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: hit in lower jaw during flag football game major surgical or invasive procedure: orif mandibular fracture emergent right-sided needle decompression/tube thoracostomy right sided pigtail catheter placement history of present illness: 19m presented to as a trauma stat after being hit in the lower jaw during a flag football game. no loss of consciousness. no other injuries. gcs 15 on arrival. past medical history: pmh: none psh: denies : none social history: nonsmoker, college student at college family history: nc physical exam: 97.9, 60, 111/70, 18, 97 % on room air no acute distress, alert and oriented, well-appearing rrr, no murmurs, rubs, gallops clear breath sounds bilaterally with occasional wheezes, some decreased breath sounds at the right lung base, 28fr right sided chest tube in place, 14fr right sided pigtail catheter in place abdomen soft nontender nondistended extremities without edema pertinent results: mandible panoramic xr - single panorex view shows a minimally displaced fracture of the angle of the mandible on the left with a parasymphysis fracture on the right. cxr - selective intubation of the right main bronchus with right-sided tension pneumothorax. cxr - in comparison with the earlier study of this date, right chest tube is in place and the ipsilateral lung has substantially re-expanded with a small residual pneumothorax. mediastinal contents are now in normal position though there is some continued increased opacification in the left lung. tip of the endotracheal tube is now properly positioned about 4 cm above the carina. cxr - as compared to the previous radiograph, the position of the endotracheal tube and of the right-sided chest tube is unchanged. currently is no evidence of right-sided pneumothorax. the tip of the endotracheal tube is in unchanged position. the right-sided picc line has been removed in the interval. in the interval, the pre-existing opacity in the left lung has completely cleared. cxr - as compared to the previous radiograph, the right-sided chest tube is in unchanged position. the patient has been extubated. the lung volumes are unchanged. there currently is no evidence for a right pneumothorax. the cardiac silhouette and the left lung are unchanged. cxr - small right pneumothorax is new or newly apparent since :53 a.m. today. there is persistent atelectasis at the right lung base medially. subsequent chest radiograph, 12:25 a.m. reported separately showed a substantially large right pneumothorax and worsening right lower lobe collapse. cxr - moderate-to-large right pneumothorax has increased, with slight increase of the small dependent pleural fluid collection. there is more right lower lobe atelectasis. left lung is grossly clear. the heart size is top normal. right apical pleural drain still in place. cxr - single right chest drain tube is seen with its tip ending near the lung apex. mild-to-moderate pneumothorax seen on previous radiograph dated has completely resolved. no residual pneumothorax. cardiomediastinal silhouette is stable. cxr - small right apicolateral pneumothorax with chest tube in place. enlarging right pleural effusion with adjacent worsening right mid and lower lung opacities. cxr - unchanged right pleural effusion and right mid and lower lung zone opacity. no evidence of pneumothorax. cxr - in comparison with the study of , there is again extensive opacification at the right base consistent with pleural effusion and volume loss in the lower lung. enlargement of the cardiac silhouette persists without definite vascular congestion. right chest tube remains in place, and there is no evidence of pneumothorax. in the appropriate clinical setting, supervening pneumonia would have to be considered. cxr - in comparison with the earlier study of this date, there is no interval change following placement of the chest tube on waterseal. no evidence of pneumothorax. patient has taken a somewhat better inspiration. cxr - tiny right apical pneumothorax is clinically insignificant. apical thoracostomy tube, unchanged since . basal pigtail pleural drain better localized on the subsequent chest cta, abutting the collapsed right lower lobe. mid hemothorax unchanged in volume compared to . left lung grossly clear. cardiomediastinal silhouette unremarkable. - chest ct indication: assess for track formation, leak or fluid. old man with ventilator-acquired pneumonia status post pigtail placement. assess for fistulous tract, leak and fluid resolution. technique: contrast enhanced cect of thorax was performed using a standard department protocol for assessment of pulmonary embolism. contiguous axial images at 5-mm and 2.5-mm slice thickness were reviewed concurrently with coronal and sagittal reformats. no prior chest ct studies were available for comparison. findings: mediastinum: main pulmonary artery proximal to bifurcation measures 26 mm and is normal in caliber. main, lobar, and segmental pulmonary arteries are devoid of filling defects to suggest pulmonary embolism. due to suboptimal opacification of the sub-segment pulmonary arteries, their assessment was limited. heart is of normal size without pericardial effusion. there is no right heart strain or septal bulge. multiple lymph nodes are present at different mediastinal stations but none of them meet ct size criteria for pathological enlargement and are likely reactive. airways and lungs: airways are patent to subsegmental bronchi. single right chest tube drain ends near the right lung apex with its tip occluded by a fluid. moderate-to-large, non-hemorrhagic, loculated right pleural collection is present with a single pigtail catheter drain teminating at right lung base within the collection. few airpockets within are likely from chest drain placement. smooth enhancement of the pleural lining does not necessarily suggestive of exudative effusion, since this appearance can be seen in long standing transudative pleural effusion as well. there is no evidence of any fistulous tract or leakage of the pleural fluid into the subcutaneous or the intramuscular plane along the chest wall. adjacent lung atelectasis is mild to moderate. mild pneumothorax is present in the upper lung. no pleural effusion or lung consolidation on the left side. abdomen: this study is not designed for assessment of subdiaphragmatic pathologies. her limited views were remarkable for small mesenteric and retroperitoneal lymph nodes. both adrenal glands are normal. bones: no bone lesion suspicious for malignancy or infection. impression: 1. no evidence of pulmonary embolism. assessment of sub-segment pulmonary arteries was limited due to suboptimal opacification. 2. moderate, non-hemorrhagic, loculated right pleural effusion with few air pockets, likely related to a pigtail drain. minimal and smoothly enhancing pleural lining does not necessarily indicates exudate nature of the fluid since this appearance can be seen in longstanding transudate effusion too. no evidence of subcutaneous fistulous tract or leak of the fluid into the subcutaneous or the intramuscular plane of the chest. 3. minimal right pneumothorax. 4. mild-to-moderate right lower lung atelectasis. 09:15pm blood wbc-16.0* rbc-4.65 hgb-14.0 hct-41.4 mcv-89 mch-30.2 mchc-33.9 rdw-12.5 plt ct-334 02:05am blood wbc-14.8* rbc-4.20* hgb-12.9* hct-38.0* mcv-90 mch-30.7 mchc-33.9 rdw-12.9 plt ct-231 06:20am blood wbc-15.4* rbc-4.14* hgb-12.4* hct-37.4* mcv-90 mch-29.9 mchc-33.1 rdw-12.6 plt ct-284 04:55am blood wbc-20.1* rbc-4.65 hgb-13.9* hct-41.9 mcv-90 mch-29.8 mchc-33.1 rdw-12.4 plt ct-310 04:50am blood wbc-22.0* rbc-4.90 hgb-14.7 hct-44.0 mcv-90 mch-30.0 mchc-33.4 rdw-12.3 plt ct-362 06:10am blood wbc-20.1* rbc-4.61 hgb-13.8* hct-41.4 mcv-90 mch-30.0 mchc-33.4 rdw-12.3 plt ct-362 05:55am blood wbc-20.7* rbc-4.69 hgb-13.6* hct-42.0 mcv-90 mch-29.0 mchc-32.4 rdw-12.4 plt ct-366 05:03am blood wbc-20.5* rbc-4.31* hgb-12.9* hct-38.4* mcv-89 mch-30.0 mchc-33.6 rdw-12.3 plt ct-351 05:00am blood wbc-17.2* rbc-4.24* hgb-12.7* hct-37.9* mcv-89 mch-29.9 mchc-33.4 rdw-12.2 plt ct-376 05:00am blood wbc-19.1* rbc-4.45* hgb-13.2* hct-40.0 mcv-90 mch-29.8 mchc-33.1 rdw-12.6 plt ct-361 10:35 am sputum site: expectorated source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): multiple organisms consistent with oropharyngeal flora. respiratory culture (final ): moderate growth commensal respiratory flora. 06:14pm pleural wbc-305* rbc-2125* polys-96* lymphs-0 monos-0 eos-0 macro-4* 06:14pm pleural totprot-4.9 glucose-39 ld(ldh)-989 albumin-2.9 6:14 pm pleural fluid gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): 6:14 pm fluid received in blood culture bottles pleural. fluid culture in bottles (preliminary): no growth. 9:57 pm urine source: cvs. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. (reference range-negative). performed by immunochromogenic assay. a negative result does not rule out infection due to other l. pneumophila serogroups or other legionella species. furthermore, in infected patients the excretion of antigen in urine may brief hospital course: 19 m w/ mandibular fracture during a flag football game. the patient was admitted to the acs service and made npo for or with omfs. during the case, the intubation was traumatic via nare. postoperatively, it was difficult to ventilate the patient and he started showing signs and symptoms consistent with a right sided tension pneumothorax. he had an air leak around the cuff and low tidal volume with decreased sats. cxr revealed a right mainstem bronchus intubation and development of a right tension ptx. after needle decompression a ct was placed. the patients sats improved dramatically and his blood pressure remained stable. the patient was reintubated due to a large chest tube leak. the patient was successfully extubated on pod 1, his diet was advanced to softs, his foley was removed, and he was transferred to the floor. the ct was placed to waterseal on pod1 and the film taken later that day did show a small apical pneumothorax increased in the interval period. the patient had an episode of increased right sided chest pain with labored breathing later that evening, but continued to maintain his sats. another film was taken at that time showing enlarging right apical pneumothorax and his chest tube was placed back to suction after this finding. on pod2, the chest tube was continued on suction and the cxr showed reexpansion of the ptx. late evening on pod2, the patient spiked a fever to 103.3 and then continued to have fevers from 100-101. on evaluation he noted a worsening productive cough and periods of diaphoresis. he continued to maintain his sats in the high 90's on 1-2l nc and was breathing comfortably. a fever workup was sent. on pod3, ceftriaxone was started after reviewing the am cxr showing signs concerning for a worsening right sided infiltrate. his wbc count increased from 15.4 to 20.1. the chest tube was continued on suction and he was out of bed ambulating and tolerating a diet. on pod4, antibiotics were broadened to vancomycin, cefepime, ciprofloxacin with an ongoing leukocytosis to 22 and intermittent fevers. patient noted his sputum began to clear and become thinner in quality. on pod6, chest tube was placed to waterseal, post film showed no pneumothorax, cough began to improve, wbc still elevated to 20, tmax of 100.7, eating well, walking, feeling better. on pod7, id was consulted for continuing low grade temperatures and persistent leukocytosis. they recommended obtaining a ct of the chest, changing antibiotics to vancomycin and zosyn and considering drainage of pleural fluid, sending it off for studies. a right sided 14fr pigtail catheter was placed, fluid was exudative. on pod8, a ct of the chest was obtained which showed a complex right sided loculated pleural effusion and persistent collection despite placement of pigtail catheter. thoracic surgery was consulted who recommended a vats, drainage, possible decortication procedure. the patient's mother was interested in first pursuing a course of tpa treatment which was instituted on pod8 and pod9 to both chest tubes. on pod9, the patient and family requested transfer to bay state for further care to facilitate being closer to home. the patient was given his second tpa treatment prior to transfer. his wbc is 19.1, he had a tmax of 100.0 and was afebrile throughout the day on pod9. medications on admission: none discharge medications: 1. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheezing. 3. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 4. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 7. vancomycin 500 mg recon soln sig: 1500 (1500) mg intravenous q 8h (every 8 hours). 8. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: 4.5 grams intravenous q8h (every 8 hours). 9. alteplase 10mg/40ml 20ml to each chest tube for 2 hours x 3 days (started on 111/29/11) discharge disposition: home discharge diagnosis: bilateral mandibular fracture right sided tension pneumothorax persistent, loculated right pleural effusion discharge condition: stable for transfer discharge instructions: further management per receiving hospital follow up with clinic for a postop visit - followup instructions: consulting teams: interventional pulmonology, infectious diseases, thoracic surgery, omfs procedure: insertion of intercostal catheter for drainage insertion of endotracheal tube injection or infusion of thrombolytic agent other incision of pleura open reduction of mandibular fracture cardiopulmonary resuscitation, not otherwise specified diagnoses: unspecified pleural effusion other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure accidents occurring in residential institution other complications due to other internal prosthetic device, implant, and graft closed fracture of mandible, multiple sites spontaneous tension pneumothorax accidents occurring in place for recreation and sport striking against or struck accidentally by object in sports with subsequent fall activities involving american flag or touch football 

Answer: The patient is high likely exposed to