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: 78m s/p unwitnessed fall, unresponsive, with multiple l rib fractures and pneumothorax major surgical or invasive procedure: : intubated in the ed secondary to agitation and emesis with aspiration : placement l chest tube in ed, later removed as it was found to be in subcutaneous space. : arterial line placed : insertion left-sided 3-lumen subclavian cvl : percutaneous tracheostomy at icu bedside for failure to wean from vent history of present illness: pt is a 78m with a hx of alcohol dependence who was found down and unresposive by his wife after apparently down 8 concrete steps. the pt was initially oriented x1 with a gcs of 4 on the scene, however his gcs was 15 in the ed. he became agitated in the ed, vomited, and desaturated and was therefore intubated for airway protection. ct in the ed showed left sixth through ninth rib fractures and a small left-sided pneumothorax. past medical history: pmh: cad, peripheral neuropathy, depression, gout, etoh dependence, asbestosis/lung scar psh: cabg, aortic valve (tissue) replacement social history: pt is married, lives in his own home with his wife. a daughter lives on next street and a son lives in . he is a retired fire fighter. he has been independent in his adls. he has a history of tobacco and etoh dependence, on arrival was +etoh with bal=206 family history: non-contributory physical exam: hr:75 bp:118/62 resp:22 o(2)sat:93 nrb low constitutional: moaning, uncomfortable, confused heent: pupils equal, round and reactive to light, extraocular muscles intact, c-collar, no crepitus chest: clear to auscultation, + l chest wall ttp cardiovascular: regular rate and rhythm abdominal: soft, diffuse ttp, r inguinal hernia easily reducible, fast negative, stable pelvis extr/back: c/o diffuse pain with vertebral palpation skin: r lateral thigh ecchymosis, r knee laceration, l arm abrasion neuro: confused, follows commands, mae, equal strength bilaterally, decreased sensation to l.t. in bilateral feet(which patient states is old) pertinent results: ct a/p: mildly displaced multilevel left-sided rib fractures. at the site of rib fractures there is a chest tube, which does not enter into the thoracic cavity. there is subcutaneous emphysema with a small amount of hematoma at this site. small left basilar and apical pneumothorax. bibasilar atelectasis. pleural calcifications may reflect asbestos exposure, correlate clinically. ct c-spine: no fracture of the cervical spine. compression deformity at t2 age-indeterminate but may relate to degenerative changes. degenerative changes at c3-4 and c4-5 cause mild degree of central canal narrowing may predispose to cord injury in the setting of trauma. if there is concern for cord injury, mri would be recommended. left apical pneumothorax, seen on concurrent ct torso. patient is intubated. nasogastric tube in the esophagus. ct head: . no acute intracranial findings. parenchymal atrophy and small vessel disease. tls-spine mri: no evidence of acute fractures. compression fractures involving t2, t5 and l1 are likely chronic given absence of marrow edema. mild multilevel degenerative changes as described above with multiple areas of mild to moderate foraminal stenosis and mild cord indentation at t5-t6 without cord signal intensity abnormality. well-circumscribed 2-cm upper back subcutaneous lesion, most consistent with an epidermal inclusion cyst or a sebaceous cyst. minimal marrow edema l2 and l3 and l5-s1 facets and c1-2 lateral mass joints , pattern most compatible with degenertive changes without secondary features to indicate acute trauma. multilevel degenerative changes as described above. cxr: asymmetric lucency of the left lung suggests an anterior pneumothorax in this supine patient. right lower lobe opacity likely reflects new right pleural effusion (moderate) and right lower lobe consolidation. new moderately severe pulmonary edema. ct chest: bilateral moderate-sized simple pleural effusions and associated compressive atelectasis of the lower lobes, new since the prior study. multifocal ground-glass opacities in the right lung may represent infection or aspiration. extensive subcutaneous emphysema in the left anterior chest wall, has increased since the prior study. interval resolution of a left-sided pneumothorax. multiple left recent rib fractures and non-acute right rib fractures. cxr: the dobbhoff catheter is in the left main bronchus and should be removed. stable severe right lower lobe pneumonia, bilateral pleural effusions and left lower lobe atelectasis. cxr: the dobbhoff tube is coiled in the stomach. the tip projects over the middle parts of the stomach. normal tracheostomy tube. no evidence of complications. unchanged left subclavian vein catheter. mild retrocardiac atelectasis. unchanged size of the cardiac silhouette. the study and the report were reviewed by the staff radiologist. cxr: improved ventilation at both lung bases with small remnant areas of atelectasis. no newly-occurred focal parenchymal opacities. mild cardiomegaly without pulmonary edema. cxr: as compared to the previous radiograph, the dobbhoff tube has been advanced. the tip of the tube now projects over the middle parts of the stomach. no evidence of complications. otherwise, the radiograph is unchanged. 09:50pm blood wbc-8.4 rbc-4.40* hgb-13.8* hct-40.1 mcv-91 mch-31.4 mchc-34.4 rdw-16.2* plt ct-343 09:50pm blood plt ct-343 09:50pm blood fibrino-382 04:32am blood glucose-53* urean-13 creat-0.8 na-131* k-4.5 cl-102 hco3-19* angap-15 09:50pm blood ck(cpk)-109 04:32am blood alt-12 ast-27 ck(cpk)-304 alkphos-76 totbili-0.3 04:32am blood ck-mb-12* mb indx-3.9 ctropnt-0.02* 12:54am blood ck-mb-6 ctropnt-<0.01 04:32am blood albumin-3.2* calcium-7.6* phos-3.5 mg-1.8 09:50pm blood asa-neg ethanol-206* acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 11:09pm blood type-art tidal v-500 peep-5 fio2-100 po2-501* pco2-52* ph-7.20* caltco2-21 base xs--7 aado2-182 req o2-38 -assist/con intubat-intubated 02:32am blood type-art temp-38.8 peep-10 po2-116* pco2-43 ph-7.41 caltco2-28 base xs-1 intubat-intubated brief hospital course: neuro: the patient requires medication for agitation, and should continue oxycodone and tylenol prn pain, as well as clonidine, seroquel qhs, q16:00 and prn. zyprexa zydis was used prn as well. for his history of etoh dependence and previous episodes of complicated withdrawal he was maintained on ciwa protocol with thiamine, folate & multivitamin for neuroprotection. benzodiazepines were stopped . he has been in restraints intermittently for agitation and pulling at lines. cv: the pt was initally in septic shock from his pneumonia and required pressors to mainatin hemodynamic stability. these were discontinued on . the pt has been maintained on metoprolol 25 mg pulm: the pt was initially intubated in the emergency department for agitation, emesis and concern for aspiration. he was found to have a leftsided pneumothorax and a chest tube was placed in the ed. this was found to enter the subcutaneous space and was removed. the pneumothorax did resolve on serial films. the pt did develop a likely aspiration pneumonia and was treated empirically with vancomycin and zosyn, and completed a 10-day course on . the pt was unable to wean from the vent and was very agitated by the ett tube, a bedside percutaneous tracheostomy was performed in the icu with a #8 portex. he has been able to wean to cpap and, on the day of discharge did have a trial with trach mask. fen/gi: pt had dobhoff tube placed x3 for tube feeds. he pulled out the first two and the third was carefully secured with tape. tube feeds were initiated per nutrition recommendations and, at time of discharge, were running at goal (55cc/hr). id: the pt was initially septic from his pnemonia and completed a 10-day course of vanc/zosyn on , pressors d/c'ed . gu: the pt has been diuresed with lasix 20mg iv bid. he has a foley catheter. musculoskeletal: pt has lateral l rib fractures of . he also has old compression deformities of t2, t5, l1. he came off logroll precautions and had his c-spine cleared . heme: heparin sc and venodyne boots for dvt prophylaxis, ppi for ulcer prophylaxis medications on admission: zocor, asa, omeprazole, allopurinol, ativan, neurontin, atenolol discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection (2 times a day). 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 6-10 puffs inhalation q4h (every 4 hours) as needed for wheezing. 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 50 mg/5 ml liquid sig: 10 (ten) ml po bid (2 times a day). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. pantoprazole 40 mg recon soln sig: 40 (forty) mg intravenous q24h (every 24 hours). 7. quetiapine 25 mg tablet sig: one (1) tablet po hs (at bedtime). 8. quetiapine 25 mg tablet sig: 0.5 tablet po daily (daily): at 16:00. 9. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 10. quetiapine 25 mg tablet sig: 0.5 tablet po bid prn () as needed for agitation. 11. acetaminophen 650 mg/20.3 ml solution sig: six y (650) mg po q6h (every 6 hours) as needed for fever. 12. oxycodone 5 mg/5 ml solution sig: five (5) ml po q4h (every 4 hours) as needed for pain. 13. multivitamin tablet sig: one (1) tablet po daily (daily). 14. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 15. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): hold sbp<90, hr<50. 16. furosemide 20 mg iv bid 17. hydralazine 10 mg iv q6h:prn sbp > 140 18. metoclopramide 5 mg iv q6h:prn residuals 19. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for secretions. 20. clonidine 0.1 mg tablet sig: one (1) tablet po tid (3 times a day). 21. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 22. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). 23. glucagon (human recombinant) 1 mg recon soln sig: one (1) mg injection q15min () as needed for hypoglycemia protocol. 24. regular insulin sliding scale fsbs q6h glucose regular insulin dose 0-70mg/dl proceed with hypoglycemia protocol 71-100mg/dl 0 units 101-150mg/dl 2 units 151-200mg/dl 4 units 201-250mg/dl 6 units 251-300mg/dl 8 units 301-350mg/dl 10 units 351-400mg/dl 12 units > 400mg/dl notify m.d. instructons for npo patients: evening prior to surgery/procedure: if on glargine or detemir: give 80% of usual dose; if on nph: give 100% usual dose. morning of surgery/procedure: if on glargine or detemir: give 80% of usual dose; if on nph: give 50% of usual dose; if on premix insulin (e.g. 70/30, 75/25): take total number of am units ordered, divide by 3, and give that many units as nph; if on sliding scale of short acting insulin: administer according to hs schedule. hold all oral antidiabetic medications, and consider sliding scale coverage; if appropriate, give ivf with dextrose to prevent hypoglycemia. discharge disposition: extended care facility: - discharge diagnosis: -displaced 6-9th left-sided rib fractures & small pneumothorax s/p unwitnessed fall -alcohol dependence -aspiration pneumonia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair has ambulated in icu with assist discharge instructions: please call your doctor or nurse practitioner or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain in not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon. avoid driving or operating heavy machinery while taking pain medications. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have staples, they will be removed at your follow-up appointment. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. followup instructions: please call ( to schedule a follow-up appointment in the acute care surgery clinic in weeks. md, procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances arterial catheterization arterial catheterization temporary tracheostomy bronchoscopy through artificial stoma diagnoses: acidosis unspecified septicemia severe sepsis gout, unspecified aortocoronary bypass status percutaneous transluminal coronary angioplasty status pneumonitis due to inhalation of food or vomitus accidental fall on or from other stairs or steps septic shock heart valve replaced by transplant traumatic pneumothorax without mention of open wound into thorax unspecified hereditary and idiopathic peripheral neuropathy other disorders of neurohypophysis asbestosis acute alcoholic intoxication in alcoholism, continuous closed fracture of four ribs physical restraints status 

Answer: The patient is high likely exposed to