Category Archives: infectious diseases

Resources for information on Canine Circovirus

Many of our clients have called and sent email to ask about Canine Circovirus. The news has picked up the stories of dogs in Ohio, California, and Michigan. New information is somewhat hard to come by. The virus isn’t thoroughly understood at this point in time. Investigators are working hard to bring us more information. In the meantime, here are a few links that lead to more info on Circovirus.

Circovirus FAQ from the AVMA

Guidance for Veterinarians about Circovirus

Information from Michigan State University’s Diagnostic Center for Population and Animal Health:

LANSING, MI – Based on recent cases in California and Ohio that may indicate the emergence of a new canine circovirus, the Diagnostic Center for Population and Animal Health (DCPAH) at the Michigan State University College of Veterinary Medicine has added two real time PCR assays for canine circovirus to its test catalog. Running two PCRs for this virus is important as the initial research on the virus indicates some genetic variation. The PCR assay can be run on fresh or formalin-fixed tissue. DCPAH has received requests for canine circovirus testing from Michigan clients and two positive results have been found. However, both animals also had simultaneous infections with other organisms; therefore identification of the circovirus was not necessarily linked to the cause of the disease shown by the animals. DCPAH is currently working on an in situ hybridization (ISH) technique which is a crucial next step. ISH is a method that uses DNA or RNA probes to detect virus in microscopic lesions.

“It is important to note that circovirus has been found in the feces of healthy dogs. Also, the initial research shows that nearly 70% of dogs showing clinical signs of illness and found positive for circovirus were also infected with other viruses or bacteria known to cause disease. Currently, circovirus by itself is not associated with a specific disease process. However, coinfection with canine circovirus and other pathogens may have the potential to cause disease as has been demonstrated in other species, for example pigs,” says DCPAH acting director Thomas Mullaney.

Matti Kiupel, section chief for DCPAH’s pathology laboratory adds, “In order to link circovirus to the cause of a disease process, a full diagnostic work-up (including a postmortem in the case of deceased animals) is essential. This also allows diagnosticians and pathologists to identify the full spectrum of infections and/or diseases that are present in a specific case.”
Recent publicity about circovirus in Michigan dogs is not cause for panic. Veterinarians should consider possible circovirus infection in animals showing clinical signs including vomiting, diarrhea (possibly hemorrhagic) only after other more common causes have been diagnostically excluded. Ascites, pleural effusion, hypovolemic shock, bicavitary hemorrhage, and disseminated intravascular coagulation may also be present, but as with gastrointestinal symptoms, more common causes should be excluded. According to the early research by Li et al, circovirus “should be considered in cases of unexplained vasculitis in dogs.”

Dog owners whose pets show signs of illness, including vomiting, diarrhea, lethargy, should contact their veterinarian and seek diagnosis and treatment. There is no evidence to-date that canine circovirus can be transmitted to humans or cause human disease. Since many pathogens are transmitted from animals to humans (zoonotic diseases such as rabies, leptospirosis, salmonellosis) thorough hand-washing should be standard practice after handling animals, especially those showing signs of illness, or animal waste.

Additional information on circovirus developed by the American Veterinary Medical Association (AVMA) for veterinarians and the general public is available on the DCPAH website at animalhealth.msu.edu.

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Emerging Viral Disease (Maybe)

The news has been active over the last week or so due to the possibility of a new, emerging viral infection in Ohio. Some dogs have been sick, and a number have died, from what may be circovirus. This would be a new finding in dogs, and the State Veterinarian in Ohio is working with regulatory agencies and veterinary schools to try and figure things out.

Here’s a link to an article in an Ohio newspaper.

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Amur (Siberian) Tigers Killed by Canine Distemper Virus

I’m sorry that I’m running behind on the blog this week. Thursday was occupied by a big project that I’ll start discussing in a post later on Sunday.

I’ve mentioned before that nature and conservation are important to me. Sometimes, my profession and my passion for conservation overlap. The article I’m linking is an example of that intersection. It’s a sad occurrence.

Canine distemper virus, which can infect not only dogs but animals like raccoons and foxes, has spread into a massive area in Russia. The virus has been responsible for the death of several Siberian (Amur) tigers, which are a highly endangered species. Apparently, the tigers have come into contact with the virus in part by hunting and killing domestic dogs. This is the result of encroachment on the tiger’s habitat by human settlement.

This cross-species infection is another example of the adaptability and easily altered behavior of some viruses. The canine distemper vaccine may pose a danger to these tigers if it were given, and there’s no vaccine designed for cats of any kind to protect against canine distemper. It’s a tough dilemma in deciding how to protect these rare and valuable tigers.

The full article can be found here.

An additional article with lots of overlap but some additional info can be found here.

790px Harbin Siberian Tigers

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West Nile Virus Article

I’d like to share some information about West Nile Virus today. The first article talks about a fatal infection in a human — it’s a pretty strong reminder to protect yourself from mosquitos.

The article can be found here.

This is a link to the CDC’s webpage about West Nile Virus.

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Thursday News – New Flu Virus

The H7N9 flu has shown signs of genetic diversity since the first three patients were diagnosed, said Richard Webby, director of a World Health Organization collaborating center for the virus at St. Jude Children’s Research Hospital in Memphis. It already appears more infectious than the H5N1 strain of bird flu that has been circulating since 2003, infecting 600 people and killing 60 percent of them, he said.

Here’s a link to the full article on H7N9…

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New Flu Virus

So far, this virus isn’t being transmitted from human to human. However, as we’ve previously discussed, an animal virus has made the jump to infecting people. I realize it’s not happy news, but it’s something we need to be aware of.

Here’s a link to an article in the Washington Post that discusses the new H7N9 strain.

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Thursday News

Treating infections is one of the most widely known aspects of medical practice. Humans and other animals are in a constant and highly variable relationship with the microscopic world inside and outside our bodies. Bacteria help us digest and use our food, but they can also cause life-threatening infections. Dealing with the bad bugs often requires an antibiotic, a chemical that kills the bacteria. Finding new antibiotics that can be brought to the market as a safe, effective treatment is a long, expensive, arduous process. As a result, we don’t see too many new antibiotics.

Scientists have discovered a small molecule in the bloodstream of the giant panda that has antibacterial properties. The pandas make this small chain of amino acids (a peptide) naturally and it circulates in their body. Interestingly, it kills bacteria very quickly — more quickly than the drugs and molecules we already know about. The hope, of course, is that we can find a way to make this available to help humans and other animals. Scientists are working on making this peptide in the lab so that wild pandas can be protected.

This is another example of why research into the natural world is far, far more important than it might at first seem. Nature has a great deal to share with us about elegant solutions.

Here’s the link to the article. (It’s pretty short.)

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Guest Blog – Stray Cat Adoptions

Winter made its presence certain today when we woke up to some snow on the ground. Whenever the weather turns cold like this, I wonder what happens to all of the stray cats and dogs that have been outside since the summertime. I always hope that someone will be able to take them in so they don’t suffer from exposure to the weather or starvation. It’s a rough time of year.

We frequently see stray cats that are brought in for the winter. Most of the time, clients have the best intentions and I certainly applaud their generosity in opening their homes, hearts, and wallets for these ragtag pets. There are a few dangers that I wish clients knew about ahead of time, especially if there are already cats in the house.

This week’s post was written by Diane, one of our LVTs. She will touch on a few of the concerns we have when taking in a new cat.

—–

A gentleman was in the hospital with his dog recently, and mentioned that he got a cat. I said, “Oh, where did you get him?” He responded that the cat wandered to his house, and the man decided to keep him. The gentleman commented, “We figured he’s been around a while outside and is still alive, so he must be healthy because he hasn’t died from anything yet, right?” I shuddered and my mind raced with all of the possible diseases and problems I needed to warn him about. I gathered some informational brochures and started the conversation.

I started with zoonotic diseases, which are diseases that can be transmitted from animals to humans. Rabies is by far the most important and deadly disease, but not the most common, and is transmitted by a bite from an infected animal. Intestinal parasites carried by animals must be addressed first. Roundworms, hookworms, and toxoplasmosis are all parasitic diseases that are spread to humans by contact with cat feces in soil or cat littler. Cat Scratch Fever is a flea-borne infection typically transmitted by a cat’s scratch or bite. A stool sample to check for intestinal parasites is the best way to find out what a cat may be carrying inside.

The next topic of conversation was about two viral diseases that the new cat could be carrying without any signs. Feline Immunodeficiency Virus (FIV) and Feline Leukemia (FeLV) are diseases in cats found in every region of the country. Each is highly contagious fro cat to cat. They can be fatal infections. Both have few outward signs initially, and no “sure” signs. [Dr.H adds: when a sign of disease is 100% certain to be from that disease, we call it a pathognomonic sign. FIV and FeLV don’t have pathognomonic signs.]

These viral diseases are associated with illness and death of more cats than any other disease. The viruses work by weakening a cat’s immune system. Without testing, there is no way to know whether the cat is infected. Without a diagnosis, the cat cannot be treated properly. In some cats, signs don’t appear for weeks, months, or even years after they are infected. Testing is important so we know whether a cat is carrying these diseases.

Infected cats can show vomiting, diarrhea, weight loss, weakness, fever, pale gums, dull or matted hair coat, swollen lymph nodes, mouth sores, or behavior changes. If the cat has been living outside for months or years, a new owner might not be aware of these sometimes subtle changes.

[Dr.H adds: Upper respiratory diseases, fleas/ticks, and ear mites are also very common problems seen in stray or orphan cats. While these problems aren’t generally life-threatening, they can be a serious headache for a new owner. These problems are highly contagious and rapidly spread to other cats in the household. Fleas and ticks are also a risk to humans. Vaccination and treating external parasites are a critical part of a “new stray cat” vet visit.]

If a person wants to bring in a stray, it’s imperative that the cat is examined and tested before coming into contact with people or other pets. Testing, vaccinating, and deworming should be performed, and a quarantine period may be appropriate, too.

I thanked the client for his willingness to give a stray cat a permanent home, but also tried to show him the risks a cat with an unknown history can bring. A full health check with the veterinarian is the first step to providing a loving, caring home.

——

Diane’s focus on the viral diseases is very appropriate. I counsel all owners of newly acquired cats to allow us to perform the simple blood test that can detect FIV and FeLV. Results are available within 10 minutes right in the hospital, and the test is quite sensitive. There are some nitpicky concerns with the age of testing for FIV, but FeLV can be tested for at *any* age.

I feel that knowing the viral status of new cats is the most important first step. These diseases will shorten a cat’s life considerably. While some owners are able to take in a cat that is positive for one/both of these infections, some owners don’t want to put their other cats at risk. In a rescue situation, the resources that will be spent on a cat with a generally fatal viral infection could be used to rescue several other healthy cats. It’s a very sticky situation wrapped up in ethics and harsh realities. Ultimately, as each owner or rescue group makes a decision about how to handle these cats, one thing is clear: it’s better to know what you’re dealing with. Testing is step one!

Please ask questions. We’ve brushed the surface of adopting a new cat, so I know there must be some things that you’d like us to go over in more detail. Thanks for reading!

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Filed under ethics, fleas, guest, infectious diseases, parasites, preventive care, vaccines, zoonotic

Thursday News – Tasmanian Devils

We’ve talked a lot about cancer in the past few weeks. The many wicked faces of cancer is concern enough for pet owners. Thankfully, cancer isn’t a contagious disease…usually. Dogs can get a venereal tumor that is transmitted through sexual contact. Tasmanian devils are also being wiped out of their natural habitat by a type of cancer that is transmitted easily from one devil to another.

The Tasmanian tumors are aggressive. They grow quickly, and they’re disgustingly nasty. Most of the time, they grow on the face. They get so big that the devils can’t eat enough to stay alive. Metastasis to other organs, including the heart, is also very common.

There’s a great article here, with a video, talking more about the Devil Facial Tumor Disease (DFTD).

Wikipedia also has an extensive article about DFTD. The wiki article includes a picture.

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News – More West Nile

High Level of West Nile Virus Activity Recorded

The Michigan Department of Community Health (MDCH) is recording high levels of West Nile Virus (WNV) activity in many parts of the state. So far this season, our human case count is the highest it has been since 2002 when WNV first appeared in Michigan. Persons bitten by an infected mosquito can become severely ill; in some cases, especially among persons age 50+, WNV can be fatal.

It is important to take precautions to protect oneself and others. As you head outdoors, and particularly this weekend while you enjoy the holiday weekend, please take precautions to protect yourself and your family by following the 4Ds of West Nile Virus prevention:

DUSK
Avoid being outside when mosquitoes are most active: dusk and dawn.

DEET
Use insect repellent containing DEET, picaridin, or oil of lemon eucalyptus.

DRESS
Wear long sleeves and pants when possible outdoors.

DRAINAGE
Drain all standing water around your home.

During the WNV press briefing held yesterday, MDCH reported 80 cases and 4 deaths, 62 of the 80 cases were severe and required hospitalization. The Michigan mosquito season peaks in late August and will decline as evening temperatures get below 50 degrees.

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West Nile Virus

We’re firmly entrenched in the last week of August, and with the weather running warm to hot for the foreseeable future, I want to take some time to discuss a zoonotic disease that’s making headlines locally and nationally. This is something that -everyone- should pay attention to, whether you’re an outdoorsy or indoorsy person. Dog and Cat owners don’t have much to be concerned about with their pets, but horse owners should be concerned.

West Nile Virus (WNV) is closely related to a small set of viruses known as flaviviruses. It’s found throughout the majority of the US. While it generally infects birds, animals and people are potential hosts for the virus. Interestingly, WNV in the US hasn’t changed much since about 1999. In contrast, many types of virus can change their makeup more frequently.

WNV is primarily found in birds. Birds can survive the infection and become immune, but some of them will die after being infected. Mosquitos transfer the virus from bird to bird when they bite to drink a blood meal. These same mosquitos can bite other animals or people, which can lead to infection of those other animals. The main difference in the infections is that birds develop very high levels of virus in the bloodstream. Humans and other animals generally do NOT develop high levels of virus in the bloodstream. Animals other than birds and humans are called “dead-end hosts” because they don’t serve as a means for the virus to reproduce.

WNV 21August 2012 a

WNVcycle4 18 big
Spending time outdoors is the primary risk factor for contracting WNV. Anywhere that you can get bitten by a mosquito puts you at risk for contracting WNV. One of the mosquito species that transmits WNV can survive the winter by hibernating in places like barns, underground, or in root cellars. The presence of mosquitos indoors means that people and indoor pets are at risk of being infected.

As I mentioned, dogs and cats are quite resistant to this virus. The CDC reports that a 1999 study (in New York) showed many dogs are infected by WNV but do not develop any symptoms. Horses, on the other hand, seem to be more susceptible. Not every horse that is infected will get sick, but those that do have a 40% chance of dying from the infection. A vaccine exists, but no one is certain how much it’s helping protect horses.

For people that are infected by WNV, about 80% will have no signs or symptoms at all. People over 50 years of age, or those with diabetes or other immune suppression, are more susceptible. About 20% of the people infected will develop flu-like symptoms 3-14 days after being bitten by a mosquito: fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. People can feel sick for a few days to a few weeks. About 1 in 150 of the people who are infected will get severely sick. High fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis can occur. These symptoms may last several weeks, and neurological effects may be permanent. If you think you may have WNV, you should contact your physician for further instructions.

There is no vaccine for people. Preventing mosquito bites is the best way to avoid contracting WNV. According to the CDC, these methods can be used to lessen your risk:

Many mosquitoes are most active at dusk and dawn. Be sure to use insect repellent with an EPA-registered insect repellant. Wear long sleeves and pants at these times or consider staying indoors during these hours. Make sure you have good screens on your windows and doors to keep mosquitoes out. Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children’s wading pools empty and on their sides when they aren’t being used.

Here’s the CDC webpage about WNV.

Here is the wikipedia page about WNV.

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Infectious Disease in Michigan

I received a newsletter from the State Veterinary Office this week. It contained some interesting data on infectious diseases in Michigan. We strongly recommend vaccinating against two of these diseases. I get a fair amount of pushback from clients on these recommendations, surprisingly. I’d like to share some of the data with you.

Leptospirosis

(details here in a prior blog post)

There were 74 cases of Lepto reported in Michigan in 2011. Keep in mind that these are only the cases that veterinarians actually called the state to report. (Reportable diseases are those which require a vet to call the state when diagnosed.) Of those 74 cases, 13 were in Macomb county; 10 were in Oakland county; and 33 were in Wayne county. So, our tri-county area accounted for 56 out of 74 cases. That’s about 75%!

A very wide variety of breeds were affected, but many were small dog breeds. In my experience, these are the dogs that owners insist don’t have exposure because they only go outside very briefly. They’re also the breeds that breeders frequently tell clients should not have lepto vaccinations.

Three quarters of the strains of lepto that caused illness in these cases were strains we can vaccinate for. This means that the affected dogs probably did NOT have the vaccine. (It is possible for a vaccinated dog to still get sick. It’s just unlikely.)

The take-home message here is that dogs in Oakland county need to be vaccinated for Lepto.

Rabies

From January 1 to August 8 of 2012, there were 45 confirmed cases of Rabies in Michigan. Of those 45 cases, 37 were bats. Eight were skunks. In all of 2011, there were 65 confirmed cases. For 2012, Oakland county has had 2 positive bats and 3 positive skunks. There’s a neat map at this link showing where the positive cases have come from.

Michigan law requires all dogs be vaccinated for rabies. However, there is no law regarding cats. There really is no reason to avoid vaccinating a healthy cat. If a bat gets into the house, the cat will be the first to find it. Cats that go outside are also far more likely to come into contact with other wild animals than the average stay at home dog, so a cat’s risk is high enough to warrant vaccinating for rabies.

Finally, as rabies is frequently a fatal infection in people, the need to protect people by keeping our pets vaccinated is simply the smart thing to do.

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West Nile Virus Found In Oakland County (Thursday News Early)

WARNING FOR EARLY WNV ACTIVITY

The Michigan Department of Community Health Bureau of Laboratories has confirmed the first human West Nile virus (WNV) case for 2012 in a 44 year old male from Oakland County. He was hospitalized earlier this month and is now at home recovering.

Michigan and other Midwest states are experiencing early WNV activity, likely related to the unusually hot and dry summer. The risk of mosquito-borne disease is likely to remain high this summer. Residents should be reminded to take precautions to avoid mosquito bites throughout the summer and fall months in Michigan.

View Additional Information on West Nile Virus and Prevention

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Rabies Cases Increasing

Reports of rabies cases in animals and people have been on the rise in the last couple of years. It may be that we’re reporting the disease more, or perhaps because cases have been deemed ‘newsworthy.’ Regardless, this is an important public health risk that everyone should be aware of.

Any mammal can be affected by rabies. In different regions of the country, different animals are more prominent carriers of rabies. In our area, skunks and bats are most frequently affected. Interestingly, rodents don’t often carry rabies. Woodchucks – an animal found in our area – do carry rabies.

Most people think of dogs frothing at the mouth when rabies is mentioned. We rarely consider that rabies can affect large mammals like cattle and horses. The article linked to below reports on six people exposed to rabies by a horse.

Six being treated after exposure to rabid horse — DALTON, GA. (WRCB)

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Of Mange and Mites

I’m going to sneak in a “by request” post this week. I didn’t have an opportunity to photograph a spay procedure on Wednesday, but as soon as I can get an image set together, I’ll post that. The topic today will be “mites.” While there are a ton of different mites, I’m going to show you the three we deal with most commonly. The first two are seen primarily in dogs, and the third in cats.

Demodex (Red Mange)

Demodex mites (Demodex canis) are allays found in the skin of dogs in small numbers. They live in the hair follicles and oil glands. Humans have a couple of varieties of mites, too, that live in eyelash/eyebrow follicles. People and dogs don’t trade Demodex back and forth. Dogs generally don’t infect one another with mites, either. The body usually keeps the population under control so that there aren’t any problems. In some patients, the immune system can’t keep the mite population under control. When mites overpopulate, they damage the hair follicle. Hairs fall out, causing bald patches (usually a circular spot). These patches really aren’t itchy at first. However, the follicles are damaged and inflamed, so secondary infection sets in. This bacterial infection causes a lot of itching, swelling, scabbing, and oozing. Dogs can have these small spots spread all over the body, too. That’s called Generalized Demodicosis. Here are some pictures of the mites and the skin of an affected dog. Notice the cigar-shaped body of the mite.

Demodex Milbe adult

Demodexdog

We diagnose Demodex taking a scraping of the skin to examine under the microscope. We apply a little mineral oil to the skin, squeeze the skin to push the mites out of the follicles, then scrape the skin with a special little spatula. We have to scrape deep enough to get some bleeding: it ensures that we’ve obtained material from inside the follicles where the mites hide. We examine that under a microscope to look for mites or mite eggs.

Demodex is treatable. The spots of hair loss can be treated with an ointment called Goodwinol. It contains a naturally substance called rotenone that kills Demodex mites. (Interestingly, rotenone is used by indigenous tribes to kill fish for food.) Dogs that have the generalized form have to have special baths/dips with a drug called amitraz. Amitraz does have some side effects: drowsiness, drooling, and loss of appetite. Most are very temporary. If they’re severe, they can be treated with an antidote. Treating generalized Demodex can take months. Some patients need to have dips forever to keep the infestation controlled. Alternative treatments include use of ivermectin or milbemycin (the ingredients in heart worm prevention) on a daily basis for 3-8 months.

Cats have their own type of Demodex. We treat much the same as in dogs. I think I’ve only seen one or two cases of this in the last 7 years at Pet Authority.

Sarcoptes (Sarcoptic Mange)

Sarcoptes scabei is a very different problem than Demodex. These mites are highly contagious, so affected animals can give mites to animals contact. Boarding facilities, kennels, groomers, and the vet’s office are common places for exposure. Two to six weeks pass before dogs show signs of infestation. The mites burrow through the skin, leaving behind substances and eggs that cause dogs to have an allergic reaction. Affected dogs are insanely itchy. They literally can’t do anything but itch and scratch and chew. Their hair falls out, the skin gets crusty, may have a rash, and both dogs and owners are miserable. The most common sites for lesions are the ears, elbows, and hocks (ankles).

Here are pictures of the mites and the skin damage they cause. That’s a red fox, which normally has a fluffy tail and bright orange hair coat. The poor guy is a mess! Dogs look this way or worse when they have scabies.

Sarcoptes scabei
Sarcoptesmmite
Sarcoptesfox

We diagnose Sarcoptes by attempting a skin scrape. Scrapes are not done as deeply as when we’re looking for Demodex. Scrapes find Sarcoptes only 50% of the time. This is one of the very diseases we diagnose and treat based on the examination and history.

This is a zoonotic disease! You can catch sarcoptic mange from your dog. The rash is usually in a limited area, and as long as the dog is treated, the human infestation will go away without treatment. Sometimes people do require treatment by a dermatologist.

Treament is very easy. There are topical medications (Revolution/Selamectin), injections (ivermectin), dips (amitraz and lyme sulfur), and oral medications (milbemycin). Most patients are cured within a few weeks. We also treat patients with antihistamines and steroids to reduce the itching.

Otodectes (Ear Mites)

This mite affects cats more than dogs. Ear mites are officially named Otodectes cynotis. They live in the ears and cause intense itching. They also leave behind a very crusty, sticky black material that is distinct from other types of discharge we see in ears. These mites are highly contagious among cats and from dogs to cats or vice-versa. If a household has more than one pet, all of them need to be treated. Fleas can also carry mites and eggs from pet to pet and into the environment.

The mites are visible with an otoscope when we examine the ears. We take a q-tip sample from the ear and inspect the debris under the microscope. It’s easy to see these mites. They’re similar to the Sarcoptes mites in appearance. Thankfully, these are easy to diagnose. Here’s a picture of the mites and the ear discharge.

Otodectes

Otodectesear

Otodectes are easy to treat. Topical medications (moxidectin, selamectin, ivermectin) are all very efficient at killing these mites. We to treat for 3-6 weeks. The only trouble is that these mites can live in the environment, and once in a while they are found on the animal’s body as well as in the ears. The topical medications we use for flea control work for treating mites anywhere on the body. Environmental treatment is also advised, which includes vacuuming/washing and application of an insecticide.

That’s the tour of the microscopic critters that can infest pets! It’s honestly one of the grosser things to investigate. Parasites are exceptionally good at doing what they do. In a clinical way, it’s fascinating, but it’s also enough to keep you awake at night! The best way to prevent all of these disgusting passengers on your pets is to keep them healthy and protected by a topical flea prevention and/or flea/heartworm prevention product.

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