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: status-post bicycle accident versus car with polytrauma major surgical or invasive procedure: 1. exploratory laparotomy with control of liver hemorrhage with argon, gelfoam and packing. 2. suture control of mesenteric vessels. 3. placement of negative pressure dressing. 1. irrigation and debridement down to and inclusive of bone right tibia shaft fracture. 2. intramedullary nailing with 10 x 3.15 nail. 3. placement of vacuum sponge in right tibia. 4. irrigation and debridement left knee joint. 5. arthrocentesis left knee joint. 1. exploratory laparotomy. 2. removal of lap pads x3. 3. suture repair of stomach and right colon. 1. irrigation and debridement down to and inclusive of bone. 2. placement of split-thickness thickness graft on soft- tissue muscle bed. 3. vacuum sponge to skin graft 5x5 cm. ercp ercp with sphincterotomy, pigtail catheter placed in pancreatic duct for cannulation, then removed and placement of stent in hepatic duct. pigtail placement of right pleural catheter for pleural effusion history of present illness: 23 y/o f helmeted bicyclist struck by car today presents to ed. patient was taken emergently to the or by trauma for a tenuous abdomen. per report, patient was a gcs of 14 at scene and then deteriorated. she was intubated on route and taken to ct scan where a l acute edh was found. patient was then taken to the or for exploratory laparoscopy. in the or, patient was coagulopathic with an inr of 3; she was given 5 units ffp and prbcs. past medical history: anxiety, depression, history of proteinuria, history of alcohol abuse/ivdu social history: past use of narcotics, +etoh family history: noncontributory physical exam: upon presentation: temp 97 hr: 89 bp: 104/70 resp: 17 o(2)sat: 100 normal constitutional: intubated, sedated heent: pupils equal, round and reactive to light, stable midface, laceration to r occiput, lip ett tube in place chest: equal breath sounds cardiovascular: regular rate and rhythm, normal first and second heart sounds abdominal: soft, distended gu/flank: abrasions to r flank extr/back: rle with open fx at tib/fib, soft compartments, intact distal pulses skin: lacerations to scalp, r elbow, r knee neuro: intubated, sedated, making purposeful movements psych: intubated and sedated heme//: no petechiae upon discharge: general: in no acute distress, comfortably lying in bed heent: pupils equal, round, reactive. eom intact. sclera anicteric. mucus membranes moist, nares clear, trachea at midline cv: regular rate/rhythm, no murmurs, rubs, or gallops pulm: clear to auscultation bilaterally down to bases abd: + bs, soft, nontender, nondistended. midline incision clean, dry and intact. msk: warm, well perfused. right lower extremity wound clean, dry; distal aspect of wound with wick in place. neuro/psych: alert, oriented to person, place, time. mildly flattened affect. pertinent results: : ct head: 1. acute epidural hematoma (8mm thickness) along the left middle cranial fossa with mixed attenuation suggesting active bleeding. no signs of herniation at this time. 2. parenchymal contusion and small extra-axial hemorrhage involving the right temporal lobe. 3. no fracture. soft tissue/scalp hematoma posteriorly. ct head: impression: no change in left subdural or right temporal fossa hemorrhages tibia/fibula/ankle bilateral: right lower extremity: comminuted mid shaft tibial and fibular fracture left lower extremity: left knee is congruent. cross-table lateral demonstrates no lipohemarthrosis. left tibia,fibula, ankle joint appear intact. lower extremity fluoroscopy, intra-operative for orif right tibia/fibula: status post orif of the tibia with antegrade intramedullary nail and interlocking screws. the hardware is intact. improved alignment of the comminuted tibial diaphyseal fracture. improved alignment of the comminuted fibular diaphyseal fracture. ct abdomen/pelvis: 1. liver laceration in the right lobe of the liver, through segment vii extending to the ivc, with no definite active extravasation of contrast to suggest active bleeding. 2. high-attenuation ascites in the abdomen and pelvis, consistent with old hemorrhagic component. 3. large bilateral pleural effusions with overlying atelectasis. ct head: 1. expected evolution of a right inferior temporal lobe intraparenchymal hemorrhage. 2. evolution of blood products within a left parietal epidural hematoma. stable non-displaced left parietal skull fracture. 3. left temporal lobe extra-axial collections are much less apparent. no new hemorrhage. hida scan: 1. probable bile leak with accumulation of radiotracer just above the superolateral aspect of the right lobe of the liver. 2. delay in gallbladder filling. ruq u/s: 1. large right hepatic lobe hematoma with central liver laceration extending from the liver capsule to the intrahepatic ivc. the laceration itself has decreased in size from the ct, however, the surrounding hematoma is more apparent on the current examination. 2. moderate subcapsular hematoma with mass effect on the superior and posterior right hepatic lobe appears essentially stable from ct, although, direct comparison is difficult. cxr: large right pleural effusion has markedly increased. the cardiomediastinum is mildly shifted towards the left side. left lower lobe retrocardiac atelectasis is unchanged. drains project in the upper abdomen. cxr: the patient has received a new right-sided catheter. the tip of the catheter projects close to the midline. the previously placed right pleural catheter is in unchanged position. extent of the pre-existing right pleural effusion has further increased. only a minimal part of right apical lung is ventilated. the left lung is unremarkable, apart from a small left basal atelectasis. no left pleural effusion. known right clavicular fracture ct chest: 1. pulmonary emboli. 2. decreased amount of right pleural effusion but with new loculation. 3. interval drainage of subcapsular fluid collection with large persistent hypodense area in the liver associated with parenchymal injury 4. small lung nodule (4 mm) in the left upper lobe, of doubtful clinical significance. 5. comminuted complete right-sided clavicle fracture. cxr: since the prior study, there is no substantial change in the partially loculated right pleural effusion. right basal atelectasis as well as the position of the right chest tube are unchanged. left lung is clear. cardiomediastinal silhouette is unremarkable. brief hospital course: ms. is a 23 year-old female, unhelmeted bicyclist struck by car who was admitted to acute care surgery and subsequently transferred from field, and intubated after deterioration of her neurologic status. her immediate list of injuries included: - left acute epidural hematoma - left subdural hematoma - liver laceration - right open tib/fib fracture - right midclavicular fracture pt was emergently transferred to operating room for exploratory laparotomy and 2 quadrant packing with open abdomen and rle orif/vac placement which went well without complication (reader referred to the operative notes for details) and subsequently transferred to the trauma surgical intensive care unit for evaluation and treatment of polytrauma. attending of record was dr. of the acute care surgical service. the patient arrived to the trauma surgical intensive care unit intubated/sedated, on iv fluids, iv antibiotics, with a foley catheter, nasogastric tube, vac dressing, and fentanyl for pain control. the patient required minimal single- vasopressor for bp parameters. neuro: the patient received fentanyl/propofol with good effect and adequate pain control while intubated in tsicu. when extubated, pt transitioned to iv pain medication with good effect. parents noted significant history of alcohol use, and the patient was started prophylactically on ciwa protocol without evidence of dts. when tolerating oral intake, the patient was transitioned to oral pain medications. serial neuro exams were stable with and seizure prophlaxis was administered without evidence of seizure activity. repeat head ct stable. neurosurgery subsequently signed-off. when on the floor, the patient's pain was managed with po dilaudid on a scheduled basis in addition to oxycodone given the patient's history of drug and alcohol use. cv: the patient arrived to the icu with single- vasopressor for bp parameters for icp which was weaned hd2. pt remained hemodynamically stable throughout remainder of hospital admission. pulmonary: the patient arrived to the icu intubated on minimal vent settings and was subsequently extubated hd 2 s/p abdominal closure without issue. on , however, the patient spiked a temperature to 103.1f one week after drain placement for a ruq fluid collection, likely bile leak or biloma secondary to her liver laceration. a cxr that day demonstrated a large right pleural effusion, for which she subsequently received a pigtail drain by interventional pulmonology. drain output was monitored on a frequent basis, which progressive decreases in sero-sanguinous output prior to discharge. her drain was pulled on by interventional pulmonology, as an ultrasound of the right lung showed very minimal pleural fluid. good pulmonary toilet, incentive spirometry and early ambulation was encouraged throughout this admission. ct chest on showed a pulmonary embolus and patient was bridged from a heparin drip to coumadin for pe treatment. her goal inr is and her inrs were followed closely daily and coumadin dosed daily as well. her pcp was and was willing to follow her inrs for her coumadin dosing. she has an appointment with dr. on monday . gi/gu/fen: diet was advanced when extubated and appropriate, which was well tolerated. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. lfts were monitored given her liver laceration. her total bilirubin peaked at 9.2 on , however, began trending downward thereafter. ast and alt both peaked on initial presentation on and remained an a downward trend until the next week when her alk phosphatase began to trend upwards, with corresponding ruq pain per patient; a hida scan was ordered on which demonstrated a subdiaphragmatic fluid collection. the next day a ct-guided drain was placed within the subcapsular hepatic fluid collection with approximately 100cc bile immediately drained. the drain output was frequently monitored, which plateaued within 2 days. the patient then underwent an ercp on , but was not successful as the operators were not able to visualize or cannulate the cbd, with repeat attempt on which showed a leak from the right hepatic duct; a sphincterotomy was performed and a plastic biliary stent placed. the patient's lfts have since been trending downwards back to normal range, with last total bilirubin on at 0.6. the patient will be discharged with the biliary drain in place with one-month follow-up in clinic for stent evaluation/possible removal. diet: the patient's diet was advanced when appropriate, which she tolerated well. she was discharged home on a regular diet. id: the patient's white blood count and fever curves were closely watched for signs of infection. please defer to gi and pulmonary sections for specific details regarding bile leak secondary to liver laceration and pleural effusion, likely reactive. once the ruq collection was found on hida scan (), the patient was started on zosyn and fluconazole for appropriate coverage for one week. cytology and culture from the pleural fluid collection was negative, but bile drain contents demonstrated questionable but was deemed likely a contaminant. wound care: incisional wounds were regularly monitored for signs of infection of which there were none. rle orif site vac'd and subsequently changed per ortho trauma service; a split-thickness skin graft was also performed intra-operatively, which appeared not to completely take within several days; antibiotics: the patient received peri-operative intravenous antibiotics for rle extremity per ortho trauma which was subsequently discontinued. fever curve and wbc was closely followed without signs of infection from the lower extremity wound. endocrine: the patient's blood sugar was monitored throughout this admission. insulin dosing was adjusted accordingly during her brief icu stay. she did not require insulin for the majority of her days while on the floor and maintained blood sugars within normal range without insulin prior to discharge. hematology: the patient's complete blood count was examined routinely. the patient was transfused 6 units prbc intra-op for active intraabdominal hemorrhage and coagulopathy, post-transfusion hematocrit of 37; she also received an additional 5ffp, 1 unit of platelets, 1 unit of cryoprecipitate. pt received rh+ transfusion with rh- status and subsequently pt received winrho. hct downtrending throughout admission without hemodynamic instability. coagulapathy corrected as above. as noted earlier, the patient was found to have a pulmonary embolus in her left lung and was placed on heparin drip on and subsequently bridged to coumadin for long-term pe treatment/prevention. prophylaxis: the patient received subcutaneous heparin and venodyne boot during this admission and was encouraged to get up and ambulate as early as possible. she was bridged from heparin to coumadin for a pulmonary embolus found on ct on . please refer to hematology/pulmonology sections for further details. msk: the patient initially underwent an orif for her right tibia-fibula fracture, with continuous measurements of compartment pressures without evidence of compartment syndrome in the first few post-operative days. she was followed by the orthopedics service throughout her admission and was weight bearing as tolerated. she was able to ambulate with crutches prior to discharge. she also sustained a right clavicular fracture, which was managed non-operatively. medications on admission: klonipin discharge medications: 1. tramadol 50 mg tablet sig: one (1) tablet po four times a day as needed for pain for 14 days. disp:*60 tablet(s)* refills:*1* 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation for 30 days. disp:*30 tablet(s)* refills:*2* 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation for 30 days. disp:*60 tablet, delayed release (e.c.)(s)* refills:*3* 4. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. clonazepam 0.5 mg tablet sig: one (1) tablet po twice a day as needed for anxiety for 14 days. disp:*28 tablet(s)* refills:*1* 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily) for 30 days. disp:*30 tablet(s)* refills:*2* 8. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain/fever. 9. dilaudid 4 mg tablet sig: 1-2 tablets po three times a day as needed for pain for 10 days. disp:*60 tablet(s)* refills:*1* 10. coumadin 2.5 mg tablet sig: one (1) tablet po once a day: please check pt/inr daily until inr is therapeutic and stable between . disp:*30 tablet(s)* refills:*2* 11. coumadin 5 mg tablet sig: one (1) tablet po once for 1 doses: take around 4 pm today. . disp:*1 tablet(s)* refills:*0* discharge disposition: home with service facility: vnacare network discharge diagnosis: s/p bike v. car 1. parenchymal contusion and small extra-axial hemorrhage involving the right temporal lobe 2. acute epidural hematoma 3. soft tissue/scalp hematoma posteriorly 4. right clavicle fracture 5. grade 3 liver laceration 6. right open tibia and fibula shaft fracture 7. left knee open wound 8. right shoulder laceration 9. bile leak 10.pulmonary embolism 11.subhepatic fluid collection 12.right pleural effusion discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: * you were admitted to the hospital after being struck by a car while riding your bicycle. you suffered multiple injuries including bleeding and bruising in your brain, a laceration on your scalp, a laceration of your liver, a broken right collar bone, a right leg fracture, left knee laceration and a right shoulder laceration. * you required multiple operations to repair your injuries and you are recovering well. * your tib/fib fracture was repaired and a skin graft was placed on it. you still have a small wound in the area that will require wet-to-dry dressing changes twice a day until it is healed. * another injury found after your admission was a bile leak from one of the ducts in your liver. this was diagnosed with blood tests and an ercp. a stent needed to be placed to stop the leak and it was successful. you will need another ercp in 4 weeks. you have a drain in place to drain the bile leak, which has decreased. that drain will need to stay in until your stent is removed in order to make sure the leak has completely stopped. * you also developed a clot in your lung called a pulmonary embolism. this likely occurred due to your immobility. you will need to be on a blood thinner called coumadin and the dose will be regulated by your primary care doctor based on a blood test called an inr. you will need to be very careful with any sharp objects as you will bleed easily on a blood thinner. * eat well and stay well hydrated. * you will need to continue with close follow up at . * if you develop any increased yellow jaundice, abdominal pain,nausea or increased pain please call your doctor or return to the emergency room. followup instructions: call the acute care clinic at for a follow up appointment in weeks. call your primary care doctor for a follow up appointment next week. you have an appointment on monday, at 11am at dr. clinic: please call ( for directions. her clinic will be following your coumadin levels. the clinic address is: , , ma call dr. from ercp at for a follow up appointment in 4 weeks for a repeat ercp for stent removal and re evaluation. call the clinic at for a follow up appointment in 2 weeks. call dr. from neurosurgery at for a follow up appointment in 4 weeks. you will need a non contrast head ct prior to the appointment and the secretary can arrange that for you. call dr. from plastic surgery at for a follow up appointment in 2 weeks if you feel it is necessary for your wound that currently is dressed with wet to dry dressings daily. procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours other revision of vascular procedure enteral infusion of concentrated nutritional substances thoracentesis endoscopic sphincterotomy and papillotomy endoscopic sphincterotomy and papillotomy exploratory laparotomy removal of packing from trunk, not elsewhere classified arterial catheterization suture of laceration of large intestine control of hemorrhage, not otherwise specified local excision of lesion or tissue of bone, tibia and fibula other skin graft to other sites arthrocentesis debridement of open fracture site, tibia and fibula open reduction of fracture with internal fixation, tibia and fibula delayed closure of granulating abdominal wound application of splint closed reduction of fracture without internal fixation, tibia and fibula percutaneous aspiration of liver suture of laceration of stomach replacement of stent (tube) in biliary or pancreatic duct other repair of mesentery combined alcohol and drug detoxification suture of capsule or ligament of other lower extremity diagnoses: acquired coagulation factor deficiency other, mixed, or unspecified drug abuse, unspecified personal history of tobacco use alcohol abuse, unspecified accidental puncture or laceration during a procedure, not elsewhere classified dysthymic disorder other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure accidental cut, puncture, perforation or hemorrhage during other specified medical care other specified disorders of biliary tract subdural hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness precipitous drop in hematocrit other pulmonary embolism and infarction traumatic hemothorax without mention of open wound into thorax open wound of knee, leg [except thigh], and ankle, without mention of complication open fracture of shaft of fibula with tibia contusion of face, scalp, and neck except eye(s) nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] open wound of knee, leg [except thigh], and ankle, complicated edema hallucinations injury to liver without mention of open wound into cavity, laceration, major closed fracture of shaft of clavicle injury to other gastrointestinal sites, with open wound into cavity motor vehicle traffic accident involving collision with other vehicle injuring motorcyclist other pulmonary insufficiency, not elsewhere classified, following trauma and surgery other digestive system complications 

Answer: The patient is high likely exposed to