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: fever of unknown origin major surgical or invasive procedure: none history of present illness: 43 year old male firefighter who was struck by an auto which left him with anoxic encephalopathy, seizure disorder, atrial fibrillation, and multiple extremity wounds. he returns from his rehab facility with fevers of unknown origin, which have persisted despite antibiotic treatment with vancomycin, fluconazole, and amikacin. cultures at the rehab facility were positive for gram negative staphylococcus bacteremia and acenitobacter in his sputum. urine and stool cultures were negative. past medical history: polytrauma requiring multiple operative interventions anoxic brain injury placement of ivc filter, percutaneous gastrostomy, tracheostomy social history: firefighter married with children family history: noncontributory physical exam: vs: temp 100.6, bp 145/68, hr 110, rr 16, o2 sat 100% on 10l trach mask gen: nad, cachectic, responsive but mildly confused lungs: cta b/l, mild upper airway transmission heart: s1s2 rrr, no murmurs, gallops, or rubs. abd: soft, nt/nd, + bowel sounds. gtube in place. back: 7x7 cm sacral decubitus ulcer with fibrinous base, nonpurulent. ext: b/l le with vacs intact. r arm cast. pertinent results: 02:29am wbc-16.6* rbc-2.81* hgb-8.9* hct-26.8* mcv-96 mch-31.7 mchc-33.2 rdw-14.2 02:29am glucose-118* urea n-12 creat-0.3* sodium-133 potassium-4.3 chloride-100 total co2-23 anion gap-14 02:29am alt(sgpt)-300* ast(sgot)-73* ld(ldh)-151 alk phos-262* amylase-41 tot bili-0.3 09:45pm blood hbsag-negative hbsab-positive hbcab-negative hav ab-negative igm hav-negative ***** wound culture: wound culture (final ): due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for pseudomonas aeruginosa, staphylococcus aureus and beta streptococcus). gram negative rod(s). moderate growth. probable enterococcus. moderate growth. pseudomonas aeruginosa. moderate growth. gram negative rod #3. sparse growth. ***** sputum culture: respiratory culture (final ): oropharyngeal flora absent. acinetobacter baumannii. >100,000 organisms/ml.. "note, for amp/sulbactam, higher-than-standard dosing needs to be used, since therapeutic efficacy relies on intrinsic activity of the sulbactam component". sulfa x trimeth sensitivity testing per dr (). sulfa x trimeth performed by -. stenotrophomonas (xanthomonas) maltophilia. 10,000-100,000 organisms/ml.. ***** head ct: findings: there is no intracranial hemorrhage, shift of normally midline structures, or evidence of acute major vascular territorial infarct. no abnormal enhancement is noted. compared to , -white matter distinction and cerebral edema has improved. surrounding osseous structures demonstrate normal aeration of the paranasal sinuses and mastoid air cells. additionally, subcutaneous swelling has improved compared to . impression: no intracranial hemorrhage or edema ***** ct abdomen/pelvis: ct abdomen with contrast: opacification within distal bronchi at the right base likely represent secretions and the lung bases are otherwise unremarkable. no focal hepatic lesion is identified and the gallbladder, pancreas, spleen, and adrenal glands are within normal limits. the kidneys enhance symmetrically and excrete contrast normally and there is no evidence of hydronephrosis or hydroureter. subcentimeter hypoattenuating bilateral renal lesions measure up to 7 mm in size and are too small to further characterize. intra-abdominal loops of large and small bowel are unremarkable and there is no free air, free fluid, or pathologically enlarged mesenteric or retroperitoneal lymph nodes. a g- tube is present within the stomach and an ivc filter is in place. the abdominal aorta is of normal caliber throughout. ct pelvis with contrast: the rectum, sigmoid colon, seminal vesicles, prostate are unremarkable. a foley is present within the bladder which contains nondependent air. no free fluid or pathologically enlarged lymph nodes are seen within the pelvis. bone windows reveal no worrisome lytic or sclerotic lesions. a few small foci or air within the subcutaneous tissues just inferior to the coccyx may represent decubitus ulceration, new since . impression: 1. new decubitus ulceration just inferior to and approaching the coccyx bone. recommend clinical correlation. 2. opacification of a few right lower lobe bronchi likely represent secretions. 3. hypoattenuating renal lesions are too small to characterize ***** chest xray: findings: comparison with the study of , the tracheostomy tube remains in place. the right central catheter has been removed. specifically, there is no evidence of acute pneumonia ***** ruq ultrasound: findings: the liver demonstrates no focal or textural abnormality. there is no intra- or extra-hepatic biliary ductal dilatation. there is a mild amount of sludge within the gallbladder with a few tiny hyperechoic foci measuring up to 4 mm which may represent /small stones. the common bile duct measures 3 mm. the main portal vein demonstrates normal hepatopetal flow. no free fluid is identified in the right upper quadrant. impression: gallbladder sludge with tiny /stones. no evidence of cholecystitis. ***** tib/fib xrays: impression: status post orif of comminuted left tibial plateau fracture and multiple comminuted right tibial fractures. evidence of interval fracture healing without hardware complication. ***** b/l venous duplex: impression: no evidence of dvt in both legs. ***** transthoracic echo: the left atrium is normal in size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). 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 regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: normal study. no valvular pathology or pathologic flow identified. compared with the prior study (images reviewed) of , systolic function is now normal. brief hospital course: he was admitted to the trauma icu on for expected ventilator dependency. he was able to tolerate being off of the ventilator on trach mask around the clock. a complete fever workup was initiated, including cultures of the blood, urine, sputum, stool, and sacral ulcer. his left arm midline that was inserted at the rehab facility was removed and cultured. his blood, urine, and stool cultures were negative, and remained negative on repeat cultures as well. his wound culture was positive for pseudomonas and enterococcus, and sputum was positive for acinetobacter and strophomonas. the infectious disease service was consulted, and as he was hemodynamically stable, the decision was made to stop all of his antibiotics. his fever persisted for several days, during which xrays of the chest and a ct of the abdomen and pelvis were performed, and were negative for sources of infection. lower extremity ultrasounds were negative for dvt. as his liver enzymes were elevated, a ruq ultrasound was done, which showed gallbladder sludge but was negative for cholecystitis. hepatitis serologies were negative as well. at this time his fever curve began to trend down, and he was transferred to the surgical floor. a transthoracic echo was done, which was negative for endocarditis. during his hospital stay the plastic surgery service was consulted as well for management of his open wounds. they determined that revision of the sacral ulcer would not be necessary at this time, but that the wounds to the lower extremities and right elbow were suitable for skin grafting. unfortunately he was not able to be scheduled for grafting during this hospital stay, and will have plastic surgery followup as an outpatient. as his fever had resolved and all workup was negative, the decision was made to discharge him back to his rehabilitation facility on . during his hospital stay he was also evaluated by physical and occupational therapy; he will continue to require ongoing intensive rehabilitation because of his multiple injuries. medications on admission: 1. keppra qhs, 1500 qam 2. folate 1g daily 3. colace 100 4. metoprolol 50mg tid 5. diflucan 400mg daily 6. vancomycin 1.25g q12h 7. amikacin 1175mg daily 8. dilantin 100mg qid 9. topamax 100mg 5x daily 10. dilaudid 4mg iv q4hprn 11. sodium bicarbonate 2 tabs tid 12. magnesium oxide 400 mg daily 13. senna 2 tabs 14. lansoprazole 30 mg 15. potassium chloride 16. mvi daily discharge medications: 1. acetaminophen 500 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for fever. 2. therapeutic multivitamin liquid : one (1) cap po daily (daily). 3. senna 8.6 mg tablet : two (2) tablet po bid (2 times a day) as needed. 4. ferrous sulfate 325 (65) mg tablet : one (1) tablet po daily (daily). 5. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 6. topiramate 100 mg tablet : one (1) tablet po 5x/day (5 times a day). 7. levetiracetam 100 mg/ml solution : 1500 (1500) mg po qam (once a day (in the morning)). 8. levetiracetam 100 mg/ml solution : () mg po qhs (once a day (at bedtime)). 9. folic acid 1 mg tablet : one (1) tablet po daily (daily). 10. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 11. metoprolol tartrate 25 mg tablet : three (3) tablet po tid (3 times a day). tablet(s) 12. hydromorphone (dilaudid) 1-4 mg iv q4h:prn pain pt stabilized on regimen 13. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 14. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 15. insulin regular human 100 unit/ml solution : one (1) dose injection four times a day as needed for per sliding scale. discharge disposition: extended care facility: northeast - discharge diagnosis: fever of unknown origin grade iv decubitus ulcer discharge condition: stable discharge instructions: you were admitted to the hospital with fever of unknown origin. your picc line was thought to be a potential source of infection and was removed. your fever resolved without antibiotic treament. you were seen by the plastic surgeons who will perform skin grafting to your legs and try to repair your elbow at a future date. plastic surgery also evaluated your sacral ulcer and did not think any intervention was needed at this time. you will be called by the plastic surgery service with a date and time for your surgery. if you are not contact regarding a time for your surgery, you should call plastic surgery clinic. . please call your doctor or return to the hospital for: * return of fevers (t > 101)or chills * abdominal pain * nausea or vomiting . diet: you may resume tube feeds as before. . medication: please continue medications as listed: 1. acetaminophen 500 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for fever. 2. therapeutic multivitamin liquid : one (1) cap po daily (daily). 3. senna 8.6 mg tablet : two (2) tablet po bid (2 times a day) as needed. 4. ferrous sulfate 325 (65) mg tablet : one (1) tablet po daily (daily). 5. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 6. topiramate 100 mg tablet : one (1) tablet po 5x/day (5 times a day). 7. levetiracetam 100 mg/ml solution : 1500 (1500) mg po qam (once a day (in the morning)). 8. levetiracetam 100 mg/ml solution : () mg po qhs (once a day (at bedtime)). 9. folic acid 1 mg tablet : one (1) tablet po daily (daily). 10. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 11. metoprolol 75mg po tid 12. hydromorphone (dilaudid) 1-4 mg iv q4h:prn pain followup instructions: follow-up with dr. ( clinic ) in 4 weeks. please call plastic surgery clinic ( if you are not contact regarding a date and time for your surgery within the next week. follow up with dr. , trauma surgery in 4 weeks or sooner if necessary, call for an appointment. md, procedure: enteral infusion of concentrated nutritional substances diagnoses: atrial fibrillation other convulsions anoxic brain damage pressure ulcer, lower back streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] gastrostomy status pseudomonas infection in conditions classified elsewhere and of unspecified site tracheostomy status long-term (current) use of aspirin other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms late effects of motor vehicle accident chronic osteomyelitis, other specified sites aftercare for healing traumatic fracture of lower leg late effect of unspecified injury unspecified level upper limb amputation status 

Answer: The patient is high likely exposed to