As reservoirs for intracellular bacteria during the acute tissue infection. the data suggest that this could be a mechanism to avoid antibiotic eradication, which might explain why a high bacterial load was present even in tissues collected after prolonged intravenous antibiotic therapy. the authors also note that the localization of gas varied and depended on the severity of tissue infection; intracellular localization was most frequent in noninfl amed tissue, which also had a low bacterial load. osterlund’s study had already shown that intracellular gas was present in pharyngeal epithelial and macrophage-like cells of patients with tonsillitis. however, the current study by thulin and colleagues shows for the fi rst time that this occurred in vivo during severe invasive gas soft-tissue infections in humans, even while patients are on antibiotic therapy. the theoretical implication of this study is that if intracellular bacteria are most commonly found in newly involved tissue with low infl ammation and low bacterial load, it might be the case that internalization could promote the spread of bacteria within the tissue. this so-called trojan horse approach is also seen in the fi sh, and sometimes human, pathogen streptococcus iniae , which invades macrophage-like cells in a similar way. studies are currently exploring whether this also occurs in gas soft-tissue infections. but in any case, the clinical implication of this fi nding is that alternate therapies will be required if clinicians are going to improve the morbidity and mortality associated with severe gas soft-tissue infections