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: history of present illness: this is 50 year old white female with congestive cardiomyopathy, diabetes mellitus, chronic renal insufficiency, hypertension, anemia, and tracheal stenosis, who developed severely swollen legs in , during an episode of congestive heart failure. the patient's lasix dose was increased with improvement of symptoms. however, the patient developed ulcerations of her legs secondary to the swelling and was admitted to the vascular surgical service from until . cultures of the patient's left heel during that admission showed no growth. non-invasive arterial studies showed tibial disease, right greater than left. the patient was discharged home on unasyn for a total of two weeks. the patient was seen in the office with worsening ulcers, right greater than left. the patient was no longer on any antibiotics. the patient complained of severe leg pain, ), which had been a problem since discharge home. the patient had been seen at the pain clinic. a tens unit was tried. however, the patient still had severe pain in her legs. most recently, the patient was using aspirin for pain and darvocet prior to that without any significant pain relief. she has been unable to sleep through the night or tolerate any dressings on her leg ulcers. the patient is admitted for further treatment. past medical history: 1. congestive cardiomyopathy: echocardiogram in , showed severe global biventricular contractile dysfunction with an ejection fraction of 20%; catheterization in in showed no coronary artery disease. 2. myocarditis in . 3. diabetes mellitus since age 11, with triopathy; f/p laser treatment. 4. chronic renal insufficiency. 5. anti-phospholipid antibody syndrome. 6. hypertension. 7. anemia, status post multiple transfusions. 8. peripheral vascular disease. 9. history of arterial embolus to the right first toe, right fifth finger. 10. tracheal stenosis following tracheostomy for respiratory failure in ; requires cpap. 11. osteoporosis. past surgical history: 1. right hemiarthroplasty by dr. , , at . 2. tracheostomy in . family history: noncontributory. social history: the patient lives with her husband. she does not smoke cigarettes. she does not use alcohol. she has been very physically inactive since her leg ulcers started in . allergies: benadryl causes palpitations. the patient is very sensitive to morphine. admission medications: 1. digoxin 0.125 mg p.o. q. 48 hours. 2. diovan 80 mg p.o. q. day. 3. lasix 80 mg p.o. twice a day. 4. zestril 20 mg p.o. q. a.m. 5. calcium carbonate 500 mg two tablets p.o. twice a day. 6. calcitriol 0.25 micrograms p.o. q. day. 7. iron sulfate 325 mg p.o. twice a day. 8. epogen 4000 units subcutaneously tuesday, thursday and saturday. 9. nph insulin 10 units subcutaneously q. a.m. 10. insulin regular, zero to 6 units subcutaneously q. a.m. 11. sliding scale regular insulin at lunch and at dinner. 12. nph insulin 5 units subcutaneously q. h.s. physical examination: vital signs with temperature 98.9 f.; pulse 91; respirations 16; blood pressure 112/60; o2 saturation equals 95% on room air. in general, alert, cooperative white female complaining of severe leg pain secondary to ulcers. skin warm and dry. no rashes. heent: sclerae anicteric. mouth with no lesions. neck: range of motion within normal limits; no lymphadenopathy or thyromegaly. carotids palpable. no bruits. breast examination not done. chest: lungs with decreased breath sounds throughout. heart: regular rate and rhythm without murmur. abdomen soft, nontender; few bowel sounds. rectal examination deferred. extremities with no ankle edema. feet equally warm. large necrotic ulcer present on the right lower anterior leg. multiple small dry ulcers on the right leg. left lower extremity: dry gangrene of the entire heel present. multiple dry surrounding ulcerations of the right foot. vascular examination: carotids, radial and femoral pulses two plus bilaterally. abdominal aorta nonpalpable. popliteal pulses nonpalpable. dorsalis pedis and posterior tibial pulses have doppler signals. neurological examination non-focal. admission laboratory: white blood cell count 7.0, hemoglobin 8.8, hematocrit 28.8, platelets 524,000. sodium 134, potassium 4.8, chloride 98, carbon dioxide 22, bun 108, creatinine 3.6, glucose 157. pt 14.4, ptt 28.0, inr 1.4. albumin 3.2, calcium 7.3, phosphorus 4.5, magnesium 3.6, uric acid 8.7, alt 35, ast 30, alkaline phosphatase 150, total bilirubin 0.1, digoxin level less than 0.3. urinalysis negative. portable chest x-ray shows cardiomegaly without congestive heart failure or pneumonia. ekg shows a normal sinus rhythm at 87, left axis deviation, poor r wave progression, nonspecific st-t changes. possible old inferior myocardial infarction. no significant change since previous ekg. hospital course: the patient was admitted to the hospital on . she was started on levofloxacin and flagyl in renal doses. right anterior leg ulcer was cultured. the patient was unable to tolerate any dressings to her legs. she was extremely fearful of taking pain medications which might affect her respiratory function which was already affected by residual tracheal stenosis after a tracheostomy in . the patient uses cpap routinely. she agreed to try ultram 50 mg p.o. for pain until the pain service could be consulted in the morning; the patient had moderate pain relief with one dose of ultram. on , the service was consulted to manage the patient's insulin requirements during hospitalization. the patient was followed by dr. as an outpatient at the . the renal service was consulted also to monitor the patient's renal function. she was followed by dr. of the renal service. dr. , the patient's cardiologist was consulted for preoperative clearance. the pain service was consulted and started on a fentanyl pca. on , the patient expressed suicidal ideation. a one-to-one sitter was ordered. a psychiatry consultation was requested. psychiatry recommended that the patient restart zoloft, which she had been on in the recent past. the patient started on 25 mg q. day and was titrated up to 100 mg p.o. q. day. the one-to-one sitter was maintained until , when psychiatry felt that the patient no longer had any suicidal or homicidal ideations. on , the patient had a persantine-mibi study requested by dr. . the study showed several moderate fixed defects, with diffuse hypokinesis and an ejection fraction of 19%. the patient was cleared for below the knee amputation surgery. because of the patient's worsening renal status, she underwent an mra of her legs rather than an arteriogram. the mra done on , showed moderate stenosis in the right superficial femoral artery, two-vessel runoff and a good quality dorsalis pedis with distal attenuation. the left sva and popliteal arteries were normal. there was two-vessel runoff into the foot with a high-grade stenosis in the mid-portion of the dorsalis pedis artery. the patient had forefoot pulse volume recordings done on , which showed a 6 millimeter deflection on the right and a 16 millimeter deflection on the left. a left below the knee amputation was recommended by dr. because of the extent of gangrene in the heel and the poor circulation in the foot itself. the patient underwent dialysis on , and received one unit of packed red blood cells for a hematocrit of 27.3. her post-transfusion hematocrit was 31. on , the patient underwent an uneventful left below the knee amputation. her dressing was taken down on postoperative day number two. the incision was clean, dry and intact. the patient had feared losing her legs for many years. she expressed great relief at having the surgery over and now being able to get on with her life. psychiatry recommended discontinuing the one-to-one sitter on postoperative day number one. they recommended continuing the zoloft at 100 mg p.o. q. day. follow-up outpatient psychiatry will be arranged at the clinic by the patient's primary care physician, . . the patient's pca was discontinued on postoperative day number two. her postoperative pain was managed with dilaudid 2 to 4 mg p.o. q. four to six hours p.r.n. physical therapy consultation was requested on postoperative day number two. the patient will be seen on , following the long holiday weekend. the patient will follow-up with dr. in the office per his instructions at time of discharge. the patient's surgical staples will remain in place for one month following surgery. in the meantime, she will have a dry sterile dressing placed on the incision q. day pending further orders at discharge. the patient's right shin ulcer appears cleaner with a central area of granulation tissue. the shin ulcer is to have a saline dressing wet-to-dry q. a.m. and a regranex dressing in the evening per protocol. discharge medications: 1. levofloxacin 250 mg p.o. q. 48 hours. 2. flagyl 500 mg p.o. twice a day. 3. digoxin 0.125 mg p.o. q. 48 hours. 4. lasix 80 mg p.o. twice a day. 5. ferrous sulfate 325 mg p.o. twice a day. 6. calcitriol 0.25 mg p.o. q. day. 7. calcium carbonate 500 mg p.o. three times a day with meals. 8. calcium gluconate one gram p.o. twice a day. 9. epogen 4000 units subcutaneously tuesday, thursday and saturday. 10. zoloft 200 mg p.o. q. day. 11. albuterol 1 to 2 puffs q. six hours p.r.n. 12. fentanyl patch 50 micrograms per hour topically q. 72 hours. 13. colace 100 mg p.o. twice a day. 14. dulcolax one to two tablets p.o. q. day p.r.n. 15. dulcolax suppository, one per rectum q. day p.r.n. 16. heparin 5000 units subcutaneously twice a day. 17. dilaudid 2 to 4 mg p.o. q. four to six hours p.r.n. breakthrough pain. 18. nph insulin 5 units subcutaneously q. a.m. 19. nph insulin 1 unit subcutaneously q. h.s.; hold if blood sugar less than 160. 20. sliding scale regular insulin four times a day. condition on discharge: satisfactory. disposition: rehabilitation facility. discharge diagnoses: 1. infected, gangrenous ulcers, both legs. 2. left below the knee amputation on . secondary diagnoses: 1. suicidal ideation, resolved. 2. worsening renal failure, no hemodialysis at this time. 3. chronic anemia, status post transfusion. 4. tracheal stenosis requiring cpap. 5. type 1 diabetes mellitus with triopathy. 6. cardiomyopathy. 7. hypertension. , m.d. dictated by: medquist36 procedure: coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization hemodialysis transfusion of packed cells other amputation below knee diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified coronary atherosclerosis of unspecified type of vessel, native or graft hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute myocardial infarction of unspecified site, initial episode of care gangrene ulcer of other part of lower limb diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled secondary cardiomyopathy, unspecified 

Answer: The patient is high likely exposed to