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: mvc major surgical or invasive procedure: : right craniectomy / dr. : trach / dr. : peg / dr. : open reduction with internal fixation of right mandibular body fracture batal, hussam dmd left sided vp shunt dr. and dr. history of present illness: 25yo woman restrained driver in mvc. intubated on scene, reportedly posturing. brought to via ambulance. ct revealed depressed skull fx, multiple facial and skull base fractures, diffuse cerebral edema, and right frontal/temporal contusion. past medical history: unknown social history: unknown family history: non-contributory physical exam: physical exam on admission: o: t:97.6 bp: 132/79 hr: 89 r cmv o2-80% o2sats: 99% gen: sedated, intubated, nonresponsive. heent: pupils: right 6mm fixed/nonreactive, left 3mm minimally reactive. bilateral orbital/periorbital swelling (pt's eyes effectively swollen shut). bright red blood actively collecting in the r external ear canal. neck: supple. extrem: warm and well-perfused. neuro: (pt sedated) extensor posturing w/ noxious stimuli, no withdrawal. babinski equivocal exam on discharge: pt opens left eye only to voice and or noxious. she occasionally makes eye contact and looks to the tv when it is on. her right pupil is fixed and non reactive. her left pupil is 6mm-4mm and sluggish. she at times has had a dwonward gaze and this seems to correlate with shunt pressure settings. she occasionally purses her lips and then it is evident that she has a right facial. she does not follow commands. she attempts to localize with lue>rue. she has triple flexion in the lower extremities. her incisions are well healed and her right cranial defect is sunken. her current valve setting on her shunt is 0.5 pertinent results: ct head: impression: 1. extensive intracranial hemorrhage including right frontal and temporal lobe intraparenchymal contusions, right hemispheric acute subdural hematoma , diffuse subarachnoid hemorrhage in the basal cisterns and the right cerebral hemisphere as well as intraventricular hemorrhage. 2. mild-to-moderate right cerebral edema with shift of normally midline structures to the left by about 6 mm. 3. depressed right frontotemporoparietal calvarial fracture, right and equivocal left temporal bone fractures, complex right greater sphenoid and anterior clinoid process fracture as well as right bilateral zygomatic bone, orbital wall, maxillary sinus wall, pterygoid process fractures, and bilateral occipital condyle fractures. c-spine: impression: 1. no evidence for acute cervical spine fracture or malalignment. 2. right occipital and temporal bone fractures and right facial fractures. cta head/neck: no dissection. ct torso: bilateral lung contusions. no other acute injuries noted. head ct: interval post-op changes. decreased midline shift. interval increase of r frontal iph. increased edema with some herniation of brain tissue through the craniectomy site. stable sdh/ivh. facial ct: impression: 1. bilateral le fort fracture(1,2 and 3 on the right, 1 on the left) with involvement of the superior, medial and lateral orbital walls and the orbital surfaces of the greater and zygomatic bones bilaterally. 2. inferior orbital wall; posterior, medial and anterior maxillary sinus wall fractures as well as right zygomatic arch, complex right greater and anterior clinoid process as well as temporal bone fracture on the right. 3. bilateral occipital condyle fractures. 4. hemorrhage in the right maxillary sinus, the nasal cavity, sphenoid sinus, frontal sinus and nasal cavity. 5. left posterior maxillary sinus wall fracture (series 2, image 51). 6. right mandibular fossa and squamous portion of the right temporal bone fractures.there is a right mandible body fracture. head ct: 1. slighltly increased intraparenchymal hemorrhage within the right frontal, temporal, and parietal lobes. 2. unchanged edema with swelling of brain tissue through the craniectomy site. continued decrease in shift of midline structures. 3. interval decrease in effacement of the suprasellar cistern. 4. unchanged right subdural hematoma, intraventricular and subarachnoid hemorrhage. mri total spine 1. small amount of fluid layering in the dependent distal thecal sac, compatible with subarachnoid blood extending from extensive intracranial hemorrhage. 2. no abnormalities of the spinal cord or vertebral bodies. no hematoma, fracture, or malalignment. mr and mr orbit without contrast 1. large hemorrhagic contusions in the right frontal, parietal, and temporal lobes as previously, decompressed via large right craniectomy, but persistent mass effect on the right midbrain. 2. large hematoma in the right parietotemporal lobe with layering contents. blood extends into the intraventricular space. 3. extensive white matter changes in the corpus callosum, dorsal midbrain and cerebral peduncles indicating diffuse axonal injury. 4. right optic nerve grossly normal, but motion limits evaluation for edema. orbital apex demonstrates some crowding, although is decompressed by fracture. intraconal hemorrhage remains, but does not appear to predominate at the orbital apex. ct head noncontrast 1. interval increase in herniation through the right craniectomy site, resulting in infarction of the herniated edges, and 4mm rightward shift of midline structures. 2. multiple intraparenchymal hematomas are similar in appearance to the prior study. 3. interval decrease in effacement of the lateral ventricles. there remains a small intraventricular blood component in the right occipital . eeg : slowing compatible with a diffuse encephalopathy, no seizure activity. eeg : slowing compatible with a diffuse encephalopathy, no seizure activity. eeg : late in the recording, epileptiform activity in the right central region was identified in an unsustained fashion; however, technical problems started at 21:00 hours where it appears that the connector must have become dislodged. prior to that, activity over the left was also abnormal but less so and, over the course of the record, appeared to gradually improve with better activity centrally and some faster frequency activity noted posteriorly. eeg : this is an abnormal extended routine eeg due to focal epileptiform discharges in the right frontal region without clear evolution suggestive of cortical irritability in this region. however, there was no evidence of electrographic seizures during this recording period. additionally, there is attenuation and polymorphic delta slowing in the right hemisphere suggestive of subcortical dysfunction as well as underlying structural lesions such as a subdural hematoma. the background throughout the recording was slow and disorganized; however, at times, showed some reactivity to external stimuli. slowing of the background is likely secondary to a moderate to severe encephalopathy. ct sinus : there is increasing opacification of the sphenoid sinus, but with lesser opacification of the ethmoid sinuses, particularly on the left side. there is mild mucosal thickening in the right frontal sinus air cell. there is moderately prominent mucosal thickening in the right maxillary sinus, although the likely post-traumatic hemorrhagic elements seen on the prior study have resolved. the left maxillary sinus appears to be normally pneumatized. there is continued opacification of the right mastoid sinus complex, through which a fracture is again noted. there is moderate left mastoid sinus mucosal thickening. the sinus mucosal abnormalities are consistent with an ongoing inflammatory process. ct head : conclusion: considerable enlargement of left frontal-parietal, chronic appearing subdural fluid collection. increasing subfalcine herniation to the right of midline and increasing ventricular size. ct head : impression: 1. interval decrease in 8-mm left frontal sdh, with corresponding decrease in 13 mm rightward subfalcine herniation. 2. continued cerebral herniation through right craniectomy defect, with associated focal hypodensity reflecting edema and/or developing infarct. 3. evolving areas of hemorrhage in right frontal and temporal lobes and splenium of corpus callosum. 4. diffuse cerebral edema. 5. placement of left ventriculostomy catheter, with trace residual intraventricular hemorrhage in right occipital . 6. complex facial bilateral le fort fractures and right temporal bone fractures, better evaluated on maxillofacial ct from . lenis : no evidence of dvt. bue venous ultrasound : left cephalic venous thrombosis with no deep venous thrombosis identified in right or left upper extremities. ct head : impression: 1. compared to , there is reaccumulation of left frontal subdural hematoma with slight increase in rightward subfalcine herniation. 2. intraventricular shunt catheter remains in unchanged position. since , there is reaccumulation of fluid in the ventricles, with degree of hydrocephalus similar to that seen on . 3. continued diffuse right cerebral edema, with continued cerebral herniation through the right craniectomy defect. 4. complex bilateral facial le fort type fractures previously evaluated on maxillofacial ct. right temporal bone fractures, evaluated on concurrent temporal bone ct, which is reported separately. ct orbit : impressions: 1. longitudinal and transverse fractures through the right temporal bone extend into carotid canal, jugular fossa, vestibular aqueduct, andpossibly the facial nerve canal. dislocated incus and malleus, with a possible incus fracture. 2. non-displaced longitudinal fracture through left temporal bone traverses mastoid air cells, without evidence of complications. ct head : impression: 1. compared to , unchanged hypodense left frontal subdural fluid collection likely representing hygroma. the degree of rightward subfalcine herniation is unchanged. 2. intraventricular shunt catheter unchanged in position with improved ventricular dilatation and trapping. 3. unchanged diffuse right cerebral hemispheric edema with continued cerebral herniation into the right craniectomy defect without evidence of new hemorrhage. 4. complex bilateral facial fractures and right temporal bone fracture previously described in detail on maxillofacial and temporal bone ct, respectively. ct head : impression: 1. slight decrease in degree of right frontoparietal herniation through the craniectomy defect. slight decrease in shift of normally midline structures. 2. ventriculostomy in unchanged position with no evidence of developing hydrocephalus. 3. unchanged hypodense subdural fluid collection in the left frontoparietal region likely representing hygroma. 4. no evidence of new intracranial hemorrhage. ct head : impression: 1. slight increased prominence of the temporal of the right lateral ventricle represents mildly increasing hydrocephalus. 2. similar appearance of external herniation through frontoparietal craniotomy. the degree of midline shift to the right has increased from 8 mm to 11 mm compared with prior. 3. stable position of ventriculostomy catheter. 4. stable appearance of left frontal subdural hygroma. 5. redemonstration of temporal and facial fractures. lenis : impression: no evidence of deep vein thrombosis in either leg head ct : increase in right subfalcine hernation due to enlarging left subdural collection. stable enlargement of temporal of right lateral ventricle due to entrapment. no new hemorrhage. eeg : impression: there were no obvious electrographic or clinical seizures. there was some suspicious activity in the left lateral, frontal, temporal region that will be clarified over time by continuing to review the video eeg correlates. the eeg itself shows a severe disturbance of function over the right hemisphere maximum centrally and posteriorly and interictal epileptiform activity seen in a multifocal distribution and also some mild diffuse encephalopathic changes. head ct : impressions: 1. compared to two days prior, left subdural collection has slightly decreased, with corresponding slight decrease in rightward subfalcine herniation. 2. unchanged position of left frontal ventriculoperitoneal shunt catheter. while still enlarged due to entrapment, size of the right lateral ventricle is slightly decreased compared to two days prior. 3. continued diffuse right cerebral edema and sulcal effacement, with apparent slight decrease in transcranial herniation. no new hemorrhage. brief hospital course: pt brought emergently to the operating room from the emergency department and underwent a right sided craniectomy. surgery was without complication. she was transfered post operatively to the trauma icu for close neurological monitoring. post op head ct revealed an interval decrease in midline shift but increased cerebral edema and herniation of brain tissue outside of craniectomy site. a subdural drain was placed intraop and maintained. plastics, ent, and opthamology were consulted and care recommendations were made regarding facial fractures, r orbital injury, and r ear csf leak/laceration. exam showed no eye opening, r pupil fixed and dilated, l pupil 3mm and fixed, bue extending, ble triple flexion. on an mri brain and c/t/l spine was obtained to further assess given the patient's exam. brain mri showed diffuse axonal injury. total spine mri demonstrated no vertebral fractures or signal changes within the spinal cord. on the subdural drain was discontinued. the patient was managed on hypertonic saline drip with a goal serum na of 150. the drip was held on for na greater than 150 and was restarted on for na of 142. repeat head ct from showed interval increase in herniation through the right craniectomy site and 4mm rightward shift of midline structures. pt's exam remained grossly unchanged although when the fentanyl wean was attempted she did exhibit move movement of her extremities to stimulation but her movements did not appear pursposeful. during a fentanyl wean she became hemodynamically unstable with hypertension and tachycardia. however she did not respond to fentanyl boluses and it was not clear that her hemodynamic instability was due to fentanyl withdrawal. eeg continuous 24hr monitoring was initiated to rule out seizure as a cause of her instability. she stabilized , her hypertonic saline was decreased to 30cc/hr. the beta transferrin was negative for csf on her r ear. on her hypertonic saline was decreased to 20cc/hr and then discontinued on . her serum sodiums remained stable after her hypertonic saline is off. on she went to the or with omfs for open reduction with internal fixation of her right mandibular body fracture and had her trach/peg placed. post-operatively she remained stable. she was weaned to a trach mask on with good results. a head ct was done on the mornign of which showed increase in the extracranial herniation of brain tissue as well as external hydrocephalus. as a result dr took her to the operating room for placement of a left sided vp shunt and the shunt was set at 0.5. she tolerated the procedure well and returned to the tsicu after the surgery. her exam improved post-operatively as she was spontaneously moving her upper extremities as well as to noxious. on her ct of the head showed that she had developed external hydrocephalus and midline shift and a small left sided subdural fluid collection. she was taken to the operating room for placement of vps on the left. on she remained clinically stable, she continues to have fevers and is being treated with vanc and nafcillin. gpc/gnr found in sputum. on , patient had a head ct which showed hydrocephalus and shunt was reprogrammed to 0.5 from 2. repeat head ct on showed decrease in ventricular size. on , patient had bilious emesis, g-tube was placed to gravity and had significant output. kub was done which did not show obstruction. on , stool like material in g-tube, general surgery was consulted. a cxr was also done to rule out aspiration. no infectious process was seen on x-ray. a repeat head ct was stable from previous study on the 12th. general surgery recommendations were to keep g-tube at gravity for a day or two and restart tube feeds in am at very slow rate and then increase. no need for further imaging due to decreasing output from g-tube. the tube feeds were restarted slowly on , which patient tolerated. on a lue twitch was noted but remained self limited. on her sutures/staples were removed. on a head ct and eeg was ordered as she continued to have a lue twitch. the head ct showed a worsening subdural collection on eeg was started. she remained stable. no overt seizures were noted. on a repeat head ct was improved. trach ties were removed on . she remained stable and was discharged to rehab on . medications on admission: none discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 4. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 5. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for rash. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). 8. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 9. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 10. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). 11. oxycodone 5 mg/5 ml solution sig: po q4h (every 4 hours) as needed for pain. 12. acetaminophen 650 mg/20.3 ml solution sig: one (1) po q6h (every 6 hours) as needed for pain. 13. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 14. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 15. levetiracetam 100 mg/ml solution sig: one (1) po bid (2 times a day). discharge disposition: extended care facility: discharge diagnosis: traumatic brain injury r temporal sah/sdh w/ brain compression r temporal/frontal contusion r depressed temporal bone fx r occipital/skull base fx r superior/lateral orbital fx r tmj fx seizures discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: general instructions ?????? 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 wash your hair only after sutures and/or staples have been removed. if your wound closure uses dissolvable sutures, you must keep that area dry for 10 days. ?????? 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. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. you have been discharged on keppra (levetiracetam), you will not require blood work monitoring. followup instructions: follow-up appointment instructions a surgical date of has been arranged for you for your cranioplasty - a packet will be sent to the rehab for pre-op instructions ** you will need a ct scan of the brain / this will be arranged for the to be done prior to your procedure **your appointment with the oral surgery clinic at is on friday 28th at 10:00 am. call if you need to change your appointment. **you will also need to be seen by ent : please call to schedule follow up exam 4-6 weeks following discharge with otolaryngology. / audiogram and eval procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] ventricular shunt to abdominal cavity and organs arterial catheterization temporary tracheostomy linear repair of laceration of eyelid or eyebrow open reduction of mandibular fracture other repair of cerebral meninges other craniectomy open reduction of malar and zygomatic fracture suture of laceration of external ear video and radio-telemetered electroencephalographic monitoring central venous catheter placement with guidance diagnoses: obstructive hydrocephalus pneumonia due to other gram-negative bacteria open wound of forehead, without mention of complication compression of brain acute respiratory failure cerebral edema precipitous drop in hematocrit closed fracture of other facial bones open wound of external ear, unspecified site, without mention of complication mechanical complication of gastrostomy motor vehicle traffic accident involving collision with other vehicle injuring driver of motor vehicle other than motorcycle closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level closed fracture of mandible, body, other and unspecified cerebrospinal fluid otorrhea acute venous embolism and thrombosis of superficial veins of upper extremity open wound of ear drum, without mention of complication post traumatic seizures 

Answer: The patient is high likely exposed to