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Original article
ENT Involvement in Leishmania Infections
Implicación ORL en infecciones por Leishmania
Francisco Javier García Callejo
Corresponding author
jgarciacall@hotmail.com

Corresponding author.
, Ramón Balaguer García, Miguel Juantegui Azpilicueta, José María García Aguayo
Servicio de Otorrinolaringología, Hospital de Requena, Requena, Valencia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Leishmaniasis is a spectrum of diseases caused by species of the protozoan <span class="elsevierStyleItalic">Leishmania</span>&#44; of the family Trypanosomatidae&#46; It is an obligate intracellular parasite in humans&#44; where it survives in its flagellate form&#44; and it infects through the bite of female mosquitoes of the genus <span class="elsevierStyleItalic">Phlebotomus</span> in the Old World&#44; and of the genus <span class="elsevierStyleItalic">Lutzomyia</span> in the New World&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the intestinal tract of the vector&#44; the protozoan evolves into flagellate form&#44; which can be inoculated into humans and other healthy vertebrates&#44; which become reservoirs of the parasite&#46; These reservoirs are essentially canines in our catchment areas&#44; but on other continents it affects up to 70 species of animals&#46; The phlebotomus transmits the protozoa from an infected animal to a healthy animal or to humans after modifying its expression of membrane antigens in the intestine to make it infectious&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Leishmania</span> includes more than 20 species and 3 sub-genera within complexes that are constantly being revised&#44; producing lesions at the cutaneous&#44; mucocutaneous and visceral levels through the bite of the vector&#44; which characterise&#44; respectively&#44; the oriental sore or chiclero ulcer&#44; espundia and kala-azar&#44; as well as some disseminated and systemic variables that are highly related to immune involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A high percentage of cutaneous forms and almost all mucocutaneous forms have ENT involvement&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5</span></a> Ninety-five percent of these 2 forms are detected in the Americas&#44; Ethiopia&#44; Iran and Syria&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Leishmaniasis is considered a zoonotic and emerging tropical disease&#44; prevalent in 98 countries&#44; with 2 million new cases per year worldwide and 350 million subjects at clear risk of contracting it&#46; Cutaneous leishmaniasis is three times more frequent than visceral leishmaniasis&#44; and is endemic in large tropical and subtropical areas and in the Mediterranean basin&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The 2009 outbreak in the Community of Madrid was the largest in the history of the disease in Europe&#44; which allowed the development of basic diagnostic and epidemiological behaviour patterns as to how to act in the Old World&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">To appreciate the involvement of the specialty in the clinical peculiarities of this disease&#44; the documentation reviewed typically reports short series and isolated cases&#46; From the collection of data in a regional hospital with very particular characteristics of health care and a rural and agricultural setting&#44; the aim was to further define the importance of the clinical manifestations of parasitosis at the head and neck level&#44; in order to alert and make the specialist aware of its presence in our environment&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Longitudinal and retrospective study of the cases attended and diagnosed with leishmaniasis from June 1993 to the present at the Hospital General de Requena&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This was carried out based on data obtained from the centre&#8217;s bank of clinical records and data extracted from the electronic medical records through the Abucasis programme&#44; which provides coverage for the entire Valencia region&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The Health Department where the review was performed provides health care to 18 municipalities corresponding to 5 Basic Health Zones&#44; including 2 regions &#8211; La Plana de Utiel-Requena and the Valle de Ayora-Cofrentes &#8211; and 2 additional municipalities&#46; All of which cover a mean population volume in the last 4 years of 58&#44;500 inhabitants&#44; to which a further 7500 are added from nearby municipalities belonging to the Autonomous Region of Castilla-La Mancha&#44; by agreement with Insalud&#46; This adds up to a stable population of some 66&#44;000 individuals per year since 2015&#44; not including the floating population which reaches a further 35&#44;500 between the months of April and October&#44; and who due to population logistics attend their referral hospitals if they have made occasional or intermittent medical consultations&#46; This Health Department covers 3047&#46;5&#8239;km<span class="elsevierStyleSup">2</span>&#44; which makes it the largest in the Valencian Community&#44; as well as the least populated &#8212; only the municipalities of Requena and Utiel have more than 10&#44;000 inhabitants&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The climate is predominantly continental&#44; with 2 maximum rainfalls in spring and autumn&#44; and a summer minimum in July and August&#46; It comprises up to 75&#37; of arable land&#44; with 5&#37; of the territory considered wetlands&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Some of the cases diagnosed&#44; either because of their concomitant underlying disease or because they belong to other autonomous communities&#44; could have been treated in different hospitals&#44; although there was evidence of progression from diagnosis to definitive medical discharge of the medical problem by doctors from our Health Department&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The data obtained included clinical reasons for consultation and organs affected&#44; epidemiological characteristics of the patients&#44; affiliation&#44; concomitant diseases&#44; methodology and waiting time to definitive diagnosis&#44; treatment and response&#46; Special emphasis was placed on those cases with contribution by ENT in the management of the disease&#46; With the case studies obtained it was possible to define the incidence and prevalence figures of the disease in our Department&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the clinical-epidemiological peculiarities of the cases of leishmaniasis diagnosed at the Hospital General de Requena in 26 years&#46; This covered 13 patients&#44; 8 males and 5 females &#40;ratio 1&#46;6&#58;1&#41;&#44; with ages ranging from 31 to 68 years &#40;mean 53&#46;7&#8239;&#177;&#8239;10&#46;8 years&#41;&#46; Seven cutaneous forms were detected&#44; 4 mucocutaneous and 2 visceral&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The cutaneous forms manifested in the form of a nodule or erythematous papule which&#44; without treatment&#44; progressed to abrasion and ulceration &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; one case of cervical adenopathy was associated&#46; Of the mucocutaneous forms&#44; the 3 detected in the nasal mucosa began with unilateral respiratory blockage &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; and sinusopathy &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; and the glottic form presented dysphonia &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The 2 visceral pictures showed constitutional syndrome with abdominal pain&#44; hepatosplenomegaly and fever of unknown origin&#44; elevation of acute phase reactants&#44; anaemia and thrombocytopenia&#46; Leishmaniasis shows a prevalence in our Health Department of 2&#37; and an approximate incidence of cases of 1&#46;5&#58;100&#44;000 inhabitants-year&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Immunosuppression was present in 8 of the cases &#40;61&#37;&#41;&#44; of which 4 were HIV-positive&#46; The 2 visceral forms were detected among the latter&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">ENT assessment was necessary in 9 cases &#40;69&#37;&#41; &#8212; the 4 mucocutaneous forms&#44; and another 4 cutaneous and one visceral form due to the involvement of nasofacial skin or the presence of cervical adenopathy&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Up to 11 of the patients lived in towns with fewer than 5000 inhabitants &#40;84&#37;&#41;&#44; and although only 2 cases were able to identify previous mosquito bites weeks or months earlier&#44; 7 subjects lived closely with dogs &#40;53&#37;&#41; &#8212;2 of them also lived with pigs and rabbits&#46; The disease was diagnosed from 3 to 10 months after the start of symptoms&#44; at an average of 6&#46;5&#8239;&#177;&#8239;2&#46;5 months&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In 12 patients&#44; the diagnosis was made from exudate swabs or biopsies from the affected area&#44; identifying the amastigotes of the protozoa inside histiocytes&#44; easily recognisable by their Giemsa dye uptake &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#44; 2 and 4</a>&#41;&#44; although haematoxylin-eosin staining also detects intracellular protozoa &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; One of the two cases of visceral leishmaniasis was diagnosed by anti-<span class="elsevierStyleItalic">Leishmania</span> antibody ELISA&#46; From 2007&#44; diagnosis was confirmed by detection of flagellar kinetoplast DNA by polymerase chain reaction&#44; which allowed the identification of 7 cases of <span class="elsevierStyleItalic">Leishmania infantum</span> and one case of <span class="elsevierStyleItalic">Leishmania tropica</span>&#44; corresponding to the 2011 visceral picture&#46; In this case&#44; amastigotes were also identified in bone marrow aspirate&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In 5 cases the treatment included removal of the detected lesions &#8212; in one case of cutaneous disease the treatment was limited to surgical resection&#46; In 11 cases pentavalent antimony compounds were used &#40;meglumine antimoniate&#44; Glucantime&#174;&#41;&#44; either intralesionally or intravenously&#44; and in 3 cases amphotericin B was administered &#8212; in the 2 visceral forms complementarily and in the more recent mucocutaneous form as single therapy&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In 12 patients &#40;92&#37;&#41; parasitological cure of the disease was achieved&#46; One of the cases with visceral leishmaniasis and HIV positive died due to systemic clinical worsening due to progression to stage <span class="elsevierStyleSmallCaps">iii</span> of underlying AIDS and multiorgan failure&#46; The other case of visceral leishmaniasis showed an intense maculopapular rash on the head&#44; neck and back 11 months after treatment due to recurrence of the disease&#44; and meglumine antimoniate was administered again&#46; Other clinical complications &#40;renal failure&#44; TB reactivation&#41; were adequately corrected&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Leishmaniasis is an infectious vector-borne protozoan disease in which the transmitting mosquito and the animal reservoir vary according to geographical location&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> Cellular immunity plays a key role in the generation of disease and in the variability and severity of its manifestations&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6&#44;10</span></a> The number of cases described has increased dramatically in the last 25 years&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the Mediterranean area the disease is endemic&#44; and the main reservoir is the sick dog&#46; The infection is acquired by bite&#44; animal to animal&#44; or by ingestion of infected meat&#46; The vector of the disease is the blood-sucking female of various types of phlebotomus &#40;sand fly&#41;&#44; especially <span class="elsevierStyleItalic">Phlebotomus perniciosus</span> and <span class="elsevierStyleItalic">Phlebotomus ariasi</span> in Spain&#44; with <span class="elsevierStyleItalic">Leishmania infantum</span> being the predominant pathogenic species in our country&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Interhuman transmission also occurs through sharing syringes&#44; and only exceptionally by tick bite&#44; transfusion&#44; through the placenta&#44; or human to human&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Direct inhalation of the agent has not been ruled out&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The optimal conditions for the development of the mosquito are moderate temperature&#44; with low light&#44; high relative humidity and high organic matter content&#44; settling in wall hallows&#44; woodsheds and pens&#44; with a priority seasonal life span from May to October&#46; Other predisposing factors are socio-economic conditions&#44; malnutrition&#44; population movements&#44; landscape transformation and climate change&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6&#44;11</span></a> All these factors increase the volume of weakened reservoirs and hosts and of vector mosquito species&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Until 2000&#44; some 400 cases of leishmaniasis had been documented in Spain&#44; but between 2000 and 2010&#44; where were 6220 hospitalisations with this diagnosis&#44; which was the main diagnosis in 2739&#44; corresponding to a national average rate of 2&#46;8 hospitalisations per 100&#44;000 inhabitants per year and an annual prevalence of 2&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a> There is certainly a lack of records for treated cutaneous forms not requiring admission&#46; This reinforces the fact that the disease is widely distributed and that health professionals must be vigilant&#44; regardless of the degree of immunosuppression&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Isolated cutaneous infection is by far the most common form of the disease&#46; The clinical spectrum offered by the insect bite is broad and varies evolutionarily from indurated papules and scaly erythema to necrotising ulcers &#8211; classically known as oriental sore &#8211; including areas of erysipelas or perichondritis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Oriental sore and chiclero ulcer&#44; very characteristic forms of cutaneous leishmaniasis&#44; are not&#44; however&#44; the most common forms of the disease &#8211; as occurred in our series &#8211;&#44; therefore it is often the persistence and growth of lesions or loss of substance from the area involved that requires a biopsy in our setting for a differential diagnosis of keratoacanthomas and epitheliomas&#46; The sample detects abundant leishmaniasis except in very crusted or evolved cases&#46; If the lesion exudes a swab it is equally valid&#46; The picture is likely to be self-limiting and go unnoticed in immunocompetents&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a> Involvement of in the head and neck is up to 50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The mucocutaneous forms are of interest to the ENT setting in 90&#37;&#44; generating a highly fleshy papilliform growth on the surface of the oral cavity or nostrils&#44; indistinguishable from more common neoplasms in the area&#44; such as fibroids&#44; papilloma or malignant neoplasms&#44; which are painless and have no symptoms other than those due to obstruction or dysfunction of the organ in which they are located&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;16&#44;17</span></a> Concomitance with areas of skin induration adjacent to the oronasal orifices should raise suspicions of espundia &#8211; inflammatory and friable tissue&#44; rich in histiocytes and macrophages full of lysosomes with amastigote forms of the protozoa &#8211; and therefore biopsy is especially indicated&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;10&#44;13&#44;17</span></a> Lysosomal release of cytokines with necrotising capacity causes erosions in the palate&#44; nostril floor&#44; septum and nasal cartilages&#44; which are highly destructive and deforming&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;18</span></a> Under conditions of immunosuppression&#44; they destructure the architecture of the facial skeleton&#44; with infiltration of the paranasal mucosa&#44; thinning of its bone walls and osteochondral disintegration of the septum&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;16&#44;19&#44;20</span></a> They simulate granulomatous lesions of the midline with aggressive behaviour and promote the characteristic tapir&#8217;s nose deformity in advanced forms&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;20</span></a> Given their ability to spread through adjacent tissues or via the lymphohematogenous route&#44; neoformations are described in the pharynx&#44; tonsils and vocal folds&#44; in which histopathological uncertainty requires samples to be taken&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;13</span></a> It was also suspected that the administration of inhaled corticosteroids favoured respiratory spread of the disease&#44; and that the disease can progress by simple inhalation from infected areas from other animals&#46; The latter possibility&#44; although unverified&#44; could explain the appearance of Leishmania lesions in territories with no vascular afferents&#44; such as the pharyngeal tonsil&#44; maxillary mucosa or glottal epithelium&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;17</span></a> Regional adenopathies have also been documented&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The visceral form or kala azar represents distant spread of the disease&#44; with the lowest incidence of the condition in our country due to the improvements in control and treatment of immunodeficiency states secondary to other diseases&#46; It rarely reaches the ENT setting&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;15</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The most important national outbreak was detected in the southwest of the Community of Madrid &#40;Fuenlabrada&#41;&#44; with 758 affected between 2009 and 2018&#44; and the main reservoir was located in hares&#46; Mucocutaneous forms accounted for 36&#37; of the disease and ENT involvement was present in 50&#37; of all cases&#44; with 320 individuals affected with skin or nasal mucosa disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> Between the summers of 2012 and 2013 another outbreak was declared in Tous &#40;Valencia&#41;&#44; with 19 cases detected&#44; with an estimated incidence of 1&#46;44&#37; and only 21&#37; of immunosuppression conditions - none with HIV&#46; Eighty-nine percent of the cases were cutaneous forms&#44; of which 56&#37; involved the face and neck&#46; The average time from symptom onset to notification of the disease was 133 days&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Until 1985&#44; 70&#37; of leishmaniasis cases worldwide occurred in children under 15 years of age&#46; Currently&#44; more than 75&#37; are in adults&#44; of which 60&#37; are infected with HIV &#40;with a prevalence of 2&#37;&#8211;3&#37; in this population&#41; and other groups of immunosuppressed patients&#44; in the aetiopathogenesis of either of the two infectious agents&#44; the deficient or inactive cell&#44; the CD4 lymphocyte&#44; disables the immune system on onset of the other&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Without doubt&#44; the gold standard diagnosis is identification of the protozoan in its amastigote form in histiocytes and macrophages of the affected organ&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;10&#44;21</span></a> Its confirmation by detection of <span class="elsevierStyleItalic">Leishmania</span> kinetoplast DNA in the specimen or patient by polymerase chain reaction provides information on the species involved and the systematic nature of the process&#44; and although it is rarely used in field work&#44; it has allowed the detection of 5&#46;9&#37; of asymptomatic patients in Spain &#8211; doubling that of France and quadrupling that of Italy or Greece &#8211; 7&#46;9&#37; in Brazil and up to 10&#37; in Iran&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;22&#44;23</span></a> Serological testing is of limited value in cutaneous and mucocutaneous leishmaniasis&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">For accessibility&#44; the tests used for asymptomatic infections or in negative biopsies include the direct agglutination test and immunofluorescence antibody titres&#46; In epidemiological studies&#44; the <span class="elsevierStyleItalic">Leishmania</span> skin test and whole blood stimulation analysis<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> are widely used&#44; identifying specific IL-2 in plasma exposed to soluble <span class="elsevierStyleItalic">Leishmania</span> antigen&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The therapeutic protocol should involve a three-pronged approach&#58; individualised treatment of each patient&#44; notification of the disease and control of infected reservoirs&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Medical treatment includes physical measures for cutaneous lesions&#44; simple removal is very widely used for the cutaneous forms in South America and the East&#44; with various groups of drug alternatives&#46; Antimony compounds have been the treatment of choice for 80 years&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The clinical response to them depends largely on the immunity of the host&#46; The best tolerated drug is meglumine antimoniate &#40;Glucantime&#174;&#41; administered intralesionally or parenterally&#44; at doses between 3 and 20&#8239;mg&#47;kg&#47;day for 28&#8211;40 days&#46; The increasing resistance detected is associated with the inability of the infected macrophage to reduce the substance to its trivalent active form&#44; characteristically in parasites with previous exposure&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Therefore&#44; miltefosine should not be the choice in mucocutaneous forms&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Its alternative is amphotericin B at an intravenous dose of &#46;5&#8211;&#46;7&#8239;mg&#47;kg&#47;day for 3&#8211;4 weeks in a liposomal presentation&#44; allowing high doses with fewer secondary effects since macrophages trap the lysosomes by vehiculating the drug&#46; Together with antimony compounds&#44; they constitute the therapeutic basis for diffuse disseminated cutaneous&#44; mucocutaneous and visceral forms&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Aminosidine or paramomycin is an aminoglycoside antibiotic with activity against <span class="elsevierStyleItalic">Leishmania per se</span>&#44; which acts synergistically with antimony compounds&#46; Pentamidine is used at doses of 4&#8239;mg&#47;kg&#47;day intravenously for 3&#8211;4 weeks but is ineffective in visceral forms&#46; Oral ketoconazole&#44; itraconazole and fluconazole are given for skin forms at antifungal doses for weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">In Spain&#44; human leishmaniasis has been monitored since 1982 through the compulsory notification system&#46; In 1995 the decision was made to notify it only in the 10 Autonomous Regions where the disease was endemic&#46; In 2015 it was again considered a nationally notifiable disease&#44; supported by the National Epidemiological Surveillance Network&#44; which is managed by the National Epidemiology Centre&#46; This is a decentralised structure that reflects the organisation into autonomous regions of our country in the presentation&#44; risk pattern and distribution of the disease in the population&#46; As it is a regional responsibility of local application&#44; notification biases rise in hospitals caring for patients from diverse communities like ours&#44; duplicated or lack of notification can be verified&#44; with the consequent delay in actions for relatives&#44; reservoirs and insects&#46; The Department of Health of the Region of Valencia documented 100 cases in 2017 alone in the province of Valencia&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Epidemiological strategies in the control of leishmaniasis should include public awareness programmes&#44; environmental cleaning of vectors&#44; identification of potential hosts and application protection against insects&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#44;24</span></a> Blocking vector contact with wild hosts is recognised as a basic measure in this control&#44; especially in urban areas and parks&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;24</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">In Spain&#44; 5&#37;&#8211;10&#37; of the dog population is parasitized by <span class="elsevierStyleItalic">Leishmania</span>&#44; 20&#37; in the Region of Valencia&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;10&#44;25</span></a> Recognition&#44; vaccination and treatment of the animals constitute a sentinel indicator of the prevalence of infection&#44; but this detection is not very accessible in large&#44; unpopulated areas such as ours&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Cure of cutaneous leishmaniasis is considered to be the disappearance of inflammatory signs with re-epithelisation of the ulcerated lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Mucocutaneous forms often require surgical cleaning of sterile residual granulomas in the nose causing obstruction&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;10&#44;16&#44;18</span></a> Cure of the disease from the parasitological point of view is the disappearance of the protozoa in biopsies and&#44; more specifically&#44; the absence of DNA quantification in the sample or in peripheral blood&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">The information provided by state and community registries coincide in a very fortuitous way&#44; and even the latter give very different volumes of cases between hospitals that cover Health Departments that are very close to one another&#44; which is very difficult to understand from an epidemiological point of view&#46; Inclusion of <span class="elsevierStyleItalic">Leishmania</span> in the differential diagnosis of the disease has not yet taken root among most of the physicians involved in its study&#44; starting with the need to make the relevant Notifiable Disease reports in our country&#46; Diagnosis by staining samples of exudate and lesion biopsies is sufficient to initiate a therapeutic protocol&#46; Another diagnostic methodology may be unnecessary&#46; A not insignificant volume of cases does not indicate an evident history of mosquito bite&#44; although most of those who revealed direct contact with potentially infectious animal reservoirs had shown the presence of the protozoa&#46; Immunodeficiency is a condition associated with the aggravation and reappearance of the condition&#46; ENT is obviously involved in this parasitosis and the specialist must be aware of its potential presence and its diagnostic and therapeutic management&#44; even when a multidisciplinary competence&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of Interests</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-09-25"
    "fechaAceptado" => "2019-11-20"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1332554"
          "palabras" => array:6 [
            0 => "Leishmaniasis"
            1 => "Protozoan infection"
            2 => "Cutaneous disease"
            3 => "Mucocutaneous disease"
            4 => "Biopsy"
            5 => "Antimonials"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1332553"
          "palabras" => array:6 [
            0 => "Leishmaniasis"
            1 => "Infecci&#243;n protozoaria"
            2 => "Enfermedad cut&#225;nea"
            3 => "Enfermedad mucocut&#225;nea"
            4 => "Biopsia"
            5 => "Antimoniales"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Leishmaniasis comprises a group of diseases caused by protozoan parasites of the genus <span class="elsevierStyleItalic">Leishmania</span> that are transmitted by the bite of infected phlebotomine mosquitoes from animal reservoirs&#46; Three different clinical forms are generated&#58; cutaneous&#44; mucocutaneous and visceral&#46; We present the findings in the head and neck of this disease observed in our health area&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A review of the last 26 years in our hospital&#44; noting the clinical&#44; diagnostic and therapeutic characteristics of the cases detected&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Thirteen cases were identified&#44; 7 cutaneous&#44; 4 mucocutaneous and 2 visceral or kala-azar&#46; The mean age was 53&#46;7&#8239;&#177;&#8239;10&#46;8 years&#46; Immunodeficiency was identified in 61&#37; of the cases&#46; The incidence of the disease was 1&#46;5&#58;100&#44;000 inhabitants&#47;year&#44; with a prevalence of 2&#37;&#46; Of those infected&#44; 69&#37; had involvement of the ENT area&#46; In 12 cases the diagnosis was established by biopsy of the lesions&#46; The time from clinical debut to diagnosis ranged from 3 to 10 months&#46; Antimony compounds were used as treatment in 11 patients and amphotericin B in 3&#44; alone or combined with the former&#46; One cutaneous form resolved with excision of the lesion&#46; Ninety-two percent healed clinically and parasitologically&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Leishmaniasis in Spain frequently entails cutaneous and mucocutaneous involvement&#44; often of the skin of the head&#44; face and neck or upper-airway mucosa&#46; Its clinical presentation varies greatly&#44; and it should be suspected if there is no response to conventional therapies and in conditions of immunodeficiency&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La leishmaniasis comprende un grupo de enfermedades provocadas por par&#225;sitos protozoos del g&#233;nero <span class="elsevierStyleItalic">Leishmania</span> que se transmiten mediante la picadura de la hembra de mosquitos flebotomos infectados desde reservorios animales&#44; generando 3 formas cl&#237;nicas diferentes&#58; cut&#225;nea&#44; mucocut&#225;nea y visceral&#46; Presentamos los hallazgos en cabeza y cuello de esta enfermedad observados en nuestra &#225;rea de salud&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n de los &#250;ltimos 26 a&#241;os en nuestro hospital&#44; anotando las caracter&#237;sticas cl&#237;nicas&#44; diagn&#243;sticas y terap&#233;uticas de los casos detectados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Fueron identificados 13 casos&#44; 7 con s&#237;ndrome cut&#225;neo&#44; 4 mucocut&#225;neo y 2 visceral o kala azar&#46; Su edad media fue de 53&#44;7&#8239;&#177;&#8239;10&#44;8 a&#241;os&#46; En un 61&#37; de los casos se verific&#243; inmunodeficiencia&#46; La incidencia de la enfermedad fue de 1&#44;5&#58;100&#46;000 habitantes-a&#241;o&#44; con una prevalencia del 2&#37;&#46; El 69&#37; de los infectados mostraron afectaci&#243;n del &#225;rea otorrinolaringol&#243;gica&#46; En 12 casos el diagn&#243;stico se estableci&#243; mediante biopsia de las lesiones&#46; El tiempo desde el inicio cl&#237;nico al diagn&#243;stico oscil&#243; entre 3 y 10 meses&#46; Como tratamiento se emplearon compuestos antimoniales en 11 pacientes y anfotericina B en 3&#44; sola o combinada con el anterior&#46; Una forma cut&#225;nea se resolvi&#243; con escisi&#243;n de la lesi&#243;n&#46; El 92&#37; mostr&#243; curaci&#243;n cl&#237;nica y parasitol&#243;gica&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La leishmaniasis en Espa&#241;a genera frecuentes cuadros de afectaci&#243;n cut&#225;nea y mucocut&#225;nea&#44; a menudo en la piel de cabeza&#44; cara y cuello o mucosa de v&#237;as altas&#46; Su presentaci&#243;n cl&#237;nica es muy variable&#44; debi&#233;ndose sospechar ante la ausencia de respuesta a terapias convencionales y en condiciones de inmunodeficiencia&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Garc&#237;a Callejo FJ&#44; Balaguer Garc&#237;a R&#44; Juantegui Azpilicueta M&#44; Garc&#237;a Aguayo JM&#46; Implicaci&#243;n ORL en infecciones por <span class="elsevierStyleItalic">Leishmania</span>&#46; Acta Otorrinolaringol Esp&#46; 2021&#59;72&#58;3&#8211;10&#46;</p>"
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        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 884
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            "Tamanyo" => 98746
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            "identificador" => "at0005"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous leishmaniasis&#46; <span class="elsevierStyleItalic">Leishmania</span> lesions in the skin of the nasal pyramid of 2 patients&#46; Scaling papule &#40;A&#41; and ulcerated and exudative nodule &#40;B&#41; in which the swab identified macrophages infested with protozoan structures with Giemsa stain 400&#215; &#40;C&#41;&#46;</p>"
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        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 667
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Nasal mucocutaneous leishmaniasis&#46; Nasolabial skin plaque &#40;A&#41; and espundia in left nasal vestibule &#40;B&#41; with biopsy of the mucosal lesion showing intracellular forms of <span class="elsevierStyleItalic">Leishmania</span> with Giemsa stain 10&#215; &#40;C&#41;&#46;</p>"
        ]
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        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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            "imagen" => "gr3.jpeg"
            "Alto" => 552
            "Ancho" => 1500
            "Tamanyo" => 125095
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          0 => array:3 [
            "identificador" => "at0015"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sinus mucocutaneous leishmaniasis&#46; Left maxillary occupation in CT study with fraying&#44; rarefaction and thinning of its walls by affected mucosa &#40;A&#41; and biopsy of the same with detection of Leishmania with haematoxylin-eosin staining 10&#215; &#40;B&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1247
            "Ancho" => 800
            "Tamanyo" => 256523
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Glottic mucocutaneous leishmaniasis&#46; Larynx with image of diffuse nodular cobbled appearance affecting bands and vocal cords by leishmaniasis &#40;A&#41; and biopsy that identifies Leishmania amastigote with Giemsa stain 100&#215; &#40;B&#41;&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at0025"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">AFB&#58; amphotericin B&#59; C&#58; cutaneous&#59; F&#58; female&#59; FUO&#58; fever of unknown origin&#59; IL&#58; intralesional&#59; IV&#58; intravenous&#59; M&#58; male&#59; MC&#58; mucocutaneous&#59; Sb&#58; antimony compound&#59; TB&#58; tuberculosis&#59; tt&#58; treatment&#59; V&#58; visceral&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex-age &#40;Years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Form&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ID&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Setting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Evidence of Insect Bite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Direct Contact With Animal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Travel to Endemic Areas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Affected Organs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time of Onset of Symptoms- First Consultation &#40;Months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time of First Consultation-diagnosis &#40;Months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin ulcer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin of foot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Removal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1997<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin nodule-ulcer &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin of nasal pyramid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Removal&#8239;&#43;&#8239;IL Sb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1998<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F-60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nasal respiratory failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urban&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Turbinate polyp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV Sb&#8239;&#43;&#8239;removal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2002<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F-62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nasal respiratory failure &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rheumatoid arthritis with etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin of septal foot&#44; paranasal mucosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Removal&#8239;&#43;&#8239;IL Sb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&#46; Acute chronic kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FUO and constitutional syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urban&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spleen&#44; liver&#44; abdominal adenopathies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV Sb&#8239;&#43;&#8239;IV AFB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worsening of AIDs&#46; Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin ulcer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chronic kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin of leg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL Sb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&#46; Atrophic scar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2008<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cutaneous papule &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin of forehead&#44; nose&#44; trunk and limbs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV Sb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2010<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin ulcer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neck skin and cervical adenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL Sb&#8239;&#43;&#8239;IV Sb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&#46; Recurrence of TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2011<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F-57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdominal pain and hypertransaminasaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liver&#44; abdominal and mediastinal adenopathies&#46; Facial Leishmaniasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV AFB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leishmaniasis after one year of tt&#46; Adequate response afterwards&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV Sb&#8239;&#43;&#8239;IV AFB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL Sb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2012<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F-54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin ulcer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chemotherapy due to ovarian cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urban&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Temple and malar skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL Sb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&#46; Hypopigmented scar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2014<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dysphonia &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vocal fold&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Removal&#8239;&#43;&#8239;IV Sb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin nodule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin of the arm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL Sb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2019<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F-68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nasal respiratory failure &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nasolabial&#44; septal mucosa skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV AFB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cure&#46; Mild kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                    0 => array:2 [
                      "titulo" => "An insight into the constitutive proteome throughout <span class="elsevierStyleItalic">Leishmania donovani</span> promastigote growth and differentiation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "P&#46;J&#46; Alcolea"
                            1 => "A&#46; Alonso"
                            2 => "F&#46; Garc&#237;a Tabares"
                            3 => "M&#46;C&#46; Mena"
                            4 => "S&#46; Ciordia"
                            5 => "V&#46; Larraga"
                          ]
                        ]
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Int Microbiol"
                        "fecha" => "2019"
                        "volumen" => "22"
                        "paginaInicial" => "143"
                        "paginaFinal" => "154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30810941"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brote comunitario de leishmaniasis cut&#225;nea en la comarca de La Ribera&#58; a prop&#243;sito de las medidas de Salud P&#250;blica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Roth Damas"
                            1 => "M&#46; Sempere Manuel"
                            2 => "A&#46; Mialaret Lahiguera"
                            3 => "C&#46; Fern&#225;ndez Garc&#237;a"
                            4 => "J&#46;J&#46; Gil Tom&#225;s"
                            5 => "J&#46; Colomina Rodr&#237;guez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eimc.2016.04.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Infecc Microbiol Clin"
                        "fecha" => "2017"
                        "volumen" => "35"
                        "paginaInicial" => "338"
                        "paginaFinal" => "343"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27236236"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ear&#44; nose and throat manifestations of mucocutaneous leishmaniasis&#58; a literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Marra"
                            1 => "M&#46;C&#46; Chiappetta"
                            2 => "V&#46; Vincenti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Biomed"
                        "fecha" => "2014"
                        "volumen" => "85"
                        "paginaInicial" => "3"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24897964"
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                          ]
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              "referencia" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between leishmaniasis and AIDS&#58; the second 10 years"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Alvar"
                            1 => "P&#46; Aparicio"
                            2 => "A&#46; Aseffa"
                            3 => "M&#46; Den Boer"
                            4 => "C&#46; Ca&#241;avate"
                            5 => "J&#46;P&#46; Dedet"
                          ]
                        ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Microbiol Res"
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                        "volumen" => "21"
                        "paginaInicial" => "334"
                        "paginaFinal" => "359"
                      ]
                    ]
                  ]
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                      "titulo" => "Situaci&#243;n epidemiol&#243;gica y de los factores de riesgo de transmisi&#243;n de <span class="elsevierStyleItalic">Lesihmania infantum</span> en Espa&#241;a"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Su&#225;rez Rodr&#237;guez"
                            1 => "B&#46; Isidoro Fern&#225;ndez"
                            2 => "S&#46; Santos Sanz"
                            3 => "M&#46;J&#46; Sierra Moros"
                            4 => "R&#46; Molina Moreno"
                            5 => "J&#46; Astray Mochales"
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                        ]
                      ]
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                    0 => array:2 [
                      "doi" => "10.4321/S1135-57272012000600002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Salud P&#250;blica"
                        "fecha" => "2012"
                        "volumen" => "86"
                        "paginaInicial" => "555"
                        "paginaFinal" => "564"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23325131"
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                          ]
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                      ]
                    ]
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              "etiqueta" => "6"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of asymptomatic <span class="elsevierStyleItalic">Leishmania</span> infection and associated risk factors&#44; after an outbreak in the south-western Madrid region&#44; Spain&#44; 2015"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;V&#46; Ibarra Meneses"
                            1 => "E&#46; Carrillo"
                            2 => "J&#46; Nieto"
                            3 => "C&#46; S&#225;nchez"
                            4 => "S&#46; Ortega"
                            5 => "A&#46; Estirado"
                          ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.2807/1560-7917.es.2019.24.22.1800379"
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                        "tituloSerie" => "Euro Surveill"
                        "fecha" => "2019"
                        "volumen" => "24"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacies of prevention and control measures applied during an outbreak in Southwest Madrid&#44; Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; De Paixao Sev&#225;"
                            1 => "M&#46; Martcheva"
                            2 => "N&#46; Tuncer"
                            3 => "I&#46; Fontana"
                            4 => "E&#46; Carrillo"
                            5 => "J&#46; Moreno"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0186372"
                      "Revista" => array:4 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2017"
                        "volumen" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29287100"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Re-emergence of leishmaniasis in Spain&#58; community outbreak in Madrid&#44; Spain&#44; 2009 to 2012"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Arce"
                            1 => "A&#46; Estirado"
                            2 => "M&#46; Ordobas"
                            3 => "S&#46; Sevilla"
                            4 => "N&#46; Garc&#237;a"
                            5 => "L&#46; Moratilla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2807/1560-7917.es2013.18.30.20546"
                      "Revista" => array:5 [
                        "tituloSerie" => "Euro Surveill"
                        "fecha" => "2013"
                        "volumen" => "18"
                        "paginaInicial" => "20546"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23929177"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Un caso de leishmaniasis lar&#237;ngea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Monz&#243; Gand&#237;a"
                            1 => "F&#46;J&#46; Garc&#237;a Callejo"
                            2 => "A&#46;M&#46; Calatayud Blas"
                            3 => "J&#46; Calvo Gonz&#225;lez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.otorri.2012.09.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Otorrinolaringol Esp"
                        "fecha" => "2014"
                        "volumen" => "65"
                        "paginaInicial" => "194"
                        "paginaFinal" => "196"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23116572"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative study of the in situ immune response in oral and nasal mucosal leishmaniasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;R&#46; Palmeiro"
                            1 => "F&#46;N&#46; Morgado"
                            2 => "C&#46;M&#46; Valete Rosalino"
                            3 => "A&#46;C&#46; Martins"
                            4 => "J&#46; Moreira"
                            5 => "L&#46;P&#46; Quintella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-3024.2011.01343.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Parasite Immunol"
                        "fecha" => "2012"
                        "volumen" => "34"
                        "paginaInicial" => "23"
                        "paginaFinal" => "31"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22098533"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Servicio de Vigilancia y Control Epidemiol&#243;gico Subdirecci&#243;n General de Epidemiolog&#237;a&#44; Vigilancia de la Salud y sanidad Ambiental&#46; Direcci&#243;n General de Salud P&#250;blica&#46; Conselleria de Sanitat Universal i P&#250;blica&#46; Informe de enfermedades transmitidas por vectores&#46; Comunidad Valenciana&#46; <a target="_blank" href="http://www.sp.san.gca.es/epidemiologia">http&#58;&#47;&#47;www&#46;sp&#46;san&#46;gca&#46;es&#47;epidemiologia</a>&#46;"
                ]
              ]
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            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The molecular genetics of inflammatory&#44; autoimmune&#44; and infectious diseases of the sinonasal tract&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;T&#46; Montone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5858/arpa.2013-0038-RA"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pathol Lab Med"
                        "fecha" => "2014"
                        "volumen" => "138"
                        "paginaInicial" => "745"
                        "paginaFinal" => "753"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24878014"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mucocutaneous leishmaniasis&#58; clinical markers in presumptive diagnosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;L&#46; Diniz"
                            1 => "M&#46;O&#46; Costa"
                            2 => "D&#46;U&#46; Goncalves"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s1808-86942011000300018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Otorhinolaryngol"
                        "fecha" => "2011"
                        "volumen" => "77"
                        "paginaInicial" => "380"
                        "paginaFinal" => "384"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21739015"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A proposed new clinical staging system for patients with mucosal leishmaniasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;A&#46; Lessa"
                            1 => "M&#46;M&#46; Lessa"
                            2 => "L&#46;H&#46; Guimar&#228;es"
                            3 => "C&#46;M&#46; Lima"
                            4 => "S&#46; Arruda"
                            5 => "P&#46;R&#46; Machado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.trstmh.2012.03.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Trans R Soc Trop Med Hyg"
                        "fecha" => "2012"
                        "volumen" => "106"
                        "paginaInicial" => "376"
                        "paginaFinal" => "381"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22578516"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and parasitological factors in parasite persistence after treatment and clinical cure of cutaneous leishmaniasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Mart&#237;nez Valencia"
                            1 => "C&#46;F&#46; Daza Rivera"
                            2 => "M&#46; Rosales Chilama"
                            3 => "A&#46; Cossio"
                            4 => "E&#46;J&#46; Casadiego Rinc&#243;n"
                            5 => "M&#46;M&#46; Desai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pntd.0005713"
                      "Revista" => array:4 [
                        "tituloSerie" => "PLoS Negl Trop Dis"
                        "fecha" => "2017"
                        "volumen" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28505198"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leishmaniasis mucocut&#225;nea&#58; una enfermedad importada con repercusi&#243;n en ORL"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Gonz&#225;lez"
                            1 => "F&#46; Benito"
                            2 => "L&#46; Garc&#237;a"
                            3 => "A&#46; Iglesias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.otorri.2009.01.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Otorrinolaringol Esp"
                        "fecha" => "2009"
                        "volumen" => "60"
                        "paginaInicial" => "298"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19814979"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Localized mucosal leishmaniasis caused by <span class="elsevierStyleItalic">Leishmania infantum</span> mimicking cancer in the rhinolaryngeal region"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Cobo"
                            1 => "J&#46; Rodr&#237;guez Granger"
                            2 => "C&#46; G&#243;mez Camarasa"
                            3 => "A&#46; Sampedro"
                            4 => "L&#46; Aliaga Mart&#237;nez"
                            5 => "J&#46;M&#46; Navarro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijid.2016.08.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Infect Dis"
                        "fecha" => "2016"
                        "volumen" => "50"
                        "paginaInicial" => "54"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27515498"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nasal septal ulceration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Sardana"
                            1 => "K&#46; Goel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2014.02.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol"
                        "fecha" => "2014"
                        "volumen" => "32"
                        "paginaInicial" => "817"
                        "paginaFinal" => "826"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25441476"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cutaneous leishmaniasis&#58; an overlloked etiology of midfacial destructive lesions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Alam"
                            1 => "O&#46; Abbas"
                            2 => "R&#46; Moukarbel"
                            3 => "I&#46; Khalifeh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pntd.0004426"
                      "Revista" => array:4 [
                        "tituloSerie" => "PLos Negl Trop Dis"
                        "fecha" => "2016"
                        "volumen" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27657909"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Facial structure alterations and abnormalities of the paranasal sinuses on multidetector computed tomography scans of patients with treated mucosal leishmaniasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "A&#46;C&#46; Nicodermo"
                            2 => "D&#46;V&#46; Sumi"
                            3 => "E&#46;M&#46; Gebrim"
                            4 => "F&#46;F&#46; Tuon"
                            5 => "L&#46;M&#46; de Camargo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pntd.0003001"
                      "Revista" => array:4 [
                        "tituloSerie" => "PLoS Negl Trop Dis"
                        "fecha" => "2014"
                        "volumen" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25330220"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New serological tools for improved diagnosis of human tegumentary leishmaniasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;E&#46; Costa"
                            1 => "B&#46;C&#46; Salles"
                            2 => "P&#46;T&#46; Alves"
                            3 => "A&#46;C&#46; Dias"
                            4 => "E&#46;R&#46; Vaz"
                            5 => "F&#46;F&#46; Ramos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jim.2016.04.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Immunol Methods"
                        "fecha" => "2016"
                        "volumen" => "434"
                        "paginaInicial" => "39"
                        "paginaFinal" => "45"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27090730"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Drug resistance and treatment failure in leishmaniasis&#58; a 21st century challenge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "F&#46; Gamarro"
                            2 => "J&#46;C&#46; Dujardin"
                            3 => "M&#46;P&#46; Barrett"
                            4 => "R&#46; L&#243;pez V&#233;lez"
                            5 => "R&#46; Garc&#237;a Hern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pntd.0006052"
                      "Revista" => array:3 [
                        "tituloSerie" => "PLoS Negl Trop Dis"
                        "fecha" => "2017"
                        "volumen" => "11"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Amphotericin B&#58; 30 years of clinical experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;A&#46; Gallis"
                            1 => "R&#46;H&#46; Drew"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
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                        "tituloSerie" => "Rev Infect Dis"
                        "fecha" => "1990"
                        "volumen" => "12"
                        "paginaInicial" => "308"
                        "paginaFinal" => "329"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2184499"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methods of control of the <span class="elsevierStyleItalic">Leishmania infantum</span> dog reservoir&#58; state of the art"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            3 => "F&#46; Iannino"
                            4 => "N&#46; Ferri"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Vet Med Int"
                        "fecha" => "2011"
                        "volumen" => "2011"
                        "paginaInicial" => "215964"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21772963"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "25"
              "referencia" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Leishmaniasis canina y humana&#58; una visi&#243;n de conjunto"
                      "autores" => array:1 [
                        0 => array:2 [
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Article information
ISSN: 21735735
Original language: English
DOI:10.1016/j.otoeng.2019.11.003
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