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: pt is a 49 yo male transferred via med flight from osh s/p gsw. pt was brought directly to the or. major surgical or invasive procedure: operation: 1.median sternotomy, multiple cardiac repairs as dictated by dr. , repair of right upper lobe parenchymal laceration, exploratory laparotomy,chromic suturing and argon beam coagulation of 4 liver lacerations,abdominal packing, vac closure of abdomen. 2. emergency median sternotomy. 3. evacuation cardiac tamponade. 4. repair of bullet injury to the right ventricle free wall. 5. tricuspid valve replacement with a size 29 mosaic tissue valve. 6. repair of ventricular septal defect caused by the bullet with dacron patch. 7. left ventriculotomy to remove the bullet. 8. laparotomy and repair liver lacerations and also lung parenchymal injury by dr. as seen in her operation dictation note. 9. mediastinal exploration and washout. 10. mediastinal exploration and closure of the sternotomy. 11.exploratory laparotomy/reopening of recent laparotomy, washout of the abdomen and closure, as well as exploration of the right arm wounds, debridement and packing 12.exploratory laparotomy and abdominal washout. abdominal wall debridement.liver biopsy. abdominal wall closure with retention sutures. history of present illness: this is a 49-year-old patient who sustained a gunshot injury to the right chest. he was apparently very unstable in the field with multiple arrests resuscitated successfully and on reaching the outside hospital at he was apparently reasonably stable. there, further investigations with x-rays revealed the bullet had traversed through the right hemithorax(chest tubed placed) across the heart and lodged itself into the left heart border and he was transferred emergently to the hospital for further exploration and repair. on arrival to the hospital, he was actively resuscitated to maintain reasonable hemodynamics and emergency surgery was carried out by , and the trauma surgeon, dr. , and initially explored by dr. as well. past medical history: +etoh, dm, htn, ? methadone user, s/p hit by train social history: heroin addict family history: non-contributory physical exam: admission physical deferred- rushed emergently to o.r. pertinent results: tee focused study for chest closure and ongoing pressor requirement: left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). there is a muscular ventricular septal defect (vsd) just below the prosthetic tricuspid valve with left to right flow. this is approximately 1 cm superior to the vsd observed on that was repaired. the remaining left ventricular segments contract normally. 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 appears structurally normal with trivial mitral regurgitation. a bioprosthetic valve is seen in the tricuspid position. there is a very small pericardial effusion. dr. was notified in person of the results on at 0830. following chest closure overall systolic function was unchanged from prior. chest and abd ct scan: 1.small apical right pneumothorax. 2.small bilateral pleural effusions with overlying atelectasis; however, infection cannot be excluded, especially at the left lung base. chest tube in appropriate position. 3.small fluid collection inferior to the cecum with high density material concerning for extravasation of oral contrast. associated focal wall thickening of the cecum which may be due to colitis: infections or inflammatory. 3. wedge-shaped hypodense lesion within segment of the liver, likely representing repaired liver laceration. small amount of perihepatic free fluid. 4. open anterior abdominal wall wound with a small amount of fluid or stranding inferiorly in the anterior abdominal wall. 5. fractured left 1st and 2nd ribs. discharge labs: 06:18am blood wbc-9.5 rbc-2.98* hgb-8.4* hct-27.0* mcv-91 mch-28.3 mchc-31.1 rdw-16.5* plt ct-381 06:18am blood glucose-68* urean-28* creat-1.8* na-126* k-4.8 cl-93* hco3-23 angap-15 04:51am blood wbc-10.0 rbc-2.94* hgb-8.4* hct-26.8* mcv-91 mch-28.4 mchc-31.2 rdw-16.7* plt ct-401 05:19am blood wbc-12.9* rbc-2.99* hgb-8.6* hct-26.8* mcv-90 mch-28.8 mchc-32.1 rdw-16.6* plt ct-431 04:51am blood plt ct-401 05:19am blood plt ct-431 02:53am blood pt-15.0* ptt-42.0* inr(pt)-1.4* 04:51am blood glucose-78 urean-30* creat-2.1* na-125* k-4.2 cl-93* hco3-25 angap-11 05:19am blood glucose-96 urean-34* creat-2.2* na-122* k-4.0 cl-89* hco3-23 angap-14 05:50am blood alt-72* ast-131* alkphos-108 amylase-87 totbili-1.9* 02:01am blood alt-62* ast-170* ld(ldh)-378* alkphos-97 tbili-2.6* 05:50am blood lipase-49 02:07am blood lipase-204* 04:51am blood mg-2.2 05:19am blood mg-2.1 10:58 am stool **final report ** c. difficile dna amplification assay (final ): negative for toxigenic c. difficile by the illumigene dna amplification assay. (reference range-negative). 9:52 pm sputum source: endotracheal. gram stain (final ): <10 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): rare growth commensal respiratory flora. stenotrophomonas (xanthomonas) maltophilia. sparse growth. identification and sensitivities performed on culture # . 3:12 pm blood culture source: line-ij 2 of 2. blood culture, routine (final ): serratia marcescens. identification and sensitivities performed on culture # 353-3223v . anaerobic bottle gram stain (final ): gram negative rod(s). aerobic bottle gram stain (final ): gram negative rod(s). radiology report chest port. line placement study date of 2:54 pm final report: in comparison with study of , there has been placement of a left subclavian picc line that extends to the lower portion of the svc. continued low lung volumes with bibasilar effusions and atelectasis. no definite pulmonary edema. left apical pleural cap again is seen, representing a loculated, possibly extrapleural fluid collection related to the recent rib fracture. brief hospital course: the patient was admitted from an outside hospital and went emergently to the or after sustaining gunshot wound to the chest. he underwent extensive surgery to repair trauma sustained to chest. he was brought from the or after undergoing median sternotomy, tvr/vsd closure/rv repair by dr. , repair of right upper lobe parenchymal laceration, exploratory laparotomy, chromic suturing and argon beam coagulation of 4 liver lacerations,abdominal packing, vac closure of abdomen .please see multiple operative notes for further details. he arrived from or intubated, sedated, paralyzed on epi/levo/vasopressin, open chest. he was bleeding from his chest tubes and required multiple blood products and returned to the or for abd and chest washout, repair of diaphragmatic bleeder. returned from or continued to be hypotensive, elevated transaminases, chest and abd open and wound vac in place. he developed rapid afib and received amiodarone with good effect. he returned to the or on pod#2 for chest closure which he tolerated well. abdominal wound remained open and packed. after chest closure pressors were weaned slowly over the course of several days. on pod# 4 his abd was closed. his sedation was weaned off, he remained neurologically intact and his c-spine was cleared by acs. he spiked fevers and became bacteremic. he grew serratia from his blood and stenotrophomonas and enterobacter from sputum on . he was covered with broad coverage antibiotics, (vanc, fagyl, cefepime) id were consulted and bactrim was added. he developed drainage upper aspect of abd wound and was brought back to the or by acs. the abd was opened and packed. he returned a few days later for abd wound closure but the skin remained open. he was extubated on pod#7 but was reintubated 3hr later 2nd to resp distress. left chest tube was placed for moderate to large effusion. he was again reextubated on pod#10. due to his current drug history he was seen by the acute pain service for management of meds. he continued to progress slowly and was transitioned off tube feeds, seen by speech and swallow and cleared to eat regular diet. appetite is poor and he is on supplements. his tranaminases have continued to improve. he developed acute renal failure peak creatinine 2.5. and was therefore gently diuresed. his creat continues to be above normal. he was noted to have developed a pressure sore to the back of his head for which he was seen by wound nurse and place in foam mattress. chest tubes and pw were remove without incident. he eventually transitioned to the floor on pod#12. on the floor he continued to progress. he has remained very weak and deconditioned. he developed c-diff and was started on po vanco which he had completed. he became hyponatremic which has been slowly improving and was placed on fluid and free water restriction and meds were adjusted. he has remained afebrile and will continue on bactrim until . the patient was evaluated by the physical therapy service for assistance with strength and mobility. at the time of discharge on pod 24 the patient was requiring max assist and was screened for rehab. he is able to sit and stand at the bedside he has a continued flat affect requiring encouragement to partake in physical therapy. all his wounds are healing well, his abdominal wound has several retention sutures and a vac in place to assist with wound healing. he was noted to be lethargic a few days prior to discharge and pain meds were adjusted, he has tolerated the adjustment and noted to be less lethargic. the patient was discharged to sianai in in good condition with appropriate follow up instructions. medications on admission: none discharge medications: 1. acetaminophen 650 mg po/pr q4h:prn temperature >38.0 2. amiodarone 200 mg po daily 3. aspirin 81 mg po daily 4. bisacodyl 10 mg pr hs:prn constipation 5. docusate sodium 100 mg po bid 6. furosemide 20 mg po bid 7. heparin 5000 unit sc tid 8. metoprolol tartrate 12.5 mg po bid hold and call ho for sbp<90 hr<55 9. milk of magnesia 30 ml po daily:prn constipation 10. nystatin cream 1 appl tp groin 11. oxycodone (immediate release) 2.5 mg po q4h:prn pain rx *oxycodone 5 mg 0.5 (one half) tablet(s) by mouth every four (4) hours disp #*40 tablet refills:*0 12. oxycodone sr (oxycontin) 10 mg po q12h rx *oxycodone 10 mg 1 tablet(s) by mouth every four (4) hours disp #*60 tablet refills:*0 13. ranitidine 150 mg po daily 14. tizanidine 0.5 mg po bid:prn pain 15. sodium chloride 1 gm po tid discharge disposition: extended care facility: at medical center discharge diagnosis: 1)gunshot wound to chest with resultant injuries to heart, diaphragm, lung and liver resulting in massive hemorrhage and pericardial tamponade. 2)bleeding from diaphragm. 3)fascial dehiscence and evisceration 4)serratia bacteremia pmh: htn, dm discharge condition: alert and oriented x3 nonfocal bed to chair with assist(per pt)full assist-lift(per nursing) pain managed with oral narcotics extremities:warm well perfused-no edema abd wound:with vac, incision-clean occiput: pressure ulcer-keep on sponge pillow discharge instructions: look at your incisions daily no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and in the evening take your temperature, these should be written down on the chart vab dressing chnage to abdomin q 72hrs (last change ) no driving for one month or while taking narcotics. do not drive until follow up with surgeon no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: recommended follow-up: you are scheduled for the following appointments surgeon: dr phone: date/time: 1:00 in the medical office building cardiologist:needs referral please call to schedule appointments with your: acute care surgery(acs): call to schedule f/u appt in 2 weeks primary care dr., in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery enteral infusion of concentrated nutritional substances closed (percutaneous) [needle] biopsy of liver cardioplegia other repair of chest wall other repair of abdominal wall nonexcisional debridement of wound, infection or burn closure of laceration of lung closure of laceration of liver excision or destruction of lesion or tissue of abdominal wall or umbilicus open and other replacement of tricuspid valve with tissue graft hypothermia (systemic) incidental to open heart surgery suture of laceration of diaphragm other repair of heart and pericardium diagnoses: other postoperative infection cellulitis and abscess of trunk unspecified essential hypertension cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis atrial fibrillation alcohol abuse, unspecified laceration of heart with penetration of heart chambers with open wound into thorax injury to liver without mention of open wound into cavity, laceration, minor pressure ulcer, other site intestinal infection due to clostridium difficile other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation opioid abuse, unspecified traumatic shock disruption of external operation (surgical) wound personal history of sudden cardiac arrest cardiac tamponade acute respiratory failure following trauma and surgery septicemia due to serratia secondary and recurrent hemorrhage pressure ulcer, unstageable traumatic pneumohemothorax with open wound into thorax assault by other and unspecified firearm open wound of upper arm, complicated laceration of lung with open wound into thorax injury to diaphragm, with open wound into cavity 

Answer: The patient is high likely exposed to