Diagnosis at first sight
Abdominal pain and asthenia in a 7 years old boy
Dolor abdominal y astenia en niño de 7 años
Raquel Plácido Paiasa,
, Alejandro Rodríguez Martínezb, María Dolores Falcón Neyrac
Corresponding author
a Servicio de Pediatría, Hospital de Mérida, Mérida, Badajoz, Spain
b Sección de Gastroenterología, Hepatología y Nutrición Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain
c Sección de Infectología e Inmunopatología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Badajoz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Gastroenterología, Hepatología y Nutrición Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Infectología e Inmunopatología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dolor abdominal y astenia en niño de 7 años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figs. 1–3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 473 "Ancho" => 1800 "Tamanyo" => 121354 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fibrin-covered superficial circumferential ulcers in the ascending colon and caecum, with adjacent areas of seemingly healthy mucosa.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">Caucasian 7-year-old boy of Spanish origin admitted due to abdominal pain and mucus and blood in the stool for 3 months, sporadic arthralgia, and asthenia and low-grade fever in the last 12 days, with no other prior history. Physical examination: asthenia and pallor with no other findings. Weight 22.3<span class="elsevierStyleHsp" style=""></span>kg (−0.94 SD), height 124<span class="elsevierStyleHsp" style=""></span>cm (−1.10 SD) and body mass index (BMI) 14.5<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (−0.84 SD). Leukocytosis 24,400<span class="elsevierStyleHsp" style=""></span>cell/μl (17,700<span class="elsevierStyleHsp" style=""></span>neutrophils/μl), haemoglobin 9.3<span class="elsevierStyleHsp" style=""></span>g/dl (MCV 65.1<span class="elsevierStyleHsp" style=""></span>fl, MCH 20.2<span class="elsevierStyleHsp" style=""></span>pg), platelets 762,000<span class="elsevierStyleHsp" style=""></span>μl and CRP 129.7<span class="elsevierStyleHsp" style=""></span>mg/l, normal transaminases, serum albumin 2.7<span class="elsevierStyleHsp" style=""></span>g/dl, serum iron 10.5<span class="elsevierStyleHsp" style=""></span>μg/dl (50–170); negative antigliadin and IgA anti-transglutaminase antibodies, elevated faecal calprotectin (929<span class="elsevierStyleHsp" style=""></span>μg/g). Negative HIV and HBV serology. Negative coproculture and parasites. The abdominal ultrasound revealed ileal loop wall thickening (7<span class="elsevierStyleHsp" style=""></span>mm). No gastroduodenal or intestinal transit abnormalities found. The colonoscopy revealed pale mucosa with punched-out ulcers, particularly in the caecum and ascending colon, and the oedematous and stenotic ileocaecal valve with fibrin-covered superficial circumferential ulcers (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1–3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Clinical course</span><p id="par0010" class="elsevierStylePara elsevierViewall">Given that Crohn's disease (CD) was initially suspected, induction treatment was started with exclusive polymeric enteral nutrition. Before initiating treatment with immunomodulators, a tuberculin skin test was performed, with a 12<span class="elsevierStyleHsp" style=""></span>mm induration at 72<span class="elsevierStyleHsp" style=""></span>h and a diagnosis of tuberculosis infection. The chest X-ray showed upper left lobe condensation. Positive gastric aspirate smear microscopy, Xpert MTB PCR positive for <span class="elsevierStyleItalic">Mycobacterium tuberculosis (M. tuberculosis)</span> and Lowenstein culture with <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> growth in fewer than 7 days and sensitive to first-line drugs. Intestinal histology showed ulcerative and granulomatous colitis in the caecum, with minor involvement of the ascending and descending colon, sigmoid and rectum. In the biopsy samples, the Ziehl-Neelsen stain, PCR and Lowenstein culture were all positive. Conventional treatment was started (induction: 2 HRZ, maintenance: 7 HR); triple therapy against pan-susceptible bacteria was prescribed for 9 months due to the extrapulmonary location and severity of clinical symptoms. Exclusive polymeric enteral nutrition formula was added for 8 weeks as coadjuvant therapy. Upon completion of treatment, the child was asymptomatic with recovered anthropometric parameters: weight: 28.3<span class="elsevierStyleHsp" style=""></span>kg (−0.38 SD), height: 129.5<span class="elsevierStyleHsp" style=""></span>cm (−0.96 SD) and BMI: 16.88<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> (−0.38 SD). Follow-up gastroscopy and colonoscopy without findings and with normal histology.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Final comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">In 2013, the incidence of childhood tuberculosis in Spain was 5.4/100,000 population, with intestinal tuberculosis (IT) accounting for 0.5% of all cases.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> It is primarily caused by the bacteria <span class="elsevierStyleItalic">M. tuberculosis</span> and the ileocaecal region is most commonly affected.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical manifestations of IT are nonspecific and develop slowly,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a> resulting in a delayed diagnosis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Abdominal pain and fever are the most common symptoms, together with weight loss, asthenia and episodes of diarrhoea or constipation. Intestinal obstruction is the most common complication.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Laboratory tests are nonspecific, with elevated reactants, anaemia and lymphocytopaenia or leukocytosis<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> all manifesting in our patient. The tuberculin skin test and interferon-gamma release assays offer limited sensitivity in IT diagnosis owing to the functional immunodeficiency caused by malnutrition that many of these patients suffer.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Abdominal ultrasound and computed tomography may be useful in diagnosing the extent of the disease, although findings tend to be largely nonspecific.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Colonoscopy shows the most commonly affected region to be the ileocaecal valve. Intestinal lesions usually manifest in the form of multiple superficial and circumferential ulcers with normal surrounding mucosa, instead of linear ulcers surrounded by inflamed and nodular mucosa typical of Crohn's disease.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The differential diagnosis with CD poses a real challenge. The histology is similar in both conditions, although deep ulcers, lymphoid aggregates, transmural inflammation and non-caseating granuloma are more typical of CD, whereas large caseating and coalescent granuloma are suggestive of IT.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">IT diagnosis is confirmed by detecting the bacteria in the histological sample. However, the low sensitivity and specificity of traditional microbiological techniques, coupled with slow bacterial growth, limit the usefulness of these techniques.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> PCR to detect <span class="elsevierStyleItalic">M. tuberculosis</span> is a rapid and useful method of diagnosing pulmonary and extrapulmonary tuberculosis.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Subacute tuberculous enteritis is treated using classic regimens. Clinical response is apparent less than 2 weeks after treatment initiation, and patients should be reassessed in the event of a lack of response.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We have presented this case due to its epidemiological and clinical interest, and due to the diagnostic difficulties encountered. High clinical suspicion in this field is essential to ensure early diagnosis and treatment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest concerning the preparation and publication of this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical course" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Final comment" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Plácido Paias R, Rodríguez Martínez A, Falcón Neyra MD. Dolor abdominal y astenia en niño de 7 años. Enferm Infecc Microbiol Clin. 2017;35:260–261.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figs. 1–3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 473 "Ancho" => 1800 "Tamanyo" => 121354 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fibrin-covered superficial circumferential ulcers in the ascending colon and caecum, with adjacent areas of seemingly healthy mucosa.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Informe epidemiológico sobre la situación de la tuberculosis en España. Año 2013" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Centro Nacional de Epidemiología" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2014" "editorial" => "Instituto de Salud Carlos III" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intestinal tuberculosis: a diagnostic challenge – case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Giouleme" 1 => "P. Paschos" 2 => "M. Katsaros" 3 => "F. Papalexi" 4 => "S. Karabatsou" 5 => "M. Masmanidou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MEG.0b013e32834a9470" "Revista" => array:6 [ "tituloSerie" => "Eur J Gastroenterol Hepatol" "fecha" => "2011" "volumen" => "23" "paginaInicial" => "1074" "paginaFinal" => "1077" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21849904" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tuberculosis in gastroenterology practice: clinical challenges" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Bandyopadhyay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Update" "fecha" => "2011" "volumen" => "21" "paginaInicial" => "321" "paginaFinal" => "331" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abdominal tuberculosis in children: a diagnostic challenge" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Yo-Spring" 1 => "H. Yhu-Chering" 2 => "L. Tzou-Yien" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1684-1182(10)60030-8" "Revista" => array:6 [ "tituloSerie" => "J Microbiol Immunol Infect" "fecha" => "2010" "volumen" => "43" "paginaInicial" => "188" "paginaFinal" => "193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21291845" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abdominal tuberculosis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Tinsa" 1 => "L. Essaddam" 2 => "Z. Fitouri" 3 => "I. Brini" 4 => "W. Dourina" 5 => "S. Ben Becher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr Gastroenterol Ntr" "fecha" => "2010" "volumen" => "50" "paginaInicial" => "634" "paginaFinal" => "638" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of clinical and endoscopic findings in differentiating Crohn's disease from intestinal tuberculosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Li" 1 => "X. Liu" 2 => "Y. Zou" 3 => "C. Ouyang" 4 => "X. Wu" 5 => "M. Zhou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-010-1231-4" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2011" "volumen" => "56" "paginaInicial" => "188" "paginaFinal" => "196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20467901" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.J. Lee" 1 => "S.K. Yang" 2 => "J.S. Byeon" 3 => "S.J. Myung" 4 => "H.S. Chang" 5 => "S.S. Hong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2006-924996" "Revista" => array:6 [ "tituloSerie" => "Endoscopy" "fecha" => "2006" "volumen" => "38" "paginaInicial" => "592" "paginaFinal" => "597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16673312" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differentiating intestinal tuberculosis from Crohn's disease: a diagnostic challenge" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Almadi" 1 => "S. Ghosh" 2 => "A.M. Aljebreen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2008.162" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2009" "volumen" => "104" "paginaInicial" => "1003" "paginaFinal" => "1012" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19240705" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.T. Gan" 1 => "Y.Q. Chen" 2 => "Q. Ouyang" 3 => "H. Bu" 4 => "X.Y. Yang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2002.05686.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2002" "volumen" => "97" "paginaInicial" => "1446" "paginaFinal" => "1451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12094863" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopathology and TB-PCR kit analysis in differentiating the diagnosis of intestinal tuberculosis and Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X.J. Jin" 1 => "J.M. Kim" 2 => "H.K. Kim" 3 => "L. Kim" 4 => "S.J. Choi" 5 => "I.S. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "2496" "paginaFinal" => "2503" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20503449" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000004/v1_201704140226/S2529993X17300801/v1_201704140226/en/main.assets" "Apartado" => array:4 [ "identificador" => "65382" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Diagnostic at first sight" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000004/v1_201704140226/S2529993X17300801/v1_201704140226/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17300801?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 1 | 9 |
| 2024 October | 13 | 8 | 21 |
| 2024 September | 23 | 9 | 32 |
| 2024 August | 18 | 9 | 27 |
| 2024 July | 23 | 11 | 34 |
| 2024 June | 13 | 5 | 18 |
| 2024 May | 9 | 4 | 13 |
| 2024 April | 17 | 7 | 24 |
| 2024 March | 22 | 5 | 27 |
| 2024 February | 30 | 5 | 35 |
| 2024 January | 25 | 7 | 32 |
| 2023 December | 11 | 5 | 16 |
| 2023 November | 11 | 9 | 20 |
| 2023 October | 22 | 5 | 27 |
| 2023 September | 17 | 5 | 22 |
| 2023 August | 19 | 10 | 29 |
| 2023 July | 20 | 7 | 27 |
| 2023 June | 13 | 1 | 14 |
| 2023 May | 42 | 1 | 43 |
| 2023 April | 44 | 4 | 48 |
| 2023 March | 35 | 10 | 45 |
| 2023 February | 36 | 5 | 41 |
| 2023 January | 25 | 2 | 27 |
| 2022 December | 15 | 6 | 21 |
| 2022 November | 15 | 5 | 20 |
| 2022 October | 21 | 13 | 34 |
| 2022 September | 20 | 12 | 32 |
| 2022 August | 18 | 5 | 23 |
| 2022 July | 15 | 6 | 21 |
| 2022 June | 11 | 6 | 17 |
| 2022 May | 30 | 5 | 35 |
| 2022 April | 24 | 10 | 34 |
| 2022 March | 34 | 10 | 44 |
| 2022 February | 33 | 6 | 39 |
| 2022 January | 57 | 7 | 64 |
| 2021 December | 24 | 10 | 34 |
| 2021 November | 24 | 9 | 33 |
| 2021 October | 16 | 8 | 24 |
| 2021 September | 13 | 12 | 25 |
| 2021 August | 13 | 9 | 22 |
| 2021 July | 13 | 11 | 24 |
| 2021 June | 22 | 5 | 27 |
| 2021 May | 28 | 13 | 41 |
| 2021 April | 74 | 10 | 84 |
| 2021 March | 30 | 8 | 38 |
| 2021 February | 9 | 10 | 19 |
| 2021 January | 26 | 12 | 38 |
| 2020 December | 26 | 7 | 33 |
| 2020 November | 44 | 10 | 54 |
| 2020 October | 49 | 5 | 54 |
| 2020 September | 96 | 11 | 107 |
| 2020 August | 24 | 5 | 29 |
| 2020 July | 25 | 12 | 37 |
| 2020 June | 20 | 5 | 25 |
| 2020 May | 18 | 7 | 25 |
| 2020 April | 10 | 4 | 14 |
| 2020 March | 10 | 3 | 13 |
| 2020 February | 19 | 3 | 22 |
| 2020 January | 8 | 2 | 10 |
| 2019 December | 14 | 7 | 21 |
| 2019 November | 10 | 2 | 12 |
| 2019 October | 13 | 8 | 21 |
| 2019 September | 13 | 1 | 14 |
| 2019 August | 8 | 2 | 10 |
| 2019 July | 15 | 3 | 18 |
| 2019 June | 26 | 18 | 44 |
| 2019 May | 77 | 16 | 93 |
| 2019 April | 28 | 12 | 40 |
| 2019 March | 4 | 1 | 5 |
| 2019 February | 6 | 1 | 7 |
| 2019 January | 2 | 2 | 4 |
| 2018 December | 2 | 1 | 3 |
| 2018 November | 7 | 2 | 9 |
| 2018 October | 11 | 3 | 14 |
| 2018 September | 5 | 0 | 5 |
| 2018 August | 3 | 0 | 3 |
| 2018 July | 6 | 0 | 6 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 2 | 0 | 2 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 7 | 0 | 7 |
| 2018 January | 4 | 0 | 4 |
| 2017 December | 9 | 1 | 10 |
| 2017 November | 2 | 1 | 3 |
| 2017 October | 7 | 1 | 8 |
| 2017 September | 2 | 0 | 2 |
| 2017 May | 3 | 0 | 3 |
| 2017 April | 1 | 0 | 1 |
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