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: trauma: post c2 body fx w/ c2-3 flex-distraction bilat preseptal hemorrhage small bilateral ptx splenic injury s/p splenectomy l sqaumous temporal bone fx bilat anterior acetabular fx r inferior pubic ramus fx laceration x2 r anterior shin/knee shallow impaction fx ant tibial cortex rll contusion carotid->cav sinus fistula s/p embol. annular tear c2/3 disk prevertebral hematoma, skull base -> c4 major surgical or invasive procedure: open trach/peg c2-3 ant fusion w/ iliac bone graft; halo application coil/gel foam embolization multiple splenic branches splenectomy embolization of superior ophthalmic vein history of present illness: 27 y/o f w/ history of opiate abuse s/p mva w/ another vehicle: unrestrained driver, trapped requiring extrication +loc; s/p 1u prbcs in the field; 2u prbcs in ed. positive fast. intubated for decline in mental status. past medical history: unknown social history: uk family history: uk physical exam: physical examination hr: 145 bp: 90/70 resp: 29 o(2)sat: 100 normal constitutional: appears altered, gcs 14 heent: bilateral periorbital ecchymosis, perrla dilated pupils with nystagmus 5mm-->4mm blood from mouth, lax lower jaw, mid face stable, teeth intact, no hemotympanum, + gag chest: clear to auscultation, ecchymosis l chest cardiovascular: regular rate and rhythm, normal first and second heart sounds abdominal: soft, tender diffusely, guarding + fast, grossly, mildly distended pelvic: pelvis stable rectal: brown stool, no gross blood, normal rectal tone gu/flank: no hematuria extr/back: multiple large lacerations to le, along tib fib on r neuro: moving all ext psych: altered physical examination upon discharge vital signs: 98.5, hr=93, bp=106/93, resp. rate 18, oxygen sat 97% ra general: nad, talking valve in place, halo cv: ns1, s2, -s3, -s4 lungs: diminshed throughout abdomen: soft, non-tender ext: mild erythema right lower leg suture line, no exudate, +dp bil., no pedal edema bil neuro: alert and oriented x3, speech clear, no tremors, right eye conjunctival edema and injection, limited right lat. movement, full upward, and downward gaze pertinent results: 05:06am blood wbc-15.5* rbc-3.23* hgb-9.6* hct-30.2* mcv-93 mch-29.8 mchc-32.0 rdw-14.9 plt ct-1033* 05:06am blood wbc-22.8* rbc-3.20* hgb-9.7* hct-29.8* mcv-93 mch-30.2 mchc-32.4 rdw-14.8 plt ct-964* 02:53am blood wbc-22.1* rbc-3.16* hgb-9.3* hct-29.1* mcv-92 mch-29.5 mchc-32.1 rdw-15.0 plt ct-840* 06:05pm blood wbc-46.6* rbc-4.02* hgb-12.0 hct-37.6 mcv-94 mch-29.9 mchc-32.0 rdw-12.3 plt ct-354 05:06am blood neuts-59 bands-0 lymphs-12* monos-11 eos-15* baso-3* atyps-0 metas-0 myelos-0 05:06am blood plt smr-very high plt ct-1033* 11:07am blood pt-13.0* ptt-25.2 inr(pt)-1.2* 11:13pm blood fibrino-116*# 05:06am blood glucose-118* urean-12 creat-0.4 na-138 k-4.5 cl-97 hco3-35* angap-11 02:53am blood glucose-129* urean-10 creat-0.3* na-139 k-4.4 cl-98 hco3-33* angap-12 01:46am blood alt-42* ast-31 alkphos-161* 08:21pm blood alt-80* ast-155* ld(ldh)-454* alkphos-50 amylase-62 totbili-0.6 05:06am blood calcium-9.4 phos-4.4 mg-2.1 03:36am blood vanco-12.6 01:50pm blood hcg-<5 02:04am blood freeca-1.20 : cat scan of c-spine: impression: 1. c2-3 flexion-distraction with comminuted fractures of posterior c2 body and bilateral transverse processes ("hangman's fracture"). due to involvementof the transverse foramina, ct angiography should be considered because of the potential for vertebral artery injury. 2. right thyroid nodule can be evaluated by ultrasound when clinically appropriate. : cat scan of the head: 1. comminuted fractures of both temporomandibular joints, with subluxation on the right and complete dislocation on the left. 2. fracture of the left squamous temporal bone, with trace pneumocephalus in the middle cranial fossa. 3. bilateral preseptal hemorrhages and right retroorbital contusion/hemorrhage. : cat scan of abdomen/pelvis: 1. shattered spleen (grade 5 injury,) with extensive active arterial extravasation arising from the superior pole, and massive hemoperitoneum. additional foci of active bleeding in the left upper quadrant are also not excluded noting extensive pooling of the extravasated contrast. 2. suspected focal dissection and potentiallly partially occlusive thrombus of the suprahepatic ivc, although flow is patent. 3. tiny bilateral pneumothoraces, without displaced rib fractures. 4. right lower lobe contusions and/or aspiration. 5. bilateral anterior acetabulum and right inferior pubic ramus fractures. : right tib/fib x-ray: impression: shin laceration, with shallow impaction fracture of the anterior tibial cortex; correlation with physical findings is suggested as the appearance raises concern for an open fracture. : cat scan of sinus and mandible: impression: 1. comminuted fractures of the bilateral temporal bones and mandibular condyles, with subluxation on the right mandibular condyle and complete dislocation on the left with a displace angulated fracture. 2. fracture through the left squamous temporal bone with associated nearby intracranial pneumocephalus along the floor of the middle cranial fossa. 3. bilateral preseptal hemorrhages and right retroorbital fat stranding suggesting contusion with suspected hemorrhage. : tran-cath. embolization: impression: 1. uncomplicated splenic arteriogram with coil and gelfoam embolization of the upper pole branch distribution. 2. uncomplicated ivc-gram. : ct of the sinuses: impression: 1. right greater than left proptosis, with interval increase in dense fluid collection posterior to the globe. the optic nerve appears stretched and thinned. there is enlargement of the superior ophthalmic veins and cavernous sinuses,right more than left, increased compared with the prior study concerning for carotid-cavernous fistula. please correlate for presence of bruit. 2. multiple fractures, described previously : cta head: impression: 1. bilateral enlargement of the cavernous sinus, dilatation of the superior ophthalmic veins and proptosis with definite right-sided prominence of pathology. altogether, these findings are consistent with the diagnosis of right-sided carotid cavernous sinus fistula, which in the meantime has been also identified by conventional angiography. 2. multiple fractures of the facial skull as previously reported. 3. no acute intracranial abnormality : trans. cath embollization: impression: successful embolization of the superior ophthalmic vein on the right. unsuccessful embolization of the carotid cavernous fistula. further treatment will be attempted at a later time when the patient stabilizes : car./. angio: impression: successful embolization of the superior ophthalmic vein on the right. unsuccessful embolization of the carotid cavernous fistula. further treatment will be attempted at a later time when the patient stabilizes. the following coils were used to place into the superior ophthalmic vein. gdc 18 4 mm x 10 cm coil. gdc 18 2d 7 mm x 30 cm coil: 8 mm x 20 cm cashmere 14 coil. 9 mm x 22 cm cashmere 14 coil. 10 mm x 25 cm cashmere 14 coil. 8 mm x 20 cm cashmere 14 coil. gdc 18 2d 8 mm x 30 cm coil. : mr cervical spine: impression: 1. c2/c3 flexion distraction with fracture of the posterior c2 body and transverse processes, better demonstrated on ct c-spine. 2. posttraumatic annular tear of the c2/c3 intervertebral disc as well as a tear of the posterior longitudinal ligament. 3. questionable mild injury to the posterior ligamentous complex at the c2/c3 level. 4. extensive prevertebral hematoma from skull base to c4 as well as diffuse hemorrhage involving the suboccipital soft tissues. 5. no evidence of cord contusion. : x-ray of c-spine: findings and impression: endotracheal tube and temperature probe are present. surgical instrument is seen within the anterior disc space of c2-c3. subsequently acdf of c2-c3 with anterior instrumentation at intervertebral cage. normal alignment. please see operative report for further details. : chest x-ray: findings: in comparison with the study of , there is little overall change. monitoring and support devices remain in place. hazy opacification bilaterally is consistent with pleural effusion with some basilar atelectasis. engorgement of pulmonary vessels is consistent with elevated pulmonary venous pressure. : chest x-ray: findings: as compared to the previous radiograph, the patient has been extubated. the lung volumes are unchanged. the presence of bilateral mild-to-moderate pleural effusions cannot be excluded. unchanged borderline size of the cardiac silhouette, mild fluid overload. retrocardiac atelectasis of constant extent. : chest x-ray: findings: as compared to the previous radiograph, the patient has received a tracheostomy tube. the tip of the tube projects 2.8 cm above the carina. there is no evidence of complications. unchanged position of left subclavian catheter. unchanged moderate cardiomegaly. the bilateral parenchymal opacities show a decreasing trend. after splenectomy, free intra-abdominal air is now visible under the right hemidiaphragm : ct of the head: impression: 1. interval embolization of the right superior ophthalmic vein. persistent right-sided proptosis and preseptal soft tissue swelling. 2. no evidence of intracranial hemorrhage. 3. limited examination secondary to artifact from the halo. no gross territorial infarction. : cat scan of the c-spine: impression: 1. fracture lines involving the body of c2 extending to the bilateral transverse processes, compatible with a "hangman's fracture" are still evident though the previously noted distraction of c2 on c3 is improved status post anterior c2-c3 fusion with intervertebral disc spacer placement. 2. known associated prevertebral hematoma and swelling. brief hospital course: 27 year old female who was involved in a car/car mvc. she was brought to ed as trauma activation . following trauma evaluation patient was admitted to acs trauma service for further care in tsicu intubated/sedated. systems based hospital course as follows: injuries: - bilateral comminuted mandibular fx (omfs non-operative) - basilar skull fx (non-operative) - l squamous temporal bone fx (non-operative) - post c2 body fx w/ c2-3 flex-distraction (s/p ant fusion ortho-spine) - bilat preseptal hemorrhage (s/p neuro ir coiling/optho following/stable iop) - tiny bilateral ptx (stable) - splenic injury (s/p splenectomy) - bilat anterior acetabular fx (stable, wb as tol) - r inferior pubic ramus fx (stable, wb as tol) - laceration x2 r anterior shin/knee (stable, wb as tol) - shallow impaction fx ant tibial cortex (stable, wb as tol) - rll contusion (stable, wb as tol) neuro: patient was intubated in trauma bay for altered mental status. ct head showed no tbi. sedation was administered as needed for patient comfort. followed commands when sedation lightened throughout. sedation weaned as appropriate. given hx opiate abuse chronic pain service was contact to assist w pain control issues. methadone was started in combination w dilaudid combination long/short acting analgesia. mental status noted to be markedly improved . ct of the head and c-spine were completed as part of trauma evaluation revealing likely carotid-cavernous sinus fistula as well as c2 hangman's fracture. patient went to neuro ir for embolization of carotid-cavernous fistula. type i cc fistula w enlarged superior ophtalmic vein was seen and embolized. unable to embolize cavernal sinus. b/l femoral sheaths were removed. neurosurgery cleared patient for c-spine repair . repair was initially deferred secondary to presumed pulmonary infection and hesitance to insert ortho spine hardware in setting of active infection. patient went to or with ortho spine for c2-3 anterior fusion w/ iliac bg and halo application. per ortho/nsurg, ct head/c-spine performed revealed interval placement of multiple embolization coils within the right superior ophthalmic vein. no coils are demonstrated in the region of the right cavernous sinus. there is persistent right-sided proptosis and preseptal soft tissue swelling. no evidence of intracranial hemorrhage. on she underwent a repeat cartoid angiogram and had placment of 3 coils to the right carotid sinus fistula. right ophthalmologic injury noted with ophtho consult obtained on . bedside evaluation was notable for bedside periorbital blood evacuation by opthalmology. drops/ointments were applied per ophtho recs. optho exam was notable for pressures as follows: r eye pressure 18,23,21. l eye pressure 18,22,19. opthalmologic evaluation continued on ongoing basis. pressures were approaching normal limits. cv: patient was resuscitated per trauma protocol with adequate/appropriate response. the patient was stable from a cardiovascular standpoint; vital signs were routinely monitored. pulmonary: patient was intubated in trauma bay for altered mental status/agitation. noted to have small b/l ptx though chest tubes not required. remained intubated for procedures as well as likely vap (see id). patient made progress weaning ventilatory support. bronch with bal was repeated but was not terribly impressive. respiratory status improved . trajectory of pulmonary progress improved such that patient met criteria for extubation . patient proceeded to decompensate from respiratory standpoint requiring urgent nasotracheal intubation (given halo). with difficult airway and tenuous respiratory status patient was taken to or for trach/peg . speculated that poor gag at this time may be related to superior laryngeal nerve stress in setting of recent neck instrumentation. bronch repeated with clearing secretions. patient weaned off of ventilatory support. tolerated trach mask throughout day. patient also noted to cough well with good clearance of respiratory secretions. s&s tried pmv eval which patient did not tolerate due to coughing and increase secretions. concern for laryngeal edema. vital signs were routinely monitored. gi/gu: trauma scan revealed splenic laceration for which patient was brought to ir for attempted embolization. adequate hemostasis required coil/gel foam embolization multiple splenic branches. given likelihood of subsequent splenic infarct patient was taken to or for splenectomy . patient tolerated this well and was brought to tsicu for further management intubated/sedated. patient was given iv fluids on arrival per trauma resuscitation protocol. dobhoff was placed and tfs initiated which were tolerated well. peg was placed without incident and tfs resumed . she was also started on a bowel regimen to encourage bowel movement. patient had bowel function per normal with flatus and bms. foley was placed as part of trauma evaluation. urine output was adequate and patient resuscitated accordingly. intake and output were closely monitored. id: patient noted to be febrile . tylenol and cooling measures were initiated. 4+gnr on sputum were found on gram stain and cipro/zosyn started for antipseudomonal coverage. abx were changed to vanc/cefepime/cipro for broad coverage on pna. bronch performed for desat to 89 with large amount of thick secretions demonstrated. bal specimen was sent showing 3+pmns, no orgs on gram stain. bronchs were repeated as needed with specimens sent accordingly. nystatin was started . abx d/c'd as all cultures remained negative. prophylaxis: the patient received subcutaneous heparin during this stay, and was encouraged to get up and ambulate as early as possible. msk: see neuro for mgmt of c2 fx. omfs consult requested for mandibular fx. noted that evaluation should take place when patient awake/cooperative so formal evaluation deferred through . on eval for mandibular fx omfs stated no indication for operative intervention. rec chlorhexidine rinse x 1month. pelvic fractures as above injury list. eval by ortho notable for non-op management. heme: patient required massive transfusion protocol initiation at time of arrival for hypotension. patient received 7 prbc, 4 ffp, 1 pack platelets. hct throughout remainder of admit remained stable. no further transfusions required as of . dispo: remained in icu from - for recovery. pt consult was placed . central line and a-line d/c'd with expectation that patient would go to floor . transferred to the surgical floor on . she was evaluated for placement of a speaking valve in hopes of allowing her to speak and to assess her ability to manage her secretions. she was reported to have severe coughing with the cuff deflated and recommendations made to down-size trach tube before attempts made to allow oral intake. her trach tube was down-sized to a #7 non-cuffed fenestrated trach tube on . tube feedings continued as per order. she was evaluated by opthamology for further assessement of visual acuity, but exam deferred related to patient's mental status, but recommendations made for lacrilube to right eye every 2 hours. she was re-evaluated by speech and swallow on to assess her ability to tolerate a speaking valve. a sheily speaking valve was placed and patient was able to vocalize. she did experience coughing after swallowing thick nectar and pain with chewing. in order to better assess her swallowing, she underwent a video swallow and was found to continue to aspirate with liquids, but did tolerate pureed foods. she will need to be evaluated again by speech/swallow prior to increasing her diet (see note speech/swallow) the patient was found to be making good progress with ambulation, and balance, but continues to have require trach care and tube feedings and for this reason was evaluated for a rehabilitation facility where she can further regain her strength and mobility. she did receive her post-splenectomy vaccines on of note: she will need follow-up for repeat angio on . neuro. is aware and will call facility regarding time and place. medications on admission: none discharge medications: 1. bacitracin-polymyxin b 500-10,000 unit/g ointment sig: one (1) appl ophthalmic q8h (every 8 hours): apply to rigth eye. 2. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day): right eye. 3. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for yeast . 4. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 5. methadone 10 mg tablet sig: ten (10) mg po bid (2 times a day). 6. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day). 7. docusate sodium 50 mg/5 ml liquid sig: ten (10) cc po bid (2 times a day): hold for loose stools. 8. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). 9. acetaminophen 650 mg/20.3 ml solution sig: 20.3 ml po q6h (every 6 hours). 10. dilaudid 2 mg tablet sig: 1-2 tablets po every 3 hours: as needed for pain, may cause increased drowsiness. 11. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 12. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic q2h (every 2 hours): right eye. 13. lorazepam 0.5 mg tablet sig: 0.5 mg po q4h (every 4 hours) as needed for anxiety . 14. bisacodyl 10 mg suppository sig: one (1) suppository rectal at bedtime as needed for constipation. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: trauma: bilateral comminuted mandibular fx basilar skull fx post c2 body fx w/ c2-3 flex-distraction bilat preseptal hemorrhage small bilateral ptx splenic injury s/p splenectomy l sqaumous temporal bone fx bilat anterior acetabular fx r inferior pubic ramus fx laceration x2 r anterior shin/knee shallow impaction fx ant tibial cortex rll contusion carotid->cav sinus fistula s/p embol. annular tear c2/3 disk prevertebral hematoma, skull base -> c4 discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive( pt has trach) activity status: non-op pelvic fx wbat; spine-s/p c2-3 fusion with halo discharge instructions: you were admitted to the hospital after you were involved in a motor vehicle accident in which you sustained a cervical spine fracture, facial fracture, and a laceration to your spleen. to stabilize your cervical spine, you had a bone graft and halo brace for additional stability. you sustained a lacertation to your spleen and had your spleen removed. because of your injuries and your neck instability, you had a trach performed and a feeding tube placed for nutrition. you were monitored in the intensive care unit for 2 weeks. once your vital signs stabilized, you were transferred your vital signs have stabilized and you are now preparing for discharge to an extended care facility where you can further regain your strength. followup instructions: follow-up with dr. when discharge. omfs will call you.(they have been informed of discharge) you follow-up appointment will be at yawkey ambulatory care center at in the oral surgery clinic on the . address is . phone number is . name: , md location: dept of orthopaedic surgery/spine center address: , 2, , phone: we are working on a follow up appointment with dr. in the next 2 weeks. you will be called at the facility with the appointment. if you have not heard within 2 business days or have questions, please call the number listed above. department: general surgery/ when: tuesday at 2:00 pm with: , md 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. please arrive there at 1:30pm. department: orthopedics when: tuesday at 10:00 am with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: tuesday at 10:20 am with: , np building: campus: east best parking: garage please follow with mass eye/ear oculoplastics in 1 week. you can schedule an appointment by calling # . please follow up with the eye clinic in weeks. you can schedule your appointment by calling # md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus other cervical fusion of the anterior column, anterior technique total splenectomy closure of skin and subcutaneous tissue of other sites other endovascular procedures on other vessels excision of bone for graft, other bones repair of vertebral fracture canthotomy insertion or replacement of skull tongs or halo traction device plastic operation on pharynx spinal traction using skull device insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae insertion of recombinant bone morphogenetic protein endovascular embolization or occlusion of vessel(s) of head or neck using bioactive coils endovascular embolization or occlusion of vessel(s) of head or neck using bioactive coils diagnoses: unspecified essential hypertension chronic hepatitis c without mention of hepatic coma other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure closed fracture of second cervical vertebra traumatic pneumothorax without mention of open wound into thorax other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle ventilator associated pneumonia orbital hemorrhage opioid abuse, unspecified contusion of lung without mention of open wound into thorax closed fracture of pubis other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms closed fracture of acetabulum closed fracture of shaft of tibia alone injury to spleen without mention of open wound into cavity, massive parenchymal disruption closed fracture of mandible, condylar process closed fracture of base of skull without mention of intra cranial injury, with loss of consciousness of unspecified duration injury to multiple blood vessels of head and neck cerebrospinal fluid rhinorrhea traumatic compartment syndrome of other sites 

Answer: The patient is high likely exposed to