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Wang L, Luo Y, Li X, Li Y, Xia Y, He T, Huang Y, Xu Y, Yang Z, Ling J, Weng R, Zhu X, Qi Z, Yang J. Talaromyces marneffei Infections in 8 Chinese Children with Inborn Errors of Immunity. Mycopathologia 2022; 187:455-467. [PMID: 36180657 PMCID: PMC9524311 DOI: 10.1007/s11046-022-00659-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/12/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Talaromyces marneffei (TM) is an opportunistic fungus leading to multi-organ damages and poor prognosis in immunocompromised individuals. TM infections in children are rare and our knowledge to TM infection is insufficient. To investigate the clinical characteristics of TM-infected children and to explore the underlying mechanisms for host against TM, we analysed TM-infected patients diagnosed in our hospital. METHODS Eight patients with TM infections have been identified in Shenzhen Children's Hospital during 2017-2021. Clinical data were collected from medical records. Immunological features were evaluated by flow cytometry. Literatures were also reviewed to summarize the reported inborn errors of immunity (IEIs) with TM infections. RESULTS All 8 children were HIV-negative. The most common symptom of TM infections was fever (8/8), followed by weight loss (7/8), pneumonia (7/8), hepatomegaly (7/8), splenomegaly (6/8), anemia (6/8), lymphadenopathy (5/8), thrombocytopenia (3/8), diarrhea (3/8), rashes or skin lesions (3/8), and osteolytic lesions (1/8). Five children died during the follow-ups. CD3+ T cells were decreased in 6 patients. Eight patients had reduced natural killer cells. All patients went gene sequencing and were finally diagnosed as IEIs, including STAT1 gain-of-function, IL-2 receptor common gamma chain deficiency, adenosine deaminase deficiency, CD40 ligand deficiency, and STAT3 deficiency. Another 4 types of IEIs (CARD9, IFN-γ receptor 1, RelB, and NFKB2 deficiency), have been reported with TM infections based on literature review. CONCLUSION TM infections resulted in systemic injuries and high mortality. The spectrum of IEIs underlying TM infections indicated that T cell-mediated immunity, IFN-γ, IL-17 signalings and NF-κB pathways were important for host responses against TM infection. In reverse, for HIV-negative children without other secondary immunodeficiencies, IEIs should be considered in TM-infected children.
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Affiliation(s)
- Linlin Wang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
- Shenzhen Institute of Pediatrics, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Ying Luo
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Xiaolin Li
- Department of Pediatric Rheumatology and Immunology, Zhongshan Boai Hospital Affiliated to Southern Medical University, Zhongshan, 528403, China
| | - Yixian Li
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Yu Xia
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Tingyan He
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Yanyan Huang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Yongbin Xu
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Zhi Yang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Jiayun Ling
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Ruohang Weng
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Xiaona Zhu
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Zhongxiang Qi
- Shenzhen Institute of Pediatrics, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China
| | - Jun Yang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, 7019 Yitian Road, Shenzhen, 518026, China.
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2
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Bunmaprasert T, Munpinit M, Sugandhavesa N, Liawrungrueang W. Talaromycosis marneffei of the Cervical Spine: An Unusual Infection. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202106000-00009. [PMID: 34106903 DOI: 10.5435/jaaosglobal-d-21-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/13/2021] [Indexed: 06/12/2023]
Abstract
Talaromyces marneffei infection (TMI) causing vertebral osteomyelitis of the cervical spine is extremely rare. TMI in an HIV-uninfected patient is also unusual. This report presents the successful treatment of an HIV-uninfected TMI patient who underwent C6 and T1 vertebrectomies, bone grafting, and anterior cervical plating accompanied by antifungal therapy. A 63-year-old woman was diagnosed with adult-onset immune deficiency. She suddenly developed progressive neck pain without neurologic deficit. The plain radiographs and magnetic resonance imaging showed inflammation and abscess formation along the prevertebral area from C3-4 to T2-3 with vertebral body destruction. Intraoperative pus culture and tissue specimens were determined to be T marneffei. The patient was treated intravenously with amphotericin B deoxycholate for 4 weeks (0.6 mg/kg/d) and oral itraconazole (400 mg/d) for 12 months. Over a 2 consecutive year follow-up period, she achieved a full recovery with an absence of neck pain.
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Affiliation(s)
- Torphong Bunmaprasert
- From the Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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3
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Tun N, Mclean A, Deed X, Hlaing M, Aung Y, Wilkins E, Ashley E, Smithuis F. Is stopping secondary prophylaxis safe in HIV-positive talaromycosis patients? Experience from Myanmar. HIV Med 2020; 21:671-673. [PMID: 32741092 PMCID: PMC7590157 DOI: 10.1111/hiv.12921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Abstract
Objectives The aim of the study was to determine whether it is safe to stop secondary prophylaxis in patients with talaromycosis after immune reconstitution with a sustained increase in CD4 count to ≥ 100 cells/µL after antiretroviral therapy (ART). Methods A retrospective cohort analysis was performed in HIV‐infected patients treated for talaromycosis between June 2009 and June 2017 in Medical Action Myanmar (MAM) clinics. Results Among a cohort of 5466 HIV‐infected patients, 41 patients were diagnosed with and treated for clinical talaromycosis. All the patients were on ART and had a CD4 count < 100 cells/µL. Of these 41 patients, 24 patients (71%) were skin smear positive for talaromycosis, while results were negative in 17 patients. Median CD4 count and haemoglobin concentration were 24 cells/µL and 7.7 g/dL, respectively. Seventy‐three per cent (30) were male. Among the 41 patients, 11 (27%) died and six (15%) were transferred to other centres. Twenty‐four patients (58% of the total diagnosed) stopped itraconazole secondary prophylaxis after starting active ART with CD4 counts > 100 cells/µL for at least 1 year. Throughout the duration of follow‐up post itraconazole cessation, the observed incidence of relapse was zero with a total follow‐up of 93.8 person‐years (95% confidence interval 0–4 per 100 person‐years). The median (25th, 75th percentile) duration of follow‐up post‐prophylaxis discontinuation was 2.8 (2.1, 6.3) years. Conclusions Secondary prophylaxis can be safely stopped in patients with talaromycosis after immune reconstitution with a sustained increase in CD4 count to ≥ 100 cells/µL after highly active antiretroviral therapy.
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Affiliation(s)
- N Tun
- Medical Action Myanmar, Yangon, Myanmar.,Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - A Mclean
- Medical Action Myanmar, Yangon, Myanmar.,Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - X Deed
- Medical Action Myanmar, Yangon, Myanmar
| | - M Hlaing
- Medical Action Myanmar, Yangon, Myanmar
| | - Y Aung
- Medical Action Myanmar, Yangon, Myanmar
| | - E Wilkins
- North Manchester, Infectious Diseases Crumpsall Manchester, Manchester, UK
| | - E Ashley
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Centre for Tropical Medicine and Global Health Oxford, Oxford University, Oxfordshire, UK
| | - F Smithuis
- Medical Action Myanmar, Yangon, Myanmar.,Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Centre for Tropical Medicine and Global Health Oxford, Oxford University, Oxfordshire, UK
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4
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Le T, Adenis A, Limper A, Harrison T. Itraconazole and antiretroviral therapy: strategies for empirical dosing - Author's reply. THE LANCET. INFECTIOUS DISEASES 2017; 17:1123-1124. [PMID: 29115263 DOI: 10.1016/s1473-3099(17)30582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Thuy Le
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, France
| | | | - Thomas Harrison
- Institute of Infection and Immunity, St George's, University of London, London SW17 ORE, UK.
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5
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Kulkarni S, Jadhav S, Khopkar P, Sane S, Londhe R, Chimanpure V, Dhilpe V, Ghate M, Yelagate R, Panchal N, Rahane G, Kadam D, Gaikwad N, Rewari B, Gangakhedkar R. GeneXpert HIV-1 quant assay, a new tool for scale up of viral load monitoring in the success of ART programme in India. BMC Infect Dis 2017; 17:506. [PMID: 28732472 PMCID: PMC5521114 DOI: 10.1186/s12879-017-2604-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/17/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Recent WHO guidelines identify virologic monitoring for diagnosing and confirming ART failure. In view of this, validation and scale up of point of care viral load technologies is essential in resource limited settings. METHODS A systematic validation of the GeneXpert® HIV-1 Quant assay (a point-of-care technology) in view of scaling up HIV-1 viral load in India to monitor the success of national ART programme was carried out. Two hundred nineteen plasma specimens falling in nine viral load ranges (<40 to >5 L copies/ml) were tested by the Abbott m2000rt Real Time and GeneXpert HIV-1 Quant assays. Additionally, 20 seronegative; 16 stored specimens and 10 spiked controls were also tested. Statistical analysis was done using Stata/IC and sensitivity, specificity, PPV, NPV and %misclassification rates were calculated as per DHSs/AISs, WHO, NACO cut-offs for virological failure. RESULTS The GeneXpert assay compared well with the Abbott assay with a higher sensitivity (97%), specificity (97-100%) and concordance (91.32%). The correlation between two assays (r = 0.886) was statistically significant (p < 0.01), the linear regression showed a moderate fit (R2 = 0.784) and differences were within limits of agreement. Reproducibility showed an average variation of 4.15 and 3.52% while Lower limit of detection (LLD) and Upper limit of detection (ULD) were 42 and 1,740,000 copies/ml respectively. The misclassification rates for three viral load cut offs were not statistically different (p = 0.736). All seronegative samples were negative and viral loads of the stored samples showed a good fit (R2 = 0.896 to 0.982). CONCLUSION The viral load results of GeneXpert HIV-1 Quant assay compared well with Abbott HIV-1 m2000 Real Time PCR; suggesting its use as a Point of care assay for viral load estimation in resource limited settings. Its ease of performance and rapidity will aid in timely diagnosis of ART failures, integrated HIV-TB management and will facilitate the UNAIDS 90-90-90 target.
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Affiliation(s)
- Smita Kulkarni
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India.
| | - Sushama Jadhav
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Priyanka Khopkar
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Suvarna Sane
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Rajkumar Londhe
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Vaishali Chimanpure
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Veronica Dhilpe
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Manisha Ghate
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Rajendra Yelagate
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Narayan Panchal
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Girish Rahane
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Dilip Kadam
- Byramjee Jeejeebhoy Medical College (BJMC), Sassoon General Hospital, Jai Prakash Narayan Road, Near Pune Railway Station, Pune, Maharashtra, 411001, India
| | - Nitin Gaikwad
- Yashwantrao Chavan Memorial Hospital (YCM), No.476/2692, Sant Tukaram Nagar, Pimpri, Pimpri-Chinchwad, Pune, Maharashtra, 411018, India
| | - Bharat Rewari
- World Health Organization (WHO) Country office for India, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi, Delhi, 110002, India
| | - Raman Gangakhedkar
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
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6
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Wang RJ, Miller RF, Huang L. Approach to Fungal Infections in Human Immunodeficiency Virus-Infected Individuals: Pneumocystis and Beyond. Clin Chest Med 2017; 38:465-477. [PMID: 28797489 DOI: 10.1016/j.ccm.2017.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Many fungi cause pulmonary disease in patients with human immunodeficiency virus (HIV) infection. Pathogens include Pneumocystis jirovecii, Cryptococcus neoformans, Aspergillus spp, Histoplasma capsulatum, Coccidioides spp, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Talaromyces marneffei, and Emmonsia spp. Because symptoms are frequently nonspecific, a high index of suspicion for fungal infection is required for diagnosis. Clinical manifestations of fungal infection in HIV-infected patients frequently depend on the degree of immunosuppression and the CD4+ helper T cell count. Establishing definitive diagnosis is important because treatments differ. Primary and secondary prophylaxes depend on CD4+ helper T cell counts, geographic location, and local prevalence of disease.
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Affiliation(s)
- Richard J Wang
- Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Robert F Miller
- Research Department of Infection and Population Health, Institute of Global Health, University College London, Gower Street, London WC1E 6BT, UK; Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London WC1E 7HT, UK
| | - Laurence Huang
- Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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7
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Thanh NT, Vinh LD, Liem NT, Shikuma C, Day JN, Thwaites G, Le T. Clinical features of three patients with paradoxical immune reconstitution inflammatory syndrome associated with Talaromyces marneffei infection. Med Mycol Case Rep 2016; 19:33-37. [PMID: 29379703 PMCID: PMC5775071 DOI: 10.1016/j.mmcr.2016.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 11/08/2022] Open
Abstract
Talaromyces marneffei infection is a major cause of death in HIV-infected individuals in South and Southeast Asia. Talaromycosis immune reconstitution inflammatory syndrome has not been well described. Here we report the clinical features, management, and outcomes of three HIV-infected patients with talaromycosis-associated paradoxical immune reconstitution inflammatory syndrome in Ho Chi Minh City, Vietnam.
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Affiliation(s)
- Nguyen Tat Thanh
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
| | - Le Duc Vinh
- Vietnam Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
| | - Nguyen Thanh Liem
- Vietnam Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
| | - Cecilia Shikuma
- Hawaii Center for AIDS, University of Hawaii at Manoa, 651 Ilalo St., BSB, Suite 231, Honolulu, HI 96813, USA
| | - Jeremy N Day
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford OX3 7FZ, UK
| | - Guy Thwaites
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford OX3 7FZ, UK
| | - Thuy Le
- Oxford University Clinical Research Unit, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford OX3 7FZ, UK.,Hawaii Center for AIDS, University of Hawaii at Manoa, 651 Ilalo St., BSB, Suite 231, Honolulu, HI 96813, USA
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8
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Panapruksachat S, Iwatani S, Oura T, Vanittanakom N, Chindamporn A, Niimi K, Niimi M, Lamping E, Cannon RD, Kajiwara S. Identification and functional characterization of Penicillium marneffei pleiotropic drug resistance transporters ABC1 and ABC2. Med Mycol 2016; 54:478-91. [PMID: 26782644 DOI: 10.1093/mmy/myv117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 12/18/2015] [Indexed: 11/14/2022] Open
Abstract
Penicilliosis caused by the dimorphic fungus Penicillium marneffei is an endemic, AIDS-defining illness and, after tuberculosis and cryptococcosis, the third most common opportunistic infection of AIDS patients in tropical Southeast Asia. Untreated, patients have poor prognosis; however, primary amphotericin B treatment followed by prolonged itraconazole prophylaxis is effective. To identify ATP-binding cassette (ABC) transporters that may play a role in potential multidrug resistance of P. marneffei, we identified and classified all 46 P. marneffei ABC transporters from the genome sequence. PmABC1 and PmABC2 were most similar to the archetype Candida albicans multidrug efflux pump gene CDR1. P. marneffei Abc1p (PmAbc1p) was functionally expressed in Saccharomyces cerevisiae, although at rather low levels, and correctly localized to the plasma membrane, causing cells to be fourfold to eightfold more resistant to azoles and many other xenobiotics than untransformed cells. P. marneffei Abc2p (PmAbc2p) was expressed at similarly low levels, but it had no efflux activity and did not properly localize to the plasma membrane. Interestingly, PmAbc1p mislocalized and lost its transport activity when cells were shifted to 37 °C. We conclude that expression of PmAbc1p in S. cerevisiae confers resistance to several xenobiotics indicating that PmAbc1p may be a multidrug efflux pump.
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Affiliation(s)
| | - Shun Iwatani
- Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Japan
| | - Takahiro Oura
- Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Japan
| | | | | | - Kyoko Niimi
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, New Zealand
| | - Masakazu Niimi
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, New Zealand
| | - Erwin Lamping
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, New Zealand
| | - Richard D Cannon
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, New Zealand
| | - Susumu Kajiwara
- Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Japan
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9
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Llibre JM, Walmsley S, Gatell JM. Backbones versus core agents in initial ART regimens: one game, two players. J Antimicrob Chemother 2016; 71:856-61. [PMID: 26747092 DOI: 10.1093/jac/dkv429] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The advances seen in ART during the last 30 years have been outstanding. Treatment has evolved from the initial use of single agents as monotherapy. The ability to use HIV RNA as a surrogate marker for clinical outcomes allowed the more rapid evaluation of new therapies. This led to the understanding that triple-drug regimens, including a core agent (an NNRTI or a boosted PI) and two NRTIs, are optimal. These combinations have demonstrated continued improvements in their efficacy and toxicity as initial therapy. However, the need for pharmacokinetic boosting, with potential drug-drug interactions, or residual issues of efficacy or toxicity have persisted for some agents. Most recently, integrase strand transfer inhibitors, particularly dolutegravir, have shown unparalleled safety and efficacy and are currently the core agents of choice. Regimens that included only core agents or only backbone agents have not been as successful as combined therapy in antiretroviral-naive patients. It appears that at least one NRTI is needed for optimal performance and lamivudine and emtricitabine may be the ideal candidates. Several studies are ongoing of agents with longer dosing intervals, lower cost and new NRTI-saving strategies to address unmet needs.
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Affiliation(s)
- Josep M Llibre
- HIV Unit and 'Lluita contra la SIDA' Foundation, University Hospital Germans Trias I Pujol, Badalona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sharon Walmsley
- Infectious Diseases, University Health Network, University of Toronto, Toronto, Canada
| | - Josep M Gatell
- Infectious Diseases & AIDS Units, Hospital Clinic/IDIBAPS, University of Barcelona, Barcelona, Spain
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10
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Son VT, Khue PM, Strobel M. Penicilliosis and AIDS in Haiphong, Vietnam: evolution and predictive factors of death. Med Mal Infect 2014; 44:495-501. [PMID: 25391487 DOI: 10.1016/j.medmal.2014.09.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/05/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The study objective was to assess the lethality rates and the predictive factors for death in AIDS patients infected by Penicillium marneffei (Pm) in Hai Phong, Vietnam. METHODS A retrospective cohort study was conducted by reviewing 103 medicals records of confirmed cases from June 2006 to August 2009. RESULTS Penicilliosis-related mortality was very high (33%). The majors risk factors of death were: (i) patient lacking complete treatment, a regimen with both of secondary prophylaxis by itraconazole and HAART (OR=52.2, P<0.001); (ii) patients having received only secondary prophylaxis (OR=21.2, P<0.001); (iii) patients coinfected by hepatitis C (OR=2.3, P=0.02) and tuberculosis (OR=1.97, P=0.04). Penicilliosis occurred in 28 cases after initiation of ART, probably caused by IRIS, with the same signs and symptoms as "common" penicilliosis. However, the diagnosis of IRIS was ruled out because the viral load could not be assessed. CONCLUSIONS Penicilliosis is very frequent in the North of Vietnam. A good compliance to a complete treatment with healing antifungal (Amphotericin B) then secondary prophylaxis (Itraconazole) associate with ART, prolongs survival, prevents relapse, and also allows discontinuing a secondary prophylaxis in a half of the cases.
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Affiliation(s)
- V T Son
- Institut francophone pour la médecine tropicale, rue Samsènethai, BP 9519, Vientiane, Lao Democratic People's Republic
| | - P M Khue
- Université de médecine et de pharmacie de Haiphong, 72A, Nguyen Binh Khiem, Ngo Quyen, Hai Phong, Viet Nam.
| | - M Strobel
- Institut francophone pour la médecine tropicale, rue Samsènethai, BP 9519, Vientiane, Lao Democratic People's Republic
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11
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Ding CH, Tzar MN, Rahman MM, Muttaqillah NAS, Redzuan SRM, Periyasamy P. Paecilomyces lilacinus fungaemia in an AIDS patient: the importance of mycological diagnosis. Pak J Med Sci 2014; 30:914-6. [PMID: 25097544 PMCID: PMC4121725 DOI: 10.12669/pjms.304.4937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/02/2014] [Accepted: 04/12/2014] [Indexed: 11/15/2022] Open
Abstract
Fungaemia due to Paecilomyces lilacinus is generally not considered in AIDS patients because this condition is not categorised as an AIDS-indicator illness. We report a case of a 25-year-old lady who presented to our hospital with Guillain-Barré Syndrome, with the subsequent development of refractory fungaemia, multi-organ failure and disseminated intravascular coagulopathy. Amphotericin B was given as empirical antifungal therapy. HIV screening was reactive and Paecilomyces lilacinus was isolated from her blood. The fungaemia did not resolve after one week of amphotericin B treatment. The addition of itraconazole was also unsuccessful in clearing the fungaemia. Accurate mycological diagnosis is important in the care of AIDS patients with fungaemia because of the risk of treatment failure with empirical therapy.
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Affiliation(s)
- Chuan Hun Ding
- Chuan Hun Ding, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Mohd Nizam Tzar
- Mohd Nizam Tzar, Department of Medical Microbiology & Immunology, v Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Md Mostafizur Rahman
- Md Mostafizur Rahman, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Najihan Abdul Samat Muttaqillah
- Najihan Abdul Samat Muttaqillah, Department of Medical Microbiology & Immunology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Shazatul Reza Mohd Redzuan
- Shazatul Reza Mohd Redzuan, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Petrick Periyasamy, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
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Chaiwarith R, Praparattanapan J, Nuntachit N, Kotarathitithum W, Supparatpinyo K. Discontinuation of primary and secondary prophylaxis for opportunistic infections in HIV-infected patients who had CD4+ cell count <200 cells/mm(3) but undetectable plasma HIV-1 RNA: an open-label randomized controlled trial. AIDS Patient Care STDS 2013; 27:71-6. [PMID: 23373662 DOI: 10.1089/apc.2012.0303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract The CDC recommends discontinuing opportunistic infections (OIs) prophylaxis in HIV-infected patients who have CD4+ cell count >200 cells/mm(3) after receiving combination antiretroviral therapy (cART). A prospective randomized controlled trial was conducted at Chiang Mai University Hospital from June 1, 2009 to January 31, 2012 in 74 adult HIV-infected patients who had received cART and had CD4+ cell count <200 cells/mm(3) but plasma HIV-1 RNA<50 copies/ml. Forty-three patients (58.1%) were male and the mean age was 41.8±8.1 years; 68 (91.9%) and 59 (79.7%) patients were receiving co-trimoxazole and antifungal prophylaxis, respectively. The median CD4+ cell counts at enrollment were 142 (IQR 108, 161) and 158 (IQR 141, 176) cells/mm(3) among patients who discontinued and continued OIs prophylaxis, respectively (p value=0.041). One of 37 patients (2.7%) in the discontinuation group developed Pneumocystis jiroveci pneumonia, giving the incidence rate of 1.57/1000 person-months. None of the 37 patients in the continuation group developed OIs. The difference in the prevention rates of OIs between groups was -2.7% (95% CI -7.9, 2.5). In conclusion, in the setting where plasma HIV-RNA measurement is available, e.g., Asia-Pacific region, discontinuation of prophylaxis is considerably safe in HIV-infected patients receiving cART with undetectable plasma HIV-RNA but incomplete immune recovery.
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Affiliation(s)
- Romanee Chaiwarith
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Nontakan Nuntachit
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wilai Kotarathitithum
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Khuanchai Supparatpinyo
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Research Institutes for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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Chitasombat M, Supparatpinyo K. Penicillium marneffei Infection in Immunocompromised Host. CURRENT FUNGAL INFECTION REPORTS 2012. [DOI: 10.1007/s12281-012-0119-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Sudjaritruk T, Sirisanthana T, Sirisanthana V. Immune reconstitution inflammatory syndrome from Penicillium marneffei in an HIV-infected child: a case report and review of literature. BMC Infect Dis 2012; 12:28. [PMID: 22289885 PMCID: PMC3285031 DOI: 10.1186/1471-2334-12-28] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 01/31/2012] [Indexed: 01/31/2023] Open
Abstract
Backgrounds Disseminated Penicillium marneffei infection is one of the most common HIV-related opportunistic infections in Southeast Asia. Immune reconstitution inflammatory syndrome (IRIS) is a complication related to antiretroviral therapy (ART)-induced immune restoration. The aim of this report is to present a case of HIV-infected child who developed an unmasking type of IRIS caused by disseminated P. marneffei infection after ART initiation. Case presentation A 14-year-old Thai HIV-infected girl presented with high-grade fever, multiple painful ulcerated oral lesions, generalized non-pruritic erythrematous skin papules and nodules with central umbilication, and multiple swollen, warm, and tender joints 8 weeks after ART initiation. At that time, her CD4+ cell count was 7.2% or 39 cells/mm3. On admission, her repeated CD4+ cell count was 11% or 51 cells/mm3 and her plasma HIV-RNA level was < 50 copies/mL. Her skin biopsy showed necrotizing histiocytic granuloma formation with neutrophilic infiltration in the upper and reticular dermis. Tissue sections stained with hematoxylin and eosin (H&E), periodic acid-Schiff (PAS), and Grocott methenamine silver (GMS) stain revealed numerous intracellular and extracellular, round to oval, elongated, thin-walled yeast cells with central septation. The hemoculture, bone marrow culture, and skin culture revealed no growth of fungus or bacteria. Our patient responded well to intravenous amphotericin B followed by oral itraconazole. She fully recovered after 4-month antifungal treatment without evidence of recurrence of disease. Conclusions IRIS from P. marneffei in HIV-infected people is rare. Appropriate recognition and properly treatment is important for a good prognosis.
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Affiliation(s)
- Tavitiya Sudjaritruk
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, 50200 Chiang Mai, Thailand
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Penicillium marneffei Infection: Knowledge, Gaps, and Future Directions. CURRENT FUNGAL INFECTION REPORTS 2011. [DOI: 10.1007/s12281-011-0067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Wong SYN, Wong KF. Penicillium marneffei Infection in AIDS. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:764293. [PMID: 21331327 PMCID: PMC3038620 DOI: 10.4061/2011/764293] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 01/06/2011] [Indexed: 11/20/2022]
Abstract
Penicillium marneffei is a dimorphic fungus which is endemic in Southeast Asia. It is an opportunistic pathogen which has emerged to become an AIDS-defining illness in the endemic areas. Early diagnosis with prompt initiation of treatment is crucial for its management. Prompt diagnosis can often be established through careful cytological and histological examination of clinical specimens although microbiological culture remains the gold standard for its diagnosis. Standard antifungal treatment for AIDS patients with penicilliosis is well established. Highly active antiretroviral therapy should be started early together with the antifungal treatment. Special attention should be paid to potential drug interaction between antiretroviral and antifungal treatments. Secondary prophylaxis may be discontinued with a low risk of relapse of the infection once the immune dysfunction has improved.
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Affiliation(s)
- Stephenie Y N Wong
- Department of Pathology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
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Vu Hai V, Ngo A, Ngo V, Nguyen Q, Massip P, Delmont J, Strobel M, Buisson Y. La pénicilliose au Vietnam : une série de 94 cas. Rev Med Interne 2010; 31:812-8. [DOI: 10.1016/j.revmed.2010.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 07/19/2010] [Accepted: 07/27/2010] [Indexed: 10/19/2022]
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Abstract
Fungal pulmonary infections are becoming more prevalent as a consequence of the rising prevalence of immunocompromised patients. Besides ubiquitous opportunistic fungi such as Aspergillus spp and geographically delimited mycoses, fungi that were previously thought to be of uncertain pathogenicity, such as hyaline and dematiaceous molds, are increasingly being diagnosed as the causes of invasive disease in profoundly immunosuppressed hosts. Overall progress in the clinical management of fungal pulmonary infections has been slow compared with other areas of infectious diseases. However, recent encouraging advances in fungal diagnostics and therapeutics have resulted in improved clinical outcomes, particularly in vulnerable patient populations such as solid organ or allogeneic hematopoietic stem cell transplant recipients. This article provides an overview of endemic mycoses and other emerging fungal pulmonary infections. Recent developments in terms of the diagnosis and clinical management of these infections are also discussed.
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Affiliation(s)
- Li Yang Hsu
- Department of Medicine, National University Health System, Singapore 119074, Singapore.
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Ho A, Shankland GS, Seaton RA. Penicillium marneffei infection presenting as an immune reconstitution inflammatory syndrome in an HIV patient. Int J STD AIDS 2010; 21:780-2. [DOI: 10.1258/ijsa.2010.010164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe a case of Penicillium marneffei infection acquired in Thailand, manifesting as an immune reconstitution inflammatory syndrome (IRIS) in a Caucasian man with advanced HIV-related immunosuppression (CD4 72 cells/mm3). Initial presentation was consistent with Pneumocystis jirovecii pneumonia, and empirical co-trimoxazole resulted in clinical improvement. One month after initiating antiretroviral therapy (ART), an enlarging scaly lesion on his forehead and erythematous nodules on his face, trunk and limbs developed. P. marneffei was isolated from a skin aspirate. Response to antifungal therapy was complicated by drug interactions but cure was complete after four months of treatment. Few cases of IRIS associated with P. marneffei have been reported.
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Affiliation(s)
- A Ho
- The Infection, Tropical Medicine and Counselling Services, Brownlee Centre, Gartnavel General Hospital
| | | | - R A Seaton
- The Infection, Tropical Medicine and Counselling Services, Brownlee Centre, Gartnavel General Hospital
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Pongpom M, Vanittanakom N. Characterization of an MPLP6, a gene coding for a yeast phase specific, antigenic mannoprotein in Penicillium marneffei. Med Mycol 2010; 49:32-9. [PMID: 20608782 DOI: 10.3109/13693786.2010.496796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A gene encoding an antigenic mannoprotein of Penicillium marneffei, MPLP6, was isolated by an antibody screening approach and characterized. The polypeptide chain containing deduced 220 amino acids has a predicted molecular mass of 24 kDa. It has high similarity to Mp1p, the first mannoprotein antigen isolated from P. marneffei. The polypeptide sequence presents the property of cell wall mannoproteins by containing a putative N-terminal signal peptide and potential O-linked glycosylation sites. However, absence of a GPI-anchored signal sequence suggested that this protein is secreted. The MPLP6 transcript was present specifically in the pathogenic yeast form. The transcript was completely absent in the mold phase and conidia. The fusion protein produced in E. coli was Western immunoblotted with P. marneffei-infected human sera and 95% of the patients' sera were positive in the assay. None of the sera obtained from patients with aspergillosis, tuberculosis, histoplasmosis or cryptococcosis tested positive. These results suggest that Mplp6 can be used as a marker in a serodiagnostic assay.
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Affiliation(s)
- Monsicha Pongpom
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Miró JM. Prevención de las infecciones oportunistas en pacientes adultos y adolescentes infectados por el VIH en el año 2008. Enferm Infecc Microbiol Clin 2008; 26:437-64. [DOI: 10.1157/13125642] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
PURPOSE OF REVIEW Since the start of the HIV pandemic, systemic infection with Penicillium marneffei has developed from a very rare diagnosis to the third most common opportunistic infection in HIV co-infected patients in South East Asia. HIV patients who have travelled to or lived in Asia may present with this infection in nonendemic countries, and it has therefore become important for all those working in the field of HIV to recognize, understand and treat this emerging disease. RECENT FINDINGS The clinical features, diagnosis and treatment of this infection are reviewed. Recent data exploring antigen-based serodiagnostics, the role of newer antifungals such as voriconazole, and the possibility of discontinuation of secondary prophylaxis after immune restoration from highly active antiretrovirals are discussed. SUMMARY Large series from endemic areas and case reports from nonendemic regions have been published and provide insights into clinical features and presentation. Novel diagnostics are evolving, with galactomannan and other assays looking promising. Present therapy is largely based on noncontrolled studies, and further research into optimal therapy and the potential to discontinue secondary itraconazole prophylaxis is required.
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