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: open left tib/fib fracture s/p motorcycle accident major surgical or invasive procedure: 1. irrigation and debridement of left tibia open fracture. 2. application of multiplanar external fixator, left lower extremity. 3. closed reduction left tibia and fibula fracture. 4. application of negative pressure dressing to the left lower extremity. . 1. application of manual stress, exam under stress fluoroscopy, right ankle. 2. closed reduction of right distal fibular fracture. . irrigation and debridement of skin, subcutaneous tissue, muscle and fascia. . 1. washout debridement, open fracture down to and inclusive of bone 2. operative stabilization, left tibial shaft fracture with plate and screws. 3. insertion non biodegradable antibiotic delivery device, left tibia. . history of present illness: mr. is a 62 year-old male status-post motor cycle crash on ; he was unhelmeted at the time and was driving 40-50 mph, and swerved to avoid a car passing into his , and colliding into a tree. he was brought in by helicopter, with gcs 15, noting pain on his right shoulder, back and side, and left lower extremity. past medical history: -afib s/p ablation x4, not currently on rate/rhythm control meds -throat cancer s/p xrt/chemo -hiatal hernia -chronic lbp -transient occasional bilatateral foot numbness -hx of vertigo . psh: -previous orif of right ankle -hiatal hernia repair social history: denied smoking or drinking history. family history: non contributory physical exam: pe upon admission : vitals: gen: aox3, in discomfort but no acute distress cv: tachycardic but regular rhythm resp: nonlabored breathing, decreased chest sounds on right abd: soft pelvis: stable lle: ~15 cm laceration on the anterior aspect of his left lower leg, approximately at the midshaft tibia level. the tibia is exposed with fracture fragments visible. he has +1 dp and pt pulses. silt on s/s/sp/dp/t and he fires /fhl. pertinent results: admission labs: 12:00pm fibrinoge-260 12:00pm plt count-184 12:00pm pt-12.8 ptt-24.6 inr(pt)-1.1 12:00pm wbc-9.8 rbc-4.59* hgb-14.5 hct-42.8 mcv-93 mch-31.6 mchc-33.9 rdw-12.1 12:00pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 12:00pm lipase-24 12:00pm estgfr-using this 12:00pm urea n-17 creat-0.6 12:22pm lactate-2.4* 12:22pm po2-39* pco2-67* ph-7.28* total co2-33* base xs-2 comments-green top 04:32pm urine mucous-rare 04:32pm urine granular-15* hyaline-16* 04:32pm urine rbc-1 wbc-3 bacteria-none yeast-none epi-0 04:32pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 04:32pm urine color-yellow appear-clear sp -1.050* 04:32pm urine bnzodzpn-neg barbitrt-neg opiates-pos cocaine-neg amphetmn-neg mthdone-neg 04:32pm urine hours-random 08:45pm plt count-191 08:45pm wbc-14.2* rbc-3.68* hgb-11.8* hct-34.9* mcv-95 mch-32.0 mchc-33.7 rdw-12.2 08:45pm calcium-7.8* phosphate-3.5 magnesium-1.6 08:45pm glucose-171* urea n-18 creat-0.7 sodium-139 potassium-5.1 chloride-105 total co2-26 anion gap-13 . hematology: 02:18am blood wbc-10.6 rbc-3.44* hgb-10.9* hct-31.3* mcv-91 mch-31.8 mchc-35.0 rdw-12.5 plt ct-150 01:50am blood wbc-9.3 rbc-2.55*# hgb-8.2* hct-23.1*# mcv-90 mch-32.3* mchc-35.8* rdw-12.6 plt ct-123* 11:56am blood wbc-8.8 rbc-2.68* hgb-8.6* hct-24.7* mcv-92 mch-32.0 mchc-34.7 rdw-12.5 plt ct-164 06:09pm blood wbc-5.8 rbc-2.57* hgb-8.2* hct-23.1* mcv-90 mch-32.0 mchc-35.5* rdw-13.6 plt ct-110* 12:06am blood hgb-7.6* hct-21.0* 05:07am blood hgb-8.2* hct-22.6* 09:45am blood hgb-8.8* hct-24.6* 08:10pm blood hct-23.3* 03:44am blood hct-23.1* 05:07am blood wbc-5.4 rbc-2.66* hgb-8.5* hct-23.6* mcv-89 mch-31.8 mchc-35.9* rdw-14.3 plt ct-131* 09:35am blood hct-25.1* 06:30am blood wbc-6.1 rbc-2.76* hgb-8.8* hct-25.5* mcv-92 mch-31.8 mchc-34.5 rdw-14.5 plt ct-171 . coags: 02:18am blood plt ct-150 01:50am blood plt ct-123* 11:56am blood plt ct-164 06:09pm blood plt ct-110* 05:07am blood pt-12.1 ptt-28.1 inr(pt)-1.0 05:07am blood plt ct-131* 06:30am blood plt ct-171 . chemistry: 02:18am blood glucose-191* urean-21* creat-0.7 na-136 k-5.3* cl-104 hco3-24 angap-13 01:45pm blood glucose-166* urean-24* creat-0.8 na-134 k-4.6 cl-101 hco3-26 angap-12 01:50am blood glucose-140* urean-24* creat-0.7 na-132* k-4.6 cl-99 hco3-28 angap-10 06:09pm blood glucose-131* urean-20 creat-0.6 na-132* k-4.6 cl-98 hco3-30 angap-9 05:07am blood glucose-107* urean-9 creat-0.4* na-135 k-3.7 cl-98 hco3-33* angap-8 06:30am blood glucose-157* urean-11 creat-0.5 na-137 k-4.0 cl-98 hco3-31 angap-12 02:18am blood calcium-7.9* phos-3.5 mg-2.0 01:45pm blood calcium-7.9* phos-2.4* mg-1.9 01:50am blood calcium-7.6* phos-2.3* mg-2.0 06:09pm blood calcium-7.5* phos-2.5* mg-1.8 05:07am blood calcium-7.7* phos-2.0* mg-1.8 06:30am blood calcium-8.3* phos-3.0 mg-1.9 . radiology: radiology report trauma #3 (port chest only) study date of 11:58 am slightly displaced right sixth through eighth posterolateral rib fractures, with moderate right pneumothorax. this was paged to dr. on at 1:12 p.m. . radiology report ct head w/o contrast study date of 12:22 pm impression: no acute intracranial injury. addendum at attending review: there is a semilunar region of calcific density adjacent to the inner table of of the squamosal portion of the left temporal bone, measuring up to 14mm along its base and 3mm in maximal thickness, seen on images 27-31, series 3 the finding could represent a calcified meningioma. there is negligible mass effect exerted by this lesion upon the contiguous brain convexity surface. . radiology report ct c-spine w/o contrast study date of 12:23 pm impression: 1. moderate-size pneumothorax with posterior rib fractures and gas tracking up the subcutaneous tissues of the neck posteriorly. 2. no fracture of the cervical spine. there is moderate spinal degenerative change which results in mild central canal and more prominent neural foraminal narrowing. if there is concern for cord injury, mri is more sensitive for its detection. . radiology report cta chest w&w/o c&recons, non-coronary study date of 12:24 pm impression: 1. right tension pneumothorax. these findings were relayed to the trauma team, led by dr. , urgently. 2. numerous right rib fractures, many segmental, raising concern for flail chest. right scapula fracture. left first rib fracture. 3. comminuted compound left tibia and fibular diaphyseal fractures, without vascular injury. 4. no intra-abdominal injury. 5. possible fracture of the right third metatarsal. correlate with foot films if clinically warranted. . radiology report tib/fib (ap & lat) left port study date of 12:25 pm impression: open and extensively comminuted fractures of the mid tibia and proximal fibula, with displacement and angulation as described above. please refer to subsequent ct for further detail. . radiology report chest (portable ap) study date of 2:29 pm impression: placement of two right chest tubes. increased right pneumothorax, now moderate-to-large with evidence of tension. this was paged to dr. on at 2:50 p.m. . radiology report chest (portable ap) study date of 4:00 pm impression: interval re-expansion of the right lung with residual right lower lung atelectasis. no residual pneumothorax identified. . radiology report chest (portable ap) study date of 5:54 pm findings: in comparison with the earlier study of this date, there again are two chest tubes on the right with no appreciable pneumothorax. decreasing subcutaneous gas along the right lateral chest wall. there is some improvement in aeration at the right base, though bibasilar opacifications are consistent with atelectasis. . radiology report lower extremity fluoro without radiologist study date of 8:05 pm findings: multiple fluoroscopic images of the left lower leg demonstrate placement of external fixation pins within the proximal tibial shaft and within the calcaneus. please refer to the operative note for additional details. the total intraservice time was 16.1 seconds. . radiology report chest (portable ap) study date of 8:45 pm findings: in comparison with the study of earlier in this date, there is no evidence of appreciable pneumothorax. . radiology report chest (portable ap) study date of 10:01 am impression: bibasilar atelectasis with little change from . radiology report chest (portable ap) study date of 5:14 am impression: ap chest compared to through 11. right upper chest tube is the only support device visible. there is no pneumothorax or large right pleural effusion despite multiple displaced right rib fractures. bibasilar atelectasis is severe. the heart is at least moderately enlarged. there is no pulmonary edema. . radiology report lower extremity fluoro without radiologist left in o.r. study date of 3:34 pm findings: multiple fluoroscopic images of the left lower extremity demonstrate interval placement of intramedullary rod with multiple associated screws fixating a complex fracture involving the mid shaft of the tibia. there is also a fracture involving the mid shaft of the fibula with butterfly fragments. please refer to the operative note for additional details. . radiology report chest (pa & lat) study date of 3:14 pm cardiomediastinum is unchanged with cardiomegaly, elevation of the left hemidiaphragm is stable. bibasilar atelectases have improved. right apical chest tube remains in place. there is a new or newly apparent small right apical pneumothorax. there are small bilateral pleural effusions. . radiology report foot ap,lat & obl right study date of 3:15 pm impression: 1. fractures at the base of the second, third and fourth metatarsal bones. no widening between the first and second metatarsals, but the possibility of fractures at the lisfranc ligament insertion sites cannot be excluded. 2. deformity of the distal tibia and fibula, not fully evaluated on this film. 3. question small avulsion fracture along the dorsum of talus. . radiology report ankle (ap, mortise & lat) right port study date of 9:30 am findings: no previous images. there are old healed fractures of the lower shafts of the tibia and fibula with no residual portion of a metallic pin just superior to the fracture region of the tibia. considering the degree of previous injury, the ankle mortise is rather well maintained. inferior and posterior calcaneal spurs are seen and there are degenerative changes involving the tarsal bones. . radiology report chest (portable ap) study date of 4:09 pm impression: 1. increased pulmonary vascular congestion with worsening pulmonary edema and stable bilateral small pleural effusions. 2. stable tiny right apical pneumothorax with unchanged position of right pleural tube. . radiology report chest (portable ap) study date of 6:05 pm right apical pneumothorax is small. the right chest tube is not clearly seen on the current study: removed? multiple right rib fractures are noted. bibasal atelectases are present, left more than right. pleural effusion cannot be excluded. cardiomediastinal silhouette is unchanged. there is interval improvement of pulmonary edema. . radiology report chest (portable ap) study date of 7:45 am bibasilar areas of atelectasis are present, unremarkable. upper lungs are clear. heart size and mediastinum are within normal limits. no definitive evidence of pneumothorax is seen. rib fractures are better seen on the prior examination than on the current study. . radiology report chest (portable ap) study date of 7:32 am findings: there is no evidence of pneumothorax. cardiomediastinal contours are stable in appearance. persistent bibasilar atelectasis, minimally improved at the left lung base, with associated persistent moderate elevation of left hemidiaphragm and either a small left pleural effusion or pleural thickening. known right rib fractures are again visualized. . radiology report bilat lower ext veins study date of 3:59 pm impression: 1. no right lower extremity dvt. 2. no dvt in the left common femoral, superficial femoral, or popliteal vein. nonvisualization of left calf veins secondary to bandage material. . brief hospital course: mr was admitted after suffering a motorcycle collision vs tree while riding his bike unhelmeted. he suffered the following injuries: open comminuted l tib-fib fracture, r ptx, r scapular fx, and bilateral rib fx (right and left 1st rib. he was admitted to acs service on . two chest tubes were placed in the emergency room and one was taken out shortly after because of incorrect placement. there was a concern for tension pneumothorax with complete collapse of the right lung shown on ct-scan; during scanning, the patient developed shortness of breath with o2sats in high 80s, and was brought back to the trauma bay for stabilization whereupon he underwent a second chest tube placement on the right. a repeat portable cxr was obtained, which demonstrated no improvement. dr. , trauma surgery attending, was able to re-place the first chest tube with relief in the patient's symptoms with maintenance of stable o2sats in the high 90s. his remaining ct scans were then performed, which demonstrated the above injuries, with no visceral injuries. he was concomitantly evaluated by orthopedics for his left open tibia-fibular fracture, his wound was irrigated, and the leg splinted. he received gentamicin, a tetanus shot and ancef at this time. he was then taken emergently to the operating room by the orthopedic surgery service for irrigation and debridement of left tibia open fracture, application of external fixator, closed reduction left tibia and fibula fracture and placement of vac dressing, and was then tranferred to the icu for further care. after extubation, the patient noted right foot pain, with original ct scans demonstrating a questionable fracture. right foot films on showed fractures of metatarsals with a question of fracture of the base of the lisfranc ligament. orthopedics was notified of this finding, with further management by their service. plastics/reconstructive surgery was also consulted intra-operatively for a possible washout and flap for his left lower extremity wound: reader is referred to both orthopedics and plastics summaries on respective management. neuro: pain control was obtained with a dilaudid pca supplemented by a lidocaine patch and ms in the early postoperative period. he was transferred to the floor soon after orif of the left tibia-fibular fracture and was managed with morphine ir, ms , and morphine iv as well as lidocaine patch. he remained neurologically intact throughout. cvs:the patient remained hemodynamically stable. he was continued on telemetry on the floor and remained in sinus rhythm. pulm:the r chest tube was kept on suction for 48 hours with good lung re-expansion. incentive spirometry and pulmonary toilet were encouraged. prior to transfer, he was maintaining o2 sats at 93-95% on ra with additional oxygen requirement. recommendations were made to remove the chest tube after washout with the plastics service on . gi/fen: the patient was kept on a regular diet, which he tolerated well. gu: a foley catheter was initially placed for uop monitoring and was further managed by the plastics service when he was transferred on heme: hct were trended daily and dropped to 21 at midnight on . he was transfused 2u prbcs and his hct has remained stable since. id: ancef/gent were administered for 3 days for empiric coverage given open tib/fib fracture per orthopedics. he is currently on cefazolin per ortho. prophylaxis: dvt: boots and enoxaparin were employed daily stress ulcer: po famotidine was administered . on , the patient was admitted to the plastic and reconstructive surgery service status post left lower extremity debridement and wound vac placement in preparation for planned free flap to left lower extremity defect. post-procedure, the right chest tube was discontinued and patient had multiple surveillance chest xrays indicating the resolution of the right pneumothorax but the post-procedureal development of bibasilar areas of atelectasis. patient was encouraged to get out of bed to chair for extended periods and to use his incentive spirometer frequently. he was utilizing albuterol and atrovent nebulizer treatments around the clock. . on , the patient returned to the or for a free flap to his left lower extremity defect. when wound vac dressing was removed, the left lower extremity about the wound site appeared very unstable;particularly, the proximal fragment was not being well-supported by the nail and was very mobile causing deformity. ortho service was called and came to washout the wound, plate the fracture and replace the cement spacer. once this was complete, the plastic service proceeded with reconstruction of the lle utilizing a left alt flap. the patient tolerated the procedure well and stayed overnight in the post anesthesia care unit for hourly 'flap checks'. . neuro: post-operatively, the patient received a morphine pca for breakthrough pain in addition to his standing ms contin 30mg po q12h with good effect and adequate pain control. he was also given toradol iv x 3 days and tylenol 650 mg q6h for additional pain control. when tolerating oral intake, the patient was transitioned to oral pain medications. . cv: the patient was stable from a cardiovascular standpoint; vital signs were routinely monitored. . pulmonary: the patient was stable from a pulmonary standpoint; vital signs were routinely monitored. patient had standing albuterol and atrovent nebulizers around the clock. he was encouraged to cough and deep breathe and use his incentive spirometer, frequently. . gi/gu: pre and post-operatively, the patient was given iv fluids for hydration and until tolerating oral intake. his diet was advanced when appropriate, which was tolerated well. he was also started on a bowel regimen to encourage bowel movement. foley was removed. intake and output were closely monitored. . id: the patient was maintained on iv cefazolin every 8 hours. the patient's temperature was closely watched for signs of infection. . prophylaxis: the patient received subcutaneous heparin post-operatively. patient was given 121.5 mg of aspirin, daily, to maintain the vascular integrity of the flap. in addition, patient was placed on a kinair bed for the post-operative period of mandatory bedrest to protect skin integrity. a pneumoboot was placed on the rle at all times while patient in bed. . at the time of discharge on , the patient was doing well, afebrile with stable vital signs, tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. medications on admission: tramadol prn discharge medications: 1. keflex 500 mg capsule sig: one (1) capsule po every six (6) hours. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units sc injection tid (3 times a day). 4. morphine 30 mg tablet extended release sig: one (1) tablet extended release po q12h (every 12 hours). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 6. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 8. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 9. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. 10. aspirin 81 mg tablet, chewable sig: 1.5 tablet, chewables po daily (daily) for 21 days. 11. morphine 15 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 12. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours). 13. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. discharge disposition: extended care facility: discharge diagnosis: left open tibiofibular fracture, grade iiib. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: care of your left lower extremity flap: * please monitor incision lines closely for signs of infection: opening of the incision, increased redness, increased pain, if you have a fever greater than 101, swelling of the tissues around the incision line, drainage of green/yellow/grey/white/thick drainage, increased pain at the incision line, or increased warmth. * you may shower with incisions/sutures. let the warm water run over the incisions, pat all areas dry with a clean towel, and keep open to air but as clean and dry as possible. if the incisions become irritated, you may apply a dry sterile gauze dressing to the incision line. please follow-up with dr. for questions related to this most current surgery. * continue to monitor the flap. this should remain warm and a similar color to the rest of your skin. if you notice that these areas are changing in color to: red, purplish, blue, black, or pale please call dr. office immediately. * it is important to elevate your left leg on several pillows while in bed or chair to help decrease swelling. you should always have an ace wrap in place to the left lower extremity extending from toes up to the mid thigh, except when changing dressings or showering. followup instructions: please follow-up in the clinic, with dr. (you will be seeing his nurse ), next tuesday () at 9am. you will need to arrive at 8:40am to have xrays taken before your appointment. dr. clinic is located at medical center, , center, . please call if you have any questions. please follow up in the hand clinic next tuesday (), after you are discharged home or to another facility. you must call ( to make an appointment. . dr. ( procedure: insertion of intercostal catheter for drainage closed [endoscopic] biopsy of bronchus attachment of pedicle or flap graft to other sites debridement of open fracture site, tibia and fibula debridement of open fracture site, tibia and fibula debridement of open fracture site, tibia and fibula application of external fixator device, tibia and fibula open reduction of fracture with internal fixation, tibia and fibula internal fixation of bone without fracture reduction, tibia and fibula closed reduction of fracture without internal fixation, tibia and fibula removal of implanted devices from bone, tibia and fibula insertion or replacement of (cement) spacer application of external fixator device, ring system closed reduction of separated epiphysis, tibia and fibula diagnoses: atrial fibrillation pulmonary collapse other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist traumatic pneumothorax without mention of open wound into thorax hypovolemia closed fracture of scapula, unspecified part open fracture of shaft of fibula with tibia unspecified fracture of ankle, closed closed fracture of seven ribs closed fracture of metatarsal bone(s) personal history of malignant neoplasm of tongue 

Answer: The patient is high likely exposed to