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: patient is a 42-year-old white male who was struck by a car with significant front end damage. he was reported to have been thrown approximately 20 feet and was found face down at the scene. it was unknown whether the patient had loss of consciousness, but he states he does not remember the accident. he was hemodynamically stable in the field and transported to the emergency department for further evaluation. past medical history: none. past surgical history: closure of a left flank wound and left femur fracture repair. medications: none. allergies: penicillin. physical examination: on admission temperature was 96.5 f. he was hemodynamically stable with a heart rate of 66 and a blood pressure of 130/palp. respirations 20. saturating at 98% on room air. he was alert in no acute distress with a gcs of 15. he had a stellate laceration on his scalp. trachea is midline. lungs were clear with equal breath sounds bilaterally. heart was regular. abdomen was distended with moderate diffuse tenderness, no guarding. rectal was heme positive with normal tone. extremities showed bilateral lower extremity tib fib deformities with road rash on the right hip and thigh. he had palpable pulses distally bilaterally. his pelvis was nontender and stable. the back showed no deformities. the neck did have midline tenderness. neuro exam: he was alert. pupils are equal, round and reactive to light. extraocular movements were intact. he had motor strength of the bilateral upper and lower extremities. although he was complaining of tingling of both hands, there was no objective sensory deficits. laboratory data on admission: significant for a hematocrit of 37.8. n normal chemistries and normal coags. negative tox screen. chest x-ray and pelvis films were without abnormality. ct scan of the head showed intracranial bleed, shift or mass effect. ct scan of the c spine showed several significant fractures. there was an lateral occipital subluxation of approximately 3 to 4 mm. there is a hangman's site fracture of c2 and c3. there was massive fracture distraction injury at c6 and c7 with approximately 30 degree rotation of c6 on c7. ct scan of the chest showed bilateral apical contusions and bilateral rib fractures. ct scan of the abdomen showed fluid in the left pericolic gutter as well as mesenteric stranding and a small amount of pelvis fluid. hospital course: the patient was taken from the trauma resuscitation bay to the operating room where he underwent an exploratory laparotomy which revealed mesenteric hematoma and omental bleeding. this is repaired and he is taken to the surgical icu for further resuscitation. of note, the patient was performed on a hard backboard, although just prior to initiation of anesthesia, the demonstrated weakness in his lower extremities bilaterally. once he reached the trauma icu, resuscitation continued. he went to the operating room on the day following his admission for repair of his bilateral tib fib fractures and a right lateral compartment fasciotomy for elevated compartment pressures. he also underwent on an anterior discectomy and partial corpectomy at c6-c7 with fusion and instrumentation. he returned to the operating room on for posterior c6-c7 laminectomy with grafting. of note, on he also had placement of a halo for immobilization of his c2 hangman's fracture. the rest of the hospital course will be described by system. 1. neuro: the patient underwent early stabilization both anteriorly and posteriorly of his cervical spine fractures. as noted, he had a halo placed for his c2 fracture. the halo should remain for a two month time period. his initial ct scan of his head showed no intraparenchymal or intracranial process. four vessel carotid and vertebral angiogram on showed no abnormality. his current neurovascular status has been stable since after his initial exploratory laparotomy for bleeding. he has flexor strength of his upper extremities, but no movement of his lower extremities bilaterally. the extensor strength in the upper extremities has improved somewhat since his initial operation. of note, he also had a question of l4 fracture on his initial ct scan of his spine. this was felt to be degenerative. he also has spinous processes fractures of t6 and 7 which were not felt to be significant. has received sedation on an as needed basis with morphine and ativan, however he is alert, able to answer questions and express his needs without difficulty at this time. he was maintained on solu-medrol intermittent intravenous dosing for the first three days of his hospital stay. 2. cardiovascular: he has no history of cardiac disease. had no evidence of cardiovascular injury with his trauma and has had no active issues with his heart throughout his icu stay. 3. respiratory: has been ventilator dependent since his arrival. he was initially intubated with an oral tracheal tube. this is changed over to a percutaneous tracheostomy on with an #8 -tex trach. this was done at the bedside without complications. he also has developed a right lower lobe pneumonia which has cleared on recent x-rays. sputum cultures were significant only for methicillin sensitive staphylococcus aureus, however there is a high suspicion of gram negative co-infection and he has been on appropriate antibiotic coverage. this will be described in the section of id. he has required significant respiratory support thought to be secondary to not having an intercostal contribution to inspiratory phase. we have been able to wean his pressure support and his peep over the last few days. his current ventilator settings are pressure support ventilation of 10 with a peep of 13, 50% fio2. his tidal volumes are approximately 650 by a rate of 18. we will continue to wean the peep over the next couple of days in anticipation of his transfer to . 3. gastrointestinal: after undergoing the initial exploratory laparotomy for mesenteric bleeding, we had maintained initially on tpn and then on tube feeds. he has not tolerated gastric tube feeds and has had a postpyloric placed and replaced a couple of times. he tolerate postpyloric tube feeds without difficulty. current formula is peptamen with a goal of 110 cc per hour. for a bowel regimen related to his spinal cord injury, he is on reglan 10 mg iv q. six and dulcolax 10 p.r. q.d. with good effect. when these medications are stopped, he does have trouble with gastric and intestinal ability. 4. genitourinary: was initially maintained with a foley which has been changed over to q. six to eight straight catheter. he has had no evidence of urinary tract infection throughout his hospital stay and has not had any spontaneous voiding since the foley was removed. 5. hematology: after his initial resuscitation, hematocrit has been in the upper 20 range without need for transfusion in the last several weeks. for dvt prophylaxis, he was initially maintained on pneumatic boots, however a temporary ivc filter was placed on and then removed on . he was initially not thought to be a candidate for subcutaneous heparin or lovenox due to the question of an epidural hematoma along his cervical spinal cord, however in consultation with the ortho spine service, he was started on subcutaneous heparin the week of and then changed over to lovenox 30 mg subcutaneous q. 12 hours on . he has had bilateral lower extremity duplex studies on and and they were all negative for deep venous thrombosis. 6. infectious disease: through his hospital course, has had sputum cultures that grew methicillin sensitive staphylococcus aureus most recently on . he has had two culture since that time that were negative. for this he has received vancomycin, several courses initially peri-procedure. from to he received vancomycin and gentamycin as prophylaxis. after his second operation, he also received vancomycin for another 48 hours. he then received vancomycin from to for methicillin sensitive staphylococcus aureus and then was resumed on after a fever spike. he had a blood culture that was positive for coag negative staphylococcus on as well, two out of four bottles. this is also being treated by the vancomycin. he received levofloxacin from to which was then changed to cipro on for empiric gram negative coverage for presumed gram negative pneumonia. he was also resumed on gentamycin for the same empiric gram negative coverage on . the vancomycin dosing was changed over to q. day dosing on and he will be due for a level on his dose on the evening of . our plan is to continue vancomycin, gentamycin and ciprofloxacin until his white blood cell count normalized. white count today was down from 17 to 14. 7. endocrine: has been maintained on sliding scale regular insulin. while he was on the solu-medrol drip, he did require more coverage than he has recently. 8. tubes, lines and drains: currently has peripheral ivs, picc placed in his left antecubital fossa on , post pyloric feeding tube confirmed on , tracheostomy placed on with a #8 -tex and a condom catheter with intermittent bladder catheterizations. 9. prophylaxis: currently receiving tube feeds via postpyloric tube. he has pneumo-boots on bilateral lower extremities and lovenox 30 mg subcutaneous q. 12. disposition: it is anticipated that mr. will be discharged to rehabilitation center on . discharge medications: 1. vancomycin the dose has just changed to 1.5 grams iv q. 12 hours. he should have levels checked on . 2. gentamycin 600 mg iv q. 24 hours. he is due for a trough for his dose on the evening of . 3. ciprofloxacin 400 mg iv q. 12. 4. sertraline 50 mg per ng tube q.d. 5. epogen alpha 40,000 units subcutaneous q. week. 6. lovenox 30 mg subcutaneous q. 12 hours. 7. dulcolax 10 mg p.r. q.d. 8. reglan 10 mg iv q. six hours. 9. folate 1 mg per ng tube q.d. 10. iron sulfate 325 mg per ng tube q.d. 11. ativan 0.5 to 1 mg iv q. four hours p.r.n. 12. morphine sulfate 4 to 6 mg iv q. one hour p.r.n. 13. tylenol p.r.n. 14. he also receive albuterol and atrovent mdi per respiratory therapy. diet: peptamen with a goal of 115 cc per hour via postpyloric feeding tube. treatments: please see the page #2 and page #3 reports from occupational therapy, physical therapy and nursing for more details. follow up: dr. is the attending trauma surgeon. his office phone # . he can follow up on a p.r.n. basis. dr. his orthopedic and sign attending, his office # . please contact his office for follow up information. , m.d. dictated by: medquist36 procedure: parenteral infusion of concentrated nutritional substances parenteral infusion of concentrated nutritional substances interruption of the vena cava exploratory laparotomy temporary tracheostomy fasciotomy excisional debridement of wound, infection, or burn other cervical fusion of the anterior column, anterior technique excision of intervertebral disc open reduction of fracture with internal fixation, tibia and fibula other cervical fusion of the posterior column, posterior technique other suture of muscle or fascia suture of peritoneum diagnoses: methicillin susceptible pneumonia due to staphylococcus aureus traumatic hemothorax without mention of open wound into thorax closed fracture of c5-c7 level with unspecified spinal cord injury injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum non-healing surgical wound closed fracture of c1-c4 level with unspecified spinal cord injury injury to other gastrointestinal sites, without mention of open wound into cavity closed fracture of shaft of fibula with tibia quadriplegia, c5-c7, complete 

Answer: The patient is high likely exposed to