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: history of present illness: is a 33-year-old male who was a restrained passenger in a 110 mile per hour motor vehicle versus tree collision in on . the driver in the same vehicle was dead on arrival. the patient was transferred by med-flight from to the . by report, he was awake and alert at the outside hospital. he was then sedated and intubated. he was noted to be tachycardic and hypotensive on arrival at . evidence of multiple fractures and dislocations. he was admitted to on ; initially under the service of the trauma team. past medical history: history of drug abuse and ethanol abuse. medications on admission: none. allergies: no known drug allergies. social history: the patient has recently moved back to where his family lives from . he is a journalist on a local paper and is a member of a band. history of drug abuse and ethanol abuse. physical examination on presentation: on initial examination, his blood pressure was in the 170s systolic over the 80s diastolic, with a heart rate in the 140s. he arrived sedated and intubated. there was a 4-inch laceration on the right forehead which was stapled in the emergency department. the trachea was midline. no obvious facial deformities were noted. lungs were clear to auscultation bilaterally. no crepitus was noted. heart had a regular rate and rhythm. normal first heart sound and second heart sound. the abdomen was soft and flat. the pelvis was stable. back was negative for stepoff or deformities. rectal examination was heme-negative with normal tone. examination of the extremities revealed multiple long-bone fractures and dislocations. the left leg was shortened and internally rotated. the left ankle had a gross deformity noted with an open wound posteriorly. pulses were palpable. the right ankle had a gross deformity with dopplerable pulses and an open wound. positive swelling to posterior thigh. left hip posterior dislocation. examination of the upper extremity revealed normal range of motion with no gross deformities. pulses were palpable. capillary refill time was brisk. radiology/imaging: x-rays revealed ap view of the pelvis showed a left hip posterior dislocation. the pelvic ring was intact. left calcaneous fracture with talus dislocation. class ii subtalar dislocation. right nondisplaced femoral neck fractures were noted. right class iv subtalar dislocation. a chest x-ray was negative. pertinent laboratory data on presentation: white blood cell count was 15.5, hematocrit was 29.2, platelets were 212,00. pt was 14.8, ptt was 27.5, inr was 1.5. sodium was 140, potassium was 3.7, chloride was 11, bicarbonate was 19, blood urea nitrogen was 12, creatinine was 0.6, blood glucose was 162. lactate was 5.2. urinalysis was clean and negative. ethanol level was 63. hospital course: was admitted to the trauma service under the attending dr. . initially, he was fluid resuscitated in the emergency department with crystalloid and blood products. he was noted to have bilateral open ankle fractures which were reduced along with a left hip posterior dislocation which was reduced. extremities were splinted. a cervical collar was placed. on the day of admission, the patient received 7 liters of crystalloid; consisting of 4 liters of lactated ringer's, 3 liters of normal sterile saline; 3 units of packed red blood cells were transfused. one unit of fresh frozen plasma was transfused. the orthopaedic surgery service team was consulted. the patient was taken to the operating room for the following procedures: right femoral intramedullary nail/femoral neck open reduction with internal fixation; incision and drainage of bilateral ankle fractures with open reduction/internal fixation of the left talus, right talectomy. these procedures were performed for a right femoral neck fracture, right femoral shaft fracture, bilateral talar fractures, open grade ii. external fixation was placed to the patient's bilateral lower extremities. the surgery was performed by dr. . estimated blood loss was 1200 cc. the urine output was 550 cc. intravenous fluids were 6 liters in. the patient was sent to the surgical intensive care unit in stable condition. the patient remained intubated with a cervical collar placed. his pupils were equal, round, and reactive; although sluggish at 3 mm. the patient was aggressively hydrated. a ct scan was planned to rule out any source of bleeding. the patient was empirically placed on broad spectrum antibiotic coverage. the patient was placed on a morphine sulfate and propofol drip. he remained tachycardic with a regular rhythm. on postoperative day one, the patient remained sedated and intubated. he had been receiving a banana bag, protonix, and lovenox, as well as ativan. serial hematocrits were followed. laboratory data on postoperative day one included a white blood cell count of 11.4, hematocrit was 31.5, platelets were 162,000. sodium was 135, potassium was 4.3, chloride was 106, bicarbonate was 23, blood urea nitrogen was 11, creatinine was 0.8, blood glucose was 141. lactate was 2.8. calcium was 1.14, magnesium was 1.8. alt was 101, ast was 304, alkaline phosphatase was 27. the plan was to wean the patient off the ventilator. his urine output was good. he was hemodynamically stable. he was continued on the intravenous kefzol. an inpatient clinical nutrition assessment was obtained on . pin site wound care was begun on postoperative day two, consisting of half-strength hydrogen peroxide b.i.d. the orthopaedic team followed as a consultation service. on this day, the patient spiked a temperature of 102.7. late on postoperative day two, the patient was successfully extubated. he was alert and following commands. pain control regimen was changed to a patient-controlled analgesia. lovenox was continued for deep venous thrombosis prophylaxis. his cervical collar remained in place. on postoperative day three, the patient was transferred to the floor with the plan to clear the cervical spine the following day. he was transferred to the floor extubated. after the patient was alert, examination revealed a decreased light touch sensation and motor sensation to the left lower extremity. it was felt that this deficit was likely secondary to sciatic nerve palsy after his left hip posterior dislocation which was successfully reduced in the emergency department upon admission. his neurologic and motor status was closely followed thereafter. the patient continued to spike fevers to 101.4 on postoperative day four. a neurology service consultation was obtained for the patient's left foot weakness. examination was limited by the presence of external fixation, but the pattern was felt to be consistent with a peripheral lesion. a sensory distribution encompasses peroneal and tibial distributions (from the lesion to sciatic or l5 nerve root), and the saphenous is spared. given that the patient had no back pain and the left hip was displaced posteriorly, injury to the sciatic nerve seemed most likely. the neurology service recommended electromyogram/nerve conduction studies once the patient was more stable to give some prognostic information; mostly determining if the nerve is functionally transected. if the patient regained function prior to that testing, then the testing would not be necessary. on , physical therapy team involvement was begun. the patient tolerated transfers using his upper extremities well. pin care was performed as stated above. the patient received a continuous passive motion machine which he tolerated for 0 to 30 minutes for 1.5 hours for his right lower extremity. on , an addiction service consultation was obtained. the patient was transferred to the orthopaedic surgery service under the attending, dr. . the patient began to get more comfortable gradually moving his legs. he continued to work with physical therapy. due to the patient's open fractures, he did continue to receive wound care b.i.d. to left and right foot and ankle wounds. the left ankle wound exhibited some skin edge necrosis. no gross purulence was expressed. the patient was tolerating a regular diet and using the urinal at the bedside. the patient continued to perform successful out of bed to chair transfers. pain control was reasonably well tolerated with oral percocet. a first-step mattress was obtained to provide additional protective measures for the prevention of pressure ulcerations. the patient was voiding adequately. he was tolerating an oral diet well. pain control was adequate on p.o. local wound care to the heels and lower legs was continued. the patient remained stable. the left heel had an eschar that was gradually resolving with time. external fixation remained intact. pin sites showed no evidence of local infection. on , the patient plastic surgery team was consulted for their input regarding possible procedures for closure of the patient's bilateral open wounds to the lower extremities. the patient's staples were removed on . the plan was that the patient would probably need skin graft procedures performed when the patient returned to the operating room for orthopaedic surgery revisions in three weeks. the patient was placed in balkan frame. his weightbearing status remained nonweightbearing on the bilateral lower extremities with full weightbearing on the upper extremities. he was allowed to perform out of bed to wheelchair transfers, which he did frequently and successfully. on postoperative day 26 (), the patient's left heel was debrided at the bedside by the plastic surgery team who planned to place a vacuum assisted closure device then to promote granulation tissue over the patient's left heel because of some tendon exposure. the plan was for future skin graft procedure. the patient was instructed on the self-administration of lovenox injections. he understood and performed this successfully. the patient was also instructed on performing his own pin care. again, he understood and performed this with good results. on , the patient was doing well with his vac system placed to his left heel. the plastic service performed a sponge change on this day with note of good granulation tissue forming, but with tendon still exposed. the patient still complained numbness and decrease to light touch sensation to the left lower extremity; as described previously. this was consistent with the patient's baseline status post transfer to the floor. at this time, the patient had been afebrile for approximately one week. on , case management (which had been closely following the patient) noted that the patient did have a medicaid number effective as of that date. discharge planning had begun in terms of search for acceptable skilled nursing facilities, needed secondary to the patient's bilateral nonweightbearing status. he also had a vacuum assisted closure device and the bilateral external fixation system. on , a ct examination of the right foot was obtained which revealed a third metatarsal-base fragment (corresponding to a palpable prominence on the patient's dorsal foot). comminuted fractures of the anterior process of the talus, cuboid, third cuneiform, metatarsals 3, 4, and 5. a small plantar rim fracture of the base of the second metatarsal. talar fragments were displaced medially and inferiorly into the tarsal tunnel over the flexor hallucis longus muscle and the neurovascular bundle. on , the patient remained with bilateral external fixators to the lower extremities with a vac dressing to the left heel; which functioned well with scant serosanguineous drainage, and no apparent leaks. the plan was for the external fixation system to be in for a total of approximately three months. on this day, the vac sponge was changed by the plastic service team, who noted excellent coverage of the previously exposed achilles tendon. additional vac therapy was instituted to insure adequate granulation tissue coverage over the tendon before any plastic surgery procedure. on , the patient was brought to the operating room for a split-thickness skin graft from his left thigh to be placed on the patient's left heel to cover the open wound. he tolerated the procedure well without complications and was transferred from the operating room to the postanesthesia care unit with stable vital signs, and a vascular status intact. for additional details, please see the corresponding operative report. again, a vac dressing was placed to the patient's left heel and left there for five days. the patient was temporarily placed on a patient-controlled analgesia for pain control postoperatively. intravenous kefzol was continued. on hospital day 57 (), the patient's vac was functioning well with no apparent leaks. the right heel medial aspect exhibited scant purulence with compression. it was nontender. there was no surrounding or ascending erythema. no evidence of cellulitis. normal saline wet-to-dry dressing changes b.i.d. were instituted. antibiotics were continued. discharge planning issues remained due to the patient's ambulatory status and insurance issues. on (on hospital day 62), the patient was placed on ancef and levofloxacin antibiotics. he continued to perform his own pin care, lovenox injections. the patient was out of bed to wheelchair frequently. the right heel wound at the medial aspect of the ankle had an eschar which was beginning to sluff with underlying pink epithelialized tissue. no purulence or malodor was noted. the pin sites remained clean without signs of infection. the patient's split-thickness skin graft donor site from the left thigh remained viable with no evidence of infection. on hospital day 65 (on ), the patient's eschar at the right medial field was debrided at the bedside. the patient tolerated this procedure well. a black eschar was noted to be covering the wound bed of mixed granular and fibrotic tissue. on , the patient returned to the operating room for external fixation removal bilaterally with application of splints to the legs. this procedure was performed by dr. and was tolerated well. please refer to the corresponding operative note for details. on , the wounds looked clean. the dressing change regimen consisted of xeroform dressing over the right wound with normal saline wet-to-dry dressing changes for the remainder. the heel wound needed to epithelialize prior to any additional surgical procedures to be performed. the patient was to remain nonweightbearing bilaterally. the fixation appeared to be stable. the right medial ankle wound still had some fibrotic tissue as well as some granulation tissue. no purulence, malodor, or surrounding/ascending erythema was noted. the right lateral midfoot wound had a beefy red granular base. however, it was exquisitely tender upon dressing changes. there was no purulence. the left posterior heel had an eschar with a proximal area consisting of erythematous but epithelializing regions. no bulla. no purulence noted. other pin sites were clean and dry without signs of infection or drainage. the patient was placed on bilateral bivalve casts to facilitate wound inspection and dressing changes. he was to remain nonweightbearing bilaterally until the next surgical procedure; at least, which is removal of osseus fragments at the right foot and perhaps the right knee. the plan was for this to be scheduled in mid-. the patient was to call dr. office (telephone number ) to arrange an appointment. the plan was also for the patient to make a neurology appointment in early for possible electromyogram or nerve conduction studies to assess the patient's sciatic nerve palsy on the left lower extremity. according to physical therapy, the patient was stable for discharge home; assuming that his house was wheelchair assessable. however, it was not, so it was deemed that the only safe option was for mr. to be discharged to a rehabilitation or skilled nursing facility. case management was involved in trying to secure an appropriate facility. local wound care change regimen was performed as described above. the patient was deemed stable for discharge to a rehabilitation/skilled nursing facility with self-administration of lovenox injections. he was to remain nonweightbearing bilaterally. he may use a wheelchair. follow up with dr. and neurology as described above. condition at discharge: condition on discharge was stable. discharge status: to rehabilitation/skilled nursing facility. , m.d. dictated by: medquist36 procedure: other skin graft to other sites removal of external immobilization device open reduction of fracture with internal fixation, femur nonexcisional debridement of wound, infection or burn nonexcisional debridement of wound, infection or burn application of external fixator device, other bones open reduction of fracture with internal fixation, other specified bone other partial ostectomy, other bones diagnoses: other, mixed, or unspecified drug abuse, unspecified open wound of forehead, without mention of complication closed fracture of unspecified part of neck of femur motor vehicle traffic accident due to loss of control, without collision on the highway, injuring passenger in motor vehicle other than motorcycle open wound of knee, leg [except thigh], and ankle, complicated open fracture of astragalus other closed fracture of tarsal and metatarsal bones 

Answer: The patient is high likely exposed to