Sinusitis is an inflammation of the mucosa of the nose and paranasal sinuses due to viral or bacterial infection with symptoms of cough, headache, nasal drainage, and facial pain. Length of duration and frequency of symptoms classify sinusitis into five different categories: acute sinusitis, subacute sinusitis, recurrent acute sinusitis, chronic sinusitis, or acute exacerbation of chronic sinusitis. In children up to 8–10 % of pediatric upper respiratory tract infections are complicated by sinusitis. Recurrent episodes can be seen in patients with underlying diseases such as allergies, and immunodeficiency. If untreated, acute sinusitis may progress to chronic sinusitis. Optimal management involves appropriate antimicrobials against the most common pathogens, such as S. pneumoniae, H. influenzae, and M. catarrhalis, as well as treatment of underlying causes. While S. pneumoniae remains the principal pathogen in otherwise healthy children with acute disease, the microbiology of this disease is continuing to evolve. Medical and surgical treatment goals should be directed a normalizing sinus physiology and re-establishment of normal mucociliary function and clearance.


Rhinosinusitis Acute sinusitis Chronic sinusitis Nasal polyposis Nasal obstruction Pathophysiology of sinusitis Microbiology of sinusitis Medical management of sinusitis Surgical management of sinusitis Complications of Sinusitis 


  1. 1.
    Centers for Disease Control and Prevention. Vital and health statistics: current estimates from the National Health Interview Survey, 1995. U.S. Dept of Health and Human Services, Centers for Disease Control and Prevention/National Center for Health Statistics.Google Scholar
  2. 2.
    Ray NF, Baraniuk JN, Thamer M, et al. Healthcare expenditures for sinusitis in 1996: contributions of asthma, rhinitis, and other airway disorders. J Allergy Clin Immunol. 1999;103:408–14.CrossRefPubMedGoogle Scholar
  3. 3.
    Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children: duration of and frequency of complications. Pediatrics. 1991;87:129–33.PubMedGoogle Scholar
  4. 4.
    Slavin RG. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005;116(6 Suppl):13–47.CrossRefGoogle Scholar
  5. 5.
    Wolf G, Anderhuber W, Kuhn F. Development of the paranasal sinuses in children: implications for paranasal sinus surgery. Ann Otol Rhinol Laryngol. 1993;102(9):705–11.CrossRefPubMedGoogle Scholar
  6. 6.
    Wormald P-J. Surgery of the frontal recess and frontal sinus. Rhinology. 2005;43:82–5.PubMedGoogle Scholar
  7. 7.
    Hamilos DL. Chronic sinusitis. J Allergy Clin Immunol. 2000;106:213–27.CrossRefPubMedGoogle Scholar
  8. 8.
    Osguthorpe JD, Hadley JA. Rhinosinusitis: current concepts in evaluation and management. Med Clin North Am. 1999;83(1):27–41.CrossRefPubMedGoogle Scholar
  9. 9.
    Holgate ST. Asthma and allergy—disorders of civilization? QJM. 1998;91(3):171–84.CrossRefPubMedGoogle Scholar
  10. 10.
    Phipps CD, Wood WE, Gibson WS, Cochran WJ. Gastroesophageal reflux contributing to chronic sinus disease in children: a prospective analysis. Arch Otolaryngol Head Neck Surg. 2000;126(7):831–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Dibase JK, Sharma VK. Does gastroesophageal reflux contribute to the development of chronic sinusitis? A review of the evidence. Dis Esophagus. 2006;19(6):419–24.CrossRefGoogle Scholar
  12. 12.
    Sivasli E, Sirikçi A, Bayazýt YA, Gümüsburun E, Erbagci H, Bayram M, Kanlýkama M. Anatomic variations of the paranasal sinus area in pediatric patients with chronic sinusitis. Surg Radiol Anat. 2003;24(6):400–5.PubMedGoogle Scholar
  13. 13.
    Rosenstein BJ, Cutting GR. The diagnosis of cystic fibrosis: a consensus statement. Cystic Fibrosis Foundation Consensus Panel. J Pediatr. 1998;132(4):589–95.CrossRefPubMedGoogle Scholar
  14. 14.
    Casey JR, Kaur R, Friedel VC, Pichichero ME. Acute otitis media otopathogens during 2008 to 2010 in Rochester, New York. Pediatr Infect Dis J. 2013;32:805–9.PubMedCentralPubMedGoogle Scholar
  15. 15.
    McNeil JC, Hulten KG, Mason Jr EO, Kaplan SL. Serotype 19A is the most common Streptococcus pneumoniae isolate in children with chronic sinusitis. Pediatr Infect Dis J. 2009;28:766–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Olarte L, Hulten KG, Lamberth L, Mason Jr EO, Kaplan SL. Impact of the 13-valent pneumococcal conjugate vaccine on chronic sinusitis associated with Streptococcus pneumoniae in children. Pediatr Infect Dis J. 2014;33(10):1033–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Pena MT, Preciado D, Orestes M, Choi S. Orbital complications of acute sinusitis: changes in the post-pneumococcal vaccine era. JAMA Otolaryngol Head Neck Surg. 2013;139:223–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Kaplan SL, Barson WJ, Lin PL, Romero JR, Bradley JS, Tan TQ, Hoffman JA, Givner LB, Mason Jr EO. Early trends for invasive pneumococcal infections in children after the introduction of the 13-valent pneumococcal conjugate vaccine. Pediatr Infect Dis J. 2013;32:203–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Jacobs MR. Antimicrobial-resistant Streptococcus pneumoniae: trends and management. Expert Rev Anti Infect Ther. 2008;6:619–35.CrossRefPubMedGoogle Scholar
  20. 20.
    Lynch 3rd JP, Zhanel GG. Streptococcus pneumoniae: epidemiology, risk factors, and strategies for prevention. Semin Respir Crit Care Med. 2009;30:189–209.CrossRefPubMedGoogle Scholar
  21. 21.
    Kuster SP, Rudnick W, Shigayeva A, Green K, Baqi M, Gold WL, Lovinsky R, Muller MP, Powis JE, Rau N, Simor AE, Walmsley SL, Low DE, McGeer A, Toronto Invasive Bacterial Diseases Network. Previous antibiotic exposure and antimicrobial resistance in invasive pneumococcal disease: results from prospective surveillance. Clin Infect Dis. 2014;59:944–52.Google Scholar
  22. 22.
    Mills N, Best EJ, Murdoch D, Souter M, Neeff M, Anderson T, Salkeld L, Ahmad Z, Mahadevan M, Barber C, Brown C, Walker C, Walls T. What is behind the ear drum? The microbiology of otitis media and the nasopharyngeal flora in children in the era of pneumococcal vaccination. J Paediatr Child Health. 2015;21(3):300–6.CrossRefGoogle Scholar
  23. 23.
    Brook I. Current issues in the management of acute bacterial sinusitis in children. Int J Pediatr Otorhinolaryngol. 2007;71:1653–61.CrossRefPubMedGoogle Scholar
  24. 24.
    Heilmann KP, Rice CL, Miller AL, Miller NJ, Beekmann SE, Pfaller MA, Richter SS, Doern GV. Decreasing prevalence of beta-lactamase production among respiratory tract isolates of Haemophilus influenzae in the United States. Antimicrob Agents Chemother. 2005;49:2561–4.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Hotomi M, Fujihara K, Billal DS, Suzuki K, Nishimura T, Baba S, Yamanaka N. Genetic characteristics and clonal dissemination of beta-lactamase-negative ampicillin-resistant Haemophilus influenzae strains isolated from the upper respiratory tract of patients in Japan. Antimicrob Agents Chemother. 2007;51:3969–76.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Garcia-Cobos S, Campos J, Lazaro E, Roman F, Cercenado E, Garcia-Rey C, Perez-Vazquez M, Oteo J, de Abajo F. Ampicillin-resistant non-beta-lactamase-producing Haemophilus influenzae in Spain: recent emergence of clonal isolates with increased resistance to cefotaxime and cefixime. Antimicrob Agents Chemother. 2007;51:2564–73.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Murphy TF, Parameswaran GI. Moraxella catarrhalis, a human respiratory tract pathogen. Clin Infect Dis. 2009;49:124–31.CrossRefPubMedGoogle Scholar
  28. 28.
    Wald ER. Microbiology of acute and chronic sinusitis in children and adults. Am J Med Sci. 1998;316:13–20.CrossRefPubMedGoogle Scholar
  29. 29.
    Sahm DF, Brown NP, Thornsberry C, Jones ME. Antimicrobial susceptibility profiles among common respiratory tract pathogens: a Global perspective. Postgrad Med. 2008;120:16–24.CrossRefPubMedGoogle Scholar
  30. 30.
    Deshpande LM, Sader HS, Fritsche TR, Jones RN. Contemporary prevalence of BRO beta-lactamases in Moraxella catarrhalis: report from the SENTRY antimicrobial surveillance program (North America, 1997 to 2004). J Clin Microbiol. 2006;44:3775–7.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Payne SC, Benninger MS. Staphylococcus aureus is a major pathogen in acute bacterial rhinosinusitis: a meta-analysis. Clin Infect Dis. 2007;45:e121–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Brook I, Foote PA, Hausfeld JN. Increase in the frequency of recovery of meticillin-resistant Staphylococcus aureus in acute and chronic maxillary sinusitis. J Med Microbiol. 2008;57:1015–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Huang WH, Hung PK. Methicillin-resistant Staphylococcus aureus infections in acute rhinosinusitis. Laryngoscope. 2006;116:288–91.CrossRefPubMedGoogle Scholar
  34. 34.
    Whitby CR, Kaplan SL, Mason Jr EO, Carrillo-Marquez M, Lamberth LB, Hammerman WA, Hulten KG. Staphylococcus aureus sinus infections in children. Int J Pediatr Otorhinolaryngol. 2011;75:118–21.CrossRefPubMedGoogle Scholar
  35. 35.
    Woo HJ, Bae CH, Song SY, Choi YS, Kim YD. Actinomycosis of the paranasal sinus. Otolaryngol Head Neck Surg. 2008;139:460–2.CrossRefPubMedGoogle Scholar
  36. 36.
    Cherry JD, Mundi J, Shapiro NL. Rhinosinusitis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, editors. Feigin and Cherry’s textbook of pediatric infectious diseases, vol. 1. 7th ed. Philadelphia: Elsevier; 2014. p. 193–203.Google Scholar
  37. 37.
    Edvinsson M, Asplund MS, Hjelm E, Nystrom-Rosander C. Chlamydophila pneumoniae in chronic rhinosinusitis. Acta Otolaryngol. 2006;126:952–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Cultrara A, Goldstein NA, Ovchinsky A, Reznik T, Roblin PM, Hammerschlag MR. The role of Chlamydia pneumoniae infection in children with chronic sinusitis. Archi Otolaryngol Head Neck Surg. 2003;129:1094–7.CrossRefGoogle Scholar
  39. 39.
    Savolainen S, Jousimies-Somer H, Kleemola M, Ylikoski J. Serological evidence of viral or Mycoplasma pneumoniae infection in acute maxillary sinusitis. Eur J Clin Microbiol Infect Dis. 1989;8:131–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Lee RE, Kaza S, Plano GV, Casiano RR. The role of atypical bacteria in chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2005;133:407–10.CrossRefPubMedGoogle Scholar
  41. 41.
    Griffin JP, Klein EW. Role of sinusitis in primary atypical pneumonia. Clin Med. 1971;78:23–7.Google Scholar
  42. 42.
    Pitkaranta A, Starck M, Savolainen S, Poyry T, Suomalainen I, Hyypia T, Carpen O, Vaheri A. Rhinovirus RNA in the maxillary sinus epithelium of adult patients with acute sinusitis. Clin Infect Dis. 2001;33:909–11.CrossRefPubMedGoogle Scholar
  43. 43.
    Goytia VK, Giannoni CM, Edwards MS. Intraorbital and intracranial extension of sinusitis: comparative morbidity. J Pediatr. 2011;158:486–91.CrossRefPubMedGoogle Scholar
  44. 44.
    Hicks CW, Weber JG, Reid JR, Moodley M. Identifying and managing intracranial complications of sinusitis in children: a retrospective series. Pediatr Infect Dis J. 2011;30:222–6.CrossRefPubMedGoogle Scholar
  45. 45.
    McKinley SH, Yen MT, Miller AM, Yen KG. Microbiology of pediatric orbital cellulitis. Am J Ophthalmol. 2007;144:497–501.CrossRefPubMedGoogle Scholar
  46. 46.
    Teul I, Lorkowski J, Lorkiewicz W, Nowakowski D. Sinusitis in people living in the medieval ages. Adv Exp Med Biol. 2013;788:133–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Marom T, Alvarez-Fernandez PE, Jennings K, Patel JA, McCormick DP, Chonmaitree T. Acute bacterial sinusitis complicating viral upper respiratory tract infection in young children. Pediatr Infect Dis J. 2014;33:803–8.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Vaz LE, Kleinman KP, Raebel MA, Nordin JD, Lakoma MD, Dutta-Linn MM, Finkelstein JA. Recent trends in outpatient antibiotic use in children. Pediatrics. 2014;133:375–85.PubMedCentralCrossRefPubMedGoogle Scholar
  49. 49.
    Ueda D, Yoto Y. The ten-day mark as a practical diagnostic approach for acute paranasal sinusitis in children. Pediatr Infect Dis J. 1996;15:576–9.CrossRefPubMedGoogle Scholar
  50. 50.
    McLean DC. Sinusitis in children. Lessons from twenty-five patients. Clin Pediatr. 1970;9:342–5.CrossRefGoogle Scholar
  51. 51.
    Revai K, Dobbs LA, Nair S, Patel JA, Grady JJ, Chonmaitree T. Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age. Pediatrics. 2007;119:e1408–12.CrossRefPubMedGoogle Scholar
  52. 52.
    Low DE, Desrosiers M, McSherry J, et al. A practical guide for the diagnosis and treatment of acute sinusitis. Can Med Assoc J. 1997;156 Suppl 6:S1–14.Google Scholar
  53. 53.
    Leo G, Triulzi F, Incorvaia C. Sinus imaging for diagnosis of chronic rhinosinusitis in children. Curr Allergy Asthma Rep. 2012;12(2):136–43.CrossRefPubMedGoogle Scholar
  54. 54.
    Slavin RG, Spector SL, Bernstein IL, et al. American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology, Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005;116(6 Suppl):S13–47.Google Scholar
  55. 55.
    Oxford LE, McClay J. Complications of acute sinusitis in children. Otolaryngol Head Neck Surg. 2005;133:32–7.CrossRefPubMedGoogle Scholar
  56. 56.
    Herrmann BW, Forsen Jr JW. Simultaneous intracranial and orbital complications of acute rhinosinusitis in children. Int J Pediatr Otorhinolaryngol. 2004;68:619–25.CrossRefPubMedGoogle Scholar
  57. 57.
    Sultész M, Csákányi Z, Majoros T, Farkas Z, Katona G. Acute bacterial rhinosinusitis and its complications in our pediatric otolaryngological department between 1997 and 2006. Int J Pediatr Otorhinolaryngol. 2009;73(11):1507–12.CrossRefPubMedGoogle Scholar
  58. 58.
    Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM Jr, Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54:e72–112.Google Scholar
  59. 59.
    Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST, American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132:e262–80.Google Scholar
  60. 60.
    Bradley JS, Kauffman RE, Balis DA, Duffy CM, Gerbino PG, Maldonado SD, Noel GJ. Assessment of musculoskeletal toxicity 5 years after therapy with levofloxacin. Pediatrics. 2014;134:e146–53.CrossRefPubMedGoogle Scholar
  61. 61.
    Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005;115:1048–57.CrossRefPubMedGoogle Scholar
  62. 62.
    Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis. Otolaryngol Head Neck Surg. 2007;136:340–7.CrossRefPubMedGoogle Scholar
  63. 63.
    Fenoll A, Gimenez MJ, Robledo O, Aguilar L, Tarrago D, Granizo JJ, Gimeno M, Coronel P. In vitro activity of oral cephalosporins against pediatric isolates of Streptococcus pneumoniae non-susceptible to penicillin, amoxicillin or erythromycin. J Chemother. 2008;20:175–9.CrossRefPubMedGoogle Scholar
  64. 64.
    Fenoll A, Gimenez MJ, Robledo O, Aguilar L, Tarrago D, Granizo JJ, Martin-Herrero JE. Influence of penicillin/amoxicillin non-susceptibility on the activity of third-generation cephalosporins against Streptococcus pneumoniae. Eur J Clin Microbiol Infect Dis. 2008;27:75–80.CrossRefPubMedGoogle Scholar
  65. 65.
    Jenkins SG, Farrell DJ. Increase in pneumococcus macrolide resistance, United States. Emerg Infect Dis. 2009;15:1260–4.PubMedCentralCrossRefPubMedGoogle Scholar
  66. 66.
    Harrison CJ, Woods C, Stout G, Martin B, Selvarangan R. Susceptibilities of Haemophilus influenzae, Streptococcus pneumoniae, including serotype 19A, and Moraxella catarrhalis paediatric isolates from 2005 to 2007 to commonly used antibiotics. J Antimicrob Chemother. 2009;63:511–9.CrossRefPubMedGoogle Scholar
  67. 67.
    Falagas ME, Karageorgopoulos DE, Grammatikos AP, Matthaiou DK. Effectiveness and safety of short vs. long duration of antibiotic therapy for acute bacterial sinusitis: a meta-analysis of randomized trials. Br J Clin Pharmacol. 2009;67:161–71.PubMedCentralCrossRefPubMedGoogle Scholar
  68. 68.
    Wang YH, Yang CP, Ku MS, Sun HL, Lue KH. Efficacy of nasal irrigation in the treatment of acute sinusitis in children. Int J Pediatr Otorhinolaryngol. 2009;73:1696–701.CrossRefPubMedGoogle Scholar
  69. 69.
    Meltzer EO, Gates D, Bachert C. Mometasone furoate nasal spray increases the number of minimal-symptom days in patients with acute rhinosinusitis. Ann Allergy Asthma Immunol. 2012;108:275–9.CrossRefPubMedGoogle Scholar
  70. 70.
    Barlan IB, Erkan E, Bakir M, Berrak S, Basaran MM. Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children. Ann Allergy Asthma Immunol. 1997;78:598–601.CrossRefPubMedGoogle Scholar
  71. 71.
    Manning S. Surgical intervention for sinusitis in children. Curr Allergy Asthma Rep. 2001;1(3):289–96.CrossRefPubMedGoogle Scholar
  72. 72.
    Mair EA, Bolger WE, Breisch EA. Sinus and facial growth after pediatric endoscopic sinus surgery. Arch Otolaryngol. 1995;121(5):547–52.CrossRefGoogle Scholar
  73. 73.
    Ramadan HH, Terrell AM. Balloon catheter sinuplasty and adenoidectomy in children with chronic rhinosinusitis. Ann Otol Rhinol Laryngol. 2010;119(9):578–82.PubMedGoogle Scholar
  74. 74.
    Thottam PJ, Haupert M, Saraiya S, Dworkin J, Sirigiri R, Belenky WM. Functional endoscopic sinus surgery (FESS) alone versus balloon catheter sinuplasty (BCS) and ethmoidectomy: a comparative outcome analysis in pediatric chronic rhinosinusitis. Int J Pediatr Otorhinolaryngol. 2012;76(9):1355–60.CrossRefPubMedGoogle Scholar
  75. 75.
    Ahmed J, Pal S, Hopkins C, Jayaraj S. Functional endoscopic balloon dilation of sinus ostia for chronic rhinosinusitis. Cochrane Database Syst Rev. 2011;7.Google Scholar
  76. 76.
    Lindstrand A, Bennet R, Galanis I, Blennow M, Ask LS, Dennison SH, et al. Sinusitis and pneumonia hospitalization after introduction of pneumococcal conjugate vaccine. Pediatrics. 2014;134(6):e1528–36.CrossRefPubMedGoogle Scholar
  77. 77.
    Duse M, Caminiti S, Zicari AM. Rhinosinusitis: prevention strategies. Pediatr Allergy Immunol. 2007;18:S71–4.CrossRefGoogle Scholar
  78. 78.
    Wang LF, White DR, Andreoli SM, Mulligan RM, Discolo CM, Schlosser RJ. Cigarette smoke inhibits dynamic ciliary beat frequency in pediatric adenoid explants. Otolaryngol Head Neck Surg. 2012;146:659–63.CrossRefPubMedGoogle Scholar
  79. 79.
    Goldstein-Daruech N, Cope EK, Zhao KQ, Vokovic K, Kofonow JM, Doghramji L, et al. Tobacco smoke mediated induction of sinonasal biofilms. PLoS One. 2011;6, e15700.PubMedCentralCrossRefPubMedGoogle Scholar
  80. 80.
    Merenstein D, Whittaker C, Chadwell T, Wegner B, D’Amico F. Are antibiotics beneficial for patients with sinusitis complains? A randomized double-blind clinical trial. J Fam Pract. 2005;54:144–51.PubMedGoogle Scholar
  81. 81.
    Van Buchem FL, Knottnerus JA, Schrijnemaekers VJ, Peeters MF. Primary-care based randomised placebo-controlled trial of antibiotic treatment in acute maxillary sinusitis. Lancet. 1997;349:683–7.CrossRefPubMedGoogle Scholar
  82. 82.
    Wald ER, Nash D, Eickhoff J. Effectiveness of amoxicillin/clavulanate potassium in the treatment of acute bacterial sinusitis in children. Pediatrics. 2009;124:9–15.CrossRefPubMedGoogle Scholar
  83. 83.
    Wald ER, Chiponis D, Ledesma-Median J. Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial. Pediatrics. 1986;77:795–800.PubMedGoogle Scholar

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© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Pediatrics, Section of Infectious DiseasesBaylor College of MedicineHoustonUSA
  2. 2.Department of OtolaryngologyMiami Children’s HospitalMiamiUSA

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