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Endophthalmitis related to lemon allergy in a heroin addict
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Carcey, P. Garcia, O. Padilla, J.A. Castro-Rodriguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Carcey" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Garcia" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Padilla" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "Castro-Rodriguez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054616300428?idApp=UINPBA00004N" "url" => "/03010546/0000004400000005/v1_201609110107/S0301054616300428/v1_201609110107/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Endophthalmitis related to lemon allergy in a heroin addict" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "472" "paginaFinal" => "474" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Armentia, F. Pineda, B. Martin-Armentia, C. Ramos, F.J. Gil Martin, R. Palacios" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Armentia" "email" => array:1 [ 0 => "aliciaarmentia@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Pineda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "Martin-Armentia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Ramos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "F.J." "apellidos" => "Gil Martin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Palacios" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Allergy Unit, Rio Hortega University Hospital, Valladolid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "DIATER Laboratories, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Immunology, Microbiology and Parasitology Department, Rio Hortega University Hospital, Valladolid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1291 "Ancho" => 2720 "Tamanyo" => 336976 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">IgE-western blot with allergic patient's serum. MW, molecular weight standard; lane 1, lemon pulp; lane 2, lemon peel; lane 3, lemon seeds; lane 4, Candida sp; lane 5, Penicillium sp; lane 6, Mucor sp; lane 7, Aspergillus sp.; lane 8, Alternaria alternate.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lemon hypersensitivity is rare, but has been associated with hypersensitivity to pollens, wheat and other fruits.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Lemon is used as a solvent for intravenous heroin use.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> We report the case of a heroin addict with AIDS admitted due to a significant reduction in concentric vision. Hypersensitivity tests were instrumental in diagnosing the aetiology of the visual loss.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 35-year-old male with a history of HIV and drug dependence, and treatment with ETR<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>DRV/r.RTG from May 2012 until the present.</p><p id="par0015" class="elsevierStylePara elsevierViewall">He was admitted in July 2014 due to bouts of tachycardia with wide QR coinciding with a seizure. He was discharged with a diagnosis of eosinophilic esophagitis grade III, and symptomatic treatment of esophagitis has begun with pump inhibitors.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Structural cardiac or neurological disease was ruled out. The patient reported a doubtful history of hypersensitivity to morphine and penicillin.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient attended the emergency room in August 2014 complaining of visual disturbances (seeing wavy images) and occipital headache. Seizures were ruled out, the symptoms were considered secondary to heroin ingestion, and the patient was discharged. Two months later, the patient was referred by his primary care physician to the ophthalmology department due to significant visual loss. Ophthalmologic tests suggested the lesions were due to endophthalmitis, but no microbiological study of the vitreous humour was made, as it was considered that the infection had resolved and therefore the aetiological agent was unknown.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A month later, tests were requested from the allergy unit due to a doubtful hypersensitivity to beta-lactams, which was ruled out by the usual in vivo and in vitro techniques (skin, specific IgE and negative provocations). In this time we do not suspected other drug sensitisation and basal tryptase was not measured. However, the patient reported choking and, sometimes, anaphylactoid symptoms (hypotension, urticaria, glottic oedema) whenever he ingested lemon.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Allergic tests to a battery of 42 aeroallergens including fruits and citrus fruits (orange, mandarin, grapefruit and lemon) were positive only for lemon (5<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>mm) and Candida (3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm). Histamine control revealed a wheal of 5<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm. Specific IgE tests to pollen, arthropods, fungi, dander and foods were positive only for lemon (0.49<span class="elsevierStyleHsp" style=""></span>kU/L). A provocation test with lemon was refused for the patient.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Given the possibility that the patient had injected lemon juice contaminated by fungi (as he reported occasionally using lemons in a poor state), and that the visual deficit was due to endophthalmitis due to Candida, a serological study of fungi was made which ruled out fungal infection at that time. Skin tests were negative for <span class="elsevierStyleItalic">Candida</span>, <span class="elsevierStyleItalic">Penicillium</span>, <span class="elsevierStyleItalic">Aspergillus</span> and <span class="elsevierStyleItalic">Cladosporium</span> (ALK-Spain) as were specific IgE antibodies for CAP (Thermofisher, Sweden). Immunodetection was performed using the patient's serum and the following allergens: lemon, <span class="elsevierStyleItalic">Candida</span>, <span class="elsevierStyleItalic">Aspergillus</span>, <span class="elsevierStyleItalic">Penicillium</span> and <span class="elsevierStyleItalic">Alternaria</span> recombinant Alt 1 (Laboratories Diater). The results (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) showed that the patient's serum recognised a protein of approximately 25<span class="elsevierStyleHsp" style=""></span>kDa of lemon peel, one of approximately 12–13<span class="elsevierStyleHsp" style=""></span>kDa of <span class="elsevierStyleItalic">Penicillium</span>, and perfectly recognised Alt a 1. After demonstration of the response to fungi, a shock dose of intravenous amphotericin B (Fungizone<span class="elsevierStyleSup">®</span>) which acts against <span class="elsevierStyleItalic">Cryptococcus</span>, <span class="elsevierStyleItalic">Alternaria</span> and <span class="elsevierStyleItalic">Aspergillus</span>, was administered. Currently, the patient remains on maintenance treatment with Fluconazol (Diflucan<span class="elsevierStyleSup">®</span>) 200<span class="elsevierStyleHsp" style=""></span>mg/day, with improvement in vision being observed. The positive response positive response to Fluconazol might lead one to think that there was a role played by fungal agents.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Lemon juice is used to dissolve heroin in Spain and has been found in studies in 104 opioid addicts in London.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> Heroin is smoked, inhaled or injected subcutaneously either intravenously or intramuscularly. Parenteral administration was most commonly used until the discovery of AIDS; heroin is dissolved in water heated in a spoon and, after adding a few drops of lemon juice or vinegar, is introduced into the syringe and injected. It may reach the brain in 15–30<span class="elsevierStyleHsp" style=""></span>s. Currently, smoking or snorting is more common, with the heroin being heated in foil and the vapours inhaled through a tube.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Oshikata et al. recently reported the first reported fatal case of pneumonia caused by Penicillium digitatum, an environmental fungus considered pathogenic for plants, specifically for poorly-stored citrus fruits, but not for humans.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Since 1984, various studies have described the possibility of candidiasis in heroin addicts.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5–8</span></a> In 1984 and 1989 endophthalmitis due to Candida was described in drug addicts and was associated with contamination of lemons used to dissolve heroin by this fungus.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In the case presented here, positive tests for lemon allergy led to the search for Candida infection as the cause of endophthalmitis and the diagnosis of eosinophilic oesophagitis due to citrus fruit with seizures associated with anaphylaxis due to lemon. In heroin addicts with positive skin tests for lemon, the possibility of these serious complications should be taken into account.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human subjects and animals in research</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Author contribution</span><p id="par0085" class="elsevierStylePara elsevierViewall">I declare that all the authors, Alicia Armentia, Blanca Martín, Carmen Ramos, F.J. Martin-Gil, Fernando Pineda and Ricardo Palacios, have participated in the conception, design of the study, analysis and interpretation of the data. Alicia Armentia performed a careful clinical work-up, and a reminder about a rare allergy and an unusual risk factor. Blanca Martin performed IgE and other analysis, F.J. Martín-Gil and Carmen Ramos have contributed in the generation, analysis and interpretation of data with the rest of the authors. Fernando Pineda and Ricardo Palacios carried out the immunodetection and IgE-western blot. All authors have participated in the preparation and critical revision of the letter and all authors have seen and approved the final version of the manuscript. I also declare that all the authors have no conflict of interest in connection with this paper, other than any noted in the covering letter to the Editor.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors report no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres729364" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec733419" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human subjects and animals in research" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 4 => array:2 [ "identificador" => "sec0030" "titulo" => "Author contribution" ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-18" "fechaAceptado" => "2015-12-03" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec733419" "palabras" => array:8 [ 0 => "Lemon allergy" 1 => "<span class="elsevierStyleItalic">Candida</span>" 2 => "<span class="elsevierStyleItalic">Penicillium</span>" 3 => "<span class="elsevierStyleItalic">Aspergillus</span>" 4 => "<span class="elsevierStyleItalic">Cladosporium</span>" 5 => "Endophthalmitis" 6 => "Heroin allergy" 7 => "Opioids allergy" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Heroin and its contaminants may be an important source of allergens in young people. We present a case of severe endophthalmitis in a patient that also suffered from anaphylactoid symptoms (hypotension, urticaria, glottic oedema) whenever he ingested lemon.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prick tests with a battery of 42 aeroallergens including fruits and citrus fruits (orange, mandarin, grapefruit and lemon) and specific IgE to these allergens were carried out. Immunodetection was performed using the patient's serum and the following allergens: lemon, <span class="elsevierStyleItalic">Candida</span>, <span class="elsevierStyleItalic">Aspergillus</span>, <span class="elsevierStyleItalic">Penicillium</span> and <span class="elsevierStyleItalic">Alternaria</span> recombinant Alt 1 (Laboratories Diater).</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Skin tests were negative for <span class="elsevierStyleItalic">Candida</span>, <span class="elsevierStyleItalic">Penicillium</span>, <span class="elsevierStyleItalic">Aspergillus</span> and <span class="elsevierStyleItalic">Cladosporium</span> (ALK-Spain) as were specific IgE antibodies for CAP (Thermofisher, Sweden) and positive only for lemon and, doubtfully, to Candida. Specific IgE tests to pollen, arthropods, fungi, dander and foods were positive only for lemon (0.49<span class="elsevierStyleHsp" style=""></span>kU/L). Serological study of fungi ruled out fungal infection at that time. The immunodetection showed that the patient's serum recognised a protein of approximately 25<span class="elsevierStyleHsp" style=""></span>kDa of lemon peel, one of approximately 12–13<span class="elsevierStyleHsp" style=""></span>kDa of <span class="elsevierStyleItalic">Penicillium</span>, and perfectly recognised Alt a 1.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Lemon surface can be contaminated by Candida and other fungi. In heroin addicts with positive skin tests for lemon, the possibility of these serious complications should be taken into account.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1291 "Ancho" => 2720 "Tamanyo" => 336976 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">IgE-western blot with allergic patient's serum. MW, molecular weight standard; lane 1, lemon pulp; lane 2, lemon peel; lane 3, lemon seeds; lane 4, Candida sp; lane 5, Penicillium sp; lane 6, Mucor sp; lane 7, Aspergillus sp.; lane 8, Alternaria alternate.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Citrus allergy from pollen to clinical symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.A. Iorio" 1 => "S. Del Duca" 2 => "E. Calamelli" 3 => "C. Pula" 4 => "M. Lodolini" 5 => "F. Scamardella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pne.0053680" "Revista" => array:5 [ "tituloSerie" => "PLOS ONE" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "e53680" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23308273" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lemon juice as a solvent for heroin in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.B. Page" 1 => "J.S. Fraile" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Subst Use Misuse" "fecha" => "1999" "volumen" => "34" "paginaInicial" => "1193" "paginaFinal" => "1197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10359229" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Different forms of heroin and their relationship to cook-up techniques: data on and explanation of use of lemon juice and other acids" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Strang" 1 => "F. Keaney" 2 => "G. Butterworth" 3 => "A. Noble" 4 => "D. Best" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Subst Use Misuse" "fecha" => "2001" "volumen" => "36" "paginaInicial" => "573" "paginaFinal" => "588" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11419488" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fatal pneumonia caused by <span class="elsevierStyleItalic">Penicillium digitatum</span>: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Oshikata" 1 => "N. Tsurikisawa" 2 => "A. Saito" 3 => "M. Watanabe" 4 => "Y. Kamata" 5 => "M. Tanaka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2466-13-16" "Revista" => array:4 [ "tituloSerie" => "BMC Pulm Med" "fecha" => "2013" "volumen" => "23" "paginaInicial" => "16" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of the lemon in disseminated candidiasis of heroin abusers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.F. Newton-John" 1 => "K. Wise" 2 => "D.F. Looke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med J Aust" "fecha" => "1984" "volumen" => "23" "paginaInicial" => "780" "paginaFinal" => "781" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic candidiasis in heroin abusers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Podzamezer" 1 => "F. Gudiol" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Infect Dis" "fecha" => "1986" "volumen" => "153" "paginaInicial" => "1182" "paginaFinal" => "1183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3701126" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contaminated lemons as possible source of infection in heroin abusers with disseminated candidiasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Podzamezer" 1 => "M. Ventin" 2 => "G. Sauca" 3 => "P. Fernandez-Viladrich" 4 => "R. Martin" 5 => "F. Gudiol" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Clin Microbiol" "fecha" => "1986" "volumen" => "5" "paginaInicial" => "477" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3530753" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Possible role of preserved lemon juice in the epidemiology of candida endophthalmitis in heroin addicts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.S. Shankland" 1 => "M.D. Richardson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Microbiol Infect Dis" "fecha" => "1989" "volumen" => "8" "paginaInicial" => "87" "paginaFinal" => "89" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2495958" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Source of infection in candida endophthalmitis in drug addicts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.S. Shankland" 1 => "M.D. Richardson" 2 => "G.N. Dutton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br Med J" "fecha" => "1986" "volumen" => "26" "paginaInicial" => "1106" "paginaFinal" => "1107" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000004400000005/v1_201609110107/S0301054616300143/v1_201609110107/en/main.assets" "Apartado" => array:4 [ "identificador" => "5554" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004400000005/v1_201609110107/S0301054616300143/v1_201609110107/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054616300143?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 3 | 7 |
| 2024 October | 48 | 8 | 56 |
| 2024 September | 74 | 17 | 91 |
| 2024 August | 93 | 20 | 113 |
| 2024 July | 51 | 2 | 53 |
| 2024 June | 51 | 4 | 55 |
| 2024 May | 47 | 6 | 53 |
| 2024 April | 54 | 14 | 68 |
| 2024 March | 48 | 9 | 57 |
| 2024 February | 49 | 6 | 55 |
| 2024 January | 64 | 5 | 69 |
| 2023 December | 67 | 5 | 72 |
| 2023 November | 61 | 13 | 74 |
| 2023 October | 107 | 20 | 127 |
| 2023 September | 59 | 4 | 63 |
| 2023 August | 79 | 4 | 83 |
| 2023 July | 74 | 12 | 86 |
| 2023 June | 82 | 6 | 88 |
| 2023 May | 74 | 2 | 76 |
| 2023 April | 82 | 8 | 90 |
| 2023 March | 107 | 3 | 110 |
| 2023 February | 50 | 5 | 55 |
| 2023 January | 53 | 7 | 60 |
| 2022 December | 44 | 10 | 54 |
| 2022 November | 53 | 7 | 60 |
| 2022 October | 49 | 16 | 65 |
| 2022 September | 40 | 11 | 51 |
| 2022 August | 53 | 8 | 61 |
| 2022 July | 30 | 9 | 39 |
| 2022 June | 74 | 8 | 82 |
| 2022 May | 37 | 11 | 48 |
| 2022 April | 64 | 6 | 70 |
| 2022 March | 53 | 7 | 60 |
| 2022 February | 46 | 7 | 53 |
| 2022 January | 80 | 8 | 88 |
| 2021 December | 54 | 7 | 61 |
| 2021 November | 62 | 5 | 67 |
| 2021 October | 73 | 13 | 86 |
| 2021 September | 57 | 10 | 67 |
| 2021 August | 63 | 9 | 72 |
| 2021 July | 42 | 10 | 52 |
| 2021 June | 54 | 12 | 66 |
| 2021 May | 50 | 12 | 62 |
| 2021 April | 128 | 42 | 170 |
| 2021 March | 60 | 10 | 70 |
| 2021 February | 47 | 12 | 59 |
| 2021 January | 49 | 11 | 60 |
| 2020 December | 4 | 0 | 4 |
| 2020 October | 1 | 0 | 1 |
| 2020 July | 0 | 1 | 1 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 5 | 1 | 6 |
| 2018 January | 5 | 0 | 5 |
| 2017 December | 3 | 0 | 3 |
| 2017 November | 6 | 0 | 6 |
| 2017 October | 6 | 6 | 12 |
| 2017 September | 4 | 1 | 5 |
| 2017 August | 11 | 1 | 12 |
| 2017 July | 5 | 1 | 6 |
| 2017 January | 1 | 0 | 1 |
| 2016 September | 2 | 1 | 3 |
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