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: s/p motor vehicle crash major surgical or invasive procedure: 1. open treatment and fracture/dislocation of c2-3. 2. open treatment and fracture/dislocation of c6-7. 3. open treatment and fracture/dislocation of c7-t1. 4. posterior cervical arthrodesis, c2-3. 5. c2 laminectomy. 6. c5-6, c6-7, c7-t1 posterior cervical arthrodesis. 7. posterior cervical instrumentation, c5-6, c6-7, c7-t1. 8. left iliac crest bone graft. 9. application of local allograft. 1. open reduction and internal fixation of left maxillary sinus fracture. 2. closed reduction of nasal bone fracture. 1. open treatment of fracture dislocation c2-c3. 2. anterior cervical diskectomy c2-3. 3. anterior cervical arthrodesis/fusion c2-c3. 4. application of anterior cervical plate c2-c3. 5. right iliac crest bone graft. 1. tracheostomy. 2. gastrostomy. 1. tracheostomy exchange day 1 post prior tracheostomyplacement. 2. right femoral inferior vena cava filter (bard g2 type) 3. fluoroscopic control of ivc filter placement history of present illness: 42 yo male, unrestrained driver who was +etoh; s/p high speed motor vehicle crash hit jersey barrier and was then hit from behind by a truck and ejected from the car. he had a period of asystole and was resuscitated with epinephrine and atropine. he was taken to an area hospital where found to have multiple traumatic injuries and was then immediately transferred to for further care. past medical history: unknown social history: has a mother who is very involved in his care; 2 sisters and a 10 yo daughter in family history: noncontributory physical exam: exam on admission: p: 70 bp 116/45 rr: 17 o2: 90% intubated gcs 9t heent: bilat pupils 6 mm, minimally reactive with divergent gaze; proptosis of left eye with eccymosis. lacs on left and midline occiput, as well as the l pinna. blood in the nares resp: breathsounds bilat cv: heart sounds heard ab: soft ext: open fx of l forarm; lle deformity and laceration neuro: nl rectal tone; moves bilat le spont, will move deltoids of bue with noxious stimuli pertinent results: head ct : 1. extensive intracranial injury including right frontal and parietal subarachnoid hemorrhage, frontal contusions, small subdural collections and scattered foci of increased attenuation at the -white matter junction concerning for diffuse axonal injury. further characterization with mr echo sequences may be helpful for further characterization. 2. incompletely imaged facial bone fractures as above for which a maxillofacial ct is recommended for further evaluation. 3. metallic foreign body of unclear etiology in the region of the nasopharynx. clinical correlation is recommended. ct sinus : 1. multiple fractures of the left frontal and parietal bones. comminuted fracture of the left orbital walls and comminuted fractures of the left maxillary sinus walls. 2. comminuted fracture of the left parasymphyseal region of the mandible as well as fractures of the alveolar ridge of the central-to-right body of the mandible as well as the left maxillary alveolar ridge. 3. additional fractures of the anterior wall of the right maxillary sinus and the pterygoid plates bilaterally. fracture of the left hard palate and right nasal bone. 4. comminuted fracture of the right lamina of c2 and the left pedicle and body of c2. please refer to concurrent ct of the cervical spine for additional findings. 5. tiny left subdural hematoma and right subarachnoid hemorrhage. please refer to the concurrent ct of the head as well as head mr for additional significant findings. mr head : 1. multiple small areas of slow diffusion in teh cortex suspicious for contusions, although embolic infarction could present a similar appearance. 2. enlarged extra- axial csf space over the frontal and temporal lobes bilaterally, which may represent with intensity slightly greater than csf. these likely represent subdural hygromas. no significant change in size of a thin t2 hyperintense extra- axial hemorrhage over the left frontal, temporal and parietal lobes. 3. bilateral subarachnoid hemorrhages. c-spine ct the skull base through the superior endplate of t2 is well visualized on the lateral view. an endotracheal tube is noted in place. multiple fractures are identified. there is a comminuted fracture of the c2 left body lamina junction which extends to the vertebral foramen. a comminuted fracture of the right c2 lamina is seen extending into the pars inferior facet. there is clockwise rotation of c2 in relation with the c1 vertebral body. the right inferior articulating facet of c2 appears subluxed lying anterior to the inferior facet of c3. additional fractures include a comminuted c5 spinous process fracture, a comminuted fracture of the c6 spinous process extending slightly into the bilateral laminae, a distracted fracture of the c7 pedicle and a nondisplaced fracture of the right c7 lamina. nondisplaced fractures are also noted involving the anteroinferior c7 and anterosuperior t1 vertebral bodies. there is a unilateral "jumped" left facet, c6 on c7. ct does not provide intrathecal detail comparable to mr. material within the spinal canal at c6-c7 likely compresses the cord and may represent hematoma or disk material. bullous changes are present at the lung apices. a metallic foreign body is noted in the nasopharynx of unclear origin. please refer to the accompanying ct facial bone regarding numerous skull fractures. mr 1. edema and/or contusion of the cervical cord at the c2/3 level. 2. t2 and stir hyperintensity of the disc at the c2/3 level with disruption of the disc margin posteriorly. similar findings at the c7/t1 level. 3. disruption of the ligamentum flavum at the c6/7 level. 4. edema and/or hemorrhage of the interspinous ligaments extending from c3 through t1. 5. left c6/7 unilateral interfacet dislocation and right c2/3 and left c7/t1 facet joint disruption. 6. for full description of the cervical spinal fractures, please refer to the concurrent ct of the cervical spine. 7. no large epidural hematomas. no cord compression. 8. prevertebral hematoma suspicious for anterior longitudinal ligament injury. ct c/a/p 1. focal irregularity of the intima in the descending aorta concerning for minimal aortic injury. as the location is not classic differential diagnosis includes atherosclerotic plaques, although this is considered less likely. follow-up ct in 24 hours is recommended to ensure stability. 2. no mediastinal hematoma. 3. patchy airspace opacity likely representing pulmonary contusion with aspiration in the right mid lower lobes. dense consolidation at the lung bases, greater than left, may represent atelectasis versus effusion. 4. fractures of the fourth and fifth ribs with tiny amount of subpleural air. 5. fractures of the lumbar spine as described above. 6. thickening of the bladder wall extending into the distal left ureter with proximal dilatation of the ureter. the constellation of findings is comcerning for transitional cell carcinoma and atypical for traumatic injury. follow- up ct with delayed images of the ureter and a filled bladder are recommended for better delineation of the process. addendum: upon further review, it was noted that the patient had a nondisplaced fracture of the medial right scapula. findings were discussed with dr. . l femur xr/l tib fib xr : minimally displaced fracture through the distal fibula. soft tissue defect anterior to the tibia containing foci of linear hyperdensity consistent with retained foreign bodies. lue xr : no fx leni : neg ct head/sinus 1. overall unchanged appearance of the brain with diffuse subarachnoid hemorrhage, subdural hematoma, and contusion. slightly decreased -white differentiation, which can be technical. please correlate clinically. 2. numerous comminuted fractures of the skull and facial bones as described above post-surgery. fractures of the cervical spine, only partially visualized. shoulder (ap, neutral & axillary) trauma right port 4:40 pm shoulder (ap, neutral & axilla reason: r/o fracture or other processes medical condition: 42 year old man s/p fall out of bed now with increased right shoulder pain and point tenderness. reason for this examination: r/o fracture or other processes examination: right shoulder. indication: pain. fall out of bed. views of the right shoulder show no evidence of acute displaced fracture. there is, however, inferior subluxation of the humeral head by approximately 1-1.5 cm. impression: inferior subluxation of right humeral head from glenoid. ct head w/o contrast 7:52 pm ct head w/o contrast reason: eval for fx, interval change in ich medical condition: 42 year old man with chronic subdural, s/p fall out of bed, no loc, unknown head trauma reason for this examination: eval for fx, interval change in ich contraindications for iv contrast: none. indication: chronic subdural hematoma, status post fall off bed, no loss of consciousness. evaluate for change. comparison: . technique: non-contrast head ct scan. findings: there is no evidence of acute hemorrhage. again seen are bilateral frontal extra-axial collections, not significantly changed compared to prior studies, again consistent with subdural hematomas. maximum thickness again measures upwards of 9 mm, not significantly changed from prior study. there is no shift of normally midline structures. ventricles appear stable. - white matter differentiation appears preserved. likely mucous retention cyst within the right maxillary sinus, not significantly changed from prior. post- surgical sinus changes also again seen. impression: no evidence of acute hemorrhage. bifrontal subdural hematomas versus hygromas are again seen, not significantly changed in appearance from prior. chest (pa & lat) 10:52 am chest (pa & lat) reason: eval for pna medical condition: 42 year old man with multiple traumatic injuries, central cord syndrome, trach + peg w/ increasing sputum production reason for this examination: eval for pna indication: 42-year-old man with multiple traumatic injury, central cord syndrome, tracheostomy tube and peg tube placement with increasing sputum production. comparison: ap upright portable chest x-ray dated . ap upright portable chest x-ray: a tracheostomy tube is in place. the peg tube catheter is not clearly seen. the cardiac silhouette and mediastinal contours are normal and stable. atelectasis at both lung bases has increased. there is a small left pleural effusion, which appears stable in size. an underlying pneumonia is not excluded. the surrounding soft tissue and osseous structures are unchanged, with cervical plates in the lower neck. impression: increased bibasilar atelectasis. pneumonia, particularly at the left lung base, may be obscured. c-spine (ap, flex & ext) 3 views reason: assess for any cervical spine postoperative changes/processe medical condition: 42 year old man s/p mvc with cervical spine fractures; s/p spine stabilization on reason for this examination: assess for any cervical spine postoperative changes/processes cervical spine history: 42-year-old man status post motor vehicle collision with cervical spine fractures status post stabilization. assess for any postop change. technique: four views of the cervical spine were obtained including lateral flexion and extension views. findings: comparison is made to prior films of the cervical spine from . again seen is anterior fixation plate and screws spanning c2 and c3 with apparent bony fusion across the disc space. there is also posterior spinal fusion extending from c5-t1. no evidence of hardware breaks. the lower pedicle screws are not well evaluated on the lateral films. there is no evidence of loosening of the superior pedicle screws. there is no abnormal alignment of the visualized cervical spine down to the c6 level upon flexion or extension. the atlantoaxial interval is maintained. also again seen is a tracheostomy as well as multiple fixation plates, screws, and cerclage wires of the mandible and maxilla. periapical lucencies are seen around the roots of a few mandibular teeth, which may represent periodontal disease. impression: no abnormal alignment of the cervical spine upon flexion or extension down to the c6 level. the lower portion of the posterior cervical fusion is not well visualized due to the overlying shoulders. brief hospital course: he was admitted to the trauma service. orthopedic spine surgery was consulted given his spine fractures; he was taken to the operating room on for posterior instrumentation and on was taken back for anterior instrumentation; during this time he underwent placement of tracheostomy and gastrostomy tube by trauma surgery. his multiple facial fractures were also repaired on the 9th in the operating room by oral maxillo facial surgery. behavioral neurology was consulted for anoxic brain injury. several recommendations were made pertaining to his medications. he was loaded with dilantin, and remained on this for 10 days for seizure prophylaxis. there was no evidence of any seizure activity. he remained in the trauma icu for several weeks; he was difficult to wean from the ventilator despite early tracheostomy placement. he would eventually be weaned; is currently tolerating a trach mask. transfer to the regular nursing unit took place on hd #30. throughout his hospital stay he had episodes of diarrhea; he did have a positive c-diff culture on ; this was treated with flagyl course and resolved. subsequent stool cultures were obtained and were negative (most recent on ); he did continue to have intermittent loose stools. his tube feeding formula was adjusted; imodium and dto were added which has significantly decreased his amount of stools to 1-2x/day. as a result of his loose stools he did have some altered skin integrity in his peri-anal region. the wound nurse specialist was consulted; several recommendations were made and his skin has improved. he was placed on a first step mattress as well; tube feeding nutrients were optimized. a speech consult was placed for evaluation of passy muir valve; he was unable to tolerate this on the initial try. subsequent trials were not as successful given copious upper airway secretions. he was started on a scopolamine patch to help with drying some of the secretions; this did seem to help some. his trach was eventually removed on . his voice is strong, he is able to communicate his needs. he was seen in follow up by oral maxillo facial surgery for removal of his jaw wires; his oral screws were removed 2 weeks later at bedside by omfs without difficulty. he was also seen in follow up by spine surgery; follow up flexion & extension cervical spine films were done; his cervical collar was removed. he may wear a soft collar for comfort if needed. orthopedics was re-consulted for a right shoulder dislocation; this injury was non operative; he was placed in a sling for comfort. he will follow up in about 1 month in clinic. nutrition was closely involved in his care throughout his stay; tube feedings were initiated early on and are now being cycled given that he is now on an oral diet. the rate of the tube feeding should be decreased as his appetite improves. he is also being treated for a uti with ciprofloxacin 7 day course; he has 3 more days left in this course. his foley catheter was changed as well. physical and occupational therapy were consulted; he will require a rehab stay post acute hospital discharge. medications on admission: unknown discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 2. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day) as needed for constipation. 3. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day): hold for sbp <110; hr <60. 4. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) ml inhalation q8h with mucomyst (). 5. acetylcysteine 10 % (100 mg/ml) solution sig: one (1) ml miscellaneous q8h (every 8 hours). 6. opium tincture 10 mg/ml tincture sig: five (5) drop po bid (2 times a day). 7. haloperidol 1 mg tablet sig: two (2) tablet po twice a day. 8. trazodone 100 mg tablet sig: one (1) tablet po hs (at bedtime). 9. loperamide 2 mg capsule sig: one (1) capsule po 8x/day () as needed for diarrhea. 10. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 11. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 12. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 13. ciprofloxacin 250 mg tablet sig: three (3) tablet po q12h (every 12 hours) for 3 days. 14. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. discharge disposition: extended care facility: discharge diagnosis: s/p motor vehicle crash 1) c2,5,6,7,t1,l4,5 fractures 2) ant/post maxillary sinus fracture 3) fractures 4,5 ribs 4) pulmonary contusion 5) nasopharynx-foreign body 6) non-displaced left frontal/parietal fx 7) left lateral wall of orbit fracture 8) mandibular fracture 9) nasal bone fracture 10) left fibula fracture 11) right sah 12) right medial scapula fracture 13) game keeper's thumb 14) inferior subluxation of right humeral head from glenoid (nonperative) 15) uti discharge condition: good followup instructions: follow up in trauma clinic with dr. in 4 weeks, call for an appointment. follow up in clinic in 4 weeks, cal for an appointment. procedure: insertion of intercostal catheter for drainage insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube interruption of the vena cava enteral infusion of concentrated nutritional substances thoracentesis thoracentesis other intubation of respiratory tract other intubation of respiratory tract temporary tracheostomy other cervical fusion of the anterior column, anterior technique excision of intervertebral disc open reduction of maxillary fracture open reduction of mandibular fracture bronchoscopy through artificial stoma bronchoscopy through artificial stoma excision of bone for graft, other bones excision of bone for graft, other bones dorsal and dorsolumbar fusion of the posterior column, posterior technique closed reduction of nasal fracture other gastrostomy revision of tracheostomy other cervical fusion of the posterior column, posterior technique fusion or refusion of 2-3 vertebrae fusion or refusion of 4-8 vertebrae dental wiring diagnoses: anemia, unspecified urinary tract infection, site not specified infection with microorganisms resistant to penicillins alcohol abuse, unspecified cocaine abuse, unspecified pulmonary collapse intestinal infection due to clostridium difficile methicillin susceptible pneumonia due to staphylococcus aureus traumatic pneumothorax without mention of open wound into thorax other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle closed fracture of two ribs accidental fall from bed accidents occurring in residential institution closed fracture of malar and maxillary bones closed fracture of other facial bones closed fracture of scapula, unspecified part sedative, hypnotic or anxiolytic abuse, unspecified unspecified fracture of ankle, closed inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent) chronic ulcer of other specified sites closed fracture of mandible, unspecified site closed fracture of c1-c4 level with central cord syndrome closed fracture of c5-c7 level with central cord syndrome open wound of tooth (broken) (fractured) (due to trauma), complicated closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness and return to pre-existing conscious level tracheostomy complication, unspecified closed fracture of t1-t6 level with central cord syndrome foreign body in pharynx closed dislocation, third cervical vertebra closed dislocation, fourth cervical vertebra open wound(s) (multiple) of unspecified site(s), complicated closed inferior dislocation of humerus 

Answer: The patient is high likely exposed to