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Detection of enteric parasites and molecular characterization of Giardia duodenalis and Blastocystis sp. in patients admitted to hospital in Ankara, Turkey

Published online by Cambridge University Press:  28 September 2020

Fakhriddin Sarzhanov
Affiliation:
Department of Medical Microbiology, School of Medicine, Gazi University, 06490Ankara, Turkey Faculty of Medicine, Akhmet Yassawi International Kazakh-Turkish University, 161200Turkestan, Kazakhstan
Pamela Carolina Köster
Affiliation:
Parasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain
Funda Dogruman-Al*
Affiliation:
Section of Medical Parasitology, Department of Medical Microbiology, School of Medicine, Gazi University, 06490Ankara, Turkey
Begoña Bailo
Affiliation:
Parasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain
Alejandro Dashti
Affiliation:
Parasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain
Filiz Demirel-Kaya
Affiliation:
Medical Microbiology Laboratory, Ankara Education and Research Hospital, Health Science University, 06230Ankara, Turkey
David Carmena*
Affiliation:
Parasitology Reference and Research Laboratory, National Centre for Microbiology, Health Institute Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain
*
Author for correspondence: David Carmena, E-mail: dacarmena@isciii.es, Funda Dogruman-Al, E-mail: alfunda@yahoo.com
Author for correspondence: David Carmena, E-mail: dacarmena@isciii.es, Funda Dogruman-Al, E-mail: alfunda@yahoo.com

Abstract

This epidemiological study assesses the occurrence of enteric parasites in 4303 patients attended at two public hospitals in Ankara (Turkey) during 2018–2019. Microscopy was used as a screening test. Giardia duodenalis was also identified using a commercial ELISA for the detection of parasite-specific coproantigens. Giardia-positive samples by microscopy/ELISA were confirmed by real-time PCR and characterized using a multilocus genotyping scheme. Blastocystis sp. was genotyped in a sample subset. Blastocystis sp. (11.1%, 95% CI 11.4‒14.8%) and G. duodenalis (1.56%, 95% CI 1.22‒1.96) were the most prevalent pathogens found. Cryptosporidium spp., Entamoeba histolytica and intestinal helminths were only sporadically (<0.5%) found. For G. duodenalis, sequence (n = 30) analyses revealed the presence of sub-assemblages AII (23.3%), discordant AII/AIII (23.3%) and mixed AII + AIII (6.7%) within assemblage A, and BIII (10.0%), BIV (3.3%) and discordant BIII/BIV (23.3%) within assemblage B. Two additional sequences (6.7%) were assigned to the latter assemblage but sub-assemblage information was unknown. No associations between G. duodenalis assemblages/sub-assemblages and sociodemographic and clinical variables could be demonstrated. For Blastocystis sp., sequence (n = 6) analyses identified subtypes ST1, ST2 and ST3 at equal proportions. This is the first molecular characterization of G. duodenalis based on MLG conducted in Turkey to date.

Type
Research Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Adıyaman Korkmaz, G, Doğruman Al, F and Mumcuoğlu, İ (2015) [Investigation of the presence of Blastocystis Spp. in stool samples with microscopic, culture and molecular methods]. Mikrobiyoloji Bülteni Mikrobiyoloji Bülteni 49, 8597.CrossRefGoogle Scholar
Akkelle, BS, Tutar, E, Volkan, B, Sengul, OK, Ozen, A, Celikel, CA and Ertem, D (2019) Gastrointestinal manifestations in children with primary immunodeficiencies: single center: 12 years experience. Digestive diseases (Basel, Switzerland) 37, 4552.CrossRefGoogle ScholarPubMed
Alfellani, MA, Stensvold, CR, Vidal-Lapiedra, A, Onuoha, ESU, Fagbenro-Beyioku, AF and Clark, CG (2013) Variable geographic distribution of Blastocystis subtypes and its potential implications. Acta Tropica 126, 1118.CrossRefGoogle ScholarPubMed
Alver, O, Oral, B and Tore, O (2011) [The distribution of intestinal parasites detected in the Uludag University Medical School Hospital between 2005 and 2008]. Türkiye Parazitolojii Dergisi 35, 194198.Google Scholar
Ankarklev, J, Svärd, SG and Lebbad, M (2012) Allelic sequence heterozygosity in single Giardia Parasites. BMC Microbiology 12, 65.CrossRefGoogle ScholarPubMed
Ankarklev, J, Lebbad, M, Einarsson, E, Franzen, O, Ahola, H, Troell, K and Svärd, SG (2018) A novel high-resolution multilocus sequence typing of Giardia intestinalis assemblage A isolates reveals zoonotic transmission, clonal outbreaks and recombination. Infection Genetics and Evolution 60, 716.CrossRefGoogle Scholar
Aykur, M, Kurt, CC, Erdogan, DD, Avcı, CB, Vardar, R, Aydemir, S, Girginkardeşler, N, Gündüz, C and Dagci, H (2019) Investigation of Dientamoeba fragilis prevalence and evaluation of sociodemographic and clinical features in patients with gastrointestinal symptoms. Acta Parasitologica 64, 162170.CrossRefGoogle ScholarPubMed
Bahrami, F, Babaei, E, Badirzadeh, A, Riabi, TR and Abdoli, A (2020) Blastocystis, urticaria, and skin disorders: review of the current evidences. European Journal of Clinical Microbiology and Infectious Diseases 39, 10271042.CrossRefGoogle ScholarPubMed
Bayramoglu, O, Pekmezci, D and Basari, F (2013) [Investigation of Giardia and Cryptosporidium prevalence with different methods in Adana food workers]. Türkiye Parazitolojii Dergisi 37, 48.Google Scholar
Breathnach, AS, McHugh, TD and Butcher, PD (2010) Prevalence and clinical correlations of genetic subtypes of Giardia Lamblia in an urban setting. Epidemiology and Infection 138, 14591467.CrossRefGoogle Scholar
Caccio, SM, Beck, R, Lalle, M, Marinculic, A and Pozio, E (2008) Multilocus genotyping of Giardia duodenalis reveals striking differences between assemblages A and B. International Journal for Parasitology 38, 15231531.CrossRefGoogle ScholarPubMed
Caccio, SM, Lalle, M and Svard, SG (2018) Host specificity in the Giardia duodenalis species complex. Infection Genetics and Evolution 66, 335345.CrossRefGoogle ScholarPubMed
Cakir, F, Cicek, M and Yildirim, IH (2019) Determination the subtypes of Blastocystis sp. and evaluate the effect of these subtypes on pathogenicity. Acta Parasitologica 64, 712.CrossRefGoogle ScholarPubMed
Çiçek, C and Şakru, N (2015) [Genotyping of Giardia intestinalis isolates in the Thrace Region, Turkey]. Mikrobiyoloji Bülteni 49, 576585.CrossRefGoogle Scholar
Dagci, H, Kurt, Ö, Demirel, M, Mandiracioglu, A, Aydemir, S, Saz, U, Bart, A and Van Gool, T (2014) Epidemiological and diagnostic features of Blastocystis Infection in symptomatic patients in Izmir province, Turkey. Iranian Journal of Parasitology 9, 519529.Google ScholarPubMed
de Lucio, A, Amor-Aramendía, A, Bailo, B, Saugar, JM, Anegagrie, M, Arroyo, A, López-Quintana, B, Zewdie, D, Ayehubizu, Z, Yizengaw, E, Abera, B, Yimer, M, Mulu, W, Hailu, T, Herrador, Z, Fuentes, I and Carmena, D (2016) Prevalence and genetic diversity of Giardia duodenalis and Cryptosporidium Spp. among school children in a rural area of the Amhara Region, North-West Ethiopia. PLoS ONE 11, e0159992.CrossRefGoogle Scholar
Demircan, K, Onder, Z, Duzlu, O, Yildirim, A, Okur, M, Ciloglu, A, Yetismis, G and Inci, A (2019) First molecular detection and phylogenetic analyses of zoonotic Giardia intestinalis in horses in Turkey. Journal of Equine Veterinary Science 80, 5660.CrossRefGoogle ScholarPubMed
Durak, F, Dogan, M, Atambay, M, Ozgen, U and Ozen, M (2013) [Evaluation of the intestinal parasitic infections in children patients with cancer]. Türkiye Parazitolojii Dergisi 37, 179185.Google Scholar
Efstratiou, A, Ongerth, JE and Karanis, P (2017) Waterborne transmission of protozoan parasites: review of worldwide outbreaks – an update 2011–2016. Water Research 114, 1422.CrossRefGoogle ScholarPubMed
Einarsson, E, Ma'ayeh, S and Svärd, SG (2016) An up-date on Giardia And giardiasis. Current Opinion in Microbiology 34, 4752.CrossRefGoogle ScholarPubMed
Ertuğ, S, Ertabaklar, H, Özlem Çalışkan, S, Malatyalı, E and Bozdoğan, B (2016) [Genotyping of Giardia intestinalis strains isolated from humans in Aydin, Turkey]. Mikrobiyoloji Bülteni 50, 152158.CrossRefGoogle Scholar
Feng, Y and Xiao, L (2011) Zoonotic potential and molecular epidemiology of Giardia species and giardiasis. Clinical Microbiology Reviews 24, 110140.CrossRefGoogle ScholarPubMed
Fletcher, SM, Stark, D, Harkness, J and Ellis, J (2012) Enteric protozoa in the developed world: a public health perspective. Clinical Microbiology Reviews 25, 420449.CrossRefGoogle ScholarPubMed
Franzen, O, Jerlström-Hultqvis, TJ, Castro, E, Sherwood, E, Ankarklev, J, Reiner, DS, Palm, D, Andersson, JO, Andersson, B and Svärd, SG (2009) Draft genome sequencing of Giardia intestinalis assemblage B isolate GS: is human giardiasis caused by two different species? PLoS Pathogens 5, e1000560.CrossRefGoogle Scholar
Garcia, LS (2017) Diagnostic Medical Parasitology, 6th Edn. Washington, USA: ASM Press.Google Scholar
Gelanew, T, Lalle, M, Hailu, A, Pozio, E and Cacciò, SM (2007) Molecular characterization of human isolates of Giardia duodenalis from Ethiopia. Acta Tropica 102, 9299.CrossRefGoogle ScholarPubMed
Goksen, B, Appak, YC, Girginkardesler, N, Ecemis, T and Kasirga, E (2016) Coexistence of Helicobacter pylori and intestinal parasitosis in children with chronic abdominal pain. Türkiye Parazitolojii Dergisi 40, 3236.Google ScholarPubMed
Gulmez, D, Saribas, Z, Akyon, Y and Erguven, S (2013) [The results of Hacettepe University Faculty of Medicine Parasitology Laboratory in 2003–2012: evaluation of 10 years]. Türkiye Parazitolojii Dergisi 37, 97101.Google Scholar
Gultekin, M, Ural, K, Aysul, N, Ayan, A, Balikci, C and Akyildiz, G (2017) Prevalence and molecular characterization of Giardia duodenalis in dogs in Aydin, Turkey. International Journal of Environmental Health Research 27, 161168.CrossRefGoogle ScholarPubMed
Guy, RA, Payment, P, Krull, UJ and Horgen, PA (2003) Real-time PCR for quantification of Giardia and Cryptosporidium in environmental water samples and sewage. Applied and Environmental Microbiology 69, 51785185.CrossRefGoogle ScholarPubMed
Halliez, MC and Buret, AG (2013) Extra-intestinal and long term consequences of Giardia duodenalis infections. World Journal of Gastroenterology 19, 89748985.CrossRefGoogle ScholarPubMed
Hooshyar, H, Ghafarinasab, S, Arbabi, M, Delavari, M and Rasti, S (2017) Genetic variation of Giardia lamblia isolates from food-handlers in Kashan, Central Iran. Iranian Journal of Parasitology 12, 83.Google ScholarPubMed
Kasaei, R, Carmena, D, Jelowdar, A and Beiromvand, M (2018) Molecular genotyping of Giardia duodenalis in children from Behbahan, southwestern Iran. Parasitology Research 117, 14251431.CrossRefGoogle ScholarPubMed
Kocak Tufan, Z, Altun, S, Bulut, C, Kinikli, S and Demiroz, AP (2011) [Protozoal antigen positivity in diarrheal patients admitted to emergency service: a point prevalence study]. Mikrobiyoloji Bülteni 45, 765767.Google Scholar
Koloren, Z, Seferoğlu, O and Karanis, P (2016) Occurency of Giardia duodenalis assemblages in river water sources of Black Sea, Turkey. Acta Tropica 164, 337344.CrossRefGoogle ScholarPubMed
Kotloff, KL, Nataro, JP, Blackwelder, WC, Nasrin, D, Farag, TH, Panchalingam, S, Wu, Y, Sow, SO, Sur, D, Breiman, RF, Faruque, AS, Zaidi, AK, Saha, D, Alonso, PL, Tamboura, B, Sanogo, D, Onwuchekwa, U, Manna, B, Ramamurthy, T, Kanungo, S, Ochieng, JB, Omore, R, Oundo, JO, Hossain, A, Das, SK, Ahmed, S, Qureshi, S, Quadri, F, Adegbola, RA, Antonio, M, Hossain, MJ, Akinsola, A, Mandomando, I, Nhampossa, T, Acácio, S, Biswas, K, O'Reilly, CE, Mintz, ED, Berkeley, LY, Muhsen, K, Sommerfelt, H, Robins-Browne, RM and Levine, MM (2013) Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet (London, England) 382, 209222.CrossRefGoogle ScholarPubMed
Kumar, S, Stecher, G, Li, M, Knyaz, C, Tamura, K and Battistuzzi, FU (2018) MEGA X: molecular evolutionary genetics analysis across computing platforms. Molecular Biology and Evolution 35, 15471549.CrossRefGoogle ScholarPubMed
Lalle, M, Pozio, E, Capelli, G, Bruschi, F, Crotti, D and Caccio, SM (2005) Genetic heterogeneity at the beta-giardin locus among human and animal isolates of Giardia duodenalis and identification of potentially zoonotic subgenotypes. International Journal of Parasitology 35, 207213.CrossRefGoogle Scholar
Levine, MM, Nasrin, D, Acácio, S, Bassat, Q, Powell, H, Tennant, SM, Sow, SO, Sur, D, Zaidi, AKM, Faruque, ASG, Hossain, MJ, Alonso, PL, Breiman, RF, O'Reilly, CE, Mintz, ED, Omore, R, Ochieng, JB, Oundo, JO, Tamboura, B, Sanogo, D, Onwuchekwa, U, Manna, B, Ramamurthy, T, Kanungo, S, Ahmed, S, Qureshi, S, Quadri, F, Hossain, A, Das, SK, Antonio, M, Saha, D, Mandomando, I, Blackwelder, WC, Farag, T, Wu, Y, Houpt, ER, Verweiij, JJ, Sommerfelt, H, Nataro, JP, Robins-Browne, RM and Kotloff, KL (2020) Diarrhoeal disease and subsequent risk of death in infants and children residing in low-income and middle-income countries: analysis of the GEMS case-control study and 12-month GEMS-1A follow-on study. Lancet Global Health 8, e204e214.CrossRefGoogle ScholarPubMed
Maçin, S, Kaya, F, Çağdaş, D, Hizarcioglu-Gulsen, H, Saltik-Temizel, IN, Tezcan, İ, Demir, H, Ergüven, S and Akyön, Y (2016) Detection of parasites in children with chronic diarrhea. Pediatrics International 58, 531533.CrossRefGoogle ScholarPubMed
Malatyalı, E, Ertabaklar, H and Ertuğ, S (2019) [Subtype distribution of Blastocystis spp. with DNA barcoding and evaluation of diagnostic methods]. Mikrobiyoloji Bülteni 53, 308318.CrossRefGoogle Scholar
Morrison, HG, McArthur, AG, Gillin, FD, Aley, SB, Adam, RD, Olsen, GJ, Best, AA, Cande, WZ, Chen, F, Cipriano, MJ, Davids, BJ, Dawson, SC, Elmendorf, HG, Hehl, AB, Holder, ME, Huse, SM, Kim, UU, Lasek-Nesselquist, E, Manning, G, Nigam, A, Nixon, JE, Palm, D, Passamaneck, NE, Prabhu, A, Reich, CI, Reiner, DS, Samuelson, J, Svard, SG and Sogin, ML (2007) Genomic minimalism in the early diverging intestinal parasite Giardia lamblia. Science (New York, N.Y.) 317, 19211926.CrossRefGoogle ScholarPubMed
Platts-Mills, JA, Babji, S, Bodhidatta, L, Gratz, J, Haque, R, Havt, A, McCormick, BJ, McGrath, M, Olortegui, MP, Samie, A, Shakoor, S, Mondal, D, Lima, IF, Hariraju, D, Rayamajhi, BB, Qureshi, S, Kabir, F, Yori, PP, Mufamadi, B, Amour, C, Carreon, JD, Richard, SA, Lang, D, Bessong, P, Mduma, E, Ahmed, T, Lima, AA, Mason, CJ, Zaidi, AK, Bhutta, ZA, Kosek, M, Guerrant, RL, Gottlieb, M, Miller, M, Kang, GHoupt, ER and MAL-ED Network Investigators (2015) Pathogen-specific burdens of community diarrhoea in developing countries: a multisite birth cohort study (MAL-ED). Lancet Global Health 3, e564575.CrossRefGoogle Scholar
Rafiei, A, Baghlaninezhad, R, Köster, PC, Bailo, B, Hernández de Mingo, M, Carmena, D, Panabad, E and Beiromvand, M (2020) Multilocus genotyping of Giardia duodenalis in Southwestern Iran. A community survey. PLoS ONE 15, e0228317.CrossRefGoogle ScholarPubMed
Read, CM, Monis, PT and Thompson, RC (2004) Discrimination of all genotypes of Giardia duodenalis at the glutamate dehydrogenase locus using PCR-RFLP. Infection Genetics and Evolution 4, 125130.CrossRefGoogle Scholar
Reh, L, Muadica, AS, Köster, PC, Balasegaram, S, Verlander, NQ, Chércoles, ER and Carmena, D (2019) Substantial prevalence of enteroparasites Cryptosporidium Spp., Giardia duodenalis and Blastocystis sp. in asymptomatic schoolchildren in Madrid, Spain, November 2017 to June 2018. Euro Surveillance 24. doi:10.2807/1560-7917.ES.2019.24.43.1900241.Google ScholarPubMed
Rostami, A, Riahi, SM, Haghighi, A, Saber, V, Armon, B and Seyyedtabaei, SJ (2017) The role of Blastocystis sp. and Dientamoeba fragilis in irritable bowel syndrome: a systematic review and meta-analysis. Parasitology Research 116, 111.Google ScholarPubMed
Ryan, U and Cacciò, SM (2018) Zoonotic potential of Giardia. International Journal for Parasitology 43, 943956.CrossRefGoogle Scholar
Ryan, U, Hijjawi, N, Feng, Y and Xiao, L (2019) Giardia: an under-reported foodborne parasite. International Journal for Parasitology 49, 111.CrossRefGoogle ScholarPubMed
Sahagún, J, Clavel, A, Goñi, P, Seral, C, Llorente, MT, Castillo, FJ, Capilla, S, Arias, A and Gómez-Lus, R (2008) Correlation between the presence of symptoms and the Giardia duodenalis genotype. European Journal of Clinical Microbiology and Infectious Diseases 27, 8183.CrossRefGoogle ScholarPubMed
Saitou, N and Nei, M (1987) The neighbor-joining method: a new method for reconstructing phylogenetic trees. Molecular Biology and Evolution 4, 406425.Google ScholarPubMed
Scicluna, SM, Tawari, B and Clark, CG (2006) DNA barcoding of Blastocystis. Protist 157, 7785.CrossRefGoogle ScholarPubMed
Selek, MB, Bektore, B, Karagoz, E, Baylan, O and Ozyurt, M (2016) Distribution of parasites detected in stool samples of patients admitted to our parasitology laboratory during a three-year period between 2012 and 2014. Türkiye Parazitolojii Dergisi 40, 137140.Google ScholarPubMed
Siripattanapipong, S, Leelayoova, S, Mungthin, M, Thompson, RC, Boontanom, P, Saksirisampant, W and Tan-Ariya, P (2011) Clonal diversity of the glutamate dehydrogenase gene in Giardia duodenalis from Thai isolates: evidence of genetic exchange or mixed infections? BMC Microbiology 11, 206.CrossRefGoogle ScholarPubMed
Sivcan, E, Charyyeva, A, Ceylan, SS, Yürük, M, Erdoğan, E and Şahin, İ (2018) [Dientamoeba fragilis infection in patients with gastrointestinal system complaints]. Mikrobiyoloji Bülteni 52, 166179.CrossRefGoogle Scholar
Sprong, H, Cacciò, SM, van der Giessen, JWB and ZOOPNET network and partners (2009) Identification of zoonotic genotypes of Giardia duodenalis. PLoS Neglected Tropical Diseases 3, e558.CrossRefGoogle ScholarPubMed
Stark, D, Beebe, N, Marriott, D, Ellis, J and Harkness, J (2006) Evaluation of three diagnostic methods, including real-time PCR, for detection of Dientamoeba fragilis in stool specimens. Journal of Clinical Microbiology 44, 232235.CrossRefGoogle ScholarPubMed
Stensvold, CR, Ahmed, UN, Andersen, LOB and Nielsen, HV (2012) Development and evaluation of a genus-specific, probe-based, internal-process-controlled real-time PCR assay for sensitive and specific detection of Blastocystis spp. Journal of Clinical Microbiology 50, 18471851.CrossRefGoogle ScholarPubMed
Sulaiman, IM, Fayer, R, Bern, C, Gilman, RH, Trout, JM, Schantz, PM, Das, P, Lal, AA and Xiao, L (2003) Triosephosphate isomerase gene characterization and potential zoonotic transmission of Giardia duodenalis. Emerging and Infectious Diseases 9, 14441452.CrossRefGoogle ScholarPubMed
Tamer, GS, Kasap, M and Er, DK (2015) Genotyping and phylogenetic analysis of Giardia duodenalis isolates from Turkish children. Medical Science Monitor 21, 526532.Google ScholarPubMed
Van Lieshout, L and Roestenberg, M (2015) Clinical consequences of new diagnostic tools for intestinal parasites. Clinical Microbiology and Infection 21, 520528.CrossRefGoogle ScholarPubMed
Verweij, JJ (2014) Application of PCR-based methods for diagnosis of intestinal parasitic infections in the clinical laboratory. Parasitology 141, 18631872.CrossRefGoogle ScholarPubMed
Wang, Y, Gonzalez-Moreno, O, Roellig, DM, Oliver, L, Huguet, J, Guo, Y, Feng, Y and Xiao, L (2019) Epidemiological distribution of genotypes of Giardia duodenalis in humans in Spain. Parasites and Vectors 12, 432.CrossRefGoogle ScholarPubMed
World Health Organization (1991) Basic Laboratory Methods in Medical Parasitology. Geneva, Switzerland: World Health Organization.Google Scholar
Yentur Doni, N, Gürses, G, Şimşek, Z and Yıldız Zeyrek, F (2015a) Prevalence and associated risk factors of intestinal parasites among children of farm workers in the southeastern Anatolian region of Turkey. Annals of Agricultural and Environmental Medicine 22, 438442.CrossRefGoogle Scholar
Yentur Doni, N, Yildiz Zeyrek, F, Simsek, Z, Gurses, G and Sahin, İ (2015b) Risk factors and relationship between intestinal parasites and the growth retardation and psychomotor development delays of children in Şanlıurfa, Turkey. Türkiye Parazitolojii Dergisi 39, 270276.Google Scholar
Youn, S, Kabir, M, Haque, R and Petri, WA Jr (2009) Evaluation of a screening test for detection of Giardia and Cryptosporidium parasites. Journal of Clinical Microbiology 47, 451452.CrossRefGoogle ScholarPubMed
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