Different intracellular bacteria have developed various strategies to resist elimination by phagocytes (see Table 15-2). These include inhibiting phagolysosome fusion or escaping into the cytosol, thus hiding from the microbi-cidal mechanisms of lysosomes, and directly scavenging or inactivating microbicidal substances such as reactive oxygen species. The outcome of infection by these organisms often depends on whether the T cell-stimulated antimicrobial mechanisms of macrophages or microbial resistance to killing gains the upper hand. Resistance to phagocyte-mediated elimination is also the reason that such bacteria tend to cause chronic infections that may last for years, often recur after apparent cure, and are difficult to eradicate.
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