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: simvastatin / nitrofurantoin attending: chief complaint: altered mental status in the presence of acute tubular necrosis, constipation, osteomyelitis, dm2, hcv & osteomyelitis to the r heel major surgical or invasive procedure: central ine was placed in micu picc line was placed for discharge history of present illness: mr. is a 66 year old man dm2, hcv, pvd, chronic heel ulcers who presents from his nursing home with mental status changes. he was recently admitted from to the vascular surgery service for debridement of a right heel ulcer. he had a rle cath on and creatinine was stable afterwards. he underwent r heel debridement on which was without complications. . today at rehab he was found to have acute mental status changes. per reports, he was noncompliant with wound vac and keeps taking it off. today at 8am he was very lethargic with slurred spech and low blood sugars. he was given juice and sugars came up to 99. he was able to open eyes and carry out a conversation. at 11am he was given percocet for leg pain. he was noted to have serosanguinous drainage from his r heel and was sent to for further evaluation. . in the ed, initial vs were: t 100.2 p 97 bp 115/53 r 12 o2 sat 97% ra. patient was found to have a potassium of 7.7, acute renal failure with a creatinine of 5.5 and was hypotensive. he was given vanc/zosyn, 30gm of kayexalate pr, insulin, glucose, calcium gluconate. repeat potassium was 7.3. renal was consulted. he was given another round of kayexelate 30gm pr, insulin, glucose, and calcium. he was given 1 amp of bicarb and 1 albuterol neb. renal ultrasound did not show hydronephrosis. blood pressures were in the 80s-90s after 2.5l ns and he was started on levophed. hct was noted to be 23. he was guaiaic negative. . on arrival, he was mildly arousable to pain and loud voice. he was unable to answer questions. he mumbles and speech is unintelligible. in speaking to a nurse at his rehab, he was sent in for lethargy. she did not know if he was hypotensive today but normal blood pressures are 120s and up. . on the floor, hyperkalemia was maintained stable. treatment continued by attempting to match urine output, post atn diuresis. holding hctz, lasix, spironolactone. continued vanc/zosyn. id and vascular consulted, 4-6 weeks of antibiotics for osteo. the patient currently has a right sided ij. no picc was ordered yet given possibility of po antibiotics. bp has been stable. u and serum tox ok. still is encephalopathic, getting lactulose. rifaximin was started. fsbg have been ok during admission. prostate ca, has chronic foley, needed larger foley. currently not leaking, no hydronephrosis on ct. past medical history: dmii htn prostate cancer score 4+4, s/p external beam xrt, chronic foley hcv genotype ib acquired via iv drug use in the 70s rhabdomyolysis statins in and immobility in pvd s/p chronic heel ulcerations hx of osteomyelitis hx of cocaine abuse pvd anxiety . psh: r tibioperoneal trunk angioplasty (04), r akpop-pt bypass (, failed 06)non-reversed greater saphenous vein, r pt angioplasty (06)bilateral hallux arthroplasty, right fifth digit debridement (06) exlap for auto accident, hx of tracheostomy, turp , incision and drainage, left hallux, bilateral total knee replacements social history: social history (per records): smokes half pack per day; does not drink any alcohol. currently living in a nursing home, previous history of cocaine abuse. family history: diabetes in both mother and father physical exam: on admission: general: obese african american man, sleeping comfortably heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: diffusely wheezey without crackles cv: regular rate and rhythm, normal s1 + s2, 2/6 systolic ejection murmur at the rusb, rubs, gallops abdomen: protuberant, soft, non-tender, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley with urine leaking around it ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 12:00pm blood wbc-8.5 rbc-2.63* hgb-7.8* hct-23.2* mcv-88 mch-29.5 mchc-33.5 rdw-18.4* plt ct-335 06:40pm blood pt-14.9* ptt-39.0* inr(pt)-1.3* 12:00pm blood glucose-103* urean-73* creat-5.5*# na-117* k-7.5* cl-88* hco3-16* angap-21* 12:00pm blood alt-21 ast-42* ld(ldh)-272* alkphos-92 totbili-0.2 03:50pm blood ck(cpk)-488* 04:06am blood alt-20 ast-34 ld(ldh)-220 ck(cpk)-483* alkphos-87 totbili-0.4 11:21pm blood ck(cpk)-350* 03:50pm blood ck-mb-7 ctropnt-0.12* 04:06am blood ck-mb-7 ctropnt-0.07* 03:50pm blood calcium-8.8 phos-7.4*# mg-2.5 06:40pm blood crp-31.9* . urine: 01:00pm urine color-straw appear-clear sp -1.008 01:00pm urine blood-lg nitrite-neg protein-25 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 01:00pm urine rbc-0-2 wbc-0-2 bacteri-none yeast-none epi-0-2 01:00pm urine amorphx-occ 01:00pm urine eos-positive 11:37am urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg 03:47pm urine hours-random urean-255 creat-64 na-22 k-29 cl-17 03:47pm urine osmolal-232 . imaging: head ct: no acute intracranial process. renal u/s: 1. no hydronephrosis. 2. foley catheter is not visualized due to body habitus, however, no distended bladder seen. . xray r foot: there is a larger surgical defect without evidence of underlying posterior calcaneal tubercle osteomyelitis. . kub: no evidence of free air in the abdomen. . tte: the left atrium is normal in size. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve is not well seen. there is probably no aortic valve stenosis but transvalvular velocities were suboptimally assessed. no aortic regurgitation is seen. the mitral valve is probably structurally normal (views suboptimal) with trivial mitral regurgitation. there is no pericardial effusion. . ct abd/pelvis: 1. large volume of retained stool in the colon. 2. progressive degenerative change involving the hips. . discharge: blood & chem: 03:51am blood wbc-8.6 rbc-3.00* hgb-8.9* hct-26.6* mcv-88 mch-29.5 mchc-33.3 rdw-18.8* plt ct-236 04:17am blood type-art po2-96 pco2-46* ph-7.32* caltco2-25 base xs--2 03:51am blood pt-15.0* ptt-37.9* inr(pt)-1.3* 03:51am blood glucose-121* urean-11 creat-1.0 na-131* k-3.7 cl-100 hco3-26 angap-9 liver: 05:45am blood alt-13 ast-21 alkphos-59 totbili-0.2 heart: 03:50pm blood ck-mb-7 ctropnt-0.12* 04:06am blood ck-mb-7 ctropnt-0.07* 11:21pm blood ck-mb-5 ctropnt-0.04* 06:30am blood ck-mb-4 ctropnt-0.02* iron, etc: 05:34am blood vitb12-415 folate-19.7 06:30am blood caltibc-224* ferritn-274 trf-172* 05:34am blood tsh-3.8 05:34am blood psa-8.4* inflammatory markers: 06:40pm blood esr-145* 06:40pm blood crp-31.9* brief hospital course: brief micu course: mr. is a 66 year old man with dmii, hcv, chronic r heel ulcers who presents from his nursing facility with hyperkalemia, acute renal failure and mental status changes. he was treated with kayexalate, insulin, glucose, bicarb and albuterol. his potassium improved. his renal failure was felt to be due to post-obstructive vs. atn. his lasix and spironolactone were both held. his foley was changed to a #20 in the ed and he had large amounts of urine output. his mental status decline was likely due to uremia and hepatic encephalopathy and improved with lactulose. he had large amounts of stool output. he had a tte to assess his heart murmur. he arrived to the icu on levophed which was quickly weaned down. he was given vanc/zosyn due to possible sepsis. id, vascular surgery and podiatry were consulted for management of his right heel which was the only possible source of his sepsis. he had a ct of his abdomen due to abdominal distension which showed stool in the colon. his abdomen improved with a bowel regimen. initially his sedating medication were held but these were restarted when his mental status improved. he was given small doses of dilaudid for pain which was changed to percocet when he was able to eat. his blood pressure was stable for the remainder of his icu stay. . on the floor: # hyperkalemia: likely due to acute renal failure. patient has been treated with kayexelate, insulin, glucose, calcium, albuterol. potassium is normalized to normal levels and has been stable on the floor. we continued to adjust ivf in less than outs (1/2ns per renal recs). spirinolactone was held, along with lisinopril until , lisinopril was resumed. we have asked the rehab facility to check biweekly potassium to ensure appropriate levels. . # acute renal failure: likely related ot hypotensive episode causing atn. no hydronephrosis on ultrasound. patient had elevated cks but not high enough to be considered rhabdo. possible medication contribution includes lisinopril, hydrochlorothiazide, lasix, sprinolactone and antibiotics (cipro). we continued 0.5 of 1/2ns in to 1lout. creatinine was stabilized - 1.0 on . lisinopril was resumed (), hctz was resumed , foley was switched to a #20 after it was found to leak. fluid levels, as above, were maintained, lasix was also held. . # hypotension: be hypovolemia vs. sepsis. pt has been receiving 75ml/hr x 1l per day on floor. levophed was stopped. source is possibly foot ulcer. cultures in the past were positive for mrsa and patient was on cipro/clinda at rehab. pt. switched to vanco/zosyn in micu, wound now shows , pt. was switched to linezolid & zosyn. blood cultures shows no growth, we continued to hold levophed. lisinopril & hctz restarted & blood pressure stable. the patient was not started on lasix or spirinolactone on this admission. if pt. blood pressure becomes unable to control, would consider calcium channel blocker or beta blocker. . # mental status changes: differential diagnosis includes uremia from acute renal failure, hyperkalemia, toxins, hepatic encephalopathy, hypoglycemia, sepsis. the patient had a hypoglycemic event at rehab which seemed to trigger the mental status changes, unclear if this ever resolved. head ct was negative. treating patietns renal failure, as above, caused the patients symptoms to improve. urine & blood cx negative. bowel movement is now regular, rx standing lactulose. we held the mirtazapine & melatonin, and attempted to wean oxycodone and other pain medications. . # anemia: hct 21 on asmission. prior admission hct was 25-28. guaiac negative in the ed. pt was maintained around 25-27 throughout the stay. pt. restarted on iron & folate on discharge. . # pt has hcv infection, but no prior evidence of ascites. pt. was initially treated as having cirrhosis, but there is no fibrosis evident on exam or imaging. pt is making appropriate bm >once per day. . # dm2: the patient was hypoglycemic on admission, so lantus, metformin on admission & pt. was maintained on insulin ss alone. we did not administer lantus or metformin. . # r heel ulcer: per nursing facility, was not compliant with wound dressings/wound vac. pt. denied surgical intervention. per vasc, pt was poor flow distal to the ankle. per id, pt is on linezolid & zosyn x6 weeks for om. will have f/u appointments with id, vasc & pod. pod recs wet to dry dressing changes daily & multipodus boots. . pt. was full code throughout this stay - discussed with patient during this stay. medications on admission: per nursing home records: cipro 500mg po q12 x 14 days (last day ) clinda 300mg po bid x 14 days (last day ) colace 100mg po bid oxybutynin 5mg po tid clonazepam 0.5mg po bid lisinopril 20mg po daily lantus 25 units sc bid tylenol 650mg po daily prn pain dulcolax 10mg supp daily for constipation mom 30ml po if no bm in 3 days lactulose 30ml po bid metformin 1000mg po bid venlafaxine 150mg po qday doxazosin 8mg po qhs melatonin 3mg po qhs asa 81mg po qday spironolactone 25mg po daily mvi 1 tab po daily thiamine 100mg po daily hctz 12.5mg po daily folic acid 1mg po daily percocet 5/325mg 2 tabs po q6h prn pain lasix 40mg po qday ferrous sulfate 325mg po bid famotidine 20mg po daily 2 tab po daily mirtazapine 45mg po qhs gabapentin 300mg po qhs lactulose 30ml po bid oxycontin 80mg po q12h discharge medications: 1. oxycodone 40 mg tablet sustained release 12 hr sig: two (2) tablet sustained release 12 hr po q12h (every 12 hours): hold for sedation, rr<12 . disp:*120 tablet sustained release 12 hr(s)* refills:*0* 2. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation: prn constipation . 3. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sedation. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. venlafaxine 75 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po daily (daily). 6. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). 7. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 8. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed for constipation/confusion. 9. 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation/confusion. 10. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 6 weeks. 11. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily): hold is sbp <100. 12. hydrochlorothiazide 12.5 mg capsule sig: two (2) capsule po daily (daily). 13. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q4h (every 4 hours) as needed for constipation/confusion: please give if constipation does not resolve. 14. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: one (1) intravenous q8h (every 8 hours) for 6 weeks. 15. heparin, porcine (pf) 10 unit/ml syringe sig: ten (10) ml intravenous prn (as needed) as needed for line flush: line flush per protocol. 16. tylenol 325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 17. milk of magnesia 800 mg/5 ml suspension sig: one (1) po every 4-6 hours as needed for constipation. 18. doxazosin 8 mg tablet sig: one (1) tablet po at bedtime. 19. multiple vitamin tablet sig: one (1) tablet po once a day. 20. thiamine hcl 100 mg tablet sig: one (1) tablet po once a day. 21. folic acid 1 mg tablet sig: one (1) tablet po once a day. 22. percocet 5-325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. disp:*50 tablet(s)* refills:*0* 23. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 24. insulin please provide sc insulin based on provided sliding scale. 0-70 mg/dl proceed with hypoglycemia protocol breakfast lunch dinner qhs 71-150 mg/dl 0 units 0 units 0 units 0 units 151-200 mg/dl 2 units 2 units 2 units 2 units 201-250 mg/dl 4 units 4 units 4 units 4 units 251-300 mg/dl 6 units 6 units 6 units 6 units 301-350 mg/dl 8 units 8 units 8 units 8 units 351-400 mg/dl 10 units 10 units 10 units 10 units 25. outpatient lab work please check weekly cbc, chem 7 and lfts and fax to clinic at discharge disposition: extended care facility: rehabilitation & nursing center - discharge diagnosis: principle diagnosis: acute tubular necrosis hyperkalemia altered mental status right heel cellulitis . secondary diagnosis: diabetes type ii constipation hepatitis c hypotension anemia prostate cancer discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: thank you for letting us participate in the management of your care; we hope that you enjoyed your stay with us. . you were admitted for altered mental status, osteomyelitis, acute tubular necrosis and hyperkalemia. you were initially admitted to the icu in critical condition. you were treated with iv fluids and medications to correct your high potassium. you were able to be sent to the medical floor, and your symptoms continued to improve. you were eventually restarted on some of your blood pressure medications, however it was thought that you were on too many resulting in dehydration and low blood pressure that caused your initial problems. were also found to be very constipated. it is important for you to take enough stool softners/laxatives to move your bowels daily. you are on many medications that can make your constipation worse. . per infectious disease, you are to be on linezolid + zosyn for 4-6 weeks to treat your osteomyelitis of your right foot. you should have weekly cbc, chem-7's & lft's drawn. please fax these results to clinic at . you will have a scheduled follow-up with id, as you can see below. . also, you are to continue wearing your multipodus boots (which off-load both heels, and malleoli to prevent a pressure ulcer). you should also get daily wet-to-dry dressing changes to your right heel, and follow up with vascular surgery & podiatry surgery on an outpatient bases. . continue these new medications: linezolid 600 mg by mouth every 12 hours day 1 = piperacillin-tazobactam 4.5 g iv every eight hours . continue these medications: -hydrochlorothiazide 25 mg daily (increased from 12.5mg) -lisinopril 20 mg daily -aspirin 81 mg daily -insulin sliding scale (per insulin flowsheet) - bowel regimen of bisacodyl 10 mg, lactulose 30 ml, docusate sodium 100mg, mom, and as needed to induce at least one bm daily -clonazepam 0.5 mg twice a day -famotidine 20 mg daily -gabapentin 300 mg at night -oxycodone sr (oxycontin) 80 mg twice a day -percocet as needed -venlafaxine xr 150 mg daily -mvi 1 tab daily -thiamine 100mg daily -folic acid 1mg daily -doxazosin 8mg at night -ferrous sulfate 325mg po bid -tylenol 650mg po daily prn pain . the following medications were stopped - do not restart: -cipro 500mg po q12 x 14 days (last day ) -clinda 300mg po bid x 14 days (last day ) -oxybutynin 5mg po tid -lantus 25 units sc bid (did not require while inpatient) -metformin 1000mg po bid -melatonin 3mg po qhs -spironolactone 25mg po daily -lasix 40mg po qday -mirtazapine 45mg po qhs followup instructions: please keep the following appointments: department: podiatry when: tuesday at 11:40 am with: , dpm building: ba ( complex) campus: west best parking: garage department: vascular surgery when: wednesday at 12:15 pm with: , md building: lm bldg () campus: west best parking: garage department: hematology/oncology when: thursday at 10:00 am with: , md,phd building: sc clinical ctr campus: east best parking: garage department: infectious disease when: at 03:00p with: , where: lm , basement id west (sb) procedure: venous catheterization, not elsewhere classified diagnoses: hyperpotassemia anemia, unspecified acute kidney failure with lesion of tubular necrosis chronic hepatitis c without mention of hepatic coma diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of malignant neoplasm of prostate hypotension, unspecified other constipation hepatic encephalopathy knee joint replacement cellulitis and abscess of foot, except toes ulcer of heel and midfoot long-term (current) use of aspirin chronic osteomyelitis, ankle and foot 

Answer: The patient is high likely exposed to