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: aspirin attending: chief complaint: lle wound infection, pain major surgical or invasive procedure: lle incision and drainage , wound debridement, and wound closure history of present illness: 52 m with poorly controlled dm1 complicated by charot's joints, gastroparesis, orthostatic hypotension, peripheral neuropathy, and retinopathy with long history of multiple orthopedic complications. he initially fractured his left midfoot in that required external fixation and closed reduction. however, he ambulated on his leg and fractured the pins and had tibial fracture. on pin removed and had orif of left tibial fracture with plate. again, after bearing weight on , he developed a non- fracture of his tibia and plate fracture. he refused surgery and was treated conservatively. on he developed bimalleolar fracture of his left ankle which was treated conservatively. on his plate removed, and tibial rod and nails placed. on , he presented to ortho clinic with nails exposed through skin and admitted. he had removal of hardware on with i+d of left ankle abscess. gram stain of abscess grew enterobacter cloacea and he has been on zosyn for treatment. pt was to go back to or on for further debridement of his left foot wounds. of note, he had been given 4 mg ativan po, 3 doses of 20mg oxycodone, 5mg ambien after 18:00. he was last seen well at 03:00 am and most recent set of floor vitals at mn 100.3 118/72 84 20 95%(ra). at 4:20 am pt found unresponsive, diaphretic, and pulseless by nurse and code blue called. on arrival, pea arrest at 20's, given 2 rounds of epi/atropine, 1 amp of nahco3 with return of pulse to 140's and bp 115/p at 04:35 am. right femoral line placed and pt intubated. post intubation abg during code 7.15/85/424, k 4.0, lactate 7.1, and glucose 343. pt transfered to icu. on arrival to icu, a-line place and bp 130's systolic hr 70's. initiated on a/c 600/20 peep 5 fio2 100%, abg 7.38/44/379. cxr (my read) c/w lll opacity, mild chf, left rib fractures. ekg shows sinus @ 75, l axis deviation, ivcd, and no st/t wave changes compared to baseline. he was transferred to the medicine service once he became stable after extubation. past medical history: 1. dm1 since age 18 -retinopathy - s/p laser surgery -peripheral nerve neuropathy -gastroparesis 2. charcots joint 3. left phrenic nerve neuropathy 4. orthostatic hypotension 5. hypercholesterolemia 6. cath 00': no cad, ef 65% 7. breathing sleep disorder ? 8. h/o penile implant social history: social history: lives in with wife and kids. disabled. no tob, no etoh, no drugs family history: non contributory physical exam: pe 96.7 87 133/78 14 96% a/c 600/20 (3) peep 5 40% pip 38 plat 31; 7.42/49/60 gen: intubated, responds to painful stimuli heent: pupils dilated equally bilaterally, no reflex neck: supple cv: rrr, no m/r/g pulm: cta anteriorly abd: obese, ventral hernia, soft ext: left foot in -valve cast; right antecub picc c/d/i neuro: moves all 4 ext, responds to painful stimuli pertinent results: 09:17am blood wbc-11.2*# rbc-3.65*# hgb-10.5*# hct-32.1*# mcv-88 mch-28.9 mchc-32.8 rdw-15.3 plt ct-487*# 12:00am blood hct-31.6* 05:41am blood wbc-11.1* rbc-3.55* hgb-10.0* hct-31.1* mcv-88 mch-28.3 mchc-32.2 rdw-14.6 plt ct-565* 05:16am blood wbc-10.0 rbc-3.90* hgb-10.8* hct-33.9* mcv-87 mch-27.8 mchc-32.0 rdw-15.0 plt ct-624* 05:02am blood wbc-9.1 rbc-3.80* hgb-10.9* hct-33.3* mcv-88 mch-28.6 mchc-32.7 rdw-15.0 plt ct-561* 05:35am blood wbc-10.5 rbc-3.77* hgb-10.7* hct-32.8* mcv-87 mch-28.5 mchc-32.7 rdw-15.1 plt ct-550* 05:25am blood glucose-102 urean-14 creat-0.8 na-135 k-4.1 cl-95* hco3-30 angap-14 05:20am blood glucose-222* urean-15 creat-0.7 na-133 k-4.1 cl-94* hco3-33* angap-10 05:06am blood glucose-193* urean-15 creat-0.8 na-136 k-4.4 cl-96 hco3-33* angap-11 05:41am blood glucose-82 urean-17 creat-0.7 na-138 k-4.3 cl-97 hco3-34* angap-11 05:16am blood glucose-140* urean-17 creat-0.7 na-137 k-4.2 cl-95* hco3-33* angap-13 05:02am blood glucose-99 urean-20 creat-0.8 na-136 k-4.1 cl-96 hco3-32 angap-12 05:35am blood glucose-206* urean-20 creat-0.8 na-135 k-4.5 cl-97 hco3-31 angap-12 10:12am blood %hba1c-7.3* brief hospital course: 52 year old man with poorly controlled dm1 and peripheral neuropathy complicated by multiple orthopedic fractures and infections s/p pea arrest and wound debridement/closure. . # pea arrest - differential diagnosis was broad but most likely etiologies were pe, medication overdose, hypoxia. his body habitus and multiple medications preclude him to hypoventilation and hypoxia. his initial acidosis was likely secondary to hemodynamic collapse and hypoventilation. mi, tamponade, blood loss, sepsis, hyperkalemia were less likely etiologies. the patient did not require any pressors and was in fact hypertensive to the 200s on admission to the icu on propofol gtt. his cardiac enzymes were mildly elevated but felt to be secondary to demand, there were no ekg changes. a stat echo was performed in the micu on which showed no effuson/tamponade. ef 55-60%. the echo had suboptimal windows given large habitus so focal wall motion could not be excluded. cta was negative for pe but showed bilateral pulmonary infiltrates likely due to aspiration. his head ct was negative. ultrasounds of his lower extremities were negative from venous thromboembolism. his eeg was negative for seizure activity but showed slow disorganized background and generalized slowing consistent with metabolic disorder. therefore, most likely, his pea arrest was secondary to hypoxic/hypercarbic resp distress from oversedation with narcotics and benzos. since then, the amount of narcotics the patient has been receiving has been monitored closely and was slowly titrated up for optimal pain control. . # id - notable for growth of enterobacter from his lle wound, pan-sensitive to all abx. other cx, including blood, stool and urine have all been ngtd. he did have 1+ gpc in the sputum, likely aspiration pna. he was on iv zosyn for 2 weeks, and was recently switched to po cipro/flagyl to cover his lle infection and ?aspiration pna given his persistent left lower lobe consolidation on cxr. he needs to remain on these abx for 6-8 weeks, and will f/u with id on . he will need labs checked and faxed to clinic as specified in the d/c instructions. currently, no other source of infection has been indentified. depending on how his lle infection responds to abx and then off abx for at least 4 weeks, amputation is a likely possiblity if he does not clear the infection. pt will follow with dr. in clinic. . # respiratory failure his respiratory failure was likely due to excess fluid overload or hypoventilation secondary to overmedication with narcotics and osa. after the patient was extubated and transferred to the medicine floor, we very cautiously titrated up his narcotics and continued to monitor his respiratory rate. we continued to diurese him with lasix as needed. his respiratory status has been stable for several days and he has not required any supplemental oxygen in the last few days. . # delta ms it remains unclear how long patient was unresponsive and duration of hypoxic brain injury. he appeared to have fixed and dilated pupils in icu with a question of increased tone and dystonic movement. therefore, an eeg was performed on which showed diffuse slow waves with no epileptiform movement. no paralytics were given during code. the patient's mental status improved post extubation. the patient pulled his left subclavian central line on arrival to the medicine floor but showed no signs of confusion or delirium. he remained alert and oriented x3 for the remainder of his hospitalization, and was back to his baseline status. . # dm ?????? an insulin gtt was initiated on admission to the icu. on arrival to the medicine floor, the patient??????s blood glucose was poorly controlled at first but patient was followed by and with the appropriate amounts of fixed and regular insulin, he was much better controlled during the second half of his hospitalization. his blood glucose was monitored qachs by finger sticks and he remained on a diabetic diet when not npo. he should be maintained on his current insulin regimen as specified in the d/c meds. . # tachypnea: the patient became tachypneic on a couple of occasions. it was likely due to fluid overload, pneumonia, or reactive airways/bronchospasm. he responded well to albuterol nebs and diuresis. the last episode of tachypnea was due to anxiety about going to the or. patient reported being extremely anxious and responded to a small amount of ativan. he did not experience tachypnea for the last 4-5 days of hospitalization after going to the or. . #fever/hypoxia: the patient had low-grade fevers during his hospitalization with no growth on blood and urine cultures, negative ua's, and unchanged cxrs. his fever was likely due to his le infections or aspiration pna given his persistent cxr opacities. he has been afebrile for the last 1 1/2 weeks of his hospital course. . # htn the patient remained on lopressor 75 mg tid, captopril was added for better control. he responded well and his sbps were in the 110s to 130s prior to discharge. . #. fen - his electrolytes were repleted as needed. when not npo, he remained on a low sodium, heart healthy, diabetic diet. he tolerated pos well. . # . prophylaxis -patient remained on lovenox throughout his hospital course #. code - full code #. communication - wife, ; medications on admission: 1. enoxaparin 30 mg/0.3 ml syringe sig: one (1) subcutaneous (2 times a day). disp:*60 syringes* refills:*2* 2. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 3. becaplermin 0.01 % gel sig: one (1) appl topical daily (daily). disp:*1 tube* refills:*2* 4. oxycodone 20 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po q12h (every 12 hours) for 2 weeks. disp:*28 tablet sustained release 12hr(s)* refills:*0* 5. oxycodone 5 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* discharge medications: 1. outpatient lab work check cbc, esr, crp, bun, and cr in one week () and fax results to dr. at . 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*60 tablet(s)* refills:*2* 3. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). disp:*270 tablet(s)* refills:*2* 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*30 nebs* refills:*2* 5. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. disp:*30 nebs* refills:*0* 6. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day). disp:*45 tablet(s)* refills:*2* 7. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. disp:*60 ml(s)* refills:*0* 8. tramadol 50 mg tablet sig: 0.5 tablet po q8-10h () as needed. disp:*20 tablet(s)* refills:*0* 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 11. desipramine 10 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 12. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. disp:*250 ml(s)* refills:*0* 13. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*20 tablet(s)* refills:*0* 14. enoxaparin 30 mg/0.3 ml syringe sig: 30 mg subcutaneous q12h (every 12 hours). disp:*qs mg* refills:*2* 15. ciprofloxacin 250 mg tablet sig: three (3) tablet po q12h (every 12 hours). disp:*180 tablet(s)* refills:*2* 16. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 17. insulin glargine 100 unit/ml solution sig: twenty six (26) units insulin subcutaneous at bedtime. disp:*qs units insulin* refills:*2* 18. insulin regular human 100 unit/ml solution sig: six (6) units insulin injection qac. disp:*qs units insulin* refills:*2* 19. insulin lispro (human) 100 unit/ml solution sig: per sliding scale units insulin subcutaneous qachs. disp:*qs units insulin* refills:*2* 20. insulin please see attached insulin regimen sheet. discharge disposition: extended care facility: medical center - discharge diagnosis: primary: lle non left ankle fracture and wound infection; s/p pea arrest secondary: right heel pressure ulcer, iddm c/b retinopathy, peripheral neuropathym gastroparesis, htn, hl discharge condition: stable, afebrile discharge instructions: -take discharge medication as instructed -keep wounds dry and clean -go to emergency room if temperature greater than 101 or if purulent drainage occurs from wound -no weight bearing on left foot -please follow up with appointments as listed below followup instructions: appointments: provider: , dpm phone: date/time: 11:30 provider: , md phone: date/time: 9:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization excisional debridement of wound, infection, or burn application of external fixator device, tibia and fibula other immobilization, pressure, and attention to wound local excision of lesion or tissue of bone, tarsals and metatarsals removal of implanted devices from bone, tibia and fibula removal of implanted devices from bone, tarsals and metatarsals other local excision or destruction of lesion of joint, ankle application of external fixator device, ring system diagnoses: congestive heart failure, unspecified polyneuropathy in diabetes pneumonitis due to inhalation of food or vomitus cardiac arrest cellulitis and abscess of leg, except foot long-term (current) use of insulin obesity, unspecified pressure ulcer, heel unspecified sedatives and hypnotics causing adverse effects in therapeutic use diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled gastroparesis aftercare for healing traumatic fracture of other bone infection and inflammatory reaction due to other internal orthopedic device, implant, and graft arthropathy associated with neurological disorders other mechanical complication of other internal orthopedic device, implant, and graft aftercare for healing pathologic fracture of lower leg sleep disturbance, unspecified 

Answer: The patient is high likely exposed to