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: patient recorded as having no known allergies to drugs attending: chief complaint: s/p fall major surgical or invasive procedure: none history of present illness: 79yo m transferred from referring hospital s/p fall, with bilateral transverse process fracture of c2. pt admits to drinking etoh and fell down 10 stairs. complains of ruq and rlq pain. ct head here showed no ich. ct chest showed multiple right sided rib fractures. ct c spine showed bilateral c2 transverse process fractures. past medical history: prostate cancer htn hyperlipidemia social history: lives at home with wife. smokes cigars, +etoh family history: noncontributory physical exam: vs upon admission to trauma bay: 96.1 70 170/77 18 96%ra perrl, eomi, l ear ecchymosis csi rrr ctab ttp in luq, ecchymosis voer r lateral chest l shoulder abrasion, from pertinent results: 08:50pm urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:50pm plt count-175 08:50pm wbc-15.6* rbc-4.17* hgb-13.4* hct-38.2* mcv-92 mch-32.2* mchc-35.2* rdw-13.7 08:50pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 08:50pm asa-neg ethanol-167* acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 08:50pm amylase-52 09:14pm glucose-130* lactate-3.1* na+-140 k+-3.5 cl--100 tco2-25 09:15pm pt-12.4 ptt-31.9 inr(pt)-1.1 ct chest w/contrast 9:15 pm ct chest w/contrast; ct abdomen w/contrast reason: eval chest/abd trauma. please also eval tls recons field of view: 42 contrast: optiray medical condition: year old man s/p fall with r-sided abd pain, ?c2 fx, poor cxr in trauma series reason for this examination: eval chest/abd trauma. please also eval tls recons contraindications for iv contrast: none. indication: status post fall. technique: mdct was used to obtain contiguous axial images from the thoracic inlet to the pubic symphysis after administration of iv contrast. thin-cut sections were obtained as well as multiplanar reformats. ct chest with iv contrast: there are minor dependent atelectatic changes of both lungs. heart and great vessels are normal. the aorta is slightly tortuous. there are aortic vascular calcifications, but no evidence of dissection. multiple rib fractures are seen on the right, with an old healed rib fracture right #7. new rib fractures are seen at anterior aspect of right rib 2 causing a depressed chest wall deformity; there are rib fractures also seen in right rib 3, right rib 4, right rib 5, right rib 6, right rib 7, right rib 8, right rib 9. again no pneumothorax or hemothorax. there is a tiny amount of stranding in the substernal space, but without connection to the pericardium or to any vessels. there is no sternal fracture. ct abdomen with iv contrast: liver, spleen, pancreas, stomach, small bowel loops are within normal limits. both kidneys contain multiple low-density lesions within them, some of them too small to fully characterize, the largest being on the left in the upper pole measuring 20 x 26 mm and having fluid characteristics. no free air or free fluid is seen in the abdomen. no evidence of bowel perforation. ct pelvis with iv contrast: bowel loops are normal. no evidence of perforation. no free fluid. bladder is collapsed with a foley. there is sigmoid diverticulosis. vessels are calcified. there is a filling defect in the right proximal common iliac artery near the bifurcation, measuring approximately 18 mm in length from superior to inferior. contrast is seen in the artery beyond this point. no other filling defects are identified. there is no hematoma around this site. multiplanar reformats were essential in delineating the findings above, particularly of the multiple rib fractures, and of the filling defect in the right common iliac artery. impression: 1. multiple right-sided rib fractures causing mild chest wall deformity, but without pneumothorax or hemothorax. 2. small amount of stranding in the retrosternal space, without connection to the pericardium or vessels. this is of uncertain significance, as there is no sternal fracture. 3. non-occlusive filling defect in proximal portion of right common iliac artery. this is of uncertain age. contrast is seen beyond the filling defect. 4. no fractures in thoracolumbar spine or bony pelvis. preliminary findings were relayed to the ed dashboard at time of image acquisition and discussed with the trauma surgery team. mr cervical spine 2:39 am mr cervical spine reason: eval ligamentous injury medical condition: year old man with bilateral c2 transverse process fx s/p fall. reason for this examination: eval ligamentous injury exam: mri of the cervical spine. clinical information: the patient with bilateral c2 transverse process fracture status post fall. evaluate for ligamentous injury. technique: t1, t2 and inversion recovery sagittal, gradient-echo sagittal, and t2 axial images of the cervical spine were acquired. there are no prior similar examinations available for comparison. findings: there is subtle increased signal seen within the inferior portion of c2 vertebral body consistent with a fracture seen on the ct. mild prevertebral soft tissue edema is also identified. the interspinous region at this level demonstrates slight increased signal on the inversion recovery images indicative of edema and trauma to the soft tissues. there is no evidence of disruption of the interspinous or anterior or posterior longitudinal ligament seen. the vertebral flow voids bilaterally are maintained throughout the cervical spine and at the c2 level. from c2-3 to c4-5 degenerative disc disease is seen. at c5-6 and c6-7 mild bulging is noted. from c7-t1 to t3-4 mild degenerative changes are seen. the spinal cord demonstrates normal signal without extrinsic compression or intrinsic signal abnormalities. no evidence of intraspinal fluid collection seen. impression: signal changes indicative of fracture involving the c2 vertebra in the inferior portion and possibly extending to the lateral masses. increased signal within the interspinous region of c1 and c2 indicative of focal trauma to the interspinous region without evidence of disruption of the interspinous ligament. no evidence of ligamentous disruption seen at other levels. no evidence of extrinsic spinal cord compression or intrinsic spinal cord signal abnormalities. vertebral flow voids are maintained. mr contrast gadolin 2:37 am mra neck w&w/o contrast; mr contrast gadolin reason: bilat. c2 transverse process fx s/p fall. contrast: magnevist medical condition: year old man with bilateral c2 transverse process fx s/p fall. reason for this examination: eval vascular injury contraindications for iv contrast: none. history: patient with bilateral c2 transverse process fractures post fall. evaluate for vascular injury. comparison: mr of the cervical spine dated . technique: 2d time-of-flight images through the neck were obtained for evaluation of internal carotid and vertebral arteries. gadolinium-enhanced mra was also performed, with multiplanar and 3d reconstruction. mra of the neck: flow within both vertebral arteries and internal carotid arteries is appreciated on 2d time-of-flight images as well as gadolinium- enhanced mra. normal flow is visualized in the expected area of c2. however, the superior most extent of the vertebral arteries were not included or optimally protrayed on the 2d scan sequecnes. this area was also not well evaluated on gadolinium- enhanced images. to remedy these deficiencies, a followup study was scheduled to encompass the superior-most vertebral arteries. mra brain w/o contrast 8:03 pm mr head w/o contrast; mra brain w/o contrast reason: eval for stroke medical condition: 79 year old man with ?aneurysm on ct and ams reason for this examination: eval for stroke addendum: the previously described left subdural hygroma is again seen, as seen on the prior ct. mra images were additionally reviewed. there is moderate stenosis of the precavernous and cavernous right internal carotid arteries. the right internal carotid artery supplies the right middle cerebral artery, while the left internal carotid supplies the left middle cerebral artery as well as bilateral anterior cerebral arteries. the decreased caliber of right internal carotid could in part be related to the above described anatomy and/or atherosclerotic disease. the findings were discussed with dr. on the morning of . indication: evaluate vertebral arteries, not well visualized on cervical mra. comparison: cervical spine mri and mra of . technique: sagittal t1, axial t2, axial gradient echo, and axial flair images of the brain were obtained, with diffusion-weighted images. mri of the brain: there is no evidence of hemorrhage within the brain. the ventricles and cisterns are normal. there is no shift of the normally midline structures. there are a few small foci of t2 and flair hyperintensity within the frontal periventricular white matter bilaterally, likely representing small areas of chronic microvascular infarction. there are no areas of restricted diffusion to suggest acute infarction. normal flow voids are visualized in major branches of the circle of . fluid and/or mucosal thickening is noted within the left mastoid air cells, likely inflammatory in origin. mra of the circle of : technique: 3d time-of-flight images of the superior-most internal carotid arteries, vertebral arteries, and the circle of were obtained. multiplanar and 3d reconstructions were obtained. findings: this examination demonstrates evidence of normal flow within the superior-most vertebral arteries bilaterally. the superior right vertebral artery terminates into the right posterior inferior cerebellar artery, a common anatomic variant. normal flow is detected within the remainder of the circle of vessels. no aneurysmal dilation is seen. impression: normal flow is visualized within the superior-most vertebral arteries as described. no areas of aneurysmal dilation seen, specifically at the summit of the left internal carotid artery as mentioned on ct. the findings were discussed with dr. in the afternoon of . brief hospital course: in the pt received a ct of his head, c spine, chest, and abdomen. ct head and abdomen were negative with the exception of multiple right sided rib fractures. after the ct of the cspine in the ed showed a c2 fracture involving bilateral transverse foramen, spine surgery was consulted. they recommended obtaining a mri/mra. the mri showed evidence of the c2 fracture, while the pt's mra showed good vascular patency in this area. the pt was seen by pt and encouraged to use incentive spirometry. the pt also had a r ear hematoma that was debrided by plastics. the pt was placed on keflex. the ear was followed by plastics throughout the pt's course, and his keflex was stopped after 7 days. during the hospital stay the pt was initially hypertensive to the 200's systolic. this was not associated with any cp, sob, ha, lightheadedness, weakness or dizziness. bp was unresponsive to hydralazine and nitropaste. it was postulated that the hypertension may have been alcohol withdrawal and following administration of ativan, the pt's bp improved. the pt was given thiamine and folate and placed on his home regimen of bp meds. on this regimen with intermittent use of low dose hydralazine the pt's bp remained improved throughout the remainder of his hospital stay. the pt's ms fluctuated during his course. after three days in the hospital his orientation dwindled and he was increasingly lethargic. a repeat head ct showed no evidence of acute pathology. a brain mri was obtained that was normal. after being prophylaxed with ativan for dts during the initial 6 days of his hospital stay, the administration of ativan was decreased. the pt's mental status then improved and his family reported he was at his baseline level of function. the pt's hct remained stable throughout his stay. his swallowing ability was evaluated with a speech and swallow consult. this showed low risk of aspiration and as a result the pt was maintained on a pureed diet with honey thickened liquids. he tolerated this diet well and his po intake increased during the latter portion of his hospital stay. physical and occupational therapy consulted and have recommended short rehab stay. speech therapy consulted because of swallowing issues; he is currently on thickened liquids and pureed diet. as his mental status clears he should be re-evaluated for diet upgrade. social work consulted because of his etoh issues. medications on admission: aledronate 35 qwk, caclium 250''', lisinopril 40', lovastatin 40', asa 81', atenolol 25', citalopram 20', omeprazole 20' discharge medications: 1. multivitamin capsule sig: one (1) cap po daily (daily). 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day). 3. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). 4. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 5. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 6. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day): hold for sbp <110; hr <55. 9. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 10. atorvastatin 40 mg tablet sig: one (1) tablet po hs (at bedtime). 11. calcium carbonate 500 mg tablet sig: one (1) tablet po three times a day. 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 13. senna 8.6 mg tablet sig: two (2) tablet po hs (at bedtime). 14. isosorbide dinitrate 20 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* discharge disposition: extended care facility: discharge diagnosis: s/p fall cervical spine fracture rib fractures discharge condition: stable discharge instructions: call your doctor if: your neck pain is getting worse. seek care immediately if: you have pain, numbness, tingling, or weakness of your arms, face, or scalp. you have shortness of breath, a hoarse voice, or problems swallowing. followup instructions: you should follow up with at the clinic in 2 weeks to obtain another image of your neck. call to obtain an appointment. you should also follow up in trauma clinic. call to obtain an appointment. procedure: other incision of external ear diagnoses: alcohol abuse, unspecified closed fracture of second cervical vertebra accidental fall on or from other stairs or steps closed fracture of eight or more ribs contusion of face, scalp, and neck except eye(s) 

Answer: The patient is high likely exposed to