1
|
Zendri F, Richards-Rios P, Maciuca I, Ricci E, Timofte D. Disseminated Nocardiosis Caused by Nocardia farcinica in Two Puppy Siblings. Vet Sci 2022; 10:vetsci10010028. [PMID: 36669029 PMCID: PMC9860694 DOI: 10.3390/vetsci10010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
Systemic nocardiosis due to Nocardia farcinica has not been reported in canine outbreaks. Two 14-week-old female Dogue de Bordeaux siblings presented with fever and severe, acute onset limb lameness; traumatic lesions with evidence of infection were identified over the lame limbs of both dogs. The patients were euthanised owing to lack of therapeutic response and rapid escalation to systemic infection with central nervous system manifestations. The post-mortem changes consisted of multiple disseminated abscesses, mainly affecting the skin and subcutis at the limb traumatic injuries, local and hilar lymph nodes, lung, kidney and brain. Bacterial culture and identification via MALDI-TOF and 16S rRNA sequencing revealed Nocardia farcinica from several of these sites in both dogs. Clinical significance of the isolate was supported by cytology of the post-mortem organs' impression smears showing numerous branching filamentous bacteria associated with inflammation. The organism displayed marked multidrug-resistance. No history of immunosuppression was available, and immunohistochemistry ruled out viral pathogens as canine distemper and parvovirus. N. farcinica should be considered as a potential differential cause of sudden lameness and systemic infection in dogs with traumatic skin lesions over the limbs. This is the first reported small-scale outbreak of systemic nocardiosis in dogs due to N. farcinica.
Collapse
|
2
|
Gao S, Liu Q, Zhou X, Dai X, He H. Primary Cutaneous Nocardiosis Due to Nocardia Farcinica: A Case Report of an Often Overlooked Infection. Infect Drug Resist 2021; 14:1435-1440. [PMID: 33883911 PMCID: PMC8055275 DOI: 10.2147/idr.s306161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Primary cutaneous nocardiosis by Nocardia farcinica is exceedingly rare. Only six cases have been reported from PubMed in the past 15 years. We encounter such a case in a 55-year-old man receiving long-term steroid and cyclophosphamide. Owing to no characteristic symptoms, the disease can be so easily overlooked and causes fatal consequences. Therefore, we herein discuss common features of primary cutaneous nocardiosis by Nocardia farcinica that remind clinicians considering it.
Collapse
Affiliation(s)
- Siyu Gao
- Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, People's Republic of China
| | - Qiang Liu
- Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, People's Republic of China
| | - Xiaolin Zhou
- Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, People's Republic of China
| | - Xiangcheng Dai
- Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, People's Republic of China
| | - HuiQing He
- Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, People's Republic of China
| |
Collapse
|
3
|
Guo J, Li S, Xu S, Jiang L, Gao E, Liu Z. Nocardiosis in patients with nephrotic syndrome: a retrospective analysis of 11 cases and a literature review. Int Urol Nephrol 2020; 52:731-738. [PMID: 32124233 DOI: 10.1007/s11255-020-02415-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We evaluated the clinical manifestations and outcomes of nocardiosis, a rare opportunistic infection that occurs in patients with nephrotic syndrome. METHODS The records of NS patients with nocardiosis in a single hospital during 2000-2019 were retrieved and studied in detail. RESULTS Eleven patients were included. The mean time to develop nocardiosis after glucocorticoid therapy was 11.5 ± 14.8 months. Most patients had fever, elevated white blood cell counts and C-reactive protein, whereas procalcitonin levels were normal or slightly elevated in 91% (10/11) patients, except one patient suffered from septic shock. Nine patients were tested for CD4+ T-cell counts; of these, four patients had counts < 200 cells/μL. The most common site of nocardiosis involvement was lung (100%), followed by subcutaneous tissue (72.7%). Radiological findings for lungs in seven cases were characterized by isolated or scattered nodules and masses, usually located subpleural or close to the hilum. Positive smears of Nocardia were detected in 100% of samples of subcutaneous abscess and pleural fluid. Nine patients received oral trimethoprim-sulfamethoxazole, four of which received combined carbapenem, and the remaining two patients received carbapenem monotherapy. The long-term prognosis was excellent, with a treatment success rate of 100% in all patients. CONCLUSIONS NS patients can develop immunodeficiency after treatment with glucocorticoid and immunosuppressants. In cases where patients develop systemic multiple abscesses, or lung images reveal isolated or scattered nodules and masses that are subpleural or close to the hilum, nocardial infection should be considered. Early diagnosis and specific treatment may improve patient outcomes.
Collapse
Affiliation(s)
- Jinzhou Guo
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China
| | - Shijun Li
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China.
| | - Shutian Xu
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China
| | - Ling Jiang
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China
| | - Erzhi Gao
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China
| | - Zhihong Liu
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210016, China
| |
Collapse
|
4
|
Gudivada V, Gochhait D, Bhandary C, Mishra N, Siddaraju N. Cutaneous nocardiosis with discharging sinus clinically mimicking tuberculosis diagnosed by cytology. Diagn Cytopathol 2019; 47:935-938. [PMID: 31173479 DOI: 10.1002/dc.24217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/19/2019] [Accepted: 05/22/2019] [Indexed: 11/11/2022]
Abstract
Nocardiosis is primarily a pulmonary infection commonly seen in immunocompromised individuals. However, lymphocutaneous nocardiosis is observed in immunocompetent individuals often after trauma. The clinical and cytomorphological features of lymphocutaneous nocardiosis closely mimic the most common infections in India such as tuberculosis and mycetoma (very common cutaneous infection with discharging sinus). As it is crucial to differentiate nocardiosis from tuberculosis, to avoid unnecessary antitubercular treatment, special stains like modified Ziehl-Neelsen stain and Gram stain can be employed to differentiate the morphology of Nocardia from tuberculosis. Fine-needle cytology from these cutaneous lesions helps in yielding adequate material for rapid and accurate diagnosis of immediate specific antibiotic treatment. We report a rare case that presented with clinical diagnosis of tuberculosis but turned out to be nocardiosis on cytomorphology with simple and most feasible fine-needle aspiration method of tissue diagnosis and scrape cytology.
Collapse
Affiliation(s)
- Vijayalakshmi Gudivada
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debasis Gochhait
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Chandni Bhandary
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nimesh Mishra
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Neelaiah Siddaraju
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|
5
|
Disseminated nocardiosis caused by Nocardia elegans: a case report and review of the literature. Infection 2018; 46:705-710. [PMID: 29737456 DOI: 10.1007/s15010-018-1144-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Disseminated nocardiosis is a rare disease mostly occurring in immunocompromised patients. METHODS We report a case of disseminated nocardiosis in a diabetic patient with both pulmonary and cutaneous involvement. Nocardia elegans was isolated and identified using the 16s ribosomal RNA gene sequence data. RESULTS Clinical improvement was observed within 3 months after initiation of antimicrobial treatment with oral doxycycline, trimethoprim-sulfamethoxazole and intravenous penicillin, but the patient died 5 months later after arbitrary discontinuation of the treatment. CONCLUSIONS This is the first case report of disseminated nocardiosis caused by Nocardia elegans in China.
Collapse
|
6
|
McHugh KE, Sturgis CD, Procop GW, Rhoads DD. The cytopathology of Actinomyces, Nocardia, and their mimickers. Diagn Cytopathol 2017; 45:1105-1115. [PMID: 28888064 DOI: 10.1002/dc.23816] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 12/27/2022]
Abstract
Nocardia species and Actinomyces species are 2 of the most commonly diagnosed filamentous bacteria in routine cytopathology practice. These genera share many overlapping cytomorphologic features, including their thin, beaded, branching, Gram-positive, GMS-positive filamentous structures that fragment at their peripheries into bacillary- and coccoid-appearing forms. Features that help distinguish between these 2 microorganisms include the width of their filamentous structures, the angles at which they branch, and their ability or lack thereof to retain a modified acid-fast stain. In addition to cytomorphologic overlap, overlap in clinical presentation is frequent with pulmonary and mucocutaneous presentations seen in both. Differentiating between Nocardia and Actinomyces is essential because patients with these infections require different approaches to medical management. Both antibiotic susceptibilities and the need for early surgical intervention as part of the treatment plan vary greatly among these 2 groups. This review focuses on the clinical presentation, cytomorphology and staining characteristics that can be useful in identifying and distinguishing between Nocardia and Actinomyces infections, as well as their mimickers.
Collapse
Affiliation(s)
- Kelsey E McHugh
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
| | - Charles D Sturgis
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
| | - Gary W Procop
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
| | - Daniel D Rhoads
- Department of Pathology, Case Western Reserve University, 10900 Euclid Ave, Cleveland, Ohio, 44106.,Department of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, Ohio, 44106
| |
Collapse
|
7
|
Field AS, Geddie WR. Role of fine needle aspiration biopsy cytology in the diagnosis of infections. Diagn Cytopathol 2016; 44:1024-1038. [PMID: 27555237 DOI: 10.1002/dc.23568] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/04/2016] [Indexed: 12/11/2022]
Abstract
The role of fine needle aspiration biopsy (FNAB) cytology in diagnosing infections has expanded due to the increase in the number of immune compromised patients and the increasing role of FNAB in the developing world where infection is a major cause of illness. FNAB has become the first procedural test in cases where the clinical and imaging findings suggest an infectious lesion or where there is a differential diagnosis of infection or metastatic or primary tumor. This applies to FNAB of palpable or image directed or deep seated lesions accessed by EUS and EBUS. This article details a recommended approach and technique for FNAB of infectious lesions, and discusses the role of rapid on site evaluation and the application of ancillary testing including the rapidly expanding array of molecular tests based on FNAB material. The utility of recognizing suppurative and granulomatous infectious patterns in FNAB direct smears, and the specific cytomorphological features on routine Papanicolaou and Giemsa stains and on special stains of FNAB smears is described for a large number of bacterial, fungal, viral, parasitic, and protozoan infections. The role of cytopathologists is to now train cytopathologists in sufficient numbers to provide FNAB services, teach trainee cytopathologists and cytotechnologists, and to encourage our clinical colleagues to use FNAB in the diagnosis of infections and other lesions to the benefit of patients and the medical system. Diagn. Cytopathol. 2016;44:1024-1038. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Andrew S Field
- Department of Anatomical Pathology, St. Vincent's Hospital and Notre Dame University Medical School, Sydney, Australia
| | - William R Geddie
- Department of Anatomical Pathology, University Health Network, Toronto, Canada
| |
Collapse
|
8
|
Boamah H, Puranam P, Sandre R. Disseminated Nocardia farcinica in an immunocompetent patient. IDCases 2016; 6:9-12. [PMID: 27617207 PMCID: PMC5007420 DOI: 10.1016/j.idcr.2016.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/27/2016] [Accepted: 08/11/2016] [Indexed: 11/22/2022] Open
Abstract
Nocardia farcinica is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete that is infrequently associated with nocardiosis. The relative frequency of Nocardia farcinica isolates in nocardiosis is unknown but thought to be under diagnosis. It is increasingly been recognized in immunocompetent patients. We report a case of disseminated Nocardia farcinica causing brain abscess in 55 year old immunocompetent man who was successfully treated with long term antibiotics. The present report illustrates that early detection and treatment of disseminated Nocardia farcinica can lead to a good outcome.
Collapse
Affiliation(s)
- H. Boamah
- Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
- Corresponding author at: Northern Ontario School of Medicine Laurentian University 935 Ramsey Lake Road Sudbury, Ontario P3E 2C6, Canada.Northern Ontario School of MedicineLaurentian UniversitySudburyOntarioCanada
| | - P. Puranam
- Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
| | - R.M. Sandre
- Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
- Health Sciences North Infectious Prevention and Control, Sudbury, Ontario, Canada
| |
Collapse
|
9
|
Nakanishi A, Mashita T, Akiyama K, Nakanishi W, Mori T, Yano M, Asai T, Kano R, Shimamura S, Yasuda J. Suppurative granulomatous sinorhinitis associated with Nocardia spp. infection in a cat. J Vet Med Sci 2015; 77:597-9. [PMID: 25648934 PMCID: PMC4478741 DOI: 10.1292/jvms.14-0319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
A 9-year-old spayed female cat was examined for cheek skin drainage. The skin
lesion did not respond to medical therapy; thereafter, facial deformity developed. A
computed tomography revealed an intranasal mass and maxillary osteolysis. The mass was
histopathologically diagnosed as suppurative granulomatous inflammation caused by
filamentous bacteria. The lesion responded well to radiation therapy. Although
actinomycosis was suspected histopathologically, no actinomycetes were detected in the
nasal lesion by a bacterial culture conducted at a commercial laboratory. The
submandibular lymph node and subcutaneous tissue exhibited swelling. Microbiological
examination and genetic analysis based on 16S rDNA gene sequence revealed that
Nocardia spp. were isolated from both lesions.
Collapse
|
10
|
Budzik JM, Hosseini M, Mackinnon AC, Taxy JB. Disseminated Nocardia farcinica: literature review and fatal outcome in an immunocompetent patient. Surg Infect (Larchmt) 2012; 13:163-70. [PMID: 22612440 DOI: 10.1089/sur.2011.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nocardia farcinica is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete. Nocardia spp. are opportunistic pathogens, and N. farcinica is the least common species of clinical importance. METHODS Review of the recent literature and description of a immunocompetent patient with no known risk factors who contracted fatal N. farcinica sepsis. RESULTS Positive pre-mortem and post-mortem cultures from the lung and synovium correlated with acute bronchopneumonia and synovitis at autopsy. Colonies of filamentous bacteria, which were not apparent in conventional hematoxylin and eosin-stained sections, were observed with gram and methenamine silver stains, but acid-fast stains were negative. A literature review revealed that disseminated N. farcinica often is associated with an underlying malignant tumor or autoimmune disease (88% of patients). Chemotherapy or corticosteroid treatments are additional risk factors. CONCLUSIONS Trimethoprim-sulfamethoxazole typically is the first-line therapy for N. farcinica; treatment with amikacin and imipenem-cilastatin is used less often (7% of patients). Despite aggressive therapy, we observed that the death rate (39%) associated with N. farcinica in recent publications was eight percentage points higher than reported in a review from 2000.
Collapse
Affiliation(s)
- Jonathan M Budzik
- Department of Pathology, Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | | |
Collapse
|
11
|
Sánchez-Herrera K, Sandoval H, Couble A, Mouniee D, Ramírez-Durán N, Uzcategui de Morillo M, Serrano J, Bergeron E, Boiron P, Rodríguez-Nava V. Phenotypic and genotypic evaluation of 18 Nocardia isolates from human clinical samples in Mexico. J Mycol Med 2012. [DOI: 10.1016/j.mycmed.2011.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
12
|
Gupta N, Srinivasan R, Kumar R, Chakrabarti A. Two cases of nocardiosis diagnosed by fine-needle aspiration cytology: role of special stains. Diagn Cytopathol 2010; 39:363-4. [PMID: 20730901 DOI: 10.1002/dc.21441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 04/17/2010] [Indexed: 11/06/2022]
Abstract
Nocardiosis, a suppurative disease caused by aerobic actinomycetes, is a common opportunistic infection in immunocompromised patients. Unless, the infection is suspected, the diagnosis of Nocardia is tedious and difficult, as these are thin filamentous bacilli, which stain negatively on routine cytological stains. We present two such cases diagnosed on fine-needle aspiration cytology and discuss the importance of performing the modified Ziehl-Neelsen stain in such cases.
Collapse
Affiliation(s)
- Nalini Gupta
- Department of Cytopathology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | |
Collapse
|
13
|
Bawa B, Bai J, Whitehair M, Purvis T, Debey BM. Bovine abortion associated with Nocardia farcinica. J Vet Diagn Invest 2010; 22:108-11. [PMID: 20093696 DOI: 10.1177/104063871002200122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nocardia spp. are recognized as a cause of bovine mastitis, cutaneous or subcutaneous abscesses, pneumonia, and disseminated disease. Abortion caused by Nocardia spp. is uncommon, and only a few sporadic cases have been reported in horses, pigs, and cattle. In all previous reports, of nocardial abortion, the causative agent was identified as Nocardia asteroides. The current report describes an aborted bovine fetus that was infected with Nocardia farcinica. Placenta, abomasal fluid, lung, liver, and kidney specimens from a late-term bovine abortion were submitted to the Kansas State Veterinary Diagnostic Laboratory. The gross findings included purulent exudate in the placenta and numerous abscesses in lung. Histologically, there was necrotizing and suppurative placentitis, pyogranulomatous pneumonia, and nephritis with numerous intralesional branching and filamentous, Gram-positive bacteria. Nocardia farcinica was isolated by bacteriology, and the bacteriology result was confirmed by 2 established polymerase chain reaction protocols and by DNA sequencing.
Collapse
Affiliation(s)
- Bhupinder Bawa
- Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, 1800 Denison Avenue, Manhattan, KS 66506, USA
| | | | | | | | | |
Collapse
|
14
|
HARADA H, ENDO Y, SEKIGUCHI M, SETOGUCHI A, MOMOI Y. Cutaneous Nocardiosis in a Cat. J Vet Med Sci 2009; 71:785-7. [DOI: 10.1292/jvms.71.785] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hiromi HARADA
- Laboratory of Veterinary Internal Medicine, Faculty of Agriculture, Kagoshima University
| | - Yasuyuki ENDO
- Laboratory of Veterinary Internal Medicine, Faculty of Agriculture, Kagoshima University
| | - Maiko SEKIGUCHI
- Procyon Inc., Tokyo University of Agriculture and Technology
| | - Asuka SETOGUCHI
- Laboratory of Veterinary Internal Medicine, Faculty of Agriculture, Kagoshima University
| | - Yasuyuki MOMOI
- Laboratory of Veterinary Diagnostic Imaging, Faculty of Agriculture, Kagoshima University
| |
Collapse
|