Thirty cases of human subcutaneous dirofilariasis reported in Rostov-on-Don (Southwestern Russian Federation) | Enfermedades Infecciosas y Microbiología Clínica

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array:4 [ "autoresLista" => "Boris Ilyasov, Vladimir Kartashev, Nikolay Bastrikov, Liudmila Madjugina, Javier González-Miguel, Rodrigo Morchón, Fernando Simón" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Boris" "apellidos" => "Ilyasov" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Vladimir" "apellidos" => "Kartashev" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Nikolay" "apellidos" => "Bastrikov" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Liudmila" "apellidos" => "Madjugina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Javier" "apellidos" => "González-Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Rodrigo" "apellidos" => "Morchón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 6 => array:4 [ "nombre" => "Fernando" "apellidos" => "Simón" "email" => array:1 [ 0 => "fersimon@usal.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Department of Diagnostic Ultrasound, Rostov Oblast Diagnostic Centre, Rostov-na-Donu, Russia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Infectious Diseases, Rostov State Medical University, Rostov-na-Donu, Russia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Ophthalmology, Hospital of the North Caucasus Branch of the Russian Railway, Rostov-na-Donu, Russia" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Diagnostic Ultrasound, Hospital of the North Caucasus Branch of the Russian Railway, Rostov-na-Donu, Russia" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Laboratory of Parasitology, Faculty of Pharmacy and Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Treinta casos de dirofilariosis subcutánea humana reportados en Rostov del Don (suroeste de la Federación Rusa)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1048 "Ancho" => 2500 "Tamanyo" => 157135 ] ] "descripcion" => array:1 [ "en" => "Subcutaneous nodule containing a female worm surgically removed from a patient. The scale bar is in cm (A). Representative image of the PCR analysis of the DNA extracted from different worms after the surgical removal of the nodules (B). The dirofilariotic nodules were located in subcutaneous tissue of the shoulder (case no. 7) (Lane 1), ocular area (case no. 10) (Lane 2), testicular (case no. 17) (Lane 3), abdominal wall (case no. 26) (Lane 4) and. M, 100bp DNA marker; C+, positive control; C−, negative control." ] ] ] "textoCompleto" => "IntroductionZoonotic filarioses are vector borne transmitted diseases caused by parasitic filarial nematodes of the genus Dirofilaria, mainly D. immitis and D. repens. These two species are primarily parasites of domestic and wild canines and felines all over the world<a class="elsevierStyleCrossRef" href="#bib0005">1</a> being transmitted by different species of culicid mosquitoes belonging the genera Culex, Aedes and Anopheles.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Because many of these species feed indiscriminately on animal reservoirs and man, in areas where canine dirofilariosis is endemic, the risk of human infections exists.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> In Europe, canine dirofilariosis caused by D. repens is spreading from the traditionally endemic Southern Mediterranean countries to the central and Northern countries, being currently considered an emerging disease in these areas. In parallel, a dramatic increase of human subcutaneous/ocular dirofilariosis is being detected, with more than 2850 cases reported until now in the world literature, many of them diagnosed in the last 13 years in Ukraine and Southwestern Russia.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> These changes are attributed to the global warming, human interventions modifying environment and pets management.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Human subcutaneous dirofilariosis is a condition characterized by the development of subcutaneous nodules caused by the local inflammatory reaction against D. repens worms, usually immature, that mimic both benign and malignant primary or metastatic skin tumors.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> In addition live, fully developed adult worms can lodge in intraocular and retroocular locations, causing considerable damages and discomfort in patients by themselves or as a consequence of their surgical removal.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> Diagnosis of human subcutaneous dirofilariosis raises important procedure problems because of the initial suspicion of a malignant origin of the nodules and the very frequent absence of parasite larvae (microfilariae) in the blood of patients.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Thus, most cases are diagnosed by histology and morphological and/or molecular analysis, subsequent to the surgical removal of the whole cysts or the worm themselves.<a class="elsevierStyleCrossRefs" href="#bib0035">7,10,11</a>The aim of this work is to report an extensive series of human subcutaneous/ocular dirofilariosis cases observed during an 11-year period (2003–2013) in the Rostov Oblast Diagnostic Center, located in the hyperendemic area of canine dirofilariosis in Southwestern Russian Federation.MethodsCases of human subcutaneous dirofilariasis were retrospectively collected from the case record of the Rostov Regional Diagnostic Center Department of Ultrasound. This center functions as referral medical center of the Rostov region which has a population of 4,277,976 inhabitants. Cases were referred from ophthalmologists, surgeons, oncologists, urologists, or from other physicians for assessment of subcutaneous or more deeply located nodules. The data were gathered reviewing the clinical charts or the clinical, laboratory and imaging registries.Ultrasound examinations were performed in all patients on ultrasound equipment SonoCT HDI-5000 and iU22 “Philips” (Philips Healthcare, Bothell, WA, USA), using a broadband linear probes with an aperture of 38mm and the frequency of 5–12MHz and 5–17MHz. Patients were examined with multiple views scanning with the special program for superficial tissues study in B-mode as well as using a regimen of color and power Doppler with spectral curve analysis of blood flow. Ultrasounds study evaluated the skin thickness, the echogenicity and echo structure of the nodule itself and the structure of surrounding superficial and deeper tissues. Every nodule was characterized by the size, shape, borders, homogeneity, detailed characteristics of internal echo structure, presence or absence of blood flow and vascular pattern. All the nodules were afterwards surgically excised and the removed worms analyzed by the PCR technique with specific primers as described by Favia et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> In brief, DNA was extracted from each parasite with the DNeasy Blood & Tissue Kit (Qiagen, GmbH, D-40724). After activation of the Taq Gold polymerase at 94°C for 12min, PCR reactions were performed as follows: 94°C (30s), 65°C (30s), 72°C (30s) for 35 cycles and a final step at 72°C for 7min. PCR products were visualized on agarose gel.All patients provided informed consent to participate in this study having been approved by the Ethical Committee of the Rostov State Medical University.ResultsBetween 2003 and 2011, 30 patients (21 females) were diagnosed of dirofilariosis. Patients noticed a single superficial or deep nodule without history of previously diagnosed malignancies. Data on the patients, characteristics and location of the nodules appear in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The most common presentation was a painless subcutaneous nodule, visible with naked eyes (26/30) or found by palpation (2/30). Twenty-four out of the 30 nodules were located in the hypodermis and the other six were located in deeper locations. From these, two out of the 10 ocular cases appeared in retroocular location, and four additional cases in the scrotum. All the patients with ocular dirofilariosis reported history of swelling of the lower or upper eyelids or periorbital edema, burning sensation, itching, painful eye turns, conjunctival hyperemia and tearing. Some of them had the feeling of a foreign body in the eye. The patients with scrotal lesions presented with non-tender local soft tissue mass located separately from testicular appendages. One of the patients noticed a gradual increasing edema as well as hyperemia of one half of the scrotum without definite mass lesion. In other patient physical examination revealed a soft painless mass closely adjacent to the caudal portion of the epididymis (the first clinical impression was “a cyst of caudal epididymis”). Patients with other location of the nodules were asymptomatic. None have traveled outside the Rostov region in the previous past years.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>By ultrasound examination, nodules were oval and regular-shaped with well-defined but jagged and fuzzy outer contours. The inner contents of the cyst appear hypoechoic. Inside the nodule there were clear internal echoes with linear winding hyperechoic textures (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), sometimes with visible spontaneous writhing movement, detected in 14 out of 30 cases, indicating the presence of a live worm. Alive worms looked rich with hank-like multiple continuing and sharp but fine tubular textures. Dead worm showed the same structures but they looked motionless, non-continuous, mostly blurred and broken, with areas of high and low echo density. Color Doppler examination detected that none of the nodules showed any signs of internal or polar vascularity, the blood vessels being present at the periphery of the parasitic cyst wall (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Power Doppler examination confirmed the existence of blood flow only at the periphery of the nodules in the fibrotic capsule surrounding the worms (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) and adjacent tissues. The two nodules detected at retroocular location showed the same characteristic findings to those described in the rest of the nodules in both ultrasounds and color and power Doppler examinations. These characteristics allowed the attribution of the origin of all nodules to a helminthic origin, probably Dirofilaria.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Surgical removal of the parasites revealed the presence of round worms with filiform appearance with lengths from 42 to 124mm and diameters from 102 to 527μm. They were sexually immature female worms in 28 out of 30 cases (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A) and 2 immature male worms in the other 2 cases. PCR identified all of them as D. repens (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Laboratory examination did not demonstrate any kind of abnormalities in conventional blood, urine and biochemistry tests.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>DiscussionIn spite of human dirofilariosis has been considered traditionally a rare disease<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a> both the increase in clinical cases,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> mainly caused by D. repens, and the high seroprevalences revealed by serological surveys in humans<a class="elsevierStyleCrossRef" href="#bib0075">15</a> suggest a high risk of infection by Dirofilaria species for people living in areas where dirofilariosis is endemic in dogs.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> At a global level the area with the highest increase in human dirofilariosis cases is Europe where approximately 280 cases were reported until 2000, most of them in the Mediterranean countries. However, in the next 13 years the number of reported cases surpassed 2400 from which 2087 were reported in Ukraine and the Russian Federation. Moreover, with increasing frequency clinical cases are reported in Central and Northern European countries, previously considered non-endemic.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5,15</a> These changes have been associated, among other factors, to the strong thermal anomalies occurring in the area in the last years<a class="elsevierStyleCrossRef" href="#bib0080">16</a> and the wide stray dogs population not receiving chemoprophylaxis against Dirofilaria. The cases described here were reported in a single Hospital of Rostov-on-Don (Southwestern Russia), where previous epidemiological surveys revealed canine prevalences higher than 30%.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> This indicates a clear concordance among the existence of Dirofilaria in dogs and the detection of human cases. Nevertheless, there are high canine prevalences in other Southwestern Russian oblasts where only sporadic or no human cases have been reported, suggesting that the awareness of the medical community is also necessary for the correct diagnosis of human dirofilariosis.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Our series present similar epidemiological and clinical characteristics to those described previously by Pampiglione and Rivasi<a class="elsevierStyleCrossRef" href="#bib0085">17</a> in their review of the world literature, with some different aspects. Ocular location is by far the most frequent, a fact that is in agreement with the high incidence of ocular cases reported in Russia as reviewed by Avdiukhina et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Two of these cases appeared in retroocular location, having been one of them separately published to communicate this new anatomical location of D. repens.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Because of the repetition of this presentation, it is necessary to warn the physicians about the possibility to find nodules in this anatomical location in the future. The frequency of genital location in our series (13.3%) is twice that found by Pampiglione and Rivasi<a class="elsevierStyleCrossRef" href="#bib0085">17</a> and appeared mostly in adolescents. There exist also differences in the distribution by gender because we have observed 70.0% of incidence in women, clearly higher than 55.4% reviewed by Pampiglione and Rivasi.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Detection of Dirofilaria nodules frequently causes the initial suspicion of a malignant origin, in spite of their benign character.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Thus differential diagnosis is an essential step of the management of human dirofilariosis.<a class="elsevierStyleCrossRefs" href="#bib0035">7,19</a> Diagnosis of subcutaneous dirofilariosis is post-operative in most cases, causing moderate to serious injury to patients, mainly when nodules appear in internal, intraocular or retroocular locations.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> To avoid unnecessary damages and delay during the diagnostic procedure, efficient non-invasive techniques can be applied. The results obtained in the wide series of cases presented here consistently demonstrate the ability of ultrasounds combined to color and power Doppler technique in the presumptive attribution of these nodules to a dirofilariotic origin, in both superficial and deep locations. While in canine and feline cardiopulmonary dirofilariosis echocardiographic techniques are routinely used for the diagnosis and evaluation of the clinical situation of the hosts,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> these techniques have been successfully applied in the definitive diagnosis of human dirofilariosis only in very few cases<a class="elsevierStyleCrossRefs" href="#bib0105">21–23</a>, or were used only to guide fine needle aspiration biopsy.<a class="elsevierStyleCrossRefs" href="#bib0120">24,25</a> The identification of the helminthic origin of the nodules, discarding a malignant tumor, was achieved according to morphological aspect of the nodules, the presence of worms which appear as parallel hyperechotic lines inside them and even their movements in nearly half of the cases and the peripheral location of blood vessels in Dirofilaria nodules, unlike what happens in malignant tumors, where the vascularization appears inside the nodule. Specific adscription to D. repens and thus confirmation of suspicions acquired by ultrasounds and Doppler examinations was performed in all cases by PCR once removed the nodules or the worm themselves. Nevertheless, once identified the dirofilariotic origin of the nodules and discarded a malignant origin, this is a secondary matter<a class="elsevierStyleCrossRef" href="#bib0095">19</a> that must be performed when prognosis make necessary the removal of the nodules or worms.In conclusion, we present here the report of a wide series of cases of human dirofilariosis in a hospital of a hyperendemic area of dirofilariosis in Southwestern Russia by means of image and molecular techniques. These techniques allowed the identification of dirofilariotic origin of all nodules located in both superficial and deeper locations. Results of epidemiological surveys and estimations of prediction models<a class="elsevierStyleCrossRefs" href="#bib0030">6,26</a> suggest a spreading of dirofilariosis both in animal reservoir and human populations of Northern and Eastern European countries. Thus human subcutaneous/ocular dirofilariosis would be diagnosed with increasing frequency in the nearest future in Europe.Conflict of interestThe authors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres471071" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec493568" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres471070" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec493569" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-01-23" "fechaAceptado" => "2014-04-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec493568" "palabras" => array:5 [ 0 => "Dirofilaria repens" 1 => "Subcutaneous/ocular dirofilariasis" 2 => "Ultrasound" 3 => "Doppler" 4 => "Polymerase chain reaction" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec493569" "palabras" => array:5 [ 0 => "Dirofilaria repens" 1 => "Dirofilariosis subcutánea/ocular" 2 => "Ultrasonidos" 3 => "Doppler" 4 => "Reacción en cadena de la polimerasa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionDifferent species of the genus Dirofilaria, mainly D. immitis and D. repens, are responsible for emergent vector borne transmitted zoonotic diseases in the Old World. Human D. repens infections are characterized by the appearance of benign subcutaneous nodules that mimic skin malignant tumors or due to live worms in the ocular area. MethodsThirty patients presenting superficial or deep nodules were treated at the Rostov Regional Diagnostic Center (Southwestern Russian Federation). Anatomical characteristics of the nodules were studied by non-invasive ultrasound and color and power Doppler techniques. Worms were surgically removed from every nodule and their DNA analyzed by polymerase chain reaction (PCR). ResultsTwenty-four out of the 30 nodules were located in the hypodermis, two in a retro-ocular location and four in scrotal location. Image techniques allowed the identification of the helminthic origin of all nodules, based on their oval and regular shape, peripheral vasculature, and the existence of internal linear winding hyperechoic structures with or without movements, indicating the presence of live or dead worms, respectively. Specific adscription to D. repens was achieved by the PCR analysis. ConclusionThe series described in the present paper confirms the increasing risk of infection by D. repens in humans living in endemic areas of Eastern Europe. The use of non-invasive ultrasounds and Doppler techniques can contribute to an appropriate management of human dirofilariasis. Moreover, awareness of the medical community in the endemic areas influences the report of cases, and consequently the current epidemiological picture of human dirofilariasis." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónDiferentes especies del género Dirofilaria, principalmente D.immitis y D.repens, son responsables de enfermedades zoonóticas transmitidas por vectores en el viejo mundo. Las infecciones humanas causadas por D.repens se caracterizan por la aparición de nódulos subcutáneos benignos que se confunden con tumores malignos de piel o por la localización de vermes vivos en la zona ocular. MétodosTreinta pacientes con nódulos superficiales o profundos fueron tratados en el Centro de Diagnóstico Regional de Rostov (suroeste de la Federación Rusa). Las características anatómicas de los nódulos fueron estudiadas mediante ultrasonidos no invasivos y Doppler de color y potencia. Los vermes se retiraron quirúrgicamente de cada nódulo y su ADN se analizó mediante la reacción en cadena de la polimerasa (PCR). ResultadosVeinticuatro de los 30 nódulos se localizaron en la hipodermis, 2 en localización retroocular y 4 en la zona escrotal. Las técnicas de imagen permitieron la identificación del origen helmíntico de todos los nódulos, en base a su forma ovalada y regular, la vasculatura periférica y la existencia de estructuras lineales internas hiperecoicas con o sin movimientos, indicando la presencia de gusanos vivos o muertos, respectivamente. La adscripción específica a D.repens se logró mediante el análisis de PCR. ConclusiónLa serie de casos descrita en el presente trabajo confirma el creciente riesgo de infección por D.repens en las personas que viven en zonas endémicas del Este de Europa. El uso de técnicas no invasivas como los ultrasonidos y el Doppler puede contribuir a un adecuado manejo de la dirofilariosis humana. Por otra parte, el conocimiento de la enfermedad por parte de la comunidad médica de las áreas endémicas influye en el informe de los casos y, consecuentemente, en el cuadro epidemiológico actual de la dirofilariosis humana." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1422 "Ancho" => 1893 "Tamanyo" => 234207 ] ] "descripcion" => array:1 [ "en" => "Representative images from a B-scan ultrasound (A, case no. 27) and color and power Doppler sonography (B and C) examination of a parasitic nodules (both from case no. 22). Parasite appears as multiple parallel hyperechoic linear structures (rail track pattern) inside the cysts and blood flow is located in the periphery of the capsule." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1048 "Ancho" => 2500 "Tamanyo" => 157135 ] ] "descripcion" => array:1 [ "en" => "Subcutaneous nodule containing a female worm surgically removed from a patient. The scale bar is in cm (A). Representative image of the PCR analysis of the DNA extracted from different worms after the surgical removal of the nodules (B). The dirofilariotic nodules were located in subcutaneous tissue of the shoulder (case no. 7) (Lane 1), ocular area (case no. 10) (Lane 2), testicular (case no. 17) (Lane 3), abdominal wall (case no. 26) (Lane 4) and. M, 100bp DNA marker; C+, positive control; C−, negative control." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Date \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients’ sex (m/f) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients’ age (years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anatomical location \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical manifestation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nodule size (mm) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.01.2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forehead \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12×6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">07.03.2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hip \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.04.2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Testicular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Testicular mass, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.05.2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">09.01.2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ocular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eyelid swelling, painful eye turns \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11×6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.02.2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Groin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">06.03.2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Shoulder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15×7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.10.2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroocular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Periorbital edema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.01.2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hip \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, itch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14×6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.04.2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ocular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eyelid swelling, tearing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10×5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.10.2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Testicular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Testicular mass, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.02.2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheek \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13×7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">07.12.2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ocular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eyelid swelling, burning sensation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10×5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.01.2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ocular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eyelid swelling, itch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11×6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.04.2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Zygomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12×6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">03.05.2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hip \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13×7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">07.10.2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Testicular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Testicular mass, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16×7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.03.2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.11.2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ocular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eyelid swelling, conjunctivitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11×6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">08.02.2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ocular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eyelid swelling, burning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10×5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.10.2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Temporal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14×7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">09.03.2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parotid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11×6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.10.2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Groin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12×7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.04.2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14×6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.09.2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Retroocular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intermittent periorbital edema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.12.2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal wall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.01.2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Testicular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left testicular edema, skin redness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17×8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">03.03.2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ocular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eyelid redness, itch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10×5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">04.07.2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal wall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous nodule, painless \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14×7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.06.2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ocular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eyelid redness, itch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12×6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab730454.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main clinical and epidemiological characteristics of 30 cases of dirofilariosis (Dirofilaria repens) reported in Rostov-on-Don (Southwestern Russia), 2003–2013." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heartworm disease in animals and humans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.W. McCall" 1 => "C. Genchi" 2 => "L.H. Kramer" 3 => "J. Guerrero" 4 => "L. Venco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0065-308X(08)00204-2" "Revista" => array:6 [ "tituloSerie" => "Adv Parasitol" "fecha" => "2008" "volumen" => "66" "paginaInicial" => "193" "paginaFinal" => "195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18486691" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vectors of Dirofilaria nematodes: biology, behavior and host/parasite relationships" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Cancrini" 1 => "S. 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Original article

Thirty cases of human subcutaneous dirofilariasis reported in Rostov-on-Don (Southwestern Russian Federation)

Treinta casos de dirofilariosis subcutánea humana reportados en Rostov del Don (suroeste de la Federación Rusa)

Boris Ilyasova, Vladimir Kartashevb, Nikolay Bastrikovc, Liudmila Madjuginad, Javier González-Miguele, Rodrigo Morchóne, Fernando Simóne,

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fersimon@usal.es

Corresponding author.

a Department of Diagnostic Ultrasound, Rostov Oblast Diagnostic Centre, Rostov-na-Donu, Russia

b Department of Infectious Diseases, Rostov State Medical University, Rostov-na-Donu, Russia

c Department of Ophthalmology, Hospital of the North Caucasus Branch of the Russian Railway, Rostov-na-Donu, Russia

d Department of Diagnostic Ultrasound, Hospital of the North Caucasus Branch of the Russian Railway, Rostov-na-Donu, Russia

e Laboratory of Parasitology, Faculty of Pharmacy and Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, 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">Zoonotic filarioses are vector borne transmitted diseases caused by parasitic filarial nematodes of the genus <span class="elsevierStyleItalic">Dirofilaria</span>&#44; mainly <span class="elsevierStyleItalic">D&#46; immitis</span> and <span class="elsevierStyleItalic">D&#46; repens&#46;</span> These two species are primarily parasites of domestic and wild canines and felines all over the world<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> being transmitted by different species of culicid mosquitoes belonging the genera <span class="elsevierStyleItalic">Culex</span>&#44; <span class="elsevierStyleItalic">Aedes</span> and <span class="elsevierStyleItalic">Anopheles</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Because many of these species feed indiscriminately on animal reservoirs and man&#44; in areas where canine dirofilariosis is endemic&#44; the risk of human infections exists&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In Europe&#44; canine dirofilariosis caused by <span class="elsevierStyleItalic">D&#46; repens</span> is spreading from the traditionally endemic Southern Mediterranean countries to the central and Northern countries&#44; being currently considered an emerging disease in these areas&#46; In parallel&#44; a dramatic increase of human subcutaneous&#47;ocular dirofilariosis is being detected&#44; with more than 2850 cases reported until now in the world literature&#44; many of them diagnosed in the last 13 years in Ukraine and Southwestern Russia&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> These changes are attributed to the global warming&#44; human interventions modifying environment and pets management&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Human subcutaneous dirofilariosis is a condition characterized by the development of subcutaneous nodules caused by the local inflammatory reaction against <span class="elsevierStyleItalic">D&#46; repens</span> worms&#44; usually immature&#44; that mimic both benign and malignant primary or metastatic skin tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In addition live&#44; fully developed adult worms can lodge in intraocular and retroocular locations&#44; causing considerable damages and discomfort in patients by themselves or as a consequence of their surgical removal&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Diagnosis of human subcutaneous dirofilariosis raises important procedure problems because of the initial suspicion of a malignant origin of the nodules and the very frequent absence of parasite larvae &#40;microfilariae&#41; in the blood of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Thus&#44; most cases are diagnosed by histology and morphological and&#47;or molecular analysis&#44; subsequent to the surgical removal of the whole cysts or the worm themselves&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;10&#44;11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this work is to report an extensive series of human subcutaneous&#47;ocular dirofilariosis cases observed during an 11-year period &#40;2003&#8211;2013&#41; in the Rostov Oblast Diagnostic Center&#44; located in the hyperendemic area of canine dirofilariosis in Southwestern Russian Federation&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Cases of human subcutaneous dirofilariasis were retrospectively collected from the case record of the Rostov Regional Diagnostic Center Department of Ultrasound&#46; This center functions as referral medical center of the Rostov region which has a population of 4&#44;277&#44;976 inhabitants&#46; Cases were referred from ophthalmologists&#44; surgeons&#44; oncologists&#44; urologists&#44; or from other physicians for assessment of subcutaneous or more deeply located nodules&#46; The data were gathered reviewing the clinical charts or the clinical&#44; laboratory and imaging registries&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ultrasound examinations were performed in all patients on ultrasound equipment SonoCT HDI-5000 and iU22 &#8220;Philips&#8221; &#40;Philips Healthcare&#44; Bothell&#44; WA&#44; USA&#41;&#44; using a broadband linear probes with an aperture of 38<span class="elsevierStyleHsp" style=""></span>mm and the frequency of 5&#8211;12<span class="elsevierStyleHsp" style=""></span>MHz and 5&#8211;17<span class="elsevierStyleHsp" style=""></span>MHz&#46; Patients were examined with multiple views scanning with the special program for superficial tissues study in B-mode as well as using a regimen of color and power Doppler with spectral curve analysis of blood flow&#46; Ultrasounds study evaluated the skin thickness&#44; the echogenicity and echo structure of the nodule itself and the structure of surrounding superficial and deeper tissues&#46; Every nodule was characterized by the size&#44; shape&#44; borders&#44; homogeneity&#44; detailed characteristics of internal echo structure&#44; presence or absence of blood flow and vascular pattern&#46; All the nodules were afterwards surgically excised and the removed worms analyzed by the PCR technique with specific primers as described by Favia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In brief&#44; DNA was extracted from each parasite with the DNeasy Blood &#38; Tissue Kit &#40;Qiagen&#44; GmbH&#44; D-40724&#41;&#46; After activation of the Taq Gold polymerase at 94<span class="elsevierStyleHsp" style=""></span>&#176;C for 12<span class="elsevierStyleHsp" style=""></span>min&#44; PCR reactions were performed as follows&#58; 94<span class="elsevierStyleHsp" style=""></span>&#176;C &#40;30<span class="elsevierStyleHsp" style=""></span>s&#41;&#44; 65<span class="elsevierStyleHsp" style=""></span>&#176;C &#40;30<span class="elsevierStyleHsp" style=""></span>s&#41;&#44; 72<span class="elsevierStyleHsp" style=""></span>&#176;C &#40;30<span class="elsevierStyleHsp" style=""></span>s&#41; for 35 cycles and a final step at 72<span class="elsevierStyleHsp" style=""></span>&#176;C for 7<span class="elsevierStyleHsp" style=""></span>min&#46; PCR products were visualized on agarose gel&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">All patients provided informed consent to participate in this study having been approved by the Ethical Committee of the Rostov State Medical University&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">Between 2003 and 2011&#44; 30 patients &#40;21 females&#41; were diagnosed of dirofilariosis&#46; Patients noticed a single superficial or deep nodule without history of previously diagnosed malignancies&#46; Data on the patients&#44; characteristics and location of the nodules appear in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The most common presentation was a painless subcutaneous nodule&#44; visible with naked eyes &#40;26&#47;30&#41; or found by palpation &#40;2&#47;30&#41;&#46; Twenty-four out of the 30 nodules were located in the hypodermis and the other six were located in deeper locations&#46; From these&#44; two out of the 10 ocular cases appeared in retroocular location&#44; and four additional cases in the scrotum&#46; All the patients with ocular dirofilariosis reported history of swelling of the lower or upper eyelids or periorbital edema&#44; burning sensation&#44; itching&#44; painful eye turns&#44; conjunctival hyperemia and tearing&#46; Some of them had the feeling of a foreign body in the eye&#46; The patients with scrotal lesions presented with non-tender local soft tissue mass located separately from testicular appendages&#46; One of the patients noticed a gradual increasing edema as well as hyperemia of one half of the scrotum without definite mass lesion&#46; In other patient physical examination revealed a soft painless mass closely adjacent to the caudal portion of the epididymis &#40;the first clinical impression was &#8220;a cyst of caudal epididymis&#8221;&#41;&#46; Patients with other location of the nodules were asymptomatic&#46; None have traveled outside the Rostov region in the previous past years&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">By ultrasound examination&#44; nodules were oval and regular-shaped with well-defined but jagged and fuzzy outer contours&#46; The inner contents of the cyst appear hypoechoic&#46; Inside the nodule there were clear internal echoes with linear winding hyperechoic textures &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; sometimes with visible spontaneous writhing movement&#44; detected in 14 out of 30 cases&#44; indicating the presence of a live worm&#46; Alive worms looked rich with hank-like multiple continuing and sharp but fine tubular textures&#46; Dead worm showed the same structures but they looked motionless&#44; non-continuous&#44; mostly blurred and broken&#44; with areas of high and low echo density&#46; Color Doppler examination detected that none of the nodules showed any signs of internal or polar vascularity&#44; the blood vessels being present at the periphery of the parasitic cyst wall &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Power Doppler examination confirmed the existence of blood flow only at the periphery of the nodules in the fibrotic capsule surrounding the worms &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41; and adjacent tissues&#46; The two nodules detected at retroocular location showed the same characteristic findings to those described in the rest of the nodules in both ultrasounds and color and power Doppler examinations&#46; These characteristics allowed the attribution of the origin of all nodules to a helminthic origin&#44; probably <span class="elsevierStyleItalic">Dirofilaria</span>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Surgical removal of the parasites revealed the presence of round worms with filiform appearance with lengths from 42 to 124<span class="elsevierStyleHsp" style=""></span>mm and diameters from 102 to 527<span class="elsevierStyleHsp" style=""></span>&#956;m&#46; They were sexually immature female worms in 28 out of 30 cases &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41; and 2 immature male worms in the other 2 cases&#46; PCR identified all of them as <span class="elsevierStyleItalic">D&#46; repens</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Laboratory examination did not demonstrate any kind of abnormalities in conventional blood&#44; urine and biochemistry tests&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">In spite of human dirofilariosis has been considered traditionally a rare disease<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> both the increase in clinical cases&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> mainly caused by <span class="elsevierStyleItalic">D&#46; repens</span>&#44; and the high seroprevalences revealed by serological surveys in humans<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> suggest a high risk of infection by <span class="elsevierStyleItalic">Dirofilaria</span> species for people living in areas where dirofilariosis is endemic in dogs&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> At a global level the area with the highest increase in human dirofilariosis cases is Europe where approximately 280 cases were reported until 2000&#44; most of them in the Mediterranean countries&#46; However&#44; in the next 13 years the number of reported cases surpassed 2400 from which 2087 were reported in Ukraine and the Russian Federation&#46; Moreover&#44; with increasing frequency clinical cases are reported in Central and Northern European countries&#44; previously considered non-endemic&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5&#44;15</span></a> These changes have been associated&#44; among other factors&#44; to the strong thermal anomalies occurring in the area in the last years<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and the wide stray dogs population not receiving chemoprophylaxis against <span class="elsevierStyleItalic">Dirofilaria</span>&#46; The cases described here were reported in a single Hospital of Rostov-on-Don &#40;Southwestern Russia&#41;&#44; where previous epidemiological surveys revealed canine prevalences higher than 30&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> This indicates a clear concordance among the existence of <span class="elsevierStyleItalic">Dirofilaria</span> in dogs and the detection of human cases&#46; Nevertheless&#44; there are high canine prevalences in other Southwestern Russian oblasts where only sporadic or no human cases have been reported&#44; suggesting that the awareness of the medical community is also necessary for the correct diagnosis of human dirofilariosis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Our series present similar epidemiological and clinical characteristics to those described previously by Pampiglione and Rivasi<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> in their review of the world literature&#44; with some different aspects&#46; Ocular location is by far the most frequent&#44; a fact that is in agreement with the high incidence of ocular cases reported in Russia as reviewed by Avdiukhina et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Two of these cases appeared in retroocular location&#44; having been one of them separately published to communicate this new anatomical location of <span class="elsevierStyleItalic">D&#46; repens</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Because of the repetition of this presentation&#44; it is necessary to warn the physicians about the possibility to find nodules in this anatomical location in the future&#46; The frequency of genital location in our series &#40;13&#46;3&#37;&#41; is twice that found by Pampiglione and Rivasi<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and appeared mostly in adolescents&#46; There exist also differences in the distribution by gender because we have observed 70&#46;0&#37; of incidence in women&#44; clearly higher than 55&#46;4&#37; reviewed by Pampiglione and Rivasi&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Detection of <span class="elsevierStyleItalic">Dirofilaria</span> nodules frequently causes the initial suspicion of a malignant origin&#44; in spite of their benign character&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Thus differential diagnosis is an essential step of the management of human dirofilariosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;19</span></a> Diagnosis of subcutaneous dirofilariosis is post-operative in most cases&#44; causing moderate to serious injury to patients&#44; mainly when nodules appear in internal&#44; intraocular or retroocular locations&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> To avoid unnecessary damages and delay during the diagnostic procedure&#44; efficient non-invasive techniques can be applied&#46; The results obtained in the wide series of cases presented here consistently demonstrate the ability of ultrasounds combined to color and power Doppler technique in the presumptive attribution of these nodules to a dirofilariotic origin&#44; in both superficial and deep locations&#46; While in canine and feline cardiopulmonary dirofilariosis echocardiographic techniques are routinely used for the diagnosis and evaluation of the clinical situation of the hosts&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> these techniques have been successfully applied in the definitive diagnosis of human dirofilariosis only in very few cases<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;23</span></a>&#44; or were used only to guide fine needle aspiration biopsy&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a> The identification of the helminthic origin of the nodules&#44; discarding a malignant tumor&#44; was achieved according to morphological aspect of the nodules&#44; the presence of worms which appear as parallel hyperechotic lines inside them and even their movements in nearly half of the cases and the peripheral location of blood vessels in <span class="elsevierStyleItalic">Dirofilaria</span> nodules&#44; unlike what happens in malignant tumors&#44; where the vascularization appears inside the nodule&#46; Specific adscription to <span class="elsevierStyleItalic">D&#46; repens</span> and thus confirmation of suspicions acquired by ultrasounds and Doppler examinations was performed in all cases by PCR once removed the nodules or the worm themselves&#46; Nevertheless&#44; once identified the dirofilariotic origin of the nodules and discarded a malignant origin&#44; this is a secondary matter<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> that must be performed when prognosis make necessary the removal of the nodules or worms&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion&#44; we present here the report of a wide series of cases of human dirofilariosis in a hospital of a hyperendemic area of dirofilariosis in Southwestern Russia by means of image and molecular techniques&#46; These techniques allowed the identification of dirofilariotic origin of all nodules located in both superficial and deeper locations&#46; Results of epidemiological surveys and estimations of prediction models<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;26</span></a> suggest a spreading of dirofilariosis both in animal reservoir and human populations of Northern and Eastern European countries&#46; Thus human subcutaneous&#47;ocular dirofilariosis would be diagnosed with increasing frequency in the nearest future in Europe&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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          "identificador" => "xres471071"
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    "fechaRecibido" => "2014-01-23"
    "fechaAceptado" => "2014-04-08"
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            0 => "<span class="elsevierStyleItalic">Dirofilaria repens</span>"
            1 => "Subcutaneous&#47;ocular dirofilariasis"
            2 => "Ultrasound"
            3 => "Doppler"
            4 => "Polymerase chain reaction"
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            0 => "<span class="elsevierStyleItalic">Dirofilaria repens</span>"
            1 => "Dirofilariosis subcut&#225;nea&#47;ocular"
            2 => "Ultrasonidos"
            3 => "Doppler"
            4 => "Reacci&#243;n en cadena de la polimerasa"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Different species of the genus <span class="elsevierStyleItalic">Dirofilaria</span>&#44; mainly <span class="elsevierStyleItalic">D&#46; immitis</span> and <span class="elsevierStyleItalic">D&#46; repens</span>&#44; are responsible for emergent vector borne transmitted zoonotic diseases in the Old World&#46; Human <span class="elsevierStyleItalic">D&#46; repens</span> infections are characterized by the appearance of benign subcutaneous nodules that mimic skin malignant tumors or due to live worms in the ocular area&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thirty patients presenting superficial or deep nodules were treated at the Rostov Regional Diagnostic Center &#40;Southwestern Russian Federation&#41;&#46; Anatomical characteristics of the nodules were studied by non-invasive ultrasound and color and power Doppler techniques&#46; Worms were surgically removed from every nodule and their DNA analyzed by polymerase chain reaction &#40;PCR&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Twenty-four out of the 30 nodules were located in the hypodermis&#44; two in a retro-ocular location and four in scrotal location&#46; Image techniques allowed the identification of the helminthic origin of all nodules&#44; based on their oval and regular shape&#44; peripheral vasculature&#44; and the existence of internal linear winding hyperechoic structures with or without movements&#44; indicating the presence of live or dead worms&#44; respectively&#46; Specific adscription to <span class="elsevierStyleItalic">D&#46; repens</span> was achieved by the PCR analysis&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The series described in the present paper confirms the increasing risk of infection by <span class="elsevierStyleItalic">D&#46; repens</span> in humans living in endemic areas of Eastern Europe&#46; The use of non-invasive ultrasounds and Doppler techniques can contribute to an appropriate management of human dirofilariasis&#46; Moreover&#44; awareness of the medical community in the endemic areas influences the report of cases&#44; and consequently the current epidemiological picture of human dirofilariasis&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Diferentes especies del g&#233;nero <span class="elsevierStyleItalic">Dirofilaria</span>&#44; principalmente <span class="elsevierStyleItalic">D&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">immitis</span> y <span class="elsevierStyleItalic">D&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">repens</span>&#44; son responsables de enfermedades zoon&#243;ticas transmitidas por vectores en el viejo mundo&#46; Las infecciones humanas causadas por <span class="elsevierStyleItalic">D&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">repens</span> se caracterizan por la aparici&#243;n de n&#243;dulos subcut&#225;neos benignos que se confunden con tumores malignos de piel o por la localizaci&#243;n de vermes vivos en la zona ocular&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Treinta pacientes con n&#243;dulos superficiales o profundos fueron tratados en el Centro de Diagn&#243;stico Regional de Rostov &#40;suroeste de la Federaci&#243;n Rusa&#41;&#46; Las caracter&#237;sticas anat&#243;micas de los n&#243;dulos fueron estudiadas mediante ultrasonidos no invasivos y Doppler de color y potencia&#46; Los vermes se retiraron quir&#250;rgicamente de cada n&#243;dulo y su ADN se analiz&#243; mediante la reacci&#243;n en cadena de la polimerasa &#40;PCR&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Veinticuatro de los 30 n&#243;dulos se localizaron en la hipodermis&#44; 2 en localizaci&#243;n retroocular y 4 en la zona escrotal&#46; Las t&#233;cnicas de imagen permitieron la identificaci&#243;n del origen helm&#237;ntico de todos los n&#243;dulos&#44; en base a su forma ovalada y regular&#44; la vasculatura perif&#233;rica y la existencia de estructuras lineales internas hiperecoicas con o sin movimientos&#44; indicando la presencia de gusanos vivos o muertos&#44; respectivamente&#46; La adscripci&#243;n espec&#237;fica a <span class="elsevierStyleItalic">D&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">repens</span> se logr&#243; mediante el an&#225;lisis de PCR&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La serie de casos descrita en el presente trabajo confirma el creciente riesgo de infecci&#243;n por <span class="elsevierStyleItalic">D&#46;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">repens</span> en las personas que viven en zonas end&#233;micas del Este de Europa&#46; El uso de t&#233;cnicas no invasivas como los ultrasonidos y el Doppler puede contribuir a un adecuado manejo de la dirofilariosis humana&#46; Por otra parte&#44; el conocimiento de la enfermedad por parte de la comunidad m&#233;dica de las &#225;reas end&#233;micas influye en el informe de los casos y&#44; consecuentemente&#44; en el cuadro epidemiol&#243;gico actual de la dirofilariosis humana&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Representative images from a B-scan ultrasound &#40;A&#44; case no&#46; 27&#41; and color and power Doppler sonography &#40;B and C&#41; examination of a parasitic nodules &#40;both from case no&#46; 22&#41;&#46; Parasite appears as multiple parallel hyperechoic linear structures &#40;rail track pattern&#41; inside the cysts and blood flow is located in the periphery of the capsule&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Subcutaneous nodule containing a female worm surgically removed from a patient&#46; The scale bar is in cm &#40;A&#41;&#46; Representative image of the PCR analysis of the DNA extracted from different worms after the surgical removal of the nodules &#40;B&#41;&#46; The dirofilariotic nodules were located in subcutaneous tissue of the shoulder &#40;case no&#46; 7&#41; &#40;Lane 1&#41;&#44; ocular area &#40;case no&#46; 10&#41; &#40;Lane 2&#41;&#44; testicular &#40;case no&#46; 17&#41; &#40;Lane 3&#41;&#44; abdominal wall &#40;case no&#46; 26&#41; &#40;Lane 4&#41; and&#46; M&#44; 100<span class="elsevierStyleHsp" style=""></span>bp DNA marker&#59; C&#43;&#44; positive control&#59; C&#8722;&#44; negative control&#46;</p>"
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                  <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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Date&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients&#8217; sex &#40;m&#47;f&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients&#8217; age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anatomical location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical manifestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nodule size &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;01&#46;2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Forehead&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">07&#46;03&#46;2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hip&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;04&#46;2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Testicular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Testicular mass&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;05&#46;2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Forearm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">09&#46;01&#46;2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eyelid swelling&#44; painful eye turns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;02&#46;2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Groin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">06&#46;03&#46;2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shoulder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;10&#46;2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retroocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Periorbital edema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;01&#46;2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hip&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; itch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;04&#46;2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eyelid swelling&#44; tearing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;10&#46;2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Testicular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Testicular mass&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;02&#46;2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheek&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">07&#46;12&#46;2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eyelid swelling&#44; burning sensation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;01&#46;2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eyelid swelling&#44; itch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;04&#46;2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Zygomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">03&#46;05&#46;2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hip&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">07&#46;10&#46;2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Testicular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Testicular mass&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;03&#46;2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Forearm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;11&#46;2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eyelid swelling&#44; conjunctivitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">08&#46;02&#46;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eyelid swelling&#44; burning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;10&#46;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Temporal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">09&#46;03&#46;2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Parotid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;10&#46;2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Groin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;04&#46;2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Forearm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;09&#46;2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retroocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intermittent periorbital edema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;12&#46;2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal wall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;01&#46;2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left testicular edema&#44; skin redness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">03&#46;03&#46;2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eyelid redness&#44; itch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">04&#46;07&#46;2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal wall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous nodule&#44; painless&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;06&#46;2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ocular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eyelid redness&#44; itch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Main clinical and epidemiological characteristics of 30 cases of dirofilariosis &#40;<span class="elsevierStyleItalic">Dirofilaria repens</span>&#41; reported in Rostov-on-Don &#40;Southwestern Russia&#41;&#44; 2003&#8211;2013&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:26 [
            0 => array:3 [
              "identificador" => "bib0005"
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            1 => "C&#46; Genchi"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0065-308X(08)00204-2"
                      "Revista" => array:6 [
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                        "fecha" => "2008"
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                            "web" => "Medline"
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            ]
            1 => array:3 [
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vectors of <span class="elsevierStyleItalic">Dirofilaria</span> nematodes&#58; biology&#44; behavior and host&#47;parasite relationships"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Cancrini"
                            1 => "S&#46; Gabrielli"
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                        ]
                      ]
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                        "titulo" => "<span class="elsevierStyleItalic">Dirofilaria immitis</span> and <span class="elsevierStyleItalic">D&#46; repens</span> in dog and cat and human infections"
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            2 => array:3 [
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; Sim&#243;n"
                            1 => "R&#46; Morch&#243;n"
                            2 => "J&#46; Gonz&#225;lez-Miguel"
                            3 => "C&#46; Marcos-Atxutegi"
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                  "host" => array:1 [
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                      "doi" => "10.1016/j.pt.2009.06.003"
                      "Revista" => array:6 [
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            3 => array:3 [
              "identificador" => "bib0020"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Human and animal dirofilariasis&#58; the emergence of a zoonotic mosaic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Sim&#243;n"
                            1 => "M&#46; Siles-Lucas"
                            2 => "R&#46; Morch&#243;n"
                            3 => "J&#46; Gonz&#225;lez-Miguel"
                            4 => "I&#46; Mellado"
                            5 => "E&#46; Carret&#243;n"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CMR.00012-12"
                      "Revista" => array:6 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22763636"
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            4 => array:3 [
              "identificador" => "bib0025"
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                  "contribucion" => array:1 [
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                      "titulo" => "Human dirofilariasis due to <span class="elsevierStyleItalic">Dirofilaria repens</span> in Ukraine&#44; an emergent zoonosis&#58; epidemiological report of 1465 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "R&#46;V&#46; Sa&#322;amatin"
                            1 => "T&#46;M&#46; Pavlikovska"
                            2 => "O&#46;S&#46; Sagach"
                            3 => "S&#46;M&#46; Nikolayenko"
                            4 => "V&#46;V&#46; Kornyushin"
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                          ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2478/s11686-013-0187-x"
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            5 => array:3 [
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                0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Genchi"
                            1 => "L&#46; Rinaldi"
                            2 => "C&#46; Cascone"
                            3 => "M&#46; Mortarino"
                            4 => "G&#46; Cringoli"
                          ]
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                  ]
                  "host" => array:1 [
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                      "doi" => "10.1016/j.vetpar.2005.04.009"
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            6 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Human dirofilariasis due to <span class="elsevierStyleItalic">Dirofilaria</span> &#40;<span class="elsevierStyleItalic">Nochtiella</span>&#41; <span class="elsevierStyleItalic">repens</span>&#58; a review of world literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Pampiglione"
                            1 => "G&#46; CanestriTrotti"
                            2 => "F&#46; Rivasi"
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                  "host" => array:1 [
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            7 => array:3 [
              "identificador" => "bib0040"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dirofilarial infections in Europe"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Genchi"
                            1 => "L&#46;H&#46; Kramer"
                            2 => "F&#46; Rivasi"
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                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/vbz.2010.0247"
                      "Revista" => array:6 [
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                        "fecha" => "2011"
                        "volumen" => "11"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21417922"
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              "identificador" => "bib0045"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delayed diagnosis of dirofilariasis and complex ocular surgery&#44; Russia"
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Iliasov"
                            1 => "V&#46; Kartashev"
                            2 => "N&#46; Bastrikov"
                            3 => "R&#46; Morch&#243;n"
                            4 => "J&#46; Gonz&#225;lez-Miguel"
                            5 => "F&#46; Sim&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Infect Dis"
                        "fecha" => "2013"
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                        "paginaInicial" => "326"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23460991"
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Article information

ISSN: 0213005X
Original language: English

DOI:10.1016/j.eimc.2014.04.002

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Year/Month	Html	Pdf	Total

2024 October	37	5	42
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2017 October	23	4	27
2017 September	35	2	37
2017 August	31	3	34
2017 July	32	5	37
2017 June	49	12	61
2017 May	38	4	42
2017 April	35	4	39
2017 March	29	2	31
2017 February	49	4	53
2017 January	39	5	44
2016 December	53	3	56
2016 November	38	4	42
2016 October	94	5	99
2016 September	91	8	99
2016 August	44	6	50
2016 July	52	6	58
2016 June	58	8	66
2016 May	41	2	43
2016 April	38	10	48
2016 March	53	14	67
2016 February	50	13	63
2016 January	50	17	67
2015 December	37	11	48
2015 November	35	17	52
2015 October	48	10	58
2015 September	46	83	129
2015 August	63	12	75
2015 July	49	15	64
2015 June	36	13	49
2015 May	55	28	83
2015 April	47	37	84

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