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: penicillins attending: chief complaint: polytrauma s/p fall major surgical or invasive procedure: splenectomy and hepatorrhaphy 1. open reduction and internal fixation right olecranon fracture. 2. washout and debridement open fracture to bone. 1. exploratory laparotomy. 2. removal of 3 intraperitoneal lap pads. 3. insertion of inferior vena cava filter with fluoroscopy. : interventional radiology drainage of left upper quadrant fluid collection esophagogastroduodenoscopy with repair of gastric perforation i&d for r elbow wound dehiscence history of present illness: mr. is a 75 year old male who presented via on s/p 15 foot fall from roof of rv. he was reportedly found by ems and following commands on the scene. he was taken to hospital where head ct revealed subarachnoid hemorrhage/intraventricular hemorrhage and was subsequently intubated at the outside hospital. he was subsequently transferred to for further evaluation and management of his injuries. past medical history: pmh: hyperlipidemia, possible seizures psh: hip and knee replacement, open cholecystectomy social history: lives in , in for summer, staying in rv at a camping area. was planning to start trip home the day after he fell. married and was traveling with wife, who has family in area. family history: noncontributory physical exam: on arrival to : temp 97 bp: 119/60 hr: 99 rr 16 o2 sats 99% constitutional: intubated heent: pupils equal, round and reactive to light c. collar in place chest: breath sounds bilaterally, crepitus right chest, right sided chest tube in place cardiovascular: regular rate and rhythm abdominal: soft, distended pelvic: stable rectal: normal tone, no gross blood skin: large laceration over right elbow, compartments soft neuro: sedated pertinent results: laboratories: imaging: torso ct- chest: 1. 50% r anterior ptx w/ mediastinal shift and compressive effects on both lungs; r chest tube enters low and is oriented in posterior pleural space (away from ptx). 2. no l ptx. 3. no aortic or injury. 4. extensive r chest wall emphysema. 5. r posterolateral rib fx ; l posterolateral rib fx ; r clavicle fx. abdomen/pelvis: 1. worsening hepatic and splenic lacerations w/ growing perihepatic and perisplenic hematomas - active extrav around spleen; small amt blood tracking along b paracolic gutters. 2. prominent r adrenal gland - ? hematoma. 3. no free intraabdominal air. 4. extensive r abd/flank wall emphysema extending into r groin; early r flank hematoma. 5. no spine or pelvic fx. ct a/p : 1. given consideration of persistent leukocytosis, findings suggest this to be the result of scattered ill-defined pulmonary infiltrates as described as well as bibasilar consolidation versus collapse. 2. expected fluid in the splenic bed, overall benign appearance. 3. hence, no findings within the abdomen or pelvis to explain leukocytosis. 4. no change in multiple right-sided rib fractures, decrease in subcutaneous air, only small residual right pneumothorax remaining with decrease in mediastinal shift, decrease in subcutaneous air, no change in hepatic contusions. ct a/p : 1. extraluminal location of oral contrast adjacent to the fundus of stomach is concerning for a contained leak. no change in the size of a 6 x 10 cm splenic bed fluid collection which is now better organized and has new rim enhancement concerning for abscess. this is amenable to percutaneous drainage. 2. multifocal ground-glass opacities could likely represent infection or inflammation, possibly related to aspiration. 3. numerous right and left-sided rib fractures, right clavicular fracture are unchanged. microbiology: sputum cx : pan sensitive klebsiella pneumoniae, klebsiella oxytoca, enterobacter cloacae bcx : enterobacter cloacae sputum cx : stenotrophomonas maltophilia, serratia marascens - pan sensitive abscess cx : polymicrobial pathology: : spleen, splenectomy: splenic tissue with focal capsular disruption and hemorrhage, consistent with laceration. 03:35pm asa-neg ethanol-111* acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 03:35pm wbc-15.7* rbc-3.07* hgb-10.8* hct-30.7* mcv-100* mch-35.3* mchc-35.3* rdw-13.1 03:35pm neuts-87* bands-1 lymphs-5* monos-7 eos-0 basos-0 atyps-0 metas-0 myelos-0 03:35pm hypochrom-normal anisocyt-1+ poikilocy-normal macrocyt-1+ microcyt-normal polychrom-normal ovalocyt-occasional 03:35pm plt smr-normal plt count-216 03:35pm pt-14.8* ptt-27.7 inr(pt)-1.3* 03:35pm fibrinoge-140* 03:35pm lipase-67* 03:42pm type-art tidal vol-500 peep-5 po2-51* pco2-56* ph-7.15* total co2-21 base xs--9 -assist/con intubated-intubated 03:51pm lactate-3.2* brief hospital course: as per above the patient was transferred from osh via to for trauma management. he arrived intubated and sedated. stat trauma protocol was activated on arrival and patient was evaluated by acute care surgery service. in the trauma bay there was concern for a tension pneumorthorax as patient was hypotensive with mediastinal shift on trauma bay chest xray despite right chest tube at outside hospital. malpositioned chest tube was removed and r chest tube was re-positioned with good effect. further imaging was obtained in the ed showing extravasation from injured spleen and liver. patient was brought emergently to the or for exploratory laparotomy, splenectomy and repair of small hepatic defect. patient was then transferred to the tsicu with an open abdomen for further management. tsicu course: neuro: patient was admitted to tsicu intubated with sedation regimen. pain/sedation was initially controlled with fentanyl/propofol while patient was intubated and subsequently transitioned to pca on extubation with good effect and adequate pain control. when tolerating oral intake, the patient was transitioned to oral pain medications. cv: the patient arrived to the icu hemodynamically stable with single vasopressor support, subsequently successfully weaned following abdominal closure hd 2 with intermittent use until hd 6 pressors: single- vasopressor support was utilized for blood pressure support during immediate post-operative period and subsequently weaned without issue. the patient was transferred to floor hemodynamically stable without pressor requirement. pulmonary: the patient arrived to the icu intubated and sedated. patient was kept intubated with increasing ventilatory requirement 9/6-7. cta chest was negative for pe. concern for pulmonary edema with prn lasix and adequate diuresis on follow-up cxr. serial cxr were obtained given presence of r chest tube without evidence of reaccumulation. following extubation, r chest was removed with stable post-pull cxr. concern for vap was successfully treated with vap protocol antibiotics prior to transfer to floor. gi/gu/fen: postoperatively patient arrived to tsicu with open abdomen and packing in place. on patient was taken back to or for removal of packing and abdominal closure which went well without issue (reader referred to operative note for details. during work-up for persistent leukocytosis, ct was obtained which demonstrated fluid collection in luq which was subsequently drained by ir. subsequent fluoroscopic examination of this collection demonstrated a small gastric perforation communicating with aforementioned fluid collection which was subsequently repaired endoscopically. initially pt tolerated tube feeds via ir advanced dobhoff which was subsequently discontinued. pt was transferred to floor npo with ir drain in place. post-splenectomy vaccines were administered prior to transfer to floor. patient's intake and output were closely monitored, and iv fluid was adjusted when necessary. electrolytes were routinely followed, and repleted when necessary. id: the patient's white blood count and fever curves were closely watched for signs of infection. wound care: incisional wounds were regularly monitored for signs of infection of which there were none. antibiotics: patient was started on vancomycin for open fracture of r olecranon given penicillin allergy. pt was also treated for vap per protocol and fluconazole was empirically added given concern for gastric perforation with subsequent discontinuation following confirmation of the integrity of endoscopic repair. at time of transfer to floor, pt remained on antibiotics for uti infection, empiric treatment for h.pylori as well as r elbow orif per orthopedic surgery. endocrine: the patient's blood sugar was monitored throughout this admission. insulin dosing was adjusted accordingly. hematology: the patient was found to be hypotensive on arrival to and large amount free hemorrhage was found in abdomen on exploratory laparotomy . 13 units prbcs were administered on with flat hct in mid 30s. six units ffp and 2 platelets were administered per massive transfusion protocol. following operative intervention, the patient's complete blood count was examined routinely with single transfusion requirement for asymptomatic anemia. no further transfusions were required at time of transfer to floor. given patient's antibody cross-reactivity, blood bank staff was involved early in the post-operative care of this patient. please see relevant notes for pertinent work-up and recommendations. please see prophylaxis section for anticoagulation. msk: patient was found to have open fracture of r olecranon on presentation and was taken to the or with orthopedics for orif. at time of transfer to floor, patient remained stable with orthopedic surgery following. prophylaxis: heparin was not utilized on initial presentation as there was significant concern for intra-abdominal hemorrhage. an ivc filter was placed for this reason. the patient received subcutaneous heparin and venodyne boots during this admission and was encouraged to get up and ambulate as early as possible. floor course: mr. was transferred to the floor on . neuro: while on the floor, mr. complained of minimal pain which was well controlled with tylenol only. his mental status began to improve. by the day of discharge he was alert, oriented to self, place and situation. he was following commands and his speech was clear. a follow up head ct in 6 weeks was initially recommended by neurosurgery, who had signed off after multiple stable head ct's and improvement in mental status. cv: his vital signs were monitored routinely while on the floor and remained stable and afebrile. pulm: he finished the course of antibiotics for vap while on the floor. he remained on room air with stable oxygen saturations and no respiratory compromise. gi/gu: the patient had a formal speech and swallow evaluation as well as a video swallow study. pureed solids and nectar thickened liquids were recommended. the patient was able to tolerate this diet without difficutly. h. pylori treatment was continued on the floor with flagyl and pantoprazole. electrolytes were continually monitored and repleted as needed throughout his hospitalization. on he was found to have a uti and was started on a 7 day course of ciprofloxacin to be completed on . on the patient failed his void trial after his foley catheter was removed and the catheter was replaced and kept in for the remainder of his hospital stay. heme/id: mr. blood cell count began to trend downward appropriately throughout his floor course, from 24.7 on to 11.6 on . his hematocrit remained stable. sc heparin was initiated for prophylaxis on given the stability of his tbi. in addition to the cipro for uti, he remains on keflex through for rue cellulitis and flagyl through for h. pylori treatment. incisions were continually monitored for signs and symptoms of infection. msk: on the patient's rue incision was noted was noted to have dehisced, and the patient was taking to the operating room by orthopedics for an i&d and closure of the wound. his course of antibiotics was completed as described above for the cellulits. he had a physical therapy and occupational therapy evaluation, who recommended rehab for the patient. fall precautions were maintained and he remained nonweightbearing on his right arm, with a sling for comfort. endocrine: his blood sugars were monitored while on the floor and remained within normal limits with no need for coverage with insulin sliding scale, which was d/c'd on . by the day of discharge, his neuro status was stable and he was tolerating po intake. he was hemodynamically stable. he was discharged to rehab. medications on admission: asa, pravastatin discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: five hundred (500) units injection tid (3 times a day). 2. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 3. senna lax 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 5. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime). 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob/wheeze. 8. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po bid (2 times a day) as needed for agitation. 9. cephalexin 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) for 2 days: last dose 9/29. 10. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 3 days: last dose 9/30. 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 1 days: last dose 9/28. 12. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 13. levothyroxine sodium 25 mcg iv daily 14. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 15. pantoprazole 40 mg susp,delayed release for recon sig: forty (40) mg po q24h (every 24 hours). 16. tylenol 325 mg tablet sig: two (2) tablet po every six (6) hours as needed for pain. discharge disposition: extended care facility: discharge diagnosis: s/p 15 foot fall injuries: 1. left temporal traumatic sah 2. right tension pneumothorax 3. hepatic laceration 4. splenic laceration 5. right posterolateral rib fractures 6. left posterolateral rib ffractures 7. right clavicle fracture 8. right adrenal hematoma 9. right olecranon fracture discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital after falling from the roof of an rv. you sustained multiple injuries including a head bleed, collapse of your right lung, liver and spleen injuries, multiple rib fractures, a right clavicle fracture and a right elbow fracture. you sustained rib fractures which can cause sever pain and subsequently cause you to take shallow breaths because of the pain. you should take your pain medicine as as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. if the pain medication is too sedation, take half the dose and notify your physician. is a complication of rib fractures. in order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. this will help expand the samll airways in your lungs and assist in coughing up secretions that pool in the lungs. you will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. symptomatic relief with ice packs or heating pads for short periods may ease the pain. do not smoke. return to the ed right away for any acute shortness of breath, increased pain or crackling sensation around your rips (crepitus). narcotic pain medication can cause constipation. thefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. if your doctor allows, non steriodal anti-inflammatory drugs are very effective in controlling pain (i.e. ibuprofen, motrin, advil, aleve, naprosyn) but they have their own set of side effects so make sure your doctor approves. activity: do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. you may climb stairs. you may go outside, but avoid traveling long distances until you see your surgeon at your next visit. don't lift more than 20-25 lbs for 6 weeks. (this is about the weight of a briefcase or a bag of groceries.) this applies to lifting children, but they may sit on your lap.) you may start some light exercise when you feel comfortable. you will need to stay out of bathtubs or swimming pools for a time while your incision is healing, and also because of the drain in place in hour abdomen. ask your doctor when you can resume tub baths or swimming. heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. followup instructions: please follow up for a repeat ct scan of the head in 4 weeks with dr. in the clinic. call upon discharge to schedule an appointment an appointment. please follow up in the clinic in one week. call upon discharge to schedule an appointment. please follow up in the acute care surgery clinic in weeks. call upon discharge to schedule an appointment. procedure: other endoscopy of small intestine other endoscopy of small intestine interruption of the vena cava percutaneous abdominal drainage insertion of other (naso-)gastric tube total splenectomy open reduction of fracture with internal fixation, radius and ulna debridement of open fracture site, radius and ulna other laparotomy closure of laceration of liver removal of foreign body from peritoneal cavity closure of other gastric fistula local excision of lesion or tissue of bone, radius and ulna diagnoses: other postoperative infection urinary tract infection, site not specified other and unspecified hyperlipidemia other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation knee joint replacement peritoneal abscess hip joint replacement injury to liver without mention of open wound into cavity laceration, unspecified injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum closed fracture of eight or more ribs closed fracture of clavicle, unspecified part subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness persistent postoperative fistula other accidental fall from one level to another injury to spleen without mention of open wound into cavity, massive parenchymal disruption spontaneous tension pneumothorax injury to other intra-abdominal organs without mention of open wound into cavity, adrenal gland open fracture of olecranon process of ulna disruption of traumatic injury wound repair 

Answer: The patient is high likely exposed to