Enfermedades infecciosas y microbiologia clinica最新文献

{"title":"MPox virus transmission to healthcare worker in Europe","authors":"Barbara Burgos-Blasco, Noemi Cabello-Clotet, Vicente Estrada, David Díaz-Valle","doi":"10.1016/j.eimc.2025.503039","DOIUrl":"10.1016/j.eimc.2025.503039","url":null,"abstract":"","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503039"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096070","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":"Management of infections caused by Gram-negative bacteria in severely immunocompromised hosts employing Outpatient Parenteral Antimicrobial Therapy (OPAT): Preliminary evidence from a real-world observational study","authors":"Rosa Anna Passerotto ,&nbsp;Gabriele Giuliano ,&nbsp;Domenico Tarantino ,&nbsp;Francesca Raffaelli ,&nbsp;Francesco Taccari ,&nbsp;Giuseppe Puma ,&nbsp;Enrica Tamburrini ,&nbsp;Carlo Torti ,&nbsp;Giancarlo Scoppettuolo","doi":"10.1016/j.eimc.2025.503053","DOIUrl":"10.1016/j.eimc.2025.503053","url":null,"abstract":"<div><h3>Introduction</h3><div>Infections caused by Gram-negative bacteria pose a significant challenge in immunocompromised patients. Outpatient Parenteral Antimicrobial Therapy (OPAT) has emerged as a promising alternative to inpatient care, allowing patients to receive intravenous antimicrobial therapy at home while potentially improving their quality of life. However, data on the efficacy and safety of OPAT in immunocompromised patients remain limited. This study aims to evaluate the effectiveness, safety, and clinical outcomes of OPAT in this vulnerable population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational cohort study at a teaching hospital in Rome from 2020 to 2024. We included immunocompromised adult patients (≥18 years) with Gram-negative bacterial infections treated with OPAT. The primary effectiveness endpoint was treatment response. Safety endpoints included adverse events and complications.</div></div><div><h3>Results</h3><div>A total of 149 immunocompromised patients were included, with a median age of 64 years. The most common infections were urinary tract infections (51.7%) and bloodstream infections (16.8%). The most frequently isolated pathogens were <em>Escherichia coli</em> (41.9%), <em>Klebsiella</em> spp. (22.8%), and <em>Pseudomonas aeruginosa</em> (19.1%). The overall clinical cure rate was 88.6% (132/149), while 4.0% (6/149) experienced treatment failure and 3.4% (5/149) had infection recurrence within 60 days. Nearly all patients (91.9%) completed their OPAT treatment course without interruptions. Hospital readmission occurred in 7.4% (11/149) of cases. Complications were rare (5/149, 3.4%).</div></div><div><h3>Conclusion</h3><div>OPAT proved to be an effective and safe strategy for managing Gram-negative infections in immunocompromised patients. Close clinical and laboratory monitoring contributed to favorable outcomes. Further studies are needed to optimize OPAT protocols in this population.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503053"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096100","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":"Bictegravir/emtricitabine/tenofovir alafenamide: A review of the real-world experience in Spain within the last five years","authors":"Concha Amador ,&nbsp;Juan Ambrosioni ,&nbsp;Luz Martín-Carbonero ,&nbsp;Carmen Hidalgo-Tenorio ,&nbsp;Juan Tiraboschi ,&nbsp;Santiago Moreno","doi":"10.1016/j.eimc.2025.503056","DOIUrl":"10.1016/j.eimc.2025.503056","url":null,"abstract":"<div><div>Integrase strand inhibitor (INSTI)-based antiretroviral regimens are the preferred choices for treating people with human immunodeficiency virus (PWH). The once-daily single-tablet combination of INSTI bictegravir, co-formulated with emtricitabine and tenofovir alafenamide (BIC/FTC/TAF), has shown effectiveness and good tolerability in randomized clinical trials, both in treatment-naïve (TN) and virologically suppressed patients switched to this regimen. Real-world evidence represents clinical practice and may fill data gaps left by pivotal studies. Based on literature search for real-world studies in Spain within five years, and using clinical trial data as a contextual framework, this narrative review synthesizes observational experience with BIC/FTC/TAF, focusing on the interplay between comorbidities, advanced age, and treatment outcomes from underrepresented subgroups in clinical trials. This fixed-dose combination proved effective and well-tolerated for TN and treatment-experienced PWH, with low virological failure even in difficult-to-treat patients. Low rates of treatment discontinuations due to adverse events or drug-drug interactions aligned with clinical trial findings.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503056"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096073","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":"Validation of FEN-COVID phenotypes in hospitalised COVID-19 patients across the first four waves of the pandemic","authors":"Maria Giulia Caponcello ,&nbsp;María Del Rocío Fernández-Ojeda ,&nbsp;Natalia Maldonado ,&nbsp;Manuel Diéguez-Serrano ,&nbsp;Ana Laura Blanco-Taboada ,&nbsp;Paula Olivares Navarro ,&nbsp;Adriana Rivera-Sequeiros ,&nbsp;Rafael Perera ,&nbsp;Jose A. Delgado-Torralbo ,&nbsp;Luisa González-Iglesias ,&nbsp;Miguel A. Rico-Corral ,&nbsp;María Dolores Del Toro ,&nbsp;Jesús Rodríguez-Baño ,&nbsp;Zaira R. Palacios-Baena ,&nbsp;Belén Gutiérrez-Gutiérrez","doi":"10.1016/j.eimc.2025.503059","DOIUrl":"10.1016/j.eimc.2025.503059","url":null,"abstract":"<div><h3>Introduction</h3><div>The FEN-COVID study identified 3 clinical phenotypes (PhA, PhB and PhC) in hospital-admitted patients with COVID-19, which were associated with mortality. The aim of this study is to validate the assignment to phenotypes and their association with mortality in two hospitals in Spain across the first 4 waves of the pandemic, including the impact of corticosteroids and anticoagulant drugs.</div></div><div><h3>Methods</h3><div>A prospective cohort study of patients admitted for COVID-19 in the first 4 waves in two hospitals was performed. Phenotypes were assigned using the FEN-COVID calculator. The primary outcome was 30-day all-cause mortality. Kaplan–Meier (KM) curves were compared using the log-rank test. Multivariate analysis was performed using Cox regression analysis to assess the association of phenotypes with mortality.</div></div><div><h3>Results</h3><div>1839 patients were included. Of these, 257 patients were identified as PhA, 1451 as PhB and 130 as PhC; their 30-day mortality was 1.9%, 15.4% and 45.4%, respectively. In multivariate analysis and controlling for wave effect, belonging to phenotype B and phenotype C was associated with progressive increased hazards of death. In addition, appropriate treatment with corticosteroids was significantly associated with lower mortality in PhB, while low-molecular weight heparin use was significantly associated with lower mortality in PhB and PhC.</div></div><div><h3>Conclusions</h3><div>Our results confirmed that the clinical phenotypes identified in the FEN-COVID study were predictive of mortality across all waves studied. Furthermore, we confirmed the importance of identifying the phenotype to which a patient belongs on admission when considering appropriate treatment with corticosteroids and/or anticoagulants.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503059"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096102","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":"Bacteriemia caused by Mycoplasma capricolum in a hematologic patient","authors":"Diana López ,&nbsp;Beatriz Castro ,&nbsp;Alina Pérez ,&nbsp;Teresa Delgado","doi":"10.1016/j.eimc.2025.503028","DOIUrl":"10.1016/j.eimc.2025.503028","url":null,"abstract":"","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503028"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096069","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":"Oral microbiota in patients with long COVID: A pilot study","authors":"Laura Pérez-Martínez ,&nbsp;Lourdes Romero ,&nbsp;Esther Palacios ,&nbsp;Raquel Barbero ,&nbsp;Ana Moreno-Blanco ,&nbsp;Rosa del Campo ,&nbsp;José Ramón Blanco","doi":"10.1016/j.eimc.2025.503072","DOIUrl":"10.1016/j.eimc.2025.503072","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic continues to pose a substantial threat to global public health. While most efforts have focused on the acute phase SARS-CoV-2 infection, a significant proportion of individuals experience persistent symptoms after infection, known as “persistent COVID disease” (PCD). The etiology of PCD remains poorly understood, although some evidence suggests that microbiota, particularly those located in the upper respiratory tract, may play a role. The aim of this study was to investigate differences in the composition of the oral microbiota, salivary cytokine, and short-chain fatty acids (SCFAs) concentration, between PCD and healthy controls.</div></div><div><h3>Methods</h3><div>We conducted an age- and sex-matched case–control study. Oral bacterial communities were profiled by 16S rDNA gene (V3–V4) amplicon high-throughput sequencing. Salivary IL-6 and TNF-α concentrations were measured, and SCFA were quantified by liquid chromatography–tandem mass spectrometry. Cognitive and fatigue status were assessed with the Montreal Cognitive Assessment (MoCA) and the Modified Fatigue Impact Scale (MFIS).</div></div><div><h3>Results</h3><div>Oral-microbiota α/β-diversity did not differ between groups; salivary cytokines were likewise similar. After Benjamini–Hochberg correction, no SCFA differences were significant (<em>q</em> <!-->&gt;<!--> <!-->0.05); valeric acid showed the strongest uncorrected signal (<em>p</em> <!-->=<!--> <!-->0.02; <em>r</em> <!-->=<!--> <!-->0.52) but not after adjustment (<em>q</em> <!-->=<!--> <!-->0.23; power ≈0.73). CPD participants had lower MoCA and higher MFIS scores than controls (both <em>p</em> <!-->&lt;<!--> <!-->0.005).</div></div><div><h3>Conclusions</h3><div>The increase of valeric acid levels in PCD patients warrants further investigation to clarify its potential biological role and implications in the pathophysiology of this syndrome.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503072"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096072","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":"Two vaccine-associated measles cases: Transmission or coincidental cases?","authors":"Ana Hernandez-Aceituno ,&nbsp;Diana Sanabria Curbelo ,&nbsp;Isabel Falcón García ,&nbsp;Álvaro Torres Lana ,&nbsp;Roque Abián Montesdeoca Melián ,&nbsp;Eneko Larumbe-Zabala","doi":"10.1016/j.eimc.2025.503071","DOIUrl":"10.1016/j.eimc.2025.503071","url":null,"abstract":"<div><h3>Introduction</h3><div>Measles, a highly contagious airborne disease, has seen a resurgence in Spain despite the successful implementation of vaccination programs. This study examines two cases of vaccine-associated measles in children attending the same nursery school, both of whom received the measles–mumps–rubella vaccine.</div></div><div><h3>Methods</h3><div>Retrospective descriptive study of two children with vaccine-associated measles in May 2025 on the island of Gran Canaria (Spain).</div></div><div><h3>Results</h3><div>The first case involved a 12-month-old girl who developed symptoms six days post-vaccination, while the second case, a 13-month-old boy, exhibited symptoms eight days after receiving the vaccine. Both cases were confirmed as genotype A, indicating the vaccine strain. The investigation included extensive contact tracing, identifying 107 close contacts, with vaccinations administered to susceptible individuals. Laboratory tests confirmed measles through polymerase chain reaction (PCR) analysis. The findings highlight the rarity of clinically significant vaccine-associated disease and the absence of evidence for human-to-human transmission of the vaccine strain.</div></div><div><h3>Conclusion</h3><div>This study underscores the importance of genotyping in distinguishing between vaccine-associated rash illness and wild-type measles, as well as the need for continued vigilance in monitoring vaccine efficacy and outbreak responses. Ultimately, while the possibility of transmission cannot be entirely dismissed, the evidence suggests that these cases are more likely coincidental rather than a result of transmission.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503071"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096103","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":"Human parvovirus B19 infection in immunocompetent adults: A diagnostic challenge due to its multiple clinical manifestations","authors":"Raquel Zaragozá González ,&nbsp;Carlos de Leonardo Simón ,&nbsp;Melisa Hernández Febles ,&nbsp;Eduardo Lagarejos González ,&nbsp;Iñigo Rúa-Figueroa ,&nbsp;María del Val Groba Marco ,&nbsp;María del Mar Perera Alvarez ,&nbsp;Antonio García Quintana ,&nbsp;María José Pena López","doi":"10.1016/j.eimc.2025.503054","DOIUrl":"10.1016/j.eimc.2025.503054","url":null,"abstract":"<div><h3>Introduction</h3><div>Human parvovirus B19 (PVB19) is associated with diverse clinical manifestations. While acute infection in immunocompetent adults is generally considered mild, recent European outbreaks and an increase in severe cases highlight the need to always keep this virus in mind. This study aimed to describe the clinical and epidemiological features of acute PVB19 infection in immunocompetent adults requiring hospital care.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of immunocompetent patients over 14 years old diagnosed with acute PVB19 infection at a Gran Canaria tertiary hospital (2014–2024). Diagnosis was based on detection of viral DNA and/or specific IgM.</div></div><div><h3>Results</h3><div>Forty-three patients were included (mean age 40.6<!--> <!-->±<!--> <!-->13.9 years; 44.2% male). A marked increase in cases was observed in 2024 (51.2% of total). Clinical manifestations included acute polyarthritis (37.2%), cardiac involvement (34.9%), erythema (16.3%), fever of unknown origin, meningitis, and gastrointestinal symptoms. Cardiac involvement, mostly in males, included dilated cardiomyopathy, pericarditis, and myocarditis, and was associated with two deaths. Hematological abnormalities were frequent (up to 80% in cardiac patients). Two additional patients developed systemic inflammatory diseases. Serological testing alone failed to confirm diagnosis in several cases, needing molecular testing of alternative samples.</div></div><div><h3>Conclusions</h3><div>Our findings underscore the diverse and potentially severe presentation of PVB19 infection in immunocompetent adults. The high incidence of cardiac involvement and diagnostic challenges highlight the need for enhanced surveillance and clinical awareness. Incorporating PVB19 into differential diagnoses for hospitalized patients with unexplained inflammatory or hematological syndromes may improve timely recognition and management.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503054"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096101","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":"Un caso raro de pericarditis purulenta secundaria a Streptococcus constellatus por contigüidad de lesión hepática a estudio","authors":"Jordi Martinez-Matencio,&nbsp;Inmaculada Palacios-Garcia,&nbsp;Eduardo Cantón-Puig,&nbsp;José Garnacho-Montero","doi":"10.1016/j.eimc.2025.503040","DOIUrl":"10.1016/j.eimc.2025.503040","url":null,"abstract":"","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 2","pages":"Article 503040"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096071","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":"Implementing CLIA for QuantiFERON®-CMV testing: Optimizing cellular immune response against cytomegalovirus","authors":"Juliana Esperalba ,&nbsp;Maria Arnedo-Muñoz ,&nbsp;Ariadna Rando-Segura ,&nbsp;Ibai Los-Arcos ,&nbsp;Eva Revilla-López ,&nbsp;Aroa Gomez-Brey ,&nbsp;Patricia Nadal-Barón ,&nbsp;Ester Marquez-Algaba ,&nbsp;Víctor Monforte ,&nbsp;Alberto Sandiumenge ,&nbsp;Nieves Larrosa ,&nbsp;Tomàs Pumarola ,&nbsp;Oscar Len ,&nbsp;Andrés Antón","doi":"10.1016/j.eimc.2025.503050","DOIUrl":"10.1016/j.eimc.2025.503050","url":null,"abstract":"<div><h3>Introduction</h3><div>Cytomegalovirus (CMV) remains a significant infectious complication in solid organ transplant recipients. Assessing cellular immunity through interferon-gamma (IFN-γ) release assays, such as QuantiFERON®-CMV (QTF-CMV), is useful for guiding prophylactic and therapeutic decisions. Although ELISA is the validated method for QTF-CMV, chemiluminescence immunoassay (CLIA) may offer technical advantages. This study aimed to evaluate the performance of the CLIA-based LIAISON® QuantiFERON®-TB Gold Plus assay in quantifying IFN-γ in QTF-CMV testing, compared to the ELISA-based QuantiFERON®-CMV assay.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on 169 stored plasma samples from 85 lung transplant recipients. IFN-γ was quantified using both ELISA (Qiagen®) and CLIA (DiaSorin®). Specific (CMV-NIL) and nonspecific (MIT-NIL) responses were compared using Pearson and Lin's concordance correlation coefficients, Bland–Altman analysis, and ROC curves. Diagnostic agreement was assessed using the Kappa index, sensitivity, specificity, and agreement rates.</div></div><div><h3>Results</h3><div>CLIA yielded significantly higher IFN-γ values than ELISA for CMV-NIL (+0.41<!--> <!-->IU/mL) and MIT-NIL (+0.33<!--> <!-->IU/mL). Strong correlation and concordance were observed (<em>r</em> and <em>ρ</em>_c &gt;0.93). Diagnostic agreement reached 95.86% (Kappa<!--> <!-->=<!--> <!-->0.913), with fewer indeterminate results in CLIA (3.55% vs 4.73%). The optimal CLIA cut-off was 0.2754<!--> <!-->IU/mL, achieving 100% sensitivity and specificity compared to ELISA.</div></div><div><h3>Conclusions</h3><div>CLIA shows excellent agreement with ELISA in QTF-CMV testing and is a reliable and automatable alternative. Its implementation may improve laboratory workflows. Adjusting the cut-off is recommended for optimal diagnostic accuracy.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"44 1","pages":"Article 503050"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950244","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}