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Tesso ZG, Gossaye TY, Bekana DS, Kebede MA, Besir FD, Dabe NE. Plasmodium falciparum neonatal malaria with atypical presentation: a case series from southwestern Ethiopia. Malar J 2024; 23:178. [PMID: 38840266 PMCID: PMC11155096 DOI: 10.1186/s12936-024-04987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Neonatal malaria is defined as the detection of asexual stages of Plasmodium species in the cord blood within the first 28 days of life. It can be congenital or acquired through mosquito bites or blood transfusions. Neonates are generally considered to be relatively protected due to the multiple innate and acquired physiological protective effects present in neonates. However, in areas where malaria is endemic, the prevalence of malaria in neonates is high. The predominant clinical feature of malaria in neonates is fever. Other clinical manifestations of neonatal malaria include respiratory distress, pallor and anaemia, hepatomegaly, refusal to feed, jaundice and diarrhoea. Atypical presentations without fever can lead to inaccurate diagnosis and contribute to neonatal morbidity and mortality. Neonates from endemic areas with any of the above symptoms should be screened for malaria. CASE PRESENTATION We present a series of three cases of neonatal Plasmodium falciparum malaria that presented atypically without febrile episodes and were diagnosed and managed at Mizan-Tepi University Teaching Hospital between July and September 2023. The first patient presented with vomiting, refusal to feed, pallor, severe anaemia, and splenomegaly. The second patient presented with an inconsolable cry, failure to pass feces, abdominal distention, and anaemia. The third patient presented with vomiting and anaemia. All patients received a 7-day course of intravenous artesunate; the first patient also received a blood transfusion. All patients recovered and were discharged. CONCLUSIONS Partial immunity resulting from repeated malaria infections in endemic regions may result in the transfer of high levels of maternal Immunoglobulin G (IgG) antibodies through the placenta and can produce different atypical clinical presentations. In malaria-endemic areas, neonates presenting with any of the presenting signs and symptoms of malaria, including afebrile presentation, require malaria screening to avoid delays in diagnosis.
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Affiliation(s)
- Zerubabel Girma Tesso
- School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia.
| | - Tariku Yigremachew Gossaye
- Department of Pediatrics and Child Health, School of Medicine, Mizan-Tepi University College of Medicine and Health Sciences, Mizan Aman, Ethiopia
| | - Dereje Sileshi Bekana
- Department of Pediatrics and Child Health, School of Medicine, Mizan-Tepi University College of Medicine and Health Sciences, Mizan Aman, Ethiopia
| | - Molla Asnake Kebede
- School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Fikretsion Degemu Besir
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Nikodimos Eshetu Dabe
- Department of Biomedical Science, College Medicine and of Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
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Bonaiuti R, Zammarchi L, Giaché S, Modi G, Borchi B, Campolmi I, Trotta M, Ravaldi C, Ornaghi S, Di Tommaso M, Bartoloni A, Costa P, Lombardi N, Crescioli G, Vannacci A, Levi M. Prevention, diagnosis and pharmacological treatment of infections in pregnancy: The mobile app GAIA! for healthcare providers and patients. Eur J Obstet Gynecol Reprod Biol 2024; 299:96-104. [PMID: 38850898 DOI: 10.1016/j.ejogrb.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 04/12/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE To develop and assess the GAIA! app, designed to assist pregnant women and healthcare professionals in managing infectious diseases during pregnancy, and to bridge the information gap between health professionals and expectant mothers. STUDY DESIGN This collaborative initiative in Italy involved partnerships with the University of Florence, Careggi University Hospital, and other institutions. The app, built on the Ionic framework, is available on both Apple and Google App Stores. It offers two distinct modes: "healthcare providers" and "patients." Content for the app was derived from extensive literature reviews and clinical guidelines. RESULTS Since its August 2022 launch, the GAIA! app has garnered over 2,500 downloads, indicating its effectiveness and acceptance within the community. The app differentiates itself from others, such as the Sanford Guide, by focusing specifically on the needs of pregnant women. It ensures cross-platform compatibility, a user-friendly interface, and offline functionality. CONCLUSIONS The GAIA! app has successfully addressed a niche in infectious disease management for pregnant women, gaining significant traction within the community. While it has seen substantial success, challenges like continuous updates and potential language expansion remain. Future endeavors will address these challenges and further evaluate the app's impact on maternal and child health.
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Affiliation(s)
- Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; Tuscan Regional Centre of Pharmacovigilance, Viale Pieraccini 6, 50139 Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Infectious and Tropical Disease Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; Tuscany Regional Referral Center for Infectious Diseases in Pregnancy, Largo Brambilla 3, 50134 Florence, Italy; Tuscany Regional Referral Center for Tropical Diseases, Largo Brambilla 3, 50134, Florence, Italy.
| | - Susanna Giaché
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Tuscany Regional Referral Center for Infectious Diseases in Pregnancy, Largo Brambilla 3, 50134 Florence, Italy
| | - Giulia Modi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Tuscany Regional Referral Center for Infectious Diseases in Pregnancy, Largo Brambilla 3, 50134 Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Disease Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; Tuscany Regional Referral Center for Infectious Diseases in Pregnancy, Largo Brambilla 3, 50134 Florence, Italy
| | - Irene Campolmi
- Infectious and Tropical Disease Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; Tuscany Regional Referral Center for Infectious Diseases in Pregnancy, Largo Brambilla 3, 50134 Florence, Italy
| | - Michele Trotta
- Infectious and Tropical Disease Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; Tuscany Regional Referral Center for Infectious Diseases in Pregnancy, Largo Brambilla 3, 50134 Florence, Italy
| | - Claudia Ravaldi
- CiaoLapo Foundation for Perinatal Health, Via degli Abatoni 11, 59100 Prato, Italy
| | - Sara Ornaghi
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; University of Milano-Bicocca School of Medicine and Surgery, Via Pergolesi 33, 20900 Monza, Italy
| | - Mariarosaria Di Tommaso
- Department of Health Sciences, Obstetrics and Gynecology Branch, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Infectious and Tropical Disease Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; Tuscany Regional Referral Center for Tropical Diseases, Largo Brambilla 3, 50134, Florence, Italy
| | - Paolo Costa
- Spindox Spa, Via Bisceglie 76, 20152 Milan, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; Tuscan Regional Centre of Pharmacovigilance, Viale Pieraccini 6, 50139 Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; Tuscan Regional Centre of Pharmacovigilance, Viale Pieraccini 6, 50139 Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; Tuscan Regional Centre of Pharmacovigilance, Viale Pieraccini 6, 50139 Florence, Italy
| | - Miriam Levi
- Epidemiology Unit, Department of Prevention, Central Tuscany Local Health Authority, Via di San Salvi 12, 50135 Florence, Italy
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Guida Marascia F, Colomba C, Abbott M, Gizzi A, Anastasia A, Pipitò L, Cascio A. Imported malaria in pregnancy in Europe: A systematic review of the literature of the last 25 years. Travel Med Infect Dis 2023; 56:102673. [PMID: 38008239 DOI: 10.1016/j.tmaid.2023.102673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Malaria during pregnancy is associated with a greater risk of complications for the mother and fetus. The aim of the study is to analyze the features of imported cases of malaria in pregnant women in Europe and evaluate which factors are associated with a non-favourable outcome. METHODS A computerized search of the literature was performed combining the terms plasmod*, malaria, pregnan*, maternal, gravid, parturient, expectant, and congenital, from January 1997 to July 2023. RESULTS 28 articles reporting 57 cases of malaria in pregnant women immigrant in non-endemic areas were included. The patients mainly came from Sub-Saharan Africa. There were 10 asymptomatic cases, while the predominant clinical syndrome among the symptomatic women was fever associated with anaemia. The median latency period from permanence in endemic areas and diagnosis in European countries was 180 days (IQR 15-730). Pregnancy outcomes were favourable in 35 cases (61 %): all term pregnancies, no low-birth-weight newborns. There were 4 abortions; 1 child was delivered pre-term; 7 babies were reported to have a low birth weight; 10 cases of congenital malaria were documented. P. falciparum was found with a higher frequency in women with a favourable outcome, while P. vivax was, in all cases, associated with a worse prognosis. CONCLUSIONS Diagnosis of malaria in pregnant woman in non-endemic countries may be challenging and a delay in diagnosis may lead to an adverse outcome. Screening for malaria should be performed in pregnant women from endemic areas, especially if they present anaemia or fever.
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Affiliation(s)
- Federica Guida Marascia
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127, Palermo, Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy; Division of Paediatric Infectious Disease, "G. Di Cristina" Hospital, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Michelle Abbott
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127, Palermo, Italy
| | - Andrea Gizzi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127, Palermo, Italy
| | - Antonio Anastasia
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127, Palermo, Italy
| | - Luca Pipitò
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127, Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit, Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127, Palermo, Italy.
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Cardona-Arias JA, Carmona-Fonseca J. Congenital malaria: Frequency and epidemiology in Colombia, 2009-2020. PLoS One 2022; 17:e0263451. [PMID: 35180230 PMCID: PMC8856554 DOI: 10.1371/journal.pone.0263451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
Congenital Malaria (CM) is an underestimated and under-researched problem in Colombia, despite its severe clinical, epidemiological, economic, and public health consequences. The objective was to determine the general frequency of CM, the specific frequency of CM by diagnostic test and plasmodial species, and identify its associated factors. A retrospective study was carried out using the records of 567 newborns. qPCR and Thick Blood Smear (TBS) were performed. The frequency of infection was determined with a 95% confidence interval. Associated factors were identified by non-parametric tests and odds ratios; the confusion was controlled with a logistic regression model. All cases corresponded to submicroscopic CM (negative with TBS and positive with PCR), and the frequency was 12.2% (95%CI = 9.4–14.9). The detection was statistically higher in the umbilical cord with 16,2% (95%CI = 12.4–19.9) versus peripheral blood of the newborn with 2.2% (95%CI = 0.7–4.9). CM was statistically higher in newborn whose mothers had malaria in the last year, gestational and placental malaria. The median birth weight in newborn infected with CM was lower compared to the one of healthy neonates. Because the control program in Colombia is based on TBS, it must be improved with the inclusion of other tests that allow the detection of submicroscopic CM. In addition, the program has other limitations such as do not have specific actions for pregnant women and have a passive surveillance system. These difficulties do not allow to show the magnitude of CM, its consequences on neonatal and infant health, constituting a serious problem of health injustice.
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MESH Headings
- Adolescent
- Adult
- Birth Weight
- Colombia/epidemiology
- Cross-Sectional Studies
- Female
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/parasitology
- Malaria, Falciparum/blood
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/parasitology
- Malaria, Vivax/blood
- Malaria, Vivax/epidemiology
- Malaria, Vivax/parasitology
- Plasmodium falciparum/genetics
- Plasmodium vivax/genetics
- Polymerase Chain Reaction/methods
- Pregnancy
- Pregnancy Complications, Parasitic/blood
- Pregnancy Complications, Parasitic/epidemiology
- Pregnancy Complications, Parasitic/parasitology
- Retrospective Studies
- Umbilical Cord/parasitology
- Young Adult
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Affiliation(s)
- Jaiberth Antonio Cardona-Arias
- School of Microbiology, University of Antioquia, Medellín, Colombia
- “Grupo de Investigación César Uribe Piedrahíta”, Faculty of Medicine, University of Antioquia, Medellín, Colombia
- * E-mail:
| | - Jaime Carmona-Fonseca
- “Grupo de Investigación César Uribe Piedrahíta”, Faculty of Medicine, University of Antioquia, Medellín, Colombia
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Giannone B, Hedrich N, Schlagenhauf P. Imported malaria in Switzerland, (1990-2019): A retrospective analysis. Travel Med Infect Dis 2021; 45:102251. [PMID: 34973453 DOI: 10.1016/j.tmaid.2021.102251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Malaria is a life-threatening, mosquito-borne parasitic disease, caused by Plasmodium spp. It is a major public health issue. Malaria in Switzerland is primarily "imported" by infected international travellers, migrants, and asylum-seekers. METHOD We investigated the epidemiology and characteristics of imported malaria in Switzerland in the period between 1990 and 2019 using data from the Swiss Federal Office of Public Health (BAG). We also obtained traveller statistics from the World Tourism Organization (UNWTO). RESULTS During the last thirty years a total of 8'439 malaria cases and 52 deaths were reported in Switzerland. The main origin of infection was West Africa, followed by Central Africa and East Africa. The profile of malaria in migrants in Switzerland has changed, reflecting variation in migrant flows. The estimated risk of malaria in travellers sank significantly over the time frame of the study (p < 0.001, 95% CI -0.076 to -0.043). CONCLUSIONS Travel medicine should focus on West Africa, the main source of malaria in Switzerland. Despite most cases and all but one death being caused by Plasmodium falciparum, Plasmodium vivax remains a threat for travellers and is associated with complex prevention and therapy regimens. Public health authorities need to pre-empt the need for malaria screening, prevention and treatment based on the profile of migrant waves from malaria endemic areas including Eritrea and Afghanistan arriving in Europe.
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Affiliation(s)
- Bodo Giannone
- Kantonsspital St.Gallen, Emergency Department, Switzerland
| | - Nadja Hedrich
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, Switzerland
| | - Patricia Schlagenhauf
- University of Zürich, Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, Department of Global and Public Health, MilMedBiol Competence Centre, Hirschengraben 84, 8001, Zürich, Switzerland.
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Zebaze Temgoua Kemleu SG, Ngando L, Nguekeng E, Fogang B, Mafo Kapen M, Fopa SI, Biabi MF, Essangui E, Assob Nguedia JC, Ayong L. Diagnostic performance of a rapid whole blood-based RT-LAMP method for malaria diagnosis among apparently healthy blood donors and febrile neonates in Cameroon. PLoS One 2021; 16:e0246205. [PMID: 33508016 PMCID: PMC7842973 DOI: 10.1371/journal.pone.0246205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/14/2021] [Indexed: 11/23/2022] Open
Abstract
Light microscopy and rapid diagnostic tests are the two commonly used methods for malaria diagnosis that rely on the direct use of unprocessed blood samples. However, both methods do not have the level of sensitivity required for malaria diagnosis in cases of low density parasitaemia. We report here the diagnostic performance of a whole blood-based reverse transcription loop-mediated isothermal amplification method for Plasmodium falciparum malaria diagnosis in apparently healthy blood donors and febrile neonates in Cameroon. The presence of malaria parasites in whole blood samples was determined by light microscopy, antigen-based rapid diagnostic test (RDT), and by RT-LAMP using a "lyse and amplify" experimental protocol. Of the 256 blood donors tested, 36 (14.1%) were positive for malaria parasites by light microscopy, 38 (14.8%) were positive by RDT whereas 78 (30.5%) were positive by RT-LAMP. Only light microscopy and RT-LAMP detected infection among the febrile neonates (279 neonates, median age: 2 days, range: 1-9 days), with positivity rates of 8.6% and 12.2%, respectively. The overall concordance between the three methods were 75.9% for RT-LAMP and light microscopy, 75.1% for RT-LAMP and RDT, and 83.9% for light microscopy and RDT. Blood parasite densities were significantly lower in the neonates (mean: 97.6, range: 61-192 parasites/μL) compared to the blood donors (mean: 447.8, range: 63-11 000 parasites/μL). Together, the study demonstrates the usefulness of whole blood RT-LAMP for use in rapid pre-screening of blood donors and suspected neonates to avert severe consequences of P. falciparum infections.
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Affiliation(s)
- Sylvie Georgette Zebaze Temgoua Kemleu
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaounde, Cameroon
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Laure Ngando
- Bacteriology Unit, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | | | - Balotin Fogang
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Marie Mafo Kapen
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | | | | | - Estelle Essangui
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Jules Clement Assob Nguedia
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Lawrence Ayong
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaounde, Cameroon
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