Scientific letter
Onychomycosis caused by algae without chlorophyll
Onicomicosis por alga sin clorofila
a Servicio de Microbiología y Control de la Infección, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
b Servicio de Microbiología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
c Servicio de Dermatología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
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Red empty circles represent all human (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) and non-human (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1) primate IbA12G3 sequences reported globally to date. Black filled circles indicate reference sequences from GenBank<span class="elsevierStyleSup">®</span>. Bootstrapping values over 50% from 1.000 replicates are shown at the branch points. The evolutionary distances were computed using the Tamura 3-parameter method. The rate variation among sites was modelled with a gamma distribution (shape parameter<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1). <span class="elsevierStyleItalic">C. parvum</span> was used as outgroup taxa.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rosario Millán, Pamela C. Köster, Isabel Fuentes, David Carmena" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Rosario" "apellidos" => "Millán" ] 1 => array:2 [ "nombre" => "Pamela C." "apellidos" => "Köster" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "Fuentes" ] 3 => array:2 [ "nombre" => "David" "apellidos" => "Carmena" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X1930053X?idApp=UINPBA00004N" "url" => "/2529993X/0000003700000004/v1_201903280610/S2529993X1930053X/v1_201903280610/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2529993X19300541" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2018.05.013" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "1873" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Enferm Infecc Microbiol Clin. 2019;37:276-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 48 "formatos" => array:2 [ "HTML" => 29 "PDF" => 19 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Diagnosis at first sight</span>" "titulo" => "Hydrocephalus and intracranial hypertension in a woman from Ecuador" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "276" "paginaFinal" => "277" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hidrocefalia e hipertensión intracraneal en una mujer de Ecuador" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 699 "Ancho" => 900 "Tamanyo" => 195237 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Photomicrograph of hematoxylin and eosin staining of extracted tissue. A microvillous tegument and a reticular matrix with calcareous bodies are detected.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier Nieto-Moragas, Cristina Carrato, Roser García-Armengol, Gema Fernández-Rivas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "Nieto-Moragas" ] 1 => array:2 [ "nombre" => "Cristina" "apellidos" => "Carrato" ] 2 => array:2 [ "nombre" => "Roser" "apellidos" => "García-Armengol" ] 3 => array:2 [ "nombre" => "Gema" "apellidos" => "Fernández-Rivas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X19300541?idApp=UINPBA00004N" "url" => "/2529993X/0000003700000004/v1_201903280610/S2529993X19300541/v1_201903280610/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Onychomycosis caused by algae without chlorophyll" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "278" "paginaFinal" => "279" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Sante, Milagros Cuervo, Ana de Andrés del Rosario, María Lecuona" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Laura" "apellidos" => "Sante" "email" => array:1 [ 0 => "laurasante@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" => "Milagros" "apellidos" => "Cuervo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Ana" "apellidos" => "de Andrés del Rosario" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "María" "apellidos" => "Lecuona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Microbiología y Control de la Infección, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Onicomicosis por alga sin clorofila" ] ] "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" => 1089 "Ancho" => 800 "Tamanyo" => 57504 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Prototheca wickerhamii</span>. Rough, beige colonies with a yeast-like appearance.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The genus <span class="elsevierStyleItalic">Prototheca</span> are algae without chlorophyll, and are found ubiquitously in environmental sources such as plants, waters and animals.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The species most commonly isolated is <span class="elsevierStyleItalic">Prototheca wickerhamii</span>.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">P. wickerhamii</span> rarely causes infections in humans. Infections have been reported mainly in nails,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> skin and subcutaneous tissues,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> although cases of peritonitis<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and meningitis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> have also been described. They particularly affect patients with diabetes,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> patients with HIV<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> and transplant patients.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Treatment usually involves a medical and surgical approach,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> but debate surrounds the drug treatment. There are no published prospective clinical studies comparing specific treatments for protothecosis and, although various regimens have been tried, there has been no consistency in clinical responses. The most commonly used antifungals are azoles, itraconazole and amphotericin B in particular, with amphotericin B displaying the best activity.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The <span class="elsevierStyleItalic">Prototheca</span> spp. cell wall is rich in ergosterol, and it is thought that the efficacy of these antifungals lies in their ability to inhibit ergosterol.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a> However, no cut-off points have been established for the interpretation of in vitro sensitivity. As the minimum inhibitory concentration (MIC) determination tests are not always reproducible, and the results are not always correlated with clinical success, performing sensitivity tests is only recommended in cases of treatment failure, not routinely.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 57-year-old male patient with a history of hypertension, dyslipidaemia, obesity, venous insufficiency, lymphoedema and allergy to mites, under follow-up since 2014 due to repeated outbreaks of stasis eczema in the lower limbs, where he has also had venous ulcers for years which have been become infected on multiple occasions. The patient had suffered severe flare-ups of atopic dermatitis in its atopic context which at the time of presentation were well controlled with azathioprine 100<span class="elsevierStyleHsp" style=""></span>mg/day, after previously requiring repeated courses of oral and topical corticosteroids. He attended the clinic with a 2–3 week history of a slightly pruritic lesion on the back of his right hand. Examination revealed an annular-shaped, scaly plaque with a maximum diameter of about 3<span class="elsevierStyleHsp" style=""></span>cm, with centrifugal growth, central clearance with erythematous edges, and peripheral pustules. It did not give the impression of a staphylococcal infection as it lacked suppuration or characteristic impetiginised scabs. We did not consider it to be tuberculosis of the skin, as it does not present in this way and is usually accompanied by lymphadenopathy (moreover QuantiFERON<span class="elsevierStyleSup">®</span> and Mantoux were negative). We also ruled out atypical mycobacteriosis, as it develops with nodular lesions or erythematous-desquamative plaques that grow progressively without central clearance. Coccidioidomycosis was excluded as it consists of an ulcerated, indurated nodule, often accompanied by secondary nodules. Sporotrichosis and leishmaniasis were ruled out due to no history of trauma or being stung respectively. The clinical diagnosis of non-inflammatory dermatomycosis was based on the shape of the lesion and its recent onset. This circinate shape is a result of the depletion of keratin from the centre of the lesion and its peripheral spread. Once the differential diagnosis was made, flakes were taken for mycological culture and we prescribed terbinafine 250<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h and ciclopirox cream every 12<span class="elsevierStyleHsp" style=""></span>h for one month.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The flakes were seeded on Sabouraud-chloramphenicol agar (bioMérieux) and on a home-made medium of malt extract agar and incubated at 30<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span> for 30 days. Three weeks later rough, beige colonies with a yeast-like appearance were observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). They were identified by VITEK<span class="elsevierStyleSup">®</span> 2 System (bioMérieux) and MALDI-TOF VITEK<span class="elsevierStyleSup">®</span> MS (bioMérieux) with both obtaining the result of <span class="elsevierStyleItalic">P. wickerhamii</span>. One month later there were no signs of lesion when the patient attended for follow-up. Although the treatment prescribed for this case was not that of choice (due to the treatment with lipid-lowering agents and azathioprine, azoles were avoided to reduce the risk of interactions), the tinea was eradicated. Like azoles or amphotericin B, terbinafine causes a decrease in ergosterol; in this case, by inhibiting squalene epoxidase in the cell membrane.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The lack of literature and of cut-off points for the sensitivity of antifungals underline the need for further studies to investigate treatments for this type of infection.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Prototheca</span> species cause a wide range of infections in humans. These infections can occur in both immunocompetent and immunosuppressed patients, although the most severe and widespread infections usually occur in immunocompromised individuals. In view of their similar appearance to yeasts in routine media, but with very different implications for prognosis and treatment, both clinicians and microbiologists have to be aware of these organisms and work together to ensure that they are correctly diagnosed and the proper treatment provided.</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: Sante L, Cuervo M, de Andrés del Rosario A, Lecuona M. Onicomicosis por alga sin clorofila. Enferm Infecc Microbiol Clin. 2019;37:278–279.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1089 "Ancho" => 800 "Tamanyo" => 57504 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Prototheca wickerhamii</span>. Rough, beige colonies with a yeast-like appearance.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human protothecosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Lass-Flörl" 1 => "A. Mayr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/CMR.00032-06" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Rev" "fecha" => "2007" "volumen" => "20" "paginaInicial" => "230" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17428884" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Onychoprotothecosis: an uncommon presentation of protothecosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.R. Gandham" 1 => "C.R. Vyawahare" 2 => "N. Chaudhaury" 3 => "R.A. Shinde" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0255-0857.158583" "Revista" => array:6 [ "tituloSerie" => "Indian J Med Microbiol" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "435" "paginaFinal" => "437" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26068353" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protothecosis: an unusual cause of chronic subcutaneous and soft tissue infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.V. Wals" 1 => "R.A. Jonson" 2 => "S.R. Tahan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "1998" "volumen" => "20" "paginaInicial" => "379" "paginaFinal" => "382" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9700377" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Prototheca wickerhami</span> peritonitis in patients on peritoneal dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Pérez Melón" 1 => "M. Camba" 2 => "A. Tinajas" 3 => "A. Otero" 4 => "A. Iglesias" 5 => "E. Armada" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2007" "volumen" => "27" "paginaInicial" => "81" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17402885" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primer aislamiento clínico de <span class="elsevierStyleItalic">Proththeca wickerhamii</span> en Costa Rica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.L. Herrera" 1 => "A. Vargas" 2 => "M. Campos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Med Hosp Nac Niños (Costa Rica)" "fecha" => "1998" "volumen" => "33" "paginaInicial" => "25" "paginaFinal" => "27" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uncommon fungi isolated from diabetic patients toenails with or without visible onychomycoses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. González-Avila" 1 => "J.V. Gómez-Gómez" 2 => "A.P. Texis" 3 => "J.L. Imbert-Palafox" 4 => "M.A. Becerril-Flores" 5 => "J.L. Blasco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11046-011-9417-7" "Revista" => array:6 [ "tituloSerie" => "Mycopathologia" "fecha" => "2011" "volumen" => "172" "paginaInicial" => "207" "paginaFinal" => "213" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21512855" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous protothecosis in an AIDS patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Piyophirapong" 1 => "R. Linpiyawan" 2 => "P. Mahaisavariya" 3 => "C. Muanprasat" 4 => "A. Chaiprasert" 5 => "P. Suthipinittharm" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2002" "volumen" => "146" "paginaInicial" => "713" "paginaFinal" => "715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11966718" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Prototheca wickerhamii</span> algaemia: an emerging infection in solid organ transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.D. Bandaranayake" 1 => "A. Paniz Mondolfi" 2 => "D.R. Peaper" 3 => "M.F. Malinis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/tid.12407" "Revista" => array:6 [ "tituloSerie" => "Transpl Infect Dis" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "599" "paginaFinal" => "604" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26040253" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protothecosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.M. Kantrow" 1 => "A.S. Boyd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Clin" "fecha" => "2003" "volumen" => "21" "paginaInicial" => "249" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12757247" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicóticos dermatológicos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Martín-Aragón" 1 => "J. Benedí" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Farmacia Profesional" "fecha" => "2004" "volumen" => "18" "paginaInicial" => "38" "paginaFinal" => "49" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003700000004/v1_201903280610/S2529993X19300474/v1_201903280610/en/main.assets" "Apartado" => array:4 [ "identificador" => "63562" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003700000004/v1_201903280610/S2529993X19300474/v1_201903280610/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X19300474?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 1 | 7 |
| 2024 October | 16 | 9 | 25 |
| 2024 September | 18 | 11 | 29 |
| 2024 August | 19 | 8 | 27 |
| 2024 July | 14 | 17 | 31 |
| 2024 June | 19 | 3 | 22 |
| 2024 May | 5 | 4 | 9 |
| 2024 April | 13 | 8 | 21 |
| 2024 March | 24 | 6 | 30 |
| 2024 February | 39 | 1 | 40 |
| 2024 January | 20 | 2 | 22 |
| 2023 December | 28 | 4 | 32 |
| 2023 November | 46 | 3 | 49 |
| 2023 October | 48 | 1 | 49 |
| 2023 September | 27 | 1 | 28 |
| 2023 August | 17 | 3 | 20 |
| 2023 July | 25 | 3 | 28 |
| 2023 June | 33 | 4 | 37 |
| 2023 May | 47 | 8 | 55 |
| 2023 April | 45 | 3 | 48 |
| 2023 March | 43 | 7 | 50 |
| 2023 February | 29 | 2 | 31 |
| 2023 January | 74 | 45 | 119 |
| 2022 December | 29 | 7 | 36 |
| 2022 November | 22 | 3 | 25 |
| 2022 October | 16 | 5 | 21 |
| 2022 September | 7 | 4 | 11 |
| 2022 August | 13 | 4 | 17 |
| 2022 July | 12 | 6 | 18 |
| 2022 June | 12 | 6 | 18 |
| 2022 May | 13 | 5 | 18 |
| 2022 April | 14 | 6 | 20 |
| 2022 March | 16 | 6 | 22 |
| 2022 February | 8 | 5 | 13 |
| 2022 January | 17 | 7 | 24 |
| 2021 December | 15 | 10 | 25 |
| 2021 November | 39 | 6 | 45 |
| 2021 October | 18 | 16 | 34 |
| 2021 September | 13 | 6 | 19 |
| 2021 August | 25 | 9 | 34 |
| 2021 July | 18 | 10 | 28 |
| 2021 June | 10 | 7 | 17 |
| 2021 May | 19 | 6 | 25 |
| 2021 April | 19 | 15 | 34 |
| 2021 March | 16 | 9 | 25 |
| 2021 February | 6 | 6 | 12 |
| 2021 January | 12 | 10 | 22 |
| 2020 December | 8 | 5 | 13 |
| 2020 November | 13 | 7 | 20 |
| 2020 October | 13 | 3 | 16 |
| 2020 September | 8 | 7 | 15 |
| 2020 August | 11 | 8 | 19 |
| 2020 July | 17 | 6 | 23 |
| 2020 June | 7 | 4 | 11 |
| 2020 May | 8 | 10 | 18 |
| 2020 April | 5 | 7 | 12 |
| 2020 March | 16 | 3 | 19 |
| 2020 February | 10 | 1 | 11 |
| 2020 January | 9 | 2 | 11 |
| 2019 December | 10 | 7 | 17 |
| 2019 November | 8 | 2 | 10 |
| 2019 October | 7 | 2 | 9 |
| 2019 May | 2 | 0 | 2 |
| 2019 April | 5 | 0 | 5 |
| 2019 March | 1 | 0 | 1 |
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