Scientific letter
Infections by emerging serogroups of Neisseria meningitidis: A case report
Infecciones por serogrupos emergentes de Neisseria meningitidis: a propósito de un caso
Read
3640
Timeswas read the article
1397
Total PDF
2243
Total HTML
Share statistics
array:23 [ "pii" => "S0213005X18301654" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2018.03.009" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1835" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2019;37:142-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 555 "formatos" => array:2 [ "HTML" => 311 "PDF" => 244 ] ] "itemSiguiente" => array:19 [ "pii" => "S0213005X18301836" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2018.04.008" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1851" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Enferm Infecc Microbiol Clin. 2019;37:144-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1174 "formatos" => array:2 [ "HTML" => 829 "PDF" => 345 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "<span class="elsevierStyleItalic">Mycoplasma genitalium</span> y resistencia antibiótica en España; la necesidad de una respuesta eficaz a un problema emergente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "144" "paginaFinal" => "145" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Mycoplasma genitalium</span> and antibiotic resistance in Spain; the need for an effective response against an emerging problem" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Fernández-Huerta, Judit Serra-Pladevall, María-Jesús Barberá, Mateu Espasa" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "Fernández-Huerta" ] 1 => array:2 [ "nombre" => "Judit" "apellidos" => "Serra-Pladevall" ] 2 => array:2 [ "nombre" => "María-Jesús" "apellidos" => "Barberá" ] 3 => array:2 [ "nombre" => "Mateu" "apellidos" => "Espasa" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2529993X18302697" "doi" => "10.1016/j.eimce.2018.04.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X18302697?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X18301836?idApp=UINPBA00004N" "url" => "/0213005X/0000003700000002/v3_201902270625/S0213005X18301836/v3_201902270625/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0213005X18300818" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2018.03.006" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1832" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2019;37:141" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 507 "formatos" => array:2 [ "HTML" => 202 "PDF" => 305 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Caso importado de infección por <span class="elsevierStyleItalic">Shigella sonnei</span> portadora de betalactamasa de espectro extendido CTX-M-15" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "141" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Imported infection by CTX-M-15 extended-spectrum beta-lactamase-producing <span class="elsevierStyleItalic">Shigella sonnei</span>" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Patricia González Donapetry, Paula Pescador Martín, Rosa Gómez-Gil Mira, Guillermo Ruiz Carrascoso" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Patricia" "apellidos" => "González Donapetry" ] 1 => array:2 [ "nombre" => "Paula" "apellidos" => "Pescador Martín" ] 2 => array:2 [ "nombre" => "Rosa" "apellidos" => "Gómez-Gil Mira" ] 3 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Ruiz Carrascoso" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529993X18302661" "doi" => "10.1016/j.eimce.2018.03.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X18302661?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X18300818?idApp=UINPBA00004N" "url" => "/0213005X/0000003700000002/v3_201902270625/S0213005X18300818/v3_201902270625/es/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Infections by emerging serogroups of <span class="elsevierStyleItalic">Neisseria meningitidis</span>: A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "142" "paginaFinal" => "143" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Felipe Pérez-García, Raquel Abad, Cristina Almirall, Elena Abarca" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Felipe" "apellidos" => "Pérez-García" "email" => array:1 [ 0 => "felipe.perez.garcia.87@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Raquel" "apellidos" => "Abad" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Cristina" "apellidos" => "Almirall" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Elena" "apellidos" => "Abarca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Clinical Analysis, Universitary Hospital HM Sanchinarro, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Reference Laboratory for Meningococci, National Centre of Microbiology, Institute of Health Carlos III, Majadahonda, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infecciones por serogrupos emergentes de <span class="elsevierStyleItalic">Neisseria meningitidis</span>: a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 703 "Ancho" => 1000 "Tamanyo" => 214213 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Blood culture gram stain at 1000× magnification.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 18-year-old spanish female patient was admitted to our hospital in December 2017 after 2 days of fever, caugh and dyspnea. The patient had no clinical relevant history, no history of recent travel and a completed vaccination calendar. The patient accomplished sepsis clinical criteria, and examination revealed no neurologic findings or skins lesions. Laboratory findings were leucopenia, coagulopathy and elevation of acute phase reagents. Torax X-ray showed a bilateral infiltrate. The patient evolved to acute respiratory failure, which required admission to our Intensive Care Unit for respiratory support with Optiflow. Empirical antimicrobial treatment with meropenem, levofloxacin and oseltamivir was started after collection of blood and urine cultures and nasopharyngeal exudate for PCR testing for Influenza viruses.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Urine and nasopharyngeal samples were negative. After 15<span class="elsevierStyleHsp" style=""></span>h of incubation, blood cultures were positive and the Gram stain showed Gram-negative cocci in pairs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The bottles were subcultured onto Columbia sheep blood and chocolate agar plates and incubated at 35<span class="elsevierStyleHsp" style=""></span>°C in 5% CO<span class="elsevierStyleInf">2</span>. With the suspicion of meningococcemia, subculture was also made onto Martin Lewis agar and incubated at 35<span class="elsevierStyleHsp" style=""></span>°C in CO<span class="elsevierStyleInf">2</span>. After 24<span class="elsevierStyleHsp" style=""></span>h of incubation, all agar plates were grown, showing small, non-hemolytic, brilliant, grayish colonies. The oxidase test was positive and the biochemical identification panel (Api NH, Biomérieux) revealed that the isolate fermented glucose and maltose and was proline arylamidase and gamma-glutamyl transferase positive. Agglutination for capsular antigens was made (Directigen Meningitis Combo Test, Biomérieux), confirming that the isolate was <span class="elsevierStyleItalic">Neisseria meningitidis</span> serogroup C/W. The strain was susceptible to Cefotaxime (MIC<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>0.016<span class="elsevierStyleHsp" style=""></span>μg/mL). Clinicians were informed and the patient underwent targeted therapy with Cefotaxime at a dose of 2<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h for 7 days, with favorable outcome. After 12 days of hospitalization, the patient was discharged from our hospital without any clinical consequence of the infection.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The strain was sent to the Reference Laboratory for Meningococci (National Centre of Microbiology, Institute of Health Carlos III, Majadahonda, Spain) for confirmation and characterization. The isolate was identified by using slide agglutination with specific polyclonal antibodies as <span class="elsevierStyleItalic">N. meningitidis</span> serogroup W, and molecularly characterized by sequencing variable regions of the PorA protein gene<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> as genosubtype P1.5,2 (PorA VR1:5, VR2:2).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Invasive meningococcal disease (IMD) is a severe and life-threating illness, associated with different serogroups of <span class="elsevierStyleItalic">N. meningitidis</span>. In Spain, all IMD cases must be notified through the National Network of Epidemiological Surveillance, due to its high morbidity and mortality, as well as the clinical consequences of the infection. The disease is seasonal, being more frequent in the winter months. The epidemiological patterns are different depending on the involved serogroup.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Regarding the incidence of IMD, 3121 cases were reported in 2015 in EU/EEA countries (0.6 cases per 100<span class="elsevierStyleHsp" style=""></span>000 population), being the most frequent the serogroup B (61%), followed by serogroup C (14%). There is a continuous decreasing trend in the incidence of the mentioned serogroups. However, IMD by other serogroups that were rare years ago in Europe such as W and Y, are now increasing, achieving a rate of 11% for W and 10% for Y of the total number of cases in 2015.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–7</span></a> Thus, the implementation of the quadrivalent conjugate vaccination (A, C, Y and W) has been proposed in countries with increasing rates of IMD by serogroup W such as United Kingdom, Greece, Austria and Czech Republic.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In Spain we have attended a similar scenario: on the one hand a decrease on the incidence of IMD by serogroup C and B. On the other hand, the number of IMD due to non-frequent serogroups (W and Y) has also increased (8.2% of W and 5.2% of Y in 2015–2016 season).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">These serogroups are nowadays considered as emerging and they should be considered in patients with clinical suspicion of meningococcal infection. The possibility of quadrivalent conjugate vaccine implementation in Spain should be evaluated in response to the increasing risk of IMD cases by serogroup W.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This case report illustrates the emerging importance of these local-acquired non-B/C meningococcal infections which have to be considered as a differential diagnosis in patients with either sepsis of respiratory origin with or without neurological or skin findings. In addition, it could serve to point out the potential benefit of implementing the quadrivalent vaccine in Spain. However, prospective multicentric studies are needed to establish the incidence of these emerging serogroups and also to assess the convenience of the quadrivalent vaccine implementation in Spain, as it has already been implemented in other EU/EEA countries.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 703 "Ancho" => 1000 "Tamanyo" => 214213 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Blood culture gram stain at 1000× magnification.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antigenic and/or phase variation of PorA protein in non-subtypable <span class="elsevierStyleItalic">Neisseria meningitidis</span> strains isolated in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Alcalá" 1 => "C. Salcedo" 2 => "L. Arreaza" 3 => "R. Abad" 4 => "R. Enríquez" 5 => "L. De La Fuente" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/jmm.0.05517-0" "Revista" => array:6 [ "tituloSerie" => "J Med Microbiol" "fecha" => "2004" "volumen" => "53" "paginaInicial" => "515" "paginaFinal" => "518" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15150331" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vacunas antimeningocócicas Situación epidemiológica mundial y estrategias de prevención mediante la vacunación" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Rivero Calle" 1 => "C. Rodriguez-Tenreiro Sánchez" 2 => "F. Martinón-Torres" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2015.03.001" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "257" "paginaFinal" => "267" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25795150" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Invasive meningococcal disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "ECDC (European Centre for Disease Prevention and Control)" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "ECDC annual epidemiological report for 2015. Stockholm" "fecha" => "2017" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of invasive meningococcal disease in EU/EEA countries, 2004–2014" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Whittaker" 1 => "J.G. Dias" 2 => "M. Ramliden" 3 => "C. Ködmön" 4 => "A. Economopoulou" 5 => "N. Beer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.vaccine.2017.03.007" "Revista" => array:5 [ "tituloSerie" => "Vaccine [Internet]" "fecha" => "2017" "volumen" => "35" "paginaInicial" => "2034" "paginaFinal" => "2041" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An international invasive meningococcal disease outbreak due to a novel and rapidly expanding serogroup w strain, Scotland and Sweden July to August 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Lucidarme" 1 => "K.J. Scott" 2 => "R. Ure" 3 => "A. Smith" 4 => "D. Lindsay" 5 => "B. Stenmark" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eurosurveillance" "fecha" => "2016" "volumen" => "21" "paginaInicial" => "1" "paginaFinal" => "9" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emergency meningococcal ACWY vaccination program for teenagers to control group W meningococcal disease England, 2015–2016" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H. Campbell" 1 => "M. Edelstein" 2 => "N. Andrews" 3 => "R. Borrow" 4 => "M. Ramsay" 5 => "S. Ladhani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3201/eid2307.170236" "Revista" => array:6 [ "tituloSerie" => "Emerg Infect Dis" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "1184" "paginaFinal" => "1187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28409739" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meningococcal serogroup y disease in Europe: continuation of high importance in some European regions in 2013" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Bröker" 1 => "S. Emonet" 2 => "C. Fazio" 3 => "S. Jacobsson" 4 => "M. Koliou" 5 => "M. Kuusi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hum Vaccines Immunother" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "2281" "paginaFinal" => "2286" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="http://vaccine-schedule.ecdc.europa.eu/Pages/Scheduler.aspx">http://vaccine-schedule.ecdc.europa.eu/Pages/Scheduler.aspx</a>" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vaccine scheduler [Internet]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "ECDC (European Centre for Disease Prevention and Control)" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2016" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad meningocócica en España Análisis de la temporada 2015–2016" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Gutiérrez González" 1 => "E.V. Martínez Sánchez" 2 => "R. Amillategui dos Santos" 3 => "R. Cano Portero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Boletín epidemiológico Sem" "fecha" => "2017" "volumen" => "25" "paginaInicial" => "57" "paginaFinal" => "72" "itemHostRev" => array:3 [ "pii" => "S0161642013003606" "estado" => "S300" "issn" => "01616420" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early evidence of expanding W ST-11 CC meningococcal incidence in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Abad" 1 => "J.A. Vázquez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jinf.2016.06.010" "Revista" => array:6 [ "tituloSerie" => "J Infect" "fecha" => "2016" "volumen" => "73" "paginaInicial" => "296" "paginaFinal" => "297" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27387450" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack394597" "titulo" => "Acknowledgement" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">We thank Rebeca Bailén for her help with the preparation of the manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/0213005X/0000003700000002/v3_201902270625/S0213005X18301654/v3_201902270625/en/main.assets" "Apartado" => array:4 [ "identificador" => "8590" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/0213005X/0000003700000002/v3_201902270625/S0213005X18301654/v3_201902270625/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X18301654?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 15 | 7 | 22 |
| 2024 September | 26 | 27 | 53 |
| 2024 August | 24 | 27 | 51 |
| 2024 July | 19 | 6 | 25 |
| 2024 June | 18 | 17 | 35 |
| 2024 May | 15 | 10 | 25 |
| 2024 April | 34 | 38 | 72 |
| 2024 March | 36 | 39 | 75 |
| 2024 February | 28 | 14 | 42 |
| 2024 January | 20 | 21 | 41 |
| 2023 December | 26 | 29 | 55 |
| 2023 November | 28 | 17 | 45 |
| 2023 October | 26 | 31 | 57 |
| 2023 September | 27 | 8 | 35 |
| 2023 August | 17 | 8 | 25 |
| 2023 July | 28 | 119 | 147 |
| 2023 June | 24 | 35 | 59 |
| 2023 May | 33 | 9 | 42 |
| 2023 April | 24 | 6 | 30 |
| 2023 March | 25 | 3 | 28 |
| 2023 February | 19 | 14 | 33 |
| 2023 January | 13 | 8 | 21 |
| 2022 December | 39 | 18 | 57 |
| 2022 November | 32 | 27 | 59 |
| 2022 October | 35 | 17 | 52 |
| 2022 September | 30 | 26 | 56 |
| 2022 August | 39 | 47 | 86 |
| 2022 July | 25 | 13 | 38 |
| 2022 June | 27 | 16 | 43 |
| 2022 May | 40 | 16 | 56 |
| 2022 April | 53 | 25 | 78 |
| 2022 March | 49 | 26 | 75 |
| 2022 February | 44 | 23 | 67 |
| 2022 January | 27 | 19 | 46 |
| 2021 December | 32 | 24 | 56 |
| 2021 November | 33 | 13 | 46 |
| 2021 October | 102 | 27 | 129 |
| 2021 September | 17 | 12 | 29 |
| 2021 August | 30 | 13 | 43 |
| 2021 July | 41 | 16 | 57 |
| 2021 June | 45 | 16 | 61 |
| 2021 May | 41 | 17 | 58 |
| 2021 April | 124 | 40 | 164 |
| 2021 March | 65 | 18 | 83 |
| 2021 February | 51 | 16 | 67 |
| 2021 January | 33 | 18 | 51 |
| 2020 December | 21 | 10 | 31 |
| 2020 November | 34 | 15 | 49 |
| 2020 October | 22 | 14 | 36 |
| 2020 September | 54 | 19 | 73 |
| 2020 August | 37 | 17 | 54 |
| 2020 July | 43 | 13 | 56 |
| 2020 June | 20 | 10 | 30 |
| 2020 May | 41 | 30 | 71 |
| 2020 April | 35 | 8 | 43 |
| 2020 March | 30 | 14 | 44 |
| 2020 February | 28 | 10 | 38 |
| 2020 January | 48 | 17 | 65 |
| 2019 December | 36 | 17 | 53 |
| 2019 November | 20 | 5 | 25 |
| 2019 October | 29 | 11 | 40 |
| 2019 September | 32 | 16 | 48 |
| 2019 August | 21 | 12 | 33 |
| 2019 July | 0 | 2 | 2 |
| 2019 June | 2 | 15 | 17 |
| 2019 May | 4 | 56 | 60 |
| 2019 April | 5 | 27 | 32 |
| 2019 March | 12 | 9 | 21 |
| 2019 February | 89 | 38 | 127 |
| 2019 January | 1 | 0 | 1 |
| 2018 July | 0 | 2 | 2 |
| 2018 June | 0 | 1 | 1 |
| 2018 May | 0 | 13 | 13 |
Show all
