysema. _____ catheter care and findings of this _____ pulmonary nodule discussed with dr. at 4:30 p.m. on . . liver or gallbladder us (single organ) port 8:20 pm impression: 1. ascites and pulsatile flow within the portal vein which may relate to congestive heart failure. 2. extensive sludge within the gallbladder (which may relate to the patient's overall clinical status), but no evidence of acute cholecystitis. . chest (portable ap) 7:03 am impression: new right-sided chest tube. no evidence of pneumothorax. interval improvement in right pleural effusion with residual small amount of fluid remaining in the right major fissure. . chest (portable ap) 3:22 am portable ap chest radiograph was compared to , obtained at 2:18 p.m. the pigtail catheter inserted in the upper pleural space in the right upper lobe is unchanged. there is no interval change in small amount of intrafissural pleural fluid on the right as well as there is no change in the right basal areas of atelectasis. there is interval progression of the engorgement in the left perihilar area which may represent mild volume overload with asymmetric distribution due to patient's position. bibasilar retrocardiac atelectasis are unchanged. no pneumothorax or left effusion is demonstrated. . ecg: study date of 9:28:38 pm sinus rhythm. left ventricular hypertrophy with secondary st-t wave changes although myocardial ischemia cannot be ruled out. compared to the previous tracing of left ventricular hypertrophy is more prominent and st segment depressions in the lateral leads are also more prominent. tracing #1 . ecg: study date of 9:45:50 am atrial fibrillation with rapid ventricular response. left ventricular hypertrophy. st segment depression in leads v4-v6 which may be related to ischemia in the setting of left ventricular hypertrophy. clinical correlation is suggested. compared to the previous tracing of atrial fibrillation persists with a slightly slower ventricular response. . ecg:study date of 1:06:08 pm atrial fibrillation with rapid ventricular response slight nonspecific intraventricular conduction delay nonspecific st-t abnormalities since previous tracing of , precordial qrs voltage less prominent and st-t wave changes decreased brief hospital course: . #pneumonia: patient found to have consolidation on admission, with ct scan demonstrating loculated pleural effuions. sputum cultures grew moraxella. patient was started on zosyn in house. pig-tail catheter was placed to drain pleural effusion, and cultures sent, but were without growth. moraxella felt to be an unlikely pathogen, and patient was clinically improving on zosyn, so was continued on this regimen for plan of full 14 day course. pig-tail catheter was pulled on the floor after several days and consultation with thoracics. cxr following removal demonstrated no pneumothorax, or significant reaccumulation of fluid. plan to complete course of zosyn via picc as directed below for full 14 days. - patient should have repeat cxr in weeks time to document resolution of his infiltrate. - please remove picc upon completion of antibiotics. . #atrial fibrillation: patient with a. fib with rvr. during initial presentation did not tolerate this rhythm well and was hypotensive requiring icu stay. as a result, patient was loaded with amiodarone with goal of maintaining sinus rhythm. patient tolerated amio load well and converted to sinus rhythm prior to call-out from the icu. did have recurrence of a. fib with rvr on the floor that second of which required iv diltiazem to break. patient was then started on low dose oral diltiazem for rate control and remained in sinus rhythm for the remainder of his hospital stay and 48 hours prior to discharge. plan to continue amiodarone and diltiazem and f/u with outpatient for further management. not require long term amiodraone for rhythm control and would consider discontinuation once his pneumonia resolved. patient was not anticoagulated given he his only indication was history of chf. . #hypotension: in setting of a. fib with rvr and pneumonia. consistent with sepsis and unstable tachycardia. improved with ivf's and rhythm control of his a. fib. recommend monitoring blood pressures by mentation, and l-forearm given av fistula on r-arm and picc proximal on the left. . #amputation: patient had successful 1st/2nd toe amputation with debridement of his arterial ulcer. patient followed closely by surgery in house who recommended outpatient follow-up on discharge. continue current wound-care and wound vac with changes as directed. . #esrd: continued on hd in house. last session on day of discharge - saturday. continue t/h/sat dialysis. . #sacral wound: seen by wound care nurse in-house. continue dressing changes as directed. . #coagulopathy: mild coagulopathy in house on antibiotics. thought to abx and nutriotional status. given po vitamin k with subsequent improvement. . #transaminitis/liver: developed in-house. thought to hypotension/shock liver. normalized prior to discharge. if recurs would consider amiodarone toxicity. patient with persistent alk phos elevation and ggt confirming it to be hepatic and not from recent amputation. liver usd with biliary sludge but no e/o cholecystitis/ductal dilation or other acute pathology. would consider outpatient ercp/mrcp in future given h/o crohn's disease and elevated alk phos - concern for psc. sent p-anca in house - pending at time of discharge. . #crohn's disease: continued on outpatient regimen. no diarrhea. #leukocytosis: mild new leukocytosis on day prior to discharge. vitals stable, afebrile, and without e/o infection. if develops diarrhea would have concern for c. diff in this hospitalized, hd patient on zosyn. . #lung nodule: patient had several ct scans in house. on one occasion a scan found a 6 mm right middle lobe pulmonary nodule. recommend repeat evaluation w/ ct scan of this nodule as an outpatient once acute pneumonia has resolved to better ascertain size of nodule and assess for interval change. # chronic anemia. stable, likely anemia of chronic disease. # cad s/p mi with pci in the 's. no signs of active ischemia. st depressions on ekg correlated with a. fib w/ rvr and enzymes stable. troponin mildly elevated but to esrd and demand from rapid rate. - continue aspirin, nitroglycerin prn. . # psych. continue buspirone and sertraline. stable. # prophylaxis. heparin subcutaneously, ppi. antiemetics prn. # access: tunnelled line, midline. please remove midline after completion of antibiotics. # code: dnr/dni . medications on admission: oxygen 2l/min carvedilol 25 omeprazole 20 asacol 1200 tid phoslo 3 caps tid alprazolam buspar zoloft qhs ec-asa 325 qd nitro 0.4 sl prn fe pills . discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 3. mesalamine 400 mg tablet, delayed release (e.c.) sig: three (3) tablet, delayed release (e.c.) po tid (3 times a day). 4. calcium acetate 667 mg capsule sig: three (3) capsule po tid w/meals (3 times a day with meals). 5. alprazolam 0.25 mg tablet sig: two (2) tablet po bid (2 times a day) as needed. 6. buspirone 10 mg tablet sig: one (1) tablet po bid (2 times a day). 7. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 10. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 11. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed. 12. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours). 13. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day) for 2 days: through , and then begin reduced dose prescription. 14. amiodarone 200 mg tablet sig: one (1) tablet po once a day: to start on after completion of loading phase. 15. diltiazem hcl 30 mg tablet sig: 0.5 tablet po q6h (every 6 hours): hold for sbp < 100. 16. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 17. piperacillin-tazobactam 2.25 gram recon soln sig: one (1) recon soln intravenous q12 () for 5 days: through for total of 2 weeks. 18. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 19. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. discharge disposition: extended care facility: - discharge diagnosis: 1st and second toe amputation arterial ulcer atrial fibrillation with rapid ventricular response pneumonia sepsis end stage renal disease transaminitis sacral ulcer discharge condition: stable, non-weight bearing. discharge instructions: you were admitted to the hospital for a toe amputation. on admission it was found that you had a pneumonia. your amputation was performed successfully and your leg ulcer was surgically debrided. you were then treated for your pneumonia. . you also developed an irregular heart rate known as atrial fibrillation and required the intensive care unit for monitoring and control of your heart rate. you were started on 2 new medications for control of this heart rate - amiodarone and diltiazem. you should discuss these with your doctor as you may not need to take them long term. in the short term however, please take all new medications as directed upon leaving the hospital. . please call your physician should you develop any new lower extremity pain, chest pain, palpitations, shortness of breath, fever > 101 or any other symptom concerning to you. . you must take the following medications: 1. piperacillin/tazobactam - for total of 2 weeks through 2. amiodarone - 400mg twice daily and then 200mg daily thereafter. please do not discontinue this medication without discussing it with your doctor. 3. diltiazem 15mg by mouth every 6 hours. please do not discontinue this medication without discussing it with your doctor. 4. please continue all other medications as directed. followup instructions: provider: , md phone: date/time: 12:30 on the building, chest disease center, , building. you will see the np or report to the clinical center, radiology for a chest x-ray 45 minutes before your appointment. .. provider: surgery -> at 11:45am, with , 110 5c, ( . provider: , , , please call for an appointment in the next 1 month. procedure: venous catheterization, not elsewhere classified hemodialysis thoracentesis amputation of toe amputation of toe excisional debridement of wound, infection, or burn diagnoses: pneumonia, organism unspecified anemia in chronic kidney disease end stage renal disease unspecified pleural effusion congestive heart failure, unspecified unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation other and unspecified hyperlipidemia regional enteritis of unspecified site septic shock pressure ulcer, lower back atherosclerosis of native arteries of the extremities with gangrene above knee amputation status ulcer of ankle chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to