A sudden onset of fever, chills, rapid respiration, cough, vomiting and diarrhea, abdominal distention, and elevated peripheral white blood cells are the commonest manifestations. Rarely, apnea and hypotensive shock are observed. The onset of the infection is sometimes more insidious than acute non-aspiration pneumonia. Chemical pneumonitis due to aspiration is generally not accompanied by fever. Weeks to months of malaise, low-grade fever, and cough, with significant weight loss and anemia, may precede consolidation and abscess formation. Examination may reveal dyspnea with frequent expiratory grunts, dilated nostrils, flushed cheeks, cyanosis, rales, diminished breath sounds, dullness, and prolonged expiration. The presence of a pneumonic process in a posterior upper lobe or superior lower lobe suggests the presence of aspiration and lung abscess. Cavitation with an air-fluid level establishes the diagnosis.
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