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: morphine / beta-blockers (beta-adrenergic blocking agts) attending: chief complaint: fall from standing, new paraplegia and sensory loss major surgical or invasive procedure: 7-26-2012anterior cervical diskectomy c6-c7 and fusion 7-26-2012posterior decompression via bilateral laminectomies at c4, c5, c6 and superior c7 with instrumented fusion ivc filter placement history of present illness: mr. is a 74 yo m transferred from hospital ed to ed for reported paraplegia and sensory loss below level of t8 after fall this morning. patient is intubated and sedated on exam, no family members available for collateral; all history is second-hand. per report, patient had a fall from standing position while outside grocery store this morning, hitting his forehead on the sidewalk. unclear whether this was mechanical fall vs. syncope. he was found by grocery store manager; at the time he had normal mental status but complained of bilateral leg paralysis and numbness from above his bellybutton down to his feet. he was transported by ems to hospital where ct head, c-spine and t-spine were performed. he was then transferred to by helicopter for further evaluation. during the flight patient became agitated, so he was given fentanyl and ativan. on arrival to ed patient was lethargic, sedated, responsive only to pain, gcs 8 (2,1,5). he was intubated for airway protection prior to imaging. a code cord was called. repeat c/t spine ct showed no spine fracture, hemorrhage, canal stenosis; however, read of osh spine ct revealed widening of canal at c6-7. follow-up mri was ordered. neurosurgery was then consulted to evaluate patient. on initial exam by neurosurgery, gcs was 7 (1,1,5). patient was intubated, exam was performed after pt off propofol x5 min (although had received succinylcholine bolus 20 minutes prior to exam). he was grimacing to noxious stim, localizing to noxious stim in bilateral upper extrem, and triple flexing bilateral lower extrem to noxious stim. toes were upgoing on left, mute on right. he had flaccid rectal tone. past medical history: -copd -htn -glaucoma -arthritis social history: lives at home with wife. is retired. rarely drinks alcohol. no cigarettes or illicits. family history: nc physical exam: admission physical exam: o: t 98.6 bp 139/63 p 48 rr 14 sao2 100% gen: overweight elderly m, intubated, sedated. heent: 2 inch laceration on forehead above right eye. neck: in c-collar extrem: warm and well-perfused. neuro: -mental status: gcs 7 (1,1,5). grimaces and localizes ble to noxious stim, does not open eyes. -cranial nerves: perrl, 2mm to 1mm bilaterally. gaze midline, no nystagmus. no papilledema. cough/gag intact. -motor: normal bulk and tone bilaterally. localizes to noxious stim in bue. triple flexes ble to noxious stim. -sensation: intact to noxious stim in bue and ble. -babinski: toes upgoing on left, downgoing on right -rectal tone: flaccid paralysis discharge physical exam: patient is alert and awake on o2 nasal cannula. incisions - anterior neck with steri strip, posterior neck with nylon neuro: - eo spont, motor: movement in bue spont l>r, moves toes on rle to nox, flicker movement lle to nox babinski is extensor bilaterally + clonus no tone or spasticity pertinent results: noncontrast head ct (, hospital): there is no hemorrhage, edema, mass effect, or territorial infarction. the ventricles and sulci are normal in size and configuration. the basal cisterns are patent and -white matter differentiation is preserved. no fractures are identified. the visualized paranasal sinuses, mastoid air cells, and middle ear cavities are clear. impression: no acute hemorrhage or mass effect. noncontrast ct c-spine (, hospital): there is no fracture or malalignment of the cervical spine. there is no prevertebral soft tissue edema and the atlanto-occipital joints are intact. there are multilevel degenerative changes with anterior and posterior osteophytes with moderate spinal canal stenosis, worst at c5-6 and c6-7. there is disc bulge narrowing the thecal sac at c6-7. there is fusion and ossification of the pll at c5/6 .there is widening of the disc space at c6/7, recommend mri for further evaluation. there is no cervical lymphadenopathy. there are mild atherosclerotic calcifications in the carotid bifurcations. the thyroid gland is normal. impression: no fracture of the cervical spine. multilevel degenerative changes as described above.there is widening of the disc space at c6/7, recommend mri for further evaluation. noncontrast ct c/t-spine (, ): 1. no fracture of the thoracic spine. multilevel degenerative changes. 2. 4 mm left apical nodule. if this patient is high risk, this can be followed up with ct chest in 12 months. mri c/t/l-spine (): 1. abnormal widening of the c6/7 disc space, with associated anterior stir hyperintensity at the same level. this suggests traumatic injury at this level, with anterior longitudinal ligament tear. 2. spinal cord signal hyperintensity at c6/7. in the setting of the extensive degenerative change at this level, some component of the signal change is likely related to chronic myelomalacia. however, a component of trauma-related intramedullary edema is not excluded. 3. degenerative findings of the spine, most notably in the cervical spine. ct head : there is no hemorrhage, edema, mass effect, or territorial infarction. the ventricles and sulci are normal in size and configuration. the basal cisterns are patent and -white matter differentiation is preserved. opacification of the paranasal sinuses is consistent with interval intubation. there is no fracture. the mastoid air cells and middle ear cavities are clear. cxr (): in comparison with the earlier study of this date, the tip of the endotracheal tube now measures approximately 2.7 cm above the carina. ng tube extends at least to the upper stomach, where it crosses the inferior margin of the image. there is opacification at the left base with elevation of the hemidiaphragmatic contour. the appearance is consistent with pleural effusion and compressive atelectasis. tte (): the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. cxr (): in comparison with the study of , the left base is somewhat clear with the hemidiaphragm well defined. the pulmonary vessels are indistinct, suggesting elevated pulmonary venous pressure. endotracheal tube tip lies approximately 2.2 cm above the carina and the nasogastric tube extends well into the stomach. cardiovascular report ecg study date of 2:29:30 pm sinus bradycardia with low amplitude p waves. compared to the previous tracing of ventricular ectopic activity is no longer noted. tracing #1 read by: , intervals axes rate pr qrs qt/qtc p qrs t 44 194 82 514/486 -8 20 -46 c-spine non-trauma views port study date of 9:11 pm findings: there is posterior fusion spanning c4-c7 with anterior fusion at the . no evidence of hardware-related complication in these immediately post-surgical images. radiology report chest (portable ap) study date of 2:45 pm findings: this radiograph was obtained for assessment of a feeding tube, which terminates within the stomach. as compared to the previous study, perihilar edema has slightly improved, left lower lobe atelectasis is persistent, and right lower lobe atelectasis has substantially improved. small pleural effusions are again demonstrated, with interval improvement on the right. brief hospital course: # c6-7 central cord syndrome: mri c/t spine revealed abnormal c6/7 disk space widening with anterior stir hyperintensity at same level suggesting traumatic hyperextension injury. multiple c-spine degenerative changes were also noted, in particular a large osteophyte at c6 and autofusion at c4-c5. in setting of chronic cervical stenosis, patient's hyperextension injury likely caused significant cord compression resulting in central cord syndrome. : patient was started on methylprednisolone burst followed by 23-hour methylpred drip. he was admitted to the neurosurgical icu for further management. on , patient's neurologic exam was stable. he was bradycardic and hypotensive(likely spinal shock, see below), managed with pressors. # shock: patient was bradycardic to 40s-50s on admission, normotensive, suspected spinal shock secondary to his spinal cord injury. cardiogenic was ruled out via normal tte; cardiac enzymes negative x3. septic shock also unlikely (normal bcx/ucx and cxr). on hd #2 patient became bradycardic to 20s with resultant hypotension, so dopamine gtt was started to maintain sbp 90-140 to optimize cord perfusion. patient then developed nsvt. cardiology was consulted and recommended switching to phenylephrine which is less arrythmogenic; arrythmia subsequently resolved. on , patient's neuro exam was unchanged. on : the patient was cleared for surgery by cardiology.the patient was scheduled for a posterior and anterior cervical decompression for the following day. the patient was in atrial fibrillation and blood pressures were stable. on : the patient underwent anterior cervical diskectomy c6-c7 and fusion& posterior decompression via bilateral laminectomies at c4, c5, c6 and superior c7 with instrumented fusion with placement of hemovac drain with dr .the patient was transferred to the neurosurgery service and was recovered in the trauma intensive care unit. the patient remained intubated, was in atrial fibrillation. he required a diltiazem intravenous drip for his atrial fibrillation and phnelephrine to keep his systolic blood pressure for a map or 65 or greater. the patient required propofol for sedation due to blood pressure and heart rate instability when woken up. on exam, the patient was examined off propofol for 1 minite. the patient was able to open his eyes spontaneously. he blinks to command. the patient was able to move his bilateral upper extremities spontaneously, symmetrically w antigravity strength (prox greater than distal). the patient demonstrated slight triple-flexion to noxious stimulus in bilateral lower extremities. the patient had upgoing toes bilaterally. there was no rectal tone noted on exam. on , the patient was intubated and continued on continuous intravenous infusions which included : phenylephrine, prop/fent/dilt/insulin gtt. the patient continued to experience some hemodynamic instability when off sedation and was only taken off propofol for 5 minities at a time for exams. the hemovac drain was left in place given large output. the wbc was stable at 20. the patient was electively extubated at 1100 am. the patient required a lot of encouragement to cough and deep breath and required nasal tracheal suctioning. on , the patient remained extubated, but exhibited poor effort. the patient was determined high risk for deep vein thrombosis and the patient underwent placement of a ivc filter. due to large hemovac output the hemovac drain remained in place. the phenylephrine gtt was weaned to off today. the diltiazem continuous intravenous gtt for atrial fibrillation continued.the chest xray was consistent with the feeding tube, which terminates within the stomach. as compared to the previous study, perihilar edema has slightly improved, left lower lobe atelectasis is persistent, and right lower lobe atelectasis has substantially improved. small pleural effusions are again demonstrated, with interval improvement on the right. on , the patient was agitated and delirious. the surgical incisions were well approximated, clean dry and intact. the hemovac drain was discontinued. the patient was tachycardic to a heart rate in the 140s. the patient was started on a po diltiazem. the patient was moniotired for sepsis. the white blood count trending down and was 12.8. the neurological exam was unchanged. the patient was unable to move his lower extremities but reports sensation in his legs. he moves his left upper extremity more than the right. on , the patient ws febrile 101 overnight axillary. the white blood count trended down 13. the patient was on continous oxygen delivered by face tent. the patient continues in the hard cervical collar. the patient continues on po diltiazem and remains in atrial fibrillation. the neurological exam is unchanged. the chest xray from today which showed interval placement of a left picc with tip terminating in the mid-lower svc. now dod, he is afebrile, vss, patient will be discharged to acute rehabe in stable condition. medications on admission: unknown discharge medications: 1. albuterol 0.083% neb soln 1 neb ih q6h:prn wheezing/dyspnea/hypoxia 2. artificial tear ointment 1 appl both eyes prn dry eyes 3. aspirin 81 mg po daily 4. bisacodyl 10 mg po/pr daily:prn constipation 5. digoxin 0.125 mg po daily 6. diltiazem 30 mg po q6h please hold for sbp < 100, hr < 60 7. docusate sodium 100 mg po bid 8. glargine 10 units breakfast insulin sc sliding scale using reg insulin 9. oxycodone liquid 10 mg po q3h:prn pain 10. senna 1 tab po bid:prn constipation discharge disposition: extended care facility: hospital discharge diagnosis: central cord syndrome spinal cord injury atrial fibrillation spinal cord shock hypotension post op pyrexia leukocytosis respiratory failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ?????? do not smoke. ?????? keep your wound(s) clean and dry / no tub baths or pool swimming for two weeks from your date of surgery. ?????? if you have steri-strips in place, you must keep them dry for 72 hours. do not pull them off. they will fall off on their own or be taken off in the office. you may trim the edges if they begin to curl. ?????? no pulling up, lifting more than 10 lbs., or excessive bending or twisting. ?????? if you are required to wear one, wear your cervical collar or back brace as instructed. ?????? you may shower briefly without the collar or back brace; unless you have been instructed otherwise. ?????? take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. call your surgeon immediately if you experience any of the following: ?????? pain that is continually increasing or not relieved by pain medicine. ?????? any weakness, numbness, tingling in your extremities. ?????? any signs of infection at the wound site: redness, swelling, tenderness, and drainage. ?????? fever greater than or equal to 101?????? f. ?????? any change in your bowel or bladder habits (such as loss of bowl or urine control). followup instructions: follow up instructions/appointments ??????please return to the office in days (from date of surgery) for removal of your staples/sutures and/or a wound check. this appointment can be made with the nurse practitioner. please make this appointment by calling . if you live quite a distance from our office, please make arrangements for the same, with your pcp. ??????please call ( to schedule an appointment with dr. to be seen in 4 weeks. ??????you will need cervical x-rays and or cervical ct-scan prior to your appointment. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more interruption of the vena cava enteral infusion of concentrated nutritional substances arterial catheterization other cervical fusion of the anterior column, anterior technique other cervical fusion of the posterior column, posterior technique fusion or refusion of 4-8 vertebrae insertion of recombinant bone morphogenetic protein insertion of recombinant bone morphogenetic protein diagnoses: unspecified pleural effusion unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use chronic airway obstruction, not elsewhere classified atrial fibrillation unspecified glaucoma pulmonary collapse acute respiratory failure other specified cardiac dysrhythmias long-term (current) use of insulin fall from other slipping, tripping, or stumbling traumatic shock leukocytosis, unspecified cervical spondylosis without myelopathy arthropathy, unspecified, site unspecified dysphagia, oropharyngeal phase other musculoskeletal symptoms referable to limbs postprocedural fever closed fracture of c5-c7 level with complete lesion of cord c5-c7 level with central cord syndrome secondary diabetes mellitus with unspecified complication, not stated as uncontrolled, or unspecified 

Answer: The patient is high likely exposed to