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: mva vs. tree major surgical or invasive procedure: : right elevation of skull fracture and wound washout history of present illness: this is a 20 year old gentleman who was an unrestrained driver in a single vehicle motor vehicle accident early in the morning of . per reports the patient was driving on route 128 under the influence of etoh when he swerved off the road into a collection of trees and then back onto the road. there was significant damage to the car with the windshield being blown out and debris surround the patient. he did not require extubation at the scene but was brought to where he was intubated for airway protection. he had an obvious open right fronto-parietal skull fracture approximately 2cm in size as well as inches of exposed bone with pieces of what appear to be wood infiltrating the open portion of the fracture. the patient was paralyzed upon arrival of neurosurgery but per reports both at the scene and upon arrival in the er the patient was moving all extremities and opening his eyes but was not following commands and his gcs was estimated to be 8. he also was noted to have vomited multiple times both in the field and in the er here. he was pan-scanned per trauma protocol which did not reveal any significant injuries to other parts of his body on preliminary reports and then was taken emergently to the or for washout and elevation of his open depressed skull fracture. past medical history: none social history: he is a student at institute.he is in his third year. his parents report only etoh, no ivdu, blood transfusions etc family history: unknown physical exam: on admission: exam: gen: intubated, paralyzed heent:large area of exposed skull right fronto-parietal c/w degloving injury of the scalp pupils: perrl per ed prior to paralysis eoms: unable to assess neck: hard cervical collar in place. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: paralyzed orientation: unable to obtain language: intubated and paralyzed cranial nerves: i: not tested ii: pupils equally round and reactive to light, 4mm to 2mm bilaterally. can not assess visual fields iii-xii: unable to ass given patients clinical status motor: moves all extremities spontaneous per ems report and er staff upon arrival prior to being paralyzed sensation: unable to ass given patients clinical status at discharge: he has scalp sutures and staples. he has facial lacerations and lip edema with sutures. pertinent results: head ct: large right frontoparietal scalp subgaleal hematoma, subcutaneous locules of gas and laceration. there is an underlying comminuted, displaced and depressed fracture of the right frontoparietal bone, extending posteriorly to the lambdoid suture. there are hyperattenuating foci along the right frontal region, which may represent small contusions or foci of diffuse axonal injury (). no evidence of shift of normally midline structures or central herniation at this time. note added in attending review: there is also "contre-coup" subarachnoid hemorrhage in the contralateral sylvian fissure, as well as likely small contusion or focus of or less likely, subdural hemorrhage, in the periphery of the left frontal operculum, without significant mass effect. ct torso: left lung base consolidation likely aspiration. no other injury to the chest, pelvis, or abdmomen noted. ct cspine: 1. no evidence of acute cervical spine fracture or alignment abnormality. 2. ng tube appears coiled in the oral cavity and the upper thoracic esophagus (as on the concurrent cect torso); correlate clinically. ct head 1. small hyperattenuating foci in the right frontal l.obe and "contre-coup" lesion in the left frontal operculum, representing contusion or , are unchanged. trace subarachnoid hemorrhage in the left sylvian fissure is also stable. 2. no mass effect or new hemorrhage identified. 3. stable large right frontoparietal subgaleal hematoma, status post operative repair of depressed skull fracture and scalp laceration. cxr left lower lobe consolidation has largely cleared since consistent with resolved aspiration or pulmonary contusion. lungs are fully expanded and clear. normal cardiomediastinal and hilar silhouettes and pleural surfaces. c-spine flexion and extension imaging no radiographic evidence for dynamic instability chest x-ray right pic c line ends in the right atrium. suggest pulling back 4 cm. otherwise, normal radiographic examination of the chest. brief hospital course: mr. was intubated in the ed for airway protection. he did have multiple episodes of vomiting per report from emt en route to the hospital. he had a ab/pelvis/chest ct per trauma protocol which did not reveal any significant abdominal injuries on preliminary reports but his left lung base had a consolidation. he was taken directly to the or from the er for elevation of the skull fracture and washout of the wound. in the or, wood was seen in the fracture cavity but no dural penetration. pieces of the wood was sent for culture. he was then admitted to the neuro icu for close monitoring. he was started on vanc/flagyl/cetrax. mrsa screen is pending. plastic surgery came and sutured his lip. infectious disease was consulted and they recommended the tdap vaccine. he remained intubated for his repeat head ct. this showed post-op chnages and no new hemorrhage. he was extubated. on he was transfered to the floor. his cervical spine was cleared by the icu after ct c-spine showed no fracture. his diet was advanced. he was voiding well. on he reported neck pain. flexion and extension x-rays showed no sign of instability. he was seen by pt and ot. his surgical dressing was removed. wound nurses did not feel that there was any special dressing needed. plastic surgery requested bactitracin to facial lacerations as needed. pt felt that he could beneift from home pt. mrsa and blood culures were negative as of and a picc line was requested and placed. id made new recommendations for cefepime 2q12, flagyl 500 tid x 10d. we got names from his pcp for plastic and neurosurgery follow up. the plastic surgeons do not take his insurance. the cost for suture removal was relayed to the parents. they should go to their pediatrician for the sutures if they choose. medications on admission: unknown discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever/pain: max 400mg per day. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 4. bacitracin 500 unit/g ointment sig: one (1) appl ophthalmic tid (3 times a day). 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. phenytoin 50 mg tablet, chewable sig: two (2) tablet, chewable po tid (3 times a day). 7. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*90 tablet(s)* refills:*0* 8. outpatient physical therapy eval and treat for traumatic brain injury 9. cefepime 2 gram recon soln sig: two (2) grams injection q12h (every 12 hours): d/c 12. disp:*72 grams* refills:*0* 10. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 18 days. disp:*54 tablet(s)* refills:*0* 11. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. order was filled by pharmacy with a dosage form of syringe and a strength of 10 unit/ml . disp:*10 ml(s)* refills:*6* 12. sodium chloride 0.9 % 0.9 % piggyback sig: three (3) ml intravenous q12h (every 12 hours): before and after each abx dose. disp:*180 ml(s)* refills:*2* 13. line care sig: one (1) treatment weekly: change dressing weekly and as needed. disp:*1 * refills:*2* discharge disposition: home with service facility: discharge diagnosis: depressed comminuted skull fracture, sah, sdh, cerebral contusion confirmed on ct head foreign body within fracture cavity confirmed on ct head aspiration pneumonia confirmed on ct chest discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: general instructions you need to see a neurosurgeon near your home in 2weeks for a wound check (around ). the staples and sutures should stay in place for 3 weeks (around ). no resorbable sutures were used under the skin in case of infection. you should have a ct of the head +contrast in 4 weeks-the week after ++ . dr. is a neurosurgeon in your area. we have faxed him your records and is will review them to decide if he can see you in your area. you should see a plastic surgeon in your area in 1 weeks to follow up on your facial lacerations. dr. and dr. are plastic surgeons in your area. we called them and they only acccept medicaide or $200 out of pocket pay for suture removal. if this is a problem, please refer to your pediatrician for wound check and removal of remaining sutures in a week. you should use an over the counter topical antibiotic cream to your facial lacerations as needed. you and your family should have the flu vaccine in about weeks. ?????? have a friend/family member check your incision daily for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? you may shower before this time using a shower cap to cover your head. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. ?????? you have been prescribed dilantin (phenytoin) for anti-seizure medicine, take it as prescribed for 7 days. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. followup instructions: please follow-up with dr or local neurosurgeon in 4 weeks with a head ct with w/o contrast. please call . you will need a suture removal appt 3 weeks post-op. please call to make this appointment. if in rehab- they may remove them there. we recommend you see dr in the traumatic brain injury (tbi) clinic the phone number is . if you have any problems booking this appointment please ask for . md procedure: other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain insertion of endotracheal tube suture of laceration of lip closure of skin and subcutaneous tissue of other sites elevation of skull fracture fragments suture of laceration of external ear diagnoses: alcohol abuse, unspecified pneumonitis due to inhalation of food or vomitus open wound of lip, without mention of complication motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle open wound of face, unspecified site, without mention of complication open wound of auricle, ear, without mention of complication other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration other open skull fracture with cerebral laceration and contusion, with loss of consciousness of unspecified duration 

Answer: The patient is high likely exposed to