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Schematic involvement of the TTSS in a self-propagating pathogenic cycle. The TTSS is associated with acute lung injury through different mechanisms, including an enhancement of the proinflammatory response and a decrease in the number of alveolar neutrophils, both of which lead to impaired bacterial clearance from the lungs and a higher mortality rate. The darkly stained neutrophils may have been killed through a TTSS-dependent mechanism.
