Diagnosis at first sight
Infant with exanthema and fever
Preescolar con exantema cutáneo y fiebre
Read
3803
Timeswas read the article
565
Total PDF
3238
Total HTML
Share statistics
array:24 [ "pii" => "S2529993X18300017" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2016.07.009" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1575" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2018;36:137-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 667 "formatos" => array:2 [ "HTML" => 578 "PDF" => 89 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0213005X16302002" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2016.07.004" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1575" "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. 2018;36:137-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1893 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 1566 "PDF" => 326 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Diagnóstico a primera vista</span>" "titulo" => "Preescolar con exantema cutáneo y fiebre" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "137" "paginaFinal" => "139" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Infant with exanthema and fever" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2200 "Ancho" => 1650 "Tamanyo" => 269900 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se observan con mayor detalle la afectación a nivel de glúteos, con las lesiones vesiculosas con base eritematosa cubiertas en su mayoría por costras.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sara Barbed-Ferrández, Marta Arrudi-Moreno, Marcial Álvarez-Salafranca, Matilde Bustillo-Alonso" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Sara" "apellidos" => "Barbed-Ferrández" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Arrudi-Moreno" ] 2 => array:2 [ "nombre" => "Marcial" "apellidos" => "Álvarez-Salafranca" ] 3 => array:2 [ "nombre" => "Matilde" "apellidos" => "Bustillo-Alonso" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529993X18300017" "doi" => "10.1016/j.eimce.2016.07.009" "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/S2529993X18300017?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X16302002?idApp=UINPBA00004N" "url" => "/0213005X/0000003600000002/v2_201802071725/S0213005X16302002/v2_201802071725/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2529993X18300029" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2016.09.005" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1608" "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. 2018;36:140-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 303 "formatos" => array:2 [ "HTML" => 238 "PDF" => 65 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Diagnosis at first sight</span>" "titulo" => "Skin nodules in a liver transplant recipient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "140" "paginaFinal" => "141" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulos cutáneos en trasplantado hepático" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 713 "Ancho" => 950 "Tamanyo" => 83621 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dark cotton-like colonies in Sabouraud-dextrose agar medium after 10 days of incubation at 86<span class="elsevierStyleHsp" style=""></span>°F.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María José Blanco-Vidal, Leyre López-Soria, Araceli Monzón-de la Torre, Jose Miguel Montejo-Baranda" "autores" => array:4 [ 0 => array:2 [ "nombre" => "María José" "apellidos" => "Blanco-Vidal" ] 1 => array:2 [ "nombre" => "Leyre" "apellidos" => "López-Soria" ] 2 => array:2 [ "nombre" => "Araceli" "apellidos" => "Monzón-de la Torre" ] 3 => array:2 [ "nombre" => "Jose Miguel" "apellidos" => "Montejo-Baranda" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213005X16302890" "doi" => "10.1016/j.eimc.2016.09.009" "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/S0213005X16302890?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X18300029?idApp=UINPBA00004N" "url" => "/2529993X/0000003600000002/v2_201802191141/S2529993X18300029/v2_201802191141/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2529993X18300066" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2015.11.002" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1461" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Enferm Infecc Microbiol Clin. 2018;36:120-36" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 852 "formatos" => array:2 [ "HTML" => 699 "PDF" => 153 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Helminthosis and eosinophilia in Spain (1990–2015)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "120" "paginaFinal" => "136" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Helmintosis y eosinofilia en España (1990–2015)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1637 "Ancho" => 2337 "Tamanyo" => 185373 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Strategy for the selection of articles.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Carranza-Rodríguez, Miriam Escamilla-González, Isabel Fuentes-Corripio, María-Jesús Perteguer-Prieto, Teresa Gárate-Ormaechea, José-Luis Pérez-Arellano" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Carranza-Rodríguez" ] 1 => array:2 [ "nombre" => "Miriam" "apellidos" => "Escamilla-González" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "Fuentes-Corripio" ] 3 => array:2 [ "nombre" => "María-Jesús" "apellidos" => "Perteguer-Prieto" ] 4 => array:2 [ "nombre" => "Teresa" "apellidos" => "Gárate-Ormaechea" ] 5 => array:2 [ "nombre" => "José-Luis" "apellidos" => "Pérez-Arellano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213005X15004577" "doi" => "10.1016/j.eimc.2015.11.019" "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/S0213005X15004577?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X18300066?idApp=UINPBA00004N" "url" => "/2529993X/0000003600000002/v2_201802191141/S2529993X18300066/v2_201802191141/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Diagnosis at first sight</span>" "titulo" => "Infant with exanthema and fever" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "137" "paginaFinal" => "139" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sara Barbed-Ferrández, Marta Arrudi-Moreno, Marcial Álvarez-Salafranca, Matilde Bustillo-Alonso" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Sara" "apellidos" => "Barbed-Ferrández" "email" => array:1 [ 0 => "sarabarbed@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" => "Marta" "apellidos" => "Arrudi-Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Marcial" "apellidos" => "Álvarez-Salafranca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Matilde" "apellidos" => "Bustillo-Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Materno-Infantil Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Lozano Blesa, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Preescolar con exantema cutáneo y fiebre" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1300 "Ancho" => 1733 "Tamanyo" => 246142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Affectation of the back of the hand and lesion spread across the upper limb with distal predominance.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The hand-foot-and mouth disease is an acute viral infection characterized by fever and vesicular exanthema affecting predominantly the palms of the hands, the palms of the feet, and the oral mucose.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The isolated etiological agents most commonly associated with this disease are the coxackievirus A16 and the human enterovirus 71,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> although other enteroviruses, mainly class A, and echoviruses, have also been identified.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,5</span></a> The mechanism of transmission is fecal-oral through respiratory secretions or else, contact with the exudate of the lesions,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> since the virus replicates in the pharynx and the intestines. This disease predominantly affects kids under five (5) years of age.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Clinical case</span><p id="par0010" class="elsevierStylePara elsevierViewall">Two-year-old kid who presented to the ER with an initially perioral pruringinous exanthema of palmoplantar affectation that in a matter of a few hours invaded the gluteal region, the upper and lower limbs with distal predominance, and the auricular pavilion, with some mild affectation at abdominal level. These are vesicular lesions on an erythematous base and, on some occasions, on a purpuric base, being some of them scabs that make up plaques with isolated petechial lesions in the abdominal region. In the perioral zone, we can see lesions in the impetiginized scabies phase. For the last 48<span class="elsevierStyleHsp" style=""></span>h, the patient had a fever with maximum peaks of 101.3<span class="elsevierStyleHsp" style=""></span>°F accompanied by rhinitis and cough. The device-based systematic examination was anodyne except for the aforementioned exanthema. The patient's personal history showed the presence of poorly controlled atopic dermatitis. In an attempt to structure the filiation of the etiology of the patient's clinical manifestations, one blood test was conducted with hemogram, hemostasis, and biochemistry including infection markers and one microbiological study taking samples for blood culture and serological purposes (HBV, HCV, CMV, mycoplasma, EBV, and parvovirus). Also, one vesicular exudate was collected in order to conduct PCR analyses of enteroviruses, and skin smear to rule out bacterial infection and nasopharyngeal aspirate. Both the hemogram, and the studies of biochemistry and hemostasis conducted were anodyne, while the infection markers were discreetly high showing one PCR score of 3.22<span class="elsevierStyleHsp" style=""></span>mg/dl, and one PCT score of 0.33<span class="elsevierStyleHsp" style=""></span>ng/ml. The microbiological study only showed the isolation of the saprophytic flora (Candida parasilopsis) and the PCR analysis tested positive, which is why the sample was sent to the reference lab for its genotyping, that confirmed the presence of coxackievirus A6. Oral hydroxyzine treatment was administered plus IV amoxicillin-clavulanic acid and topical mupirocin on the superinfected lesions. During the hospital admission and subsequent office follow-ups, an adequate progression of the patient's lesions was confirmed with disappearance of these lesions leaving no visible marks and followed by furfuraceous desquamation (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–4</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comments</span><p id="par0015" class="elsevierStylePara elsevierViewall">This was a sporadic case managed at our center ER that happens to be part of the most serious and disseminated spectrum of the hand-foot-and mouth disease called “eczema coxsackium” classified from cases with similar characteristics and reported to the Centers for Disease Control and Prevention. From 2008, the coxackievirus A6, which was rare until now as the culprit in this disease, has been tagged as the etiological agent involved in these most severe episodes, initially in Western Asia and Europe and, more recently, in the United States.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">During childhood, the period that has the highest incidence rates is between 12 and 36 months of age – exactly the age of our patient, 24 months old. Clinically, and just as it has been published and reviewed in similar cases so far, the clinical manifestations are different from the classic disease in that there is greater skin damage that may include the back of hands and feet, calves, forearms, trunk, and neck, and a lower percentage of cases with intraoral affectation, as it was the case with our patient.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,7</span></a> The lesions usually coalesce making up large blistering lesions that progress into erosions and scabs. The development of perioral papulovesicular affectation has been associated with infections due to coxackievirus A6.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Same as it happens with the eczema herpeticum, in kids affected by atopic dermatitis like our case, vesicular lesions usually spread in eczematous regions.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">If we take a look at the cases reported so far, the course of this new variant is acute, benign, and similar to the typical clinical manifestations. The systemic symptoms usually disappear in a few days and the skin lesions go away, leaving no visible marks, in a matter of days or weeks.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Comments" ] 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: Barbed-Ferrández S, Arrudi-Moreno M, Álvarez-Salafranca M, Bustillo-Alonso M. Preescolar con exantema cutáneo y fiebre. Enferm Infecc Microbiol Clin. 2018;36:137–139.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2000 "Ancho" => 2667 "Tamanyo" => 463740 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) We can see elemental lesions in the form of vesicles on erythematous base making up groups, plus lesions covered by scabs. (C) We can see how the lesions spread across the lower limbs and the gluteal region with distal predominance and some of them, purpiric base.</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" => 1926 "Ancho" => 2999 "Tamanyo" => 385847 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Lesion in the perioral zone and nasal cavity covered by meliceric scabs suggestive of impetiginization. (B and D) Palmoplantar affectation. (C) Significant lesion damage to the auricular pavilion.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1300 "Ancho" => 1733 "Tamanyo" => 246142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Affectation of the back of the hand and lesion spread across the upper limb with distal predominance.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2200 "Ancho" => 1650 "Tamanyo" => 268069 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Affectation a gluteal region level with vesicular lesions of erythematous base mostly covered by scabs.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular epidemiology of enterovirus 71, <span class="elsevierStyleItalic">coxsackievirus</span> A16 and A6 associated with hand, foot and mouth disease in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Cabrerizo" 1 => "D. Tarragó" 2 => "C. Muñoz-Almagro" 3 => "E. del Amo" 4 => "M. Domínguez-Gil" 5 => "J.M. Eiros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1469-0691.12361" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "O150" "paginaFinal" => "O156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24033818" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Genetic diversity of <span class="elsevierStyleItalic">coxsackievirus</span> A16 associated with hand, foot, and mouth disease epidemics in Japan from 1983 to 2003" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Hosoya" 1 => "Y. Kawasaki" 2 => "M. Sato" 3 => "K. Honzumi" 4 => "A. Hayashi" 5 => "T. Hiroshima" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.00718-06" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2007" "volumen" => "45" "paginaInicial" => "112" "paginaFinal" => "120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17093028" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human enterovirus 71 and hand, foot and mouth disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.S. Wong" 1 => "C.C. Yip" 2 => "S.K. Lau" 3 => "K.Y. Yuen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0950268809991555" "Revista" => array:6 [ "tituloSerie" => "Epidemiol Infect" "fecha" => "2010" "volumen" => "138" "paginaInicial" => "1071" "paginaFinal" => "1089" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20056019" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical hand, foot, and mouth disease: a vesiculobullous eruption caused by <span class="elsevierStyleItalic">Coxsackie</span> virus A6" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.M. Feder Jr." 1 => "N. Bennett" 2 => "J.F. Modlin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(13)70264-0" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2014" "volumen" => "14" "paginaInicial" => "83" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24287184" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hand, foot, and mouth disease outbreak caused by <span class="elsevierStyleItalic">coxsackievirus</span> A6, China, 2013" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.F. Han" 1 => "S. Xu" 2 => "Y. Zhang" 3 => "S.Y. Zhu" 4 => "D.L. Wu" 5 => "X.D. Yang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jinf.2014.03.015" "Revista" => array:6 [ "tituloSerie" => "J Infect" "fecha" => "2014" "volumen" => "69" "paginaInicial" => "303" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24704297" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hand, foot, and mouth disease outbreak and <span class="elsevierStyleItalic">coxsackievirus</span> A6, northern Spain, 2011" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Montes" 1 => "J. Artieda" 2 => "L.D. Piñeiro" 3 => "M. Gastesi" 4 => "I. Díez-Nieves" 5 => "G. Cilla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3201/eid1904.121589" "Revista" => array:4 [ "tituloSerie" => "Emerg Infect Dis" "fecha" => "2013" "volumen" => "19" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23965613" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eczema <span class="elsevierStyleItalic">coxsackium</span> and unusual cutaneous findings in an enterovirus outbreak" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.F. Mathes" 1 => "V. Oza" 2 => "I.J. Frieden" 3 => "K.M. Cordoro" 4 => "S. Yagi" 5 => "R. Howard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2012-3175" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2013" "volumen" => "132" "paginaInicial" => "e149" "paginaFinal" => "e157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23776120" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003600000002/v2_201802191141/S2529993X18300017/v2_201802191141/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/0000003600000002/v2_201802191141/S2529993X18300017/v2_201802191141/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X18300017?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 2 | 11 |
| 2024 October | 46 | 7 | 53 |
| 2024 September | 53 | 14 | 67 |
| 2024 August | 49 | 22 | 71 |
| 2024 July | 33 | 17 | 50 |
| 2024 June | 22 | 8 | 30 |
| 2024 May | 19 | 14 | 33 |
| 2024 April | 16 | 12 | 28 |
| 2024 March | 16 | 17 | 33 |
| 2024 February | 23 | 14 | 37 |
| 2024 January | 51 | 15 | 66 |
| 2023 December | 36 | 19 | 55 |
| 2023 November | 48 | 16 | 64 |
| 2023 October | 55 | 10 | 65 |
| 2023 September | 25 | 3 | 28 |
| 2023 August | 43 | 3 | 46 |
| 2023 July | 65 | 7 | 72 |
| 2023 June | 72 | 10 | 82 |
| 2023 May | 113 | 14 | 127 |
| 2023 April | 64 | 2 | 66 |
| 2023 March | 89 | 6 | 95 |
| 2023 February | 68 | 5 | 73 |
| 2023 January | 74 | 4 | 78 |
| 2022 December | 52 | 5 | 57 |
| 2022 November | 56 | 11 | 67 |
| 2022 October | 84 | 8 | 92 |
| 2022 September | 84 | 7 | 91 |
| 2022 August | 71 | 7 | 78 |
| 2022 July | 65 | 8 | 73 |
| 2022 June | 31 | 5 | 36 |
| 2022 May | 38 | 6 | 44 |
| 2022 April | 35 | 7 | 42 |
| 2022 March | 57 | 7 | 64 |
| 2022 February | 47 | 5 | 52 |
| 2022 January | 115 | 12 | 127 |
| 2021 December | 63 | 11 | 74 |
| 2021 November | 80 | 8 | 88 |
| 2021 October | 52 | 10 | 62 |
| 2021 September | 29 | 7 | 36 |
| 2021 August | 72 | 8 | 80 |
| 2021 July | 14 | 6 | 20 |
| 2021 June | 35 | 9 | 44 |
| 2021 May | 42 | 4 | 46 |
| 2021 April | 78 | 8 | 86 |
| 2021 March | 58 | 4 | 62 |
| 2021 February | 43 | 7 | 50 |
| 2021 January | 40 | 9 | 49 |
| 2020 December | 23 | 4 | 27 |
| 2020 November | 24 | 6 | 30 |
| 2020 October | 21 | 4 | 25 |
| 2020 September | 16 | 8 | 24 |
| 2020 August | 28 | 7 | 35 |
| 2020 July | 28 | 5 | 33 |
| 2020 June | 23 | 9 | 32 |
| 2020 May | 18 | 5 | 23 |
| 2020 April | 10 | 0 | 10 |
| 2020 March | 27 | 5 | 32 |
| 2020 February | 22 | 3 | 25 |
| 2020 January | 17 | 2 | 19 |
| 2019 December | 29 | 5 | 34 |
| 2019 November | 34 | 3 | 37 |
| 2019 October | 46 | 5 | 51 |
| 2019 September | 64 | 7 | 71 |
| 2019 August | 31 | 2 | 33 |
| 2019 July | 39 | 16 | 55 |
| 2019 June | 53 | 13 | 66 |
| 2019 May | 35 | 17 | 52 |
| 2019 April | 62 | 3 | 65 |
| 2019 March | 18 | 5 | 23 |
| 2019 February | 17 | 2 | 19 |
| 2019 January | 15 | 3 | 18 |
| 2018 December | 4 | 0 | 4 |
| 2018 November | 6 | 3 | 9 |
| 2018 October | 75 | 1 | 76 |
| 2018 September | 14 | 2 | 16 |
| 2018 August | 1 | 0 | 1 |
| 2018 February | 8 | 0 | 8 |
Show all
