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que puede ser desencadenada por diferentes ant&#237;genos&#46; Histol&#243;gicamente&#44; los hallazgos var&#237;an con la evoluci&#243;n temporal de las lesiones&#46; En las lesiones tempranas se observa edema y hemorragia en los septos del tejido celular subcut&#225;neo&#44; con un infiltrado de neutr&#243;filos dispuestos entre los haces de col&#225;geno&#46; En las fases tard&#237;as&#44; se observa una fibrosis de los septos con tejido de granulaci&#243;n periseptal e infiltrado inflamatorio compuesto por linfocitos&#44; histiocitos y c&#233;lulas gigantes multinucleadas&#46; Es muy caracter&#237;stico observar granulomas radiales de Miescher&#58; agregados nodulares de histiocitos rodeados de neutr&#243;filos que se disponen radialmente alrededor de los vasos sangu&#237;neos&#44; y que se localizan en el l&#237;mite entre el septo afectado y el lobulillo hipod&#233;rmico&#46; Las lesiones de EN no presentan vasculitis ni necrosis de adipocitos y&#44; a pesar de la intensa fibrosis&#44; se resuelven por completo en unas semanas<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Aunque una proporci&#243;n importante de casos de EN son idiop&#225;ticos &#40;17-72&#37;&#41;&#44; se ha demostrado la asociaci&#243;n del EN con procesos infecciosos&#58; faringoamigdalitis estreptoc&#243;cica&#44; tuberculosis o infecciones por <span class="elsevierStyleItalic">Yersinia&#59;</span> autoinmunes&#58; sarcoidosis&#44; enfermedad inflamatoria intestinal o enfermedad de Beh&#231;et&#59; f&#225;rmacos&#58; anticonceptivos orales o sulfamidas&#59; o con el embarazo&#46; El EN puede aparecer como un proceso paraneopl&#225;sico en linfomas o leucemias<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En cuanto al tratamiento&#44; debe tratarse espec&#237;ficamente la enfermedad causal subyacente siempre que sea posible&#46; Respecto al tratamiento dirigido para EN&#44; la mayor&#237;a de los casos remiten espont&#225;neamente en pocas semanas con reposo&#46; Como tratamiento sintom&#225;tico&#44; pueden emplearse analg&#233;sicos y antiinflamatorios no esteroideos&#44; que deben evitarse en caso de una enfermedad de Crohn subyacente&#59; yoduro de potasio&#44; colchicina&#44; hidroxicloroquina o corticoides &#40;tras haber descartado una causa infecciosa de EN&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Por su gran variedad etiol&#243;gica&#44; las causas predominantes de EN pueden variar entre &#225;reas geogr&#225;ficas&#44; &#233;pocas del a&#241;o o seg&#250;n el &#225;mbito de asistencia sanitaria&#46; El objetivo de nuestro trabajo es describir las causas m&#225;s frecuentes de EN en pacientes ingresados en un hospital espa&#241;ol de tercer nivel y comparar nuestros resultados con los obtenidos en otros trabajos&#46; Adem&#225;s&#44; comparamos los marcadores anal&#237;ticos de inflamaci&#243;n en funci&#243;n de si la causa de EN es una enfermedad inflamatoria o no inflamatoria&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Pacientes y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio retrospectivo&#44; observacional y descriptivo de pacientes ingresados por EN en el Hospital Universitario 12 de Octubre de Madrid &#40;Espa&#241;a&#41; entre el 1 de enero de 2005 y el 31 de diciembre de 2015&#46; Los pacientes se obtuvieron a partir de los archivos de historias cl&#237;nicas de alta hospitalaria de nuestro centro&#46; El diagn&#243;stico de EN se estableci&#243; mediante criterios cl&#237;nicos o por estudio histol&#243;gico compatible&#44; cuando estuvo disponible&#46; La etiolog&#237;a de EN se determin&#243; a trav&#233;s de la historia cl&#237;nica del paciente seg&#250;n las siguientes definiciones&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Faringoamigdalitis estreptoc&#243;cica&#58;</span> cuadro cl&#237;nico compatible en las 6 semanas previas al diagn&#243;stico de EN&#44; con 4-5 criterios de McIsaac<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a>&#44; ASLO positivo o detecci&#243;n de <span class="elsevierStyleItalic">Streptococcus pyogenes</span> en exudado faringoamigdalar&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Infecci&#243;n tuberculosa latente&#58;</span> Mantoux positivo &#40;&#62;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mm en pacientes no vacunados y &#62;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm en pacientes vacunados&#41;&#44; sin infecci&#243;n cl&#237;nicamente activa ni detecci&#243;n de micobacterias&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Enfermedad tuberculosa&#58;</span> cuadro cl&#237;nico compatible con lesiones radiol&#243;gicas tuberculosas&#44; detecci&#243;n microbiol&#243;gica de micobacterias o Mantoux positivo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel"><span class="elsevierStyleItalic">-</span></span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Otras infecciones&#58;</span> cuadro cl&#237;nico compatible y confirmaci&#243;n microbiol&#243;gica&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Enfermedad inflamatoria intestinal&#58;</span> cuadro cl&#237;nico compatible y estudio histol&#243;gico confirmatorio&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sarcoidosis&#58;</span> cuadro cl&#237;nico-radiol&#243;gico compatible&#44; con o sin confirmaci&#243;n histol&#243;gica&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Enfermedad de Beh&#231;et&#58;</span> seg&#250;n los criterios del International Study Group for Behcet&#39;s Disease<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Otras enfermedades autoinmunes&#58;</span> criterios cl&#237;nicos y serol&#243;gicos compatibles&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Enfermedades hematol&#243;gicas&#58;</span> confirmaci&#243;n cl&#237;nica e histol&#243;gica&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Embarazo&#58;</span> mujeres embarazadas&#44; sin otra causa&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">F&#225;rmacos&#58;</span> consumo previo al desarrollo de EN&#44; sin otra causa&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Idiop&#225;tico&#58;</span> aquellos casos que ten&#237;an un estudio etiol&#243;gico negativo&#44; que deb&#237;a incluir como m&#237;nimo anamnesis y exploraci&#243;n f&#237;sica dirigidas a causas conocidas de EN &#40;incluyendo f&#225;rmacos&#41;&#44; anal&#237;tica general b&#225;sica&#44; estudio de autoinmunidad&#44; prueba de Mantoux y radiograf&#237;a de t&#243;rax&#46;</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">Se determin&#243; de cada paciente el sexo&#44; la edad al diagn&#243;stico de EN&#44; la realizaci&#243;n o no de biopsia cut&#225;nea y par&#225;metros anal&#237;ticos de inflamaci&#243;n&#58; leucocitos&#44; velocidad de sedimentaci&#243;n globular y prote&#237;na C reactiva&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">An&#225;lisis estad&#237;stico</span><p id="par0100" class="elsevierStylePara elsevierViewall">Las variables cualitativas se expresaron como frecuencias absolutas y relativas&#46; Las variables cuantitativas se expresaron como media y desviaci&#243;n est&#225;ndar&#46; La comparaci&#243;n de par&#225;metros inflamatorios entre casos de EN de etiolog&#237;a inflamatoria y no inflamatoria se realiz&#243; mediante la prueba no param&#233;trica de Mann-Whitney&#46; Se consider&#243; estad&#237;sticamente significativo un valor p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con el software SAS&#174; 9&#46;04 &#40;University Edition&#41;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="par0105" class="elsevierStylePara elsevierViewall">Se recogieron 116 pacientes con un diagn&#243;stico inicial de EN&#46; Se excluyeron 64 pacientes por una historia cl&#237;nica incompleta&#44; por carecer del estudio etiol&#243;gico m&#237;nimo&#44; por presentar un diagn&#243;stico final distinto de EN o por haber presentado el diagn&#243;stico correcto de EN fuera del periodo de recogida de datos&#46; La cohorte final qued&#243; compuesta por 52 pacientes&#44; con una edad media de 36&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;4 a&#241;os y un 76&#44;9&#37; de mujeres&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> describe las caracter&#237;sticas de los pacientes y su distribuci&#243;n etiol&#243;gica&#46; En 35 &#40;67&#44;3&#37;&#41; pacientes se confirm&#243; el diagn&#243;stico mediante estudio histol&#243;gico&#46; Hubo 10 &#40;19&#44;2&#37;&#41; casos idiop&#225;ticos&#44; 18 &#40;34&#44;6&#37;&#41; casos secundarios a infecci&#243;n&#58; 7 a faringoamigdalitis estreptoc&#243;cica y 5 a enfermedad tuberculosa&#59; otros 18 &#40;34&#44;6&#37;&#41; a enfermedad autoinmune&#58; 9 a sarcoidosis&#44; 6 a enfermedad inflamatoria intestinal y 2 a enfermedad de Beh&#231;et&#59; y 4 casos &#40;7&#44;7&#37;&#41; secundarios a embarazo&#46; No se identificaron casos secundarios a causas habituales de EN&#44; como f&#225;rmacos&#44; linfomas sist&#233;micos&#44; yersiniosis o micosis sist&#233;micas&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Los casos secundarios recibieron tratamiento dirigido seg&#250;n la causa etiol&#243;gica&#46; Para el manejo sintom&#225;tico&#44; 25 &#40;48&#37;&#41; pacientes fueron tratados con antiinflamatorios no esteroideos y&#47;o paracetamol&#44; 17 &#40;32&#44;7&#37;&#41; con corticoides&#44; 9 &#40;17&#44;3&#37;&#41; con yoduro de potasio y 5 &#40;9&#44;6&#37;&#41; con colchicina&#46; Por no estar registrado en las historias cl&#237;nicas examinadas&#44; no fue posible determinar el porcentaje de recurrencias de EN ni el tiempo de resoluci&#243;n de las lesiones&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Se definieron como causas inflamatorias de EN las infecciosas y las autoinmunes&#46; Comparando las causas inflamatorias con las no inflamatorias&#44; no se observaron diferencias significativas en los valores medios de leucocitos &#40;10&#46;428 vs&#46; 9&#46;964&#44;6<span class="elsevierStyleHsp" style=""></span>leucocitos&#47;mm<span class="elsevierStyleSup">3</span>&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;82&#41;&#44; velocidad de sedimentaci&#243;n globular &#40;65&#44;85 vs&#46; 61&#44;27<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;68&#41; ni prote&#237;na C reactiva &#40;6&#44;97 vs&#46; 8&#44;63<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;53&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> comparamos los resultados obtenidos en nuestra muestra con los publicados en otras cohortes de pacientes diagnosticados de EN&#46; Nuestra cohorte presenta una edad media similar y una proporci&#243;n algo menor de mujeres&#46; Hubo menos casos idiop&#225;ticos que en otras cohortes&#44; quiz&#225; por tratarse de una muestra de pacientes hospitalizados con un estudio diagn&#243;stico probablemente m&#225;s exhaustivo&#46; La proporci&#243;n de causas infecciosas es similar a la de otros estudios europeos<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7&#8211;10</span></a>&#44; aunque inferior a la observada por Varas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> en Chile&#44; siendo la faringoamigdalitis estreptoc&#243;cica y la enfermedad tuberculosa las causas infecciosas m&#225;s frecuentes en nuestra serie y en las dem&#225;s series revisadas&#46; Nuestra cohorte presenta una proporci&#243;n mayor de casos atribuibles a enfermedad autoinmune&#44; a expensas de una mayor frecuencia de casos de enfermedad inflamatoria intestinal y sarcoidosis&#44; aunque esta &#250;ltima con una frecuencia similar a la observada por Garc&#237;a et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> en nuestro mismo pa&#237;s&#46; La proporci&#243;n de casos secundarios a enfermedad de Beh&#231;et es similar a las observadas en otros trabajos&#46; Destacaba en nuestro estudio la ausencia de casos secundarios a f&#225;rmacos y una mayor proporci&#243;n de casos secundarios a embarazo y neoplasias&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Al igual que Garc&#237;a et al&#46;&#44; no observamos diferencias significativas en los par&#225;metros anal&#237;ticos de inflamaci&#243;n en funci&#243;n de causa inflamatoria o no inflamatoria de EN&#46; S&#237; se observaron diferencias en estos par&#225;metros en los estudios de Varas et al&#46; y de Mert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a>&#46; En los casos no biopsiados&#44; siendo tan caracter&#237;stica la lesi&#243;n de EN&#44; es poco probable el error diagn&#243;stico&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el EN presenta un amplio diagn&#243;stico diferencial en su etiolog&#237;a&#46; El origen hospitalario de nuestra cohorte parece favorecer un bajo porcentaje de casos idiop&#225;ticos y que no se observaran causas habituales de EN&#44; como el uso de f&#225;rmacos&#46; Las infecciones y las enfermedades autoinmunes fueron las causas m&#225;s frecuentes de EN secundario en nuestra cohorte&#46; No observamos diferencias en los marcadores anal&#237;ticos de inflamaci&#243;n en funci&#243;n de causa inflamatoria o no inflamatoria de EN&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Para establecer el diagn&#243;stico etiol&#243;gico en pacientes hospitalizados por EN&#44; parece razonable una aproximaci&#243;n inicial mediante anamnesis y exploraci&#243;n f&#237;sica dirigidas a causas habituales de EN&#44; incluyendo f&#225;rmacos&#59; realizaci&#243;n de hemograma&#44; bioqu&#237;mica b&#225;sica&#44; velocidad de sedimentaci&#243;n globular y prote&#237;na C reactiva&#59; determinaci&#243;n de ASLO y realizaci&#243;n de radiograf&#237;a simple de t&#243;rax y prueba de Mantoux&#46; La solicitud de serolog&#237;as infecciosas e inmunol&#243;gicas&#44; y la realizaci&#243;n de otras pruebas complementarias deber&#225;n estimarse en funci&#243;n de la cl&#237;nica acompa&#241;ante al episodio de EN&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicto de intereses</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El eritema nudoso &#40;EN&#41; es la paniculitis m&#225;s frecuente y aunque puede ser idiop&#225;tico&#44; presenta m&#250;ltiples procesos causales&#46; Elaboramos un estudio retrospectivo&#44; observacional y descriptivo de las causas de EN en pacientes ingresados en un hospital espa&#241;ol de tercer nivel durante un per&#237;odo de 11 a&#241;os&#44; y comparamos los resultados obtenidos con los publicados en otros trabajos&#46; Comparamos los marcadores anal&#237;ticos de inflamaci&#243;n entre causas inflamatorias y no inflamatorias de EN&#46; La cohorte final qued&#243; compuesta por 52 pacientes&#44; con un 20&#37; de casos idiop&#225;ticos&#44; un 34&#37; de casos secundarios a infecciones y otro 34&#37; de casos secundarios a enfermedades autoinmunes&#46; No hubo casos secundarios a f&#225;rmacos o linfomas&#46; No observamos diferencias significativas en los par&#225;metros anal&#237;ticos de inflamaci&#243;n en funci&#243;n de causa inflamatoria o no inflamatoria de EN&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Erythema nodosum &#40;EN&#41; is the most frequent panniculitis&#44; and although it can be idiopathic&#44; it presents multiple causal processes&#46; We made a retrospective&#44; observational and descriptive study about causes of EN in patients admitted to a third-level Spanish hospital over a period of 11 years&#44; and we compared the results obtained with those published in other studies&#46; We compared the analytical markers of inflammation between inflammatory and non-inflammatory causes of EN&#46; The final cohort was composed by 52 patients&#44; with 20&#37; of idiopathic cases&#44; 34&#37; of cases secondary to infections and another 34&#37; of cases secondary to autoimmune diseases&#46; There were no cases secondary to drugs or lymphomas&#46; We did not observe significant differences in the analytical parameters of inflammation between inflammatory or non-inflammatory cause of EN&#46;</p></span>"
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                  \t\t\t\t">2&#47;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Secundario</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;64&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infeccioso</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;61&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Enfermedad tuberculosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>ITL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FAA estreptoc&#243;cica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5-48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;71&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FAA no estreptoc&#243;cica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>EIP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>GEA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Strongyloides</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Meningitis v&#237;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> Turqu&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Varas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Chile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Torralba y Alda Madrid &#40;Espa&#241;a&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tama&#241;o muestral</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">129&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">106&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Porcentaje de mujeres</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#193;mbito de estudio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hospitalizados y ambulatorios en Dermatolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hospitalizados y ambulatorios en Medicina Interna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hospitalizados en Medicina Interna&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hospitalizados&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hospitalizados en Medicina Interna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hospitalizados&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad en a&#241;os&#44; media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Rango etario</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9-70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15-71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16-76&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1-72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idiop&#225;ticos &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33280&#44;84&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#44;7112&#44;22&#44;23&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">F&#225;rmacos &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Neoplasias &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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COMUNICACIÓN BREVE
Causas de eritema nudoso en pacientes ingresados en un hospital español de tercer nivel
Causes of Erythema Nodosum in Patients Admitted to a Tertiary Care Hospital in Spain
Á. Torralba-Moróna,
Autor para correspondencia
angelito_torralba@hotmail.com

Autor para correspondencia.
, I. Alda-Bravob
a Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
b Servicio de Oncología Radioterápica, Hospital Universitario 12 de Octubre, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El eritema nudoso &#40;EN&#41; es la paniculitis m&#225;s frecuente&#46; Se manifiesta como n&#243;dulos eritematoviol&#225;ceos no ulcerados&#44; profundos y dolorosos&#44; de 1-10<span class="elsevierStyleHsp" style=""></span>cm de di&#225;metro&#44; que se localizan preferentemente en la cara anterior de las piernas&#44; aunque pueden aparecer en otras localizaciones&#46; Desaparecen espont&#225;neamente en 2-8 semanas sin dejar lesiones residuales&#46; Pueden ser recurrentes y es habitual que se acompa&#241;en de fiebre&#44; malestar general y poliartralgias&#46; Es m&#225;s frecuente en mujeres y su incidencia es mayor entre la segunda y la cuarta d&#233;cadas de la vida<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El EN se desarrolla como consecuencia de una reacci&#243;n de hipersensibilidad retardada tipo <span class="elsevierStyleSmallCaps">iv</span>&#44; que puede ser desencadenada por diferentes ant&#237;genos&#46; Histol&#243;gicamente&#44; los hallazgos var&#237;an con la evoluci&#243;n temporal de las lesiones&#46; En las lesiones tempranas se observa edema y hemorragia en los septos del tejido celular subcut&#225;neo&#44; con un infiltrado de neutr&#243;filos dispuestos entre los haces de col&#225;geno&#46; En las fases tard&#237;as&#44; se observa una fibrosis de los septos con tejido de granulaci&#243;n periseptal e infiltrado inflamatorio compuesto por linfocitos&#44; histiocitos y c&#233;lulas gigantes multinucleadas&#46; Es muy caracter&#237;stico observar granulomas radiales de Miescher&#58; agregados nodulares de histiocitos rodeados de neutr&#243;filos que se disponen radialmente alrededor de los vasos sangu&#237;neos&#44; y que se localizan en el l&#237;mite entre el septo afectado y el lobulillo hipod&#233;rmico&#46; Las lesiones de EN no presentan vasculitis ni necrosis de adipocitos y&#44; a pesar de la intensa fibrosis&#44; se resuelven por completo en unas semanas<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Aunque una proporci&#243;n importante de casos de EN son idiop&#225;ticos &#40;17-72&#37;&#41;&#44; se ha demostrado la asociaci&#243;n del EN con procesos infecciosos&#58; faringoamigdalitis estreptoc&#243;cica&#44; tuberculosis o infecciones por <span class="elsevierStyleItalic">Yersinia&#59;</span> autoinmunes&#58; sarcoidosis&#44; enfermedad inflamatoria intestinal o enfermedad de Beh&#231;et&#59; f&#225;rmacos&#58; anticonceptivos orales o sulfamidas&#59; o con el embarazo&#46; El EN puede aparecer como un proceso paraneopl&#225;sico en linfomas o leucemias<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En cuanto al tratamiento&#44; debe tratarse espec&#237;ficamente la enfermedad causal subyacente siempre que sea posible&#46; Respecto al tratamiento dirigido para EN&#44; la mayor&#237;a de los casos remiten espont&#225;neamente en pocas semanas con reposo&#46; Como tratamiento sintom&#225;tico&#44; pueden emplearse analg&#233;sicos y antiinflamatorios no esteroideos&#44; que deben evitarse en caso de una enfermedad de Crohn subyacente&#59; yoduro de potasio&#44; colchicina&#44; hidroxicloroquina o corticoides &#40;tras haber descartado una causa infecciosa de EN&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Por su gran variedad etiol&#243;gica&#44; las causas predominantes de EN pueden variar entre &#225;reas geogr&#225;ficas&#44; &#233;pocas del a&#241;o o seg&#250;n el &#225;mbito de asistencia sanitaria&#46; El objetivo de nuestro trabajo es describir las causas m&#225;s frecuentes de EN en pacientes ingresados en un hospital espa&#241;ol de tercer nivel y comparar nuestros resultados con los obtenidos en otros trabajos&#46; Adem&#225;s&#44; comparamos los marcadores anal&#237;ticos de inflamaci&#243;n en funci&#243;n de si la causa de EN es una enfermedad inflamatoria o no inflamatoria&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Pacientes y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio retrospectivo&#44; observacional y descriptivo de pacientes ingresados por EN en el Hospital Universitario 12 de Octubre de Madrid &#40;Espa&#241;a&#41; entre el 1 de enero de 2005 y el 31 de diciembre de 2015&#46; Los pacientes se obtuvieron a partir de los archivos de historias cl&#237;nicas de alta hospitalaria de nuestro centro&#46; El diagn&#243;stico de EN se estableci&#243; mediante criterios cl&#237;nicos o por estudio histol&#243;gico compatible&#44; cuando estuvo disponible&#46; La etiolog&#237;a de EN se determin&#243; a trav&#233;s de la historia cl&#237;nica del paciente seg&#250;n las siguientes definiciones&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Faringoamigdalitis estreptoc&#243;cica&#58;</span> cuadro cl&#237;nico compatible en las 6 semanas previas al diagn&#243;stico de EN&#44; 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sin otra causa&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">F&#225;rmacos&#58;</span> consumo previo al desarrollo de EN&#44; sin otra causa&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Idiop&#225;tico&#58;</span> aquellos casos que ten&#237;an un estudio etiol&#243;gico negativo&#44; que deb&#237;a incluir como m&#237;nimo anamnesis y exploraci&#243;n f&#237;sica dirigidas a causas conocidas de EN &#40;incluyendo f&#225;rmacos&#41;&#44; anal&#237;tica general b&#225;sica&#44; estudio de autoinmunidad&#44; prueba de Mantoux y radiograf&#237;a de t&#243;rax&#46;</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">Se determin&#243; de cada paciente el sexo&#44; la edad al diagn&#243;stico de EN&#44; la realizaci&#243;n o no de biopsia cut&#225;nea y par&#225;metros anal&#237;ticos de inflamaci&#243;n&#58; leucocitos&#44; velocidad de sedimentaci&#243;n globular y prote&#237;na C reactiva&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">An&#225;lisis estad&#237;stico</span><p id="par0100" class="elsevierStylePara elsevierViewall">Las variables cualitativas se expresaron como frecuencias absolutas y relativas&#46; Las variables cuantitativas se expresaron como media y desviaci&#243;n est&#225;ndar&#46; La comparaci&#243;n de par&#225;metros inflamatorios entre casos de EN de etiolog&#237;a inflamatoria y no inflamatoria se realiz&#243; mediante la prueba no param&#233;trica de Mann-Whitney&#46; Se consider&#243; estad&#237;sticamente significativo un valor p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con el software SAS&#174; 9&#46;04 &#40;University Edition&#41;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="par0105" class="elsevierStylePara elsevierViewall">Se recogieron 116 pacientes con un diagn&#243;stico inicial de EN&#46; Se excluyeron 64 pacientes por una historia cl&#237;nica incompleta&#44; por carecer del estudio etiol&#243;gico m&#237;nimo&#44; por presentar un diagn&#243;stico final distinto de EN o por haber presentado el diagn&#243;stico correcto de EN fuera del periodo de recogida de datos&#46; La cohorte final qued&#243; compuesta por 52 pacientes&#44; con una edad media de 36&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;4 a&#241;os y un 76&#44;9&#37; de mujeres&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> describe las caracter&#237;sticas de los pacientes y su distribuci&#243;n etiol&#243;gica&#46; En 35 &#40;67&#44;3&#37;&#41; pacientes se confirm&#243; el diagn&#243;stico mediante estudio histol&#243;gico&#46; Hubo 10 &#40;19&#44;2&#37;&#41; casos idiop&#225;ticos&#44; 18 &#40;34&#44;6&#37;&#41; casos secundarios a infecci&#243;n&#58; 7 a faringoamigdalitis estreptoc&#243;cica y 5 a enfermedad tuberculosa&#59; otros 18 &#40;34&#44;6&#37;&#41; a enfermedad autoinmune&#58; 9 a sarcoidosis&#44; 6 a enfermedad inflamatoria intestinal y 2 a enfermedad de Beh&#231;et&#59; y 4 casos &#40;7&#44;7&#37;&#41; secundarios a embarazo&#46; No se identificaron casos secundarios a causas habituales de EN&#44; como f&#225;rmacos&#44; linfomas sist&#233;micos&#44; yersiniosis o micosis sist&#233;micas&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Los casos secundarios recibieron tratamiento dirigido seg&#250;n la causa etiol&#243;gica&#46; Para el manejo sintom&#225;tico&#44; 25 &#40;48&#37;&#41; pacientes fueron tratados con antiinflamatorios no esteroideos y&#47;o paracetamol&#44; 17 &#40;32&#44;7&#37;&#41; con corticoides&#44; 9 &#40;17&#44;3&#37;&#41; con yoduro de potasio y 5 &#40;9&#44;6&#37;&#41; con colchicina&#46; Por no estar registrado en las historias cl&#237;nicas examinadas&#44; no fue posible determinar el porcentaje de recurrencias de EN ni el tiempo de resoluci&#243;n de las lesiones&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Se definieron como causas inflamatorias de EN las infecciosas y las autoinmunes&#46; Comparando las causas inflamatorias con las no inflamatorias&#44; no se observaron diferencias significativas en los valores medios de leucocitos &#40;10&#46;428 vs&#46; 9&#46;964&#44;6<span class="elsevierStyleHsp" style=""></span>leucocitos&#47;mm<span class="elsevierStyleSup">3</span>&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;82&#41;&#44; velocidad de sedimentaci&#243;n globular &#40;65&#44;85 vs&#46; 61&#44;27<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;68&#41; ni prote&#237;na C reactiva &#40;6&#44;97 vs&#46; 8&#44;63<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;53&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> comparamos los resultados obtenidos en nuestra muestra con los publicados en otras cohortes de pacientes diagnosticados de EN&#46; Nuestra cohorte presenta una edad media similar y una proporci&#243;n algo menor de mujeres&#46; Hubo menos casos idiop&#225;ticos que en otras cohortes&#44; quiz&#225; por tratarse de una muestra de pacientes hospitalizados con un estudio diagn&#243;stico probablemente m&#225;s exhaustivo&#46; La proporci&#243;n de causas infecciosas es similar a la de otros estudios europeos<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7&#8211;10</span></a>&#44; aunque inferior a la observada por Varas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> en Chile&#44; siendo la faringoamigdalitis estreptoc&#243;cica y la enfermedad tuberculosa las causas infecciosas m&#225;s frecuentes en nuestra serie y en las dem&#225;s series revisadas&#46; Nuestra cohorte presenta una proporci&#243;n mayor de casos atribuibles a enfermedad autoinmune&#44; a expensas de una mayor frecuencia de casos de enfermedad inflamatoria intestinal y sarcoidosis&#44; aunque esta &#250;ltima con una frecuencia similar a la observada por Garc&#237;a et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> en nuestro mismo pa&#237;s&#46; La proporci&#243;n de casos secundarios a enfermedad de Beh&#231;et es similar a las observadas en otros trabajos&#46; Destacaba en nuestro estudio la ausencia de casos secundarios a f&#225;rmacos y una mayor proporci&#243;n de casos secundarios a embarazo y neoplasias&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Al igual que Garc&#237;a et al&#46;&#44; no observamos diferencias significativas en los par&#225;metros anal&#237;ticos de inflamaci&#243;n en funci&#243;n de causa inflamatoria o no inflamatoria de EN&#46; S&#237; se observaron diferencias en estos par&#225;metros en los estudios de Varas et al&#46; y de Mert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a>&#46; En los casos no biopsiados&#44; siendo tan caracter&#237;stica la lesi&#243;n de EN&#44; es poco probable el error diagn&#243;stico&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el EN presenta un amplio diagn&#243;stico diferencial en su etiolog&#237;a&#46; El origen hospitalario de nuestra cohorte parece favorecer un bajo porcentaje de casos idiop&#225;ticos y que no se observaran causas habituales de EN&#44; como el uso de f&#225;rmacos&#46; Las infecciones y las enfermedades autoinmunes fueron las causas m&#225;s frecuentes de EN secundario en nuestra cohorte&#46; No observamos diferencias en los marcadores anal&#237;ticos de inflamaci&#243;n en funci&#243;n de causa inflamatoria o no inflamatoria de EN&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Para establecer el diagn&#243;stico etiol&#243;gico en pacientes hospitalizados por EN&#44; parece razonable una aproximaci&#243;n inicial mediante anamnesis y exploraci&#243;n f&#237;sica dirigidas a causas habituales de EN&#44; incluyendo f&#225;rmacos&#59; realizaci&#243;n de hemograma&#44; bioqu&#237;mica b&#225;sica&#44; velocidad de sedimentaci&#243;n globular y prote&#237;na C reactiva&#59; determinaci&#243;n de ASLO y realizaci&#243;n de radiograf&#237;a simple de t&#243;rax y prueba de Mantoux&#46; La solicitud de serolog&#237;as infecciosas e inmunol&#243;gicas&#44; y la realizaci&#243;n de otras pruebas complementarias deber&#225;n estimarse en funci&#243;n de la cl&#237;nica acompa&#241;ante al episodio de EN&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicto de intereses</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El eritema nudoso &#40;EN&#41; es la paniculitis m&#225;s frecuente y aunque puede ser idiop&#225;tico&#44; presenta m&#250;ltiples procesos causales&#46; Elaboramos un estudio retrospectivo&#44; observacional y descriptivo de las causas de EN en pacientes ingresados en un hospital espa&#241;ol de tercer nivel durante un per&#237;odo de 11 a&#241;os&#44; y comparamos los resultados obtenidos con los publicados en otros trabajos&#46; Comparamos los marcadores anal&#237;ticos de inflamaci&#243;n entre causas inflamatorias y no inflamatorias de EN&#46; La cohorte final qued&#243; compuesta por 52 pacientes&#44; con un 20&#37; de casos idiop&#225;ticos&#44; un 34&#37; de casos secundarios a infecciones y otro 34&#37; de casos secundarios a enfermedades autoinmunes&#46; No hubo casos secundarios a f&#225;rmacos o linfomas&#46; No observamos diferencias significativas en los par&#225;metros anal&#237;ticos de inflamaci&#243;n en funci&#243;n de causa inflamatoria o no inflamatoria de EN&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Erythema nodosum &#40;EN&#41; is the most frequent panniculitis&#44; and although it can be idiopathic&#44; it presents multiple causal processes&#46; We made a retrospective&#44; observational and descriptive study about causes of EN in patients admitted to a third-level Spanish hospital over a period of 11 years&#44; and we compared the results obtained with those published in other studies&#46; We compared the analytical markers of inflammation between inflammatory and non-inflammatory causes of EN&#46; The final cohort was composed by 52 patients&#44; with 20&#37; of idiopathic cases&#44; 34&#37; of cases secondary to infections and another 34&#37; of cases secondary to autoimmune diseases&#46; There were no cases secondary to drugs or lymphomas&#46; We did not observe significant differences in the analytical parameters of inflammation between inflammatory or non-inflammatory cause of EN&#46;</p></span>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">EII&#58; enfermedad inflamatoria intestinal&#59; EIP&#58; enfermedad inflamatoria p&#233;lvica&#59; FAA&#58; faringoamigdalitis aguda&#59; GEA&#58; gastroenteritis aguda&#59; H&#58; hombre&#59; ITL&#58; infecci&#243;n tuberculosa latente&#59; M&#58; mujer&#59; NA&#58; no aplica por tratarse de un solo caso&#46;</p>"
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;61&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Enfermedad tuberculosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>ITL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FAA estreptoc&#243;cica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5-48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;71&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>FAA no estreptoc&#243;cica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>EIP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>GEA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Strongyloides</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Meningitis v&#237;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Autoinmune</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14-72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;61&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sarcoidosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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