Diagnosis at first sight
An unusual cause of low back pain in a patient with sepsis
Una causa inusual de dolor lumbar en paciente con sepsis
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Nicolás Albertz Arévalo, Elena Belloch Ramos, Antonio Guerrero Espejo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "José Pablo" "apellidos" => "León Salinas" "email" => array:2 [ 0 => "jpabloleons@gmail.com" 1 => "jpabloleonsalinas@hotmail.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" => "Nicolás" "apellidos" => "Albertz Arévalo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Elena" "apellidos" => "Belloch Ramos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Antonio" "apellidos" => "Guerrero Espejo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitario de La Ribera, Alzira, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Consultor de Enfermedades Infecciosas, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Una causa inusual de dolor lumbar en paciente con sepsis" ] ] "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" => 1357 "Ancho" => 1500 "Tamanyo" => 230957 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MRI of the lumbar spine consistent with facet joint septic arthritis of right L4–L5. Axial (A) and sagittal (B) T1-weighted fat-suppressed image with intravenous contrast. Axial T2-weighted image (C). Joint effusion (black arrow) and a small collection (white arrow) located behind the facet joint is observed. The adjacent paraspinal musculature shows inflammatory changes (black arrowheads). In the posterior and lateral right epidural space, a thickening and contrast enhancement is observed (white arrowhead), due to adjacent focal meningitis.</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">A 61-year-old male with type II, insulin-dependent diabetes mellitus with poor control, came in for progressive low-back pain and persistent fever associated with dysuria. For the past 3 days, he had been taking oral amoxicillin plus clavulanic acid due to a suspected urinary tract infection. During the physical examination, there was notable pain in the right renal fossa with positive kidney punch. The basic analysis showed leukocytosis of 18,300<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10e<span class="elsevierStyleSup">9</span>/l with neutrophilia of 92.3%, elevated lactate (2.7<span class="elsevierStyleHsp" style=""></span>mmol/l), procalcitonin (11.57<span class="elsevierStyleHsp" style=""></span>ng/ml) and fibrinogen (703<span class="elsevierStyleHsp" style=""></span>mg/dl). Urine sediment showed no bacteriuria or leukocyturia. An emergency abdominal ultrasound was performed with no pathologically significant findings.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Clinical course</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was admitted with a diagnosis of sepsis, of probable urinary focus. Treatment with amoxicillin/clavulanic acid was switched to ceftriaxone plus amikacin. In the haemocultures done at admission, <span class="elsevierStyleItalic">Escherichia coli</span> grew with the following susceptibility pattern: sensitive to cefuroxime, ciprofloxacin, gentamicin and co-trimoxazole, intermediate sensitivity to amoxicillin/clavulanic acid and resistant to ampicillin. The uroculture was negative. In light of these results, the same treatment was continued. On the fourth day of admission, backache and fever persisted, with additional pain irradiating to the right lower limb. For this reason, an MRI of the lumbar spine was requested due to suspicion of spondylodiscitis. Findings compatible with facet joint septic arthritis with adjacent focal meningitis were observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A CT-guided puncture aspiration of the right L4–L5 facet joint was performed, collecting joint fluid, the culture of which was also positive for <span class="elsevierStyleItalic">E. coli</span>. In order to detect possible intra-abdominal foci that would explain the presence of these bacteria in the facet joint, an abdominal CT was performed, observing focal pyelonephritis in the right kidney (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient was discharged after 10 days of intravenous antibiotic treatment, showing good response thereto, receiving oral antibiotic therapy with cefuroxime plus ciprofloxacin for 30 days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Final comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Facet joint septic arthritis is a rare entity.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> Said condition forms part of the differential diagnosis of back pain and is probably being under-diagnosed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main agent implicated in this condition is <span class="elsevierStyleItalic">Staphylococcus aureus</span>; however, there have been cases published that implicate other micro-organisms, although less frequently.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4</span></a> Micro-organisms reach the joint haematogenously (occasionally due to vascular catheter infection), but has also been reported due to direct inoculation via diagnostic or therapeutic punctures, or due to proximity.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnosis of facet joint septic arthritis is a clinical, microbiological, and radiological challenge. On the one hand, it is a rare condition, with poorly orienting symptoms, and, on the other hand, the definitive microbiological diagnostic method involves invasive techniques to obtain joint fluid. Its clinical presentation is very similar to spondylitis or spondylodiscitis, with it being important to distinguish between them given the differences in treatment and prognosis. Spondylodiscitis, due to the pain and risk of instability, requires greater immobilisation and subsequent physical therapy, tending to have more complications, mainly epidural abscesses, spinal cord compression and spinal column deformities.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> In this context, the imaging techniques play a key role in reaching the definitive diagnosis. These include MRI, due to its greater sensitivity and specificity, that make it the main diagnostic method for this entity.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Treatment for this condition mainly requires use of systemic antibiotics, although in some cases severe neurological impairment can arise requiring percutaneous and/or surgical drainage.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Although this entity does not usually have a fatal outcome, it may leave permanent functional sequelae or be accompanied by systemic complications secondary to sepsis.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 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: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: León Salinas JP, Albertz Arévalo N, Belloch Ramos E, Guerrero Espejo A. Una causa inusual de dolor lumbar en paciente con sepsis. Enferm Infecc Microbiol Clin. 2017;35:536–538.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1357 "Ancho" => 1500 "Tamanyo" => 230957 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MRI of the lumbar spine consistent with facet joint septic arthritis of right L4–L5. Axial (A) and sagittal (B) T1-weighted fat-suppressed image with intravenous contrast. Axial T2-weighted image (C). Joint effusion (black arrow) and a small collection (white arrow) located behind the facet joint is observed. The adjacent paraspinal musculature shows inflammatory changes (black arrowheads). In the posterior and lateral right epidural space, a thickening and contrast enhancement is observed (white arrowhead), due to adjacent focal meningitis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 672 "Ancho" => 1500 "Tamanyo" => 141082 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abdominal CT scan showing findings consistent with right focal pyelonephritis. Axial (A) and coronal (B) image with intravenous contrast in nephrographic phase. A focal hypodensity with poorly defined borders (white arrows) is observed in the lower end of the kidney, affecting the cortex and medulla.</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" => "<span class="elsevierStyleItalic">Escherichia coli</span> septic arthritis of a lumbar facet joint following urinary tract infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.I. Herrero Herrero" 1 => "J. Garcia Aparicio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijid.2009.11.004" "Revista" => array:6 [ "tituloSerie" => "Int J Infect Dis" "fecha" => "2011" "volumen" => "15" "paginaInicial" => "e63" "paginaFinal" => "e65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21093340" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Septic arthritis of the facet joint" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Andre" 1 => "M. Pot-Vaucel" 2 => "C. Cozic" 3 => "E. Visee" 4 => "M. Morrier" 5 => "S. Varin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medmal.2015.04.001" "Revista" => array:6 [ "tituloSerie" => "Med Mal Infect" "fecha" => "2015" "volumen" => "45" "paginaInicial" => "215" "paginaFinal" => "221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25958100" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hematogenous pyogenic facet joint infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.J. Muffoletto" 1 => "L.M. Ketonen" 2 => "J.T. Mader" 3 => "W.N. Crow" 4 => "A.G. Hadjipavlou" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Spine" "fecha" => "2001" "volumen" => "26" "paginaInicial" => "1570" "paginaFinal" => "1576" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11462088" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "pii:bcr2015211135" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic septic arthritis of a lumbar facet joint associated with paraspinal abscess" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.B. Kitova-John" 1 => "A. Azim-Araghi" 2 => "F.T. Sheikh" 3 => "B.D. Kitov" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr-2014-208269" "Revista" => array:4 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2015" "volumen" => "2015" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25948848" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Septic facet joint arthritis after a corticosteroid facet injection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.N. Weingarten" 1 => "W.M. Hooten" 2 => "M.A. Huntoon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1526-4637.2006.00089.x" "Revista" => array:6 [ "tituloSerie" => "Pain Med" "fecha" => "2006" "volumen" => "7" "paginaInicial" => "52" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16533197" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utility of magnetic resonance imaging in the differential diagnosis of tubercular and pyogenic spondylodiscitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Galhotra" 1 => "T. Jain" 2 => "P. Sandhu" 3 => "V. Galhotra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0976-9668.160016" "Revista" => array:6 [ "tituloSerie" => "J Nat Sci Biol Med" "fecha" => "2015" "volumen" => "6" "paginaInicial" => "388" "paginaFinal" => "393" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26283836" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spondylodiscitis: update on diagnosis and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Gouliouris" 1 => "S.H. Aliyu" 2 => "N.M. Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Antimicrob Chemother" "fecha" => "2010" "volumen" => "65" "paginaInicial" => "11" "paginaFinal" => "24" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolated septic facet joint arthritis as a rare cause of acute and chronic low back pain – a case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Klekot" 1 => "A. Zimny" 2 => "B. Czapiga" 3 => "M. Sasiadek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pol J Radiol" "fecha" => "2012" "volumen" => "77" "paginaInicial" => "72" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23269942" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous septic arthritis of the lumbar facet caused by methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> in an otherwise healthy adolescent" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.N. Papaliodis" 1 => "T.T. Roberts" 2 => "N.G. Richardson" 3 => "J.B. Lawrence" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Orthop (Belle Mead NJ)" "fecha" => "2014" "volumen" => "43" "paginaInicial" => "325" "paginaFinal" => "327" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous pyogenic facet joint infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Narváez" 1 => "J.M. Nolla" 2 => "J.A. Narváez" 3 => "L. Martínez-Carnicero" 4 => "E. de Lama" 5 => "C. Gómez-Vaquero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2005.09.003" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2006" "volumen" => "35" "paginaInicial" => "272" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16616150" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000008/v2_201711110108/S2529993X17302083/v2_201711110108/en/main.assets" "Apartado" => array:4 [ "identificador" => "63560" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Diagnosis at first sight" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000008/v2_201711110108/S2529993X17302083/v2_201711110108/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17302083?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 233 | 7 | 240 |
| 2024 September | 280 | 30 | 310 |
| 2024 August | 244 | 14 | 258 |
| 2024 July | 224 | 9 | 233 |
| 2024 June | 170 | 5 | 175 |
| 2024 May | 183 | 7 | 190 |
| 2024 April | 245 | 9 | 254 |
| 2024 March | 215 | 9 | 224 |
| 2024 February | 249 | 3 | 252 |
| 2024 January | 251 | 10 | 261 |
| 2023 December | 258 | 6 | 264 |
| 2023 November | 281 | 7 | 288 |
| 2023 October | 291 | 9 | 300 |
| 2023 September | 255 | 3 | 258 |
| 2023 August | 234 | 7 | 241 |
| 2023 July | 236 | 4 | 240 |
| 2023 June | 255 | 5 | 260 |
| 2023 May | 282 | 7 | 289 |
| 2023 April | 218 | 4 | 222 |
| 2023 March | 260 | 4 | 264 |
| 2023 February | 222 | 5 | 227 |
| 2023 January | 203 | 9 | 212 |
| 2022 December | 156 | 19 | 175 |
| 2022 November | 210 | 10 | 220 |
| 2022 October | 173 | 7 | 180 |
| 2022 September | 182 | 13 | 195 |
| 2022 August | 173 | 7 | 180 |
| 2022 July | 148 | 11 | 159 |
| 2022 June | 131 | 7 | 138 |
| 2022 May | 127 | 6 | 133 |
| 2022 April | 112 | 11 | 123 |
| 2022 March | 144 | 6 | 150 |
| 2022 February | 183 | 5 | 188 |
| 2022 January | 241 | 7 | 248 |
| 2021 December | 181 | 15 | 196 |
| 2021 November | 204 | 11 | 215 |
| 2021 October | 201 | 8 | 209 |
| 2021 September | 160 | 10 | 170 |
| 2021 August | 160 | 7 | 167 |
| 2021 July | 232 | 11 | 243 |
| 2021 June | 174 | 11 | 185 |
| 2021 May | 315 | 8 | 323 |
| 2021 April | 398 | 27 | 425 |
| 2021 March | 258 | 12 | 270 |
| 2021 February | 175 | 9 | 184 |
| 2021 January | 204 | 11 | 215 |
| 2020 December | 228 | 8 | 236 |
| 2020 November | 531 | 12 | 543 |
| 2020 October | 470 | 8 | 478 |
| 2020 September | 189 | 12 | 201 |
| 2020 August | 200 | 8 | 208 |
| 2020 July | 189 | 12 | 201 |
| 2020 June | 167 | 10 | 177 |
| 2020 May | 180 | 10 | 190 |
| 2020 April | 250 | 5 | 255 |
| 2020 March | 357 | 8 | 365 |
| 2020 February | 299 | 6 | 305 |
| 2020 January | 301 | 2 | 303 |
| 2019 December | 235 | 10 | 245 |
| 2019 November | 214 | 4 | 218 |
| 2019 October | 218 | 2 | 220 |
| 2019 September | 180 | 6 | 186 |
| 2019 August | 195 | 4 | 199 |
| 2019 July | 215 | 4 | 219 |
| 2019 June | 272 | 33 | 305 |
| 2019 May | 371 | 20 | 391 |
| 2019 April | 218 | 11 | 229 |
| 2019 March | 138 | 2 | 140 |
| 2019 February | 118 | 4 | 122 |
| 2019 January | 84 | 1 | 85 |
| 2018 December | 42 | 2 | 44 |
| 2018 November | 40 | 5 | 45 |
| 2018 October | 39 | 7 | 46 |
| 2018 September | 37 | 4 | 41 |
| 2018 August | 50 | 0 | 50 |
| 2018 July | 12 | 2 | 14 |
| 2018 June | 5 | 0 | 5 |
| 2018 May | 4 | 1 | 5 |
| 2018 April | 10 | 0 | 10 |
| 2018 January | 9 | 0 | 9 |
| 2017 December | 11 | 2 | 13 |
| 2017 November | 18 | 2 | 20 |
| 2017 October | 19 | 3 | 22 |
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