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: patient recorded as having no known allergies to drugs attending: chief complaint: unresponsiveness and altered mental status major surgical or invasive procedure: central line placement intubation removal of external fixation devices to bilateral lower extremities skull flap replacement emergent evacuation of epidural fluid collection post-skull flap replacement picc line placement wide debridement, right ankle. free vascularized anterolateral thigh flap to right ankle. advancement flap closure of thigh donor site. debridement of left ankle. split thickness skin graft, left ankle. history of present illness: mr. is a 51 year old man with a history of recent hospitalization () following motor vehicle accident with resultant left subdural hematoma status post drainage, subarachnoid hemorrhage, right frontal contusion, left occipital stroke, bilateral open ankle fractures, right eye hematoma, t11/t12 burst fractures status post posterior arthrodesis lateral mass screws from t8-l2 who was discharged to rehab on where he became more confused and was noted to be minimally responsive with rightward gaze yesterday prompting his return to . notes indicate that on admission on , he was "alert and oriented x 1 with intact upper extremity strength, he was unable to cooperate in a full exam". then, on he was noted to have "an acute change in mental status." per notes, he became unresponsive, with increased respiratory rate. exam at that time notable for normal vital signs, unresponsiveness, eyes deviated to the right, decreased movement of his right arm. he received 2mg ativan with little change in exam. he was then transferred to . in the emergency department, he was found to be febrile to 101.8. he was intubated for airway protection and ct scan. he was started on ceftriaxone, vancomycin, and ampicillin. he was then transferred to the micu. past medical history: 1. coronary artery disease 2. mechanical aortic valve replacement. 3. motor vehical accident in left subdural hematoma status post drainage, subarachnoid hemorrhage, right frontal contusion, left occipital stroke, bilateral open ankle fractures status post external fixation, right eye hematoma complicated by mrsa infection, t11/t12 burst fractures status post posterior arthrodesis lateral mass screws from t8-l2. 4. alcohol abuse 5. tobacco dependence social history: he lived with his family prior to accident. he has a 20 pack year smoking history. he had a history of intermittent heavy alcohol use and normally drinks 2-4 drinks per day. family history: his mother had hypercholesterolemia. there is no history coronary artery disease. physical exam: vitals: temperature:98.5 blood pressure:115/55 pulse:90 respiratory rate:17 oxygen saturation:99% on room air. gen: lying in bed in some discomfort heent: healed craniotomy scar on left side of head, partially healed scar on forehead, soft area of skull at craniectomy site, conjuctival injection and purulent drainage from right eye, poor dentition. neck: no resistance to passive flexion cv: regular rate and rhythm, normal s1 and s2, 2/6 systolic ejection murmur, mechanical aortic click lung: course breath sounds anteriorly abdomen: soft, slightly distended, tender around peg site back: laminectomy site with prurulent material extremities: vac dressing on left heel neuro: alert and oriented only to time of day, not place or person. cranial nerves grossly ii-xii intact, no focal deficits. pertinent results: hematology: wbc-12.0 hgb-10.5 hct-29.6 plt count-227 neuts-87.3 lymphs-9.3 monos-2.8 eos-0.5 basos-0 wbc-4.6 hct-30.9 mcv-89 plt ct-245 pt-12.9 ptt-25.7 inr(pt)-1.1 . chemistries: sodium-124 potassium-4.8 chloride-92 total co2-20 urea n-12 creat-0.5 glucose-126 calcium-9.2 phosphate-4.0 magnesium-1.3 glucose-115* urean-14 creat-0.8 na-136 k-4.6 cl-99 hco3-26 calcium-10.9* phos-4.6* mg-1.6 . lfts: alt(sgpt)-22 ast(sgot)-24 ck(cpk)-26 alk phos-173 amylase-135 tot bili-1.0 lipase-217 albumin-3.1 . blood gases: intubated on 60% oxygen: po2-184 pco2-32 ph-7.45 total co2-23 . imaging: 1. 2. chest x-ray: subtle alveolar opacities in the right upper lung zone and left retrocardiac region; the former was seen on the prior chest x-ray. these may relate to either pneumonia or asymmetric congestive heart failure. ett well positioned; balloon cuff mildly overinflated . 2. ct head: resolving products of intracranial hemorrhages, seen previously. status post craniectomy. larger size of low attenuation chronic subdural collection along the left frontal convexity, now 8 mm in diameter, and also with perhaps slightly greater rightward shift of normally midline structures. increased size of the supratentorial ventricles ct head : comparison with the prior study of reveals no significant interval change in either the extent of the previously noted epidural fluid collection subjacent to and marginated by the craniotomy flap nor the low density areas seen within the right frontal and left occipital- temporal portions of the brain. there are no new areas of intracranial hemorrhage, mass effect or shift of normally midline structures. the surrounding osseous and soft tissue structures, as well, are unaltered in appearance. . 3. ct abd/pelvis: interval decrease in size of left rectus abdominal muscle inflammation. no abscess visualized in this region or within the abdomen. small bibasilar pleural effusions with atelectasis. . 4. lower extremity x-rays: external fixation devices intact with evidence of healing fractures. . 5. ct c spine: healing nondisplaced transverse process fractures of t2, t1, and c7 are unchanged. no large paraspinal abscess is seen. brief hospital course: this is 51 year-old man with a history of recent hospitalization () following motor vehicle accident who was admitted following an episode of unresponsiveness accompanied by rightward eye deviation. . 1. change in mental status: his presentation of unresponsiveness and right eye deviation was thought to be initially possibly seizure activity or a stroke. on admission, he was subtherapuetic on coumadin and heparin, therefore a stroke was possible given that he had a mechanical valve. a head ct was negative for a stroke. his dilantin level was also subtherapeutic. his intracranial bleed, underlying infection, hyponatremia, and hypomagnesemia could all lower his seizure threshold. an eeg was consistent with encephelopathy but did not show any seizure focus. he was reloaded with dilantin and was maintained on dilantin and then converted to keppra. initially, he required a 1:1 sitter and restraints as he continued to pull at lines. his mental status improved such that he was oriented to place and time occasionally and was no longer agitated. by the end of his hospital stay he was oriented to person, place and date. he occasionally forgot the name of the hospital. . 2. infection: on admission, he had a leukocytosis. given his altered mental status, there was concern for an underlying infectious etiology. there was initially concern for an epidural abscess given his back wound; however, a ct was negative for any paraspinal collection. an mri could not be performed secondary to his mechanical valve. a lumbar puncture to look for menigitis was deemed to risky given the risk of seeding infection through the back wound. his back wound grew enterobactercloacae and mrsa. one set of admission cultures grew coag neg staph (unclear if real vs. contaminant), picc line tip (not blood culture) grew mrsa. subsequent blood cultures were negative, and he completed a 2 week course vancomycin and meropenem on . he has been afebrile for weeks now with no sign of re-infection. his mental status improved with antibiotic treatment. he will be seen by ophthalmology in follow up as an outpatient for hx eye hematoma infection. . 3. status post mva: on his previous admission, he underwent numerous surgeries including laminectomy and rod placement, craniotomy/craniectomy for subdural hematoma evacuation and relief of intracranial pressure, external fixation application to bilateral open ankle fractures. during this admission once his acute infections had resolved, his external fixation devices were removed. wounds vacs were maintained on bilateral ankle wounds to promote skin healing. he will remain non-weight bearing on his b/l lower extremities with range of motion of his left knee. he will follow up with orthopedics on th after his next hospitalization. the left ankle had adequate granulation tissue. the right ankle, however, did not heal. plastic surgery performed a right ankle skin flap and left ankle stsg with graft from the right thigh. he tolerated the procedure well and the grafts were healing well at discharge. woudn care will be continued at rehab with lle xeroform rle daily sterile dry dressings. he will follow up in plastic surgery clinic on friday, . his craniectomy site remained stable and neurosurgery replaced the skull flap. post-procedure, he developed increased confusion and lethargy. a head ct demonstrated a large epidural fluid collection with mass effect and midline shift. he underwent emergent evacuation and his mental status improved. weekly serial head cts demonstrated improvement in the fluid collection. because of this intracranial bleed, he was kept off of full anticoagulation. repeat head ct on demonstrate stable appearance of the epidural collection, but neurosurgery felt an additional 2 weeks off anticoagulation were appropriate. he was discharged to a skilled nursing facility with plans to return on for repeat head ct and start of anticoagulation. his ct scan should be reviewed by neurosurgery prior to restarting anticoagulation. . 4. mechanical aortic valve: he was subtherapeutic on coumadin on admission. he was started on heparin until he was therapeutic on coumadin. he required escalating doses of coumadin to 17.5 at night. since he was going to the operating room, his coumadin was held and he was maintained on heparin. his full anticoagulation was planned to be held for 4 weeks after his neurosurgery procedure given his large epidural bleed. however, in re-evalutaing his head ct neurgosurgeyr though it would be prudent to hold on anticoagulation for an addition 2 weeks. he will be re-admitted on for head ct and in house anticoagulation. he was started on aspirin 2 weeks post-operatively to decrease his stroke risk. . 5. coronary artery disease: he was maintained on his outpatient lisinopril and metoprolol. his sbp ranged in high 90's to low 100's throughout admission. . 6. fen: he was maintained on tube feeds initially. once his mental status had improved he was able to obtain enough calories from a regular diet. his electrolytes were repleted. he was tolerating good po by discharge. . 7. hypercalcemia with hyperphosphatemia: this was a new development in the setting of his multiple injuries and was felt likely to be secondary to decreased mobility, as his calcium was normal at the time of mva. it has progressively increased with his prolonged hospitalization. , , pth have already been checked and are normal. his calcium should be followed up to be sure it resolves after his acute issues are dealt with. . 8. access: he had a right ij that was replaced by a picc line. . 9. code: full medications on admission: insulin - hiss artificial tears prn lansoprazole 30mg suspension daily metoprolol 100mg tid tylenol prn nicotine patch 14mg/24h qday colace senna bisacodyl bacitracin-polymixin ointment - to eyes coumadin 2mg qday discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 3. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for rash. 4. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. multivitamin capsule sig: one (1) cap po daily (daily). 6. magnesium oxide 400 mg tablet sig: one (1) tablet po bid (2 times a day). 7. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic qid (4 times a day). 8. bacitracin-polymyxin b 500-10,000 unit/g ointment sig: one (1) appl ophthalmic (2 times a day). 9. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed. 10. quetiapine 25 mg tablet sig: two (2) tablet po hs (at bedtime). 11. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 12. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 13. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 14. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 15. oxycodone 5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 16. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 17. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection (2 times a day). 18. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 19. senna 8.6 mg tablet sig: one (1) tablet po twice a day. 20. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 21. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. 22. heparin lock flush (porcine) 100 unit/ml syringe sig: two (2) ml intravenous daily (daily) as needed: 10 ml ns followed by 2 ml 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site . discharge disposition: extended care facility: the center discharge diagnosis: primary 1. mental status changes 2. bacteremia 3. wound infection 4. eye infection (mrsa) 5. status post laminectomy and craniotomy/craniectomy 6. bilateral open ankle fractures 7. epidural bleed 8. status post right ankle free flap and left ankle stsg secondary 1. mechanical aortic valve 2. cad discharge condition: afebrile, hemodynamically stable, satting 100 % on ra, alert, awake and oriented. discharge instructions: seek medical attention immediately if you experience symptoms including, but not limited to, seizures, headache, bleeding from your wounds, pain, lightheadedness, loss of vision/hearing, loss of sensation, decreased ability to use arms/legs, others. take all medications as directed. please keep all of you follow up appointments. followup instructions: you are scheduled to be directly admitted at on monday, for a repeat ct of your head, its review by neurosurgery and monitoring while you are restarted on you anticoagulation. * you have a follow up appointment with dr. in the orthopedic clinic: orhto xray (scc 2) phone: date/time: 11:20 , md phone: date/time: 11:40 please call with any questions or if you need to reschedule. please schedule a follow up appointment with the clinic in weeks after discharge. if this is not possible, they will evaluate you when you are re-admitted to the hospital. you have a follow up appointment in the plastic surgery clinic: plastic surgery clinic phone: date/time: 2:30 you should also see your primary doctor 1-2 weeks after leaving rehab. you should discuss the plan for regarding your g tube. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances other skin graft to other sites other skin graft to other sites attachment of pedicle or flap graft to other sites excisional debridement of wound, infection, or burn other cranial osteoplasty other cranial osteoplasty transfusion of packed cells transfusion of platelets other immobilization, pressure, and attention to wound removal of implanted devices from bone, tibia and fibula removal of implanted devices from bone, tarsals and metatarsals other local excision or destruction of lesion of joint, ankle diagnoses: coronary atherosclerosis of native coronary artery other postoperative infection congestive heart failure, unspecified toxic encephalopathy hyposmolality and/or hyponatremia hematoma complicating a procedure heart valve replaced by other means acute respiratory failure methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site disorders of phosphorus metabolism infection and inflammatory reaction due to other vascular device, implant, and graft hypercalcemia carrier or suspected carrier of group b streptococcus late effects of motor vehicle accident acute conjunctivitis, unspecified non-healing surgical wound aftercare for healing traumatic fracture of lower leg late effect of fracture of lower extremities orbital edema or congestion old disruption of posterior cruciate ligament 

Answer: The patient is high likely exposed to