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: i was in a car accident major surgical or invasive procedure: lumbar fusion l 345 on . blood transfusion . multiple intubations history of present illness: this is a 48 /o white male with non significant pmhx who was involved in a mva. pt states he was belted driver who was leaving friends house and then remembers seeing a car that he thought was parked and next thing he recalls his friend was banging on his window. pt was transferred to from a new hospital after w/u revealed l4 burst fracture. pt currently admits to low back pain and tingling in lle when he everts his l foot. denies nausea, vomiting, headache, double or blurred vision, loss of control of bowel or bladder. past medical history: testicular cancer s/p orchiectomy and radical lymph node dissection social history: he drinks at least one bottle of wine a day, and on the weekends drinks more hard liquor (whiskey), occasional cocaine use, most recently on the day of his accident. he has had 2 prior to this one. prior to that he hadn't used any cocaine for "years." he denies tobacco use, has girlfriend of 12 years who he lives with at home. he works as a musician. family history: nc physical exam: physical exam: o: 162/82, 88, 18, 100% 99.6 gen: wd/wn, comfortable, nad. heent: ncat, no hemotympanum, no battles or raccoons, no csf rhinorrhea or otorrhea. neck: without point tenderness from occiput to c7 lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. no c/c/e. . neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. motor: exam full throughout, slight breaking of strength to lle ke and hf to pain. . sensation: intact to light touch. no sensory levels noted sensation intact distal to proximal as well reflexes: upper extremity brisk, b/l knee jerks 2+, ankle jerks absent/pt unable to participate. toes downgoing bilaterally rectal exam slightly increased rectal tone, normal sphincter control, no priapism at present.no clonus, no spasticity. pertinent results: 03:54pm hct-24.0* 09:10am hct-25.4* 04:31am glucose-111* urea n-7 creat-0.5 sodium-138 potassium-4.2 chloride-102 total co2-25 anion gap-15 04:31am alt(sgpt)-28 ast(sgot)-67* alk phos-96 amylase-30 tot bili-1.8* 04:31am lipase-19 04:31am albumin-3.9 calcium-8.3* phosphate-3.4 magnesium-2.3 04:31am wbc-8.1 rbc-3.51* hgb-7.9* hct-25.9* mcv-74* mch-22.6* mchc-30.6* rdw-18.5* 04:31am plt count-121* 04:31am pt-18.4* ptt-31.4 inr(pt)-1.7* 12:04am comments-green top 12:04am glucose-122* lactate-2.8* na+-138 k+-4.6 cl--101 tco2-25 . : mri of lumbar spine findings: there is minimal increased t2 signal within the l4 vertebral body in the location of the burst fracture. there is mild retropulsion of few of the fracture fragments. there is a large degree of loss of the vertebral body height. there is no evidence of neural foraminal narrowing at any level. just posterior to the burst fracture, the retropulsed fragments cause mild-to- moderate spinal canal stenosis. they may impinge upon the traversing l4 nerve roots in the lateral recesses. again the study is moderately limited due to patient motion artifact. there is no high-degree compression of the cauda equina. the remaining vertebral bodies are normal in alignment and marrow signal. impression: burst fracture of l4 with mild edema. there is moderate retropulsion of few of the fracture fragments. while these do not cause high- grade spinal canal stenosis, they may impinge upon the l4 nerve roots in the lateral recesses. please correlate with patient's physical examination. . ct of the chest, abdomen, and pelvis after contrast. () 1. bilateral pleural effusions with associated atelectasis. 2. ascites. 3. no evidence of metastatic disease. . ct chest without contrast () impression: 1. no significant interval change compared to . redemonstrated are bilateral dependent atelectatic changes with small pleural effusions, stable. 2. no evidence of pulmonary consolidations to suggest a presence of pneumonia. fine detail in the lungs is obscured by motion artifact. 3. abdominal ascites. . ct head +/- contrast:negative ct of the brain without evidence of enhancing mass, particularly within the cerebellopontine angle. however, mri is more sensitive for the detection of a mass and mri with gadolinium should be considered if there remains clinical concern. . ruq ultrasound liver ultrasound study with doppler: both grayscale and color doppler ultrasound examination of the liver was performed. no focal liver lesions are seen. coarsened echotexture of the liver consistent with cirrhosis. there is no intrahepatic or extrahepatic biliary ductal dilatation. there is no ascites. the common bile duct measures 5 mm in diameter. the gallbladder is relatively contracted. the right kidney measures 11.7 cm in length, and there are no renal stones or hydronephrosis seen. the main portal vein, anterior, and posterior branches of the right portal vein, and left portal vein are patent with appropriate directionality. the hepatic vein and its branches are patent. impression: no focal liver lesions or ascites. patent vessels as described above. coarsened echotexture of the liver consistent with cirrhosis. . eeg impression: largely normal portable eeg. plentiful movement artifact and the faster beta rhythm (possibly due to benzodiazepine medication) obscured much of the background, but no focal abnormalities or epileptiform features were evident. brief hospital course: impression/plan: 47 y/o man with pmhx s/f testicular cancer, etoh and cocaine abuse, admitted after mvc with l4 burst fracture s/p l3-5 fusion on . he had a prolonged icu course complicated by respiratory failure with multiple intubations, altered mental status and likely alcohol withdrawl/dt's. . micu course: pt was admitted through the emergency department after an mva. he was admitted to the icu and placed on log roll precautions for his spine. he was intubated on hospital day number 2 for his safety as he was experiencing the dt's and was being non compliant with his bedrest status. he was taken to the or later that day for a lumbar fusion l 345. the operation was without complication. he did receive blood transfuion and transfusion of platelets for a hct <25 and an inr of 1.5. he later than trended up again on his inr to 1.4 however we did not continue to treat as he was now post-op. he had a drain placed in the lumbar region in the or which was removed on #2. a tlso was ordered pre-operatively and is in use while pt is oob. he also had a head ct and a ct of the torso with and without contrast for two reasons. one, on his original head ct he had what appeared to be a right sided cpa possible meningioma. this was unfounded on the contrasted image. the ct of the torso was performed because the outside tramua images were "wet read" as having spots on the liver. the torso ct here is negative however there is a hypodensity noted in one of the lobes of the liver that is too small to characterize that should be follwed by the pcp. was placed in the d/c instructions. on pod#4 (hosp day 6)he had altered mental status and possible aspiration and required reintubation. he was started on broad coverage antibiotics (ceftaz and flagyl) for pneumonia. although the patient transiently improved on and was weaned to , he was noted to have fluctuations in ms copious secretions on . extubated , but continued to have copious secretions which he could not clear. approximately 12h later the patient became extremely anxious due to inability to clear secretions and req'd re-intubation. . on the patient was transferred to the micu service for management of his requirement for mechanical ventilation. on transfer the patient was started on lactulose for presumed hepatic encephalopathy. his antibiotic coverage was expanded to include vancomycin for a presumed vap. a repeat ct of the chest did not show any evidence of pneumonia and his antibiotics were held. since the patient was out of the window for etoh w/d, his agitation was managed w/ haldol standing and prn. on the patient was extubated (following commands, good cough, minimal secretions). . course on the floor: transferred on . 1. respiratory failure: patient had multiple failed extubations likely secondary to untreated liver failure causing encephalopathy. he responded to lactulose and now has been extubated since , satting well on room air. although patient was febrile during his micu course he didnt have pneumonia on cxr or on ct scan. d/c all antibiotics. he had an incentive spirometer at bedside for use. . 2. altered mental status: probably secondary to liver disease with encephalopathy, in combination with alcohol withdrawl. no evidence of head trauma, and his eeg was non-focal. patient likely out of alcohol withdrawl at this point, more than two weeks into hospital stay. his mental status has improved slightly, but because of continued slowing, an mri/mra of the brain was obtained to assess for diffuse axonal injury. neurology followed throughout hospital course. his standing haldol was discontinued to prevent confusion, and he did not require any during his stay on the floor. mri/mra of brain showed no evidence of diffuse axonal injury as was suspected due to his generalized slowed cognitive function. at discharge, he had some residual deficits, thought to be secondary to resolving encephalopathy, likely with some underlying retardation due to chronic alcohol abuse. he was scheduled for follow-up behavioral neurology evaluation as an outpatient. . 3. liver disease: likely secondary to alcoholic cirrhosis. hepatitis serologies are negative, except for prior infection/vaccination for hepatitis b. iron not significantly elevated, indicating that hemochromatosis is not a likley cause of his liver dysfunction. he does have evidence of impaired liver function with increased inr. meld score is 4, indicating low 90 day mortality. ruq ultrasound shows evidence of cirrhosis, no ascites. outpatient follow up with hepatology in , to assess his esld. he should continue lactulose and metoprolol for variceal prophylaxis. addictions consult provided patient with places to go for alcohol rehabilitation. patient states intent to first return home to assess his capacity to be in his native environment. he has a follow up appointment with hepatology in . . 4. l4 burst fracture s/p fusion on : he should continue tlso brace when out of bed, should continue using it until he sees neurosurgery 6 weeks after fusion. he will need standing thoracic and lumbar spine films with his tlso brace on that neurosurgery will follow up with at their appointment. at the time of discharge, he was unable to stand on his own, and we were not able to do these in house. they will need to be done by the rehab facility or by his pcp. well on oxycodone for pain control . 5. fever: this was never an issue while on the medical floor. sbp r/o with paracentesis. have been related to alcohol withdrawl. he was been afebrile on admission to the floor and did not continue to spike fevers. . 6. anemia: likely secondary to combo of malnutrition, anemia chronic disease, given low mcv and low iron with normal tibc. transfuse for hct < 25. continue mvi, folate, thiamine, and iron supplementation. . 7. fen: s/s done on . advance diet to soft solids and thin liquids with supervised feedings. alternate bites and sips. pills crushed in puree. monitor for aspiration. added ensure to lunch and dinner per nutrition recs. . 8. prophylaxis: heparin sq, pneumoboots, ppi as an inpatient. dvt prophylaxis was discontinued at discharge, as patient was ambulating with his walker. . 9. code: full . 10. dispo: given patient's deconditioned state as a consequence of the protracted hospital course, and previously fully functional status, he was discharged to rehabilitation. prior to discharge, he was provided with a self help face sheet with resources for aa and other addiction services. medications on admission: none discharge medications: 1. multivitamin capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*3 l* refills:*2* 5. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. disp:*30 tablet(s)* refills:*0* 6. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 7. enalapril maleate 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qthur (every thursday). disp:*4 patch weekly(s)* refills:*2* 9. ferrous sulfate 300 mg/5 ml liquid sig: one (1) teaspoon po daily (daily). disp:*150 ml* refills:*2* 10. ranitidine hcl 15 mg/ml syrup sig: two (2) teaspoons po bid (2 times a day). disp:*1 l* refills:*2* 11. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). disp:*1 l* refills:*2* discharge disposition: extended care facility: - discharge diagnosis: s/p lumbar fusion l345 discharge condition: neurologically stable discharge instructions: 1) please call the neurosurgery office at if you have any questions or concerns, please call immediately if you have any fever 101.5 or greater, any redness swelling or drainage from or around your incision. please call if your pain is not controlled by your pain meds or if you have any new numbness tingling or weakness. . 2) call your primary care doctor at if you have worsening swelling of your abdomen, legs, shortness of breath, vomiting up blood, dark, tarry stools, or mental status changes. . 3) you have been provided with information about addiction rehabilitation options. you should give serious consideration to the resources that are available. please make every effort to abstain from alcohol and drug use after you are discharged. followup instructions: you are scheduled to follow-up with neurologist dr. on next monday, at 10:30 a.m. her office is in of the building at located at . her office number is should you need to reschedule or cancel. . please follow up with your neurosurgeon dr. on , at 10:45. around 9:30 on that same morning, you should go to care center, department of radiology on the to have x-rays of your spine. his office number is . after your x-rays, you will go to dr. office in the located at . . you have an appointment to see your new primary care doctor, , md , at 3 p.m. her office is in the building on the , central suite. (. please call to confirm your address, information. . you have been scheduled to follow up with a hepatologist regarding your liver cirrhosis. you have an appointment scheduled for , @ 1:50, with dr. , , , (. md, procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube lumbar and lumbosacral fusion of the anterior column, posterior technique other exploration and decompression of spinal canal alcohol detoxification excision of bone for graft, other bones transfusion of packed cells repair of vertebral fracture fusion or refusion of 2-3 vertebrae other therapeutic apheresis diagnoses: anemia of other chronic disease alcoholic cirrhosis of liver unspecified protein-calorie malnutrition pulmonary collapse acute respiratory failure pneumonitis due to inhalation of food or vomitus personal history of malignant neoplasm of testis iron deficiency anemia, unspecified other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle other psoriasis cocaine dependence, continuous other and unspecified alcohol dependence, continuous street and highway accidents closed fracture of lumbar spine with spinal cord injury 

Answer: The patient is high likely exposed to