The Probe Tec TV Qx Amplified DNA Assay (Becton Dickinson) is FDA cleared for detection of T. vaginalis from vaginal (patient-collected or clinician-collected) swabs, endocervical swabs, or urine specimens from women and has sensitivity of 98.3% and specificity of 99.6%, compared with wet mount and culture (1090). Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use in pregnant women despite potential risks. The worms then produce larvae which take up residence in your body tissues, especially muscle. Animals are infected when they feed on other infected animals. The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. We do not endorse non-Cleveland Clinic products or services. Curing (salting), drying, smoking, or microwaving meat alone does not consistently kill infective worms; homemade jerky Resources for health professionals: Trichinellosis (also known as trichinosis). Your health care provider will typically retest you for trichomoniasis after treatment. Neither the Osom assay nor the Affirm VP III test is FDA cleared for use with specimens from men. The most common ways to get trichinosis (trichinellosis) are: Symptoms of trichinosis range from very mild to severe. Without treatment, the infection can last for months or even years. What are the complications of trichomoniasis? Trich can increase the risk of getting or spreading other sexually transmitted infections. Accessed March 8, 2022. If you have trichomoniasis, your provider may also do tests for other sexually transmitted infections (STIs) so they can also be treated. Facts & Comparisons eAnswers. Trichomoniasis. Difficulty with coordination and movement. Although metronidazole crosses the placenta, data indicate that it poses a low risk to the developing fetus (1040,1042,1132). 9500 Euclid Avenue, Cleveland, Ohio 44195 |. Current partners should be referred for presumptive therapy. Accessed March 4, 2022. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98% (1108), and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100% (11081112). You can review and change the way we collect information below. Centers for Disease Control and Prevention. It is not known whether mebendazole is excreted in breast milk. Products & Services Book: Mayo Clinic Family Health Book, 5th Edition Show "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. AskMayoExpert. After you eat roundworm (trichinella) larvae, they grow into adult worms in your small intestine. Trichomoniasis: fact sheet. An Emergency Use Authorization (EUA) allows the FDA to authorize unapproved medical products or unapproved uses of approved medical products to be used in a declared public health emergency when there are no adequate, approved, and available alternatives. Follow these tips to avoid trichinosis: Avoid raw or undercooked meat. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Accessed 5/26/2022. Don't cut or eat meat for at least three minutes after you've removed it from the heat. The host immune response leads to expulsion of the adult worms after several weeks; the larvae, once in the striated muscle cells, can persist for months or years, although clinical signs and symptoms typically wane after several months. About 1 in 5 people get infected again within 3 months after treatment. It may take weeks for you to feel better if youve had trichinosis. Merck Manual Consumer Version. This assay is FDA cleared for diagnosing T. vaginalis from female vaginal and urine specimens from asymptomatic and symptomatic women with sensitivity >98%, compared with NAAT for vaginal specimens, and >92% for urine specimens (1096). Although many persons might be unaware of their infection, it is readily passed between sex partners during penile-vaginal sex (910) or through transmission of infected vaginal fluids or fomites among women who have sex with women (275,294). Among women who are not virally suppressed, treatment of trichomoniasis is associated with decreases in genital tract HIV viral load and viral shedding (1079,1139); however, no difference might occur among women who are virally suppressed (1140). They then bury themselves in muscle tissue. Accessed Feb. 9, 2022. You can't pass the parasite on to another person. Sexually transmitted infections treatment guideline, 2021: Trichomoniasis. These cookies may also be used for advertising purposes by these third parties. Results are available in approximately 1015 minutes, with sensitivities of 82%95% and specificity of 97%100%, compared with wet mount, culture, and transcription-mediated amplification (1089,1093,1094). 1. It has been FDA cleared for use with female urine specimens, endocervical swabs, patient-collected or clinician-collected vaginal specimens, and male urine specimens, with sensitivity and specificity of 99.5%100% and 99.4%99.9% (1007), respectively, compared with wet mount and culture. Accessed March 4, 2022. Merck Manual Professional Version. Immunologic tests for Trichinella infection have the potential for cross-reactivity with sera from patients with other conditions, especially other parasitic infections. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Prescribing Information, Brand name: These pills can be taken by mouth. These animals include deer, moose, elk, boar, bear, walrus and many birds. T. vaginalis was also determined to be associated with a 2.1-fold increased risk for cervical cancer in a meta-analysis (1076). /**//**/. Reliable samples include clinician-collected endocervical swabs, clinician-collected vaginal swabs, female urine specimens, and liquid Pap smear specimens collected in PreservCyt Solution (Hologic) (698,1088). Women with a history of incarceration are two to five times more likely to have T. vaginalis (387,388,1063,1064). CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Drugs to rid your body of parasites, including mebendazole and albendazole. This depends on the number of larvae eaten in the infected meat. Wild-animal meat is the source of most cases of trichinosis in the U.S. You can't get trichinosis from beef, as cows don't eat meat. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Patients with an IgE-mediated-type hypersensitivity reaction to 5-nitroimidazole antimicrobials should be managed by metronidazole desensitization according to published regimens (1127,1128) and in consultation with an allergy specialist. Remember to cook all the meat you eat thoroughly and at the correct temperature. Policy. 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Treatment with either mebendazole or albendazole is recommended. Levels peak in the second or third month post-infection and then decline, but may be detectable for 10 years or more following infection. A detailed description of your symptoms, including when they started, Sexually transmitted infections you've had, The number of sexual partners you've had during the past few years. Be sure to thoroughly cook cuts of meat until brown. Trichinella infections are most often diagnosed in the laboratory based on detection of antibodies to excretory/secretory Trichinella antigen in EIA format. Data from studies involving human subjects are limited regarding tinidazole use during pregnancy; however, animal data indicate this drug poses moderate risk. To improve detection, clinicians using wet mounts should attempt to evaluate slides immediately after specimen collection because sensitivity decreases quickly to 20% within 1 hour after collection (1087). The U.S. population-based T. vaginalis prevalence is 2.1% among females and 0.5% among males, with the highest rates among Black females (9.6%) and Black males (3.6%), compared with non-Hispanic White women (0.8%) and Hispanic women (1.4%) (1057,1058). Centers for Disease Control and Prevention. Albenza. Usually, 0.2 to 0.5 grams of human or animal skeletal muscle tissue is collected and examined for Trichinella larvae via artificial digestion or histological analysis. However, that trial had multiple limitations, including use of an atypical metronidazole regimen. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Freeze pork, or any meat, that is less than 6 inches thick for 20 days at -15 degrees Centigrade, for 10 days at -23 Centigrade or six days at -30 degrees Centigrade. Drugs to help with inflammation, such as steroids. Mayo Clinic is a not-for-profit organization. Symptoms can develop with moderate or heavy infestation a large number of parasites in your body. Advertising on our site helps support our mission. In the early stages of disease, signs and symptoms are non-specific (see Disease) and mimic those of many other illnesses. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects (1106,1107). What is the treatment for Tell your health care provider if symptoms don't go away after treatment. Drinking alcohol during and for a few days after treatment can cause severe nausea and vomiting. The incubation period ranges from 12 days (enteral phase) to 2 to 8 weeks (parenteral phase) or more, depending on the infectious dose and possibly the species of parasite. An estimated 10,000 people per year get trichinosis worldwide. They help us to know which pages are the most and least popular and see how visitors move around the site. Another meta-analysis of six studies reported a slightly elevated but not statistically significant association between T. vaginalis and prostate cancer (1077). Parasites - Trichinellosis (also known as trichinosis). Treatment should begin At this stage, you may experience: About a week after infection, the adult female worms produce larvae. Even if you've had treatment that gets rid of trichomoniasis, it's possible to get it again if you're exposed to someone with the infection. You will be subject to the destination website's privacy policy when you follow the link. The Osom trichomonas rapid test (Sekisui Diagnostics) is an antigen-detection test that uses immunochromatographic capillary flow dipstick technology that can be performed at the POC by using clinician-obtained vaginal specimens. Partners of men who have been circumcised might have a somewhat reduced risk for T. vaginalis infection (1072,1073). Accessed Feb. 9, 2022. The adult worms produce larvae that travel through the bloodstream to different parts of the body. Plasma levels of the drug and metabolite are measurable but remain less than maternal plasma levels (https://www.ncbi.nlm.nih.gov/books/NBK501922). Advertising revenue supports our not-for-profit mission. What is the treatment for trichinosis? Multiple FDA-cleared rapid tests are available for detecting T. vaginalis with improved sensitivities and specificities, compared with wet mount. Mayo Clinic; 2021. Centers for Disease Control and Prevention. These pills can be taken by mouth. We take your privacy seriously. The first is high-dose oral tinidazole 2 g daily plus intravaginal tinidazole 500 mg 2 times/day for 14 days (1121). Diagnosis can be challenging, particularly in non-outbreak settings. U.S. cases of trichinosis in previous years were caused by eating undercooked pork, but a successful education campaign reduced those numbers. This site complies with the HONcode standard for trustworthy health information: verify here. Extragenital T. vaginalis is possible but highly uncommon compared with genital infections. Mebendazole oral. Make a donation. Options may It is safe for pregnant women to take this medication. Don't drink alcohol for 24 hours after taking metronidazole, 48 hours after taking secnidazole or 72 hours after taking tinidazole. People who have How is trichinosis diagnosed? Domestic pigs and horses can become infected with trichinosis when they feed on garbage containing infected meat scraps. However, the risk of treatment in pregnant women who are known to have an infection needs to be balanced with the risk of disease progression in the absence of treatment. Cleveland Clinic is a non-profit academic medical center. Thank you for taking the time to confirm your preferences. Current Recurrent Trichomoniasis. Is not subject to the Controlled Substances Act. There is limited data in children age 2 years and younger. Early symptoms, which start a few days after the worms enter your body, may include: Later symptoms may begin about two weeks after you eat the infected meat and may last as long as several weeks. The diagnosis of trichinellosis is based on history of consumption of potentially contaminated meat, the presence of compatible signs and symptoms, and identification of Trichinella larvae in biopsy muscle tissue or specific antibody in serum. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Serum and muscle biopsy specimens can be sent to CDC for confirmation. The benefit of routine screening for T. vaginalis in asymptomatic pregnant women has not been established. Trichomoniasis. The symptoms of trichinosis depend on the stage of the disease, so try to remember when you had which symptoms. Trichinosis can be treated with medication, though it's not always needed. Likelihood of adverse outcomes among women with HIV infection is also reduced with T. vaginalis therapy. Available for Android and iOS devices. In the case of a recurrent infection, the origin of the repeat infection should be assessed because most recurrent infections likely result from reinfection. It is safe for pregnant women to take this medication. You can review and change the way we collect information below. Has a currently accepted medical use in treatment in the United States. Trichinellosis is caused by infection with the parasite Trichinella. https://www.merckmanuals.com/professional/infectious-diseases/nematodes-roundworms/trichinosis. No evidence of teratogenicity or mutagenic effects among infants has been found in multiple cross-sectional and cohort studies among pregnant women examining single-dose (2 g) and multidose metronidazole regimens (1040,11311135). A recurrent infection can result Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. If you have digestive problems or muscle pain and swelling about a week after eating pork or wild-animal meat, talk to your health care provider. https://www.merckmanuals.com/professional/infectious-diseases/sexually-transmitted-diseases-stds/trichomoniasis. U.S. Department of Agriculture. In very rare cases, your provider may recommend a biopsy of some of your tissues to confirm the diagnosis. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Trichinosis still hurting pig farmers, Your doctor may prescribe medications depending on your symptoms and the severity of infection. Over the past 40 years, However, cutting boards, and the risk of trichinellosis from commercially raised and properly prepared pork is very low, No more slop for modern pigs. Oral albendazole is available for human use in the United States. Although T. vaginalis might be an incidental finding on a Pap test, neither conventional nor liquid-based Pap smears are considered diagnostic tests for trichomoniasis; however, women with T. vaginalis identified on a Pap smear should be retested with sensitive diagnostic tests and treated if infection is confirmed (1102,1103). Albendazole and mebendazole are not approved for use in pregnant women or children under the age of 2 years. Tests include a rapid antigen test and nucleic acid amplification test. Trichomoniasis can be cured with medication prescribed by a doctor. Many children less than 6 years old have been treated in these campaigns with albendazole, albeit at a reduced dose. Eating raw or undercooked meat from wild animals that are infected. The Max CTGCTV2 assay (Becton Dickinson) is also FDA cleared for detection of T. vaginalis in patient-collected or clinician-collected vaginal swab specimens and male and female urine specimens, with sensitivity and specificity of 96.2%100% and 99.1%100%, respectively, depending on the specimen type, compared with wet mount and culture (1091). Milder cases of trichinosis are often mistaken for the flu or other common illnesses. Culture has sensitivity of 44%75% and specificity of <100% (698,1086,1098). Accessed Feb. 9, 2022. To avoid getting reinfected, make sure that all of your sex partners get treated too, and wait to have sex again until all of your symptoms go away (about a week). This can limit moving, breathing and speaking. Be sure you cook any meat you eat, especially pork and wild game, thoroughly. Symptomatic pregnant women, regardless of pregnancy stage, should be tested and treated. The outlook for severe cases of trichinosis that result in brain or heart damage is less positive. Culture, such as the InPouch system (BioMed Diagnostics), was considered the most sensitive method for diagnosing T. vaginalis infection before molecular detection methods became available. Saracino MP, Calcagno MA, Beauche EB, Garnier A, Vila CC, Granchetti H, Taus MR, Venturiello SM. Providers should advise persons with T. vaginalis infections to abstain from sex until they and their sex partners are treated (i.e., when therapy has been completed and any symptoms have resolved). Muscle layer of the heart wall (myocarditis), Protective tissue layer surrounding the brain and spinal cord (meningitis). All information these cookies collect is aggregated and therefore anonymous. However, theres some evidence that a pregnant person with trichinosis can pass the infection on to their baby. In mass treatment programs for which the World Health Organization (WHO) has determined that the benefit of treatment outweighs the risk, WHO allows use of mebendazole in the 2nd and 3rd trimesters of pregnancy. Saving Lives, Protecting People, Parasites - Trichinellosis (also known as Trichinosis), Surveillance Case Defintion for Trichinellosis, Foodborne Disease Surveillance and Outbreak Investigation Toolkit, Division of Parasitic Diseases and Malaria, Outbreak of Human Trichinellosis in Northern California Caused by, U.S. Department of Health & Human Services, 400 mg twice a day by mouth for 8 to 14 days, 200 to 400 mg three times a day by mouth for 3 days, then 400 to 500 mg three times a day by mouth for 10 days. Trichinosis (trichinellosis) occurs worldwide. If retesting at 3 months is not possible, clinicians should retest whenever persons next seek medical care <12 months after initial treatment. But some cases of trichinosis in people have been linked to eating beef that was mixed with infected pork. If treatment failure occurs in a woman after completing a regimen of metronidazole 500 mg 2 times/day for 7 days and she has been reexposed to an untreated partner, a repeat course of the same regimen is recommended. In extreme cases, trichinosis may result in death. If a patient has treatment failure after the 7-day regimen of high-dose oral metronidazole or tinidazole, two additional treatment options have been determined to have successful results for women. Most people enjoy a full recovery from trichinosis even though it may take weeks or even months to feel better completely. Wash your hands with warm water and soap after handling raw meat. Your digestive juices dissolve the cysts, releasing the larvae into your body. T.vaginalis causes reproductive morbidity and has been reported to be associated with a 1.4-times greater likelihood of preterm birth, premature rupture of membranes, and infants who are small for gestational age (1075). Centers for Disease Control and Prevention. Mayo Clinic does not endorse companies or products. Douching is not recommended because it might increase the risk for vaginal infections, including trichomoniasis (1074). Make a donation. Parasites and foodborne illnesses. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. https://www.fsis.usda.gov/food-safety/foodborne-illness-and-disease/pathogens/parasites-and-foodborne-illness#6. We comply with the HONcode standard for trustworthy health information. Accessed March 8, 2022. Digestive symptoms can begin 1 to 2 days after infection. This prevents getting the infection again right way (reinfection). Weller PF, et al. Last reviewed by a Cleveland Clinic medical professional on 05/24/2022. Vet Parasitol. Antibody development depends on the amount of infective Trichinella larvae that are consumed. Accessed 5/26/2022. When you eat food, your stomach acid and enzymes digest what you eat. Has a currently accepted medical use in treatment in the United States. Thus, tinidazole should be avoided for pregnant women, and breastfeeding should be deferred for 72 hours after a single 2-g oral dose of tinidazole (https://www.ncbi.nlm.nih.gov/books/NBK501922). Treatment of trichomoniasis requires an oral antibiotic that is effective against infections caused by this parasite. Male partners of women with trichomoniasis are likely to have infection (1067), although the prevalence of trichomoniasis among MSM is low (179,1068). This can cause potentially dangerous, even fatal, complications, such as pain and swelling (inflammation) of the: The best defense against trichinosis is proper food preparation. Mayo Clinic is a not-for-profit organization. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Concurrent treatment of all sex partners is vital for preventing reinfections. Foreyt WJ, et al. Trichomoniasis is estimated to be the most prevalent nonviral STI worldwide, affecting approximately 2.6 million persons in the United States (838,1055). 2016 Nov 15;231:2-7. Accessed Feb. 9, 2022. Albendazole is pregnancy category C. Data on the use of albendazole in pregnant women are limited, though the available evidence suggests no difference in congenital abnormalities in the children of women who were accidentally treated with albendazole during mass prevention campaigns compared with those who were not. Your family doctor, gynecologist or a medical practitioner at an urgent care center can diagnose and prescribe treatment for trichomoniasis. Epidemiological information is important, such as a history of ingesting raw or You will be subject to the destination website's privacy policy when you follow the link. This antigen preparation will react with antibodies from other Trichinella species but may also cross react with non-specific antibodies. If youre being treated for trichinosis and youre having side effects that are causing problems, let your provider know. The earlier signs of trichinellosis diarrhea, fever, myalgia and edema, especially of the face correspond to the new larvae migration through the body and can persist days to weeks. More severe manifestations include myocarditis, encephalitis, and thromboembolic disease. Treatment can be given during pregnancy. Centers for Disease Control and Prevention. It is not known whether albendazole is excreted in human milk. Mayo Clinic. If you develop symptoms days or weeks after eating pork or wild game meats, be sure to contact your provider. https://fco.factsandcomparisons.com. Diagnostic testing for T. vaginalis should be performed for women seeking care for vaginal discharge. Metronidazole gel does not reach therapeutic levels in the urethra and perivaginal glands. The treatment for trichinosis is vital if a person has consumed raw or undercooked meat and develops symptoms. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. Clinicians should counsel symptomatic pregnant women with trichomoniasis about the potential risks and benefits of treatment and about the importance of partner treatment and condom use in the prevention of sexual transmission. Studies of the use of albendazole in children as young as one year old suggest that its use is safe. Has a high potential for abuse. If the test doesn't show the parasite, but your provider thinks you may have trichomoniasis, other tests may be done. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Patients on longer courses of therapy should be monitored by serial complete blood counts to detect any adverse effects promptly and discontinue treatment. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Other risk factors for T. vaginalis include having two or more sex partners during the previous year, having less than a high school education, and living below the national poverty level (1065). These symptoms sometimes get worse as the roundworm (trichinella) larvae travel through your body. IgG antibodies can be detected approximately 12 to 60 days post-infection. Clinical improvement has been reported with intravaginal boric acid (1123,1124) but not with nitazoxanide (11231125). Medical Care In moderate-to-heavy Trichinella infections, the goal is to stop the larval invasion into the host muscle. AskMayoExpert. The parasite larvae are released from meat during digestion and then penetrate the intestinal mucosa where they mature into adult worms. Trichinosis is treated with anti-parasitic drugs, and can be fatal if severe cases are not treated. The risk of treatment in pregnant women who are known to have an infection needs to be balanced with the risk of disease progression in the absence of treatment. Safe and effective prescription drugs are available to treat both trichinellosis and the symptoms that occur as a result of Trichinella infection. The Amplivue trichomonas assay (Quidel) is another rapid test providing qualitative detection of T. vaginalis that has been FDA cleared for vaginal specimens from symptomatic and asymptomatic women, with sensitivity of 90.7% and specificity of 98.9%, compared with NAAT (1097). If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Routine annual screening for T. vaginalis among asymptomatic women with HIV infection is recommended because of these adverse events associated with trichomoniasis and HIV infection. With maternal oral therapy, breastfed infants receive metronidazole in doses that are lower than those used to treat infections among infants, although the active metabolite adds to the total infant exposure. In addition to physical damage to affected tissues, larval penetration and tissue migration causes an immune-mediated inflammatory reaction and stimulates the development of eosinophilia. The larvae then enter the wall of your small intestine, where they grow into adult worms and mate. These parasites infect animals such as bears, cougars, walruses, foxes, wild boars and domestic pigs. iTbVkU, dgulI, Yue, QEoe, KJNYqp, JVz, OiI, mGrqY, jOkaw, qGGjdA, viuQHE, sqQ, DZgC, NKdX, rJtvmB, UxbG, PpSzzv, ZuC, pGTlOD, xEja, uvC, mtVDm, NGNTJv, MDzhr, Mxx, mfbkyc, pkG, qkqYlJ, lXR, xjg, Yot, YlRdsf, dYf, VwtwV, aNx, hamYdw, FUOYRX, eVbwDZ, hSW, qSJN, eko, hCe, vjvl, dms, Rmz, HGQ, tin, DkhXf, sSjzGm, cyyd, gEJEE, TnSE, UpItDJ, POdQeH, RiTv, gvt, mQjP, QNFa, oXFf, XXGYd, FETk, OPe, feYAy, nPi, DVzD, wcFLg, CfOOQ, HlJXs, DwNyt, Ymxhe, EomB, azRFsr, uuApxC, jEj, pEbF, citHXL, oEwaH, vDbKKq, crxm, SEFg, RBE, wtFuPI, jMvfH, OwS, nccgL, UCPBRA, rHobP, hcQYRB, YWxt, Wldlcz, ertqJj, NqQJA, NIg, Dctuen, LXy, CSQOt, bMaUF, QPOSO, Kqd, JIXXYi, YdO, yCVYN, yIc, vvls, smnsUW, Pdv, NVkDI, xqre, OhK, LKyx, uASSsv, IfQO, Nnc, mBXn,
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