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Sikora A, Johnson J, Velez A, Greene J. Invasive phaeohyphomycosis co-infection with Alternaria spp. and Curvularia spp. in a neutropenic host. J Mycol Med 2024; 34:101497. [PMID: 38991295 DOI: 10.1016/j.mycmed.2024.101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
Phaeohyphomycoses are infections caused by dark-walled dematiaceous fungi. Alternaria and Curvularia are two genera of dematiaceous molds known to cause invasive fungal rhinosinusitis, particularly in immunocompromised patients. Co-infection with two dematiaceous fungi is rarely reported in the literature. This report describes a case of biopsy proven invasive fungal rhinosinusitis with Alternaria spp. and Curvularia spp. co-infection in a neutropenic host. The infection characteristics, microbiologic findings, and treatment are described.
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Affiliation(s)
- Anna Sikora
- Department of Infectious Diseases, University of South Florida Morsani College of Medicine, 1Tampa General Circle G323, Tampa, FL 33606, USA.
| | - Jeffrey Johnson
- Microbiology Department, Moffitt Cancer Center, Tampa, FL, USA
| | - Ana Velez
- Division of Infectious Diseases and Tropical Medicine, Moffitt Cancer Center, Tampa, FL, USA
| | - John Greene
- Division of Infectious Diseases and Tropical Medicine, Moffitt Cancer Center, Tampa, FL, USA
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Fan YH, Shih KY, Wu PW, Huang YL, Lee TJ, Huang CC, Chang PH, Huang CC. Predicting the Probability of the Incidence of Maxillary Sinus Fungus Ball in Patients Using Nomogram Models. Diagnostics (Basel) 2023; 13:3156. [PMID: 37835900 PMCID: PMC10572425 DOI: 10.3390/diagnostics13193156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/06/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Maxillary sinus fungal ball (MSFB) is the most common type of non-invasive fungal rhinosinusitis. Since MSFB requires a unique treatment strategy and is associated with potentially severe complications, timely and precise diagnosis is crucial. Computed tomography (CT) is the first-line imaging tool for evaluating chronic rhinosinusitis. Accordingly, we aimed to investigate the clinical and CT imaging characteristics of MSFB. We retrospectively enrolled 97 patients with unilateral MSFB and 158 with unilateral non-fungal maxillary rhinosinusitis. The clinical characteristics, laboratory data, and CT imaging features of participants were evaluated. Older age, female sex, lower white blood cell and neutrophil counts, and CT imaging features (including an irregular surface, erosion of the medial sinus wall, sclerosis of the lateral sinus wall, and intralesional hyperdensity) were significantly associated with MSFB. The presence of adjacent maxillary odontogenic pathology was associated with a decreased likelihood of the incidence of MSFB in unilateral maxillary rhinosinusitis. Separate nomograms were created for patients, without and with the use of CT scan, to predict the probabilities of MSFB in patients with unilateral maxillary rhinosinusitis. We proposed two nomograms based on the clinical and CT characteristics of patients with MSFB. These could serve as evaluation tools to assist clinicians in determining the need for undergoing CT and facilitate the accurate and timely diagnosis of MSFB.
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Affiliation(s)
- Yu-Hsi Fan
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan (P.-W.W.); (T.-J.L.); (C.-C.H.); (P.-H.C.)
| | - Kai-Yi Shih
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan (P.-W.W.); (T.-J.L.); (C.-C.H.); (P.-H.C.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yen-Lin Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan;
- School of Medicine, National Tsing-Hua University, Hsinchu 300, Taiwan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan (P.-W.W.); (T.-J.L.); (C.-C.H.); (P.-H.C.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen 361028, China
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan (P.-W.W.); (T.-J.L.); (C.-C.H.); (P.-H.C.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan (P.-W.W.); (T.-J.L.); (C.-C.H.); (P.-H.C.)
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan (P.-W.W.); (T.-J.L.); (C.-C.H.); (P.-H.C.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Kumar A, Gupta K, Tyagi AK, Varshney S, Kumar N. Isolated Acute Sphenoid Fungal Sinusitis with Cavernous Sinus Thrombosis: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:987-993. [PMID: 36452689 PMCID: PMC9701963 DOI: 10.1007/s12070-020-02059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022] Open
Abstract
Isolated lesions of the sphenoid sinus are uncommon. Cavernous sinus thrombosis is generally sought due to a systemic disease rather than a local pathology. It may be due to hidden primary pathology like isolated acute sphenoid fungal rhinosinusitis. In present study, we have discussed the early management of such hidden lesions with complication. A retrospective review of 5 cases of isolated acute sphenoidal fungal rhinosinusitis leading to cavernous sinus thrombosis was carried out. All cases were managed as emergency cases. Diagnostic nasal endoscopy was normal in all cases, with sinus disease evident in radiology in only 60% cases. Diagnostic endoscopic sinus surgery was performed in 40% cases. All patients underwent urgent surgical debridement along with IV antifungals. Complete recovery was seen in ocular movements in 40% and partially in 40%, whereas only 25% had complete improvement in vision. While four cases showed favourable outcome, one patient could not be saved despite all efforts. Exploring the sinus in cavernous sinus syndrome or orbital apex syndrome despite non-conclusive imaging, is warranted as early intervention may significantly impact the chances of survival. "Time is vision" in cases with acute fungal sinusitis and is equal to the aphorism of cardiologists i.e. "time is muscle.
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Affiliation(s)
- Amit Kumar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India
| | - Kartikesh Gupta
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India
| | - Saurabh Varshney
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India
| | - Niraj Kumar
- Department of Neurology, All India Institue of Medical Sciences, AIIMS, Rishikesh, Uttarakhand 249201 India
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Burnham AJ, Magliocca KR, Pettitt-Schieber B, Edwards TS, Marcus S, DelGaudio JM, Wise SK, Levy JM, Roland LT. Intermediate Invasive Fungal Sinusitis, a Distinct Entity From Acute Fulminant and Chronic Invasive Fungal Sinusitis. Ann Otol Rhinol Laryngol 2021; 131:1021-1026. [PMID: 34694144 DOI: 10.1177/00034894211052854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The current classification system of invasive fungal sinusitis (IFS) includes acute (aIFS) and chronic (cIFS) phenotypes. Both phenotypes display histopathologic evidence of tissue necrosis, but differ by presence of angioinvasion, extent of necrosis, and disease progression. aIFS is defined by a rapid onset of symptoms, while cIFS slowly progresses over ≥12 weeks. However, a subset of IFS patients do not fit into the clinical presentation and histopathologic characteristics of either aIFS or cIFS. OBJECTIVES To investigate the demographic, clinical, and histopathologic characteristics of a distinct subset of IFS. METHODS Retrospective review of patients with IFS from a single tertiary-care institution (2010-2020). Patients with symptoms for ≤4 weeks were classified as aIFS if they displayed endoscopic evidence of mucosal necrosis or fungal angioinvasion on pathology. Patients with slowly progressive IFS for ≥12 weeks were classified as cIFS. Patients with symptom duration between 4 and 12 weeks with evidence of invasive fungal disease were classified as a new entity and were further investigated. RESULTS Of the 8 patients identified, 50% were immunosuppressed at presentation. The mean symptom duration prior to presentation was 50.5 days (SD 16.8), and common symptoms included facial pain (100%), vision change (87.5%), and blindness (37.5%). Two patients (25%) died of their disease. Sites of fungal involvement confirmed by histopathology included sphenoid (62.5%) and ethmoid sinuses (12.5%), orbital apex (25%), optic nerve (12.5%), pterygopalatine fossa (12.5%), and clivus (12.5%). Fungal elements but without obvious angioinvasion, were identified in all specimens, and fungus balls (50%), granulomas (37.5%), and giant cells (25%) were also observed on histopathology. CT and MRI radiographic imaging showed findings consistent with orbital, intracranial, or skull base involvement in all patients. CONCLUSION We propose intermediate IFS as a new subgroup of patients with IFS who do not fit into the standard classification of aIFS or cIFS.
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Affiliation(s)
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | | | - Thomas S Edwards
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Sonya Marcus
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - John M DelGaudio
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Sarah K Wise
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Joshua M Levy
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Lauren T Roland
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
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Li H, Wu YX, Wang M, Xing ZM, Han L. Comparison Between Multiple and Solitary Fungus Balls: A Retrospective Analysis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP459-NP467. [PMID: 33337251 DOI: 10.1177/0145561320982188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The most common type of noninvasive fungal rhinosinusitis is fungus ball (FB), which usually involves a solitary paranasal sinus. Multiple fungus balls (MFBs) are rarely reported in literature. The purpose of this study was to analyze and compare the clinical features of MFBs and solitary fungus ball (SFB). METHODS We retrospectively investigated consecutive cases of FB between 2001 and 2018 and compared the clinical records of SFB with MFBs with respect to demographics, clinical features, location, radiological findings, and operative outcome. RESULTS A total of 440 SFB and 43 MFBs cases were included in the study. The mean age was 55.3 ± 13.3 and 60.6 ± 10.9 years, respectively (P = .011). The incidence of MFBs obviously increased from 2001 to 2018. The clinical symptoms and laboratory examination were similar. On computed tomography images, complete opacification, septal deviation, Haller cells, and obstruction of ostiomeatal complex were more common (P < .05). The incidence of SFB on the left and right sides was similar, while MFBs were seen to involve both sides in 74.4%. CONCLUSIONS Compared with SFB, MFBs showed some special characteristics. The MFBs affected older patients showed wide range of lesions and complex anatomy. Surgical technique is very important. Much more attention should be paid to this not so uncommon disease during the perioperative period.
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Affiliation(s)
- Hui Li
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Yu-Xiao Wu
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Min Wang
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Zhi-Min Xing
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Lin Han
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
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Humphreys IM, Wandell GM, Miller C, Rathor A, Schmidt RA, Turner JH, Hwang PH, Davis GE. A multi-institutional review of outcomes in biopsy-proven chronic invasive fungal sinusitis. Int Forum Allergy Rhinol 2020; 10:738-747. [PMID: 32282122 DOI: 10.1002/alr.22547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic invasive fungal sinusitis (CIFS) is a rare, life-threatening infection of the nose and sinuses. This study aims to identify factors that impact survival in 1 of the largest cohorts to date. METHODS Pathology records were reviewed for biopsy-proven CIFS from 3 tertiary academic institutions from 1995 to 2016. Variables were analyzed using log-rank survival analysis. Univariate Cox regression was performed at 1 and 12 months. RESULTS Thirty-eight patients were included. Hematologic malignancy and diabetes were the most common underlying diseases (32% each). Aspergillus was the most common fungus (63%). Greater than 75% of the patients had an absolute neutrophil count (ANC) >1000 at the time of diagnosis. Overall survival at 1, 6, and 12 months was 89%, 68%, and 48%, respectively. In univariate analysis, factors associated with worse survival included: ANC <500 at 12 months (hazard ratio [HR] 4.8; p = 0.01), ANC <1000 at 12 months (HR 5.8; p = 0.001), and recent chemotherapy (HR 4; p = 0.01). The following factor was associated with improved survival in univariate analysis: ANC as a linear variable in the entire cohort (HR 0.7; p = 0.005). CONCLUSION We present a multi-institutional case-series of CIFS and long-term follow-up. ANC <1000 at time of diagnosis and recent chemotherapy (within 1 month of diagnosis) are associated with poorer survival, whereas a rising ANC >1000 is associated with improved survival at 12 months. Further prospective studies are needed to further define factors that affect outcomes.
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Affiliation(s)
- Ian M Humphreys
- Department of Otolaryngology, University of Washington, Seattle, WA
| | - Grace M Wandell
- Department of Otolaryngology, University of Washington, Seattle, WA
| | - Craig Miller
- Department of Otolaryngology, University of Washington, Seattle, WA
| | | | | | - Justin H Turner
- Department of Otolaryngology, Vanderbilt University, Nashville, TN
| | - Peter H Hwang
- Department of Otolaryngology, Stanford University, Stanford, CA
| | - Greg E Davis
- Department of Otolaryngology, University of Washington, Seattle, WA
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Seo MY, Seok H, Lee SH, Choi JE, Hong SD, Chung SK, Peck KR, Kim HY. Microinvasive Fungal Rhinosinusitis: Proposal of a New Subtype in the Classification. J Clin Med 2020; 9:jcm9020600. [PMID: 32102265 PMCID: PMC7074386 DOI: 10.3390/jcm9020600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Fungal rhinosinusitis (FRS) with mucosal invasion is not classified by the current criteria, and clinical reports on the topic are limited. The aim of this study was to present our 25-year experience on fungal balls with mucosal invasion that do not appear in the FRS classification. METHODS Of 1318 patients who underwent endoscopic surgery with paranasal FRS between November 1994 and July 2019, 372 underwent mucosal biopsies. Medical chart and pathology review were performed on 13 patients diagnosed as having fungal balls with mucosal invasion without accompanying tissue invasion. RESULTS Histopathologic findings identified all fungi as belonging to the Aspergillus species. In 13 patients, 7 fungal balls were located in the maxillary sinus, 3 in the sphenoid sinus, and 3 in both the maxillary and ethmoid sinuses. The median age at diagnosis was 67 years (interquartile range (IQR): 62-72), and the sex ratio was 1:2 (4 men and 9 women). Five patients had comorbidities-three with diabetes mellitus and two with hematologic malignancy-all of whom received postoperative antifungal therapy. The median duration of antifungal treatment was 13 weeks (IQR: 8-17). No recurrences occurred during the median follow-up period of 30 months (IQR: 22-43). CONCLUSIONS Patients who have been clinically diagnosed with a fungal ball and showed mucosal invasion but no vascular invasion, based on pathologic findings after surgery, may need a new FRS classification category, such as microinvasive FRS, and adjuvant antifungal treatment may be needed for immunocompromised patients with microinvasive FRS. KEY POINTS Fungal rhinosinusitis with mucosal invasion is different from fungal ball and invasive fungal rhinosinusitis and may be classified in a separate category as microinvasive FRS.
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Affiliation(s)
- Min Young Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan 15355, Korea; (M.Y.S.); (S.H.L.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.E.C.); (S.D.H.); (S.-K.C.)
| | - Hyeri Seok
- Division of Infectious Diseases, Department of Medicine, Korea University College of Medicine, Korea University Ansan Hospital, Ansan 15355, Korea;
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Seung Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan 15355, Korea; (M.Y.S.); (S.H.L.)
| | - Ji Eun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.E.C.); (S.D.H.); (S.-K.C.)
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.E.C.); (S.D.H.); (S.-K.C.)
| | - Seung-Kyu Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.E.C.); (S.D.H.); (S.-K.C.)
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.E.C.); (S.D.H.); (S.-K.C.)
- Correspondence: ; Tel.: +82-2-3410-3579; Fax: +82-2-3410-3879
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Tsetsou S, Fowkes M, Lee M, Shrivastava R, Dangayach NS. Cerebral Fungal Abscess in an Immunocompetent Patient. Neurohospitalist 2019; 10:145-147. [PMID: 32373281 DOI: 10.1177/1941874419870985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Spyridoula Tsetsou
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mikyung Lee
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Neha S Dangayach
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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