Case and research letters
Leukocytoclastic Vasculitis Related to Cocaine Use
Vasculitis leucocitoclástica asociada a consumo de cocaína
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Salas-Espíndola, A. Peniche-Castellanos, I. López-Gehrke, P. Mercadillo-Pérez" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Y." "apellidos" => "Salas-Espíndola" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "A." "apellidos" => "Peniche-Castellanos" "email" => array:1 [ 0 => "amelia_peniche@yahoo.com.mx" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "López-Gehrke" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Mercadillo-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General de México, México, D.F" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatopatología, Hospital General de México, México, D.F" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vasculitis leucocitoclástica asociada a consumo de cocaína" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 876 "Ancho" => 951 "Tamanyo" => 282714 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology: mainly neutrophilic, abundant perivascular inflammatory infiltrate that infiltrates and partially destroys blood vessel walls; prominent leukocytoclasis and multiple foci of vascular thrombosis (periodic acid-Schiff, original magnification x40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Vasculitis is a rare complication of cocaine abuse and poses significant diagnostic and management problems. We report a case of this type of vasculitis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 45-year-old woman with a history of cocaine abuse from age 23 years consulted because of a 20-day history of a widespread skin condition that affected practically the whole body surface, was accompanied by fever and intense pain, and prevented her from walking. At the time of admission, the patient was underweight, had facies dolorosa, normal vital signs, and dry mucosas. Physical examination revealed multiple ulcers of varying shape and size, with a purulent, foul-smelling exudate; several were covered by necrotic slough (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Additional tests, based on a suspected clinical diagnosis of systemic vasculitis, gave the following results: white blood cell count, 12 500/μL; hemoglobin, 9.8<span class="elsevierStyleHsp" style=""></span>g/dL; reactive thrombocytosis, 658 000/μL; hypoalbuminemia, 2.0<span class="elsevierStyleHsp" style=""></span>g/dL; alanine aminotransferase, 68 U/L; aspartate aminotransferase, 62 U/L; γ-glutamyltransferase, 181 U/L; alkaline phosphatase, 326 U/L; creatinine clearance, 88.3<span class="elsevierStyleHsp" style=""></span>mL/min with renal function of 86.6%; C-reactive protein, 1.40<span class="elsevierStyleHsp" style=""></span>mg/dL; a negative Venereal Disease Research Laboratory test, negative rheumatoid factor; antineutrophil cytoplasmic antibodies (c-ANCA), 1:40; perinuclear (p) ANCA, 1:2560 U/mL; p-ANCA antilactoferrin, 48.2 U/mL; culture of the skin exudate, <span class="elsevierStyleItalic">Escherichia coli</span>; positive total hepatitis A virus antibody; negative anti-hepatitis B and anti-hepatitis C virus antibodies; negative human immunodeficiency virus (enzyme-linked immunosorbent assay). Skin biopsy revealed leukocytoclastic vasculitis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The otorhinolaryngology department reported perforation of the cartilaginous portion of the nasal septum, confirmed by computed tomography, but biopsy of the nasal mucosa only revealed chronic inflammation. The psychiatry department diagnosed the patient as having a mixed personality disorder and treatment was initiated with amitriptyline, perphenazine, and diazepam. The general surgery department then performed surgical debridement of the ulcers and escharectomy. The patient was treated with antibiotics (trimethoprim-sulfamethoxazole, 160/800<span class="elsevierStyleHsp" style=""></span>mg, administered intravenously every 12<span class="elsevierStyleHsp" style=""></span>hours for 14 days), analgesics, and thalidomide (100<span class="elsevierStyleHsp" style=""></span>mg/d); prednisone (0.5<span class="elsevierStyleHsp" style=""></span>mg/kg) was added after achieving control of the infection. The response was satisfactory and the patient was discharged after 37 days, with the presence of granulation tissue and partial reepithelialization of the ulcerated areas. Diagnosis at discharge was cocaine-related vasculitis based on the clinical findings, histopathological study, the positivity of serum markers (p-ANCA and lactoferrin), a history of long-term consumption of the drug, and the exclusion of other causes.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Follow-up confirmed the reepithelialization of most lesions, which developed into hypertrophic scars and retractile keloids, currently awaiting surgical treatment by the plastic surgery department (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Cocaine consumption is increasing worldwide, leading to a rise in related diseases. The spectrum of skin lesions caused by cocaine is broad and has been related to digital vasospasm, bullous diseases, small- and medium-vessel vasculitis, which present as purpura, necrotizing vasculitis, urticarial vasculitis, ulcers, livedo reticularis, Buerger disease, pyoderma gangrenosum, and gangrene.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Some authors hold levamisole, an adulterant found in the end product, responsible for the damage in cases involving microvascular thrombosis and neutropenia.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There are reports of cocaine consumption in patients with Wegener granulomatosis,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and since both may cause midline destructive lesions of the face, distinguishing between them can be difficult. In our patient, the absence of granulomatous vasculitis of the respiratory tract, renal involvement, and high titers of c-ANCA enabled us to rule out this possibility.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study protocol for cocaine-related vasculitis is identical to drug-related vasculitis and includes a blood count, erythrocyte sedimentation rate, routine biochemistry, chest x-ray, urinalysis, liver function tests, and fecal occult blood. More specific studies should subsequently be considered, such as histopathology with or without direct immunofluorescence, anticardiolipin antibodies, homocysteine levels, proteins S and C, and cryoglobulins. Serum levels of ANCA, antinuclear antibodies, rheumatoid factor, complement, and hepatitis B and C virus antibodies should also be determined, together with human immunodeficiency virus serology.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The case presented here was a drug-dependent patient whose clinical lesions were compatible with necrotizing vasculitis confirmed by histopathology, with a diagnosis of an ANCA-positive cutaneous vasculitis (p-ANCA, 1:2560 U/mL, antilactoferrin antibodies, 48.2 U/mL). The differential diagnosis included other forms of ANCA-positive small-vessel vasculitis. The role of ANCA in the pathogenesis of vasculitis is still unclear. One hypothesis suggests that ANCA stimulate neutrophil degranulation, activation, and apoptosis, leading to direct and indirect endothelial damage.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Drug-induced ANCA show a perinuclear fluorescence pattern (p-ANCA) and positivity to several antigens (myeloperoxidase, cathepsin G, proteinase 3, azurocidin, bactericidal/permeability-increasing protein, lactoferrin, and human neutrophil elastase). Reports in the literature suggest that the presence of lactoferrin and human neutrophil elastase supports the diagnosis of a cocaine-related syndrome.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The management of these patients is still a matter of debate, but good outcomes have been reported with the use of systemic steroids, nonsteroidal immunosuppressants, antihistamines, dapsone, pentoxifylline, and intravenous immunoglobulin.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Our patient stopped taking cocaine and was treated with thalidomide and systemic steroids. Although the outcome was excellent, significant scarring could not be avoided.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Salas-Espíndola Y, et al. Vasculitis leucocitoclástica asociada a consumo de cocaína. Actas Dermosifiliogr.2011;102:825-826.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1532 "Ancho" => 951 "Tamanyo" => 214306 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photograph at presentation. Ulcers with a purulent exudate and covered with necrotic slough.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 876 "Ancho" => 951 "Tamanyo" => 282714 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology: mainly neutrophilic, abundant perivascular inflammatory infiltrate that infiltrates and partially destroys blood vessel walls; prominent leukocytoclasis and multiple foci of vascular thrombosis (periodic acid-Schiff, original magnification x40).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 697 "Ancho" => 1301 "Tamanyo" => 131313 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Photograph at 7 months of follow-up. There is reepithelialization of the lesions and scarring.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vasculitis: a collection of pearls and myths" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.H. Stone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rdc.2007.09.002" "Revista" => array:6 [ "tituloSerie" => "Rheum Dis Clin North Am" "fecha" => "2007" "volumen" => "33" "paginaInicial" => "691" "paginaFinal" => "739" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18037113" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Piodermas gangrenosos eruptivos asociados al consumo de cocaína inhalada. Presentación de dos casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Roche" 1 => "T. Martínez-Menchón" 2 => "J.L. Sánchez-Carazo" 3 => "V. Oliver" 4 => "V. Alegre de Miquel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2008" "volumen" => "99" "paginaInicial" => "727" "paginaFinal" => "730" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19087813" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cocaine related retiform purpura: evidence to incriminate the adulterant, levamisole" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N.M.G. Walsh" 1 => "P.J. Green" 2 => "R.W. Burlingame" 3 => "S. Pasternak" 4 => "J.G. Hanly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0560.2010.01613.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2010" "volumen" => "37" "paginaInicial" => "1212" "paginaFinal" => "1219" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20738457" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PR3-ANCA-positive necrotizing multi-organ vasculitis following cocaine abuse" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Neynaber" 1 => "N. Mistry-Burchardi" 2 => "C. Rust" 3 => "W. Samtleben" 4 => "W.H.C. Burgdorf" 5 => "M.A. Seitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2340/00015555-0514" "Revista" => array:6 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "2008" "volumen" => "88" "paginaInicial" => "594" "paginaFinal" => "596" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19002345" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug-induced vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.A. Merkel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rheum Dis Clin North Am" "fecha" => "2001" "volumen" => "27" "paginaInicial" => "849" "paginaFinal" => "862" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11723768" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Khasnis" 1 => "C.A. Langford" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaci.2009.04.024" "Revista" => array:7 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2009" "volumen" => "123" "paginaInicial" => "1226" "paginaFinal" => "1236" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19501230" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0010782408002849" "estado" => "S300" "issn" => "00107824" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and immunological features of drug-induced and infection-induced proteinase 3-antineutrophil cytoplasmic antibodies and myeloperoxidase-antineutrophil cytoplasmic antibodies and vasculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Csernok" 1 => "P. Lamprecht" 2 => "W.L. Gross" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/BOR.0b013e3283323538" "Revista" => array:7 [ "tituloSerie" => "Curr Opin Rheumatol" "fecha" => "2010" "volumen" => "22" "paginaInicial" => "43" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19770659" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673600026994" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "P-ANCA positive cocaine associated vasculitis: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Pham" 1 => "C. Heinly" 2 => "C. Herman" 3 => "M.A. Selim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2008" "volumen" => "32" "paginaInicial" => "109" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010200000010/v1_201304241244/S1578219012000169/v1_201304241244/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010200000010/v1_201304241244/S1578219012000169/v1_201304241244/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000169?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 11 | 23 |
| 2024 October | 145 | 41 | 186 |
| 2024 September | 179 | 32 | 211 |
| 2024 August | 227 | 48 | 275 |
| 2024 July | 244 | 49 | 293 |
| 2024 June | 189 | 46 | 235 |
| 2024 May | 249 | 34 | 283 |
| 2024 April | 125 | 26 | 151 |
| 2024 March | 190 | 43 | 233 |
| 2024 February | 164 | 29 | 193 |
| 2024 January | 236 | 43 | 279 |
| 2023 December | 165 | 33 | 198 |
| 2023 November | 165 | 40 | 205 |
| 2023 October | 163 | 41 | 204 |
| 2023 September | 96 | 41 | 137 |
| 2023 August | 109 | 28 | 137 |
| 2023 July | 118 | 50 | 168 |
| 2023 June | 94 | 39 | 133 |
| 2023 May | 102 | 45 | 147 |
| 2023 April | 91 | 32 | 123 |
| 2023 March | 123 | 25 | 148 |
| 2023 February | 126 | 34 | 160 |
| 2023 January | 102 | 39 | 141 |
| 2022 December | 80 | 37 | 117 |
| 2022 November | 70 | 25 | 95 |
| 2022 October | 42 | 21 | 63 |
| 2022 September | 48 | 39 | 87 |
| 2022 August | 33 | 36 | 69 |
| 2022 July | 32 | 31 | 63 |
| 2022 June | 22 | 37 | 59 |
| 2022 May | 88 | 41 | 129 |
| 2022 April | 117 | 49 | 166 |
| 2022 March | 119 | 62 | 181 |
| 2022 February | 114 | 36 | 150 |
| 2022 January | 116 | 41 | 157 |
| 2021 December | 71 | 43 | 114 |
| 2021 November | 89 | 43 | 132 |
| 2021 October | 81 | 59 | 140 |
| 2021 September | 63 | 47 | 110 |
| 2021 August | 97 | 41 | 138 |
| 2021 July | 84 | 34 | 118 |
| 2021 June | 52 | 33 | 85 |
| 2021 May | 50 | 55 | 105 |
| 2021 April | 112 | 71 | 183 |
| 2021 March | 116 | 24 | 140 |
| 2021 February | 64 | 39 | 103 |
| 2021 January | 65 | 29 | 94 |
| 2020 December | 63 | 20 | 83 |
| 2020 November | 29 | 27 | 56 |
| 2020 October | 28 | 18 | 46 |
| 2020 September | 50 | 28 | 78 |
| 2020 August | 21 | 21 | 42 |
| 2020 July | 35 | 22 | 57 |
| 2020 June | 39 | 28 | 67 |
| 2020 May | 35 | 27 | 62 |
| 2020 April | 37 | 20 | 57 |
| 2020 March | 34 | 22 | 56 |
| 2020 February | 6 | 14 | 20 |
| 2020 January | 3 | 12 | 15 |
| 2019 December | 8 | 13 | 21 |
| 2019 November | 4 | 5 | 9 |
| 2019 October | 0 | 4 | 4 |
| 2019 September | 8 | 6 | 14 |
| 2019 August | 4 | 14 | 18 |
| 2019 July | 4 | 17 | 21 |
| 2019 June | 7 | 16 | 23 |
| 2019 May | 4 | 26 | 30 |
| 2019 April | 4 | 14 | 18 |
| 2019 March | 5 | 12 | 17 |
| 2019 February | 0 | 6 | 6 |
| 2019 January | 5 | 3 | 8 |
| 2018 December | 2 | 2 | 4 |
| 2018 November | 7 | 4 | 11 |
| 2018 October | 18 | 0 | 18 |
| 2018 September | 2 | 0 | 2 |
| 2018 April | 0 | 3 | 3 |
| 2018 March | 2 | 0 | 2 |
| 2018 February | 58 | 1 | 59 |
| 2018 January | 76 | 9 | 85 |
| 2017 December | 67 | 6 | 73 |
| 2017 November | 55 | 7 | 62 |
| 2017 October | 40 | 5 | 45 |
| 2017 September | 69 | 11 | 80 |
| 2017 August | 124 | 16 | 140 |
| 2017 July | 106 | 4 | 110 |
| 2017 June | 115 | 19 | 134 |
| 2017 May | 94 | 13 | 107 |
| 2017 April | 79 | 11 | 90 |
| 2017 March | 74 | 24 | 98 |
| 2017 February | 173 | 12 | 185 |
| 2017 January | 81 | 11 | 92 |
| 2016 December | 78 | 11 | 89 |
| 2016 November | 131 | 16 | 147 |
| 2016 October | 125 | 18 | 143 |
| 2016 September | 202 | 11 | 213 |
| 2016 August | 195 | 11 | 206 |
| 2016 July | 96 | 13 | 109 |
| 2016 June | 18 | 0 | 18 |
| 2016 May | 5 | 14 | 19 |
| 2016 April | 7 | 3 | 10 |
| 2016 March | 6 | 1 | 7 |
| 2016 February | 2 | 3 | 5 |
| 2016 January | 7 | 1 | 8 |
| 2015 December | 9 | 0 | 9 |
| 2015 November | 30 | 5 | 35 |
| 2015 October | 14 | 1 | 15 |
| 2015 September | 9 | 4 | 13 |
| 2015 August | 11 | 3 | 14 |
| 2015 July | 178 | 11 | 189 |
| 2015 June | 76 | 9 | 85 |
| 2015 May | 117 | 18 | 135 |
| 2015 April | 75 | 10 | 85 |
| 2015 March | 85 | 11 | 96 |
| 2015 February | 89 | 14 | 103 |
| 2015 January | 58 | 17 | 75 |
| 2014 December | 79 | 17 | 96 |
| 2014 November | 67 | 17 | 84 |
| 2014 October | 75 | 26 | 101 |
| 2014 September | 58 | 13 | 71 |
| 2014 August | 75 | 23 | 98 |
| 2014 July | 45 | 19 | 64 |
| 2014 June | 82 | 22 | 104 |
| 2014 May | 76 | 19 | 95 |
| 2014 April | 54 | 19 | 73 |
| 2014 March | 67 | 20 | 87 |
| 2014 February | 63 | 18 | 81 |
| 2014 January | 75 | 19 | 94 |
| 2013 December | 69 | 9 | 78 |
| 2013 November | 31 | 15 | 46 |
| 2013 October | 23 | 1 | 24 |
| 2013 September | 14 | 8 | 22 |
| 2013 August | 15 | 5 | 20 |
| 2013 July | 12 | 8 | 20 |
| 2013 June | 14 | 16 | 30 |
| 2013 May | 15 | 3 | 18 |
| 2013 April | 15 | 8 | 23 |
| 2013 March | 20 | 13 | 33 |
| 2013 February | 45 | 5 | 50 |
| 2013 January | 78 | 4 | 82 |
| 2012 December | 43 | 11 | 54 |
| 2012 November | 0 | 1 | 1 |
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