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: no known allergies / adverse drug reactions attending: chief complaint: victim of multiple gunshot wounds major surgical or invasive procedure: : exploratory laparotomy : compartment releases of left lower extremity (lateral, anterior, posterior, and deep posterior). application of negative pressure dressing, left lower extremity. irrigation and debridement of multiple open wounds, left lower extremity. compartment release of right thigh anterior and posterior compartments : or procedures: 1. irrigation and debridement of skin, subcutaneous tissue, fascia, muscle and bone. 2. complex closure of right thigh wound. 3. complex closure of left medial leg wound. 4. split-thickness skin graft of left lateral leg wound (5 x 18 cm). 5. exploration of left deep peroneal nerve history of present illness: the patient is an unidentified male who is likely in his 30's spanish-speaking male who was shot multiple times prior to being brought by ems to the trauma bay here. initial trauma evaluation revealed him to be tachycardic with multiple gunshot wounds, including one to his left posterior flank. some of the wounds were actively oozing. fast examination at the time of initial evaluation was positive, and he became acutely hypotensive with systolic pressure in the 70s, despite fluid boluses and eventual transfusion. given the distribution of gun shot wounds, hypotension, and fast examination, exploratory laparotomy was warranted in an emergent fashion, and as such consent was waived for the procedure. past medical history: pmh: none psh: none prior to current admission social history: unknown family history: nc physical exam: physical examination upon admission: hr: 134 bp: 115/70 resp: 21 o(2)sat: 100 normal constitutional: uncomfortable, in pain, gcs 14 heent: normocephalic, atraumatic, pupils equal, round and reactive to light, extraocular muscles intact; nares normal, tm intact, no hemotympanum oropharynx within normal limits chest: clear to auscultation cardiovascular: tachycardic rate and rhythm, normal first and second heart sounds abdominal: soft, nontender, nondistended; fast equivocal, abnormal luq pelvic: pelvis stable rectal: no gross blood extr/back: r posterior thigh with wound, r thigh swelling, tournequet applied; numerous gsw to back, l and r buttock, midline spine in mid back and above anus, anterior and posterior thigh on l and r, l flank pulses intact bilateral le neuro: moving all extremities psych: awake, alert, in pain pertinent results: hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:40 5.9 2.94* 8.6* 25.8* 88 29.4 33.5 14.9 454* 06:55am blood wbc-6.8 rbc-3.04* hgb-9.1* hct-26.9* mcv-89 mch-29.9 mchc-33.8 rdw-15.1 plt ct-457* 06:10am blood wbc-7.4 rbc-2.97* hgb-9.0* hct-25.8* mcv-87 mch-30.2 mchc-34.7 rdw-15.4 plt ct-484* 12:45pm blood wbc-9.2 rbc-2.91* hgb-8.8* hct-25.7* mcv-88 mch-30.4 mchc-34.4 rdw-15.4 plt ct-470* 01:35pm blood wbc-23.3*# rbc-3.73* hgb-11.6* hct-32.6* mcv-87 mch-31.0 mchc-35.5* rdw-15.7* plt ct-564*# 06:03pm blood hct-26.2* 07:50am blood wbc-21.0*# rbc-4.22* hgb-12.6* hct-36.6* mcv-87 mch-30.0 mchc-34.5 rdw-15.3 plt ct-215 04:30am blood wbc-8.9 rbc-4.36* hgb-13.2* hct-38.3* mcv-88 mch-30.2 mchc-34.4 rdw-15.0 plt ct-264 12:45pm blood neuts-78.6* lymphs-13.5* monos-4.5 eos-3.0 baso-0.5 03:59am blood neuts-79* bands-0 lymphs-17* monos-1* eos-3 baso-0 atyps-0 metas-0 myelos-0 06:10am blood ptt-52.3* 12:16am blood ptt-44.3* 05:35pm blood ptt-22.8 12:35am blood ptt-63.7* 12:45pm blood plt ct-470* 06:30am blood plt ct-484* 06:30am blood ptt-74.2* 01:30am blood pt-11.7 ptt-22.1 inr(pt)-1.0 01:29am blood pt-11.7 ptt-23.7 inr(pt)-1.0 04:30am blood pt-12.4 ptt-20.2* inr(pt)-1.0 05:15am blood fibrino-115* 04:30am blood fibrino-203 06:55am blood glucose-95 urean-19 creat-1.2 na-139 k-4.2 cl-105 hco3-23 angap-15 06:10am blood glucose-92 urean-19 creat-1.5* na-138 k-4.5 cl-104 hco3-26 angap-13 12:45pm blood glucose-116* urean-25* creat-1.9* na-136 k-4.1 cl-103 hco3-23 angap-14 06:30am blood glucose-94 urean-27* creat-2.4*# na-140 k-4.1 cl-106 hco3-24 angap-14 07:50am blood glucose-131* urean-12 creat-0.8 na-137 k-5.1 cl-111* hco3-19* angap-12 04:30am blood urean-13 creat-1.3* 01:30am blood ck(cpk)-1345* 01:29am blood ck(cpk)-2132* 01:35am blood ck(cpk)-4651* 06:55am blood calcium-9.1 phos-4.1 mg-2.3 06:10am blood calcium-8.8 phos-3.6 mg-2.5 12:45pm blood calcium-8.4 phos-4.2 mg-2.6 06:10am blood osmolal-287 07:25pm blood vanco-17.6 07:07am blood vanco-11.4 04:30am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 09:33pm blood type-art po2-87 pco2-38 ph-7.50* caltco2-31* base xs-5 01:35am blood type-art po2-108* pco2-49* ph-7.41 caltco2-32* base xs-4 02:08pm blood type-art po2-146* pco2-44 ph-7.39 caltco2-28 base xs-1 08:07am blood type-art temp-36.0 tidal v-450 peep-5 po2-198* pco2-42 ph-7.27* caltco2-20* base xs--7 -assist/con intubat-intubated 05:47am blood type-art temp-36 rates-14/ tidal v-750 fio2-80 po2-69* pco2-39 ph-7.31* caltco2-21 base xs--6 aado2-466 req o2-79 intubat-intubated vent-controlled 05:18am blood type-art po2-151* pco2-51* ph-7.22* caltco2-22 base xs--7 intubat-intubated vent-controlled 04:49am blood po2-34* pco2-58* ph-7.19* caltco2-23 base xs--7 comment-green top 03:10am blood lactate-2.0 05:47am blood glucose-138* lactate-3.1* na-137 k-3.9 cl-113* 05:18am blood glucose-144* lactate-4.3* na-137 k-3.9 cl-111 04:49am blood glucose-194* lactate-6.8* na-141 k-3.2* cl-103 05:47am blood hgb-11.2* calchct-34 o2 sat-93 01:35am blood freeca-1.10* 02:08pm blood freeca-1.01* : chest x-ray: impression: no acute cardiothoracic process on chest x-ray. : cta chest: comminuted left proximal fibula fracture with osseous and bullet fragments with no opacification of the left peroneal artery, posterior tibialis artery and anterior tibialis artery distally and without reconstitution of flow. the expected course of the peroneal and posterior tibialis arteries lies along the fracture and bullet fragments and vascular injury cannot be excluded. compartment syndrome is also of particular concern. a fasciotomy was subsequently performed. 2. bullet fragments in the left lower lobe without evidence of pneumothorax. 3. bibasilar lung opacities. 4. comminuted left greater trochanteric fracture with adjacent bullet fragments. 5. post-surgical findings following exploratory laporotomy. : ekg: sinus tachycardia, rate 140. minor st-t wave abnormalities likely due to heart rate. no previous tracing available for comparison. : chest x-ray: findings: as compared to the previous radiograph, the right central venous access line has been removed. there is mild decrease in extent of the pre-existing signs suggesting pulmonary edema. unchanged cardiomegaly at low lung volumes. mild retrocardiac atelectasis but no evidence of pneumonia. : cat scan of abdomen and pelvis: impression: 1. comminuted fracture of the left greater trochanter (300b:84) with adjacent bullet fragments. 2. resolution of pneumoperitoneum since . 3. bibasilar atelectasis is improved since . 4. fat stranding along the ventral abdominal wall incision extending into the anterior peritoneal fat appears increased since and may indicate post surgical changes versus infectious process. there is no evidence of associated focal fluid collections. 5. clot is seen within the right common femoral vein, new since the prior examination. : 3:33 am blood culture source: line-arterial. **final report ** blood culture, routine (final ): bacillus species; not anthracis. isolated from only one set in the previous five days. aerobic bottle gram stain (final ): reported to and read back by @ 1855 . gram positive rod(s) consistent with clostridium or bacillus species. 2:30 pm sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). smear reviewed; results confirmed. respiratory culture (final ): sparse growth commensal respiratory flora. gram negative rod(s). rare growth. 5:39 am blood culture source: venipuncture. **final report ** blood culture, routine (final ): no growth. 9:28 pm blood culture **final report ** blood culture, routine (final ): no growth 11:48 pm urine source: cvs. **final report ** urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination 6:50 am blood culture #2. blood culture, routine (pending): brief hospital course: 34 year old gentleman brought intubated from scene after sustaining multiple gsws immediately prior to arrival. on arrival, patient was found to be hemodynamically stable and was noted to have approximately 12 entry/exit wounds involving the back (thorax and lumbar region)and lower extremities. during secondary survey, patient became hypotensive and was immediately brought to the operating room for exploratory laparotomy. by report, laparotomy revealed no abdominal visceral injury and no evidence of intraperitoneal or retroperitoneal hematoma. during the procedure, he was given 3 units of prbcs and approximately 5 l of crystalloid. despite this resuscitative effort, he remained hypotensive and phenylephrine drip was started. his abdomen was closed and given his lower extremity penetrating trauma, he was brought immediately to ct for a cta c/a/p with le runoff. while this study revealed no majory thoracic or abdominal vascular injury, it did demonstrate likely vascular injury with lack of opacification distal to the knee. he was admitted to the tsicu for further monitoring. neuro: he was initally intubated and sedated. once his sedation was weaned, he experienced episodes of delerium, associated with dilaudid dosing, and was changed to oxycodone. when not delirious, he had episodes of anxiety related to his shooting, for which both social work and psychiatry were consulted. he was started on seroquel for his delirium. cv: he had issues with sinus tachycardia while in the icu, possibly related to anxiety. he was started on a beta-blocker with improvement in his heart rate. pulm: he was kept intubated post-operatively and weaned from the vent on . his pulmonary status was routinely monitored and did not require intervention. fen/gi: he was kept npo/ivf after his ex-lap and lower extremity surgeries. once extubated and awake, he was started on a clear liquid diet and advanced as tolerated. gu: a foley catheter was placed in the ed, and was kept in place for urine output monitoring in the icu. heme: his hematocrit was 38.3 on admission, and dropped to a nadir of 22.6. he was transfused prbc's when appropriate, and his hematocrit responded appropriately. id: two blood cultures drawn in the ed grew gram-positive rods, for which he was treated with vancomycin. a sputum culture grew gnr's and was treated with zosyn. he was transferred to the surgical floor on : he continued to have episodes of delirium and visual halllucinations. a spanish interpreter was sought for re-orientation to his surroundings. a psychiatrist and social worker were also consulted. plastic surgery was consulted regarding closure of the fasciotomies of his lower extremities. vac dressing changes to lower extremities continued every 3 days by orthopedics. as his health status gradually progressed, physical and occupational therapy was consulted regarding his mobility and recommendations made for ambulating. his vancomycin and zosyn were discontinued on hd #8. at this time, he became increasingly agitated, refusing to take his anti-psychotic medications. security and psychiatry were notified and restraints applied. because there was concern for evolving sepsis, he was transferred back to the intensive care unit on hd #9. at the same time, he was found to have an elevated white blood cell count and fever. he resumed the vancomycin and zosyn. he underwent a cat scan of his abdomen which was negative for an abdominal abscess, but did show a right femoral vein dvt for which he was started on lovenox. his anti-coagulation regimen was changed to heparin infusion per plastic surgery in anticipation of his upcoming wound closure. his agitation and delirium gradually resolved on zyprexa and seroquel and on hd #11 he returned to the surgical floor. his vancomycin and zosyn were discontinued on hd #16. his white blood cell count normalized and his fever abated. his heparin infusion was discontinued on hd #17 in preparation for his return to the operating room for skin grafts to his lower extremities. he was taken to the operating room on hd #17 for complex closure of right thigh wound and left leg wound, split-thickness skin graft of left lateral leg wound, and exploration of left peroneal nerve. the operative course was stable with minimal blood loss. the peroneal nerve was found to be intact. drain and vac dressing were applied to the left leg during the operative procedure. both the vac and drain were discontinued on hd #22. his post-operative course was uneventful. his heparin infusion continued along with daily dosing of coumadin. his heparin infusion was discontinued on when his inr reached 1.7 and he has been on daily coumadin dosing. he has been evaluated by physical therapy and cleared for discharge home. he is preparing for discharge to his uncle's after dressings changes have been reviewed with the family. he has instructions to follow up with plastic surgery, the acute care service, orthopedics and with the coumadin clinic. he has been assigned a health care provider in and will follow up in the coumadin clinic. : pt=25.4, inr=2.4 coumadin 5 mg given prior to discharge ....discussed with providers in coumadin clinic. given script for 5mg tablets ( which were split by nurse to 2.5 mg) medications on admission: none discharge medications: 1. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic qid (4 times a day) as needed for dry eyes. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation . 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation . 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po hs (at bedtime). 5. metoprolol tartrate 25 mg tablet sig: three (3) tablet po q 8h (every 8 hours). 6. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain: may cause increased sedation. disp:*20 tablet(s)* refills:*0* 7. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for dyspepsia. 8. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical daily (daily) as needed for pruritis. 9. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) gms po daily (daily) as needed for constipation. 10. acetaminophen 650 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain, fevers. 11. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*20 tablet(s)* refills:*0* 12. quetiapine 50 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). disp:*20 tablet(s)* refills:*0* 13. coumadin 5 mg tablet s po........dosing as per coumadin clinic #5......no refills ( tablets have been split) discharge disposition: home discharge diagnosis: trauma: multiple gun-shot wounds: gsw back, l of midline gsw above sacrum gsw l flank gsw r buttock gsw l medial thigh comminuted left fibular fracture bilateral fasciotomies exploratory laparotomy r lle close,lle musto5cmfibbreak,llelatstsg,vac dressing left common peroneal nerve neuropathy femoral dvt lll bullet frat (no ptx) b/l lung contusions discharge condition: spanish speaking: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital after you received multiple gun shot wounds to your back and lower extremities. you were taken to the operating room for an exploratory lapartomy and incisons were made to release the swelling in the right thigh. you were monitored in the intensive care unit after your procedure. after your vital signs stabilized, you were transferred to the surgical floor. you returned to the operating room where you had skin grafts to the left leg and placement of a vac dressing. the vac dressing was removed and you are now having dressing changes to your left leg. your vital signs have stablized and you are now preparing for discharge to a relatives home where you can further regain your strength and mobility. dress your skin graft sites with xeroform daily. do not scrub them while in the shower. take great care to ensure that nothing rubs on the grafts as they are quite fragile. skin graft donor site open to air. please cover donor site and left lower extremity in plastic when you shower. please apply small xeroform gauze to wounds on back and lower extremities and cover with dressing daily please report the following: *increased reddness from wound sites *increased drainage frm wound sites *fever *chills *abdominal pain *increasing size of abdomen *drainage from abdominal wound *opening of abdominal wound *increased pain in right leg *inability to move toes right foot *numbness toes right foot *any new symptom that concerns you followup instructions: please follow up with the acute care service in 2 weeks. you can schedule this appointment 24 hours after discharge by calling # . please call ( for a follow up appointment in one week with dr. (plastic surgery). please follow-up with your primary care provider, . on at 3:20 pm in the building, atrium. the telphone number is # . prior to your appointment, you will need to have lab work done. please report to the of the sharpiro building for your lab work. please follow up with dr. nurse practitioner, in 2 weeks. you can schedule your appointment by calling # . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances exploratory laparotomy other skin graft to other sites debridement of open fracture site, tibia and fibula debridement of open fracture site, tibia and fibula closure of skin and subcutaneous tissue of other sites other myectomy other incision of soft tissue diagnoses: hyperpotassemia acute posthemorrhagic anemia hyposmolality and/or hyponatremia other opiates and related narcotics causing adverse effects in therapeutic use other specified cardiac dysrhythmias alkalosis bacteremia retention of urine, unspecified acute venous embolism and thrombosis of deep vessels of proximal lower extremity drug-induced delirium traumatic compartment syndrome of lower extremity traumatic shock open wound of abdominal wall, lateral, without mention of complication posttraumatic stress disorder open wound of buttock, without mention of complication open wound of hip and thigh, without mention of complication accident caused by unspecified firearm missile injury to peroneal nerve open wound of abdominal wall, anterior, without mention of complication laceration of lung with open wound into thorax contusion of lung with open wound into thorax open fracture of shaft of fibula alone open fracture of trochanteric section of neck of femur, unspecified 

Answer: The patient is high likely exposed to