5 Equine Pneumonia

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Questions and Answers

What is the significance of determining the inciting pathogen in cases of equine pneumonia?

  • It primarily helps in predicting the horse's lifespan following diagnosis.
  • It is mainly for research purposes and has limited impact on treatment.
  • It is crucial for establishing an effective treatment plan. (correct)
  • It is essential for preventing the spread of the disease to other animals.

Why is it important to avoid indiscriminate antimicrobial use in treating equine pneumonia?

  • To reduce the cost of treatment.
  • To minimize the risk of antimicrobial resistance. (correct)
  • To prevent staining of the horse's teeth.
  • To maintain the balance of gut flora.

Which factor contributes most significantly to the increased risk of pneumonia in young horses during their first two years of life?

  • Fully developed immune system.
  • Developing immunity coupled with potential immunosuppression from stress. (correct)
  • Limited exposure to pathogens.
  • Strictly controlled environmental conditions.

A 3-month-old foal presents with acute onset of dyspnea, fever, and cough. Which of the following diagnostic findings would be MOST consistent with a diagnosis of Rhodococcus equi pneumonia?

<p>Marked neutrophilic leukocytosis and hyperfibrinogenemia. (D)</p> Signup and view all the answers

When evaluating thoracic radiographs of a foal suspected of having Rhodococcus equi pneumonia, which characteristic finding would be most indicative of the disease?

<p>Perihilar abscessation and alveolarization. (D)</p> Signup and view all the answers

What is the primary mechanism by which Rhodococcus equi establishes infection in foals?

<p>Inhalation of bacteria from stalls and paddocks. (A)</p> Signup and view all the answers

What is the role of VapA (Virulence-associated protein A) in Rhodococcus equi's pathogenesis?

<p>It facilitates the bacterium's survival and replication within macrophages. (D)</p> Signup and view all the answers

Considering the age susceptibility of foals to specific bacteria, in which age range is a foal most likely to be infected with Rhodococcus equi?

<p>2-4 months. (D)</p> Signup and view all the answers

Which of the following is a primary clinical sign observed in foals affected by Rhodococcus equi pneumonia?

<p>Acute onset of dyspnea. (A)</p> Signup and view all the answers

What is the most common isolate found during a transtracheal wash (TTW) in a horse with pneumonia or pleuropneumonia?

<p>Streptococcus equi subsp. zooepidemicus. (A)</p> Signup and view all the answers

Which aspect of environmental management is most critical in reducing the risk of pneumonia in young horses?

<p>Maintaining optimal air quality and minimizing dust exposure. (D)</p> Signup and view all the answers

What diagnostic procedure is essential for identifying the specific bacterial cause of pneumonia in a horse, especially in cases unresponsive to initial treatment?

<p>Transtracheal wash with culture and sensitivity testing. (D)</p> Signup and view all the answers

A horse being transported long distances is at an increased risk of developing pneumonia primarily due to which factor?

<p>Lowered immune defenses associated with stress. (A)</p> Signup and view all the answers

Which of the following clinical signs would suggest a progression from bronchopneumonia to pleuropneumonia in a horse?

<p>Lethargy in addition to abnormal auscultation. (A)</p> Signup and view all the answers

What is the primary goal of using antiulcer medication as an additional therapeutic in treating Rhodococcus equi infections?

<p>To counteract the gastrointestinal side effects of macrolide antibiotics. (A)</p> Signup and view all the answers

What is the primary reason for monitoring herd health with complete blood counts (CBC) and fibrinogen levels every two weeks in a population at risk for Rhodococcus equi infection?

<p>To detect subclinical infections early. (B)</p> Signup and view all the answers

According to studies, what proportion of foals with small pulmonary abscesses due to Rhodococcus equi may recover without antimicrobial therapy?

<p>At least 40%. (B)</p> Signup and view all the answers

Why are foals born in January or February considered at higher risk for contracting R. equi?

<p>Increased concentration of bacteria in stalls and paddocks. (B)</p> Signup and view all the answers

What is the most concerning adverse effect associated with macrolide use in equine medicine?

<p>Anhidrosis and hyperthermia. (C)</p> Signup and view all the answers

What is the appropriate treatment of Rhodococcus equi?

<p>Azithromycin +/- Rifampin. (A)</p> Signup and view all the answers

In addition to a Gram-positive bacteria, what other pathogen is more likely to be present in Equine Pneumonia?

<p>Parasites. (C)</p> Signup and view all the answers

When is hyperimmune plasma needed in Equine Pneumonia?

<p>First 1-2 days of life and again at 28-30 days. (D)</p> Signup and view all the answers

Which age range are weanlings in?

<p>6-12 months. (C)</p> Signup and view all the answers

What age range do Yearlings fall into?

<p>12-24 months. (C)</p> Signup and view all the answers

What is the best way to diagnose Pneumonia?

<p>Thoracic radiographs. (A)</p> Signup and view all the answers

How does chronic disease lead to anemia?

<p>Inflammation. (C)</p> Signup and view all the answers

Which of the following medications would be used as a bronchodilation?

<p>Anitcholinergic. (B)</p> Signup and view all the answers

What is another clinical sign besides pneumonia that Rhodococcus equi can cause?

<p>Osteomylitis/septic arthritis. (B)</p> Signup and view all the answers

Which of the following is NOT a bacterial pathogen of equine pneumonia?

<p>Clostridium difficile. (D)</p> Signup and view all the answers

Which of the following diagnostics confirms Streptococcus zooepidemicus?

<p>Transtracheal wash. (A)</p> Signup and view all the answers

Besides bacterial infections, what other conditions can cause equine pneumonia?

<p>Viral Infections. (A)</p> Signup and view all the answers

When would the patient not need rebreathing?

<p>When there is no obvious distress. (A)</p> Signup and view all the answers

Where can a horse contract Rhodococcus equi?

<p>Stalls and paddocks. (D)</p> Signup and view all the answers

Besides azithromycin/rifampin, what is a second choice of medication to treat Rhodococcus equi?

<p>Clarithromycin. (A)</p> Signup and view all the answers

What does a thoracic radiograph of Rhodococcus equi present as?

<p>Pulmonary abscesses. (D)</p> Signup and view all the answers

During a physical exam, what is a symptom that indicates the development of pneumonia?

<p>Audible tracheal rattle. (B)</p> Signup and view all the answers

What is a bacterial pathogen found in adults that is unusual in foals?

<p>Pasteurella spp. (C)</p> Signup and view all the answers

What does VapA do inside Equine Macrophages with Rhodococcus equi?

<p>Inhibits the fusion of lysosomes. (C)</p> Signup and view all the answers

What is the BEST prevention method if you have a neonate shedding live bacteria in the feces?

<p>Isolate the affected foals. (D)</p> Signup and view all the answers

In managing a herd of young horses, what critical adjustment to environmental control can significantly minimize the risks associated with Rhodococcus equi pneumonia?

<p>Optimizing ventilation in indoor housing to reduce the concentration of airborne bacteria and dust. (A)</p> Signup and view all the answers

Considering the pathophysiology of Rhodococcus equi, which aspect of its interaction with the host immune system complicates treatment?

<p>Its intracellular survival within macrophages, which shields it from extracellular antibiotics and immune responses. (D)</p> Signup and view all the answers

How does the presence of concurrent parasitic infections, such as Parascaris equorum, exacerbate the risk and severity of pneumonia in young horses?

<p>By causing inflammation and physical damage to the respiratory tract during larval migration, predisposing to secondary bacterial infections (C)</p> Signup and view all the answers

Which aspect of managing a foal's environment is MOST likely to reduce the risk of Rhodococcus equi pneumonia?

<p>Ensuring adequate colostrum intake and monitoring IgG levels. (D)</p> Signup and view all the answers

What specific characteristic of VapA contributes directly to the persistence and severity of Rhodococcus equi infections in foals?

<p>VapA's function in promoting the survival and replication of <em>R. equi</em> inside macrophages, evading immune clearance. (B)</p> Signup and view all the answers

In cases of equine pneumonia complicated by pleuropneumonia, what finding on thoracic ultrasound would MOST strongly indicate the need for drainage?

<p>A fibrinous effusion with large, organized loculations and evidence of gas pockets within the pleural space. (A)</p> Signup and view all the answers

Considering the complex interplay of factors contributing to equine pneumonia, which management strategy would be MOST effective in reducing disease incidence on a large breeding farm?

<p>Optimizing ventilation, reducing overcrowding, and ensuring adequate passive transfer of immunity. (D)</p> Signup and view all the answers

Given the pathogenesis of Rhodococcus equi, why might aerosolized lipopolysaccharide (LPS) be used to prevent infection from R. equi?

<p>LPS triggers a localized immune response that enhances the clearance of <em>R. equi</em> without causing systemic inflammation. (B)</p> Signup and view all the answers

What is the MOST significant rationale for carefully selecting and monitoring antimicrobial therapy in foals with Rhodococcus equi pneumonia?

<p>The potential for inducing antimicrobial resistance and adverse effects, such as fatal enterocolitis in the dam. (C)</p> Signup and view all the answers

In a foal diagnosed with Rhodococcus equi pneumonia and concurrent immune-mediated polysynovitis, what does the presence of the latter suggest about the disease process?

<p>The immune system is excessively activated, leading to cross-reactivity with joint tissues. (C)</p> Signup and view all the answers

What is the underlying mechanism by which chronic pneumonia can lead to anemia in horses?

<p>Suppression of erythropoiesis due to chronic inflammation. (D)</p> Signup and view all the answers

Why are foals born in January or February at a particular disadvantage, predisposing them to a greater risk of contracting Rhodococcus equi?

<p>The limited time to develop robust immunity before environmental bacterial load increases in the spring. (B)</p> Signup and view all the answers

In a clinical scenario where a foal with Rhodococcus equi pneumonia is non-responsive to initial macrolide and rifampin therapy, what would be the MOST appropriate next diagnostic step?

<p>Perform a transtracheal wash (TTW) and submit for culture and sensitivity testing. (A)</p> Signup and view all the answers

In cases of equine pneumonia, what is the primary rationale for administering anti-ulcer medications as part of the treatment plan?

<p>To prevent or mitigate the development of gastric ulcers secondary to stress and medication. (B)</p> Signup and view all the answers

What is the likely significance of identifying Streptococcus equi subsp. zooepidemicus as the causative agent in a case of pneumonia in a mature horse?

<p>The infection is a result of a compromised immune system or recent stress. (B)</p> Signup and view all the answers

An owner wants to adopt a neonate that has Rhodococcus equi, what is the BEST thing to tell them to prevent other horses from becoming infected?

<p>Separate affected foals to prevent exposure to the shed bacteria via feces. (A)</p> Signup and view all the answers

If a 90-day old Thoroughbred foal shows signs of lethargy and increased respiratory rate, has crackles in cranioventral lung fields, and a fever of 103.5; what would be the next best differential?

<p>Rhodococcus equi (C)</p> Signup and view all the answers

What is the significance of identifying perihilar abscessation and alveolarization on thoracic radiographs for a foal suspected of having pneumonia?

<p>These findings are strongly suggestive of Rhodococcus equi pneumonia. (B)</p> Signup and view all the answers

When evaluating treatment methods on a farm with endemic Rhodococcus equi, how effective is antimicrobial therapy on foals with subclinical pulmonary abscesses?

<p>A majority of foals with small pulmonary abscesses recover without antimicrobial therapy. (C)</p> Signup and view all the answers

What is the initial response to anti-microbial therapy in Arabian foals around 7 months old infected with Streptococcus zooepidemicus pneumonia?

<p>Transient response (A)</p> Signup and view all the answers

Which findings would necessitate that a clinician should rebreath a horse diagnosed with Bronchopneumonia?

<p>Obvious distress (C)</p> Signup and view all the answers

Identify the immune component from the options, that plays a significant role in the prevention of Equine Pneumonia?

<p>Host Immunity (B)</p> Signup and view all the answers

Recognizing that transportation can elevate a horse's susceptibility to contracting pneumonia, what underlying cause primarily supports the condition?

<p>Stress suppresses the immune system. (B)</p> Signup and view all the answers

How can a veterinary professional recognize/confirm the presence of Streptococcus zooepidemicus?

<p>TTW (Transtracheal Wash) (C)</p> Signup and view all the answers

Which of the following could be a cause of Equine Pneumonia excluding bacteria?

<p>All of the above (D)</p> Signup and view all the answers

During an examination, which of the following could indicate that the patient has developed Pneumonia?

<p>Abnormal lung sounds (B)</p> Signup and view all the answers

When bacteria such as Rhodococcus equi are found, what function does VapA gene regulate inside Equine Macrophages?

<p>Promotes the bacterias pathogenicity (C)</p> Signup and view all the answers

Why do veterinarians complete blood counts and fibrinogen levels every two weeks in at-risk populations?

<p>Monitor herd health (C)</p> Signup and view all the answers

Which factor plays a key role in predisposing horses during long-distance transport to pneumonia?

<p>Viral presence (B)</p> Signup and view all the answers

Select which of the following is least likely to be used to treat Rhodococcus equi.

<p>Tilmicosin (A)</p> Signup and view all the answers

A group of yearlings must travel to a different facility, list what would improve their immunity and reduce their chances of developing pneumonia.

<p>Provide the yearlings a large, open space. (B)</p> Signup and view all the answers

A neonatal foal is found to be shedding a live bacteria in its feces in its stall. What prevention method should the veterinarian prescribe?

<p>Incorporate hyperimmune plasma (B)</p> Signup and view all the answers

If the patient requires additional therapeutics while fighting Rhodococcus equi infection, which of the following would be the BEST choice?

<p>Antiulcer medication (D)</p> Signup and view all the answers

A client lives in a very dusty environment; to help prevent Equine Pneumonia from developing, what can the owner utilize to prevent this?

<p>Change the type of bedding and frequently clean (C)</p> Signup and view all the answers

Under what circumstances may bacterial pneumonia in adult horses need to use multiple therapeutics?

<p>Bronchopneumonia transitions to Pleuropneumonia (D)</p> Signup and view all the answers

Flashcards

Equine Pneumonia

Inflammation of the lungs in horses, affecting both young and adult animals.

Equine pneumonia: young horses

Horses in their weanling (6-12 months) and yearling (12-24 months) stages.

Disease Risk in Horses

Foals possess developing immunity, making them prone to disease. Stress can suppress their immune system.

Neonatal Foal Immunity

Host immunity and pathogen exposure.

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Six Months of Age Immunity

Loss of maternal antibodies and vaccinations from 6-12 months.

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Immunity factors

Stress due to travel and indoor or outdoor environmental management.

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Clinical Signs of Equine Pneumonia

Developing a fever or depression, or abnormal lung sounds.

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Signs of Pneumonia

Fever, depression, and abnormal lung sounds.

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Bacterial Pathogens

Includes Streptococcus equi subsp. zooepidemicus, Streptococcus pneumoniae, Actinobacillus equuli, and Rhodococcus equi.

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Rhodococcus equi

The Gram-positive, pleomorphic, intracellular bacteria which multiplies within alveolar macrophages.

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Rhodococcus equi

A Gram-positive facultative intracellular pathogen that is one of the most common causes of pneumonia in foals.

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R. equi Exposure

The bacteria is inhaled from stalls and paddocks. Endemic on many high-traffic broodmare farms

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VapA

Virulence associated protein A promotes survival and replication.

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Clinical Signs of Rhodococcus equi

Acute onset of dyspnea, fever, and cough, as well as hyperfibrinogenemia.

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Thoracic Radiograph Findings

Characterized by perihilar abscessation and alveolarization.

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Additional Therapeutics

Is a treatment that involves supportive therapies like antiulcer medication, flunixin meglumine, O2 insufflation, and bronchodilation

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Hyperimmune Plasma

Is used to bind circulating bacteria.

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Pneumonia in the Young Horse

Includes bacterial colonization; Gram positive bacteria and Parascaris equorum.

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Bacterial Pneumonia: adults

In adult horses, viral infections, secondary invaders, and long distance transport can cause bacterial pneumonia.

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Bronchopneumonia → Pleuropneumonia

Progresses to Pyrexia and exercise intolerance. Requires observation of clinical signs.

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Clinical Approach to Pneumonia / Pleuropneumonia

Involves physical examination, hematology and serum chemistry profile, and transtracheal wash.

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Equine Pneumonia Summary

broncho and adult, geriatric horses as well as Streptococcus equi subspecies zooepidemicus is the most common pathogen of the equine lung

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Study Notes

  • Equine pneumonia affects both young and adult horses

Equine Pneumonia in Young Horses

  • Weanlings are horses between 6-12 months old.
  • Yearlings are horses from 12-24 months old
  • Stress and extensive use can lead to immunosuppression in horses.
  • Immunity develops during the first two years, making horses susceptible to disease

Immunity

  • Neonatal foals get host immunity and pathogen exposure.
  • Foals at six months experience a loss of maternal antibodies
  • From 6-12 months of age, foals can start vaccination
  • Stress from Travel and Competition can affect immunity
  • Environmental management, considering indoor versus outdoor settings, is important

Clinical Signs

  • Clinical signs of Equine Pneumonia include:
    • Fever
    • Depression
    • Abnormal lung sounds
    • Purulent nasal discharge
    • Elevated fibrinogen, neutrophilic leukocytosis
  • Predisposing factors include EHV-4, weaning, overcrowding, parasitic pulmonary migration and transportation

Bacterial Pathogens

  • Bacteria that can cause equine pneumonia:
    • Streptococcus equi subsp. zooepidemicus
    • Streptococcus pneumoniae
    • Actinobacillus equuli
    • Pasteurella spp.
    • Klebsiella spp.
    • Escherichia coli
    • Bordetella bronchoseptica
    • Rhodococcus equi

Diagnosing Systemically Ill Foals

  • Bloodwork, including complete blood count and serum chemistry analysis
  • Transtracheal wash
  • Thoracic ultrasound and radiographs are performed

Rhodococcus Equi

  • R. equi is a gram-positive, pleomorphic, intracellular bacterium.
  • R. equi multiplies within alveolar macrophages and is a common cause of pneumonia in foals between 2-3 months old
  • Acute manifestation can occur because of chronic disease
  • Clinical signs of R. equi:
    • Acute onset of dyspnea, fever, and cough
    • Marked neutrophilic leukocytosis
    • Hyperfibrinogenemia
    • Possible diarrhea and abdominal abcess formation
    • Possible immune-mediated polysynovitis and/or osteomyelitis/septic arthritis
  • R. equi can be detected via thoracic radiographs with perihilar abscessation and alveolarization

R. Equi Transmission

  • R. equi is transmitted via:
    • Inhalation from stalls and paddocks
    • Exhaled air from infected foals
    • Acquisition of infection within the first week of life
  • January/February foals are at higher risk
  • R. equi is endemic on many high-traffic broodmare farms

Virulence Factors in R. equi

  • Virulence associated protein A = VapA
  • VapA is a virulence factor that supports pathogenicity, survival and replication within macrophages
  • Key characteristic is granulomatous inflammation

Treatment for Rhodococcus equi

  • Treatment includes Azithromycin +/- Rifampin typically for 3 to 5 weeks
  • Other options:
    • Clarithromycin at 7.5 mg/kg PO BID
    • Erythromycin at 25 mg/kg PO QID on an empty stomach
    • Gamithromycin IV diluted and not IM.
    • Tulathromycin or tilmicosin are not used
  • Macrolides have adverse reactions:
    • Anhidrosis and hyperthermia
    • Enterocolitis
    • Fatal entercolitis in dams
  • Additional Theraputics:
    • Antiulcer medication
    • Flunixin meglumine
    • O2 insufflation
    • Bronchodilation

Prevention of Rhodococcus equi

  • Use hyperimmune plasma to bind circulating bacteria during the first 1-2 days of life
  • Avoid overcrowding and separate affected foals
  • Monitor herd by checking CBC and fibrinogen every 2 weeks
  • Do ultrasonographic screening as majority of foals with subclinical infection will resolve lesions
  • The spontaneous recover rate is between 60-88%

Laboratory Results

  • For a 7 month old Arabian foal with transient response to ceftiofur and TMS:
    • TTW culture showed Streptococcus zooepidemicus
    • Parascaris and strongyle were detected
    • Parascaris was 910 epg
    • Strongyle was 1840 epg
  • This indicates additional diagnostic testing is needed

Other Causes for Bacterial Colonization

  • R. equi for 2-4 month olds
  • S. equi subsp. zooepidemicus for 4-12 month olds
  • Other potential pathogens along with deworming history and resistance

Diagnosing a 90-Day Old Foal

  • For a 90 day old Thoroughbred foal with lethargy and increased respiratory rate:
    • Crackles in cranioventral lung fields with paroxysmal cough
    • Audible tracheal rattle and a fever of 103.5
    • Thoracic ultrasound reveals peripheral hypoechoic areas measuring 2-6 cm in diameter, which are multiple and bilaterally present
    • Thoracic radiographs show alveolar and nodular patterns
    • The foal exhibited inflammatory leukogram with hyperfibrinogenemia, further testing with transtracheal wash

Equine Pneumonia in Adult Horses

  • Viral causes
    • Secondary invaders
  • Influenced by long distance travel
  • Pneumonia can develop following esophageal obstruction or co-mingling

Bacterial Pathogens

  • Bacteria that can cause equine pneumonia in adults include:
    • Streptococcus equi subsp. zooepidemicus
    • Escherichia coli
    • Actinobacillus equuli
    • Pasteurella spp.
    • Klebsiella spp.
    • Anaerobes
    • Bacteroides

Bronchopneumonia and Pleuropneumonia

  • Characteristics of includes:
    • Pyrexia
    • Lethargy
    • Exercise intolerance -Influenced by Long distance transport and Esophageal obstruction
    • Abnormal auscultation
    • Need to hear breath sounds with increased inhaled C02 and deeper breaths

Diagnosing Pleuropneumonia

  • Leukopenia during acute stages
  • Leukocytosis later and with chronicity
  • Hyperfibrinogenemia may be marked
  • Anemia with chronicity is anemia of chronic disease (ACD)
  • Azotemia may be associated with severity of illness and suggests a more guarded prognosis

Clinical Approach to Pneumonia / Pleuropneumonia

  • Conduct a physical examination, hematology, serum chemistry profile and thoracic ultrasound
  • Perform a transtracheal wash for bacterial isolates and antibiotic susceptibility profile. Streptococcus equi subsp. zooepidemicus is the most common isolate
  • Assess pleural fluid through thoracocentesis, cytology and culture
  • Obtain thoracic radiographs and select antimicrobial intervention
  • Develop a long term plan dependent on response to therapy

Summary of Diagnosing Equine Pneumonia

  • Bronchopneumonia can happen in young, adult and geriatric horses
  • Determining the inciting pathogen is key to an effective plan
  • A definitive diagnosis and appropriate treatment plan provides the most favorable prognosis
  • Streptococcus equi subspecies zooepidemicus is the most common pathogen of the equine lung
  • Treat for disease resolution but avoid wide use of antimicrobials to prevent AMR/MDR organisms

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