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: codeine / demerol / oxycodone attending: chief complaint: s/p mvc major surgical or invasive procedure: - ivc filter placement - tracheostomy, peg tube placement - non-instrumented fusion c5-t6 history of present illness: 50m unrestrained driver s/p rollover mvc with ejection. pt was found 10 ft from his car with +loc. on arrival to the , pt was hypotensive to sbp 50s but mentating appropriately with gcs 15. exam revealed loss of motor and sensory function below the xiphoid process. despite fluid resuscitation he remained hypotensive and was started on pressors with suspicion of neurogenic shock. imaging revealed t3-t5 vertebral body fractures with severe spinal cord injury concerning for transection, along with multiple bony thoracic fractures and a small left hemopneumothorax. he was admitted to the tsicu for close monitoring. following admission to the tsicu he underwent closure of extensive scalp lacertaions. his respiratory mechanics worsened; found to have progressed to flail chest in the setting of multiple bilateral rib fractures. given his increasing fatigue, he was intubated, and a left subclavian line was placed. a post-intubation/line film revealed a significantly increased left pneumothorax with increasing pressor requirement. a chest tube was placed which drained approximately 500cc blood upon placement, with hemodynamic improvement thereafter. past medical history: pmh: bipolar disorder psh: appy social history: 1ppd x 30 yrs heavy etoh in the past, trying to cut down family history: n/c physical exam: vitals: t 99.4, hr 59, bp 133/52, rr 20, o2 50% trach collar gen: a&o x3, nad cv: rrr, no murmur resp: cta bilat abd: soft, nt, nd, +bs extr: warm, 2+ pulses pertinent results: ct head : 1. no acute hemorrhage or intracranial process. 2. left occipital condyle fracture better assessed on cervical spine ct. 3. bilateral extensive deep scalp lacerations (degloving injury) with debris and gas within the wounds. ct c-spine : 1. multiple fractures in the cervicothoracic junction including: c7 spinous process, t1 vertebral body, both t1 pedicles and transverse processes, t2 body, t2 left inferior facet and right transverse process. extensive fracture of t3 which is detailed with the ct torso report. 2. bilateral small pneumothoraces, upper lung contusions, large paravertebral hematoma surrounding the upper thoracic spine with extensive bilateral upper (posterior displaced and comminuted) rib fractures. 3. acute fracture of the left occipital condyle. ct torso : 1. severe injury to the thoracic spine with a flexion teardrop injury at t3 likely causing severe spinal cord injury. additional fractures of vertebrae: c7 - t9, described in detail above. extensive paravertebral hematoma without active bleeding. 2. extensive ribcage injury involving every rib, many displaced and segmental. 3. bilateral scapula fractures, sternal fracture with retrosternal hematoma. 4. bilateral small hemothorax, small bilateral pneumothores and pulmonary contusion in the upper lungs. mri spine : 1. multiple fractures of the upper thoracic spine, most notably with instable 3 column burst fracture of t3. the latter demonstrates significant retropulsion with cord compression and cord signal abnormality, representing either contusion, edema, ischemic change or a combination of those. burst fracture of t4 with mild retropulsion and no cord abnormality. injury to the anterior and posterior longitudinal ligaments; assessment of other ligaments is limited. small amount of epidural hematoma is posisbly noted and distinction from osseous component is limited. osseous details are better seen on prior ct. (pl. note that the injury is at t3 and t4 levels and not t10 as mentioned on the wet read.) 2. mild compression fracture of t1. 3. multilevel spinous, transverse process and rib fractures, better characterized on previous ct torso. 4. extensive signal abnormality along the posterior paraspinal soft tissues and interspinous ligaments from c2 through t8, suggesting soft tissue edema, multilevel disruption of the posterior ligamentous complex or, most likely, a combination of both. 5. stable extent of pre/paravertebral hematoma and hemothorax. 6. degenerative changes in the cervical spine. 7. a 2.0cm lesion in the right kidney-? cyst- see prior ct torso study brief hospital course: mr. was evaluated in the ed as a trauma activation, and the following injuries were identified: -scalp degloving/lacerations -c7 spinous process fracture -t1 body fracture -t3 flexion teardrop comminuted fx w/ retrolisthesis -severe spinal cord injury at t3 w/ concern for transection -t4, t5 burst fx -paraspinal hematoma, upper t spine -sternal fx w/ retrosternal hematoma -rib fx (r , l , ) -small l hemo-ptx -bilateral apical pulmonary contusions -bilateral scapular fx -occipital condyle fx he was admitted to the ticu for evaluation and monitoring. his extensive scalp lacerations were thoroughly irrigated and debrided, then closed. his hospital course is detailed below, and he was discharged to vent rehab. neuro: he had pain control issues throughout his admission to the icu, for which the chronic pain service was consulted. he suffered a severe spinal cord injury at the level of his thoracic spine injuries, with complete bilateral lower extremity paralysis. he went to the operating room for fusion of his spinal fractures, but was unable to tolerate the prone position. instead of having an instrumented fusion, as planned, he had a non-instrumented fusion with bone matrix, and was placed in a brace post-operatively. this was changed to a halo on . cv: he was initially hypotensive and bradycardic, consistent with spinal shock, and required pressors at the beginning of his hospital stay. the pressors were slowly weaned, and he remained hemodynamically stable. resp: he was breathing well on arrival to the hospital, though he had extensive bilateral rib fractures. overnight on hd 1, he developed respiratory distress, and imaging was consistent with flail chest, so was intubated. he was kept intubated for the or with spine, and was unable to wean from the vent post-operatively. he also developed a pneumonia, which was treated with appropriate antibiotics. he underwent tracheostomy on hd 8. he has been able to wean to cpap/psv, and has been tolerating trach collar the past 24 hours. his rib fractures were evaluated by thoracic surgery, who did not think he would benefit from rib plating. he will be discharged to vent rehab. gi/gu: he was kept npo with ivf while intubated. he was initially started on tube feeds through an og tube, then transitioned to feeds through his peg after placement on hd 8. he was cleared to start an oral diet on , and was given sips, which he tolerated well. his peg tube was inadvertently removed by the patient on , and was replaced with a foley catheter. catheter position in the stomach was confirmed with contrast x-ray. he will have this exchanged under fluoroscopy next week for a formal g-tube, but may have feeds through the foley until that time. he developed a transaminitis on hd 14, which continued to increase, and a hida scan was obtained, which was normal. he was started on ursodiol for presumed cholestasis, with improvement in his lft's. his foley catheter was removed on and he began having intermittent straight caths performed, which will be continued at rehab. he developed a uti on , which is being treated with cipro x7 days. heme: an ivc filter was placed for protection from embolism, and heparin subcutaneously was given for dvt prophylaxis. his hematocrit intermittently drifted to the low 20's, though he never manifested signs or symptoms of acute bleeding, and always responded appropriately to transfusion. a ct scan obtained to evaluate his abdomen on showed migration of his ivc filter above the renal veins. ir attempted to retrieve and replace the filter on , but were unable to do so, as there was clot in the filter. he will be given a 2-week course of lovenox, and then will have a repeat ct scan. if the clot burden has resolved, he will then have the filter retrieved and replaced by ir. id: he developed a moraxella pneumonia while intubated, and was appropriately treated with antibiotics. he continued to spike fevers despite antibiotics, so id was consulted. after completing his antibiotic course, he remained afebrile without leukocytosis. he was started on cipro for a uti on , and will complete a 7-day course of antibiotics at his rehab facility. medications on admission: -simvastatin 40mg daily -potassium citrate 20meq tid -nexium 40mg daily -abilify 20mg daily -carbamazepine 200mg -fluoxetine 40mg daily -hydroxyzine 50mg q6h prn -topamax 200mg -gabapentin 300mg tid discharge medications: 1. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q4h (every 4 hours) as needed for wheezing, dyspnea. 4. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. 5. fluoxetine 20 mg/5 ml solution sig: ten (10) ml po daily (daily). 6. insulin regular human 100 unit/ml solution sig: one (1) injection injection asdir (as directed). 7. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 8. acetaminophen 650 mg/20.3 ml solution sig: six y (650) mg po q6h (every 6 hours). 9. polyethylene glycol 3350 17 gram powder in packet sig: one (1) powder in packet po daily (daily) as needed for constipation. 10. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 11. senna 8.8 mg/5 ml syrup sig: five (5) ml po bid (2 times a day). 12. gabapentin 400 mg capsule sig: three (3) capsule po q8h (every 8 hours). 13. lorazepam 2 mg/ml syringe sig: one (1) mg injection q4h (every 4 hours) as needed for anxiety. 14. hydromorphone (pf) 1 mg/ml syringe sig: 1-2 mg injection q3h (every 3 hours) as needed for breakthrough pain. 15. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). 16. lorazepam 2 mg/ml syringe sig: ml injection q4h (every 4 hours) as needed for anxiety. 17. enoxaparin 100 mg/ml syringe sig: one hundred (100) mg subcutaneous q12h (every 12 hours). 18. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 19. cipro 500 mg/5 ml suspension, microcapsule recon sig: five hundred (500) mg po twice a day for 5 days. 20. outpatient lab work please check creatinine weekly. discharge disposition: extended care facility: hospital for continuing medical care - ( center) discharge diagnosis: s/p polytrauma bilateral rib fractures thoracic spinal cord injury bilateral scapula fractures discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the acute care surgery service after your traumatic injuries. you were kept in the icu during your stay, and required multiple surgical procedures. you are now being discharged to rehab to continue your recovery. please follow these instructions to aid in your recovery. *please take all medications as prescribed. *please contact our office if you develop fever, chills, increased pain, or drainage from your wounds. followup instructions: provider: scan phone: date/time: 3:15 provider: scan phone: date/time: 3:30 provider: scan phone: date/time: 3:45 - acute care surgery clinic, 3:45pm lm bldg (), surgical associates clinic starts at 1pm. come directly from spine appointment and will try to work-in for earlier visit. - ,spine, 11am sc clinical ctr, spine center (sb) procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more interruption of the vena cava enteral infusion of concentrated nutritional substances thoracentesis percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus nonexcisional debridement of wound, infection or burn dorsal and dorsolumbar fusion of the posterior column, posterior technique repair of vertebral fracture other repair and reconstruction of skin and subcutaneous tissue insertion or replacement of skull tongs or halo traction device plastic operation on pharynx angiocardiography of venae cavae fusion or refusion of 4-8 vertebrae insertion of recombinant bone morphogenetic protein central venous catheter placement with guidance diagnoses: hyperpotassemia tobacco use disorder urinary tract infection, site not specified acute posthemorrhagic anemia unspecified protein-calorie malnutrition other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure traumatic pneumohemothorax without mention of open wound into thorax pressure ulcer, other site paralytic ileus other specified disorders of biliary tract surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation hyperosmolality and/or hypernatremia ventilator associated pneumonia closed fracture of seventh cervical vertebra delirium due to conditions classified elsewhere contusion of lung without mention of open wound into thorax flail chest traumatic shock mechanical complication of other vascular device, implant, and graft closed fracture of scapula, unspecified part closed fracture of t1-t6 level with complete lesion of cord motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle closed fracture of eight or more ribs other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms other venous embolism and thrombosis of inferior vena cava pressure ulcer, unspecified stage bipolar i disorder, most recent episode (or current) depressed, unspecified open wound of scalp, complicated acute respiratory failure following trauma and surgery closed fracture of base of skull without mention of intra cranial injury, with loss of consciousness of unspecified duration 

Answer: The patient is high likely exposed to