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: fall major surgical or invasive procedure: lumabr drain placement peg history of present illness: this is a 65 year old male who was delivering food to a business and was found down by bystanders at the bottom of 7 metal grate stairs on a concrete landing. he was found in a pool of blood with the blood being reported to be coming from his nose. when paramedics arrived on scene he was awake and noted to be incontinent of stool and aggressively restless with bruising to both knees. he was transported to an osh for management. upon arrival to the osh he was found to have a gcs of 10 and became increasingly combative. as a result of his combativeness he was intubated at the osh. imaging at the osh showed bilateral parietal sah, basilar skull fracture, basilar and left posterior parietal subgaleal hematoma, gross blood in left mastoid, pneumocephalus, and question of a left parietal intraparenchymal hemorrhage. he was transferred to for further management and evaluation. past medical history: dm, htn per family social history: no etoh or tobacco use per family family history: nc physical exam: on admission: o: t:97.9 bp: 127/56 hr:64 r: 20 o2sats 100% neurologic exam: pt is intubated and not sedated, pupils are 3mm and nonreactive bilaterally, +corneals bilaterally, +cough to extreme deep suction, no response to deep sternal rub, no response in upper extremities to proximal or distal noxious. +triple flexion to deep noxious bilateral lower extremities. heent exam: + blood in bilateral nares unable to assess for csf rhinorrhea with nasal packing on right, left ear canal grossly bloody unable to assess for hemotympanum or csf otorrhea, no hemotympanum or csf otorrhea on right. right eye proptotic with raccoons sign, left eye edematous, no battles sign bilaterally. left occiput boggy to palpation, no bony step off. on discharge: expressive aphasia is improving and able to say some words and sentences. following commands is inconsistent. he is able to move all extremities. pupils are equal and reactive and face is symmetric. pertinent results: ct c-spine: 1.no acute fracture, traumatic malalignment, or prevertebral hematoma seen. 2. moderately severe congenital narrowing of spinal canal from c3 through c7. severe canal narrowing at c5-c6 where posterior disc and osteophyte causes deformity of the spinal cord. if there is concern for acute cord injury, mri would be recommended for more sensitive evaluation. 3. please refer to ct maxillofacial bones for description of skull base and facial bone fractures, as well as lytic and sclerotic lesions of the skull base. 4. please refer to ct head for extent of intracranial hemorrhage. small amount of high-density subarachnoid blood tracks inferiorly from the head into the upper cervical canal. 5. 10-mm left thyroid nodule. ct sinus: 1. multiple facial bone fractures as described above, involving bilateral frontal sinuses, the left temporal bone and zygomatic arch, floor of the sphenoid sinus/clivus, and the hard palate. there is pneumocephalus as well as blood layering in the paranasal sinuses, left mastoid air cells, and left middle and external ear. right intraorbital extraconal gas seen, with right proptosis but no retrobulbar hematoma. 2. for more complete assessment of intracranial hemorrhage, please see ct head report. 3. multiple sclerotic and mixed lytic and sclerotic foci involving the clivus, the occipital condyles, and the left sphenoid bone raise concern for metastatic disease. correlation with history of malignancy recommended and, if clinically indicated, bone scan may be helpful to evaluate extent of disease. ct torso: 1. no acute traumatic injury seen within the torso other than mild soft tissue stranding adjacent to the left hip. 2. bilateral dependent lung opacities, likely atelectasis. 3. several scattered sclerotic foci within the spine and pelvis. these could represent bone islands, but correlation with any history of prior malignancy is recommended including with psa. a bone scan can be obtained for further evaluation. cta head: diffuse subarachnoid hemorrhage, more significant at the basal cisterns as described above. small bilateral subdural hematomas with no significant mass effect. hemorrhagic contusion identified at the left temporal lobe and right frontoparietal lobe are noted. cta shows no aneurysm. large left occipitoparietal subgaleal hematoma and pneumocephalus on the right temporal fossa with associated facial bone fractures. please see the ct maxillofacial report for details. ct head: 1. diffuse bilateral subarachnoid hemorrhage with foci of intraparenchymal hemorrhage within the bilateral temporal lobes and right frontal lobe. subdural hematoma layering along the tentorium and the right cerebral convexity, similar in appearance. interval development of intraventricular hemorrhage with blood layering in the left posterior of the lateral ventricle. no significant shift of normally midline structures. close short- yerm interval followup is recommended. 2. multiple facial bone fractures with fluid and hemorrhage within the paranasal sinuses, better evaluated on recent dedicated ct of facial bones. 3. large left parietal subcutaneous hematoma and soft tissue swelling. 4. mixed lytic and sclerotic lesions of skull base. : cxr a new nasogastric tube is seen with side port in the distal esophagus and tip just beyond the gastroesophageal junction. bowel gas pattern is unremarkable. bibasilar atelectasis persists, left greater than right. mild cardiomegaly and interstitial edema are present. ct head no evidence for new hemorrhage. multiple foci of hemorrhagic contusion, with associated subarachnoid, intraventricular, and subdural blood are again identified. there is slightly increased edema associated with the hemorrhagic contusions. there is no new hydrocephalus or evidence of acute infarction. : lens no evidence of bilateral lower extremity dvt. bilateral soft tissue edema. : chest x-ray: ap single view of the chest has been obtained with patient sitting semi-erect position. comparison is made with the next previous similar study of . the lung fields remain clear. no new infiltrates are identified. relatively high-positioned diaphragms account for somewhat crowded appearance of the pulmonary vasculature on the bases and a linear plate atelectasis on the right side. again new acute infiltrates are not seen, and no pneumothorax is identified in the apical area. in comparison with the next previous study of no significant progressive abnormality has been identified. : ct head: 1. decrease in amount and density of the intraventricular hemorrhage and the hemorrhage associated with the temporal bone contusions bilaterally. 2. unchanged vasogenic edema associated with the bitemporal contusions and unchanged subarachnoid hemorrhage. 3. unchanged hemorrhage in the sphenoid sinus, multiple facial bones and left sphenoid bone fracture. ct temporal bones : 1. complex fracture of the left temporal bone with a predominantly transverse orientation extending through the mastoid air cells at the level of the ossicular chain without evidence of ossicular disruption. however, subtle disruption cannot entirely be excluded. subsequent near complete opacification of mastoid air cells and inner ear on the left. 2. fracture of the posterior medial wall of the right sphenoid sinus extending adjacent to the posterior wall of the left carotid canal without definite involvement. if there is clinical concern for a vascular injury, a cta of the head is recommended for further evaluation. 3. transversely oriented fracture of the left sphenoid bone extending into the left foramen ovale without involvement of the petrous portion of the carotid canal. 4. partial opacification of the right mastoid air cells without evidence of right temporal bone fracture. 5. redemonstration of bitemporal contusions and associated vasogenic edema, intraventricular hemorrhage, and a small amount of probable subarachnoid blood. cisternogram: on four hour imaging, activity has progressed to the basilar cisterns. there was no evidence of extra cranial activity at that time. on 24-hour imaging, there is some further progression of activity with considerable absorption of activity, but activity was still present in the basilar cisterns. again, there was no evidence of extra cranial activity. gauze which had been placed over the ear had no evidence of activity using a survey meter. impression: csf leak was no demonstrated on 4 or 24 hour imaging. brief hospital course: mr. was admitted to the csicu on . he was intubated and on the trauma service. his torso was cleared by trauma on . he was extubated and his c-spine was cleared by trauma on . he was transferred to neurosurgery service. transfer orders for the step down unit were written on . heent: he was seen by prs and ent for ? csf leak from the left ear. hob, cipro were recommended. no clear csf leak was able to be determined. continued csf leak was noted at left ear on . a lumbar drain placement was requested. this was done on in interventional radiology. csf was noted in the left ear on the weekend of . the ld goal was increased to 15 cc/hr. there was no leaking around the ld site. the drainage was brown in color. ent saw the patient on to try to determine if this was from debris in the ear or true csf. they cleaned the canal but were not able to clearly define a csf leak. they recommended ct temporal bones and a nuclear medicine study. indium tracer was ordered and administered through the ld on . the cisternogram was done at 4hrs and 24hrs. there was no sign of csf leak on imaging. there was also no sing of csf on ear gauze. ent felt that any further brownish/bloody drainage was a result of tm rupture, not csf leak. he had an ng tube placed in the trauma icu. the patient removed this when he was being transferred off the stretcher upon return from the ld placement. the neurosurgery/ent and ir departments were hesitant to replace this in ,light of multiple facial fractures. we opted to proceed with a peg. this was placed by the trauma team, dr. on . he had a speech and swallow exam on and a pureed diet was initiated. he was re-evaluated on and the recommendations remained unchaged. neuro: he was on dilantin for seizure prophylaxis. he needed several dilantin boluses over the next few day s for subtherepeutic levels. he was transition ed to keppra. he has not had a seizure but due to the extensive damage to the left temporal lobe, a one month course was recommended. head ct's showed continued evolution of contusions as expected. ct head on showed no sdh formation from csf drainage. his speech production improved significantly on the weekend of . he was suing more english phrases, appropriately at times. he still appeared to have a mixed dysphasia. gi: he was advanced to pureed diet per sp/sw on . he had guaiac positive stool x2 after the peg. trauma team was called with this info. they were asked to evaluate the peg on as the anchor was deep and causing skin erosion and was not able to be adjusted by the wound care nurses. trauma adjusted the peg and there were no further issues. id: he was febrile to 101.1 on and 101.8 on . blood cultures were negative. ua and culture were positive and levaquin was started. cxr showed vascular congestion. lens were negative for dvt. csf was sent on and . the gram stains were negative. final cultures showed no growth. he remained afebrile after uti treatment. **ct imaging at presentation revealed bone islands and sclerotic changes of the axial skeleton. he has no history of malignancy. psa was sent. a bone scan may be needed in the future after he recovers from his trauma. his pcp's office was called. they have no records of this condition or any malignancy. they were made aware of his current condition and need for bone scan in the future. he was seen by pt/ rehab was recommended. he was medically c;eared for rehab on after the cisternogram was read. rehab screening was in place. he remained stable and eventually was transferred to rehab on . medications on admission: unknown discharge medications: 1. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 2. senna 8.6 mg tablet sig: two (2) tablet po daily (daily). 3. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for gi distress. 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 5. insulin regular human 100 unit/ml solution sig: one (1) unit injection asdir (as directed). 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever. 7. levetiracetam 500 mg/5 ml solution sig: 1000 (1000) mg intravenous (2 times a day) for 1 months: star . duration 1 month. 8. hydromorphone (pf) 1 mg/ml syringe sig: 0.125 mg injection q4h (every 4 hours) as needed for pain. 9. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 10. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 11. senna 8.6 mg tablet sig: two (2) tablet po daily (daily). 12. hydromorphone (pf) 1 mg/ml syringe sig: 0.125 mg injection q4h (every 4 hours) as needed for pain. 13. quetiapine 25 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for agitation. 14. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 15. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 16. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 17. ciprofloxacin 0.3 % drops sig: five (5) drop ophthalmic tid (3 times a day) for 2 weeks: continue until . 18. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 19. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day) for 1 months. 20. insulin regular human 100 unit/ml solution sig: two (2) units injection asdir (as directed): follow flow sheet please. discharge disposition: extended care facility: - discharge diagnosis: bilateral subarachnoid hemorrhage intraparenchymal hemorrhage bilateral temporal lobes and right frontal lobe. subdural hematoma at tentorium intraventricular hemorrhage left lateral ventricle multiple facial bone fractures: bilateral frontal sinuses, the left temporal bone and zygomatic arch, floor of the sphenoid sinus/clivus, and the hard palate. hemosinus left parietal subcutaneous hematoma. right peri-orbital hematoma cervical spinal stenosis c5-c6 hnp and osteophyte pneumocephalus uti left tympanic membrane rupture discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: general instructions ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? 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. ?????? you have been prescribed an anti-seizure medicine, keppra, take it as prescribed. ?????? call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion, lethargy 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. the one stitch placed at the lumabr drain site should be removed at rehab on . followup instructions: follow-up appointment instructions neurosurgery: please call ( to schedule an appointment with dr. , to be seen in 4 weeks. ??????you will need a ct scan of the brain without contrast. ent: please call ( to to schedule an appointment to see dr. in weeks with an audiogram. plastic surgery: please call to schedule an appointment to see dr. in weeks for facial fractures. pcp: pcp was . when you are discharged from rehab you need to see your pcp to discuss the bone abnormalities on your torso ct. a bone scan may be needed in the future. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] arterial catheterization other exploration and decompression of spinal canal replacement of gastrostomy tube diagnoses: urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified protein-calorie malnutrition pulmonary collapse other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure long-term (current) use of insulin accidental fall on or from other stairs or steps altered mental status nonspecific abnormal findings in stool contents aphasia closed fracture of malar and maxillary bones closed fracture of other facial bones spinal stenosis in cervical region other specified vaccinations against streptococcus pneumoniae [pneumococcus] contusion of face, scalp, and neck except eye(s) other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with brief [less than one hour] loss of consciousness other specified gastritis, without mention of hemorrhage other gastrostomy complications other conditions of brain closed fracture of base of skull with cerebral laceration and contusion, with brief [less than one hour] loss of consciousness exophthalmos, unspecified cerebrospinal fluid otorrhea open wound of ear drum, without mention of complication 

Answer: The patient is high likely exposed to