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: trazodone / naltrexone / wasp venom / yellow hornet venom / honey bee venom attending: chief complaint: trauma major surgical or invasive procedure: right craniotomy for evacuation of hematoma peg placement history of present illness: 29-y.o. male motorcycle vs. car, unresponsive at scene, gcs 8 and therefore he was intubated at the scene. he was found to have absent r lung sounds requiring needle decompression with rush of air. pt was transfered to for further care. past medical history: multiple motorcycle accidents (? what injuries) prev oxycontin addiction (now on methadone) social history: unknown. family history: non-contributory physical exam: on admission: p 101 bp 130/palp intubated, sedated and paralyzed pupils fixed 2mm bilaterally bilateral hemotympanum, blood in the right ear canal bilateral breath sounds, r chest tube in place no chest crepitus heart rrr abdomen soft, nt, nd abrasion r hand contusion bilateral knees contusion left pretibia contusion right occiput pt had purposeful movement of right upper extremity when sedation was held. on discharge: aox3, following complex commands slight left ptosis. perrla, eoms full. tongue midline. mae with full and equal strength, walking the floor without assistance. good comprehension. fluent speech. pertinent results: labs: 07:52pm glucose-133* urea n-7 creat-0.6 sodium-142 potassium-3.0* chloride-112* total co2-25 anion gap-8 07:52pm calcium-7.2* phosphate-1.4* magnesium-1.6 07:52pm wbc-14.0* rbc-3.92* hgb-11.1* hct-32.0* mcv-82 mch-28.4 mchc-34.7 rdw-14.4 07:52pm plt count-317 07:52pm pt-14.4* ptt-25.0 inr(pt)-1.2* 07:52pm fibrinoge-384 06:36pm type-art o2-100 po2-263* pco2-37 ph-7.44 total co2-26 base xs-1 aado2-434 req o2-73 intubated-intubated 02:50pm lipase-25 02:50pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 02:50pm urine bnzodzpn-pos barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-pos imaging: ct head noncontrast : impression: 1. large right epidural hematoma adjacent to right temporal fracture, 2. hemorrhagic contusion in the left inferior frontal and temporal lobe. small extra-axial hemorrhage along the left posterior frontal lobe. 3. complex skull base fracture, as detailed above, extending along the sphenoid at the midline and laterally to involve both temporal bones. 4. diffuse ventricular, sulcal and cisternal effacement. portable cxr : single bedside frontal radiograph of the chest: an endotracheal tube is in place, terminating 3.5 cm above the carina. the lung volumes are low. there is no pleural effusion or pneumothorax. there is no focal consolidation. ct cervical spine : impression: no acute fracture or traumatic malalignment involving the cervical spine. extraaxial blood about the cord at the foramen magnum likely reflects tracking from blood seen in the basilar cisterns. ct chest/abdomen/pelvis : impression: 1. et tube and og tube positioned appropriately. right chest tube tip terminates at the right lung apex. 2. bilateral posterior lung consolidations likely represent combination atelectasis/aspiration. 3. localized hemothorax at the right apex. 4. tiny right pneumothorax could represent the sequelae of chest tube insertion. 5. no acute injuries in the abdomen or pelvis. postoperative ct head noncontrast : status post right craniotomy and evacuation of epidural hematoma. the majority of the epidural blood is no longer present. there is a small amount of expected pneumocephalus and small amounts of residual blood products. on the left side, note is made of subarachnoid and parenchymalhemorrhage, unchanged from the comparison study and most notable in the left frontal and temporal lobes. there is no new intracranial hemorrhage, edema or mass effect. the degree of mass effect exerted by the right epidural hematoma has been alleviated. the previously noted hemorrhage on the right side of the foramen magnum/upper cervical region is decreased on the present study. a small hypodense area in the left temporal lobe poster-medially is unchanged. extracranial soft tissues reveals small amount of subgaleal gas as expected given the recent procedure. intracranial drain, entering the cranium at the superior margin of the osseous surgical defect and with the tip terminating in the right middle cranial fossa. cta head : the major intracranial arteries are patent. no flow-limiting stenosis or occlusion is noted. ct head noncontrast : impression: no significant interval change compared to postoperative study. ct sinus/ mandible/maxillofacial noncontrast : findings: again seen are multiple complex facial, skull base, and temporal fractures. facial fractures include comminuted nasal fractures. skull base fractures include the sphenoid body and both greater wings, extending into the bilateral carotid canals. high-attenuation material persists in the left maxillary sinus, sphenoid sinuses, and ethmoid air cells, compatible with evolving blood products. note is made of mild pan-nasal mucosal thickening and aerosolized secretions. the frontal sinuses are under-pneumatized. bilateral haller cells are present, right greater than left. the lamina papyracea and cribriform plates are intact. type 1 olfactory fossa are noted bilaterally. there is mild s-shaped deviation of the nasal septum, apparently due to an acute fracture, with a rightward bony spur that does not obstruct the middle meatus. orbits and intraconal structures appear preserved. in the right temporal , anterior longitudinal fracture involves the mastoid and petrous segments, and extends into the middle ear. there is dislocation of the incus from the maleus. in the left temporal , a transverse fracture involves the petrous portion, extending to the temporomandibular joint anteriorly and the middle ear posteriorly. there is high-density fluid within both external auditory canals, extending into the middle ears, with complete encasement of the auditory ossicles, and partial opacification of the mastoid air cells. structures of the inner ear, including the cochlea, vestibule, semicircular canals, and internal auditory canals, appear intact. changes of right temporal craniotomy are noted, with lateral fixation plate and screws. moderate soft tissue swelling and trace subcutaneous gas is noted overlying the craniotomy site. residual pneumocephalus is present in the right middle cranial fossa, along with a heterogeneous extra-axial fluid collection measuring up to 8 mm in depth. hemorrhagic contusions measuring 3 x 2.2 cm in the left temporal lobe and 2.2 x 1.3 cm in the left frontal lobe continue to evolve. subarachnoid hemorrhage along the left cerebral and convexity and suprasellar/perimesencephalic cistern also persists. the ventricles and basal cisterns are persistently effaced. there is contour deformity of the inferior left maxilla, with abnormal lateral concavity and absence of the maxillary left bicuspids and molars, suggesting remote injury. on the right, the maxillary second molar is absent, with fluid opacification of the bony cavity and erosion of the lateral maxillary wall. the mandible appears intact, but there is absence of the left mandibular first and second bicuspid, and the right mandibular second bicuspid. upper cervical spine alignment is preserved. note is made of congenital non-fusion of the posterior arch of c1. impression: 1. multiple facial, skull base, and temporal fractures, as described above. extensive blood throughout paranasal sinuses and middle ear structures. 2. incomplete dentition. 3. right craniotomy, with residual epidural blood products. 4. left frontotemporal hemorrhagic contusions and multifocal subarachnoid hemorrhage. ct head noncontrast : stable appearance of brain with multiple fractures, right craniotomy and residual extra-axial fluid collection, left frontotemporal contusion, diffuse subarachnoid and subdural hemorrhage, global cerebral edema, and blood in paranasal sinuses and middle ear cavities. chest xray : lung volumes are low. the new left-sided picc tip is difficult to see but extends at least into the right atrium and should be pulled back by at least 5 cm. supine portable view exaggerates the cardiac size. there is bibasilar atelectasis but otherwise the lungs appear clear. there is no pleural effusion or pneumothorax. ct orbit: impression: 1. complex longitudinal right temporal fracture, involving middle ear with 0.7-mm incudomalleal diastasis. given the large amount of surrounding blood, it is difficult to determine whether this finding represents true dislocation. repeat imaging following resolution of hemorrhage would be helpful. 2. nondisplaced transverse left temporal fracture, extending through middle ear and mastoid segment of the facial nerve canal. 3. multiple facial and skull base fractures, better evaluated on prior maxillofacial ct. 4. decreased sinus hemorrhage and evolving intracranial hemorrhage. ct head: impression: 1. continued evolution of left inferior frontal and temporal hemorrhagic contusions, with expected decreased density of edema, but no increase in the hyperdense hemorrhagic components, and no increased mass effect. 2. stable small residual right extra-axial collection. 3. evalution of subarachnoid hemorrhage is limited by artifacts. 4. diffuse cerebral edema, grossly unchanged allowing for artifacts. 5. multiple skull base, bilateral temporal and facial fractures, better assessed on prior studies. cxr - negative brief hospital course: on , the patient was transferred to the operating room emergently for right epidural hematoma evacuation. on , repeat ct head was stable. epidural drain was removed. patient not responding to commands. plastic surgery was consulted for extensive facial fractures. he was started on a 7 day course of clindamycin and placed on sinus precautions for sinus fractures. no urgent intervention required. on , dilantin dose was increased, ct head was stable, and the patient was started on precedex and fentanyl infusions in an attempt to wean sedation for extubation. he had no cough or gag reflex, so extubation was deferred. on , he was extubated without complication, although he continued to not follow commands. right chest tube was withdrawn. he remained in the unit until when he was transferred to the regular floor onto the neurosurgery service. ent was consulted for bilateral temporal fractures and a dedicated ct temporal was obtained. pt will need an audiogram and ent followup at a later date. on , the patient's potassium was repleated for a level of 3.0. the patient was evaluated by trauma service for gastric feeding tube. the team felt that the patient was at high risk for pulling out his feeding tube once placed due to his current mental status and decisded to defer placement of a gastric feeding tube over weekend to see if patient can tolerate a po diet. it was felt that he would require placement of a peg for nutrition as he was unable to take adequate po due to his depressed mental status and inability to follow commands. patient was ordered for physical and occupational therapy consults who recommended acute rehab. on exam, the patient was more alert. his diet was advanced to sips of nectar liquids. , the patient was transitioned to keppra for seizure prophylaxis. he was started on a dose of 750 . he was noted to have right sided facial twitching that resolved within minutes. the patient's potassium was repleated for a level of 3.2. the patient's inr 1.8 was fpund to be slightly elevated. the decision was made to not reverse this inr for risk of dvt/pe per dr . a non contrast head ct was ordered which was stable. the patient foley catheter was discontinued. on the patient was neurologically stable but continued to be restless. he was evaluated by speech and swallow who did not clear him for a full diet. acs was consulted for peg placement. inr was again elevated and it was decided to continue to monitor. on a u/a was obtained for preop which was postitive therefore he was started on a course of cipro. a culture was added on. wbc was noted to be elevated which was thought to be due to uti, but inr was within normal limits. he went to the or for peg placement which he tolerated well. on the patient was started on tube feeds with a goal of replete with fiber at 95ml/hr per nutrition recommendation. he was switched to oral cipro for uti. on overall he was somewhat brighter on exam, attending to examiner but still with dysphasia, nonsensical words at times. he is awaiting rehab disposition pending procuration of insurance. on the family requests transfer of the patient to medical center to the care of dr. as it is a hardship for them to travel in and out of with the associated expenses and time off from work. the transfer was not able to happen given the bed situation at . dr from cognitive neurology was contact to give input regarding his care and the plans were for him to be seen on friday . speech and swallow was reconsulted as patient's neuro status was improved. they recommended to advance diet to soft with thin liquids. pt remained neurologically stable. he was started on calorie counts in hopes of weaning his tube feeds. on his tf's were changed to cycle overnight only. he was able to walk with physical therapy and his neurological status continued to improve with improving comprehension and speech. on a family meeting was requested but do to inabilty of case management involvement the meeting was delayed. a family meeting was scheduled for with case management, pt/ot, the neurosurgery team and social work with a goal set to discuss a safe plan for the patient to return home with supervision as he no longer qualified for rehab due to his improvements in mobility and adls. however the patient's mother cancelled the meeting stating that she would prefer to talk over the phone with individuals. his clinical status continued to improve and he was ambulatory independently. he consistently was oriented x 3 and more appropriate when interacting. he was started on calorie counts and continued to tolerate a good oral diet. thus tfs were discontinued and his medications were transition to oral. gen was contact and they recommend at least 6 weeks from initial placement to remove the peg tube. he had completed pt/ot, but continues to require cognitive therapy. at this time a home plan with 24hour supervision is recommended as he continues to improve. at the time of discharge he is tolerating a regular diet, ambulating without difficulty, afebrile with stable vital signs. his plan of care involves 24 hour supervision provided by family and friends, outpatient occupational therapy and outpatient cognitive therapy. medications on admission: methadone discharge disposition: home discharge diagnosis: right epidural hematoma right traumatic pneumothorax multiple facial fractures including commminuted nasal fxs, bilat ethmoid fxs complex skullbase fractures bilateral temporal fractures agitation confusion dysphagia uti - e. coli insomnia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: general instructions ?????? daily wound check for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? you may wash your hair only after your 2 week wound check in clinic. ?????? you may shower before this time using a shower cap to cover your head. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion or change in mental status. ?????? any numbness, tingling, weakness in your extremities. ?????? pain or headache that is continually increasing, or not relieved by pain medication. ?????? any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: follow-up appointment instructions ??????please call ( to schedule an appointment with dr. to be seen in 8 weeks. ??????you will need a ct scan of the brain without contrast. - followup with plastic surgery to follow facial fractures. please call dr. office to make an appointment (. - followup with ent for bilateral temporal fractures and audiogram as an outpatient in 8 weeks . - follow up with dr in the eye clinic as an outpatient in 8 weeks for your 6th nerve palsy. the eye clinic is . - followup in general surgery in early to evaluate your peg for removal. call ( to schedule an appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] other craniotomy implantation or replacement of intracranial neurostimulator lead(s) diagnoses: urinary tract infection, site not specified unspecified protein-calorie malnutrition compression of brain cerebral edema other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness closed fracture of nasal bones contusion of knee cerebellar or brain stem contusion without mention of open intracranial wound, unspecified state of consciousness 

Answer: The patient is high likely exposed to