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: self inflicted left forearm laceration major surgical or invasive procedure: 1. irrigation and debridement of the left forearm down to bone with excision of necrotic muscle. 2. exploration of the wound with neurolysis of the median and radial nerve. 3. ligation of a small tributary of the radial artery. . 1. washout, debridement, dressing change to left forearm wound. . 1. irrigation and debridement with removal of necrotic muscle. 2. application of vacuum-assisted closure device measuring 20 x 20 cm. . irrigation and debridement of left forearm skin, subcutaneous tissue, fascia, and muscle. . 1. irrigation, washout, debridement of nonviable skin, subcutaneous tissue and muscle, left forearm. 2. flexor digitorum superficialis to flexor pollicis longus tendon transfer, left forearm. 3. local advancement bipedicled flaps x2. total of 60 sq cm. 4. split-thickness skin graft from right side of left forearm 132 sq cm. history of present illness: 24m transferred from osh by med flight after a near drowning episode. found by ems in fresh water pond after severely degloving his left forearm with a boxcutter. unclear whether he walked or jumped into the pond. was initially responsive and breathing spontaneously, decompensated at osh ed and was intubated. hypoxic and hypotensive despite 6l crystalloid and 2u prbcs. received 2g ancef, tetanus at osh. hypothermic to 31c in the ambulance. hypotensive w/sbp in 80s and bradycardic in the 50s en route and on arrival to . received 3 add'l units prbcs. placed in c-spine precautions given unclear hx and refractory hypotension w/bradycardia, ct neg for spinal cord injury. hct 27 after transfusion. past medical history: paranoid schizophrenia dx ; +auditory hallucinations, negative symptoms; hx mult anti-psychotics social history: lives on cape, was very bright and smart, attended community college, studied bhuddism, is a pacificist. family very supportive. family history: non-contributory physical exam: upon presentation to : gen: intubated, sedated cv: pulse rrr resp: intubated lue: there are two deep longitudinal volar lacerations that extend from the wrist to approximately 5 cm distal to the elbow crease. the wounds penetrate fascia and the entire superfical musculature of the volar forearm is visible. the wound is contaminated with debris. there is significant bleeding although no discrete arterial injury. median and ulnar nerves are not clearly visible. upon removal of the tourniquet, biphasic dopperable signals of radial and ulnar artery at the wrist are present. pertinent results: 11:10pm glucose-147* urea n-23* creat-0.8 sodium-140 potassium-3.8 chloride-116* total co2-15* anion gap-13 11:10pm alt(sgpt)-20 ast(sgot)-18 alk phos-22* tot bili-0.6 11:10pm albumin-1.7* calcium-5.6* phosphate-3.7 magnesium-1.5* 11:10pm digoxin-less than 11:10pm wbc-9.0 rbc-2.93* hgb-9.2* hct-26.1* mcv-89 mch-31.5 mchc-35.4* rdw-14.0 11:10pm plt count-42* 11:10pm pt-20.1* ptt-49.3* inr(pt)-1.8* 11:10pm fibrinoge-69* 11:09pm type-art po2-502* pco2-33* ph-7.28* total co2-16* base xs--9 11:09pm glucose-134* lactate-3.7* na+-134* k+-3.8 cl--115* 11:09pm hgb-8.9* calchct-27 11:09pm freeca-0.80* 10:20pm glucose-153* lactate-5.3* na+-134* k+-4.5 cl--111 tco2-15* 10:10pm urea n-26* creat-1.1 10:10pm estgfr-using this 10:10pm lipase-18 10:10pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 10:10pm wbc-unable to 10:10pm ptt-unable to 08:50pm urine hours-random 08:50pm urine bnzodzpn-neg barbitrt-neg opiates-pos cocaine-neg amphetmn-neg mthdone-neg 08:50pm urine color-straw appear-clear sp -1.011 08:50pm urine blood-tr nitrite-neg protein-neg glucose-100 ketone-10 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:50pm urine rbc-<1 wbc-<1 bacteria-few yeast-none epi-<1 08:50pm urine rbc-<1 wbc-<1 bacteria-few yeast-none epi-<1 08:50pm urine mucous-rare 01:20pm blood wbc-6.1 rbc-2.73* hgb-8.6* hct-25.2* mcv-92 mch-31.4 mchc-34.0 rdw-16.6* plt ct-412 01:20pm blood plt ct-412 01:20pm blood glucose-127* urean-16 creat-0.6 na-141 k-3.7 cl-105 hco3-27 angap-13 01:20pm blood alt-38 ast-27 alkphos-89 totbili-0.2 01:20pm blood calcium-8.7 phos-2.3* mg-1.9 . microbiology: 11:33 am tissue site: arm deep forearm wound extra anc and aer swabs received same site. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. tissue (final ): reported to and read back by dr. , j 10:47am. aeromonas species. rare growth. sensitivity testing performed by microscan. cefepime <=2mcg/ml. bactrim (=septra=sulfa x trimeth) <=2/38mcg/ml. meropenem <=1mcg/ml. ampicillin/sulbactam () >16/8mcg/ml. pseudomonas aeruginosa. rare growth. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ aeromonas species | pseudomonas aeruginosa | | amikacin-------------- 8 s ampicillin/sulbactam-- r cefepime-------------- s <=1 s ceftazidime----------- <=1 s 2 s cefuroxime------------ <=4 s ciprofloxacin--------- <=0.5 s <=0.25 s gentamicin------------ 4 s <=1 s imipenem-------------- =>8 r levofloxacin---------- <=1 s meropenem------------- s 0.5 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- s anaerobic culture (final ): no anaerobes isolated. . radiology: radiology report ct head w/ contrast study date of 8:49 pm impression: no acute intracranial process. . radiology report ct c-spine w/o contrast study date of 8:50 pm impression: no acute fracture or dislocation. . radiology report ct abd & pelvis with contrast study date of 8:51 pm impression: evaluation is slightly limited by artifact from the arms down by the patient's side. 1. high-density fluid within the right paracolic gutter, concerning for blood. small focus of gas along the hepatic flexure- unclear whether definitively intra- or extraluminal, but may be extraluminal. above findings raise concern for possible bowel injury. 2. small amount of free fluid within the abdomen and periportal edema is likely secondary to aggressive resuscitation. 3. small amount of pneumomediastinum. 4. og tube within the stomach. side port is just inferior to the ge junction and could be slightly advanced. 5. nodularity with tree-in- opacities in the left upper lobe is most likely infectious or inflammatory in nature. . radiology report pelvis (ap only) study date of 9:26 pm impression: very superior iliac wings not included on the images. contrast seen within the urinary bladder from recent ct. no evidence of acute fracture or dislocation. . radiology report wrist(3 + views) left study date of 9:26 pm impression: extensive left forearm laceration, with probable retained foreign bodies, but no acute fracture. . other reports: cardiology report ecg study date of 2:36:18 am sinus rhythm at lower limits of normal rate. vertical axis. low precordial voltage. no previous tracing available for comparison. clinical correlation is suggested. . neurophysiology report eeg study date of impression: this is a normal awake and sleep eeg. no focal abnormalities or epileptiform features were seen. no electrographic seizures were recorded. . cardiology report ecg study date of 7:08:36 pm sinus rhythm. since tracing #1 t wave amplitude has improved. otherwise, findings are unchanged. brief hospital course: he was admitted to the acute care team and was evaluated by ortho hand due to the large left upper extremity laceration with exposed muscle. he was taken urgently to the operating room for irrigation and debridement of the left forearm down to bone with excision of necrotic muscle; exploration of the wound with neurolysis of the median and radial nerve and ligation of a small tributary of the radial artery. he was transferred to the trauma icu postoperatively for close hemodynamic monitoring. on he was taken back to the operating room by ortho hand for further washout, debridement and dressing change. the patient subsequently went back to or for multiple washout and debridements of his left forearm wound and application of vacuum-assisted closure device. he underwent a trauma tertiary survey and no other issues were identified. on patient was transferred to the plastic surgery service. on , patient underwent irrigation, washout, debridement of nonviable skin, subcutaneous tissue and muscle of the left forearm; flexor digitorum superficialis to flexor pollicis longus tendon transfer, left forearm; local advancement bipedicled flaps x2; split-thickness skin graft from right side of left forearm. he tolerated the procedure well. a bolster was applied to left forearm skin graft site and a jp drain was in place. his right thigh skin graft donor site was left open to air. the bolster dressing was removed on sunday, revealing pink and viable skin graft over both forearm sites with 100% take. there was no drainage noted, no evidence of hematoma. the jp drain was removed for scant drainage output. the skin graft sites were dressed daily with xeroform, gauze fluffs, kerlix and ace wraps and splint reapplied. mental/psych: psychiatry was consulted immediately due to the nature of his trauma, he was placed on 1:1 sitter and recommended for in patient psychiatric placement once medically stable. zyprexa and ativan prn were initially recommended. a section 12 was put into place and patient could not leave against medical advice. patient was severely psychotic, paranoid and with suicidal ideation upon admission. he was initially refusing care and medications. psychiatry worked closely with patient and teams to assist with management of this psychotic patient. a 1:1 sitter was maintained during this patients entire inpatient stay on a regular floor. the zyprexa was discontinued on and patient was started on iloperidone on recommendation of psych service. the patient was compliant with taking the medication and titrated up to a standing dose of iloperidone 10 mg po/ng . the patient had continued psychosis and paranoia but became more compliant with care and staff after continuing to take the fanept medication. on , patient's mother reported that she witnessed patient's eyes rolling back in his head and various hand movements. for this purpose, an eeg was obtained and compaired to a previous eeg from outside facility. this showed a normal awake and sleep eeg. no focal abnormalities or epileptiform features were seen. no electrographic seizures were recorded. the patient was followed closely by psychiatry service during the remainder of his stay and was compliant with taking his medication. upon discharge, the patient was asking appropriate questions about his care and his discharge status and was compliant and involved with all aspects of his care. id: patient was initially started and maintained on unasyn iv on . a deep tissue swab of the left forearm was obtained during debridement and washout on . this culture eventually yielded 'aeromonas' and 'pseudomonas'. unasyn was discontinued at this point and patient was started on ampicillin and ciprofloxacin. these were eventually discontinued on . neuro/pain: on the acute pain service placed a left supraclavicular catheter for post-operative pain control for frequent dressing changes. the catheter provided excellent pain control and was discontinued on . the patient was then given dilaudid iv prn and oxycodone po prn for additional pain control. when wound was covered with skin grafts, the patient eventually required no pain medications including tylenol. cv: the patient was stable from a cardiovascular standpoint; vital signs were routinely monitored. ecg x 3 were unremarkable. pulm: the patient was stable from a pulmonary standpoint; vital signs were routinely monitored. gi/gu: post-operatively, the patient was given iv fluids until tolerating oral intake. his diet was advanced when appropriate, which was tolerated well. he was also started on a bowel regimen to encourage bowel movement. intake and output were closely monitored. medications on admission: none discharge medications: iloperidone 10 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: extended care facility: - discharge diagnosis: 1) left forearm open wound 2) paranoid schizophrenia discharge condition: mental status: paranoid thoughts and statements at times. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: followup instructions: -you should continue taking your current medication. -elevate your left arm as much as possible and maintain it in a the splint and dressing that is currently in place. -please keep your left arm dry - if your left arm begins to worsen after discharge with an acute increase in swelling or pain, please call dr. office at (. - you should keep your right thigh donor site open to air and leave the yellow xeroform dressing in place to dry out. do not get this area wet. - your left arm skin graft and repair sites will be dressed with a xeroform dressing to graft areas, fluffed gauzes covered with kerlix and then ace wrap. your splint should be warn at all times. followup instructions: please follow up with plastic surgery, hand clinic: ( , building, please follow up in the hand clinic on the next tuesday, after you are discharged home or to another facility. you must call ( to make an appointment. the clinic is open from 8-12pm most tuesdays. the clinic is located on the , building, . please make sure that you obtain a referral from your insurance company prior to your clinic appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other skin graft to other sites advancement of pedicle graft other myectomy other myectomy other myectomy other myectomy other myectomy tendon transfer or transplantation other surgical occlusion of vessels, upper limb vessels other peripheral nerve or ganglion decompression or lysis of adhesions diagnoses: thrombocytopenia, unspecified acute posthemorrhagic anemia suicide and self-inflicted injury by cutting and piercing instrument hypotension, unspecified hypothermia paranoid type schizophrenia, unspecified open wound of forearm, complicated drowning and nonfatal submersion contusion of abdominal wall other acute postoperative pain suicide and self-inflicted injury by submersion [drowning] 

Answer: The patient is high likely exposed to