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: mr. is a 41-year-old man who fell approximately 40 feet from a ladder. there is a question if there was an electrocution injury secondary to contact with a wire. the patient loss consciousness at the scene and was found to be opening his eyes spontaneously, but confused and combative. he was intubated at the scene and sedated with versed. he was boarded and collared and arrived at the hemodynamically stable with a gcs of 3t. past medical and surgical histories: at the time of admission, past medical, past surgical histories were unknown. medication: lipitor allergies: none known exam: general: the patient was intubated and sedated. vital signs: heart rate 104, pulse 120/palp, 100% on being bagged. head, ears, eyes, nose and throat: his pupils were equal. his tympanic membrane on the right was bloody. he had a right raccoon eye. back: cervical spine, no step-off. chest: clear to auscultation. heart: regular. abdomen: soft, nontender, nontender. the pelvis was stable. extremities: there were no obvious deformities of the extremities. small superficial laceration on the left elbow and left fifth finger. rectal: heme negative with decreased tone. laboratory studies: white count 19, hematocrit 41. normal chemistries. inr of 1.5. arterial blood gases 7.33, 46, 81, 25 and -1. ck of 289. trauma work up: head ct revealed a right cerebellar and left temporal intraparenchymal hemorrhage with right posterior fossa and subarachnoid blood. there is no herniation, but effacement of the cisterns. there are multiple bilateral temporal fractures, right occipital fracture, right orbital fracture and right subdural hematoma. abdominal ct showed no evidence of injury. small anterior right pneumothorax. right 5th and 10th rib fractures and right 1st or 5th lumbar transverse process fractures. ct of the chest showed no aortic injury, question of t11-t12 compression deformity and right 1st, 4th, 5th and 6th rib fractures. hand elbow films showed no fracture or dislocation. neurosurgical and oral maxillofacial consultations were obtained in the trauma bay. neurosurgery placed a vault that showed an icp of greater than 40. a post procedure head ct showed increased cerebellar hemorrhage and the patient was taken emergently to the operating room for evacuation. the patient underwent a suboccipital craniectomy with resection of right subdural bleeding and dural expansion. he was taken intubated and sedated to the trauma intensive care unit where the rest of his course will be summarized by system. hospital course: 1. neurologic: the patient had undergone injuries as described above and went to the operating room for evacuation of the hematoma. a ventricular ostomy drain was placed in the operating room and it was continued until approximately . the patient slowly regained motor function of initially of his left upper and lower extremities followed by his right upper and lower extremities. follow up head ct did not show any extension of bleeding. of note, the patient remained sedated for an extended period of time given his multiple injuries. as the sedation was weaned, he initially had difficulty with agitation and difficulty weaning the propofol, however this eventually resolved and at the time of dictation the patient requires no sedation. the cervical spine was cleared with an mri. his thoracic and lumbar spines were cleared with ct scans. ct did reveal an l4 vertebral body corner fracture and l1 through 5 right transverse process fractures which are not treated operatively. 2. cardiovascular: the patient never had hemodynamic instability throughout his course and required no pressors or drips for blood pressure control. 3. respiratory: the patient was intubated on arrival at the . he remained on vent support during the course of his stay due to his sedation. his clinical course improved. he was weaned to extubation on , however he quickly developed upper airway stridor and respiratory distress and was reintubated. a percutaneous tracheostomy was placed at the bedside on . after this point, the patient continued on vent support while he was sedated. once sedation was weaned, he was weaned to trach mask. at the time of dictation, he has been on trach mask for approximately 2.5 days. his respiratory course is complicated by right middle lobe and right lower lobe pneumonia. culture data showed this to be enterobacter which was resistant to multiple antibiotic agents and he eventually was started on a 30 day course of imipenem which started approximately . cultures also grew methicillin sensitive staphylococcus aureus from his sputum no acute distress he received an approximately 14 day course of gram positive coverage consisting of vancomycin and oxacillin. the patient was weaning well from the vent, however on , he was noted to have an acute desaturation. chest x-ray was unremarkable and ct angiogram of the chest was performed that showed bilateral pulmonary emboli. on , an ivc filter was placed. however, it was noted that the patient had anomalous venous architecture and on the second ivc filter was placed in the lower ivc. a repeat ct angiogram at this time also revealed no further extension of the clot. given his slight respiratory compromise from the clot, anticoagulation was readdressed to the neurosurgery team and after a follow up negative head ct, the patient was started on heparin drip and subsequently is being coumadinized. 4. gastrointestinal: the patient was initially kept npo without tube feeds. post pyloric feeding tube was placed under fluoroscopic guidance in the intensive care unit. he received regular tube feedings through this without difficulty. the day prior to peg placement, the tube feed was inadvertently moved on transfer. the patient's peg was placed on and the patient tolerated feedings through that well thereafter. of note, the patient had a 10 point hematocrit drop on . esophagogastroduodenoscopy revealed a 7 mm prepyloric ulcer that was cauterized. he had been maintained on appropriate antacid prophylaxis, however after this event he was changed to protonix and then prevacid . at the time of dictation, the patient is tolerating two k per cc tube feeds. this will be changed today to 1 k per cc as the patient is no longer requiring fluid restriction. 5. genitourinary: foley was placed in the initial trauma work up and has remained in place since. the patient has never had issues of inadequate urine output or electrolyte abnormalities. he is currently hep-locked. 6. heme: the patient's hematocrit drifted down throughout his stay and had the acute drop related to his upper gastrointestinal bleed. he required several units of transfusion at that time, but since his hematocrit has been stable to slowly increasing. anticoagulation for his pulmonary embolus initially consisted of heparin drip with a goal ptt of 50 to 70 followed by commencement of coumadinization. at this point, the patient's inr is only 1.5, so he is being discharged on a heparin drip until his inr is between 2 and 3. please see the nursing notes as to the doses the patient has received of coumadin to this point. 7. infectious disease: as noted above, the patient's main infectious complication has been pneumonia. he has had right middle lobe and right lower lobe infiltrates. cultures have shown enterobacter and methicillin sensitive staphylococcus aureus and he is receiving a 30 day course of imipenem which should complete around to . he also has been treated for methicillin sensitive staphylococcus aureus pneumonia and has completed his course of vancomycin and oxacillin. of note, the only positive blood cultures were coagulase negative staphylococcus aureus from an a-line which had been removed and the patient was not considered to have had a blood stream infection. 8. endocrine: the patient has been maintained on a sliding scale insulin regimen and has not had issues of hyper or hypoglycemia during his stay. 9. prophylaxis: the patient remains on prevacid down his tube. he is getting tube feeds at goal. he is on a heparin drip and being coumadinized. again, goal ptt of 50 to 70 and goal inr of 2 to 3. the heparin may be stopped once the patient is therapeutic on coumadin. of note, the patient also has two ivc filters. he also has venodyne boots. 10. tubes, lines and drains: the patient has a tracheostomy and percutaneous endoscopic gastrostomy tube which were placed on . he also has a picc line which was placed on . the tipped confirmed to be at the right atrium. he has a foley catheter and that is all. disposition: the patient has been screened and accepted to a rehabilitation facility. anticipated discharge day is . discharge medications: 1. heparin drip titrate for ptt 50 to 70 until the inr is between 2 and 3. 2. coumadin adjust dose daily for inr of 2 to 3. 3. promod with fiber 100 cc per hour via the peg tube 4. colace 100 mg per peg tube 5. prevacid 30 mg per peg tube 6. reglan 10 mg per peg q6h 7. imipenem 1 gm intravenous q6h through 8. nystatin swish and spit 5 ml po tid 9. tears 2 drops both eyes qid 10. sliding scale regular insulin as outlined on page 1. follow up: trauma clinic in two weeks' time. please call ( for an appointment. the patient should also follow up with neurosurgery, dr. , phone number ( in approximately two weeks' time. please see the physical therapy and occupational therapy recommendations page 2 and 3 reports. , md dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube interruption of the vena cava interruption of the vena cava enteral infusion of concentrated nutritional substances intravascular imaging of intrathoracic vessels temporary tracheostomy other incision of brain diagnoses: acute gastric ulcer with hemorrhage, without mention of obstruction iatrogenic pulmonary embolism and infarction accidental fall from ladder bacterial pneumonia, unspecified other closed skull fracture with cerebral laceration and contusion, with brief [less than one hour] loss of consciousness other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with brief [less than one hour] loss of consciousness renal vessel anomaly electrocution and nonfatal effects of electric current 

Answer: The patient is high likely exposed to