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: penicillins attending: chief complaint: mvc major surgical or invasive procedure: : exploratory laparotomy, washout of hemoperitoneum, debridement of laceration of the liver, ileocecectomy, ileocolostomy. : take back for exploratory laparotomy, ileocectomy : ir-guided drainage of subhepatic/ right paracolic gutter collection history of present illness: 42m car vs pole, ejected ~30ft, garbled speech at scene, + transfer from osh with c6 fracture, free fluid in abd/pelvis, hypotension peri-rsi. per ems was moving all 4 extremities at osh. taken to or upon admission, found liver lacs and performed ileocecectomy. brought to ticu intubated. taken to or for re-exploration on , evacuated ~1l old blood. past medical history: s/p left ankle orif s/p removal of adenoids social history: supportive wife, works in construction building houses +etoh, unknown tobacco/ivdu family history: noncontributory physical exam: on admission: constitutional: intubated and sedated heent: pupils equal, round and reactive to light oropharynx within normal limits chest: clear to auscultation cardiovascular: regular rate and rhythm abdominal: soft, nondistended, nontender gu/flank: no costovertebral angle tenderness extr/back: no cyanosis, clubbing or edema skin: no rash, warm and dry neuro: moves all extremities pertinent results: 12:00am blood wbc-10.8 rbc-4.50* hgb-13.5* hct-41.0 mcv-91 mch-30.1 mchc-33.0 rdw-14.1 plt ct-214 12:00am blood pt-11.4 ptt-24.9* inr(pt)-1.1 01:16am blood glucose-138* urean-14 creat-1.2 na-136 k-4.8 cl-106 hco3-16* angap-19 ct head: no acute intracranial process with small left subgaleal hematoma. ct cspine: 1. comminuted fracture of the left facet of the c6 vertebral body with extension into the lamina, pedicle and posterosuperior left-sided aspect of the c6 vertebral body. 2. right-sided c6 pedicular fracture extending into the facet and right lateral c6 vertebral body. 3. assessment of fracture extension into the transverse foramina is limited and as a result cannot fully be excluded. thus, need for cta to assess vertebral arteries is unclear. these findings were discussed with dr. by phone at 01:40. initial findings were also discussed with dr. and at 23:45 on . ct sinus: limited study due to motion without evidence of fracture. ct torso: 1. subcapsular hepatic hematoma with 1 or 2 segment vi, 4-5 cm lacerations, though others may be masked due to fatty liver and bolus timing 2. 3.2 cm right adrenal hematoma and stranding about the left adrenal gland. 3. stranding and free fluid in the mesentery as well as dependently in the pelvis suspicious for mesenteric and/or bowel injury, though no additional ct signs of bowel injury are identified. 4. non-specific stranding about the aorta and ivc without evidence of frank extravasation. 5. right sixth and seventh lateral rib fractures, right fifth rib anterior chondral fracture, left fifth through eighth anterolateral costochondral fracture-dislocations, and transverse process fractures at t6 and t12 through l5 as described above. 6. no evidence pulmonary contusion with atelectasis felt more likely. 7. right axillary soft tissue contusion. mri cspine: 1. mild stir hyperintensity in bilateral c6 pedicles and facets. there is mal-alignment of bilateral c5-c6 facet joints, left more than right which is likely secondary to rotatory subluxation. the fractures of c6 facets are better seen on the ct cervical spine. no evidence of ligamentous injury. increased mobility at this level can be assessed by flexion/extension views when patient is stable if clinically indicated. 2. a t1 and t2 hypointense soft tissue in the anterior epidural space extending from c6-c7 disc posterior to c7 body. this likely represents an extruded disc with inferior migration. this causes deformity of the ventral surface of the spinal cord. 3. no focal signal abnormality in the spinal cord. 4. degenerative changes in the cervical spine with multilevel neural foraminal stenosis. brief hospital course: mr. was admitted to the trauma icu on with the following injuries: bilateral pulmonary contusions right rib fractures left rib fractures fracture of c-spine at c6 transverse process fracture t12-l5 subcapsular liver hematoma segment 6 liver laceration (4cm) ileal mesenteric tear with small bowel ischemia blunt cardiac injury adrenal hematoma in brief, he was taken to the operating room on admission from the ed. there was a large mesenteric tear and associated small bowel ischemia. this was resected; he had a ileo cecectomy with primary anastomosis. he also was noted to have a liver laceration with associated liver ischemia, this was debrided. post-op he was monitored in the icu and was noted to be persistently tachycardic with an increasing pressor requirement. his lactate was elevated and rising and he was taken back to the or for a 2nd look laparotomy, also on . approximately 1 liter of blood was found and an internal hernia. he was hemostatic at the end of the case and he was returned to the icu. the rest of his hospital course by systems below, but in brief was characterized by a prolonged wean from the ventilator, finally extubated on and liver necrosis and eventual fluid collection which was drained by ir. his course is described below by system: neuro: he was initially sedated while intubated with a combination of propofol, fentanyl and versed but this was weaned as appropriate and after extubation he was treated with dilaudid for pain. orthopedic spine evaluation was requested for the cervical spine fracture- this was treated non operatively with a cervical collar. he will follow up in approx 4 weeks with dr. where he will have repeat spine films done. he was alert and oriented x 3 and neurologically intact with some bilateral upper extremity weakness that had improved during his admission. cardiac: patient was hypotensive during the initial days postop and required pressors. he was weaned off levophed on pod#3. echo was performed to evaluate for blunt cardiac injury and the heart appeared hyperdynamic with no wall motion abnormalities. patient was resuscitated with prbc and albumin. he remained hemodynamically stable throughout the rest of his hospital course. resp: he was intubated initially on scene then remained intubated post-operatively through two trips to the or. initially requiring high peeps this was eventually weaned though he continued to struggle with poor oxygenation and inability to wean from the vent, likely due to a combination of (noted on cxr, bal after bronch on grew mssa) and fluid overload. he was placed on a lasix drip to remove excess fluid and treated with levofloxacin (started on ) for the ; he was eventually weaned to extubation on . he remained on 40mg po lasix daily while on the floor and continued to diurese well. he was changed to diamox on to avoid hypercarbia. his supplemental oxygen was weaned and his oxygen saturation remained stable on room air. continued pulmonary toileting and incentive spirometry were encouraged. on he underwent diagnostic and therapeutic thoracentesis for 1.5l and he symptomatically improved with saturations remaining in the mid to high 90's. follow up cxr showed interval decrease in right pleural effusion with no evidence of pneumothorax after thoracentesis. gi: patient was taken for emergent laparotomy on the night of admission. postop, patient had persistent lactic acidosis and hypotension. patient was taken back to or for re-exploration, also on , as noted above. he started to spike temperatures on . in combination with his downtrending hct (to 24), a ct scan was obtained on ; it showed a fluid collection near a necrotic portion of the liver with fluid in the right paracolic gutter. hepatobiliary surgery was consulted and recommended a triple phase ct to assess progression of the liver ischemia/necrosis one week later (this was done on ) to aid in surgical planning regarding debridement. he was taken by ir on for drainage of the fluid collection near the drain. cultures grew mixed bacteria as well as b. fragilis (he was started on flagyl on along with levofloxacin). he had a triple phase ct on which demonstrated progression of necrosis with expected walling off/organization of the liver necrosis. also of note on , the drainage from his liver collection drain (placed by ir) changed from serosanguinous/yellow to thicker brown. there was concern that this was stool from a leak in his anastomosis, so he was sent down urgently for a ct scan with contrast injected through the drain. the contrast did not enter the bowel which was reassuring. the drainage color change was attributed to additional necrosis of the liver which was now sloughing off and draining through the drain. on transfer to the floor on his tube feeds were discontinued and he was started on a regular diet. nutritional supplements were added. he tolerated a regular diet and was started on a bowel regimen. he was discharged to home with the drainage catheter in place, teaching was provided to patient and his wife on the care and monitoring of the drainage catheter system. gu: on admission, patient was in acute renal failure with rhabdomyolysis. he was aggressively hydrated and his creatinine improved with downtrend in his ck from 12,0000 to 700 after which the level was no longer checked as his urine output was excellent and his creatinine normalized. his urine output was normal throughout his stay. on the floor he was diuresed as discussed above under respiratory. a foley catheter remained in place for urine output monitoring until , at which time it was removed and he voided without difficulty. he was noted with scrotal edema primarily related to fluid overload; this did eventually improve significantly with intermittent diuresis using lasix which was later changed to diamox. id: patient began to spike fevers on pod#4. he was started on levofloxacin, as noted above, for an mssa and completed a 7 day course that was dc'd on . the flagyl was also started on due to the cultures from the drain growing bacteroides. this was continued until . at time of discharge he was afebrile with a normal white count of 8.2. msk: he was evaluated by physical ad occupational therapy and at time of discharge he was supervision level with the walker. dispo: he was discharged home with his wife and was provided with follow up appointments with his pcp, surgery and orthopedic spine. medications on admission: multivitamin, vitamin d discharge medications: 1. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 2. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 3. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*80 tablet(s)* refills:*0* 4. multivitamin capsule sig: one (1) capsule po once a day. 5. vitamin d3 4,000 unit capsule sig: one (1) capsule po once a day. 6. senna 8.6 mg tablet sig: 1-2 tablets po once a day as needed for constipation. 7. clobetasol 0.05 % cream sig: one (1) appl topical (2 times a day). disp:*30 gm* refills:*2* 8. quetiapine 25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for insomnia. disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: polytrauma s/p motor vehicle crash: bilateral pulmonary contusions right rib fractures left rib fractures fracture of c-spine at c6 transverse process fracture t12-l5 subcapsular liver hematoma segment 6 liver laceration (4cm) ileal mesenteric tear with small bowel ischemia blunt cardiac injury adrenal hematoma 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 a motor vehicle crash. you sustained multiple injuries including fractures in your neck, spine, ribs and an injury to your bowel and liver. you required an operation to repair your abdominal injury. you required a stay in the intensive care unit and were transferred to the surgical floor when stable. you are continuing to recover well from your accident and are now being discharged home with the following instructions: you should remain in the cervical collar until follow up with orthopedic spine surgery. please follow up with dr. at the appointment scheduled below. you sustained rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. you should take your pain medicine as as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. if the pain medication is too sedating, take half the dose and notify your physician. is a complication of rib fractures. in order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. this will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs. you will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. symptomatic relief with ice packs or heating pads for short periods may ease the pain. do not smoke. return to the ed right away for any acute shortness of breath, increased pain or crackling sensation around your rips (crepitus). narcotic pain medication can cause constipation. thefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. if your doctor allows, non steriodal anti-inflammatory drugs are very effective in controlling pain (i.e. ibuprofen, motrin, advil, aleve, naprosyn) but they have their own set of side effects so make sure your doctor approves. general drain care: *please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *if the drain is connected to a collection container, please note color, consistency, and amount of fluid in the drain. call the doctor if the amount increases significantly or changes in character. be sure to empty the drain frequently. record the output, if instructed to do so. *measure and record the output from the draiange catheter every day and be sure to bring a log/diary of this information with you to your acute care surgery clinic follow up. *wash the area gently with warm, soapy water. *keep the insertion site clean and dry otherwise. *avoid swimming, baths, hot tubs; do not submerge yourself in water. *make sure to keep the drain attached securely to your body to prevent pulling or dislocation. you sustained rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. you should take your pain medicine as as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. if the pain medication is too sedating, take half the dose and notify your physician. is a complication of rib fractures. in order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. this will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs. you will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. symptomatic relief with ice packs or heating pads for short periods may ease the pain. do not smoke. return to the ed right away for any acute shortness of breath, increased pain or crackling sensation around your rips (crepitus). narcotic pain medication can cause constipation. thefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. activity: do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. you may climb stairs. you may go outside, but avoid traveling long distances until you see your at your next visit. don't lift more than 20-25 lbs for 4-6 weeks. (this is about the weight of a briefcase or a bag of groceries.) this applies to lifting children, but they may sit on your lap. you may start some light exercise when you feel comfortable. you will need to stay out of bathtubs or swimming pools for a time while your incision is healing. ask your doctor when you can resume tub baths or swimming. heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. how you feel: you may feel weak or "washed out" for 6 weeks. you might want to nap often. simple tasks may exhaust you. you may have a sore throat because of a tube that was in your throat during surgery. you might have trouble concentrating or difficulty sleeping. you might feel somewhat depressed. you could have a poor appetite for a while. food may seem unappealing. all of these feelings and reactions are normal and should go away in a short time. if they do not, tell your . your incision: do not remove steri-strips for 2 weeks. (these are the thin paper strips that might be on your incision.) but if they fall off before that that's okay. your incision may be slightly red around the stitches. this is normal. you may gently wash away dried material around your incision. it is normal to feel a firm ridge along the incision. this will go away. avoid direct sun exposure to the incision area. do not use any ointments on the incision unless you were told otherwise. you may see a small amount of clear or light red fluid staining your dressing or clothes. if the staining is severe, please call your . you may shower. as noted above, ask your doctor when you may resume tub baths or swimming. ove the next 6-12 months, your incision will fade and become less prominent. your bowels: constipation is a common side effect of medicine such as percocet or codeine. if needed, you may take a stool softener (such as colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. you can get both of these medicines without a prescription. if you go 48 hours without a bowel movement, or have pain moving the bowels, call your . pain management: it is normal to feel some discomfort/pain following abdominal surgery. this pain is often described as "soreness". your pain should get better day by day. if you find the pain is getting worse instead of better, please contact your . you will receive a prescription from your for pain medicine to take by mouth. it is important to take this medicine as directied. do not take it more frequently than prescribed. do not take more medicine at one time than prescribed. your pain medicine will work better if you take it before your pain gets too severe. talk with your about how long you will need to take prescription pain medicine. please don't take any other pain medicine, including non-prescription pain medicine, unless your has said its okay. if you are experiencing no pain, it is okay to skip a dose of pain medicine. remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. if you experience any of the folloiwng, please contact your : - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain danger signs: please call your if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound followup instructions: name: np location: - when: wednesday at 12pm address: , , phone: department: general surgery/ when: thursday at 1:15 pm with: acute care clinic building: lm bldg () campus: west best parking: garage *you will need a chest x-ray prior to this appointment. please go to , clinical center, radiology 30 minutes prior to your appointment. name: , when: friday at 11 am location: address: , , , phone: md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis percutaneous abdominal drainage arterial catheterization closed [endoscopic] biopsy of bronchus open and other right hemicolectomy reopening of recent laparotomy site other laparotomy peritoneal lavage other destruction of lesion of liver other repair of mesentery diagnostic ultrasound of abdomen and retroperitoneum diagnoses: acidosis hyperpotassemia other iatrogenic hypotension acute kidney failure with lesion of tubular necrosis acute and subacute necrosis of liver cardiac complications, not elsewhere classified alcohol abuse, unspecified right bundle branch block methicillin susceptible pneumonia due to staphylococcus aureus closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury other motor vehicle traffic accident involving collision on the highway injuring driver of motor vehicle other than motorcycle acute vascular insufficiency of intestine closed fracture of lumbar vertebra without mention of spinal cord injury tachycardia, unspecified injury to liver without mention of open wound into cavity, hematoma and contusion contusion of lung without mention of open wound into thorax rhabdomyolysis traumatic shock traumatic hemothorax without mention of open wound into thorax other chronic nonalcoholic liver disease injury to liver without mention of open wound into cavity laceration, unspecified injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum closed fracture of four ribs closed fracture of sixth cervical vertebra acute respiratory failure following trauma and surgery other fluid overload edema of male genital organs unspecified injury of heart without mention of open wound into thorax injury to other gastrointestinal sites, without mention of open wound into cavity injury to other intra-abdominal organs without mention of open wound into cavity, adrenal gland personal history of allergy to penicillin closed dislocation, multiple cervical vertebrae contact dermatitis and other eczema due to plants [except food] accidental poisoning from other specified plants traumatic anuria 

Answer: The patient is high likely exposed to