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: aspirin attending: chief complaint: 1. longitudinal deficiency radius, radial club hand left. 2. camptodactyly, pip flexion contractures, left long, ring and fifth fingers. 3. congenital absence of thumb left. 4. status post first angle distraction lengthening process. major surgical or invasive procedure: 1. removal of distraction apparatus, left forearm and hand. 2. scar revision, pin hole tracts ulnar aspect left hand. 3. pre vascularized fibular transfer from right leg and left forearm. 4. plastic closure left leg (35.0 cm). 5. application of short posterior splint right leg. 6. application of vac dressing left forearm. 7. c wire fixation of left long, ring and small digits. 8. application of posterior splint, left arm, elbow and forearm. 9. status post skin graft to left forearm history of present illness: 21 yo f born with radial deficiencies involving both of her upper extremities. her left upper extremity was more severely affected with complete absence of the radius. she underwent surgical stabilization of the floating thumb on the right hand and a formal centralization of the left carpus and hand in . on her initial visit, the patient had a very small forearm and she elected to undergo distraction lengthening, which resulted in approximately 122mm increased lenth over the past 2-3 months. she presents now for removal of the distraction apparatus and transplantation of a vascularized fibular graft into her left forearm. past medical history: 1. longitudinal deficiency radius, radial club hand left. 2. camptodactyly, pip flexion contractures, left long, ring and fifth fingers. 3. congenital absence of thumb left. 4. status post first angle distraction lengthening process. social history: student at college, family history: nc physical exam: vs: tm 100.2 tc 97.0 hr 97 bp 110/62 18 sat 99%ra. gen: aaox3, nad heart: rrr lungs: ctab extr: lue: surgical site looks good, no erythema, drainage; xeroform applied; fingers warm, well-perfused, sensation/motor intact rle: cast intact, toes warm, well-perfused, sensation/motor intact neuro: grossly intact. pertinent results: wbc-8.2 rbc-2.90* hgb-8.1* hct-24.1* plt ct-352 wbc-11.8* rbc-3.10* hgb-8.9* hct-25.6* plt ct-303 wbc-14.9* rbc-3.07* hgb-8.9* hct-25.2* plt ct-258 wbc-14.2* rbc-3.11*# hgb-9.0*# hct-25.8*# plt ct-237 pt-12.8 ptt-27.4 inr(pt)-1.1 pt-13.6* ptt-29.4 inr(pt)-1.2* glucose-90 urean-8 creat-0.5 na-138 k-4.2 cl-102 hco3-29 glucose-109* urean-5* creat-0.5 na-138 k-4.5 cl-104 hco3-29 glucose-110* urean-3* creat-0.4 na-138 k-4.4 cl-105 hco3-28 glucose-176* urean-5* creat-0.5 na-140 k-3.9 cl-107 hco3-25 calcium-8.4 phos-3.4 mg-2.1 calcium-8.3* phos-2.5* mg-1.9 calcium-8.1* phos-2.2* mg-2.1 calcium-7.3* phos-3.0 mg-1.4* imaging: chest (portable ap) in o.r. 7:05 pm indication: evaluate line placement. comparisons: none. supine ap chest: the tip of a right ij central venous catheter terminates in the right atrium. the tip of an endotracheal tube terminates 6.5 cm above the level of the carina. heart size is normal. widened appearance of the mediastinum is likely secondary to supine position and ap technique. the lungs are clear. there are no pleural effusions or pneumothoraces. the visualized osseous structures are grossly unremarkable. lung volumes are low. impression: right ij central venous catheter terminating in the mid right atrium. no pneumothorax. findings were discussed with dr. at 8 p.m. on , . the study and the report were reviewed by the staff radiologist. dr. dr. n. approved: 9:48 pm chest port. line placement 7:56 pm medical condition: 21 year old woman with intubated reason for this examination: eval line placmeent comparison: comparison is made to prior study of earlier the same day at 19:05 hours. ap semi-upright chest: the right internal jugular central venous catheter has been pulled back with the tip terminating in the distal svc. the et tube terminates 5.6 cm above the level of the carina. patient is rotated to the right. there are low lung volumes. no pulmonary parenchymal consolidations are identified. there are no pleural effusions or pneumothoraces. impression: 1. right internal jugular central venous catheter terminating in the distal svc. 2. no pneumothorax. the study and the report were reviewed by the staff radiologist. dr. dr. n. approved: fri 8:51 am chest (portable ap) 5:17 am medical condition: 21 year old woman w/ tachycardia reason for examination: evaluation of a patient with tachycardia. portable ap chest radiograph compared to , done at 20:00 p.m. the right internal jugular line tip terminates at the junction of internal jugular and subclavian vein. the heart size is unchanged. the mediastinal contours are unremarkable. the left lower lobe consolidation is slightly increased compared to the previous film. no sizeable pleural effusion is identified. the study and the report were reviewed by the staff radiologist. dr. dr. approved: fri 7:39 pm chest (portable ap) 8:59 am medical condition: 21 year old woman s/p free fibula to left forearm w/ fever 101.5 reason for this examination: r/o pneumonia history: fever. single portable radiograph of the chest demonstrates normal cardiomediastinal contour. there is evidence of left-sided volume loss and left apical pleural thickening. no effusion. the lungs are clear. trachea is midline. right internal jugular central venous catheter is present with its tip in the svc. impression: no acute cardiopulmonary disease. dr. approved: sun 1:11 pm operative report name: , unit no: service: psu date: date of birth: sex: f surgeon: , assistant: dr. ; dr. ; dr. ; dr. preoperative diagnosis: 1. longitudinal deficiency radius, radial club hand left. 2. camptodactyly, pip flexion contractures, left long, ring and fifth fingers. 3. congenital absence of thumb left. 4. status post first angle distraction lengthening process. postoperative diagnosis: 1. longitudinal deficiency radius, radial club hand left. 2. camptodactyly, pip flexion contractures, left long, ring and fifth fingers. 3. congenital absence of thumb left. 4. status post first angle distraction lengthening process. operation performed: 1. removal of distraction apparatus, left forearm and hand. 2. scar revision, pin hole tracts ulnar aspect left hand. 3. pre vascularized fibular transfer from right leg and left forearm. 4. plastic closure left leg (35.0 cm). 5. application of short posterior splint right leg. 6. application of vac dressing right forearm. 7. c wire fixation of left long, ring and small digits. 8. application of posterior splint, left arm, elbow and forearm. anesthesia: general endotracheal. historical note: is a young, college student in her early 20s, presently on leave from in , . she has immigrated with her family from , where she was born with radial deficiencies involving both of her upper extremities. left upper extremity was more severely affected and here, she had a complete absence of the radius. surgery done in was stabilization of the floating thumb on the right hand and a formal centralization of the left carpus and hand. when she was first seen, she had a very small forearm. she elected distraction lengthening and over the past 2-3 months, has been lengthened approximately 122 mm. she is brought to the operating room today for removal of the distraction apparatus and insertion of a vascularized fibular graft into the intercalated gap. description of procedure: with the patient on the operating table in the supine position, with the head of the bed elevated 10 degrees, general endotracheal anesthetic was induced without difficulty. due to the large unusual size of her body and large size of her breasts, she was positioned almost in the right lateral decubitus position with the right leg pronated as much as possible for the fibular dissection. tourniquet was wrapped at the left upper humeral level for dissection in the forearm and hand. left arm was on an arm board. after all of the appropriate monitoring lines, iv lines, etc. were placed, dissection started on the leg. the leg was elevated, exsanguinated and the tourniquet at the mid thigh level was inflated to 350 mmhg. the usual incision was made along the line between the lateral malleolus and the fibular head proximally. only one large perforator was identified by doppler examination intraoperatively before the incision was made. the dissection progressed through skin and large layer of subcutaneous fat to the muscular fascia which was then incised over the anterior compartment. this was then peeled down to the inner muscular septum laterally. at this point, we confirmed the presence of one perforator and only one other perforator was present and this was proximal just distal to the fibular head. the interseptum was then detached from the fibula laterally. the muscle cuff was then gently removed from the periosteum. osteotomies were made proximally and distally and then a distal to proximal elevation of the fibula with incision of the interosseous membrane both posteriorly and anteriorly was done. the peroneal vessels were clipped distally and a much larger segment of bone was harvested so that we could get as long a vascular pedicle as possible. we anticipated some potential problems with isolation of vessels in hand and in the forearm and this was indeed what we found. the peroneal pedicles were followed up to the common branch with the posterior tibia and, at this point, it was ready for transfer. the tourniquet was released after approximately 90 minutes. simultaneously on the left hand, first the distraction apparatus was removed. all 6 pins were removed. the extremity was elevated, prepped with betadine scrub and betadine paint and draped in the usual fashion. first the pin tracks over the fifth metacarpal were curetted. they were then completely excised. skin flaps were then elevated in the anterior and posterior aspects and closed primarily as a plastic closure. the incision on the forearm coursed the entire length of the forearm which had been distracted of a substantial amount. again, the sites of the pin tracts were completely excised. the skin in this patient was much more indurated and soft tissues were not as supple and pliable as most and certainly not as supple and pliable as they were on her leg. there was no gross edema but the tissue was just somewhat indurated and it was much harder mobilizing the skin flaps on the left hand and the leg area. old scar, of course, was excised. dissection progressed between the superficial and deeper layer of abundant subcutaneous fat to mobilize the skin. the intercalated gap of the fibula was very well isolated and very well exposed. the bone regenerate had developed approximately 1 inch on either side of the osteotomy toward the central portion of the intercalated gap. the profundus muscle bellies to the ulnar 3 fingers were palmar. these were isolated from what was present in the fibula and they certainly had been stretched considerably during this long distraction. subperiosteal elevation was then done. we then picked a long straight dcp reconstruction plate from the synthes set and, with the tourniquet released, this was fixed with three 4.0 mm cortical screws both proximal and distal. care was taken to off set the plate so that it was not lying directly on the incision and was slightly more posterior to it.. with the plate intact, we then elevated the arm, re-exsanguinated the arm and turned up the tourniquet. the ulnar artery had been isolated with the ulnar nerve in the forearm and this was judged to be satisfactory. we ideally wanted to convert a micro surgical problem into a macro surgical one by getting much larger vessels in the antecubital fossa. the fossa was exposed with a transverse incision in the elbow flexion crease. very meticulous dissection was done here. several veins in the antecubital region were prepared and interestingly, there was no brachial artery in the normal position. we did not go deep into the muscle layers and decided to use the arteries. the artery on the forearm was an end-to-side anastomosis. we then had a vein pedicle extending up into the antecubital region. enough of the veins in the antecubital region were followed into the forearm through this incision as far as possible so that we would have enough length on both sides, which we did. however, there was no extra and i'm glad we did this. with the tourniquet released, the peroneal artery was anastomosed end-to-side into the ulnar artery at the mid forearm level. during th dissection, the muscle was in slight spasm with application of papaverine. it dilated remarkedly well and was a good medium sized vessel. end-to-side anastomosis with simple everting interrupted 9-0 nylon sutures was uncomplicated and with clamp release, there was immediate excellent flow into the fibular graft. at this point, the forearm posterior incision was closed in layers using two 3-0 and 4-0 buried vicryl sutures. because of the tightness of the soft tissue, it was not possible to close the middle third of this wound, which later in the procedure was covered with a vac dressing. the venous pedicle was then passed over the ulnar nerve which was well mobilized. under the profundus muscles to the ulnar 3 fingers and then through a subcutaneous tunnel to the antecubital fossa. they were secured here. the venous leash was then brought up to the recipient veins. the 2 venous anastomoses were done. one was large-caliber in the 3-4 mm range with asymmetry which was gradually dealt with by very careful placement of sutures. the second vein was 3 mm and was directed end-to-end anastomosis with 9-0 nylon sutures. no couplers were used. with the clamp released, there was excellent capillary refill to all portions of the flap itself. of the vascularized bone, no skin portions were included. the sponge count was correct. needle count was correct. the lap count was correct. the background count was correct. at this point, we just checked the antecubital region to make sure that the large clamp had been removed. the antecubital wound was then closed in layers using 3-0 and 4-0 buried vicryl sutures. penrose drain exited the medial aspect of the wound. light compression dressing was applied. the pip joints of the ulnar 3 fingers was then pinned in more extension than normal as they had flexed during the distraction process. these were held with oblique .035 c wires in each digit. they were not completely extended but they are at -35 degrees. when all of the wounds had been closed, she was then immobilized with a posterior plaster splint. a vac dressing was placed on the forearm. a decision has been made to leave the middle third of the wound open and perform either a delayed primary closure or a secondary skin graft. she tolerated all of these procedures quite well. estimated blood loss: negligible. she was wakened and returned to the intensive care unit in satisfactory condition. here she will be monitored and will be given iv antibiotics and pain medication. , operative report name: , unit no: service: date: date of birth: sex: f surgeon: , assistant: dr. and dr. . preoperative diagnosis: status post vascularized fibular transfer to left forearm. postoperative diagnosis: status post vascularized fibular transfer to left forearm. operation performed: 1. debridement of wound bed left forearm. 2. split-thickness skin graft left forearm. 3. application short-leg cast. 4. application long-arm posterior plaster splint. anesthesia: general endotracheal. historical note: less than a week ago vascularized fibular transfer was done on this young lady who had undergone approximately 120 mm of distraction lengthening of the forearm. because of skin tightness the wound was not closed completely. she has been on a vac, was brought back to the operating room today for a split-thickness skin graft. the patient on the operating table supine position with head of bed up 10 degrees. general endotracheal anesthetic was induced, lma tube was used. the dressing was then removed from the left forearm. there were several blisters in the areas of old scars. the extremity was then elevated, prepped with betadine, scrubbed with betadine, painted and draped in the usual fashion. tangential excision of the wound bed with some marginal muscle fibers was then performed so we got good bleeding muscle throughout. this did not require a lot of debridement. using the dermatome a split-thickness skin graft measuring approximately 16,000 __________ was taken from the anterolateral ipsilateral left thigh. this was meshed with interstice of 1 to 1.5 and then stapled directly over the muscle bed. vac sponge was then custom cut and placed directly over this and wrapped with tegaderm in the usual fashion. the whole vac apparatus was then hooked up with good sealed suction. the drain was removed from the right leg which was the donor leg for the fibula. a well- padded short-leg walking cast was then placed. simultaneously a well padded posterior splint was placed on her arm. she was then awakened and returned to the recovery room in satisfactory condition. , brief hospital course: patient was admitted and underwent surgery on (please refer to operative note for details). she was extubated and transferred to the icu for close monitoring and administration of iv antibiotics and pain medication. patient experienced moderate post-operative pain but declined potential regional blocks by anesthesia. her pain was managed medically with good control. she went to the tsicu for close monitoring. on 1, the patient did well and had no major problems. she was mildly tachycardic from 106-132, but she was hemodynamically stable. both jp drains remained on suction and she went to the floor later that day. the vac dressing had some problems holding suctions despite numerous attempts in putting tegaterm over the foam. we changed the vac pump which did not help the siutation. we eneded up putting an ioban over the entire dressing which sealed things nicely. on 2, she still had pain. her lue and rle were nv intact and labs were drawn as well. on 3, she got out of bed and sat in the chair without any difficulty keeping her right leg elevated. on 4, she got up to the chair again without any problems. therapy stated which she had some difficulty with. on 5, the vac was changed and the operative site lookeed good. on 6, the foley, heparine, iv abx, and cvl were all d/c. additionally, she bore weight on both le. percocet worked well for pain control. on 7, she was preoped for a split thickness skin graft to the left forearm. on , she tolerated the stsg well and the donor site was covered with xerofrom. on , there were no issues. on , she continued to do well without any problems. on , the patiented expressed her desire to go home with a vac dressing. due to the holdiay, a vac could not be arranged at the time, but her insurance would not pay for a vac. patient doing much better and due for vac change on friday at the bedside. on friday, the vac was taken down and the skin staples holding the graft in place were removed. there was a small hematoma underneath the graft on the distal aspect, but no other problems were observed. she was dischaged and will follow up in clinic next week. medications on admission: valerian occasionally for stress percocet, tylox discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. disp:*40 tablet(s)* refills:*0* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: 1. longitudinal deficiency radius, left radial club hand. 2. camptodactyly, pip flexion contractures, left long, ring and fifth fingers. 3. congenital absence of left thumb. 4. status post first angle distraction lengthening process 5. status post removal of distraction apparatus 6. scar revision, pin hole tracts ulnar aspect left hand. 7. pre vascularized fibular transfer from right leg and left forearm, w/ plastic closure left leg (35.0 cm), application of short posterior splint right leg, application of vac dressing left forearm, c wire fixation of left long, ring and small digits and pplication of posterior splint, left arm, elbow and forearm. 8. status post skin graft to left forearm discharge condition: stable discharge instructions: please take all of your medications as prescribed. keep your lue elevated at all times and avoid strenuous activities. you can bear weight on both legs as tolerated. please call/return to if you experience persistent fever (temp>101f), pain/bleeding/drainage/increasing redness/swelling from the surgical sites. followup instructions: please follow-up in hand clinic in building on tuesday, please call ( for an appointment md procedure: venous catheterization, not elsewhere classified other skin graft to other sites excisional debridement of wound, infection, or burn excision of bone for graft, tibia and fibula other immobilization, pressure, and attention to wound removal of implanted devices from bone, carpals and metacarpals arthroplasty of metacarpophalangeal and interphalangeal joint without implant limb lengthening procedures, radius and ulna diagnoses: hematoma complicating a procedure longitudinal deficiency, radial, complete or partial (with or without distal deficiencies, incomplete) other anomalies of upper limb, including shoulder girdle 

Answer: The patient is high likely exposed to