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: skull fracture after stabbing major surgical or invasive procedure: craniotomy for repair of depressed skull fracture and clipping of traumatic aneurysm. history of present illness: 20m who was found down at 2 a.m this morning and was unresponisive. pt became more aggitated at the osh and also had multiple episodes of vomiting. as a result he was intubated. a head laceration was noted on the left side and a ct head was obtained. head ct showed a 4mm depressed skull fracture, traumatic sah and associated 1.5cm x 1.7cm ich with pneumocephalus and effacement of the sulci over the left convexity. pt was transfered to for further evaluation past medical history: none social history: 20m who lives with family family history: none physical exam: physical exam: admission t: afebrile bp: 110/57 hr: 68 r 14 o2sats 100% intubated and sedated. eyes slightly open, not following commands. pupils equal and reactive 2mm-->1.5mm. bilateral corneal reflexes. face appears symetric. left temporal puncture wound noted with a palpable bony defect. will localize both upper extremities to stimuli and withdraw both lower extremities to noxious. c collar in place. discharge exam: patient a&0x3. neurologically intact. slight headache to left temporal area. otherwise non focal. pertinent results: 07:25am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 07:25am pt-15.4* ptt-31.1 inr(pt)-1.3* 07:25am plt count-213 07:25am wbc-11.9* rbc-3.83* hgb-11.2* hct-32.4* mcv-85 mch-29.2 mchc-34.6 rdw-13.3 ct/cta head 1. comminuted depressed fracture of the left parietal bone with an adjacent intracerebral hematoma measuring approximately 2.5 cm. predominantly left- sided subarachnoid hemorrhage extending to the posterior fossa in the prepontine region. 2. pneumocephalus. 3. normal ct angiography of the neck. 4. ct angiography of the head demonstrates no aneurysm. no vascular occlusion. no active extravasation seen. slightly increased vascular structures in the left frontal, parietal and temporal region could be secondary to trauma to the left cerebral hemisphere. ct head post operatively status post craniectomy and evacuation of a left frontal intraparenchymal hematoma, with distribution of blood products along the left sylvian fissure, neighboring sulci, suprasellar cistern, and right tentorium. no new hemorrhage or large vascular territorial infarction is seen. the ventricles remain normal in configuration and size, and no new mass effect is present. mild pneumocephalus remains unchanged. brief hospital course: pt admitted to neurosurgery service on and taken emergently to the or for a craniotomy for repair of skull fracture and exploration of wound. pt tolerated this procedure well with no complications. post operatively he was transfered to the icu for further care including q1 neuro checks and strict blood pressure control to less than 140 systolic. post operatively he was seen and doing well. his incision was clean and dry and he was following commands off of sedation. the patient was extubated successfully after his surgery. post operatively pt was started on iv vancomycin and gentamycin for open fracture. he continued this regimen for 48 hours and was then changed to po keflex for a plan to continue for a total of one week. the patient continued to do well in the icu and recieved his dilantin every 8 hours for seizure prophylaxis. he did undergo a post op ct scan of the head that showed no new changes and was consistent with repair of skull fracture. pt was transfered to the floor in stable condition. he was seen by physical therapy and occupational therapy and his plan is for discharge home when stable from a neurosurgical standpoint. his mannitol was weaned to 12.5g q6 on the 10th with plan to dc it completely on the 11th. he continued to ambulate on his own and with the help of his family and he did well. he did develop a severe headache on the morning of , and continued to have a non focal exam. a head ct was negative for interval change. pt was seen by the pain management team who recommended dilaudid 4-8mg po q4 prn pain and a detox program as an outpatient. pt will be dc'd home in stable condition on with plan for suture removal in one week and general fu in 4 weeks with a non contrast head ct. medications on admission: none discharge medications: 1. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 2. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 4. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 7 days. disp:*28 capsule(s)* refills:*0* 5. dexamethasone 2 mg tablet sig: one (1) tablet po every six (6) hours for 1 days. disp:*4 tablet(s)* refills:*0* 6. dexamethasone 1 mg tablet sig: one (1) tablet po every six (6) hours for 1 days: start after 2mg dose complete. disp:*4 tablet(s)* refills:*0* 7. hydromorphone 4 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*45 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: skull fracture traumatic aneurysm discharge condition: aox3. activity as tolerated. discharge instructions: general instructions wound care ?????? you or a family member should inspect your wound every day and report any of the following problems to your physician. ?????? keep your incision clean and dry. ?????? you may wash your hair with a mild shampoo 24 hours after your are removed. ?????? do not apply any lotions, ointments or other products to your incision. ?????? do not drive until you are seen at the first follow up appointment. ?????? do not lift objects over 10 pounds until approved by your physician. diet usually no special diet is prescribed after a craniotomy. a normal well balanced diet is recommended for recovery, and you should resume any specially prescribed diet you were eating before your surgery. medications ?????? take all of your medications as ordered. you do not have to take pain medication unless it is needed. it is important that you are able to cough, breathe deeply, and is comfortable enough to walk. ?????? do not use alcohol while taking pain medication. ?????? medications that may be prescribed include: o narcotic pain medication such as dilaudid (hydromorphone). o an over the counter stool softener for constipation (colace or docusate). if you become constipated, try products such as dulcolax, milk of magnesia, first, and then magnesium citrate or fleets enema if needed). often times, pain medication and anesthesia can cause constipation. ?????? if you have been prescribed dilantin (phenytoin) for anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing in one week. this can be drawn at your pcp??????s office, but please have the results faxed to . if you have been discharged on keppra (levetiracetam), you will not require blood work monitoring. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc, as this can increase your chances of bleeding. activity the first few weeks after you are discharged you may feel tired or fatigued. this is normal. you should become a little stronger every day. activity is the most important measure you can take to prevent complications and to begin to feel like yourself again. in general: ?????? follow the activity instructions given to you by your doctor and therapist. ?????? increase your activity slowly; do not do too much because you are feeling good. ?????? you may resume sexual activity as your tolerance allows. ?????? if you feel light headed or fatigued after increasing activity, rest, decrease the amount of activity that you do, and begin building your tolerance to activity more slowly. ?????? do not drive until you speak with your physician. ?????? do not lift objects over 10 pounds until approved by your physician. ?????? avoid any activity that causes you to hold your breath and push, for example weight lifting, lifting or moving heavy objects, or straining at stool. ?????? do your breathing exercises every two hours. ?????? use your incentive spirometer 10 times every hour, that you are awake. when to call your surgeon: with any surgery there are risks of complications. although your surgery is over, there is the possibility of some of these complications developing. these complications include: infection, blood clots, or neurological changes. call your physician immediately if you experience: ?????? confusion, fainting, blacking out, extreme fatigue, memory loss, or difficulty speaking. ?????? double, or blurred vision. loss of vision, either partial or total. ?????? hallucinations ?????? numbness, tingling, or weakness in your extremities or face. ?????? stiff neck, and/or a fever of 101.5f or more. ?????? severe sensitivity to light. (photophobia) ?????? severe headache or change in headache. ?????? seizure ?????? problems controlling your bowels or bladder. ?????? productive cough with yellow or green sputum. ?????? swelling, redness, or tenderness in your calf or thigh. call 911 or go to the nearest emergency room if you experience: ?????? sudden difficulty in breathing. ?????? new onset of seizure or change in seizure, or seizure from which you wake up confused. ?????? a seizure that lasts more than 5 minutes. important instructions regarding emergencies and after-hour calls ?????? if you have what you feel is a true emergency at any time, please present immediately to your local emergency room, where a doctor there will evaluate you and contact us if needed. due to the complexity of neurosurgical procedures and treatment of neurosurgical problems, effective advice regarding emergency situations cannot be given over the telephone. ?????? should you have a situation which is not life-threatening, but you feel needs addressing before normal office hours or on the weekend, please present to the local emergency room, where the physician there will evaluate you and contact us if needed. followup instructions: follow-up appointment instructions ??????please return to the office in days (from your date of surgery) for removal of your and a wound check. although we try to be thorough, we may miss or staples. be sure to point out any incisions, which may be covered by clothing at the time of suture/staple removal. 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 weeks. ??????you will need a ct scan of the brain without contrast. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours clipping of aneurysm other incision of brain elevation of skull fracture fragments insertion of skull plate diagnoses: assault by cutting and piercing instrument dissection of other artery open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration other dural tear 

Answer: The patient is high likely exposed to