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: penicillins / adhesive tape attending: chief complaint: s/p mvc with associated l1 burst fracture major surgical or invasive procedure: : 1. posterior decompression with laminectomies t12-l1. 2. open reduction. 3. instrumented fusion t10-l4 with bilateral pedicle screws. 4. icpg of right iliac crest plus bmp plus allograft. history of present illness: 66f with mva sustained on , restrained passenger, with ongoing abdominal and back pain. patient initially evaluated at center and had stable vitals, tenderness left sacrum, left si jt; was eurologically intact, sacral and coccyx films neg for fracture. subsequently pain in low back radiating to both hips. persistently painful to sit, walk, change position but patient denies radiation down legs, sensation changes, and bowel/bladder incontinence. past medical history: hypertension hyperparathyroidim s/p 3.5 gland resection s/p hysterectomy social history: 30 pack year history quit 17 years ago etoh drink per day family history: non-contributory physical exam: on admission: afvss gen: wd/wn, comfortable, nad. heent:ncat pupils: bil eomsintact neck: supple. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. motor: d b t we wf ip q h at g sensation: intact to light touch, propioception, pinprick and vibration bilaterally. reflexes: b t br pa ac right wnl left wnl propioception intact toes downgoing bilaterally rectal exam normal sphincter control on discharge: patient is alert, orieted to person, place and date. full strength in the upper extremities bilaterally. lle is full strength and sensation. rle is full strength and sensation. rle full strength with the exception of , at 3/5, gastroc . there is also hypersensation along this region. pertinent results: 10:00pm urine color-straw appear-clear sp -1.003 10:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 07:00pm glucose-98 urea n-11 creat-0.9 sodium-141 potassium-4.0 chloride-105 total co2-24 anion gap-16 07:00pm estgfr-using this 07:00pm lipase-22 07:00pm wbc-7.1 rbc-4.55 hgb-14.4 hct-41.2 mcv-90 mch-31.7 mchc-35.1* rdw-14.0 07:00pm neuts-64.0 lymphs-23.2 monos-7.1 eos-4.2* basos-1.4 07:00pm plt count-397# 07:00pm pt-12.4 ptt-24.3 inr(pt)-1.0 . mri : conclusion: l1 burst fracture with retropulsed fragment narrowing the spinal canal but no evidence of spinal cord compression. smaller fracture of the anterior-inferior corner of t12. . long tr images signal loss in the intervertebral discs from l2 through l5, a manifestation of degenerative disc disease. at l2-3, there is a small bulge with no significant canal narrowing. at l3-4, a slightly larger bulge produces moderate spinal canal narrowing with no evidence of cauda equina compression. there are mild facet osteophytes at this level. at l4-5, bulging of the intervertebral disc, facet osteophytes, and ligamentum flavum thickening produce moderate spinal stenosis. the neural foramina appear normal. at l5-s1, prominent facet osteophytes extend posterolaterally and do not encroach on the spinal canal. there is no abnormality of the intervertebral disc detected. the neural foramina appear normal. . ct ; 1. comminuted burst fracture of l1 with retropulsed fragment encroaching on the spinal canal. refer to the mr report from earlier today for details on spinal cord injury and degenerative changes in the lumbar spine. 2. t12 spinous process non-displaced fracture. . cxr; there are no old films available for comparison. the heart is upper limits normal in size. the aorta is mildly tortuous. the lungs are clear without infiltrate or effusion. clips are seen overlying the lower neck. . ct spine :impression: 1. unchanged appearance of the l1 burst fracture. please refer to the concurrent mri report for further detail about its effect on the thecal sac. 2. status post posterior fusion from t10 through l4. anatomic alignment. 3. probable small bone island in the t9 vertebral body. if the patient has a known primary malignancy which may present with sclerotic metastasis, then a bone scan could be obtained to exclude a more aggressive lesion. mri spine : l1 burst fracture again seen. status post posterior fusion from t10 through l4. no new abnormalities, aside from the expected postsurgical changes. . l xr : two views of the lumbar spine from the operating room demonstrates interval placement of screws within t12 and l2 with left lateral spinal rod fixating a burst fracture of l1. there is also subsequent placement of radiolucent disc prostheses at t12-l1 and l1-l2. patient has undergone posterior stabilization with multiple pedicle screws spanning t10 through l4. please refer to the procedure note for additional details. . brief hospital course: ms is a 66yo female htn/hyperparathyrodism and hysteretcomy s/p mva on where she was a restrained passenger, that presents with ongoing abdominal pain, pain with sitting and walking. on imaging noted to have l1 vertebral body burst fracture that was unstable, with kyphotic deformity. a portion of the vertebral body was retropulsed into the spinal canal and causing significant stenosis. the conus end just superior to fracture so there was no cord compression. she was admitted to neurosurgery service for for repair. she underwent a 1. posterior decompression with laminectomies t12-l1. 2. open reduction. 3. instrumented fusion t10-l4 with bilateral pedicle screws and 4. icpg of right iliac crest plus bmp plus allograft. postoperatively she did well overall however was noted to have a l foot drop and l toe extension weakness, associated with hyperesthesias at rle up the calf. a f/u mri showed a l1 burst fracture s/p posterior fusion from t10 through l4. there were no new abnormalities, aside from the expected postsurgical changes. it was felt that perhaps she while patient over, there was temporary compression of sciatic nerve vs. deep peroneal. there were no abnormalities in screw placement that would account for her symptoms/signs. over the next two days, strength in ta improved to 4-/5 and at . a ct spine showed similar findings as well as small bone island of the t9 with concern regarding ? sclerotic metastases as part of ddx.... on she underwent anterior fusion of t12 to l2 to stabilize the posterior fusion. this was an uncomplicated procedure which she tolerated well. she resumed po intake, bowel and bladder functions were intact. she underwent pt and will require lso until she is seen in follow up. she was discharged to an appropriate rehab facility on . medications on admission: vit d 1000 unavasc 30 dily norvasc 10mg daily fenoxidine 60 daily discharge medications: 1. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 2. cholecalciferol (vitamin d3) 400 unit tablet sig: 2.5 tablets po daily (daily). 3. fexofenadine 60 mg tablet sig: one (1) tablet po once a day. 4. moexipril 15 mg tablet sig: two (2) tablet po once a day. 5. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 10. diazepam 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for spasm. 11. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 12. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 13. gabapentin 100 mg capsule sig: one (1) capsule po hs (at bedtime). discharge disposition: extended care facility: - discharge diagnosis: l1 burst fracture discharge condition: neurologically stable discharge instructions: - do not smoke. - keep your wound(s) clean and dry / no tub baths or pool swimming for two weeks from your date of surgery. -you must continue to wear your lso brace at all time when out of bed and walking. you may remove it briefly to shower. - no pulling up, lifting more than 10 lbs., or excessive bending or twisting. - limit your use of stairs to 2-3 times per day. - have a friend or family member check your incision daily for signs of infection. - take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. - do not take any anti-inflammatory medications such as motrin, advil, aspirin, and ibuprofen etc. unless directed by your doctor. - increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. we recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. - clearance to drive and return to work will be addressed at your post-operative office visit. -you must also have a pet scan of your thoracic spine as an outpatient to further evaluate a lesion seen on ct at t9. your pcp can follow up on this result and schedule this for you. call your surgeon immediately if you experience any of the following: - pain that is continually increasing or not relieved by pain medicine. - any weakness, numbness, tingling in your extremities. - any signs of infection at the wound site: redness, swelling, tenderness, and drainage. - fever greater than or equal to 101?????? f. - any change in your bowel or bladder habits (such as loss of bowl or urine control). followup instructions: follow up instructions: - please return to the office in days (from date of surgery approx ) for removal of your staples and sutures and a wound check. this appointment can be made with the nurse practitioner. please make this appointment by calling . if you live quite a distance from our office, please make arrangements for the same, with your pcp. please call ( to schedule an appointment with dr. to be seen in 3 months. you will also need a ct of your thoracic and lumbar spine prior to your appointment. *you will also need an outpatient pet scan(see above for recommendations). procedure: dorsal and dorsolumbar fusion of the anterior column, anterior technique other excision of joint, other specified sites excision of bone for graft, other bones dorsal and dorsolumbar fusion of the posterior column, posterior technique repair of vertebral fracture insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae fusion or refusion of 4-8 vertebrae insertion of recombinant bone morphogenetic protein diagnoses: esophageal reflux unspecified essential hypertension asthma, unspecified type, unspecified osteoporosis, unspecified personal history of malignant neoplasm of large intestine closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury closed fracture of lumbar vertebra without mention of spinal cord injury disorder of bone and cartilage, unspecified other acquired deformities of ankle and foot nontoxic multinodular goiter other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle other kyphosis (acquired) 

Answer: The patient is high likely exposed to