Scientific letter
Invasive Haemophilus influenzae serotype b disease in adults
Enfermedad invasiva por Haemophilus influenzae serotipo b en el adulto
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"sarafuentecosio@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" => "Laura" "apellidos" => "Castelo Corral" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María" "apellidos" => "Rodríguez Mayo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Pedro" "apellidos" => "Llinares Mondejar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital San Agustín de Avilés, Avilés, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Enfermedades Infecciosas, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Microbiología, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad invasiva por <span class="elsevierStyleItalic">Haemophilus influenzae</span> serotipo b en el adulto" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Haemophilus influenzae</span> is a Gram-negative coccobacillus first described by Pfeiffer in 1892.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> It may be encapsulated, with 6 antigenically different types (a–f), or non-encapsulated. <span class="elsevierStyleItalic">H. influenzae</span> type b (Hib) was responsible for 90–95% of cases of invasive disease in children under 5 years of age, until the introduction of the conjugate vaccine,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> being rare in adults.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 63-year-old woman, with no prior history of note or contact with children, who attended the emergency department due to odynophagia, arthromyalgia and a dysthermic sensation for the last 48–72<span class="elsevierStyleHsp" style=""></span>h. Notable findings on physical examination were: fever (38<span class="elsevierStyleHsp" style=""></span>°C), tachycardia (130<span class="elsevierStyleHsp" style=""></span>bpm) and tachypnoea (20<span class="elsevierStyleHsp" style=""></span>bpm); exanthema and petechiae on the palate; pharyngeal hyperaemia; lateral cervical lymphadenopathy; and hypophonesis at the base of the right lung. Complementary tests revealed: acute renal failure (Cr 2.4<span class="elsevierStyleHsp" style=""></span>mg/dl), leukopenia (3270 leukocytes), coagulopathy (PT 1.41), high CRP (48.8<span class="elsevierStyleHsp" style=""></span>mg/dl) and procalcitonin (19.6<span class="elsevierStyleHsp" style=""></span>ng/ml), acute partial respiratory failure (pO<span class="elsevierStyleInf">2</span> 49<span class="elsevierStyleHsp" style=""></span>mmHg, pCO<span class="elsevierStyleInf">2</span> 31<span class="elsevierStyleHsp" style=""></span>mmHg), and right pleural effusion. A diagnosis of severe sepsis was made, blood cultures (BCs) were collected, empirical antibiotic therapy was started with imipenem and the patient was admitted. Once the patient was on the unit, an ear, nose and throat examination was performed; this examination was normal. After 15<span class="elsevierStyleHsp" style=""></span>h, Hib (resistant to ampicillin and susceptible to cefotaxime, azithromycin and ciprofloxacin) was isolated in her BCs, and her antibiotic therapy was adjusted to ceftriaxone. A diagnostic thoracocentesis was performed which yielded purulent fluid. Subsequently, Hib was isolated in this fluid too, and a chest tube was placed. Thereafter, the patient had arthritis in her right ankle. Arthrocentesis was performed and real-time PCR was used to detect Hib in the fluid extracted. The patient received intravenous antibiotic therapy for 2 weeks and continued with oral ciprofloxacin until she had completed 4 weeks of treatment, with resolution of her signs and symptoms and normalisation of her renal function and inflammatory parameters. An immunity study was performed. A notable finding was an IgG level of 469<span class="elsevierStyleHsp" style=""></span>mg/dl (751–1560<span class="elsevierStyleHsp" style=""></span>mg/dl). In subsequent tests, IgG levels were within normal limits (878 and 848<span class="elsevierStyleHsp" style=""></span>mg/dl, respectively). Hib-specific antibodies (1.23<span class="elsevierStyleHsp" style=""></span>mg/dl) were found to be above the protective value (>1<span class="elsevierStyleHsp" style=""></span>mg/l). Therefore, it was not necessary to vaccinate the patient, nor were there any indications for chemoprophylaxis. Hence, this was a case of bacteraemia, empyema and septic arthritis caused by Hib in an adult patient with no risk factors.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We report this case due to the rarity of invasive disease caused by Hib in an adult without comorbidity. Hib is capable of colonising the respiratory tract for long periods of time and reaching the bloodstream. This would lead to bacteraemia and metastatic infection, thanks to its polysaccharide capsule composed of polyribitol phosphate.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Asymptomatic carrier rates vary by study from 0% to 9%, and are much higher in children.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> The epidemiological characteristics of invasive disease due to <span class="elsevierStyleItalic">H. influenzae</span> have changed since the introduction in 1989 of the conjugate vaccine against Hib in children under 5 years of age. Many studies have reported a 99% decrease in incidence in this age group after the introduction of the vaccine. In adults, the epidemiological situation is different. A study conducted in Illinois from 1996 to 2004 on changes in the epidemiology of invasive disease due to <span class="elsevierStyleItalic">H. influenzae</span> showed an increase in the incidence in adults, especially those over 65 years of age.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> This increase in incidence was due to non-typeable strains in many studies.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,5–9</span></a> In addition, it has been observed that the majority of Hib infections occur in adults with comorbidities. This suggests the need to execute strategies to protect this most vulnerable group.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> The risk factors for acquiring the disease include: age, complement deficiency, hypogammaglobulinaemia, sickle cell anaemia, HIV, COPD, smoking, alcoholism, overcrowding and low immunisation.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We identified 10 cases of invasive Hib disease at our centre between 2005 and 2015. Their characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Save for one case of epiglottitis in a child and the case presented here, all were in adults (mean age 57 years, 100% males) with at least one of the above-mentioned comorbidities.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, it seems necessary to build upon studies on this disease in the adult population, and to take it into account in the differential diagnosis for early antibiotic treatment, since mortality rates in this group are far from negligible (up to 20%).<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5–7</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fuente Cosío S, Castelo Corral L, Rodríguez Mayo M, Llinares Mondejar P. Enfermedad invasiva por <span class="elsevierStyleItalic">Haemophilus influenzae</span> serotipo b en el adulto. Enferm Infecc Microbiol Clin. 2017;35:325–326.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; ENT, signs and symptoms in the ear, nose and throat area; HIV, human immunodeficiency virus; NHL, non-Hodgkin lymphoma; PDA, parenteral drug addiction.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases \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">Age \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">Sex \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">Risk factors \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">Polymicrobial \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 syndrome \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">Death \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">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">DM2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Escherichia coli</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gangrenous cholecystitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \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">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HIV<br>PDA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus pneumoniae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \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">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Smoking<br>Alcohol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus pneumoniae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \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">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">DM2<br>CKD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Streptococcus mitis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Primary bacteraemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \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">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Smoking<br>Alcohol<br>DM1<br>Malnutrition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Primary bacteraemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \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">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Smoking<br>Alcohol<br>COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \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">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NHL<br>COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \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">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Small-cell lung cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \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">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Epiglottitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \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">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ENT<br>Empyema<br>Arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414637.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cases of invasive Hib disease at Complexo Hospitalario Universitario de A Coruña from 2005 to 2015.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Haemophilus</span> species, including <span 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 11 | 9 | 20 |
| 2024 September | 15 | 13 | 28 |
| 2024 August | 17 | 11 | 28 |
| 2024 July | 17 | 5 | 22 |
| 2024 June | 26 | 2 | 28 |
| 2024 May | 10 | 8 | 18 |
| 2024 April | 20 | 7 | 27 |
| 2024 March | 17 | 7 | 24 |
| 2024 February | 11 | 4 | 15 |
| 2024 January | 28 | 5 | 33 |
| 2023 December | 9 | 7 | 16 |
| 2023 November | 10 | 18 | 28 |
| 2023 October | 23 | 8 | 31 |
| 2023 September | 13 | 5 | 18 |
| 2023 August | 14 | 1 | 15 |
| 2023 July | 11 | 3 | 14 |
| 2023 June | 25 | 5 | 30 |
| 2023 May | 43 | 1 | 44 |
| 2023 April | 34 | 0 | 34 |
| 2023 March | 31 | 2 | 33 |
| 2023 February | 32 | 5 | 37 |
| 2023 January | 24 | 6 | 30 |
| 2022 December | 21 | 3 | 24 |
| 2022 November | 19 | 7 | 26 |
| 2022 October | 16 | 3 | 19 |
| 2022 September | 12 | 9 | 21 |
| 2022 August | 14 | 9 | 23 |
| 2022 July | 12 | 7 | 19 |
| 2022 June | 10 | 8 | 18 |
| 2022 May | 11 | 5 | 16 |
| 2022 April | 13 | 16 | 29 |
| 2022 March | 26 | 9 | 35 |
| 2022 February | 28 | 7 | 35 |
| 2022 January | 19 | 6 | 25 |
| 2021 December | 18 | 14 | 32 |
| 2021 November | 31 | 8 | 39 |
| 2021 October | 17 | 12 | 29 |
| 2021 September | 16 | 10 | 26 |
| 2021 August | 18 | 17 | 35 |
| 2021 July | 18 | 8 | 26 |
| 2021 June | 13 | 5 | 18 |
| 2021 May | 13 | 9 | 22 |
| 2021 April | 6 | 13 | 19 |
| 2021 March | 10 | 9 | 19 |
| 2021 February | 10 | 5 | 15 |
| 2021 January | 11 | 11 | 22 |
| 2020 December | 6 | 5 | 11 |
| 2020 November | 13 | 13 | 26 |
| 2020 October | 12 | 7 | 19 |
| 2020 September | 13 | 9 | 22 |
| 2020 August | 8 | 8 | 16 |
| 2020 July | 5 | 7 | 12 |
| 2020 June | 19 | 10 | 29 |
| 2020 May | 11 | 8 | 19 |
| 2020 April | 7 | 6 | 13 |
| 2020 March | 12 | 3 | 15 |
| 2020 February | 17 | 3 | 20 |
| 2020 January | 16 | 6 | 22 |
| 2019 December | 11 | 7 | 18 |
| 2019 November | 13 | 8 | 21 |
| 2019 October | 14 | 8 | 22 |
| 2019 September | 16 | 3 | 19 |
| 2019 August | 8 | 3 | 11 |
| 2019 July | 9 | 9 | 18 |
| 2019 June | 12 | 33 | 45 |
| 2019 May | 63 | 27 | 90 |
| 2019 April | 6 | 22 | 28 |
| 2019 March | 3 | 13 | 16 |
| 2019 February | 2 | 9 | 11 |
| 2019 January | 3 | 4 | 7 |
| 2018 December | 1 | 6 | 7 |
| 2018 November | 2 | 4 | 6 |
| 2018 October | 2 | 5 | 7 |
| 2018 September | 4 | 0 | 4 |
| 2018 August | 3 | 2 | 5 |
| 2018 July | 5 | 2 | 7 |
| 2018 June | 2 | 11 | 13 |
| 2018 May | 3 | 2 | 5 |
| 2018 April | 11 | 2 | 13 |
| 2018 March | 5 | 0 | 5 |
| 2018 February | 3 | 0 | 3 |
| 2018 January | 11 | 1 | 12 |
| 2017 December | 4 | 1 | 5 |
| 2017 November | 8 | 1 | 9 |
| 2017 October | 2 | 0 | 2 |
| 2017 May | 1 | 0 | 1 |
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