Case and Research Letter
Disseminated Sporotrichosis With Cutaneous and Testicular Involvement
Esporotricosis diseminada con afección cutánea y testicular
C.J. Espinoza-Hernández, A. Jesús-Silva, S. Toussaint-Caire, R. Arenas
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Servicio de Dermatología, Hospital General Dr. Manuel Gea González, México D.F., Mexico
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Espinoza-Hernández, A. Jesús-Silva, S. Toussaint-Caire, R. Arenas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C.J." "apellidos" => "Espinoza-Hernández" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Jesús-Silva" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Toussaint-Caire" ] 3 => array:4 [ "nombre" => "R." "apellidos" => "Arenas" "email" => array:1 [ 0 => "rarenas98@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Dr. Manuel Gea González, México D.F., Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding Author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Esporotricosis diseminada con afección cutánea y testicular" ] ] "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" => 857 "Ancho" => 1500 "Tamanyo" => 189235 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, PAS-stained smear showing cigar-shaped yeast cells (original magnification ×100). B, Microscopic analysis of the culture showing sympodial conidia (lactophenol blue, original magnification ×40). C, Culture of <span class="elsevierStyleItalic">Sporothrix</span> species.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sporotrichosis is a subcutaneous mycosis caused by the dimorphic fungus <span class="elsevierStyleItalic">Sporothrix schenckii</span>, which can have a subacute or chronic course.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This disease has a worldwide distribution<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and is an emerging infection in Europe, where it has become quite common.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The most frequent method of transmission is traumatic inoculation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This polymorphic mycosis has 4 clinical forms: lymphocutaneous, fixed cutaneous, disseminated, and extracutaneous. The extracutaneous and disseminated forms account for 4% of total cases<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and most often affect immunocompromised patients, in whom the fungus acts as an opportunistic agent.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Amphotericin B is the treatment of choice for systemic disseminated forms.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 54 year-old male construction worker with no relevant medical history except chronic alcohol consumption. The patient reported weight loss and intermittent fever associated with rapidly spreading dermatitis, which had developed 6 months earlier and was characterized by multiple, very painful necrotic pustules and ulcers of varying size with purulent exudate, some with a verrucous surface. The lesions affected a significant percentage of the body surface, exposing muscles and tendons (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> A-D). The patient reported that he had undergone a right radical orchiectomy in another hospital for a testicular tumor that was likely malignant.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Direct examination of the skin lesions with potassium hydroxide and staining of smears with Gram stain and periodic acid Schiff (PAS) revealed abundant, elongated, cigar-shaped yeast cells (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Microscopic analysis of cells cultured in Sabouraud dextrose agar showed conidia arranged laterally on the hyphae (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> B), and identified the cells as <span class="elsevierStyleItalic">S schenckii</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). The following bacterial aggregates were also observed: <span class="elsevierStyleItalic">Acinetobacter baumanni</span> (><span class="elsevierStyleHsp" style=""></span>250,000 colony-forming units) in a qualitative skin biopsy culture; multiresistant <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> in pustule exudate; and oxacillin-resistant <span class="elsevierStyleItalic">Staphylococcus haemolyticus</span> in a blood culture. The sporotrichin skin test was negative.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The skin biopsy showed nodular and diffuse inflammatory infiltrate, which was composed of lymphocytes, epithelioid histiocytes, multinucleated giant cells, and neutrophils, and produced suppurative granulomas and tissue necrosis (<a class="elsevierStyleCrossRef" href="#fig0015">Figs. 3</a>A and B). PAS and Grocott Gomori staining revealed abundant yeast cells, both round and elongated (<a class="elsevierStyleCrossRef" href="#fig0015">Figs. 3</a><span class="elsevierStyleHsp" style=""></span>C and D).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Histology of the tissue excised in the orchiectomy revealed similar findings; chronic granulomatous inflammation was observed with multinucleated giant cells, necrosis, and polymorphonuclear infiltration (<a class="elsevierStyleCrossRef" href="#fig0020">Figs. 4</a> A and B). Staining showed spherical and cigar-shaped spores consistent with sporotrichosis (<a class="elsevierStyleCrossRef" href="#fig0020">Figs. 4</a><span class="elsevierStyleHsp" style=""></span>C and D).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Tumor staging ruled out fungal invasion of other organs, and HIV serology was negative.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient’ wounds were dressed and he was treated with amphotericin B deoxycholate for 14 days (total cumulative dose of 1.68<span class="elsevierStyleHsp" style=""></span>g) in addition to antibiotics. The clinical course of infection was prolonged due to several complications related to treatment, associated infections, and the disease itself. These included septic shock, nephrotoxicity (acute renal failure, hypokalemia, hypomagnesemia, metabolic acidosis), liver failure, and disseminated intravascular coagulation. The patient died due to severe hemodynamic compromise.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Sporotrichosis is caused by the dimorphic fungus <span class="elsevierStyleItalic">S schenckii</span>.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most common presentation is lymphocutaneous; extracutaneous forms are rare, and are more prevalent in immunosuppressed patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The case described here was classified as systemic disseminated sporotrichosis with additional extracutaneous involvement, with disseminated skin lesions, general malaise and internal organ involvement. This form is most common in immunocompromised patients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The fungal infection was highly invasive, not only in terms of its cutaneous extension and testicular involvement, but also the degree of necrosis, depth of invasion, and the destruction of adjacent muscles and tendons. The sporotrichin skin test was anergic, indicating a poor immune response to fungal invasion by the patient. The only immunosuppression-associated factor detected was chronic alcoholism. The patient had also recently undergone orchiectomy at another institution due to clinical suspicion of a malignant testicular tumor, without prior confirmation of the nature of the lesion.</p><p id="par0055" class="elsevierStylePara elsevierViewall">It was not possible to determine the mechanism of infection, but given the patient’ profession he may have acquired the microorganism via cutaneous inoculation, as the lesions first appeared on the left hand, and later spread throughout the body by hematogenous dissemination.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Sporotrichosis is definitively diagnosed by culture of the fungus obtained from a skin biopsy. Histology is usually not diagnostic, as the yeast is present in small amounts.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, in this patient, a large number of fungal elements were detected in the cutaneous and testicular biopsies.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The treatment of choice for extracutaneous and disseminated forms of sporotrichosis is amphotericin B, followed by long-term itraconazole administration in immunocompromised patients.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In summary, our patient’ chronic alcohol abuse led to a state of severe immunosuppression, favoring the fulminant course of sporotrichosis with significant fungal invasion, which, together with a lack of prior clinical suspicion as well as complications associated with the treatment, concurrent bacterial infections, and the mycosis itself, resulted in the patient's death.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Espinoza-Hernández C, Jesús-Silva A, Toussaint-Caire S, Arenas R. Esporotricosis diseminada con afección cutánea y testicular. Actas Dermosifiliogr. 2014;105:204–206.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1064 "Ancho" => 1501 "Tamanyo" => 232346 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Necrotic pustules and papules on the trunk and lower extremities. B, Ulcers and extensive necrosis on the head. C and D, Large ulcers on the left forearm with exposed tendons and muscle.</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" => 857 "Ancho" => 1500 "Tamanyo" => 189235 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, PAS-stained smear showing cigar-shaped yeast cells (original magnification ×100). B, Microscopic analysis of the culture showing sympodial conidia (lactophenol blue, original magnification ×40). C, Culture of <span class="elsevierStyleItalic">Sporothrix</span> species.</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" => 840 "Ancho" => 1500 "Tamanyo" => 301557 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Histopathology of skin samples with suppurative granuloma containing lymphocytes, epithelioid histiocytes, and multinucleated giant cells (hematoxylin-eosin, original magnification ×5). B, Higher magnification image showing phagocytosed yeast cells (hematoxylin-eosin, original magnification ×40). C, Note the abundance of yeast cells (PAS, original magnification ×20). D, Ovoid and cigar-shaped yeast cells (Gomori-Grocott, original magnification ×20).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 805 "Ancho" => 1500 "Tamanyo" => 296530 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Testicular biopsy. A, Substitution of the testicular parenchyma with chronic granulomatous inflammation with multinucleated giant cells, areas of necrosis, and polymorphonuclear infiltration (hematoxylin-eosin, original magnification ×5). B, Higher magnification image showing abundant ovoid yeast cells (hematoxylin-eosin, original magnification ×40). C and D, Spherical and cigar-shaped spores (PAS and Gomori Grocott, original magnification ×20).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sporotrichosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. 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Camacho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2010.06.011" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2011" "volumen" => "29" "paginaInicial" => "233" "paginaFinal" => "234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21330011" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sporothrix schenckii and sporotrichosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.M. Lopes" 1 => "A. Schubach" 2 => "R.O. Costa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Acad Bras Cien" "fecha" => "2006" "volumen" => "78" "paginaInicial" => "293" "paginaFinal" => "308" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clasificación de la esporotricosis. Una propuesta con base en el comportamiento inmunológico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Saúl" 1 => "A. Bonifaz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatología Rev Mex" "fecha" => "2011" "volumen" => "55" "paginaInicial" => "200" "paginaFinal" => "208" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sporotrichosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Vázquez-del Mercado" 1 => "R. Arenas" 2 => "C. Padilla-Desgarenes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2011.09.017" "Revista" => array:7 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "437" "paginaFinal" => "443" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22682194" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1552526010000142" "estado" => "S300" "issn" => "15525260" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Kauffman" 1 => "B. Bustamante" 2 => "S. Chapman" 3 => "E. Pappas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "CID" "fecha" => "2007" "paginaInicial" => "1255" "paginaFinal" => "1265" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack75381" "titulo" => "Acknowledgements" "texto" => "<p id="par0075" class="elsevierStylePara elsevierViewall">We thank Dr. José G. Chanona Vilchis, Head of the Department of Surgical Pathology of the Instituto Nacional de Cancerología, for providing testicular biopsy samples and histological descriptions.</p> <p id="par0080" class="elsevierStylePara elsevierViewall">We also thank Dr. Diana Vilar Compte of the Infectious Diseases Service at the Hospital General Dr. Manuel Gea González for microbiological identification of superadded bacterial infections, and Dr. Horacio Vidrio Morgado, Surgical Oncology Resident at the Instituto Nacional de Cancerología, and Dr. Alberto de los Ríos, Internal Medicine Resident at the Hospital General Dr. Manuel Gea González, for their role in the metabolic and surgical management of the patient.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000002/v1_201403090058/S1578219014000274/v1_201403090058/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/15782190/0000010500000002/v1_201403090058/S1578219014000274/v1_201403090058/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000274?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 18 | 29 |
| 2024 Octubre | 115 | 48 | 163 |
| 2024 Septiembre | 110 | 27 | 137 |
| 2024 Agosto | 110 | 73 | 183 |
| 2024 Julio | 101 | 42 | 143 |
| 2024 Junio | 112 | 55 | 167 |
| 2024 Mayo | 128 | 54 | 182 |
| 2024 Abril | 111 | 38 | 149 |
| 2024 Marzo | 104 | 35 | 139 |
| 2024 Febrero | 98 | 40 | 138 |
| 2024 Enero | 108 | 37 | 145 |
| 2023 Diciembre | 101 | 21 | 122 |
| 2023 Noviembre | 105 | 31 | 136 |
| 2023 Octubre | 94 | 27 | 121 |
| 2023 Septiembre | 98 | 38 | 136 |
| 2023 Agosto | 85 | 22 | 107 |
| 2023 Julio | 116 | 35 | 151 |
| 2023 Junio | 107 | 28 | 135 |
| 2023 Mayo | 117 | 27 | 144 |
| 2023 Abril | 116 | 31 | 147 |
| 2023 Marzo | 128 | 38 | 166 |
| 2023 Febrero | 81 | 19 | 100 |
| 2023 Enero | 71 | 36 | 107 |
| 2022 Diciembre | 78 | 56 | 134 |
| 2022 Noviembre | 52 | 34 | 86 |
| 2022 Octubre | 52 | 23 | 75 |
| 2022 Septiembre | 53 | 46 | 99 |
| 2022 Agosto | 51 | 33 | 84 |
| 2022 Julio | 46 | 42 | 88 |
| 2022 Junio | 47 | 42 | 89 |
| 2022 Mayo | 109 | 29 | 138 |
| 2022 Abril | 141 | 54 | 195 |
| 2022 Marzo | 119 | 52 | 171 |
| 2022 Febrero | 110 | 44 | 154 |
| 2022 Enero | 118 | 43 | 161 |
| 2021 Diciembre | 84 | 32 | 116 |
| 2021 Noviembre | 83 | 62 | 145 |
| 2021 Octubre | 99 | 59 | 158 |
| 2021 Septiembre | 78 | 51 | 129 |
| 2021 Agosto | 83 | 56 | 139 |
| 2021 Julio | 66 | 40 | 106 |
| 2021 Junio | 67 | 45 | 112 |
| 2021 Mayo | 68 | 40 | 108 |
| 2021 Abril | 163 | 73 | 236 |
| 2021 Marzo | 67 | 31 | 98 |
| 2021 Febrero | 69 | 31 | 100 |
| 2021 Enero | 36 | 31 | 67 |
| 2020 Diciembre | 29 | 27 | 56 |
| 2020 Noviembre | 31 | 18 | 49 |
| 2020 Octubre | 15 | 11 | 26 |
| 2020 Septiembre | 21 | 20 | 41 |
| 2020 Agosto | 24 | 13 | 37 |
| 2020 Julio | 27 | 16 | 43 |
| 2020 Junio | 24 | 21 | 45 |
| 2020 Mayo | 27 | 23 | 50 |
| 2020 Abril | 35 | 16 | 51 |
| 2020 Marzo | 29 | 18 | 47 |
| 2020 Febrero | 8 | 1 | 9 |
| 2020 Enero | 0 | 4 | 4 |
| 2019 Diciembre | 5 | 4 | 9 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 4 | 4 | 8 |
| 2019 Agosto | 4 | 7 | 11 |
| 2019 Julio | 8 | 13 | 21 |
| 2019 Junio | 4 | 17 | 21 |
| 2019 Mayo | 6 | 15 | 21 |
| 2019 Abril | 2 | 20 | 22 |
| 2019 Marzo | 1 | 6 | 7 |
| 2019 Febrero | 7 | 6 | 13 |
| 2019 Enero | 5 | 4 | 9 |
| 2018 Diciembre | 0 | 4 | 4 |
| 2018 Noviembre | 5 | 10 | 15 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Marzo | 8 | 0 | 8 |
| 2018 Febrero | 71 | 2 | 73 |
| 2018 Enero | 93 | 5 | 98 |
| 2017 Diciembre | 98 | 6 | 104 |
| 2017 Noviembre | 77 | 1 | 78 |
| 2017 Octubre | 103 | 3 | 106 |
| 2017 Septiembre | 55 | 11 | 66 |
| 2017 Agosto | 93 | 5 | 98 |
| 2017 Julio | 50 | 11 | 61 |
| 2017 Junio | 80 | 7 | 87 |
| 2017 Mayo | 50 | 5 | 55 |
| 2017 Abril | 33 | 10 | 43 |
| 2017 Marzo | 29 | 5 | 34 |
| 2017 Febrero | 101 | 6 | 107 |
| 2017 Enero | 39 | 10 | 49 |
| 2016 Diciembre | 65 | 8 | 73 |
| 2016 Noviembre | 75 | 12 | 87 |
| 2016 Octubre | 116 | 7 | 123 |
| 2016 Septiembre | 201 | 14 | 215 |
| 2016 Agosto | 99 | 7 | 106 |
| 2016 Julio | 44 | 5 | 49 |
| 2016 Junio | 15 | 10 | 25 |
| 2016 Mayo | 5 | 8 | 13 |
| 2016 Abril | 3 | 5 | 8 |
| 2016 Marzo | 4 | 2 | 6 |
| 2016 Febrero | 19 | 2 | 21 |
| 2016 Enero | 7 | 1 | 8 |
| 2015 Diciembre | 11 | 10 | 21 |
| 2015 Noviembre | 10 | 1 | 11 |
| 2015 Octubre | 9 | 2 | 11 |
| 2015 Septiembre | 6 | 4 | 10 |
| 2015 Agosto | 3 | 3 | 6 |
| 2015 Julio | 99 | 5 | 104 |
| 2015 Junio | 48 | 9 | 57 |
| 2015 Mayo | 71 | 11 | 82 |
| 2015 Abril | 60 | 4 | 64 |
| 2015 Marzo | 78 | 2 | 80 |
| 2015 Febrero | 52 | 4 | 56 |
| 2015 Enero | 39 | 6 | 45 |
| 2014 Diciembre | 46 | 7 | 53 |
| 2014 Noviembre | 48 | 5 | 53 |
| 2014 Octubre | 41 | 6 | 47 |
| 2014 Septiembre | 40 | 3 | 43 |
| 2014 Agosto | 25 | 6 | 31 |
| 2014 Julio | 32 | 6 | 38 |
| 2014 Junio | 40 | 5 | 45 |
| 2014 Mayo | 33 | 9 | 42 |
| 2014 Abril | 19 | 9 | 28 |
| 2014 Marzo | 8 | 6 | 14 |
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