The clinical presentation of empyema generally blends with that of an underlying pneumonia. Community-acquired S. aureus pneumonia is usually preceded by a viral upper respiratory infection or right-sided endocarditis in intravenous drug users. Patients with empyema are initially seen by a variety of physicians due to the indolent course of the disease. Typical symptoms include pyrexia, pleuritic chest pain, cough, dyspnea, and general malaise. Atypical presentations may include weight loss and anemia. Patients may have decreased breath sounds and dullness to percussion on examination of the chest. Symptoms are often masked by protracted treatment with antibiotic therapy for upper respiratory tract infections, which may result in the delayed diagnosis.
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