Abscess Formation In Patients Research Articles

Impact of Concomitant Traumatic Pancreatic and Colon Injuries on Outcomes.

Colon and pancreatic injuries have both long been independently associated with intraabdominal infectious complications in trauma patients. The goal of this study was to evaluate the impact of concomitant pancreatic injury on outcomes in patients with traumatic colon injuries. Consecutive patients over a 3-year period who underwent operative management of colon injuries were identified. Patient characteristics, severity of injury and shock, presence and grade of pancreatic injury, and intraoperative packed red blood cell (PRBC) transfusions were recorded. Outcomes including intraabdominal abscess formation and suture line failure were collected and compared. Multivariable logistic regression analysis was then performed to determine the impact of concomitant pancreatic injury on intraabdominal abscess formation. 243 patients with traumatic colon injuries were identified. 17 of these also had pancreatic injuries. Patients with combined colon and pancreatic injuries were clinically similar to those with isolated colon injuries with respect to age, gender, penetrating mechanism of injury, admission lactate, ISS, suture line failure, and admission systolic blood pressure. Both intraabdominal abscess rates (88.2% vs 29.6%, P < .001) and intraoperative PRBC transfusions (8 vs 1 units, P = .004) were higher in the combined pancreatic and colon injury group. Multivariable logistic regression identified both intraoperative PRBC transfusions (odds ratio, 1.09; 95% confidence interval, 1.04-1.15; P < .001) and concomitant pancreatic injury (odds ratio, 14.8; 95% confidence interval, 3.92-96.87; P < .001) as independent predictors of intraabdominal abscess formation. Both intraoperative PRBC transfusions and presence of concomitant pancreatic injury are independent predictors of intraabdominal abscess formation in patients with traumatic colon injuries.

Successful pneumovaginoscopic surgery for recurrent abscess of OHVIRA syndrome, preventing further recurrence and subsequent pregnancy

AbstractIntroductionOHVIRA syndrome is a rare congenital anomaly of Müllerian duct development characterized by uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. The primary treatment is surgical excision of the obstructed hemivaginal septum and hematometrial drainage. In recent years, minimally invasive approaches such as hysteroscopic or vaginoscopic septum resection have been reported. Furthermore, we originally developed some novel pneumovaginoscopic gynecologic surgeries for years using a device that consists of a cylinder that fits into the vagina and a lid that mounts multiple ports, allowing the vagina to be dilated with carbon dioxide gas, similar to a single‐port laparoscope.Materials and Surgical TechniqueWe report a successful pneumovaginoscopic surgery for a complicated recurrent abscess in a patient with OHVIRA syndrome. Conventional surgery was performed with a single forceps in a liquid, as in cystoscopy or hysteroscopy. However, this new surgery allowed multiple forceps in a gas, as in laparoscopy. So pus and blood were aspirated and washed away without leaking into the abdominal cavity via fallopian tubes. The surgical smoke generated by thermal coagulation also aspirated to clean the field of vision immediately. And thick, complicated abscesses were drained successfully. The patient conceived through IVF with ICSI and delivered safely at full term.DiscussionPneumovaginoscopy could benefit complex vaginal surgery cases, such as abscess formation in patients with OHVIRA syndrome.

18F-FDG PET/CT-derived total lesion glycolysis predicts abscess formation in patients with surgically confirmed infective endocarditis: Results of a retrospective study at a tertiary center

BackgroundAbnormal activity of 18F-FDG PET/CT is a major Duke criterion in the diagnostic work-up of infective prosthetic valve endocarditis (IE). We hypothesized that quantitative lesion assessment by 18F-FDG PET/CT-derived standard maximum uptake ratio (SURmax), metabolic volume (MV), and total lesion glycolysis (TLG) might be useful in distinct subgroups of IE patients (e.g. IE-related abscess formation).MethodsAll patients (n = 27) hospitalized in our tertiary IE referral medical center from January 2014 to October 2018 with preoperatively performed 18F-FDG PET/CT and surgically confirmed IE were included into this retrospective analysis.ResultsPatients with surgically confirmed abscess formation (n = 10) had significantly increased MV (by ~ fivefold) and TLG (by ~ sevenfold) as compared to patients without abscess (n = 17). Receiver operation characteristics (ROC) analyses demonstrated that TLG (calculated as MV × SURmean, i.e. TLG (SUR)) had the most favorable area under the ROC curve (0.841 [CI 0.659 to 1.000]) in predicting IE-related abscess formation. This resulted in a sensitivity of 80% and a specificity of 88% at a cut-off value of 14.14 mL for TLG (SUR).ConclusionWe suggest that 18F-FDG PET/CT-derived quantitative assessment of TLG (SUR) may provide a novel diagnostic tool in predicting endocarditis-associated abscess formation.

8010 Postoperative Abscess Risk with Hemostatic Agent Use in Hysterectomy

<h3>Study Objective</h3> We noticed a trend of increased re-admissions for post-op pelvic abscesses. In an attempt to further investigate causality, we identified use of hemostatic agents as a possible culprit. The study objectives were to determine if intra-operative use of hemostatic agents was associated with postoperative abscess formation in patients undergoing hysterectomy. <h3>Design</h3> Retrospective chart review identified women who underwent hysterectomy by a Gynecologic Oncologist for any indication at a single institution from January 1, 2019, through December 31, 2019. Patient and surgical characteristics were abstracted, and comparisons were made among those who received any hemostatic agent and those that did not. <h3>Setting</h3> Study was performed at an academic institution in rural Virginia. <h3>Patients or Participants</h3> 428 hysterectomies were identified among five providers over a one-year period, with a postoperative pelvic abscess rate of 3.7%. <h3>Interventions</h3> The relationship between intra-operative hemostatic agentuse and post-op pelvic abscess formation was determined using multivariate logistic regression. Secondary outcomes evaluated included the presence of other major post-operative adverse events, such as post-operative blood transfusion, presentation to the emergency room, readmission or re-operation. <h3>Measurements and Main Results</h3> Abscesses were identified in 4 (2.2%)of cases without <i>vs</i> 12 (4.9%) of cases with hemostatic use with a logistic regression model demonstrating no significant difference in the groups (OR=2.10, <i>p</i>=0.22). Data showed an increase in presentation to the ED (OR=3.43, <i>p</i>=0.002 adjusted) and higher odds of readmission to the hospital within 30 days of surgery (OR=3.19, <i>p</i>=0.03) with hemostatic agent use. <h3>Conclusion</h3> There was no association found between the use of hemostatic agent use and abscess formation; however, data showed hemostatic agent use in surgery was associated with increased odds of presentation to the ED and readmission to the hospital within 30 days of surgery.

Evaluating the risk of post-operative abscess formation following use of hemostatic agents at time of hysterectomy

ObjectiveAt an academic institution in rural Virginia, we noticed a trend of increased re-admissions for postoperative pelvic abscesses. The primary study objective was to determine if intraoperative use of hemostatic agents (HA) was associated with postoperative abscess formation in patients undergoing hysterectomy. MethodsRetrospective chart review identified women who underwent hysterectomy by a Gynecologic Oncologist for any indication at a single institution from January 1, 2019 through December 31, 2019. Patient and surgical characteristics were abstracted and comparisons were made among those who received any HA and those that did not. The relationship between intraoperative HA use and postoperative pelvic abscess formation was determined using multivariate logistic regression. Secondary outcomes evaluated included the presence of other major post-operative adverse events. Results428 hysterectomies were identified with a postoperative pelvic abscess rate of 3.7 %. Abscesses were identified in 4 (2.2 %) of cases withoutvs12 (4.9 %) of cases with HA use with a logistic regression model demonstrating no significant difference in the groups (OR = 2.10,p = 0.22).Data showed an increase in presentation to the Emergency Department (ED) (OR = 3.43,p = 0.002 adjusted) and higher odds of readmission within 30 days of surgery (OR = 3.19,p = 0.03) with HA use. ConclusionsNo association was found between HA use and abscess formation; however, data showed HA use was associated with increased odds of presentation to the ED and readmission to the hospital within 30 days of surgery.Given the potential negative impact on patient outcomes, use of these products at time of hysterectomy should be made with careful consideration.

Опыт ведения пациентов старше 65 лет с диагнозом паратонзиллит в стадии инфильтрации и в стадии абсцедирования

The article presents clinical cases of patients with paratonsillitis at the stage of abscess formation in patients in the age group from 65 to 82 years, which caused the hospitalization of patients. The clinical picture of the disease is displayed, the stages of patient examination are described, on the basis of which the diagnosis is made. The results of laboratory and instrumental research methods in dynamics and the results of histological examination are presented.

Sigmoid colon stenosis by diverticulitis-derived abscess formation in patient with ulcerative colitis -a case report-

Sigmoid colon stenosis by diverticulitis-derived abscess formation in patient with ulcerative colitis -a case report-

Diffusion weighted MR imaging in the diagnosis of acute pyelonephritis and its complications: A prospective observational study

Introduction: In diagnosing complicated pyelonephritis, imaging is essential for which traditionally computed tomography (CT) has been in use but in renal failure patients contrast enhanced CT can't be performed due to elevated serum creatine levels. This can be overcome with the help of Diffusion weighted (DW) magnetic resonance imaging (MRI). Purpose: To assess the morphological changes and signal abnormalities, in kidneys in patients with acute pyelonephritis (APN) on conventional MRI and DWI and to measure the ADC values in areas of abnormal signal intensity in DWI so as to differentiate between abscess and nephritis. Materials and Methods: In our study, 32 patients with clinical and laboratory diagnosis of pyelonephritis underwent conventional and Diffusion weighted MRI. Diffusion images were obtained by using a non-breath-hold, single-shot echo-planar sequence with b values of 50/400/800 s/mm2. Circular regions of interest were drawn in the areas of normal renal parenchyma, nephritis and abscesses. The ADC values of three tissue types were compared by using the paired t-test and ANOVA.P value Results: In our study, areas of normal renal parenchyma showed ADC values of (1.83 ± 0.06) × 10-3 mm2/s while areas of nephritis had ADC values of (1.20 ± 0.08) × 10-3 mm2/s which was significantly lower (P Conclusion: Diffusion weighted MR imaging is useful to diagnose abscess formation in patients with pyelonephritis without using IV contrast medium.

Conservative treatment for cutaneous fistula resulted from abscess formation in patients with tuberculous cervical lymphadenitis

ObjectiveThis study describes the clinical characteristics and course of conservative treatment using anti-Tb medication and dressing in patients with tuberculous cervical fistula resulting from abscess formation, and to investigate factors prognostic of dressing and treatment duration. MethodsThe medical records of patients with tuberculous cervical lymphadenitis were reviewed, and 38 of these patients who presented with cutaneous fistula that resulted from abscess formation were included in the study. ResultsThe mean duration of dressing until fistula closure was 3.7±2.0months (range 0.2–8.5), and the mean duration of treatment with anti-Tb medication was 10.6±2.6months (range 6.0–16.0). Patients with concomitant Tb, beyond the cervical lymph nodes showed significantly prolonged duration of dressing (4.6 months vs. 3.2 months, p=0.025) and anti-Tb medication (11.8 months vs. 9.8 months, p=0.015). ConclusionOur results indicate that about 3.7 months of dressing was required for fistula closure. Tuberculous cervical lymphadenitis patients with fistula who had Tb beyond the cervical lymph nodes could be expected to require dressing for 4.6 months and prolonged and anti-Tb medication treatment.

Risk of liver abscess formation in patients with prior biliary intervention following yttrium-90 radioembolization.

Patients without a competent sphincter of Oddi due to prior surgical or endoscopic therapy are at high risk for liver abscess following chemoembolization despite aggressive antimicrobial prophylaxis. We examined a cohort of such patients undergoing Y-90 resin radioembolization and compared them to a cohort of chemoembolized patients. Review of our quality-assurance database identified 24 radioembolizations performed in 16 patients with prior biliary intervention. An aggressive prophylactic regimen of oral levofloxacin and metronidazole 2 days pre-procedure continuing for 14 days after, oral neomycin/erythromycin bowel prep the day before, and IV levofloxacin/metronidazole the day of treatment was prescribed. Patients underwent resin microsphere radioembolization dosed according to the BSA method. Patients had clinical, imaging, and laboratory assessment 1 month after each treatment, and then every 3 months. The chemoembolization cohort consisted of 13 patients with prior biliary intervention who had undergone 24 chemoembolization procedures. No radioembolization patient developed an abscess. In the cohort of chemoembolized patients who received the same prophylaxis, liver abscess occurred following 3 of 24 (12.5 %) procedures in 3 of 13 (23 %) patients, one fatal. This preliminary experience suggests that the risk of liver abscess among patients with prior biliary intervention may be lower following radioembolization than chemoembolization, which could potentially expand treatment options in this high-risk population.

4:06 PM; Abstract No. 271 - Image guided percutaneous management of abscess formation in patients with duodenal perforation following ERCP

4:06 PM; Abstract No. 271 - Image guided percutaneous management of abscess formation in patients with duodenal perforation following ERCP

Risk factors for liver abscess formation in patients with blunt hepatic injury after non-operative management.

To identify risk factors for liver abscess formation in patients with blunt hepatic injury who underwent non-operative management (NOM). From January 2004 to October 2008, retrospective data were collected from a single level I trauma center. Clinical data, hospital course, and outcome were all extracted from patient medical records for further analysis. A total of 358 patients were enrolled for analysis. There were 13 patients with liver abscess after blunt hepatic injury. Patients with abscess had a significant increase in glutamic oxaloacetic transaminase (GOT, p=0.006) and glutamic pyruvic transaminase (GPT, p<0.0001), and a decrease in arterial blood pH (p=0.023) compared to patients without abscess in the univariate analyses. In addition, high-grade hepatic injury and transarterial embolization (TAE, p<0.001) were also risk factors for liver abscess formation. Five factors (GOT, GPT, pH level in the arterial blood sample, TAE, and high-grade hepatic injury) were included in the multivariate analysis. TAE, high-grade hepatic injury, and GPT level were statistically significant. The odds ratios of TAE and high-grade hepatic injury were 15.41 and 16.08, respectively. A receiver operating characteristic (ROC) analysis was used for GPT, and it suggested cutoff values of 372.5 U/L. A prediction model based on the ROC analysis had 100% sensitivity and 86.7% specificity to predict liver abscess formation in patients with two of the three independent risk factors. TAE, high-grade hepatic injury, and a high GPT level are independent risk factors for liver abscess formation.

Risk factors for abscess formation in patients with superficial cellulitis (erysipelas) of the leg

Superficial cellulitis of the leg (erysipelas) is a frequent skin infection. Abscess formation is the most frequent local complication. Determinants of abscess formation in patients with leg cellulitis have not yet been clearly established. To assess the risk factors for abscess formation in patients with leg cellulitis. The clinical, biological and bacteriological records of all patients referred to the dermatology department of a university hospital for superficial cellulitis of the leg during a 3-year period were retrospectively reviewed. Using univariate and multivariate analysis, patients' main characteristics at baseline were compared between the group of patients who developed abscess and the group who did not. A total of 164 patients (93 female, 71 male), mean age 65±18 years, were included. Abscess occurred in 13 cases (8%). The following general factors were positively associated with abscess formation: male sex, smoking, alcohol abuse and delayed introduction of antibiotic treatment. Based on multivariate analysis, only chronic alcohol abuse [odds ratio (OR) 4·3, 95% confidence interval (CI)1·08-20·57] and delayed antibiotic treatment initiation (OR 1·4, 95% CI 1·02-2·04) remained independently associated with abscess formation. Alcohol abuse and delayed initiation of antibiotic treatment are risk factors for abscess formation in patients with cellulitis of the leg. Patients with these predictors must be monitored carefully for abscess formation.

The effects of irrigation on outcomes in cases of perforated appendicitis in children

IntroductionAppendicitis is the most common indication for urgent abdominal operation in children. Approximately 20%–30% of patients will have a perforation at operation. Intra-abdominal abscess after appendectomy is reported in 3%–20% of patients and adds significantly to hospital stay with increased morbidity and overall cost. Surgical dogma has long advocated for irrigation in the setting of gross pus to prevent abscess formation. MethodsFollowing IRB approval, data were retrospectively collected for children who had undergone appendectomy for perforated appendicitis at one of two children's hospitals over the course of 5 y. Perforation was determined by review of operative notes. All patients had free fluid in their peritoneal cavity evacuated by suction, whereas some of the patients also had their peritoneal cavity irrigated with normal saline. Postoperative intra-abdominal abscess rates were determined based on clinical symptoms and confirmatory radiologic studies. ResultsThere were 99 patients in the suction-only group and 139 in the irrigation group. Standard demographics were relatively similar between the two groups. There were significantly lower rates of intra-abdominal abscess formation (4.0% versus 17.2%, P = 0.002) and wound infection (1.0% versus 8.6%, P = 0.003) in the suction-only group compared with the irrigation group. We further analyzed abscess rates by surgical treatment, either laparoscopic or open appendectomy. There were 85 patients in the laparoscopic group and 152 patients in the open appendectomy group. In this subgroup analysis, there were also significantly lower rates of abscess formation in patients treated with suction only compared with irrigation in the laparoscopic (3.5% versus 18.8%, P = 0.012) and open appendectomy groups (4.2% versus 16.3%, P = 0.036). ConclusionsResults of this retrospective review indicate that a suction-only approach significantly decreased rates of abscess formation and wound infections compared to irrigation in cases of perforated appendicitis in children.

Mo1723 Identification of Risk Factors for Intraabdominal Abscess Formation in Patients With Crohn's Disease

Mo1723 Identification of Risk Factors for Intraabdominal Abscess Formation in Patients With Crohn's Disease

Intracranial abscess after anterior skull base defect: does pneumocephalus play a role?

Intracranial complications of skull base defects are uncommon; however, they can be devastating when they do occur. Often these complications arise suddenly and without warning. Identifying patients at risk for intracranial abscesses may help with early diagnosis and allow for early interventions. We report on 2 patients with traumatic pneumocephalus who developed intracranial abscesses. Our objective was to evaluate these cases and investigate the relationship between the presence of pneumocephalus and the formation of intracranial infection. Data was reviewed on the cases of 2 patients who developed intracranial abscesses after pneumocephalus in the context of skull base defects. Two patients presented to our institution separately with the presence of intracranial abscesses. Both patients had violation of their anterior skull base--one from endoscopic sinus surgery, one from blunt trauma. Both patients had massive pneumocephalus prior to their abscess formation. Intracranial abscess formation, traumatic skull base defects, and massive pneumocephalus are uncommon entities, which may be associated. It may be prudent to have heightened suspicion for the presence of intracranial abscess formation in patients with massive pneumocephalus secondary to anterior skull base trauma.

An evidence-based definition for perforated appendicitis derived from a prospective randomized trial

Purpose Appendicitis is the most common urgent condition in general surgery, and yet there is no evidence-based definition for perforation. Therefore, all retrospective data published on perforated appendicitis are unreliable because of an ill-defined denominator. For approximately 2 years beginning in April 2005, we performed a prospective randomized trial investigating 2 different antibiotic regimens for perforated appendicitis. During this study, we strictly defined perforation as a hole in the appendix or a fecalith in the abdomen. Before this prospective study, perforation was staff surgeon opinion. We investigated the abscess rates in both the perforated and nonperforated appendicitis populations before and during the study to determine if our definition was safe and that there was not an increased risk of abscess formation in patients treated as nonperforated. Methods Records of all patients undergoing laparoscopic appendectomy for appendicitis during the immediate 2 years before using the definition were compared to those treated in the 2 years after the definition was implemented. Interval and incidental appendectomies were ruled out. The postoperative abscess rate (when perforation was not defined) was compared to the abscess rate of those for whom perforation was strictly defined. Results There were 292 patients treated for acute nonperforated appendicitis in the 2 years before the definition and 388 patients after the definition. There were 131 patients treated for perforated appendicitis before the definition and 161 after the definition was implemented. The abscess rate in those with perforated appendicitis increased from 14% to 18% after the definition was used. However, after the definition began to be used, the abscess rate for those patients treated as nonperforated decreased from 1.7% to 0.8%. Conclusions Defining perforation as a hole in the appendix or a fecalith in the abdomen is effective in identifying the patients at risk for postoperative abscess formation. Application of these criteria would allow substantial reduction in therapy for patients with purulent or gangrenous appendicitis who do not possess the same abscess risk. These data outline the first evidence-based definition of perforation.

Utility of diffusion-weighted images using fast asymmetric spin-echo sequences for detection of abscess formation in the head and neck region

The objective of this study was to evaluate the utility of new diffusion-weighted magnetic resonance images (DWI) using fast asymmetric spin-echo (FASE) sequences for the detection of abscess formation in patients with phlegmon in the oral and maxillofacial regions. We compared diffusion-weighted images using FASE sequences with those using the gradient-echo type of echo-planar images (EPI) in 10 control volunteers and 10 patients with phlegmon in the oral and maxillofacial regions. Many kinds of tissues in the oral and maxillofacial regions were relatively well visualized in all subjects on FASE-DWI, but not well on EPI-DWI. Apparent diffusion coefficients calculated from FASE sequences in abscess areas of patients with phlegmon were significantly lower than those in abscess-free areas; however, apparent diffusion coefficients calculated from EPI were not significantly different due to prominent distortion in small sample size study. We could accurately recognize the presence of abscess formation within inflammatory tissue in 5 patients with phlegmon using FASE-DWI. As an additional magnetic resonance examination, FASE-DWI might be useful in the detection of abscess formation in the oral and maxillofacial regions.

Use of Endoscopic Ultrasound to Guide Combination Medical and Surgical Therapy for Patients With Crohnʼs Perianal Fistulas

This study was performed to assess if using endoscopic ultrasound (EUS) to assess and guide combination medical and surgical therapy during fistula healing will lead to a high rate of durable fistula closure and a low or absent incidence of perianal abscess formation in patients with Crohn's perianal fistulas. This is a retrospective analysis of 21 patients who presented with a symptomatic Crohn's perianal fistula. Patients were enrolled in a clinical practice protocol of serial EUS exams. All patients underwent a baseline rectal EUS and were placed on maximal medical treatment with 6-mercaptopurine (6-MP) or azathioprine, Cipro, and infliximab (5 mg/kg at 0, 2, and 6 wk and then every 8 wk). Patients were also assessed at baseline by a colorectal surgeon who was aware of the EUS findings. Seton placement and incision and drainage were performed when appropriate. Serial EUS examinations were performed, and the findings were used to guide therapy (i.e., the presence of fistula healing on EUS was used to guide seton removal, discontinuation of infliximab, and Cipro). In the 21 patients enrolled, the median duration of active perianal symptoms was 9 wks (1-36). 10 patients (48%) had previous perianal surgery and 5 (24%) had received infliximab previously. The fistulas treated included 8 trans-sphincteric, 2 superficial, 3 recto-vaginal, and 7 with multiple and horseshoe fistulas. 13 patients (62%) had associated abscesses at presentation. Eighteen of 21 patients (86%) had complete cessation of drainage initially. Median time to cessation of drainage was 10.6 weeks (range, 4-32 wk). Sixteen of 21 patients (76%) maintained long-term cessation of drainage. The median length of follow-up was 68 weeks (range, 35-101 wk). No abscess developed during treatment in any patient. EUS evidence of persistent fistula activity was seen in 10 patients (48%). Of the 11 patients (52%) in whom EUS showed no persistent fistula activity, 7 (64%) have maintained fistula closure off of infliximab and Cipro. Median duration from last infliximab infusion was 47 weeks (range, 20-80 wk). The remaining 4 patients continued infliximab to maintain remission of their luminal disease. Only 1 patient with a horseshoe fistula showed complete healing on EUS. In conclusion, using EUS to guide therapy for Crohn's perianal fistulas with infliximab, an immunosuppressive, and an antibiotic is associated with a high short and long-term fistula response rate. EUS may identify a subset of patients who can discontinue infliximab without recurrence of fistula drainage.

Burkholderia pseudomallei stimulates low interleukin-8 production in the human lung epithelial cell line A549.

Melioidosis is a life-threatening disease caused by Burkholderia pseudomallei. The lung is the most commonly affected organ, resulting in abscess formation in patients with chronic melioidosis. Previous study has shown that B. pseudomallei was able to invade and multiply in epithelial cells. In the present study, we have demonstrated that B. pseudomallei is able to stimulate interleukin 8 (IL-8) production from the human alveolar lung epithelium cell line A549. However, the level of IL-8 production was significantly lower than when the cells were infected with other Gram-negative bacteria such as Salmonella enterica serovar Typhi (S. typhi) which were used for comparison. The degree of IkappaBalpha degradation in the B. pseudomallei-infected cells was lower than that of the S. typhi-infected cells, suggesting that B. pseudomallei is also a poorer cell activator. Inhibition of B. pseudomallei invasion by cytochalasin D did not interfere with either IL-8 production or IkappaBalpha degradation, indicating that bacterial uptake is not required for the production of this chemokine. Thus, it appears that the signalling initiated by the interaction of B. pseudomallei with the epithelial cell surface is sufficient for epithelial cell activation.