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: s/p fall with c1 and c2 fractures major surgical or invasive procedure: trach and peg on history of present illness: mr. is an 87m with a history of stroke who presented on with light-headedness. the patient fell 2 days prior to admission after drinking a . he developed light-headedness on the day of admission and his wife noticed his breathing was shallow. he denied any complaints on arrival in ed. denies headache, dizziness, numbness, weakness, tingling, neck or back pain, chest pain, dyspnea, nausea, vomiting, blurred vision, double vision, bowel or bladder incontinence. past medical history: a-fib, htn, depression, h/o seizures , hearing loss, osteopenia, s/p cva, sleep apnea, hx bezor, hx bell's palsy, gerd social history: works with wife and works as an artist. tobacco:neg, etoh:occasional, ivda:neg family history: cad, depression physical exam: physical examination on admission: o: t: 98.7 hr: 68 bp: 149/85 rr: 16 sat: 100% gen: wd/wn, comfortable, nad. heent: pupils: irregular b/l eoms intact neck: hard collar in place extrem: warm and well-perfused, except for bruising and pain in left forefinger/knuckle neuro: mental status: awake and , cooperative with exam orientation: expressive aphasia but can communicate via writing etc. oriented to month/year right nasal labial fold flattened no pronator drift motor: d b t we wf g ip q h at g r 5 5 5 5 5 5 5 5 5 5 5 5 l 5 5 5 5 5 4 5 5 5 5 5 5 sensation: intact to light touch reflexes: br pa ac right 2 2 2 left 2 2 2 no clonus, no hoffmans physical examination on discharge: awake and , nods head appropriately, follows simple commands, full strength. cto brace in place pertinent results: non-contrast head ct: 1. fracture of the anterior arch of c1 and probable fractures involving the posterior arches. recommend ct c-spine for further evaluation. 2. no acute intracranial hemorrhage. continued encephalomalacia of the left frontal and parietal lobes consistent with prior mca infarct. atrophy and chronic small vessel disease. cxr: no acute cardiopulmonary process. non-contrast cervical spine: 1. acute fractures in the anterior and posterior arches of c1 consistent with fracture with superior displacement of the posterior arch fragment. associated widening of the c1 and occipital condyle articulation on the right, concerning for ligamentous injury. 2. type 2 dens fracture with retropulsion of the superior fragment into the spinal canal. mri is recommended for further evaluation of ligamentous injury or spinal cord compromise. 3. old compression deformities of t2 and t3. left hand x-ray: dorsal dislocation of second mcp joint ct thoracic spine: interval progression in the previously demonstrated compression fractures at t3 and t5 vertebral bodies with associated kyphotic angulation and mild retropulsion. diffuse osteopenia and disc degenerative changes are identified, more significant at t7/t8 level. bilateral pleural effusions and areas of consolidation in both lung bases. : ct lumbar: 1. no evidence of lumbar spine fractures. mild-to-moderate multilevel disc degenerative changes as described above. diffuse osteopenia is noted throughout the lumbar spine. schmorl's nodes are present at the level of l3/l4 and l4/l5 levels. 2. renal cystic formation is noted on the upper pole of the left kidney, partially evaluated in this examination, possibly slightly larger in comparison with the prior ct of the chest dated , correlation with renal ultrasound is recommended if clinically warranted. c-spine (portable) : initiation of traction there is again seen a fracture involving the dens of c2. there is some separation measuring approximately 5 mm at the more anterior aspect of the site of the fracture. there are degenerative changes, worst at c3-c4 with disc space narrowing. no abnormal antero- or retro-listhesis is seen. c-spine non-trauma views port without traction there is separation of fracture by 6 mm. the dens and the anterior arch of c1 appear adjacent to one another. there is slight subluxation of the dens fragment in relation to the body of c2. degenerative changes at c3-c4 are also present. c-spine xray portable without traction: there is separation of the fracture fragments by 5mm with increased posterior displacement of the dens fragment in relation to the base of c2 measuring 8 mm, previously 4 mm. chest xray for line placement: comparison is made to previous study from . there is an endotracheal tube whose distal tip is 2.2 cm above the carina. the side port of nasogastric tube is again at the ge junction. the right-sided central venous catheter has been pulled back with the distal lead tip in the mid svc. there is a persistent left retrocardiac opacity. this is stable. there is mild atelectasis at the right base. c-spine xray portable with traction: evaluation of the c2 dens fracture is limited. there is persistent separation of the fracture fragments. the dens fragment appears in improved alignment with the base of c2, although the evaluation is limited. ct cspine with and without traction 10:00: impression: 1. no angulation or subluxation in or out of traction. this is significantly improved from the prior exam. 2. stable fracture of the c1 vertebral body. 3. stable mild distraction of the type 3 dens fracture. ct c-spine without traction 14:30: impression: 1. since the prior ct at 10 a.m. on the same day, there has been a slight increase in the posterior angulation of the fracture through the body of c2. 2. stable appearance of the burst fracture through the anterior and posterior arches of c1. 3. probable incidental osteochondroma extending off the left lateral mass of c1. 4. ossified fragment medial to the lateral mass of c1 is likely ossification of the transverse ligament or less likely a fracture fragment. this is stable from the prior exams. c-spine xray in traction, in cto brace: improved alignment of dens fracture which remains minimally seperated chest xray: portable supine chest radiograph: endotracheal tube terminates 4.4 cm above the carina. nasogastric tube terminates in the proximal stomach slightly higher than on the prior study and as mentioned previously can be advanced for more optimal positioning. right subclavian catheter terminates in the mid svc. left basal opacity and mild vascular congestion are improved with calcified granuloma seen in the right apex. : ct cspine without traction: impression: no interval change in the alignment of the fractures of c1 and c2. : ct abdomen: impression: 1. bilateral small nonhemorrhagic pleural effusion with secondary subsegmental atelectasis. 2. cholelithiasis without signs of cholecystitis. 3. no findings to suggest prior abdominal surgery cxr: semi-upright portable chest radiograph was obtained. endotracheal tube terminates 3.2 cm above the carina. nasogastric tube is again seen with side hole at the level of ge junction. right subclavian catheter terminates in the mid svc. bibasilar left greater than right atelectasis is unchanged with slight decrease in edema. a right midlung opacity is more apparent given the decreased edema and may reflect an early pneumonia. cardiac size and tortuosity of the aorta is unchanged. impression: slightly decreased edema with bibasilar atelectasis and newly evident right midlung opacity which may reflect a developing pneumonia. finding was discussed by phone with dr. by dr. at 1050 on . repeat cxr: there is a new tracheostomy tube, turned to the left, tip facing the left tracheal wall. there is no pneumothorax or mediastinal widening. small right pleural effusion is new. heart size is normal. thoracic aorta is tortuous, but not focally dilated. right subclavian line ends low in the svc. brief hospital course: mr. was admitted to the trauma/surgical icu on after presenting to the ed with lightheadedness in the setting of a recent fall. imaging revealed fractures of c1 and c2 for which the patient was initially treated with a cervical collar and monitored with hourly neuro checks. he was also found to have a dorsal dislocation of the left second metacarpal joint. on , the patient was intubated and found to have irregular pupils bilaterally. his inr was reversed with 2 units of ffp and vitamin k. he was found to have a uti and was bacteremic with gpc, started on vancomycin. mri c-spine was done to evaluate for cord involvement and c-spine x-ray obtained pre-traction for baseline studies. patient was placed in traction. the weight of traction was increased by 5 lbs each time c-spine imaging was completed and showed no change in subluxation. he was at 15lbs of traction when c-spine x-ray showed reduction of subluxation. hand was consulted for dislocation of 1st mcp joint who reduced dislocation and recommended a splint and follow up in hand clinic in weeks. on , patient was taken out of traction, pins remained in place, and he was elevated. c-spine imaging showed stable c1/c2. overnight he was febrile and full cultures were sent. morning portable ap and lateral c-spine xrays on demonstrated increased posterior displacement of the dens fragment in relation to the base of c2 and so the patient was placed back in cervical traction to 15lbs. he remained intubated with an unchanged neurological exam. on ,the patient's hematocrit was 26 from 31 the day prior. the patient was transfused with 1 unit of prbc. the post transfusion hct was 28.1. the patient had a ct of the neck in traction and out of traction with minimal displacement and a cervial hard collar with thoracic extension was ordered. the brace was fitted and the patient had another ct out of cervical traction that demonstrated posterior displacement of the dens fragment and subluxation. the patient was placed back in cervical traction. on exam, the patient was able to move his extremities antigravity to command off sedation. on c-spine xray in traction and cto demonstrated good alignment of the fragment with minimal displacement. the orthotic team was called to adjust the brace to place the patient in more flexion in order to maintain alignment. his exam and respiratory status improved and he was following commands in all 4 extremities with good strength, very attentive and interactive. on a trach and peg was placed. on he weaned from the vent. he remains interactive, attentive. follows simple commands. moves all extremities full strength. he was screened and accepted to rehab and was discahrged. medications on admission: -coumadin -keppra 500mg -tamsulosin 0.4mg qhs -metoprolol succinate 100mg daily -citalopram 20mg daily discharge medications: 1. acetaminophen 325-650 mg po q6h:prn pain, t>38.5 2. chlorhexidine gluconate 0.12% oral rinse 15 ml oral 3. ciprofloxacin hcl 500 mg po q12h 4. citalopram 20 mg po daily 5. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 6. docusate sodium (liquid) 100 mg po bid 7. heparin 5000 unit sc tid 8. fentanyl citrate 25-100 mcg iv q2h:prn pain 9. glucagon 1 mg im q15min:prn hypoglycemia protocol 10. insulin sc sliding scale fingerstick qachs insulin sc sliding scale using reg insulin 11. lansoprazole oral disintegrating tab 30 mg po daily 12. levetiracetam oral solution 500 mg po bid seizure d/o 13. metoprolol tartrate 50 mg po bid htn/hx of afib hold if sbp<100 14. piperacillin-tazobactam 4.5 g iv q8h 15. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 16. tamsulosin 0.4 mg po hs 17. warfarin 3 mg po daily goal inr 18. oxycodone liquid 5 mg po q4h:prn pain 19. vancomycin 750 mg iv q 12h discharge disposition: extended care facility: - discharge diagnosis: respiratory failure c1/2 fracture atrial fibrilation discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dr. ?????? do not smoke ?????? no pulling up, lifting more than 10 lbs., or excessive bending or twisting. ?????? limit your use of stairs to 2-3 times per day. ?????? wear your hard cervical collar with thoracic extension vest at all times. sponge bath around the vest and collar. ?????? you not take the collar off at any time ?????? take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. ?????? increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. we recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. coumadin may start at a dose of 3 mg qd. the goal inr is for intermittent atrial fibrillation which has been approved by dr (neurosurgery) and dr (primary care physician). the inr should be rechecked on monday and the primary care physician should be notified. the contact information is name: , s. location: personal health care, p.c. address: , , , phone: fax: email: call your surgeon immediately if you experience any of the following: ?????? pain that is continually increasing or not relieved by pain medicine. ?????? any weakness, numbness, tingling in your extremities. ?????? any signs of infection at the wound site: redness, swelling, tenderness, and drainage. ?????? fever greater than or equal to 101?????? f. ?????? any change in your bowel or bladder habits (such as loss of bowl or urine control). followup instructions: follow up instructions/appointments ??????please call ( to schedule an appointment with dr. to be seen in 3 months. ??????you will need ct of the cervical spine-scan prior to your appointment. the inr should be rechecked on monday and the primary care physician should be notified. the contact information is name: , s. location: personal health care, p.c. address: , , , phone: fax: email: procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy other skeletal traction closed reduction of dislocation of hand and finger diagnoses: abnormal coagulation profile esophageal reflux urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypotension, unspecified bacteremia closed fracture of second cervical vertebra long-term (current) use of anticoagulants do not resuscitate status ventilator associated pneumonia fall from other slipping, tripping, or stumbling late effects of cerebrovascular disease, aphasia disorder of bone and cartilage, unspecified other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy closed dislocation of metacarpophalangeal (joint) other and unspecified escherichia coli [e. coli] 

Answer: The patient is high likely exposed to