Note
Fungal peritonitis by Thermoascus crustaceus in a peritoneal dialysis patient from Chile
Peritonitis fúngica por Thermoascus crustaceus en un paciente en diálisis peritoneal de Chile
Read
4329
Timeswas read the article
811
Total PDF
3518
Total HTML
Share statistics
array:23 [ "pii" => "S1130140617300499" "issn" => "11301406" "doi" => "10.1016/j.riam.2017.01.004" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "440" "copyright" => "Asociación Española de Micología" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Iberoam Micol. 2017;34:225-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 944 "formatos" => array:3 [ "EPUB" => 31 "HTML" => 692 "PDF" => 221 ] ] "itemSiguiente" => array:18 [ "pii" => "S113014061730058X" "issn" => "11301406" "doi" => "10.1016/j.riam.2017.02.007" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "445" "copyright" => "Asociación Española de Micología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Iberoam Micol. 2017;34:229-32" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 788 "formatos" => array:3 [ "EPUB" => 35 "HTML" => 492 "PDF" => 261 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Note</span>" "titulo" => "Disseminated <span class="elsevierStyleItalic">Cryptococcus deuterogattii</span> (AFLP6/VGII) infection in an Arabian horse from Dubai, United Arab Emirates" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "229" "paginaFinal" => "232" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección diseminada por <span class="elsevierStyleItalic">Cryptococcus deuterogattii</span> (AFLP6/VGII) en un caballo árabe en Dubái, Emiratos Árabes Unidos" ] ] "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" => 3486 "Ancho" => 3265 "Tamanyo" => 1496143 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">MLST phylogenetic analysis. The optimal neighbor-joining phylogenetic tree is built from a 1000× bootstrap analysis; bootstrap values ≥75 are shown next to the branches. The equine isolate MB4219 and the closely related human isolate CBS12984 are identified as such by symbols.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jörg Kinne, Marina Joseph, Ulrich Wernery, Nora Nogradi, Ferry Hagen" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Jörg" "apellidos" => "Kinne" ] 1 => array:2 [ "nombre" => "Marina" "apellidos" => "Joseph" ] 2 => array:2 [ "nombre" => "Ulrich" "apellidos" => "Wernery" ] 3 => array:2 [ "nombre" => "Nora" "apellidos" => "Nogradi" ] 4 => array:2 [ "nombre" => "Ferry" "apellidos" => "Hagen" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S113014061730058X?idApp=UINPBA00004N" "url" => "/11301406/0000003400000004/v1_201711120057/S113014061730058X/v1_201711120057/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1130140617300633" "issn" => "11301406" "doi" => "10.1016/j.riam.2017.03.007" "estado" => "S300" "fechaPublicacion" => "2017-10-01" "aid" => "450" "copyright" => "Asociación Española de Micología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Iberoam Micol. 2017;34:220-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2218 "formatos" => array:3 [ "EPUB" => 38 "HTML" => 1636 "PDF" => 544 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Evaluación del efecto tóxico de hongos Basidiomycota en la eclosión de quistes de <span class="elsevierStyleItalic">Artemia franciscana</span>" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "220" "paginaFinal" => "224" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Evaluation of the toxicity of Basidiomycota fungi on the hatching of <span class="elsevierStyleItalic">Artemia franciscana</span> cysts" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 983 "Ancho" => 1682 "Tamanyo" => 84444 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mortalidad de los quistes de <span class="elsevierStyleItalic">Artemia franciscana</span> por diferentes extractos acuosos de <span class="elsevierStyleItalic">Amanita muscaria</span>, <span class="elsevierStyleItalic">Hygrophoropsis aurantiaca</span>, <span class="elsevierStyleItalic">Lactarius smithii</span> y <span class="elsevierStyleItalic">Leucopaxillus amarus</span>. Concentración del extracto en escala logarítmica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Eduardo Ruiz-González, Juan Antonio Vázquez-Zea, Fernando Vega-Villasante, Laura Guzmán-Dávalos, Saúl Rogelio Guerrero-Galván" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Luis Eduardo" "apellidos" => "Ruiz-González" ] 1 => array:2 [ "nombre" => "Juan Antonio" "apellidos" => "Vázquez-Zea" ] 2 => array:2 [ "nombre" => "Fernando" "apellidos" => "Vega-Villasante" ] 3 => array:2 [ "nombre" => "Laura" "apellidos" => "Guzmán-Dávalos" ] 4 => array:2 [ "nombre" => "Saúl Rogelio" "apellidos" => "Guerrero-Galván" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140617300633?idApp=UINPBA00004N" "url" => "/11301406/0000003400000004/v1_201711120057/S1130140617300633/v1_201711120057/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Note</span>" "titulo" => "Fungal peritonitis by <span class="elsevierStyleItalic">Thermoascus crustaceus</span> in a peritoneal dialysis patient from Chile" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "225" "paginaFinal" => "228" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Eduardo Alvarez, Alvaro Castillo, Isabel Iturrieta" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Eduardo" "apellidos" => "Alvarez" "email" => array:1 [ 0 => "ealvarezd@med.uchile.cl" ] "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" => "Alvaro" "apellidos" => "Castillo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Isabel" "apellidos" => "Iturrieta" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Mycology Unit/Filamentous Fungi – Biomedical Sciences Institute – Microbiology and Mycology Program – Universidad de Chile, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital San Juan de Dios, La Serena, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad Católica del Norte, La Serena, Chile" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Universidad Pedro de Valdivia, La Serena, Chile" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Peritonitis fúngica por <span class="elsevierStyleItalic">Thermoascus crustaceus</span> en un paciente en diálisis peritoneal de Chile" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2939 "Ancho" => 2333 "Tamanyo" => 621895 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Thermoascus crustaceus</span> ChFC (Chilean Fungal Collection)144. (A) Macroscopic appearance on Potato Dextrose Agar; (B) chains of smooth-walled conidia and phialides; (C) chain of conidia; (D) asci; (E) echinulate ascospores; (F) ascocarp.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 83-year-old female patient, with a history of cholecystectomy, hernia repair, and hip and knee osteoarthritis was admitted to our hospital. In 1990 a parathyroidectomy was performed, evolving with postoperative hypoparathyroidism, which was treated with calcitriol and oral calcium. Moreover, the patient had a history of severe arterial hypertension since 1992, managed with diuretics, calcium channel blockers and angiotensin-converting enzyme inhibitors. In 1995 the patient developed chronic renal failure. After 10 years she progressed to chronic kidney disease stage 5, opting for peritoneal dialysis. A Tenkhoff catheter was put in 2002. During the first 2 years of peritoneal dialysis the patient developed two episodes of Gram-positive bacterial peritonitis, both completely cured.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In 2012, a permanent pacemaker was implanted due to symptomatic congenital atrioventricular block. In addition, a new bacterial peritonitis due to <span class="elsevierStyleItalic">Corynebacterium</span> spp. was observed. The patient was successfully treated.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On January 2014 the patient presented with pain and cloudy peritoneal fluid. The study of the dialysate fluid showed 80 white blood cells/mm<span class="elsevierStyleSup">3</span>. No differential count was performed. Bacterial cultures were negative after 7 days of incubation at 37<span class="elsevierStyleHsp" style=""></span>°C. The patient received routine intraperitoneal antibiotics.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In June 2014, after a mild story of two months of intermittent fever peaking mainly in the evening, with occasional cloudy effluent outlet, new microbiological studies were performed. Clinically, the patient presented no abdominal pain. Again, bacterial cultures were negative after 7 days of incubation. Gram staining did not show any microbiological evidence. However, dialysate fluid cytology showed 260 white blood cells/mm<span class="elsevierStyleSup">3</span> (68% mononuclear cells). In addition, blood culture bottles inoculated with peritoneal fluid, indicated the presence of fungal growth. Growth on Sabouraud Dextrose Agar (SDA) showed the presence of yellow-light brown colonies. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the radiographic findings.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Antifungal treatment was started with intraperitoneal amphotericin B 50<span class="elsevierStyleHsp" style=""></span>mg/day for 20 days. The patient completed 10 days of treatment after which the indwelling Tenckhoff catheter was removed. Following antifungal treatment, the patient was discharged in good condition.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Mycological studies</span><p id="par0030" class="elsevierStylePara elsevierViewall">The isolate was referred to the Fungal Reference Centre at Universidad de Chile. The mould was cultured on Potato Dextrose Agar (PDA) and Corn Meal Agar (CMA) for 5 days at 25<span class="elsevierStyleHsp" style=""></span>°C and 37<span class="elsevierStyleHsp" style=""></span>°C. The growth of the isolate on PDA (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A) and CMA revealed colonies that were initially flat and buff coloured but that quickly (within 6 days) became yellowish orange with a brownish yellow reverse. Sparse conidial structures of the anamorph <span class="elsevierStyleItalic">Paecilomyces</span> were evident in 3–4 days at 25<span class="elsevierStyleHsp" style=""></span>°C on PDA and CMA. Branched conidiophores measuring between 350 and 400<span class="elsevierStyleHsp" style=""></span>μm were observed. Conidia were elliptical to subglobose, approximately 7–7.8 by 4.5–5.3<span class="elsevierStyleHsp" style=""></span>μm, smooth-walled in long chains (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B and C). In order to induce the formation of sexual stage, additional subcultures onto malt extract agar (MEA) (Becton Dickinson) at 37<span class="elsevierStyleHsp" style=""></span>°C were performed. Colonies on MEA became brown-orange and granular to crust-like with a brownish orange reverse. Subspherical, nonostiolate ascomata occurred within 7 days and contained asci that were approximately 600 by 750<span class="elsevierStyleHsp" style=""></span>μm (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D). Ascospores were elliptical, pale yellow, thick walled, approximately 4–5 by 6.5–7<span class="elsevierStyleHsp" style=""></span>μm, and predominately echinulate by light microscopy (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>E). Temperature studies were also performed by inoculating five plates of MEA in duplicate with a 1<span class="elsevierStyleHsp" style=""></span>mm portion of the isolate. Plates were incubated at 15, 25, 37, and 42<span class="elsevierStyleHsp" style=""></span>°C for 6 days, and zone sizes were measured. Optimal growth was observed at 37<span class="elsevierStyleHsp" style=""></span>°C. The ascocarp formation occurred mainly at 37<span class="elsevierStyleHsp" style=""></span>°C (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>F).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In addition, an in order to corroborate the morphological identification, molecular studies based on sequences of the ITS region were conducted. PCR amplification of fungal genomic DNA was performed using the primers and conditions as described previously.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> The results obtained from GENBANK showed a high level of identity (≥99%) with the sequences (accession number <a href="ncbi-n:FN675837">FN675837</a>) from the type strain of <span class="elsevierStyleItalic">Thermoascus crustaceus</span> (<span class="elsevierStyleItalic">T. crustaceus</span> CBS 181.67<span class="elsevierStyleSup">T</span>). In order to evaluate the genetical relationships between our isolate and those reported previously, phylogenetical analyses were conducted (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Phylogenetical inference was carried out following the protocols reported by Alvarez et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> The isolate reported in the present study has been stored in the Chilean Fungal Collection (ChFC) housed at the Mycology Unit, University of Chile, Santiago de Chile, with the unique identifier ChFC EA144. Also, the sequence of ITS region from our isolate was deposited in GENBANK database as KY115690.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Susceptibility studies</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In vitro</span> susceptibility testing was performed using broth microdilution for filamentous fungi according to the CLSI document M38-A2.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> The MIC and MEC (minimal effective concentration) values were read at 48 and 72<span class="elsevierStyleHsp" style=""></span>h. Due to the lack of clinical breakpoints for <span class="elsevierStyleItalic">Thermoascus</span> species, the following suggested cut off breakpoints were used: sensible (S), ≤1<span class="elsevierStyleHsp" style=""></span>μg/ml; intermediate (I), 2<span class="elsevierStyleHsp" style=""></span>μg/ml; and resistant (R), ≥4<span class="elsevierStyleHsp" style=""></span>μg/ml.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> Pure active powders of known potency of amphotericin B (AMB) (USP, Rockville, MD), voriconazole (VRC) (Sigma-Aldrich), itraconazole (ITC) (Janssen Pharmaceutica, Beerse, Belgium), caspofungin (CSF) (Merk & Co., Inc., Rahway, USA), micafungin (MCF) (Astellas Pharma), and anidulafungin (ANF) (Pfizer) were tested. All tests were performed in duplicates. <span class="elsevierStyleItalic">Paecilomyces variotii</span> ATCC MYA 3630 was included as quality control.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Results indicated the good activity of the antifungals tested. Amphotericin B and azoles showed MIC values of 0.5 and 0.25<span class="elsevierStyleHsp" style=""></span>μg/ml, respectively. Equinocandins showed the best activity with MIC values of 0.125<span class="elsevierStyleHsp" style=""></span>μg/ml. Based upon achievable drug concentrations using standard dosing regimens, the isolate appeared to be sensible, <span class="elsevierStyleItalic">in vitro</span>, to all the antifungal agents assayed in the present work.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Fungal peritonitis is a rare complication in patients undergoing peritoneal dialysis. The incidence is around 6%.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4,12</span></a> Etiological agents reported to date include <span class="elsevierStyleItalic">Aspergillus</span> spp.,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleItalic">Candida</span> spp.,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4,12</span></a><span class="elsevierStyleItalic">Curvularia geniculata</span>,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleItalic">Fusarium</span> spp.,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleItalic">Penicillium</span> spp.,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> and <span class="elsevierStyleItalic">T. crustaceus</span>,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> among others. Recently, following the Chile's earthquake of 2010, several cases of fungal peritonitis due to <span class="elsevierStyleItalic">Paecilomyces variotti</span> were reported.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> A search of the literature indicates that the present case is the second report describing fungal peritonitis by <span class="elsevierStyleItalic">T. crustaceus</span> in the world,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> and the first in Chile.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In an earlier examination of the fungal cultures, and based on taxonomic information from fungal structures, <span class="elsevierStyleItalic">Paecilomyces</span> species was identified in the plates incubated at room temperature. Teleomorph (<span class="elsevierStyleItalic">Thermoascus</span>) morphological structures were observed from agar plates cultured at 37<span class="elsevierStyleHsp" style=""></span>°C. It was also possible to confirm the preliminary morphological identification with the molecular tools. The ITS sequence of the studied isolate allowed us to identify it as <span class="elsevierStyleItalic">T. crustaceus</span>.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In vitro</span> susceptibility data for <span class="elsevierStyleItalic">T. crustaceus</span> is limited. However, MIC values for azoles (<0.015<span class="elsevierStyleHsp" style=""></span>μg/ml) and amphotericin B (<0.25<span class="elsevierStyleHsp" style=""></span>μg/ml) on <span class="elsevierStyleItalic">Thermoascus taitungiacus</span> have been reported,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> consistent with this study.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Usually fungal peritonitis is a serious disease. In our case the clinical picture was mild, without systemic compromise. Despite the lack of clear treatment guidelines in fungal peritonitis, the early removal of Tenckhoff catheter seems to be essential and timely antifungal treatment must be started in order to have a good prognosis. In the present study, AMB, ITC and CSF, MCF, and ANF were active against the strain of <span class="elsevierStyleItalic">T. crustaceus</span> at low MIC values.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In summary, this is the first report of fungal peritonitis caused by <span class="elsevierStyleItalic">T. crustaceus</span> in Chile. Further studies are needed to elucidate optimal treatment strategies.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres938737" "titulo" => "Abstract" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Case report" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec912436" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres938738" "titulo" => "Resumen" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec912437" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Mycological studies" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Susceptibility studies" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-07-14" "fechaAceptado" => "2017-01-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec912436" "palabras" => array:3 [ 0 => "Fungi" 1 => "<span class="elsevierStyleItalic">Thermoascus</span> spp." 2 => "Fungal peritonitis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec912437" "palabras" => array:3 [ 0 => "Hongos" 1 => "<span class="elsevierStyleItalic">Thermoascus</span> spp." 2 => "Peritonitis fúngica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fungal peritonitis is a relatively uncommon infection in peritoneal dialysis patients. However, it can be associated with significant morbimortality. In recent reports, <span class="elsevierStyleItalic">Candida</span> species and other filamentous fungi have been reported as being aetiological agents. <span class="elsevierStyleItalic">Thermoascus</span> species are ubiquitous, thermophilic fungi, with an anamorph in the <span class="elsevierStyleItalic">Paecilomyces</span> genus. Here we present the first report of fungal peritonitis by <span class="elsevierStyleItalic">Thermoascus crustaceus</span> from Chile.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present the case of an 83-year-old female patient, with a history of cholecystectomy, hernia repair, severe arterial hypertension, hip and knee osteoarthritis and several episodes of peritoneal dialysis with a cloudy exudate. Bacterial cultures were negative. In addition, a history of two months with intermittent fever peaks mainly in the evening was reported. Blood culture bottles inoculated with peritoneal fluid revealed the presence of fungal growth. Morphological and molecular studies allowed us to identify the aetiological agent as <span class="elsevierStyleItalic">Thermoascus crustaceus</span>. An antifungal susceptibility test was performed using the M38-A2 method, developed by the Clinical and Laboratory Standards Institute (CLSI). The MIC values to amphotericin B, itraconazole, voriconazole and echinochandins were 0.5, 0.25, 0.25 and 0.125<span class="elsevierStyleHsp" style=""></span>μg/ml, respectively. Antifungal treatment with amphotericin B was prescribed, with good patient progress.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Fungal peritonitis is a very rare entity. Moreover, the spectrum of fungal pathogens continues to expand, a reason for which morphological and molecular studies are necessary for a rapid diagnosis.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Case report" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Antecedentes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La peritonitis fúngica es una infección bastante infrecuente en pacientes en diálisis peritoneal. Sin embargo, puede estar relacionada con una morbimortalidad considerable. En informes recientes, se han registrado las especies de <span class="elsevierStyleItalic">Candida</span> y algunos hongos filamentosos como agentes etiológicos. <span class="elsevierStyleItalic">Thermoascus</span> es un género de hongos ubicuos, termófilos, que tienen su anamorfo en el género <span class="elsevierStyleItalic">Paecilomyces</span>. A continuación presentamos el primer caso de peritonitis fúngica por <span class="elsevierStyleItalic">Thermoascus crustaceous</span> de Chile.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Caso clínico</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de una mujer de 83 años con antecedentes de colecistectomía, hernia, hipertensión arterial grave, artrosis de cadera y rodilla, y varios episodios de diálisis peritoneal con una efusión turbia. Los cultivos bacterianos fueron negativos. Además, la paciente había presentado durante los dos últimos meses picos febriles intermitentes, principalmente por la noche. Los hemocultivos inoculados con líquido peritoneal revelaron el crecimiento de un micelio. Los estudios morfológicos y moleculares permitieron identificar el agente etiológico como <span class="elsevierStyleItalic">Thermoascus crustaceous</span>. Para el estudio de sensibilidad antifúngica se utilizó el método M38-A2, desarrollado por el Clinical and Laboratory Standards Institute. Las CMI obtenidas de anfotericina B, itraconazol, voriconazol y equinocandinas fueron 0,5; 0,25; 0,25, y 0,125 μg/ml, respectivamente. El tratamiento antifúngico con anfotericina B fue el indicado, con una buena evolución de la paciente.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La peritonitis fúngica es una entidad muy poco frecuente. Además, el espectro de hongos patógenos continúa en expansión, razón por la cual los estudios morfológicos y moleculares son necesarios para el diagnóstico rápido.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1005 "Ancho" => 1300 "Tamanyo" => 124792 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Scan picture indicating site of collection (arrow).</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" => 2939 "Ancho" => 2333 "Tamanyo" => 621895 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Thermoascus crustaceus</span> ChFC (Chilean Fungal Collection)144. (A) Macroscopic appearance on Potato Dextrose Agar; (B) chains of smooth-walled conidia and phialides; (C) chain of conidia; (D) asci; (E) echinulate ascospores; (F) ascocarp.</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" => 1599 "Ancho" => 3333 "Tamanyo" => 263666 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Neighbour-joining tree based on maximum composite likelihood corrected nucleotide distances among the ribosomal internal transcribed spacer (ITS) regions and 5.8S rRNA gene sequences of the strains of <span class="elsevierStyleItalic">Thermoascus</span> spp. Bootstrap support values above 70% are indicated at the nodes. The bar indicates genetic distance. Sequences of <span class="elsevierStyleItalic">Penicillium</span>, <span class="elsevierStyleItalic">Neosartorya</span> and <span class="elsevierStyleItalic">Aspergillus</span> were used to root the phylogram.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spectrum of zygomycete species identified from clinically significant specimens in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Alvarez" 1 => "D.A. Sutton" 2 => "J. Cano" 3 => "A.W. Fothergill" 4 => "A. Stchigel" 5 => "M.G. Rinaldi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.00036-09" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2009" "volumen" => "47" "paginaInicial" => "1650" "paginaFinal" => "1656" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19386856" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0070" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular phylogeny of the emerging pathogenic fungus <span class="elsevierStyleItalic">Saksenaea</span>: proposal of two new species" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Alvarez" 1 => "D. Garcia-Hermoso" 2 => "D.A. Sutton" 3 => "J. Cano" 4 => "A. Stchigel" 5 => "D. Hoinard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.01646-10" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2010" "volumen" => "48" "paginaInicial" => "4410" "paginaFinal" => "4416" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20926710" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0075" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uncommon causes of peritonitis in patients undergoing peritoneal dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Arfania" 1 => "E.D. Everette" 2 => "K.D. Nolph" 3 => "J. Rubin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Int Med" "fecha" => "1981" "volumen" => "141" "paginaInicial" => "61" "paginaFinal" => "64" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0080" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of fungal peritonitis complicating continuous ambulatory peritoneal dialysis with oral fluconazole. A series of 21 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.M. Chan" 1 => "C.Y. Chan" 2 => "S.W. Cheng" 3 => "W.K. Lo" 4 => "C.Y. Lo" 5 => "I.K. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "1994" "volumen" => "9" "paginaInicial" => "539" "paginaFinal" => "542" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8090334" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0085" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; Approved Standard, Second edn. CLSI Document M38-A2" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "CLSI" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2008" "editorial" => "Clinical and Laboratory Standards Institute" "editorialLocalizacion" => "Wayne, PA" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0090" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peritonitis due to <span class="elsevierStyleItalic">Thermoascus taitungiacus</span> (Anamorph <span class="elsevierStyleItalic">Paecilomyces taitungiacus</span>)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Korzets" 1 => "M. Weinberger" 2 => "A. Chagnac" 3 => "A. Goldschmied-Reouven" 4 => "M.G. Rinaldi" 5 => "D.A. Sutton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.39.2.720-724.2001" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2001" "volumen" => "39" "paginaInicial" => "720" "paginaFinal" => "724" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11158134" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0095" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Fusarium</span> peritonitis: an uncommon complication of CAPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.J. McNeely" 1 => "S.I. Vas" 2 => "N. Dombros" 3 => "D.G. Oreoppulos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Peritoneal Dial Bull" "fecha" => "1981" "volumen" => "1" "paginaInicial" => "94" "paginaFinal" => "96" "itemHostRev" => array:3 [ "pii" => "S155252601100094X" "estado" => "S300" "issn" => "15525260" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0100" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colonization of peritoneal catheter with a thermophilic fungus, <span class="elsevierStyleItalic">Thermoascus crustaceus</span>: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Oz" 1 => "N. Kiraz" 2 => "S. Ozkurt" 3 => "M. Soydan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/13693781003793838" "Revista" => array:6 [ "tituloSerie" => "Med Mycol" "fecha" => "2010" "volumen" => "48" "paginaInicial" => "1105" "paginaFinal" => "1107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20446887" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0105" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Penicillium</span> peritonitis in a CAPD patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.G. Pearson" 1 => "T.D. McKinney" 2 => "W.J. Stone" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Peritoneal Dial Bull" "fecha" => "1983" "volumen" => "3" "paginaInicial" => "20" "paginaFinal" => "21" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0110" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outbreak of <span class="elsevierStyleItalic">Paecilomyces variotii</span> peritonitis in peritoneal dialysis patients after the 2010 Chilean earthquake" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Torres" 1 => "M. Gonzalez" 2 => "M. Sanhueza" 3 => "E. Segovia" 4 => "M. Alvo" 5 => "W. Passalacqua" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Peritoneal Dialysis Int" "fecha" => "2014" "volumen" => "34" "paginaInicial" => "322" "paginaFinal" => "325" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0115" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Curvularia geniculata</span> fungal peritonitis: a case report with review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.J. Vachharajani" 1 => "F. Zaman" 2 => "S. Latif" 3 => "R. Penn" 4 => "K.D. Abreo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11255-004-0628-4" "Revista" => array:6 [ "tituloSerie" => "Int Urol Nephrol" "fecha" => "2005" "volumen" => "37" "paginaInicial" => "781" "paginaFinal" => "784" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16362599" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0120" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors predicting outcome of fungal peritonitis in peritoneal dialysis: analysis of a 9 year experience of fungal peritonitis in a single center" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Wang" 1 => "A. Yu" 2 => "P. Li" 3 => "P.K. Lam" 4 => "C.B. Leung" 5 => "K.N. Lai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/ajkd.2000.19833" "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2000" "volumen" => "36" "paginaInicial" => "1183" "paginaFinal" => "1192" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11096043" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/11301406/0000003400000004/v1_201711120057/S1130140617300499/v1_201711120057/en/main.assets" "Apartado" => array:4 [ "identificador" => "7995" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Notas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/11301406/0000003400000004/v1_201711120057/S1130140617300499/v1_201711120057/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140617300499?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 18 | 6 | 24 |
| 2024 September | 54 | 6 | 60 |
| 2024 August | 30 | 4 | 34 |
| 2024 July | 37 | 1 | 38 |
| 2024 June | 39 | 3 | 42 |
| 2024 May | 39 | 9 | 48 |
| 2024 April | 55 | 2 | 57 |
| 2024 March | 48 | 8 | 56 |
| 2024 February | 67 | 2 | 69 |
| 2024 January | 64 | 2 | 66 |
| 2023 December | 61 | 5 | 66 |
| 2023 November | 69 | 8 | 77 |
| 2023 October | 75 | 11 | 86 |
| 2023 September | 27 | 6 | 33 |
| 2023 August | 37 | 5 | 42 |
| 2023 July | 58 | 12 | 70 |
| 2023 June | 38 | 16 | 54 |
| 2023 May | 47 | 7 | 54 |
| 2023 April | 50 | 1 | 51 |
| 2023 March | 70 | 10 | 80 |
| 2023 February | 43 | 6 | 49 |
| 2023 January | 54 | 7 | 61 |
| 2022 December | 33 | 11 | 44 |
| 2022 November | 37 | 16 | 53 |
| 2022 October | 45 | 14 | 59 |
| 2022 September | 46 | 15 | 61 |
| 2022 August | 60 | 25 | 85 |
| 2022 July | 36 | 13 | 49 |
| 2022 June | 42 | 19 | 61 |
| 2022 May | 53 | 10 | 63 |
| 2022 April | 61 | 14 | 75 |
| 2022 March | 101 | 19 | 120 |
| 2022 February | 90 | 11 | 101 |
| 2022 January | 75 | 10 | 85 |
| 2021 December | 68 | 13 | 81 |
| 2021 November | 76 | 16 | 92 |
| 2021 October | 49 | 11 | 60 |
| 2021 September | 62 | 15 | 77 |
| 2021 August | 77 | 6 | 83 |
| 2021 July | 195 | 12 | 207 |
| 2021 June | 17 | 8 | 25 |
| 2021 May | 30 | 17 | 47 |
| 2021 April | 83 | 25 | 108 |
| 2021 March | 31 | 20 | 51 |
| 2021 February | 22 | 9 | 31 |
| 2021 January | 47 | 16 | 63 |
| 2020 December | 42 | 9 | 51 |
| 2020 November | 31 | 10 | 41 |
| 2020 October | 33 | 16 | 49 |
| 2020 September | 18 | 12 | 30 |
| 2020 August | 28 | 10 | 38 |
| 2020 July | 34 | 10 | 44 |
| 2020 June | 31 | 10 | 41 |
| 2020 May | 28 | 15 | 43 |
| 2020 April | 23 | 6 | 29 |
| 2020 March | 28 | 8 | 36 |
| 2020 February | 27 | 4 | 31 |
| 2020 January | 24 | 4 | 28 |
| 2019 December | 33 | 7 | 40 |
| 2019 November | 8 | 2 | 10 |
| 2019 October | 22 | 8 | 30 |
| 2019 September | 31 | 3 | 34 |
| 2019 August | 20 | 7 | 27 |
| 2019 July | 42 | 15 | 57 |
| 2019 June | 77 | 34 | 111 |
| 2019 May | 125 | 43 | 168 |
| 2019 April | 67 | 17 | 84 |
| 2019 March | 13 | 3 | 16 |
| 2019 February | 19 | 8 | 27 |
| 2019 January | 10 | 4 | 14 |
| 2018 December | 13 | 4 | 17 |
| 2018 November | 23 | 8 | 31 |
| 2018 October | 19 | 33 | 52 |
| 2018 September | 12 | 1 | 13 |
| 2018 August | 20 | 3 | 23 |
| 2018 July | 10 | 2 | 12 |
| 2018 June | 14 | 2 | 16 |
| 2018 May | 24 | 2 | 26 |
| 2018 April | 11 | 2 | 13 |
| 2018 March | 7 | 1 | 8 |
| 2018 February | 6 | 2 | 8 |
| 2018 January | 25 | 1 | 26 |
| 2017 December | 1 | 1 | 2 |
| 2017 November | 3 | 0 | 3 |
| 2017 October | 0 | 1 | 1 |
| 2017 August | 0 | 1 | 1 |
Show all
