Diagnostic microbiology and infectious disease最新文献

{"title":"A rare cause of fever of unknown origin in India","authors":"Bhagyashri B. Waghmare ,&nbsp;Prabhanjan V. Kulkarni","doi":"10.1016/j.diagmicrobio.2025.116845","DOIUrl":"10.1016/j.diagmicrobio.2025.116845","url":null,"abstract":"<div><div>In India, tuberculosis, lymphoma and adult onset Still's disease are the commonly reported causes of fever of unknown origin (FUO). We describe a case of an immunocompetent adult male patient who presented with FUO and anemia. He developed lymphadenopathy after 8 days of admission, for which further workup was done. His bone marrow aspirate showed pure red cell hypoplasia, for the evaluation of which, parvovirus-B19 (B19V) antibodies were ordered which came back positive. He was treated with a short course of steroids and on follow-up showed complete resolution of symptoms.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116845"},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-surgical resolution of a delayed esophagopleural fistula caused by tuberculous mediastinal lymphadenitis: Diagnostic challenges and therapeutic success","authors":"Duk Ki Kim ,&nbsp;Yooyoung Chong ,&nbsp;Jeeyeon Baek ,&nbsp;Chaeuk Chung","doi":"10.1016/j.diagmicrobio.2025.116834","DOIUrl":"10.1016/j.diagmicrobio.2025.116834","url":null,"abstract":"<div><h3>Background</h3><div>Esophagopleural fistula (EPF) is an abnormal pathological communication between the esophagus and the pleural space. While EPF is typically associated with malignancy or iatrogenic injury, tuberculosis (TB) is a rare cause, with only a limited number reported cases. Here, we present a case of TB related EPF that developed following diagnostic surgery and was successfully treated with anti-TB therapy alone, without the need for surgical intervention.</div></div><div><h3>Case presentation</h3><div>A 58-year-old male presented with a three-month history of a six-kilogram weight loss, chronic cough and sputum production. Chest computed tomography (CT) revealed necrotic lymphadenopathy with air bubbles within the 2R lymph node, located in the paratracheal region just below the origin of subclavian artery, raising suspicion for primary lung cancer. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed, but histopathological analysis revealed only non-neoplastic bronchial tissue and lymphoid aggregates. Given the detection of a hypermetabolic lesion in the 2R lymph node on positron emission tomography-computed tomography (PET-CT), raising suspicion of malignancy, a surgical biopsy was performed. However, histopathological examination revealed only chronic active inflammation. One-month postoperatively, the patient developed EPF, which was initially managed with nasogastric tube feeding and antibiotics for aspiration pneumonia. Microbiological tests, including sputum and bronchoscopic washing, were unremarkable. The patient was discharged after approximately 40 days at his request, despite persistent EPF without clinical improvement. Four months later, he was re-admitted due to worsening aspiration symptoms and progressive lung lesions. Repeat microbiological testing ultimately confirmed pulmonary TB, with positive acid-fast bacilli (AFB) staining and Xpert MTB/RIF assay results. Standard four-drug anti-TB therapy led to significant clinical improvement, with complete resolution of the EPF on follow-up CT after six months. The patient fully recovered without surgical intervention.</div></div><div><h3>Conclusions</h3><div>This case highlights the diagnostic challenges of TB presenting as isolated lymphadenopathy and underscores the importance of repeated testing for accurate diagnosis. Furthermore, it demonstrates that TB-related EPF can be successfully managed with medical therapy alone, even in cases of advanced disease.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116834"},"PeriodicalIF":2.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, genomic features, and antibiotic sensitivities of Neisseria meningitidis isolates from patients with invasive meningococcal disease and healthy carriers in Zhejiang Province, 2015-2023","authors":"Lingbo Wang ,&nbsp;Xuan Deng ,&nbsp;Yunyi Zhang ,&nbsp;Zhangnv Yang ,&nbsp;Zhuoying Wu ,&nbsp;Wenwu Yao ,&nbsp;Pingping Yao ,&nbsp;Hanqing He ,&nbsp;Beibei Wu","doi":"10.1016/j.diagmicrobio.2025.116843","DOIUrl":"10.1016/j.diagmicrobio.2025.116843","url":null,"abstract":"<div><h3>Objective</h3><div>A comprehensive understanding of invasive meningococcal disease (IMD) and healthy carriers is critical to monitor, control, and prevent the disease. This study investigated the epidemiology of IMD cases and carriage, and compared population-specific genetic variations and antimicrobial susceptibility of <em>Neisseria meningitidis</em> (<em>N. meningitidis</em>) strains isolated from patients with IMD and carriers.</div></div><div><h3>Methods</h3><div>Surveillance data from 2015 to 2023 on patients with epidemic meningitis and healthy carriers in Zhejiang Province, China. We successfully collected 21 isolates from meningitis patients and 16 isolates from healthy individuals during this period. Serogroups of a total of 37 <em>N. meningitidis</em> isolates were determined by polymerase chain reaction (PCR) and slide agglutination, as well as whole genome sequencing to assess various genes, single nucleotide polymorphisms (SNPs), and core-pan genome differences. The antibiotic susceptibility of 37 isolates to 12 antibiotics was evaluated using the E-Test on Mueller-Hinton agar supplemented with 5 % sheep blood.</div></div><div><h3>Results</h3><div>The annual incidence of IMD and carriage rates remained relatively low from 2015 to 2023. IMD cases were primarily observed in infants under 12 months-of-age. Healthy carriers were predominantly 5-9 and 30-59 years-of-age. Population gene analysis revealed no significant difference in genes between the two groups. Strains of patient and carrier groups were both highly resistant to quinolones and sulfonamides.</div></div><div><h3>Conclusions</h3><div>The findings enhance the understanding of <em>N. meningitidis</em> carriage in the context of prevalent invasive meningococcal strains. The findings will facilitate the development and updating of the immunization program of meningitis vaccine, and are critical in understanding the spread and drug use strategies of <em>N. meningitidis</em>.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"113 1","pages":"Article 116843"},"PeriodicalIF":2.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment of a microfluidic and RPA-based platform for rapid multi-sample detection of Mycoplasma pneumoniae","authors":"Ling Zhang ,&nbsp;Cheng-Di Sun ,&nbsp;Jiao Luo ,&nbsp;Li-Guo Liang ,&nbsp;Si-Ming Lu","doi":"10.1016/j.diagmicrobio.2025.116840","DOIUrl":"10.1016/j.diagmicrobio.2025.116840","url":null,"abstract":"<div><h3>Background</h3><div><em>Mycoplasma pneumoniae</em> (<em>M. pneumoniae</em>) is a major respiratory pathogen causing atypical community-acquired pneumonia. Early and rapid diagnosis and timely detection of pathogens are crucial. RPA is an emerging PCR technology that allows amplification at room temperature compared to conventional PCR technology, while combining the advantages of rapid detection and high specificity of PCR technology, enabling rapid and accurate detection of pathogens.</div></div><div><h3>Methods and results</h3><div>In this study, we established a platform for detection <em>of M. pneumoniae</em> based on microfluidic and RPA technologies. The RPA technology is performed in 15 to 20 minutes, and only <em>M. pneumoniae</em> is significantly amplified at a sensitivity of 10 copies/μL; microfluidic technology provides lean instrumentation and a convenient interactive system. Three groups negative and positive QCs and 18 clinical samples can be tested in a single run.</div></div><div><h3>Significance</h3><div>In conclusion, we have established a microfluidic molecular assay operating system based on RPA technology, with the advantages of being simple, rapid, accurate and economical, and providing a new tool for laboratory detection of <em>M. pneumoniae</em>.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116840"},"PeriodicalIF":2.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successfully treated myopericarditis and acute heart failure due to severe Neisseria meningitidis infection: a case report","authors":"Nikolaos Nektarios Karamanolis ,&nbsp;Christos G Nikolaidis ,&nbsp;Ioannis Gavgiotakis ,&nbsp;Aikaterini Gaki ,&nbsp;Iraklis Tatsis ,&nbsp;Alexandra Mika ,&nbsp;George D Liatsos ,&nbsp;Dimitrios Vassilopoulos","doi":"10.1016/j.diagmicrobio.2025.116837","DOIUrl":"10.1016/j.diagmicrobio.2025.116837","url":null,"abstract":"<div><div><em>Neisseria meningitidis</em> is a known cause of bacterial meningitis and sepsis. It is rarely associated with serious cardiac manifestations. A 39-year-old woman diagnosed with meningococcal meningitis/septicemia developed myopericarditis leading to severe acute heart failure. Diagnosis was established by clinical, laboratory and echocardiographic findings and was later confirmed by cardiac MRI. Management included antibiotics, vasopressors and early intubation. Her course was further complicated with disseminated intravascular coagulation and unilateral hearing loss. Cardiac dysfunction resolved completely within 6 days. In conclusion, cardiac involvement is a possible contributor to shock in patients with meningococcal sepsis and should be promptly recognized and managed. Early intubation is a potential adjunct to medical treatment.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116837"},"PeriodicalIF":2.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and evaluation of ELISA serological immunoassays for influenza and respiratory syncytial viruses","authors":"Alexandra Claudet ,&nbsp;Noémi Alcover ,&nbsp;Elise Lebigot ,&nbsp;Hana-Sofia Bouhelal ,&nbsp;Fairly Warnakulasuriya ,&nbsp;Marie-Pierre Soutiere ,&nbsp;Marie Galloux ,&nbsp;Jean-François Eleouet ,&nbsp;Marie-Anne Rameix-Welti ,&nbsp;Etienne Bizot ,&nbsp;Christelle Vauloup-Fellous ,&nbsp;Vincent Portet-Sulla","doi":"10.1016/j.diagmicrobio.2025.116835","DOIUrl":"10.1016/j.diagmicrobio.2025.116835","url":null,"abstract":"<div><h3>Introduction</h3><div>Respiratory syncytial virus (RSV) and influenza are major causes of respiratory infections globally. Although vaccines are available, serological tools to assess population-level immunity and maternal antibody transfer remain limited. This study aimed to develop and evaluate ELISA assays for detecting anti-RSV and anti-influenza antibodies as a basis for future maternal-fetal immunity research.</div></div><div><h3>Materials and Methods</h3><div>In this study, we designed ELISA immunoassays using various influenza and RSV antigens. Sensitivity and specificity were calculated using sera from presumed seronegative infants and seropositive adults.</div></div><div><h3>Results</h3><div>The influenza vaccine-based ELISA achieved 98.3 % sensitivity and 100 % specificity. The pre-fusion F protein of RSV (Arexvy®) showed 97.5 % sensitivity and 97.4 % specificity. Other antigen combinations performed less optimally.</div></div><div><h3>Discussion</h3><div>These ELISA assays are scalable tools for seroepidemiological and maternal transfer studies. Future work will include correlation with neutralizing antibodies and paired maternal-infant analyses.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 3","pages":"Article 116835"},"PeriodicalIF":2.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Description of blaKPC-carrying Escherichia coli in patients from a Brazilian hospital over a 4-year period","authors":"Letícia Kalir Pradela ,&nbsp;Tiago Casella ,&nbsp;Fernanda Zani Manieri ,&nbsp;Letícia Kellen de Andrade ,&nbsp;Marlon do Valle Barroso ,&nbsp;Nguyen Thi Khanh Nhu ,&nbsp;Mark Andrew Schembri ,&nbsp;Cristiano Gallina Moreira ,&nbsp;Mara Corrêa Lelles Nogueira","doi":"10.1016/j.diagmicrobio.2025.116833","DOIUrl":"10.1016/j.diagmicrobio.2025.116833","url":null,"abstract":"<div><div><em>Klebsiella pneumoniae</em> carbapenemase (KPC)-producing <em>Escherichia coli</em> are recognized by the World Health Organization as a critical group of bacterial priority pathogens of public health importance. Thus, increased understanding of the genetic characteristics of KPC-producing <em>E. coli</em> is required. Here, we performed a retrospective study in a Brazilian teaching-hospital to describe the genomic features linked to antimicrobial resistance, virulence, and phylogeny of 40 meropenem-resistant <em>E. coli</em>. All isolates carried the <em>bla</em>_KPC-2 gene, but amikacin, tigecycline, colistin, polymyxin B, and fosfomycin showed good activity. Molecular typing by MLST revealed 20 sequence types (STs), with a predominance of ST131. Whole-genome sequencing identified Tn<em>4401</em> as a mechanism responsible for <em>bla</em>_KPC-2 mobilization, a variety of antimicrobial resistance and virulence genes, the predominance of pathogenic phylogroup lineages, and the grouping of genomes belonging to the same ST. KPC-producing <em>E. coli</em> is not a common pathogen, but few treatment alternatives are available against potentially virulent strains.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 3","pages":"Article 116833"},"PeriodicalIF":2.1,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of humoral and cellular responses after vaccination against SARS-CoV-2 in patients with immune-mediated diseases","authors":"Thomas Escoda ,&nbsp;Sylvie Jordana ,&nbsp;Laurent Chiche ,&nbsp;Guillaume Penaranda ,&nbsp;Stanislas Rebaudet ,&nbsp;Philippe Halfon","doi":"10.1016/j.diagmicrobio.2025.116825","DOIUrl":"10.1016/j.diagmicrobio.2025.116825","url":null,"abstract":"<div><h3>Background</h3><div>Patients with autoimmune disease (AID) or immunodepression (ID), particularly those treated with anti-CD20, have an increased risk of COVID-19 infection.</div></div><div><h3>Objective</h3><div>To characterise the humoral and cellular immune responses against specific antigens of SARS-CoV-2 in immunocompromised patients, as well as their correlation and determinants.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted in outpatients with AID and/or ID for which an assessment of their humoral and cellular response was carried out and analysed in relation to demographic data, comorbidities, treatments, type of vaccine and number of doses.</div></div><div><h3>Results</h3><div>Fifty patients were included. The overall serological response rate was 76%. The cellular response was positive in 54% of patients. The main factors influencing the humoral and cellular responses were age, comorbidities and treatment with anti-CD20.</div></div><div><h3>Conclusion</h3><div>In ID patients, vaccination against COVID-19 can generate an adequate T-cell response, the character of which is an emerging issue in the context of COVID-19 infection. The main limitations of this study and those in the literature are the heterogeneity of the patients included and the absence of a control population. These results highlight the importance of evaluating the antiviral T-cell response and the impact of immunosuppressive treatments.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 3","pages":"Article 116825"},"PeriodicalIF":2.1,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand, foot and mouth disease with encephalomyelitis in adult: A case report","authors":"Kieu Nguyet Oanh Pham ,&nbsp;Minh Cuong Duong ,&nbsp;Dinh Nam Vo ,&nbsp;Dang Trung Nghia Ho","doi":"10.1016/j.diagmicrobio.2025.116832","DOIUrl":"10.1016/j.diagmicrobio.2025.116832","url":null,"abstract":"<div><div>Hand, foot and mouth disease (HFMD) complications rarely develop in adults. We present a case of a 21-year-old woman with an acute onset of impaired consciousness, ptosis, and limb weakness. She had a history of close contact with an HFMD patient, fever, vesicles on her hands and nasopharynx, and decreased limb muscle power. The results of the head and spinal cord MRI and RT-PCR of cerebrospinal fluid and throat, skin lesion, and anal swabs confirmed enterovirus 71-induced encephalomyelitis. She received a single dose of IVIG therapy and fully recovered. Our report further confirms the possibilities of HFMD with severe neurological complications in adults. A history of contact with HFMD patients and lesions on the skin and mucosa, even unobvious, help diagnose the disease. Confirming central nervous system involvement requires cerebrospinal fluid analysis and brain and spinal cord MRI. Prompt IVIG treatment could help reduce fever, skin lesions, and recovery time.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 3","pages":"Article 116832"},"PeriodicalIF":2.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CLIA immunoassay as an alternative and accurate method to detect Sars-Cov-2 antigen compared to ELISA","authors":"Keilla Gomes Machado,&nbsp;Vitória Bertelli,&nbsp;Rafaele Frassini,&nbsp;André Felipe Streck,&nbsp;Mariana Roesch Ely","doi":"10.1016/j.diagmicrobio.2025.116828","DOIUrl":"10.1016/j.diagmicrobio.2025.116828","url":null,"abstract":"<div><h3>Background</h3><div>COVID-19 has caused moderately severe infections in humans over the past few years, leading to &gt;759 million confirmed cases. This situation highlights an urgent need to develop accurate diagnostic tests to monitor infectious disease and to adopt alternative methods such as CLIA to achieve low detection levels of proteins on diagnostic platforms.</div></div><div><h3>Objectives</h3><div>Develop in-house immunoassay for ELISA and CLIA to diagnose COVID-19.</div></div><div><h3>Methods</h3><div>200 nasopharyngeal samples were collected using swabs, placed in tubes with 3 mL of PBS. 1 mL from each sample was used to perform qRT-PCR and was considered positive in samples with CT &lt; 38. The remaining volume was used for in-house sandwich immunoassay ELISA and CLIA.</div></div><div><h3>Results</h3><div>The results showed that CLIA was able to detect active disease in samples containing N protein concentrations greater than 16 ng/mL, with a sensitivity of 90 % and specificity of 94.5 %, and an area under the ROC curve (AUROC) of 0.943 (95 % CI: 0.909–0.977). ELISA showed an AUROC = 0.709 (95 % CI: 0.639–0.778), with a sensitivity of 54.4 % and specificity of 87.2 %.</div></div><div><h3>Conclusions</h3><div>The CLIA results in this study outperformed the traditional ELISA and proved to be a suitable platform for monitoring the progression of disease stages, including the diagnosis of active COVID-19 infection.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"112 4","pages":"Article 116828"},"PeriodicalIF":2.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}