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: mold extracts / codeine / percocet attending: chief complaint: status post fall, alcohol withdrawal major surgical or invasive procedure: orif/k-rod of left shoulder () and repair () posterior scalp laceration repair with staples history of present illness: this is a 48 year old male with history of depression was found by ems lying half on and half off the sidewalk incontinent of urine and stool. en route he was consfused and confabulating. after a round a bout converation, he admitted to falling down 14 stairs today. he also stated that 4 days prior he was hit in the back of the head by robbers. he also endorsed cocaine and mj use that may be been contaminated as recently as friday. . . in the ed vs were 98.1 142 154/97 19 100. gcs was 14, hard collar was placed. left shoulder with edema and accymoses. ct of the head/neck/abdomen were performed without serious abnormality. cxr of the left shoulder showed a displaced fracture of the humerus. ortho evaulated, and patient is on the schedule for or on . while in the , pt showed signs of withdrawl. he was given 1l iv thiamine, folate, mvi, 70mg valium, 40meq k, mg 2gm. he also received 9l ns for a ck of 6000. vs on transfer: t98.1 hr142 bp 154/97 rr19 100. . on the floor, pt is unable to cooperate with a coherent history. mother was for more information. she is aware that has been drinking, but unclear about when he restarted and if he has had problems with etoh in the past. past medical history: hx "mild depression per pt, treated by (addictions psychologist) and as pcp at health. pcp prescribes psych meds, no psychiatrrist he says. no prior admissions, no sa/si/sib, no hx assualtive or violent behavior pmh- psoriasis, kidney stones social history: single, gay male, bu graduate with associates degree. lives in at the braemore. h/o etoh dependence, sober since . unclear when he started drinking again. h/o cocaine in the , now claims he has been using cocaine and denies ivd, opioids, any other drug use. family history: mother with three alcoholic brothers physical exam: admission physical exam: vitals: 99.5 120 147/120 17 100% ra general: alert, oriented, no acute distress heent: perrl, eomi, sclera anicteric, mmm, oropharynx clear, blood on back of head, no open laceration, cervical hard collar neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, few rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops, old ecchymoses on chest abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly neuro: alert and oriented to person, hospital, tremor. able to give details from long term memory but not acutely. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. lue with bruising, hematoma, tenderness, and edema pertinent results: i. labs a. admission 04:02pm blood wbc-9.9 rbc-3.60* hgb-12.6* hct-37.2* mcv-103* mch-34.9* mchc-33.8 rdw-15.1 plt ct-150 04:02pm blood neuts-83.8* lymphs-10.7* monos-5.1 eos-0.3 baso-0.2 04:02pm blood pt-10.7 ptt-19.6* inr(pt)-0.9 04:02pm blood glucose-206* urean-23* creat-2.2* na-141 k-3.2* cl-96 hco3-15* angap-33* 04:02pm blood ck(cpk)-6623* 04:02pm blood ck-mb-9 07:30pm blood ctropnt-0.01 10:27pm blood ctropnt-0.01 04:02pm blood calcium-10.3 phos-3.8 mg-1.4* 07:20am blood caltibc-137* ferritn-1166* trf-105* 06:50am blood tsh-4.6* 06:50am blood t4-4.5* 04:35pm blood glucose-201* lactate-8.3* na-143 k-3.3* cl-100 calhco3-15* 07:39pm blood lactate-1.4 07:01pm blood lactate-1.3 09:42am blood methylmalonic acid-test b. discharge 07:00am blood wbc-9.4 rbc-2.83* hgb-9.1* hct-28.0* mcv-99* mch-32.3* mchc-32.6 rdw-16.8* plt ct-1090* 07:00am blood plt ct-1090* 07:00am blood glucose-107* urean-7 creat-0.7 na-138 k-4.6 cl-105 hco3-25 angap-13 06:45am blood alt-39 ast-31 ld(ldh)-317* ck(cpk)-217 alkphos-114 totbili-0.7 07:00am blood calcium-9.3 phos-3.6 mg-2.1 07:01pm blood lactate-1.3 02:28pm urine color-yellow appear-clear sp -1.004 02:28pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-2* ph-5.5 leuks-neg 02:28pm urine rbc-0 wbc-0 bacteri-none yeast-none epi-0 04:22pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg c. genetic testing 07:00 jak2 mutation (v617f) analysis, plasma based results pending ii. microbiology urine urine culture-final inpatient urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient urine urine culture-final inpatient blood culture blood culture, routine-pending inpatient serology/blood lyme serology-final inpatient lyme serology (final ): no antibody to b. burgdorferi detected by eia. reference range: no antibody detected. negative results do not rule out b. burgdorferi infection. patients in early stages of infection or on antibiotic therapy may not produce detectable levels of antibody. patients with clinical history and/or symptoms suggestive of lyme disease should be retested in weeks. blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient mrsa screen mrsa screen-final inpatient urine urine culture-final inpatient blood culture blood culture, routine-final inpatient blood culture blood culture, routine-final inpatient mrsa screen mrsa screen-final inpatient iii. neurophysiology findings: background: a well-formed 9-9.5 hz alpha rhythm background was observed throughout the record. hyperventilation: did not produce activation of the record. intermittent photic stimulation: did not produce activation of the record. sleep: the patient remained awake throughout the entire record. cardiac monitor: showed a generally regular rhythm between 90-100 bpm. impression: this is a normal routine eeg in the awake state. there were no focal abnormalities or epileptiform features present. iv. cardiology a. ekg sinus tachycardia. otherwise, tracing is within normal limits. no diagnostic interim change. tracing #2 read by: , v. intervals axes rate pr qrs qt/qtc p qrs t 115 128 90 330/426 42 10 24 b. echo conclusions the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. impression: normal global and regional biventricular systolic function. no pulmonary hypertension or clinically-significant valvular disease seen v. radiology a. head mri exam: mri of the brain. clinical information: patient with persistent memory and cognitive problems status post head trauma and alcoholism and family history of multiple sclerosis. technique: t1 sagittal and axial and flair t2 susceptibility and diffusion axial images were obtained before gadolinium. t1 axial and mp-rage sagittal images acquired following gadolinium. findings: diffusion images demonstrate no evidence of acute infarct. subtle hyperintensities on diffusion images in the brainstem appear to be secondary to t2 shine-through from mild t2 hyperintensities in the region from small vessel disease. there is no evidence of periventricular signal abnormalities. a few scattered nonspecific hyperintensities are seen in the white matter indicating minimal changes of small vessel disease. the appearances are not typical for demyelinating process. however, clinical correlation recommended. following gadolinium, no evidence of abnormal parenchymal, vascular or meningeal enhancement seen. there is mild prominence of sylvian fissures identified but there is no evidence of dilatation of the temporal horns to indicate medial temporal atrophy. on the coronal mp-rage images there is no evidence of atrophy of the hippocampi visualized or atrophy of the medial temporal lobe structure seen. following gadolinium, no evidence of abnormal parenchymal, vascular or meningeal enhancement seen. impression: except for a few non-specific scattered foci of t2 hyperintensity in the white matter, no other significant abnormalities are seen. the appearances are not typical for demyelinating disease but clinical correlation recommended. no enhancing brain lesions are seen. no evidence of medial temporal atrophy. b. cxr chest radiograph indication: status post left shoulder repair. comparison: . findings: as compared to the previous radiograph, there is no relevant change. normal size of the cardiac silhouette. no pleural effusions. no pneumothorax. minimal atelectasis in the retrocardiac lung areas. otherwise, the lung parenchyma is unremarkable. there is no evidence of focal parenchymal opacity suggesting pneumonia. no evidence of pulmonary edema and no pleural effusions. the hilar and mediastinal contours are unremarkable c. left shoulder history: orif. findings: single image from the operating suite shows extensive metallic fixation device about previous fracture of the proximal humerus. the humeral head is somewhat inferiorly displaced in relation to the glenoid fossa. d. ue doppler () impression: right basilic vein clot (this is a superficial vein). limited evaluation of the right cephalic and left brachial veins. e. mri c-spine () impression: 1. cervical spondylosis with posterior disc protrusions at c3-c4 through c6-c7. the posterior disc protrusion indents the cervical cord at c4-c5 and c5-c6. the cervical cord, c3 through c7, does demonstrate subtle t2 hyperintense signal, possibly related to myelomalacia. 2. the right neural foraminal of c6-c7 is severely narrowed due to the above mentioned disc protrusion. 2. no definite acute abnormality identified. f. left shoulder plain film history: orif left proximal humerus. fluoroscopic assistance provided to the surgeon in the or without the radiologist present. four spot views obtained. fluoro time recorded as 49.5 seconds on the electronic requisition. views demonstrate hardware related to a left proximal humeral fracture. correlation with real-time findings and when appropriate conventional radiographs are recommended for full assessment. g. c-spine history: 43-year-old male with altered mental status and head strike. comparison: concurrent head ct. technique: non-contrast cervical spine ct was obtained. multiplanar reformatted images were generated. findings: there is reversal of the normal cervical lordosis centered at c4. minimal, grade i retrolisthesis of the c5 on c6 is likely degenerative. there is no fracture of the cervical spine and no prevertebral soft tissue edema or hematoma. posterior osteophytes result in mild spinal canal narrowing at c6-7, c5-6 and c4-5 consisitent with degenerative changes of the cervical spine. at c6-7, osteophytes result in neural foraminal narrowing, right greater than left. the lung apices are clear. impression: 1. no fracture of the cervical spine. 2. multilevel degenerative changes of the cervical spine with mild canal stenosis at c4-5, c5-6 and c6-7, which could predispose to cord injury in the setting of minor trauma. mri is recommended if there is concern for ligamentous injury. brief hospital course: 48-year-old male with alcohol abuse that presents with resolved polysubstance withdrawal, confabulation, resolved delirium, resolved acute kidney injury secondary to pre-renal etiology and elevated ck, baseline tachycardia at 100 that is status post left proximal humerus orif/k-rod () and repair () secondary to repeat fall vs. non-adherence to sling. icu course: patient was admitted for etoh withdrawal in the setting of left humeral fracture, having hallucinations and being minimally responsive. he was resuscitated in the icu with fluids with subsequent transfer to the floor. # altered mental status/delirium (resolved) secondary to polysubstance abuse/underlying medical issues in first twelve hours, the patient scored frequently on the ciwa scale. he was noted to be broadly confabulating. in subsequent 24 hours he received only 10mg valium. however, he continued to lack orientation to time and continued to confabulate. he was also unable to tell a consistent story of what happened to him prior to admission. there was concern for thiamine deficiency and wernicke-korsakoff syndrome and aggressive thiamine repletion was undertaken. he also has a history of psychosis although this is questionable upon record review. his home quetiapine was restarted. it was thought that he may have delirium. various issue have been ruled out for his delirium. given left humerus fracture, polytrauma was ruled out with ct head not suggestive of bleed, cxr showed no evidence of traumatic injury, mri of c-spine showed cervical spondylosis with a variety of abnormalities not suggestive of acute abnormality. his mental status has improved and now resolving with normal eeg. as his medical issues resolve, he remains rather odd, which is normal per family. he has had intermittent alcohol sobriety periods in past year. he has had issues with attending medical appointments. he has been working with addiction specialists at but dropped out last fall. there was no evidence of organic brain disease on mri. he was given appropriate nutrition, weaned off delirium-causing medications, and psychiatry was consulted for assessment. he was initially placed on seroquel that caused orthostatic issues. he was subsequently switched to abilify 5 mg with good effect and resolution of orthostasis. his delirium had resolved. he does have poor insight at times about his alcohol habits. # orthostatic hypotension with tachycardia and gait instability the patient had a mechanical fall prompting admission and felt dizzy getting out of bed in the radiology suite with subsequent fall. his baseline heart rate is 100 per old records. during his earlier hospital course, he was triggered for tachycardia to 140 consistent with sinus tachycardia. he also has had tachycardia on exertion elevated to 140 on exertion that is non-paroxsymal in nature per telemetry. pt/ot evaluation showed orthostatic hypotension with tachycardia to 160. previously in his hospital course, considerations were hypovolemia with heart rate responding to boluses. given this current issue, medication side effect with seroquel was found to be the likely etiology resulting in orthostasis. in addition, he has had new gait instability since per his mother. confusing picture, neurology was consulted and felt based on additional imaging (mri brain) that he had the sequela of chronic alcoholism. his seroquel was changed to abilify. # tachycardia with trigger on his heart rate was 100s-130s and as high as 160 during first the first 48 hours of hospitalization with sbps 110s-160s. differential included pain, surgery, and alcohol withdrawal. heart rate and blood pressure were not noted to respond to diazepam. there was a concern for thiamine deficiency leading to beriberi prompted echocardiogram with reported attached. the patient was triggered on for sinus tachycardia to the 130s responsive to fluids. his tachycardia has likely been multifactorial and the etiology remains unknown definitively except that orthostasis may have played a role. his heart is 100 at baseline per old records. it was initially suspected that he may be withdrawing, but outside of this period, he still continued to have issues. tsh and other factors were examined and negative. it was likely attributed to a medication side effect. # left humerus fracture status post orif () and status post repair () after fall the patient had suffered a left humerus fracture from his fall. he was made non-weight bearing on his lue with a shoulder immobilization device. he subsequently fell in the radiology suite with ? injury from the fall vs. non-adherence with his splint. he was again taken to the or on for subsequent repair. he refused to wear his shoulder sling during his hospitalization and was warned about further injury. he was discharged on motrin for pain. # recurrent pyrexia the patient was febrile in both the icu and on the floor. the patient was pan-cultured with multiple negative studies. he stated that at times he has fever at home spontaneously and that it is "normal" for him. in the post-op period, aspiration pneumonia and uti were ruled out in addition to wound infection.there has been no identifiable source of infection with cultures, and ue us for dvt has been negative given left > right upper extremity swelling. withdrawal was also considered but unlikely given he was out of the normal period. # left extremity swelling and erythema given warm and left greater than right upper extremity swelling, surgery was called to re-evaulate wound on initial surgery. upper extremity us to rule out dvt showed superficial basilic clot. he extremity edema has nearly resolved on discharge. # acute kidney injury secondary to elevated cpks, pre-renal, resolved cr at admission of 2.21 now down to baseline with ck and volume depletion likely contributers. issue is resolved. # neck pain, resolved the patient had complained of neck pain and was placed in a c-spine collar. mri was performed given point tenderness over spinous processes. mri of the spine showed no acute abnormality but some anatomical issues. it is perhaps possible that he may have had ligamentous strain from fall. this pain subsequently resolved after a few days. # anemia with thrombocytosis the patient had anemia on admission (hgb 13) likely secondary to nutritional disorder, blood loss, and marrow-supressive effect of alcohol. he had a nadir to 9.1 with subsequent transfusion of 2prbc before going to the or with interval climb of 10.2. he had mild blood loss during both procedures. his stools have been hemoccult negative. the etiology of his anemia is unknown. he also had development of thrombocytosis. the patient has no apparent malignancy, so the thrombocytosis may be reactive in the post-operative period. a jak2 mutation was ordered to rule out underlying myleoproliferative disease, and he was placed on aspirin given platelets greater than 1090. in addition given macrocytosis and b12 < 400, he was empirically treated for b12 deficiency in setting of folate therapy in order to avoid masking underlying neurological symptoms. his mma returned low. b12 can be continued on an outpatient basis and re-tested. # transaminitis: the patient has initial lft elevation on admission (alt 89 ast 260 ldh 459 cpk 4207 alp 79 tot bili 1) with subsequent downtrend to normal range with remaining isolated ldh elevation. suspect acute alcohol ingestion along with component of muscle damage given concomitant ck. issue has resolved. # tobacco abuse patient was counseled about tobacco abuse and given nicotine patch. # pending tests - bcx x 2 (), bcx x 2 (), jak2 mutation # outpatient considerations - uptitration of abilify to 15 mg based on symptoms (akathisia would be main side effect that can be treated with ativan). - re-check outpatient tsh as suggestive of sick euthyroid - re-check nutritional studies - outpatient substance abuse program or alcoholics anonymous - repeat liver enzymes - consider outpatient psychiatry medications on admission: fexofenadine 60mg quetiapine 100 mg qam, 300mg qpm discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. cyanocobalamin (vitamin b-12) 500 mcg tablet sig: two (2) tablet po daily (daily). 4. aripiprazole 10 mg tablet sig: 0.5 tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 7. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. discharge disposition: extended care facility: - discharge diagnosis: 1. left humerus fracture s/p orif and repair 2. alcohol withdrawal 3. thrombocytosis 4. anemia rehab stay less than 30 days discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). use left shoulder splint. discharge instructions: mr. , you were admitted after falling onto your left shoulder. your left shoulder was repaired by the orthopedic doctors. you were also lightheaded and unstable on your feet. you fell again, and unfortunately had to return to the operating room to have your shoulder fixed a second time. by decreasing your seroquel dose and starting a new medication, abilify, your walking improved. you are now ready to go to rehab to continue working on your walking. new medications: aripiprazole 5 mg po daily aspirin 325 mg po daily cyanocobalamin 1000 mcg po daily folic acid 1 mg po daily ibuprofen 400 mg po every 8 hours as needed for pain multivitamins 1 tab po daily thiamine 100 mg po daily followup instructions: please call your primary care doctor: , ( md procedure: closure of skin and subcutaneous tissue of other sites alcohol detoxification open reduction of fracture with internal fixation, humerus open reduction of fracture with internal fixation, humerus rotator cuff repair bone graft, humerus diagnoses: acidosis tobacco use disorder unspecified essential hypertension acute kidney failure, unspecified depressive disorder, not elsewhere classified open wound of scalp, without mention of complication other b-complex deficiencies hypotension, unspecified accidental fall on or from other stairs or steps dehydration encephalopathy, unspecified fall from other slipping, tripping, or stumbling tachycardia, unspecified rhabdomyolysis other and unspecified alcohol dependence, continuous other alteration of consciousness alcohol withdrawal delirium cervical spondylosis without myelopathy closed fracture of surgical neck of humerus rotator cuff (capsule) sprain essential thrombocythemia folate-deficiency anemia closed fracture of greater tuberosity of humerus other and unspecified manifestations of thiamine deficiency 

Answer: The patient is high likely exposed to