Diagnosis at first sight
An unusual presentation of uveitis in a HIV-infected late presenter patient
Presentación inusual de uveítis en un paciente HIV late presenter
a Microbiology Department, Clinical Laboratory North Metropolitan Area, Hospital Universitari Germans Trias i Pujol, “Department of Genetics and Microbiology”, Universitat Autònoma de Barcelona, Badalona, Spain
b Ophthalmology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
c Pathology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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(b) Detail of the widespread growth of cells with little cytoplasm and granular chromatin nucleus with abundant mitosis and apoptosis. (c) Widespread positive Ck20 staining shown by paranuclear “dots” (Cytokeratin-20 ×400). (d). Ki67 staining showing elevated proliferation activity of around 80% (Ki67 ×400).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta E. Álvarez-Argüelles, Susana Rojo Alba, Blanca Vivanco Allende, Santiago Melón García" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marta E." "apellidos" => "Álvarez-Argüelles" ] 1 => array:2 [ "nombre" => "Susana" "apellidos" => "Rojo Alba" ] 2 => array:2 [ "nombre" => "Blanca" "apellidos" => "Vivanco Allende" ] 3 => array:2 [ "nombre" => "Santiago" "apellidos" => "Melón García" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X2030037X?idApp=UINPBA00004N" "url" => "/2529993X/0000003800000003/v1_202003050625/S2529993X2030037X/v1_202003050625/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2529993X20300356" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2019.07.005" "estado" => "S300" "fechaPublicacion" => "2020-03-01" "aid" => "2056" "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. 2020;38:132-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Diagnosis at first sight</span>" "titulo" => "Lung nodules and retinal lesions in an immunocompromised patient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "132" "paginaFinal" => "134" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulos pulmonares y lesiones retinianas en una paciente inmunocomprometida" ] ] "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" => 2061 "Ancho" => 2508 "Tamanyo" => 450262 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Radiologic findings. (A) Chest CT scan. Bilateral ground-glass opacifications, with nodules and consolidations in the right lung (white arrowheads). (B) Abdomen CT scan. Liver with well-defined, hypodense round lesions suggestive of abscesses (black arrowheads). (C) Brain MRI, T1 weighted sequence. Multiple brain abscesses, a small pontine lesion (white arrowheads), and (D) an intra-axial lesion in the left hemisphere, with a well-defined ring-enhancing wall and surrounding edema, that measure 18<span class="elsevierStyleHsp" style=""></span>mm in diameter (white arrowheads).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Oscar Morado-Aramburo, Brenda G. Delgado-Ávila, Sergio A. Calderón-Campas, Laura M. Badel-Ramos" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Oscar" "apellidos" => "Morado-Aramburo" ] 1 => array:2 [ "nombre" => "Brenda G." "apellidos" => "Delgado-Ávila" ] 2 => array:2 [ "nombre" => "Sergio A." "apellidos" => "Calderón-Campas" ] 3 => array:2 [ "nombre" => "Laura M." "apellidos" => "Badel-Ramos" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X20300356?idApp=UINPBA00004N" "url" => "/2529993X/0000003800000003/v1_202003050625/S2529993X20300356/v1_202003050625/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Diagnosis at first sight</span>" "titulo" => "An unusual presentation of uveitis in a HIV-infected late presenter patient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "135" "paginaFinal" => "137" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gema Fernández-Rivas, Pablo Diaz-Aljaro, Marta Ávila, Susana Ruiz-Bilbao" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Gema" "apellidos" => "Fernández-Rivas" "email" => array:1 [ 0 => "gemafrivas@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pablo" "apellidos" => "Diaz-Aljaro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Marta" "apellidos" => "Ávila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Susana" "apellidos" => "Ruiz-Bilbao" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Microbiology Department, Clinical Laboratory North Metropolitan Area, Hospital Universitari Germans Trias i Pujol, “Department of Genetics and Microbiology”, Universitat Autònoma de Barcelona, Badalona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Ophthalmology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Pathology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presentación inusual de uveítis en un paciente HIV late presenter" ] ] "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" => 1880 "Ancho" => 2501 "Tamanyo" => 330852 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Forty-eight hours after onset of symptoms, bilateral hypopion (LE hypopion movement after AC tap) and dense vitritis. Visual acuity RE 20/100 LE Hand motion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case description</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 41-year-old woman from Colombia was recently diagnosed with HIV-1 infection. A co-formulated antiretroviral treatment started when her CD4+ count was 13<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">3</span> (1.4%) and the HIV-1 viral load was 2,800,289<span class="elsevierStyleHsp" style=""></span>copies/ml.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In March 2017, the patient was admitted to the Emergency Department (ED) because she had dyspnea, fatigue and fever (39<span class="elsevierStyleHsp" style=""></span>°C). Thorax radiography revealed a multiple bilateral pulmonary interstitial and nodular pattern. A polymerase chain reaction (PCR) in plasma for cytomegalovirus (CMV) with 26,485<span class="elsevierStyleHsp" style=""></span>copies/ml and culture for <span class="elsevierStyleItalic">Mycobacterium avium</span> (MAC) in bone marrow aspirate were found positive. Therapy with gancyclovir, ethambutol, rifabutin and clarithromycin was started showing good clinical response. Nevertheless, the patient developed a unilateral peripheral CMV retinitis, and intravitreal foscarnet was therefore associated. The patient has a favorable clinical outcome and she was discharged after 45 days.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In October 2017, the patient was seen in the Ophthalmology ED for sudden bilateral blurring of vision, eye redness and ocular pain in both eyes. At this moment her CD4+ count was 165<span class="elsevierStyleHsp" style=""></span>cells/μl and her plasma viral load was undetectable (<50<span class="elsevierStyleHsp" style=""></span>copies/ml). The ophthalmologic exploration revealed a bilateral vitritis with no focus of chorioretinitis or vasculitis. The rifabutin based treatment for MAC was stopped and topical therapy with dexamethasone plus cycloplegic was started. After 24<span class="elsevierStyleHsp" style=""></span>h, visual acuity decreased in patient's right eye and bilateral hypopyon was appeared with increased vitritis in both eyes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Evolution</span><p id="par0020" class="elsevierStylePara elsevierViewall">Anterior chamber (AC) paracentesis was performed and samples were sent to the Pathology and Microbiology Department. Bacteriological and mycological cultures were negative after 48<span class="elsevierStyleHsp" style=""></span>h and 30 days of incubation respectively. In the Pathology Department two cytospin preparations were stained with Papanicolau and Giemsa stain respectively. In both smears, numerous polymorphonuclear leukocytes and macrophages were observed, but only in the Papanicolau stain a significant amount of spores consistent with microsporidia were observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). These findings were compatible with the acute infectious/inflammatory process.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A second AC paracentesis was performed for the detection of <span class="elsevierStyleItalic">Toxoplasma gondii</span> by PCR (RealCycler <span class="elsevierStyleItalic">T. gondii</span>, Valencia, Spain), which yielded negative result. A specific PCR for microsporidia (aqueous humor “in house” PCR) was positive, reinforcing the presence of microsporidia spores. Thereafter, albendazole 400<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h was administered for 7 days regressing both redness and ocular pain. However, visual acuity did not improve because of anterior segment inflammation and dense vitritis; therefore, oral and topic steroids were administered. After 6 weeks of albendazole plus dexamethasone and cycloplegic eye drops and 4 weeks of associated oral prednisone, the patient's visual function improved following her 5th month check up. Other opportunistic infections, inflammatory diseases related to HLA B27/B5 and pharmacology adverse reactions, were ruled out.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">In HIV patients a wide spectrum of differential diagnosis ought to be considered when uveitis appers with hypopion. Pharmacologic causes must be considered, as rifabutin bilateral associated-uveitis<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> is a well-known entity. In this case, symptoms did not resolve after suspension of rifabutin.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Differential diagnosis of posterior infectious uveitis should be ruled out in an immunocompromised patient: toxoplasmosis and CMV are the most frequent, although herpes zoster and herpes simplex virus play a role as well. Tuberculosis or serpiginous like chorioretinopathy and syphilis should equally be taken into account.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Recognized forms of uveitis include intraocular inflammations with occur during or following some emerging infectious diseases: Chikungunya fever, dengue, Zika or Ebola virus disease.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Microsporidiosis has been identified in immunocompromised and immunocompetent hosts.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Different species of microsporidia were involved with a broad range of clinical presentations (diarrhea, keratoconjuctivitis, disseminated disease…). Microsporidia are intracellular spore forming ubiquitous funguses with a controversial taxonomy.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ocular involvement with punctuate/stromal keratitis has been reported due to several risk factors.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Save where uveal involvement has been described in animals,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> to the best of our knowledge, this is the first case in an HIV patient. Only one case has been reported in an immunocompetent patient concerning uveal involvement.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">During the diagnostic process of uveitis, the aqueous humor analysis is mandatory to diagnose of infectious uveitis. A pars plana vitrectomy (PPV) is mainly valuable for diagnosing lymphoma and non-infectious uveitis of unknown cause.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Microsporidiosis detection is challenging and usually remains underdiagnosed. Laboratories should be alerted to the suspected diagnosis, and specific stains (periodic acid-Schiff, silver, Giemsa, acid-fast stains, modified Gram chromotrope and modified trichrome stains)<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> should be performed to identify spore-forming shapes, since routine parasites or fungal examination does not detect microsporidia. Immunofluorescence assays or molecular methods are also useful but they are still not commercialized. PCR assays for detection and identification of microsporidia species have been developed,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> although they are only performed in specialized laboratories.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Albendazole is effective against microsporidia. The treatment usually lasts for approximately four weeks. In case of confirmed ocular microsporidiosis, urine and respiratory samples should be examinated.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from fundingagencies in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Evolution" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Funding" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 5 => array:2 [ "identificador" => "xack453237" "titulo" => "Acknowledgments" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "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" => 1880 "Ancho" => 2501 "Tamanyo" => 330852 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Forty-eight hours after onset of symptoms, bilateral hypopion (LE hypopion movement after AC tap) and dense vitritis. Visual acuity RE 20/100 LE Hand motion.</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" => 962 "Ancho" => 2501 "Tamanyo" => 220584 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Acute inflammatory response intermixed with macrophagues to Microsporidia infection (Papanicolau stain; 40×). B, Microsporidia forms (Papanicolau stain; 100×).</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" => "Determinants of rifabutin-associated uveitis in patients treated with rifabutin, clarIthromycin, and ethambutol for <span class="elsevierStyleItalic">Mycobacterium avium</span> complex bacteria: a multivariate analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.D. Shafran" 1 => "J. Singer" 2 => "D.P. Zarowny" 3 => "J. Deschenes" 4 => "P. 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Chiodini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/jmm.0.026781-0" "Revista" => array:5 [ "tituloSerie" => "J Med Microbiol" "fecha" => "2011" "volumen" => "60" "paginaInicial" => "459" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21183599" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack453237" "titulo" => "Acknowledgments" "texto" => "<p id="par0070" class="elsevierStylePara elsevierViewall">We gratefully acknowledge Boris Revollo from the Infectious Diseases Department of the Germans Trias i Pujol Hspital and Fernando Izquierdo and Ángela Magnet from the Parasitology Department of the San Pablo CEU University (Madrid) for the technical support and the performance of the molecular techniques.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003800000003/v1_202003050625/S2529993X20300368/v1_202003050625/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/0000003800000003/v1_202003050625/S2529993X20300368/v1_202003050625/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X20300368?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 34 | 11 | 45 |
| 2024 September | 29 | 11 | 40 |
| 2024 August | 50 | 6 | 56 |
| 2024 July | 39 | 4 | 43 |
| 2024 June | 20 | 4 | 24 |
| 2024 May | 31 | 4 | 35 |
| 2024 April | 32 | 4 | 36 |
| 2024 March | 37 | 5 | 42 |
| 2024 February | 29 | 3 | 32 |
| 2024 January | 31 | 4 | 35 |
| 2023 December | 44 | 9 | 53 |
| 2023 November | 39 | 4 | 43 |
| 2023 October | 61 | 1 | 62 |
| 2023 September | 34 | 1 | 35 |
| 2023 August | 32 | 2 | 34 |
| 2023 July | 29 | 6 | 35 |
| 2023 June | 43 | 1 | 44 |
| 2023 May | 64 | 0 | 64 |
| 2023 April | 30 | 0 | 30 |
| 2023 March | 52 | 5 | 57 |
| 2023 February | 27 | 1 | 28 |
| 2023 January | 27 | 5 | 32 |
| 2022 December | 33 | 5 | 38 |
| 2022 November | 36 | 6 | 42 |
| 2022 October | 41 | 4 | 45 |
| 2022 September | 42 | 17 | 59 |
| 2022 August | 29 | 12 | 41 |
| 2022 July | 29 | 4 | 33 |
| 2022 June | 24 | 4 | 28 |
| 2022 May | 20 | 8 | 28 |
| 2022 April | 37 | 12 | 49 |
| 2022 March | 42 | 9 | 51 |
| 2022 February | 31 | 3 | 34 |
| 2022 January | 45 | 7 | 52 |
| 2021 December | 28 | 7 | 35 |
| 2021 November | 44 | 7 | 51 |
| 2021 October | 30 | 10 | 40 |
| 2021 September | 32 | 11 | 43 |
| 2021 August | 27 | 6 | 33 |
| 2021 July | 13 | 4 | 17 |
| 2021 June | 20 | 9 | 29 |
| 2021 May | 20 | 11 | 31 |
| 2021 April | 63 | 14 | 77 |
| 2021 March | 20 | 7 | 27 |
| 2021 February | 10 | 12 | 22 |
| 2021 January | 15 | 10 | 25 |
| 2020 December | 10 | 6 | 16 |
| 2020 November | 9 | 1 | 10 |
| 2020 October | 8 | 3 | 11 |
| 2020 September | 7 | 6 | 13 |
| 2020 August | 2 | 0 | 2 |
| 2020 March | 1 | 0 | 1 |
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