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: no known allergies / adverse drug reactions attending: chief complaint: s/p motor cycle crash major surgical or invasive procedure: placement of left chest tube , chest tube removed on picc placment . picc line removed history of present illness: 52 m +etoh, s/p motorcycle crash intubated on scene w/ left clavicle fracture, left rib fracture, pulmonary and splenic contusions. he reportedly was not moving left side of body when found by road. he was intubated for gcs of 8 at scene and was initally taken to osh but transferred to for further care given multiple injuries. past medical history: cad s/p stent (? last five years), etoh use. unknown other pmh social history: lives with mother owner of "several businesses" family history: unknown physical exam: admission physical exam - t 99.0 p: 82 r: 14 bp:141/61 sao2: 95% on nc general: asleep, responds to verbal stimuli but falls back alseep readily, on re-examination patient was more easily aroused heent: wearing stiff c-collar, abrasions and erythema of left side of face/head, with echymosis posterior to left ear neck: c-collar in place pulmonary: significant upper airway congestion with son breathing while asleep, no wheezes/rales appreciable; no chest wall crepitus cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally; skin: no rashes noted; significant echymosis over left mid-clavicular area, echymosis behind left ear as noted above mental status: somnolent, responsive to verbal stimuli and light touch, able to follow some limited midline and appendicular commands. regarded interviewer and able to localize pain. upon re-examination patient was able to nod yes to some questions but not consistently. cranial nerves: ii: perrl 2 to 1mm bilaterally iii, iv, vi: unable to evaluate fully, adduction/abduction intact bilaterally v: difficult to assess but facial sensation appeared intact to pinprick vii: no facial droop at rest, difficulty opening eyes bilaterally, decreased left sided activation with smile, noticeable deficit on left side with smiling on re-examination viii: responds to some verbal stimuli/commands, unable to assess further ix, x: +cough/gag reflex : limited by c-collar and injuries, trapezius intact bilaterally xii: tongue protrudes in midline motor: - difficulty following individual strength testing , no pronator drift on rue, extended rue above head, no rue asterixis, -normal bulk, normal tone throughout though variable increase in rue tone over course of exam. no pronator drift on right. -lue flaccid other than flicker of third and fourth digits reflexes: -rue biceps and brachioradialis 2+, triceps difficult to ellicit, -lue biceps 1 (decreased), ticeps absent, brachioradialis 2 (normal), -lower extremity reflexes 2+ throughout sensory: intact to light touch on rue, lle, rle, localized to pain on rue. appeared to have sensation to pinprick bilaterally on face though difficult to assess exam upon discharge: vs: 98.2 90 124/88 18 room air sats 98% neuro: awake, alert and oriented x2-3 cor: rrr lungs: cta bilaterally abd: soft, non tender extr: ambulates independently pertinent results: 09:06am blood wbc-7.1 rbc-3.87* hgb-12.2* hct-36.5* mcv-94 mch-31.6 mchc-33.5 rdw-12.5 plt ct-457* 09:06am blood plt ct-457* 09:06am blood glucose-108* urean-18 creat-0.9 na-141 k-3.9 cl-105 hco3-24 angap-16 09:06am blood calcium-9.8 phos-3.8 mg-1.8 02:10am blood wbc-10.0# rbc-3.00* hgb-9.8* hct-27.5* mcv-92 mch-32.7* mchc-35.6* rdw-12.2 plt ct-230 01:41am blood wbc-5.5 rbc-2.78* hgb-9.1* hct-26.1* mcv-94 mch-32.6* mchc-34.7 rdw-12.1 plt ct-193 10:15pm blood wbc-11.7* rbc-3.81* hgb-12.6* hct-36.2* mcv-95 mch-33.1* mchc-34.8 rdw-12.2 plt ct-202 02:10am blood neuts-71* bands-0 lymphs-18 monos-8 eos-2 baso-0 atyps-0 metas-1* myelos-0 nrbc-1* 02:10am blood plt smr-normal plt ct-230 01:41am blood plt ct-193 05:30pm blood fibrino-250# 12:52am blood fibrino-151* 02:10am blood glucose-130* urean-15 creat-0.8 na-142 k-3.4 cl-107 hco3-25 angap-13 01:41am blood glucose-121* urean-16 creat-0.7 na-143 k-3.4 cl-109* hco3-28 angap-9 05:30pm blood alt-45* ast-73* ld(ldh)-341* alkphos-56 totbili-1.0 : chest x-ray: cardiomediastinal contours are normal. there are low lung volumes. bibasilar opacity, larger on the left side are better seen in prior ct. there is no evident pneumothorax. multiple left rib fractures and left clavicle comminuted fracture are again noted. et tube is in standard position. ng tube tip is out of view below the diaphragm. left perihilar opacity is unchanged. : cta neck: impression: 1. new focus of subarachnoid hemorrhage in the left sylvian fissure with stable subtle and questionable trace of blood products in the right perimesencephalic cistern. 2. no evidence of contusions or extra-axial hemorrhage. 3. stable area of hyoattenuation in the left temporal lobe, likely representing encephalomalacia from prior trauma. 4. normal cta of the head and neck. : skull films: impression: 1. no radiopaque foreign body detected. 2. left rib and clavicle fractures and pleural/parenchymal changes in the left lung : mri of brachial plexus: 1. limited study as the procedure had to be abandoned for patient's safety due to agitation. limited images of the brachial plexus demonstrate no overt compressive mass. the hematoma surrounding the left clavicular fracture appears to be separate from the brachial plexus. assessment of nerve root edema cannot be made on these t1-weighted images. 2. small left pleural effusion. : mri of cervical spine: impression: no evidence of ligamentous trauma or evidence of significant bony trauma in the cervical region. no vertebral malalignment. soft tissue changes in the left supraclavicular region and left side of the neck could be secondary to patient's history of left-sided clavicular and rib fractures and correlation with brachial plexus mri recommended. no evidence of intraspinal hematoma or cord compression. degenerative changes predominantly at c5-6 and c6-7 levels. : mr of the head: impression: 1. blood in the left sylvian fissure, representing subarachnoid hemorrhage seen on the previous ct. 2.small areas of slow diffusion in the subinsular brain likely representing small acute associated infarcts. 3. slow diffusio and increased signal right lateral aspect of mid brain due to infarct or contusion. 4. no mass effect or hydrocephalus seen. 5. prominent subarachnoid spaces are seen in the frontal region, likely representing a small subdural hygromas. : chest x-ray: left lung base consolidation, most likely atelectasis with associated likely small left pleural effusion. : chest x-ray: left chest tube is present. it overlies the lower left lung. there is pleural fluid tracking along the left chest, with multiple left-sided rib fractures. the pleural effusion appears smaller compared with the film obtained earlier the same day ( at 5:28 a.m.) no pneumothorax is detected. if clinically indicated, a lateral view may help to better define the position of the left-sided chest tube. the cardiomediastinal silhouette is prominent as are the upper zone vessels, though these are likely accentuated by low inspiratory volumes. probable atelectasis in the right cardiophrenic angle, but no definite right-sided effusion. comminuted fracture of the left mid clavicle again noted. : chest x-ray: impression: 1. right-sided picc terminating at the mid svc. 2. unchanged position of a left thoracostomy tube. no pneumothorax. : echo: conclusions the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). there is no pericardial effusion. no cardiac source of embolus identified (cannot definitively exclude). agitated saline study at rest revealed evidence of an intracardiac shunt (atrial septal defect or stretched patent foramen ovale). : chest x-ray: findings: in comparison with the study of , the tip of the right subclavian catheter has been advanced to beyond the cavoatrial junction. left chest tube remains in place and there is no pneumothorax. continued low lung volumes. maild engorgement of indistinct pulmonary vessels is consistent with mild elevation of pulmonary venous pressure. areas of more coalescent opacification at the left base and mid zone could reflect developing consolidation in the appropriate clinical setting. : chest x-ray: impression: no pneumothorax following chest tube removal. : chest x-ray: increased density of left hemithorax may represent large layering effusion but is concerning for reaccumulation of known hemothorax. : leni's lower ext: impression: no dvt 8:06 am stool consistency: not applicable source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). brief hospital course: 52 year old gentleman, s/p motor-cycle crash received as a trauma transfer, already intubated. he was admitted to the acute care surgery team and transferred to the trauma icu. upon admission, he demonstrated a completely unresponsive left upper extremity and review of osh films demonstrated a left pulmonary contusion, left sided rib fractures (), left clavicle fracture, and a splenic contusion. head cat scan showed a small subarachnoid hemorrhage. his course in the icu is summarized below by system: neuro: upon admission he was initially agitated while intubated. sedation was weaned and he was extubated that day without difficulty. given his inability to move his lue and mechanism of injury, suspicion of a brachial plexus injury was high and neurology was consulted. bilateral upper extremity abis were performed to assess for arterial injury. the abi's were equal, making arterial injury very unlikely. cta of the head and neck demonstrated a small left sided subarachnoid hemorrhage. neurosurgery was consulted and they recommended a 7 day course of dilantin. an mri showed small, likely acute, infarcts in the sub insular brain, as well as slow diffusion of the right lateral midbrain. his mental status slowly improved while in the intensive care unit from initially being aphasic and agitated to eventually being easily directable and stating coherent phrases. he was given several doses of ativan daily, and we were able to wean ativan usage after beginning scheduled zyprexa on hd 6. on transfer to the floor, he was on zyprexa 10mg tid requiring no ativan. cv: he was hemodynamically stable throughout his stay. it is believed he has a drug-eluding stent, placed 3 years ago. he was reportedly on plavix prior to the accident. he was started on aspirin hospital day 2 then on hospital day 8 once tolerating po and was cleared by neurology. he was finally left on plavix with no aspirin as per recommendations of neurology. pul: there was no difficulty with ventilation while intubated and he protected his airway post-extubation despite having limited mental status. he had a very small pneumothorax on admission scan. serial chest x-ray showed a delayed left effusion (found to be hemothorax) and a chest tube was placed hd 3. the tube initially drained 600cc blood, with 500cc sero-sanguinous fluid over the next 48 hours. the chest tube was removed hd 7 and post-pull film confirmed no residual pneumothorax. gi: he had no significant gastrointestinal injuries or issues. he had a splenic contusion that was managed conservatively. gu/fen: his foley catheter was removed hospital day # 3. he was kept npo with no nutrition until hd# 6, when tpn was begun. given his functional gut, we would have preferred to use -gastric or gastrostomy feedings, but he was felt to be too high risk for pulling at or removing a feeding tube. by hd# 8, his mental status had improved to the point that a trial of po intake was begun. msk: for his left clavicle fracture, the orthopaedic consult service recommended a sling and physical therapy. his rib fractures were managed conservatively. venous access: a right upper extremity picc line was placed and removed on . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ his floor course after transfer out of the icu as follows: he was transferred to the surgical floor on hd #8. because small infarcts were seen on ct scan and mri implicating a possible stroke, recommendations were made for a echocardiogram. the agitated saline study at rest revealed evidence of an intracardiac shunt (atrial septal defect or stretched patent foramen ovale). he was seen by neurology stroke who recommended cardiac monitoring to rule out any cardiac arrhythmia as a source of his stoke. he continued on his plavix. he had been started on clear liquids on hd #8, but demonstrated difficulty swallowing and a speech a swallow study was ordered. this study showed that he was able to swallow liquids and was advanced to a regular diet with supervision during meals. his tpn was discontinued on hd #10. his neurological status continued to wax and wane with periods of agitation alternating with periods of lucidity on scheduled doses of zyprexa and intermittent haldol. with adjustments in his medication, his mental gradually improved with decreased frequency of restlessness. several family/team meetings were held during his stay to provide support and also address his discharge needs. he was intermittently agitated throughout his stay requiring anti-psychotics which were adjusted several times. psychiatry was consulted and his medications were changed so that at time of discharge he is receiving depakote 1000 mg q hs and olanzapine 10 mg po bid. his vital signs have remained stable and without fevers since his transfer out of the icu. he is tolerating a regular diet. he was evaluated by physical and occupational therapy and made significant progress in terms of his strength and balance. his left upper arm paresis related to a brachial plexus injury, as well as a right cerebral peduncle infarct has shown marked improvement. he is being discharged to a residential program specializing in neuro-cognitive issues. medications on admission: unknown discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 5. docusate sodium 100 mg capsule sig: one (1) capsule po tid (3 times a day): hold for diarrhea. 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 7. olanzapine 10 mg tablet sig: one (1) tablet po bid (2 times a day). 8. divalproex 500 mg tablet extended release 24 hr sig: two (2) tablet extended release 24 hr po hs (at bedtime). 9. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain: please take with food. discharge disposition: extended care facility: manor discharge diagnosis: s/p motor vehicle crash injuires: left clavicle fracture left rib fracture with small pneumothorax left pulmonary contusion splenic contusion small left subarachnoid hemorrhage discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - unsteady on feet, uses walker discharge instructions: you were admitted to the hospital after you were involved in a motor cycle crash. as a result of the crash, you sustained a small bleedinf injury in your head, rib fractures with a small collapse of your lung, a fracture of your left clavicle, and a small bruise to your spleen and lung. you were monitored in the intensive care unit upon admission where you had a chest tube placed for the collapsed lung. because of your injuries, you were seen by orthopedics and neurology. you did not require any surgery for your injuries. once your vital signs stabilized, you were transferred to the surgical floor. you are slowly recovering from your injuries. it is being recommended that you be discharged to a program that specializes in trauamtic brain injury - arrangments have been made for you for this after hospital discharge. followup instructions: your insurance records are incomplete- please call our registration department at ( before your first appointment. an appointment has been made for you with new primary md: 02:20p , sc clinical ctr, medical unit (sb) department: neurology when: wednesday at 1 pm with: drs. & building: sc clinical ctr campus: east best parking: garage procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours parenteral infusion of concentrated nutritional substances central venous catheter placement with guidance diagnoses: coronary atherosclerosis of native coronary artery percutaneous transluminal coronary angioplasty status other injury into spleen without mention of open wound into cavity ostium secundum type atrial septal defect cerebral artery occlusion, unspecified with cerebral infarction contusion of lung without mention of open wound into thorax traumatic hemothorax without mention of open wound into thorax other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with brief [less than one hour] loss of consciousness motor vehicle traffic accident due to loss of control, without collision on the highway, injuring motorcyclist closed fracture of six ribs postconcussion syndrome hemiplegia, unspecified, affecting nondominant side injury to brachial plexus closed fracture of shaft of clavicle 

Answer: The patient is high likely exposed to