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| # ''[[Pseudomonas aeruginosa]]'' | | # ''[[Pseudomonas aeruginosa]]'' |
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| * Atypical bacteria | | * Atypical Bacteria |
| # ''[[Mycoplasma pneumoniae]]'' | | # ''[[Mycoplasma pneumoniae]]'' |
| # ''[[Chlamydophila pneumoniae]]'' | | # ''[[Chlamydophila pneumoniae]]'' |
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| * In addition, adults with [[chronic (medicine)|chronic]] illnesses, who live in certain parts of the world, who reside in [[nursing home]]s, who have recently been treated with [[antibiotic]]s, or who are [[alcoholism|alcoholics]] are at risk for unique infections. | | * In addition, adults with [[chronic (medicine)|chronic]] illnesses, who live in certain parts of the world, who reside in [[nursing home]]s, who have recently been treated with [[antibiotic]]s, or who are [[alcoholism|alcoholics]] are at risk for unique infections. |
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| ===Infants and Newborns=== | | ===Causes by Organ System=== |
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| * GBS causes at least 50% of cases of CAP in the first week of life.{{ref|Webber}}
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| * Other bacterial causes in the newborn period include ''[[Listeria monocytogenes]]'' and ''[[Mycobacterium tuberculosis]]''.
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| * Viral causes like [[herpes simplex virus]] (most common), [[adenovirus]], [[mumps]], and [[enterovirus]].
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| ===Children===
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| * For the most part, children older than one month are at risk for the same microorganisms as adults.
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| * Children less than five years are much less likely to have pneumonia caused by ''[[Mycoplasma pneumoniae]]'', ''[[Chlamydophila pneumoniae]]'', or ''[[Legionella|Legionella pneumophila]]''.<ref name="Shachor-Meyouhas-2012">{{Cite journal | last1 = Shachor-Meyouhas | first1 = Y. | last2 = Arad-Cohen | first2 = N. | last3 = Zaidman | first3 = I. | last4 = Gefen | first4 = A. | last5 = Kassis | first5 = I. | title = [Legionella pneumonia in a child with leukemia]. | journal = Harefuah | volume = 151 | issue = 8 | pages = 479-82, 496 | month = Aug | year = 2012 | doi = | PMID = 23350295 }}</ref>
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| * In contrast, older children and teenagers are more likely to acquire ''[[Mycoplasma pneumoniae]]'' and ''[[Chlamydophila pneumoniae]]'' than adults.{{ref|Wubbel}}
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| * A unique cause of CAP in this group is ''[[Chlamydia trachomatis]]'', which is acquired during birth but does not cause pneumonia until 2-4 weeks later.
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| * Common viruses include [[respiratory syncytial virus|respiratory syncytial virus (RSV)]], [[metapneumovirus]], [[adenovirus]], [[parainfluenza]], [[influenza]], and [[rhinovirus]].
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| * RSV in particular is a common source of illness and hospitalization.{{ref|Abzug}}
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| * Fungi and parasites are not typically encountered in otherwise healthy infants, though maternally-derived [[syphilis]] can be a cause of CAP in this age group.
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| ===Adults===
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| =====Viruses=====
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| * Viruses account for about 20% cases of CAP.
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| * Common viruses are [[influenza]], [[parainfluenza]], [[respiratory syncytial virus]], [[metapneumovirus]], and [[adenovirus]].
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| * Less common viruses include [[varicella|chicken pox]], [[SARS]], [[H5N1|avian flu]], and [[hantavirus]].{{ref|Roux}}
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| =====Atypical Organisms=====
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| * ''[[Mycoplasma pneumoniae]]'', ''[[Chlamydophila pneumoniae]]'', and ''[[Legionella|Legionella pneumophila]]'' are often grouped as atypical pneumonia. Community acquired pneumonia caused by these agents present insidiously, with a non-productive cough and prominent extra-pulmonary complaints, such as myalgias and diarrhea (lack the typical pneumonia symptoms of fever, cough, and sputum).
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| * ''[[Mycoplasma pneumoniae]]'' is often referred to as "walking pneumonia." It is transmitted via respiratory droplets and is common among healthy individuals in close contact with one another, such as dormitories or military barracks.
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| * Atypical organisms are more difficult to grow, respond to different antibiotics, and were discovered more recently than the typical bacteria discovered in the early twentieth century.
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| =====''Streptococcus pneumoniae''=====
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| * ''[[Streptococcus pneumoniae]]'' is the most common cause of community-acquired pneumonia.
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| * Aspiration pneumonia is most commonly caused by anaerobic organisms.
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| * Prior to the development of antibiotics and vaccination, it was a leading cause of death.
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| * Traditionally, it was highly sensitive to [[penicillin]], but during the 1970s resistance to multiple antibiotics began to develop.
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| * Current strains of "drug resistant Streptococcus pneumoniae" or DRSP are common, accounting for twenty percent of all streptococcal infections.
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| * Adults with risk factors for DRSP including being older than 65, having exposure to children in [[day care]], [[alcoholism]], other severe underlying disease, or recent treatment with antibiotics should initially be treated with antibiotics effective against DRSP.{{ref|Ruhe}}
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| =====''Hemophilus influenzae''=====
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| * ''Hemophilus influenzae'' used to be a common bacterial cause of CAP.
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| * First discovered in 1892, it was initially believed to be the cause of influenza because it commonly causes CAP in people who have suffered recent lung damage from viral pneumonia.
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| =====Enteric Gram Negative Bacteria=====
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| * Enteric bacteria such as ''[[Escherichia coli]]'' and ''[[Klebsiella pneumoniae]]'' may cause commnity-acquired penumonia.
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| * Adults with risk factors for infection, which include living in a [[nursing home]], serious [[heart disease|heart]] and [[lung disease]], and recent antibiotic use should initially be treated with antibiotics effective against Enteric Gram negative bacteria.
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| =====''Pseudomonas aeruginosa''=====
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| * ''[[Pseudomonas aeruginosa]]'' is an uncommon cause of CAP, but it is a particularly difficult bacteria to treat.
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| * Individuals who are malnourished, have [[bronchiectasis]], are on [[corticosteroids]], or have recently had strong antibiotics for a week or more, should initially be treated with antibiotics effective against [[Pseudomonas aeruginosa]].{{ref|Lieberman}}
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| =====Special Situations=====
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| * [[Coccidioides|Coccidioides spp.]] are common in southwestern area of the United States.
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| * Anaerobic infection is common in alcoholics. Pneumococcal pneumonia remains the most common cause of CAP in alcoholics too.
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| * [[Psittacosis]] (due to [[Chlamydophila psittaci]]) should be considered in the patient with exposure to birds or bird droppings.
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| * [[Anaerobes]] are common in patients with poor dental hygiene, and a suspected large volume of aspiration.
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| * ''[[Streptococcus pneumoniae]]'', ''[[Haemophilus influenzae]]'', ''[[Moraxella catarrhalis]]'', and [[Legionella]] species are the common causes of community acquired pneumonia in [[chronic obstructive pulmonary disorders]] and [[smokers]].
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| * ''[[Streptococcus pneumoniae]]'', [[Gram negative bacilli]], ''[[Haemophilus influenzae]]'', ''[[Staphylococcus aureus]]'', [[anaerobe]]s, and ''[[Chlamydophila pneumoniae]]'' are more common in nursing home residents.
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| * ''[[Streptococcus pneumoniae]]'', ''[[Haemophilus influenzae]]'', and ''[[Mycobacterium tuberculosis]]'' are common pathogens in early stages of HIV, whereas, ''[[Pneumocystis jiroveci]]'', ''[[Histoplasma]]'', and ''[[Cryptococcus]]'' are commonly seen in late stages HIV.
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| * In patients with structural lung disease such as [[bronchiectasis]] and [[cystic fibrosis]], ''[[Pseudomonas aeruginosa]]'', ''[[Burkholderia cepacia]]'', and ''[[Staphylococcus aureus]]'' are the common pathogens involved.
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| ==Aspiration Pneumonia Causes==
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| * Incompetent [[swallowing]] mechanism, such as in neurological disease (a common cause being [[cerebrovascular accident|strokes]]) or while a person is [[Drunkenness|intoxicated]].
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| * [[Iatrogenic]] causes such as [[general anaesthesia]] for an [[Surgery|operation]]. Patients are therefore instructed to be [[nil per os]] (NPO) for at least four hours before surgery.
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| * Whether aspiration pneumonia represents a true bacterial infection or a chemical inflammatory process remains the subject of significant controversy.
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| ==Infectious Diseases Society of America/American Thoracic Society consensus statement on common etiologies of community-acquired pneumonia in adults.<ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref> (DO NOT EDIT)==
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| {| style="border: 2px solid #696969;" align="center"
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| |+ <SMALL>'' Etiology of community-acquired pneumonia.''</SMALL>
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| | style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px"| '''Location''' || style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px" | '''Etiology of community acquired pneumonia'''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''Outpatient''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''Streptococcus pneumoniae'''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Mycoplasma pneumoniae'''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Haemophilus influenzae'''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Chlamydophila pneumoniae'''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Respiratory viruses'''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''Inpatient (non-ICU)''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''S. pneumoniae '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''M. pneumoniae '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''C. pneumoniae ''''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''H. influenzae '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Legionella species '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Aspiration '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ ''''' Respiratory viruses '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Yersinia enterocolitica '''''<ref name="Wong-2013">{{Cite journal | last1 = Wong | first1 = KK. | last2 = Fistek | first2 = M. | last3 = Watkins | first3 = RR. | title = Community-acquired pneumonia caused by Yersinia enterocolitica in an immunocompetent patient. | journal = J Med Microbiol | volume = 62 | issue = Pt 4 | pages = 650-1 | month = Apr | year = 2013 | doi = 10.1099/jmm.0.053488-0 | PMID = 23242642 }}</ref>
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''Inpatient (ICU)''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''S. pneumoniae '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''Staphylococcus aureus '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''Legionella species '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''Gram-negative bacilli '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''H. influenzae '''''
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| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''Acinetobacter baumannii '''''<ref name="Oh-2013">{{Cite journal | last1 = Oh | first1 = YJ. | last2 = Song | first2 = SH. | last3 = Baik | first3 = SH. | last4 = Lee | first4 = HH. | last5 = Han | first5 = IM. | last6 = Oh | first6 = DH. | title = A case of fulminant community-acquired Acinetobacter baumannii pneumonia in Korea. | journal = Korean J Intern Med | volume = 28 | issue = 4 | pages = 486-90 | month = Jul | year = 2013 | doi = 10.3904/kjim.2013.28.4.486 | PMID = 23864808 }}</ref>
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| |}
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| ===Causes by Organ System===
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| {|style="width:80%; height:100px" border="1" | | {|style="width:80%; height:100px" border="1" |
| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular''' | | |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular''' |
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| *[[Influenza]] | | *[[Influenza]] |
| *[[K.pneumonia]] | | *[[K.pneumonia]] |
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| | {{col-break|width=33%}} |
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| *[[Klebsiella sp]] | | *[[Klebsiella sp]] |
| {{col-break|width=33%}}
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| *[[Legionella pneumophila]] | | *[[Legionella pneumophila]] |
| *[[Legionella species]] | | *[[Legionella species]] |
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| *[[Q fever]] | | *[[Q fever]] |
| *[[Rat-bite fever]] | | *[[Rat-bite fever]] |
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| | {{col-break|width=33%}} |
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| *[[Respiratory syncytial virus]] | | *[[Respiratory syncytial virus]] |
| *[[Respiratory viruses]] | | *[[Respiratory viruses]] |
| *[[Rhinovirus]] | | *[[Rhinovirus]] |
| *[[Rhodococcus equi]] | | *[[Rhodococcus equi]] |
| {{col-break|width=33%}}
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| *[[S. pneumoniae]] | | *[[S. pneumoniae]] |
| *[[Sars]] | | *[[Sars]] |
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| *[[Yersinia pestis]] | | *[[Yersinia pestis]] |
| *[[Zygomycosis]] | | *[[Zygomycosis]] |
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| {{col-end}} | | {{col-end}} |
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