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However, recurrence of the effusion after drainage led to further bacterial growth from repeat samples, ultimately clarifying the diagnosis. This illustrates how an attenuated systemic inflammatory response, consistent with immunosenescence, can complicate the diagnosis and management of pleural infection in elderly patients.<\/jats:p>","DOI":"10.1136\/bcr-2025-271602","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T15:40:20Z","timestamp":1782315620000},"page":"e271602","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Culture confirmed empyema in the absence of biomarker elevation: immune response dissociation"],"prefix":"10.1136","volume":"19","author":[{"given":"Zafir","family":"Manji","sequence":"first","affiliation":[{"name":"Respiratory, Wexham Park Hospital, Slough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lia","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Respiratory, Wexham Park Hospital, Slough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Asis","sequence":"additional","affiliation":[{"name":"Respiratory, Wexham Park Hospital, Slough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussein","family":"Chreif","sequence":"additional","affiliation":[{"name":"Respiratory, Wexham Park Hospital, Slough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Power","sequence":"additional","affiliation":[{"name":"Respiratory, Wexham Park Hospital, Slough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"2026062408401022000_19.6.e271602.1","unstructured":"Iguina MM , Danckers M . 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