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: pedestrian struck by car major surgical or invasive procedure: right tibia nail, with irrigation and debridement of right tibia orif right distal radius fracture right tibialis muscle flap and skin history of present illness: mr. is a 51 year old man who was struck by a car. he was then presented to the with injuries past medical history: unknown ivc filter in place social history: homeless daily etoh and drug use per patient report family history: unknown physical exam: upon admission: spanish speaking, following commands cardiac: regular rate/rhythm chest: clear bilaterally abdomen: soft non-tender/non-distended extremities: rle open tib/fib + pulses, + movement and sensation rue: closed deformity +pain to palpatation, + pulses, +sensation/movement. pertinent results: 06:15am blood wbc-8.4 rbc-3.26* hgb-10.0* hct-30.7* mcv-94 mch-30.8 mchc-32.7 rdw-14.9 plt ct-733* 06:00am blood wbc-9.4 rbc-3.11* hgb-10.0* hct-28.6* mcv-92 mch-32.1* mchc-34.9 rdw-15.2 plt ct-610*# 09:05pm blood wbc-9.0 rbc-3.47* hgb-12.0* hct-33.7* mcv-97 mch-34.7* mchc-35.7* rdw-14.0 plt ct-195 04:30am blood wbc-11.1* rbc-2.97* hgb-9.6* hct-28.2* mcv-95 mch-32.4* mchc-34.1 rdw-13.7 plt ct-185 06:15am blood plt ct-733* 09:05pm blood pt-12.6 ptt-43.1* inr(pt)-1.1 06:35am blood glucose-91 urean-10 creat-0.7 na-135 k-4.3 cl-103 hco3-23 angap-13 04:30am blood glucose-118* urean-9 creat-1.0 na-144 k-3.9 cl-109* hco3-24 angap-15 06:15am blood alt-39 ast-70* ld(ldh)-214 alkphos-200* totbili-0.7 08:00pm blood alt-31 ast-74* ld(ldh)-220 alkphos-89 totbili-1.9* 06:15am blood albumin-3.5 operative report , k. signed electronically by , on fri 4:48 pm name: , unit no: service: ort date: date of birth: sex: m surgeon: , preoperative diagnoses: 1. right grade 3b open segmental tibia fracture. 2. right closed both-bone forearm fracture. postoperative diagnoses: 1. right grade 3b open segmental tibia fracture. 2. right closed both-bone forearm fracture. procedure: 1. irrigation and debridement, right open tibia fracture. 2. intramedullary nailing, right open tibia fracture with synthes 345 x 10 mm expert system. 3. closed treatment and splinting of right forearm both-bone fracture. indications: mr. is a 54-year-old gentleman who was a pedestrian hit by a motor vehicle. the patient was heavily intoxicated and tested positive for alcohol and cocaine use. he was in no condition for written consent; however, given the extensive nature of his lower extremity injury, i deemed the need for debridement and stabilization an emergency, and i am taking him to the operating room in the patient's best interest. the procedure will be limited today to the management of the open right lower extremity wound. we will defer the right closed forearm fracture dilator until later when the patient is able to provide informed consent. procedure in detail: the patient was brought to the operating room and, after successful induction of general anesthesia, the right lower extremity was prepped and draped in the usual sterile manner. aggressive debridement of the open fracture, including any piece of devitalized bone and dirty edges, was performed, and lavage was performed with 6 liters of pulsed irrigation solution. after appropriate debridement had been achieved, an intramedullary nail was placed. an 8 cm incision on the knee was performed and via a medial parapatellar exposure, the entry point was identified and reamed to prepare entry of the nail. a long beaded guidewire was inserted into the canal, and the fracture was reduced over the beaded guidewire under fluoroscopic imaging. the canal was subsequently reamed to a size 11.5 mm, and 10 mm x 345 nail was inserted with great care not to displac ethe proximal tibia fracture reduction. the expert system allowed the placement of 5 proximal screws that managed the proximal tibia fracture which was closed, and also allowed for management of the distal shaft fracture. the fracture was a segmental fracture of the shaft with a proximal tibia plane approximately 5 cm from the joint in a distal open fracture with extensive comminution. there was significant loss of anterior bone cortex in the order of 2 cm, but the posterior cortex fragments appeared to span the defect. the nail was locked distally using freehand technique with 2 screws, and a vacuum dressing was applied in anterior open wound. the patient tolerated the procedure well and was taken back to the trauma icu for further workup and assessment. special issues: this was a difficult case given the segmatnal nature of the proximal tibia fracture. it requried careful nailplacment and care to keep a high proximal tibia fracture reducd while a distal open fracture with bone loss while also addressed with the same implant , md operative report , k. **not reviewed by attending** name: , unit no: service: date: date of birth: sex: m surgeon: preoperative diagnosis: right both bones forearm fracture, right distal radius styloid fracture, right distal ulna fracture, right grade 3 open tibia fracture. postoperative diagnosis: right both bones forearm fracture, right distal radius styloid fracture, right distal ulna fracture, right grade 3 open tibia fracture. procedure: 1. open reduction internal fixation both bones forearm fracture with plating. 2. open reduction internal fixation distal radius pilon fracture with percutaneous pins. 3. irrigation and debridement down to muscle and vacuum change dressing of right tibia wound fracture. assistant: , pa. indications: this is a staged procedure for mr. who was hit by a motor vehicle. he underwent emergent fixation of his tibia at the time of presentation. he now presents for a staged management of his forearm fracture and staged debridement of his wound. procedure in detail: the patient was brought to the operating room. after the successful induction of general anesthesia, he was put in the supine position and the right upper extremity was prepped and draped in the usual sterile fashion. approach to the fracture was exposed, preserving the radial artery. the fracture was reduced with tenaculums and plated with a 3.5 mm dcp plate using cortical screws. the ulna was then exposed through a dorsal incision and also plated with a dcp plate. this was a 7 hole plate. the final reduction was found to be satisfactory in stability and imaging in ap and lateral views. the acetabular fracture was pinned percutaneously with two 1.5 mm k wires. the wounds were copiously irrigated and closed in layers with vicryl sutures and staples. attention was then turned to the right lower extremity which was managed by removing the existing vacuum dressing, irrigating and debriding the wound down to the level of the muscle which appeared to be healthy and clean. subsequently a new vacuum dressing was applied. the patient tolerated the procedure well and was taken to the recovery room without incident. dr. was present for the entire procedure. , md operative report , k. signed electronically by , on fri 4:48 pm name: , unit no: service: ort date: date of birth: sex: m surgeon: , preoperative diagnoses: 1. right grade 3b open segmental tibia fracture. 2. right closed both-bone forearm fracture. postoperative diagnoses: 1. right grade 3b open segmental tibia fracture. 2. right closed both-bone forearm fracture. procedure: 1. irrigation and debridement, right open tibia fracture. 2. intramedullary nailing, right open tibia fracture with synthes 345 x 10 mm expert system. 3. closed treatment and splinting of right forearm both-bone fracture. indications: mr. is a 54-year-old gentleman who was a pedestrian hit by a motor vehicle. the patient was heavily intoxicated and tested positive for alcohol and cocaine use. he was in no condition for written consent; however, given the extensive nature of his lower extremity injury, i deemed the need for debridement and stabilization an emergency, and i am taking him to the operating room in the patient's best interest. the procedure will be limited today to the management of the open right lower extremity wound. we will defer the right closed forearm fracture dilator until later when the patient is able to provide informed consent. procedure in detail: the patient was brought to the operating room and, after successful induction of general anesthesia, the right lower extremity was prepped and draped in the usual sterile manner. aggressive debridement of the open fracture, including any piece of devitalized bone and dirty edges, was performed, and lavage was performed with 6 liters of pulsed irrigation solution. after appropriate debridement had been achieved, an intramedullary nail was placed. an 8 cm incision on the knee was performed and via a medial parapatellar exposure, the entry point was identified and reamed to prepare entry of the nail. a long beaded guidewire was inserted into the canal, and the fracture was reduced over the beaded guidewire under fluoroscopic imaging. the canal was subsequently reamed to a size 11.5 mm, and 10 mm x 345 nail was inserted with great care not to displac ethe proximal tibia fracture reduction. the expert system allowed the placement of 5 proximal screws that managed the proximal tibia fracture which was closed, and also allowed for management of the distal shaft fracture. the fracture was a segmental fracture of the shaft with a proximal tibia plane approximately 5 cm from the joint in a distal open fracture with extensive comminution. there was significant loss of anterior bone cortex in the order of 2 cm, but the posterior cortex fragments appeared to span the defect. the nail was locked distally using freehand technique with 2 screws, and a vacuum dressing was applied in anterior open wound. the patient tolerated the procedure well and was taken back to the trauma icu for further workup and assessment. special issues: this was a difficult case given the segmatnal nature of the proximal tibia fracture. it requried careful nailplacment and care to keep a high proximal tibia fracture reducd while a distal open fracture with bone loss while also addressed with the same implant , md brief hospital course: mr. was admitted to the on /006 after being hit by a car while walking on the street. he was evaluated by the trauma surgery service which consulted neurosurgery and orthopaedics. his injuries were open right tib-fib fracture, right forearm both bone fracture, and small left subdural hematoma. he intubated and taken to the or on for a right tibial nailing with debridement and splint placement on right forearm. he remained intubated postoperatively and was taken to the trauma intensive care unit. he was extubated without difficulty on and a repeat head ct was done which showed no changes, at that time neurosurgery signed off with instructions to follow up with a repeat head ct in 6 weeks. mr. was placed on a ciwa scale with ativan to monitor for any signs of etoh withdrawal. on he was transfered to the floor from the icu for further care. on he was again taken to the operating room for an orif for a right distal radius fracture. on medicine was consulted to help with managment of delerium tremens which recommende treatment be changed from ativan to valium. also at this time he was placed on bedside sitters to provide safety. on mr. has a right leg angiography done to evaluate for graft placement. on he was taken to the operating room by plastic surgery for a muscle flap/split thickness skin graft to his right leg. a vac dressing was placed over the graft per plastic surgery. on mr. was appropriate following commands with no signs of withdrawal noted and his sitter was discontinued. per plastic surgery he remained on bedrest for 7 days after the flap placement. on he was able to get off bedrest and keep his right leg dependent for 10 minutes 4 times a day while keeping his right leg non-weight bearing. he can progress each day to an additional 5 minutes of dependent positioning each day. he will follow up with plastic surgery this friday. please call to make that appointment. medications on admission: none discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for temp > 101.5. 4. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 5. labetalol 200 mg tablet sig: one (1) tablet po bid (2 times a day). 6. enoxaparin 30 mg/0.3 ml syringe sig: one (1) subcutaneous q12h (every 12 hours) for 4 weeks. 7. nicotine 14 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). 8. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 9. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. 10. oxycodone 5 mg tablet sig: 1-3 tablets po q3h (every 3 hours) as needed. discharge disposition: extended care facility: - discharge diagnosis: s/p pedestrian struck discharge condition: stable discharge instructions: keep the incision/dressing clean and dry. you may apply a dry sterile dressing as needed for drainage or comfort. if you are experiencing any redness, swelling, pain, or have a temperature >101.5, please call your doctor or go to the emergency room for evaluation. resume all of your home medication and take all medication as prescribed by your doctor. *continue your lovenox injections as prescribed for anticoagulation. please continue to be non-weight bearing on your right leg. physical therapy: activity: right lower extremity: non weight bearing left lower extremity: full weight bearing dangle 15 minutes qid increase by 5 minutes each day starting treatments frequency: keep dry dressing over flap. keep clean and dry followup instructions: please follow up with dr. in 2 weeks, please call to schedule that appointment. please follow up in plastic surgery clinic this friday, please call to scheudle that appointment. please follow up with dr. in clinic in 6 weeks, please call to schedule that appointment, please inform them that you need a follow up head ct when you make that appointment. md, procedure: other skin graft to other sites graft of muscle or fascia debridement of open fracture site, tibia and fibula open reduction of fracture with internal fixation, tibia and fibula alcohol detoxification open reduction of fracture with internal fixation, radius and ulna transfusion of packed cells application of splint other myectomy application of other wound dressing diagnoses: unspecified essential hypertension cocaine abuse, unspecified motor vehicle traffic accident involving collision with pedestrian injuring pedestrian iron deficiency anemia, unspecified other specified complications of procedures not elsewhere classified abrasion or friction burn of face, neck, and scalp except eye, without mention of infection alcohol abuse, continuous open wound of lip, without mention of complication alcohol withdrawal delirium nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] open wound of tooth (broken) (fractured) (due to trauma), without mention of complication subdural hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration open fracture of upper end of fibula with tibia closed fracture of shaft of radius with ulna 

Answer: The patient is high likely exposed to