Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-26T17:07:58.634Z Has data issue: false hasContentIssue false
  • English
  • Français

Systematic review and meta-analysis on Schistosoma mansoni infection prevalence, and associated risk factors in Brazil

Published online by Cambridge University Press:  03 January 2018

Maria Teresinha Gomes Casavechia ,
Gessilda de Alcântara Nogueira de Melo ,
Andrea Claudia Bekner Da Silva Fernandes ,
Karin Reinhold De Castro ,
Raissa Bocchi Pedroso ,
Thaís Da Silva Santos  and
Jorge Juarez Vieira Teixeira
Maria Teresinha Gomes Casavechia
Affiliation:
Graduate Program in Bioscience and Physiopathology, Department of Clinical Analysis and Biomedicine, State University Maringa, Avenida Colombo, 5790, Jardim Universitário, CEP 87020-900, Maringá, Paraná, Brazil
Gessilda de Alcântara Nogueira de Melo
Affiliation:
Graduate Program in Bioscience and Physiopathology, Department of Clinical Analysis and Biomedicine, State University Maringa, Avenida Colombo, 5790, Jardim Universitário, CEP 87020-900, Maringá, Paraná, Brazil
Andrea Claudia Bekner Da Silva Fernandes
Affiliation:
Graduate Program in Bioscience and Physiopathology, Department of Clinical Analysis and Biomedicine, State University Maringa, Avenida Colombo, 5790, Jardim Universitário, CEP 87020-900, Maringá, Paraná, Brazil
Karin Reinhold De Castro
Affiliation:
Graduate Program in Bioscience and Physiopathology, Department of Clinical Analysis and Biomedicine, State University Maringa, Avenida Colombo, 5790, Jardim Universitário, CEP 87020-900, Maringá, Paraná, Brazil
Raissa Bocchi Pedroso
Affiliation:
Graduate Program in Bioscience and Physiopathology, Department of Clinical Analysis and Biomedicine, State University Maringa, Avenida Colombo, 5790, Jardim Universitário, CEP 87020-900, Maringá, Paraná, Brazil
Thaís Da Silva Santos
Affiliation:
Graduate Program in Bioscience and Physiopathology, Department of Clinical Analysis and Biomedicine, State University Maringa, Avenida Colombo, 5790, Jardim Universitário, CEP 87020-900, Maringá, Paraná, Brazil
Jorge Juarez Vieira Teixeira*
Affiliation:
Graduate Program in Bioscience and Physiopathology, Department of Clinical Analysis and Biomedicine, State University Maringa, Avenida Colombo, 5790, Jardim Universitário, CEP 87020-900, Maringá, Paraná, Brazil
*
Author for correspondence: Jorge Juarez Vieira Teixeira, E-mail: jjvteixeira@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

We performed a systematic review and meta-analysis on the prevalence and factors associated with Schistosoma mansoni infection in Brazil. We searched the PubMed, Web of Science and Latin-American and Caribbean System on Health Sciences Information (LILACS) databases, scientific publications articles, according to The PRISMA Statement, from 2000 to 2016. A total of 27 studies were included according to the established criteria. The prevalence of S. mansoni infection varied widely, from 0·1 to 73·1%, based on Kato-Katz technique. Of the identified studies, 42·9% were performed in the state of Minas Gerais, and 33·3% were performed in the northeast region of Brazil. We identified sex, age, education level, family income, contact with water and the presence of the intermediate host snail as major risk factors associated with infection. The meta-analysis summarized a high prevalence rate pooled for Schistosoma mansoni. On the other hand, the analysis of the subgroup showed a highly significant reduction of the prevalence rate after control measures. The epidemiological factors evidenced in the studies show the influence of environmental and social conditions on the occurrence of schistosomiasis.

Keywords

Prevalenceprevention and controlrisk factorsSchistosoma mansoni
Type
Review Article
Information
Parasitology , Volume 145 , Issue 8 , July 2018 , pp. 1000 - 1014
Check for updates
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Address of the University where the work was prepared. Avenida Colombo, 5790, Jardim Universitário, CEP 87020-900, Maringá, Paraná, Brazil.

References

Bandara, M, Ananda, M, Wickramage, K, Berger, E and Agampodi, S (2014) Globalization of leptospirosis through travel and migration. Global Health 10, 61.CrossRefGoogle ScholarPubMed
Barbosa, CS, Favre, TC, Wanderley, TN, Callou, AC and Pieri, OS (2006) Assessment of schistosomiasis, through school surveys, in the Forest Zone of Pernambuco, Brazil. Memorias do Instituto Oswaldo Cruz 101(Suppl. 1), 55–62.CrossRefGoogle ScholarPubMed
Barbosa, CS, Leal-Neto, OB, Gomes, EC, Araujo, KC and Domingues, AL (2011) The endemisation of schistosomiasis in Porto de Galinhas, Pernambuco, Brazil, 10 years after the first epidemic outbreak. Memorias do Instituto Oswaldo Cruz 106, 878–883.CrossRefGoogle Scholar
Barbosa, LM, Silva, LK, Reis, EA, Azevedo, TM, Costa, JM, Blank, WA, Reis, MG and Blanton, RE (2013) Characteristics of the human host have little influence on which local Schistosoma mansoni populations are acquired. PLoS Neglected Tropical Diseases 7, e2572.CrossRefGoogle ScholarPubMed
Bartlett, C, Sterne, J and Egger, M (2002) What is newsworthy? Longitudinal study of the reporting of medical research in two British newspapers. BMJ 325, 81–84.CrossRefGoogle ScholarPubMed
Bastuji-Garin, S, Sbidian, E, Gaudy-Marqueste, C, Ferrat, E, Roujeau, JC, Richard, MA and Canoui-Poitrine, F and European Dermatology Network (EDEN) (2013). Impact of STROBE statement publication on quality of observational study reporting: interrupted time series versus before-after analysis. PLoS ONE 26, e64733.CrossRefGoogle Scholar
Begg, CB and Mazumdar, M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 1088–1101.CrossRefGoogle Scholar
Beller, EM, Glasziou, PP, Altman, DG, Hopewell, S, Bastian, H, Chalmers, I, Gotzsche, PC, Lasserson, T and Tovey, D (2013) PRISMA for abstracts: reporting systematic reviews in journal and conference abstracts. PLoS Medicine 10, e1001419.CrossRefGoogle ScholarPubMed
Bina, JC and Prata, A (2003) Schistosomiasis in hyperendemic area of Taquarendi: I-Schistosoma mansoni infection and severe clinical forms. Revista da Sociedade Brasileira de Medicina Tropical 36, 211–216.CrossRefGoogle ScholarPubMed
Blanton, RE, Barbosa, LM, Reis, EA, Carmo, TM, Dos Santos, CR, Costa, JM, Aminu, PT, Blank, WA, Reis, RB, Guimaraes, IC, Silva, LK and Reis, MG (2015) The relative contribution of immigration or local increase for persistence of urban schistosomiasis in Salvador, Bahia, Brazil. PLoS Neglected Tropical Diseases 9, e0003521.CrossRefGoogle ScholarPubMed
Brito, LL, Barreto, ML, Silva Rde, C, Assis, AM, Reis, MG, Parraga, IM and Blanton, RE (2006) Moderate- and low-intensity co-infections by intestinal helminths and Schistosoma mansoni, dietary iron intake, and anemia in Brazilian children. American Journal of Tropical Medicine and Hygiene 75, 939–944.CrossRefGoogle ScholarPubMed
Brooker, S (2007) Spatial epidemiology of human schistosomiasis in Africa: risk models, transmission dynamics and control. Transactions of the Royal Society of Tropical Medicine and Hygiene 101, 1–8.CrossRefGoogle ScholarPubMed
Burlandy-Soares, LC, de Souza Dias, LC, Kanamura, HY, de Oliveira, EJ and Ciaravolo, RM (2003) Schistosomiasis mansoni: follow-up of control program based on parasitologic and serologic methods in a Brazilian community of low endemicity. Memorias do Instituto Oswaldo Cruz 98, 853–859.CrossRefGoogle Scholar
Carrier, MA (2009) Unsettling drug patent settlements: a framework for presumptive illegality. Michigan Law Review 108, 37–80.Google ScholarPubMed
Colley, DG, Bustinduy, AL, Secor, WE and King, CH (2014) Human schistosomiasis. Lancet 383, 2253–2264.CrossRefGoogle ScholarPubMed
Colley, DG, Andros, TS and Campbel, CH Jr (2017) Schistosomiasis is more prevalent than previously thought: what does it mean for public health goals, policies, strategies, guidelines and intervention programs? Infectious Diseases of Poverty 63, 1–8.Google Scholar
Couto, JL (2005) Schistosomiasis mansoni in two mesoregions of the State of Alagoas. Revista da Sociedade Brasileira de Medicina Tropical 38, 301–304.CrossRefGoogle ScholarPubMed
da Costa, BR, Cevallos, M, Altman, DG, Rutjes, AW and Egger, M (2011) Uses and misuses of the STROBE statement: bibliographic study. BMJ Open 1, e000048.CrossRefGoogle ScholarPubMed
DerSimonian, R and Laird, N (1986) Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177–188.CrossRefGoogle ScholarPubMed
Doenhoff, MJ, Chiodini, PL and Hamilton, JV (2004) Specific and sensitive diagnosis of schistosome infection: can it be done with antibodies? Trends in Parasitology 20, 35–39.CrossRefGoogle ScholarPubMed
Egger, M, Davey Smith, G, Schneider, M and Minder, C (1997) Bias in meta-analysis detected by a simple, graphical test. Bmj 315, 629–634.CrossRefGoogle ScholarPubMed
Enk, MJ, Lima, AC, Drummond, SC, Schall, VT and Coelho, PM (2008) The effect of the number of stool samples on the observed prevalence and the infection intensity with Schistosoma mansoni among a population in an area of low transmission. Acta Tropica 108, 222–228.CrossRefGoogle Scholar
Enk, MJ, Lima, AC, Barros Hda, S, Massara, CL, Coelho, PM and Schall, VT (2010) Factors related to transmission of and infection with Schistosoma mansoni in a village in the South-eastern Region of Brazil. Memorias do Instituto Oswaldo Cruz 105, 570–577.CrossRefGoogle Scholar
Espirito-Santo, MC, Alvarado-Mora, MV, Dias-Neto, E, Botelho-Lima, LS, Moreira, JP, Amorim, M, Pinto, PL, Heath, AR, Castilho, VL, Goncalves, EM, Luna, EJ, Carrilho, FJ, Pinho, JR and Gryschek, RC (2014a) Evaluation of real-time PCR assay to detect Schistosoma mansoni infections in a low endemic setting. BMC Infectious Diseases 14, 558.CrossRefGoogle Scholar
Espirito-Santo, MC, Sanchez, MC, Sanchez, AR, Alvarado-Mora, MV, Castilho, VL, Goncalves, EM, Luna, EJ and Gryschek, RC (2014b) Evaluation of the sensitivity of IgG and IgM ELISA in detecting Schistosoma mansoni infections in a low endemicity setting. European Journal of Clinical Microbiology & Infectious Diseases 33, 2275–2284.CrossRefGoogle Scholar
Fonseca, F, Freitas, C, Dutra, L, Guimaraes, R and Carvalho, O (2014) Spatial modeling of the Schistosomiasis mansoni in Minas Gerais State, Brazil using spatial regression. Acta Tropica 133, 56–63.CrossRefGoogle Scholar
Gazzinelli, A, Velasquez-Melendez, G, Crawford, SB, LoVerde, PT, Correa-Oliveira, R and Kloos, H (2006) Socioeconomic determinants of schistosomiasis in a poor rural area in Brazil. Acta Tropica 99, 260–271.CrossRefGoogle Scholar
Gomes, EC, Leal-Neto, OB, de Oliveira, FJ Jr., Campos, JV, Souza-Santos, R and Barbosa, CS (2014). Risk analysis for occurrences of schistosomiasis in the coastal area of Porto de Galinhas, Pernambuco, Brazil. BMC Infectious Diseases 14, 101.CrossRefGoogle Scholar
Goncalves, MM, Barreto, MM, Maldonado, A Jr., Maione, VR, Rey, L and Soares Mda, S (2005). Socio-cultural and ethical factors involved in the diagnosis of Schistosomiasis mansoni in an area of low endemicity. Cadernos de saude publica 21, 92–100.Google Scholar
Gryseels, B (2012) Schistosomiasis. Infectious Disease Clinics of North America 26, 383–397.CrossRefGoogle ScholarPubMed
Gryseels, B, Polman, K, Clerinx, J and Kestens, L (2006) Human schistosomiasis. Lancet 368, 1106–1118.CrossRefGoogle ScholarPubMed
Guimaraes, IC and Tavares-Neto, J (2006) Urban transmission of schistosomiasis in children from a neighborhood of Salvador, Bahia. Revista da Sociedade Brasileira de Medicina Tropical 39, 451–455.Google ScholarPubMed
Guimaraes, RJ, Freitas, CC, Dutra, LV, Moura, AC, Amaral, RS, Drummond, SC, Scholte, RG and Carvalho, OS (2008) Schistosomiasis risk estimation in Minas Gerais State, Brazil, using environmental data and GIS techniques. Acta Tropica 108, 234–241.CrossRefGoogle Scholar
Higgins, JP, Thompson, SG, Deeks, JJ and Altman, DG (2003) Measuring inconsistency in meta-analyses. BMJ 327, 557–560.CrossRefGoogle ScholarPubMed
Igreja, RP, Gusmao, MF, Barreto, MG, Paulino, MT, da Silva, JF, Seck, OK, Goncalves, MM and Soares, MS (2010) A 15-year follow-up study on schistosomiasis in a low-endemic area in Rio de Janeiro State, Brazil. Journal of Helminthology 84, 229–233.CrossRefGoogle Scholar
Infl, WA and Manu, U (2002) WHO Manual on Animal Influenza Diagnosis and Surveillance. Geneva: World Health Organization.Google Scholar
Jejaw, A, Zemene, E, Alemu, Y and Mengistie, Z (2015) High prevalence of Schistosoma mansoni and other intestinal parasites among elementary school children in Southwest Ethiopia: a cross-sectional study. BMC Public Health 15, 600.CrossRefGoogle ScholarPubMed
Katz, N and Peixoto, SV (2000) Critical analysis of the estimated number of Schistosomiasis mansoni carriers in Brazil. Revista da Sociedade Brasileira de Medicina Tropical 33, 303–308.CrossRefGoogle ScholarPubMed
Kloos, H, Correa-Oliveira, R, Oliveira Quites, HF, Caetano Souza, MC and Gazzinelli, A (2008) Socioeconomic studies of schistosomiasis in Brazil: a review. Acta Tropica 108, 194–201.CrossRefGoogle ScholarPubMed
Kloos, H, Correa-Oliveira, R, dos Reis, DC, Rodrigues, EW, Monteiro, LA and Gazzinelli, A (2010) The role of population movement in the epidemiology and control of schistosomiasis in Brazil: a preliminary typology of population movement. Memorias do Instituto Oswaldo Cruz 105, 578–586.CrossRefGoogle Scholar
Martins-Melo, FR, Pinheiro, MC, Ramos, AN Jr., Alencar, CH, Bezerra, FS and Heukelbach, J (2014). Trends in schistosomiasis-related mortality in Brazil, 2000–2011. International Journal for Parasitology 44, 1055–1062.CrossRefGoogle ScholarPubMed
Massara, CL, Peixoto, SV, Barros Hda, S, Enk, MJ, Carvalho Odos, S and Schall, V (2004) Factors associated with Schistosomiasis mansoni in a population from the municipality of Jaboticatubas, State of Minas Gerais, Brazil. Memorias do Instituto Oswaldo Cruz 99, 127–134.CrossRefGoogle Scholar
Massara, CL, Peixoto, SV, Enk, MJ, da Silva Barros, H, dos Santos Carvalho, O, Sakurai, E and Schall, V (2006) Evaluation of an improved approach using residences of schistosomiasis-positive school children to identify carriers in an area of low endemicity. American Journal of Tropical Medicine and Hygiene 74, 495–499.CrossRefGoogle Scholar
Melo, EV, Costa, W, Conceicao, MJ and Coura, JR (2014) A comparative cross-sectional study on the prevalence and morbidity of schistosomiasis in a community in northeastern Brazil (1979–2010). Memorias do Instituto Oswaldo Cruz 109, 340–344.CrossRefGoogle Scholar
Mendes, CR, Teixeira, AT, Pereira, RA and Dias, LC (2005) A comparative study of the parasitological techniques: Kato-Katz and coprotest. Revista da Sociedade Brasileira de Medicina Tropical 38, 178–180.CrossRefGoogle ScholarPubMed
Ministério da Saúde (2012). Plano integrado de ações estratégicas de eliminação da hanseníase, filariose, esquistossomose e oncocercose como problema de saúde pública, tracoma como causa de cegueira e controle das geohelmintíases. Plano de Ação 2011–2015. Brasília. Ministério da Saúde.Google Scholar
Motta, JO and Sampaio, RN (2012) A pilot study comparing low-dose liposomal amphotericin B with N-methyl glucamine for the treatment of American cutaneous leishmaniasis. Journal of the European Academy of Dermatology and Venereology 26, 331–335.CrossRefGoogle ScholarPubMed
Palmeira, DC, Carvalho, AG, Rodrigues, K and Couto, JL (2010) Prevalence of Schistosoma mansoni infection in two municipalities of the State of Alagoas, Brazil. Revista da Sociedade Brasileira de Medicina Tropical 43, 313–317.CrossRefGoogle ScholarPubMed
Pan American Health Organization (2014). Schistosomiasis. http://www.paho.org/world-health-day-2014/wp-content/uploads/2014/02/Schistosomiasis.pdf; last Accessed April 10, 2016.Google Scholar
Pan American Health Organization/World Health Organization (2009). 49th Directing Council 61st Session of the Regional Committee. CD49.R19 Elimination of neglected diseases and other poverty-related infections.Google Scholar
Parsons, NR, Hiskens, R, Price, CL, Achten, J and Costa, ML (2011) A systematic survey of the quality of research reporting in general orthopaedic journals. The Journal of Bone and Joint Surgery. British Volume 93, 1154–1159.CrossRefGoogle ScholarPubMed
Raso, G, Matthys, B, N'Goran, EK, Tanner, M, Vounatsou, P and Utzinger, J (2005) Spatial risk prediction and mapping of Schistosoma mansoni infections among schoolchildren living in western Cote d'Ivoire. Parasitology 131, 97–108.CrossRefGoogle ScholarPubMed
Resendes, AP, Souza-Santos, R and Barbosa, CS (2005) Hospitalization and mortality from mansoni schistosomiasis in the state of Pernambuco, Brazil, 1992/2000. Cadernos de saude publica 21, 1392–1401.CrossRefGoogle ScholarPubMed
Rocha, RS, Silva, JG, Peixoto, SV, Caldeira, RL, Firmo, JO, Carvalho, OdS and Katz, N (2000) Assessment of schistosomiasis and other intestinal parasitoses in school children of the Bambui municipality, Minas Gerais, Brazil. Revista da Sociedade Brasileira de Medicina Tropical 33, 431–436.CrossRefGoogle ScholarPubMed
Rollemberg, CV, Silva, MM, Rollemberg, KC, Amorim, FR, Lessa, NM, Santos, MD, Souza, AM, Melo, EV, Almeida, RP, Silva, AM, Werneck, GL, Santos, MA, Almeida, JA and Jesus, AR (2015) Predicting frequency distribution and influence of sociodemographic and behavioral risk factors of Schistosoma mansoni infection and analysis of co-infection with intestinal parasites. Geospat Health 10, 303.CrossRefGoogle ScholarPubMed
Sarvel, AK, Oliveira, AA, Silva, AR, Lima, AC and Katz, N (2011) Evaluation of a 25-year-program for the control of Schistosomiasis mansoni in an endemic area in Brazil. PLoS Neglected Tropical Diseases 5, e990.CrossRefGoogle Scholar
Scholte, RG, Gosoniu, L, Malone, JB, Chammartin, F, Utzinger, J and Vounatsou, P (2014) Predictive risk mapping of schistosomiasis in Brazil using Bayesian geostatistical models. Acta Tropica 132, 57–63.CrossRefGoogle ScholarPubMed
Schur, N, Hurlimann, E, Stensgaard, AS, Chimfwembe, K, Mushinge, G, Simoonga, C, Kabatereine, NB, Kristensen, TK, Utzinger, J and Vounatsou, P (2013) Spatially explicit Schistosoma infection risk in eastern Africa using Bayesian geostatistical modelling. Acta Tropica 128, 365–377.CrossRefGoogle ScholarPubMed
Shamseer, L, Moher, D, Clarke, M, Ghersi, D, Liberati, A, Petticrew, M, Shekelle, P and Stewart, LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 349, g7647.CrossRefGoogle Scholar
Siqueira, LM, Coelho, PM, Oliveira, AA, Massara, CL, Carneiro, NF, Lima, AC and Enk, MJ (2011) Evaluation of two coproscopic techniques for the diagnosis of schistosomiasis in a low-transmission area in the state of Minas Gerais, Brazil. Memorias do Instituto Oswaldo Cruz 106, 844–850.CrossRefGoogle Scholar
Sorensen, AA, Wojahn, RD, Manske, MC and Calfee, RP (2013) Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement to assess reporting of observational trials in hand surgery. Journal of Hand Surgery American Society for Surgery of the Hand 38, 1584–1589.e1582.CrossRefGoogle ScholarPubMed
Steinmann, P, Keiser, J, Bos, R, Tanner, M and Utzinger, J (2006) Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk. The Lancet Infectious Diseases 6, 411–425.CrossRefGoogle ScholarPubMed
Teles, HM, Ferreira, CS, de Carvalho, ME, Zacharias, F and Magalhaes, LA (2003) The efficiency of the examination of compressed fecal samples for Schistosoma mansoni eggs. Revista da Sociedade Brasileira de Medicina Tropical 36, 503–507.CrossRefGoogle ScholarPubMed
van Lieshout, L, Polderman, AM and Deelder, AM (2000) Immunodiagnosis of schistosomiasis by determination of the circulating antigens CAA and CCA, in particular in individuals with recent or light infections. Acta Tropica 77, 69–80.CrossRefGoogle ScholarPubMed
Vasconcelos, CH, Cardoso, PC, Quirino, WC, Massara, CL, Amaral, GL, Cordeiro, R and Carvalho Odos, S (2009) Evaluation of Schistosomiasis mansoni control measures in Sabara, Minas Gerais State, Brazil, 1980–2007. Cadernos de saude publica 25, 997–1006.CrossRefGoogle Scholar
von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC and Vandenbroucke, JP and STROBE Initiative (2008). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Journal of Clinical Epidemiology 61, 344–349.CrossRefGoogle ScholarPubMed
von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gotzsche, PC and Vandenbroucke, JP (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. International Journal of Surgery 12, 1495–1499.CrossRefGoogle ScholarPubMed
World Health Assembly (2012). WHA 65.21. Elimination of schistosomiasis. http://www.who.int/neglected_diseases/mediacentre/WHA_65.21_.Eng.pdf; last Accessed January 23, 2015.Google Scholar
World Health Organization (2015). Investing to overcome the global impact of neglected tropical diseases. Third WHO report on neglected tropical diseases. Geneva. World Health Organization. http://www.who.int/neglected_diseases/9789241564861/en/; last Accessed December 17, 2015.Google Scholar
World Health Organization (2016). Schistosomiasis. Fact sheet 115. http://www.who.int/mediacentre/factsheets/fs115/en/; last Accessed October 20, 2017.Google Scholar
Supplementary material: File

Gomes Casavechia et al. supplementary material

Gomes Casavechia et al. supplementary material 1

Download Gomes Casavechia et al. supplementary material(File)
File 137 KB