Case and Research Letters
Primary Cutaneous Mucormycosis Due to Saksenaea vasiformis in an Immunocompetent Patient
Mucormicosis cutánea primaria por Saksenaea vasiformis en paciente inmunocompetente
I.M. Coronel-Péreza,
, E.M. Rodríguez-Reya, L. Castilla-Guerrab, M.C. Domínguezc
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a Servicio de Dermatología, Hospital de la Merced, Área de Gestión Sanitaria de Osuna, Sevilla, Spain
b Servicio de Medicina Interna, Hospital de la Merced, Área de Gestión Sanitaria de Osuna, Sevilla, Spain
c Servicio de Microbiología, Hospital de la Merced, Área de Gestión Sanitaria de Osuna, Sevilla, Spain
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Coronel-Pérez, E.M. Rodríguez-Rey, L. Castilla-Guerra, M.C. Domínguez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I.M." "apellidos" => "Coronel-Pérez" "email" => array:1 [ 0 => "mcoronel@aedv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E.M." "apellidos" => "Rodríguez-Rey" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Castilla-Guerra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M.C." "apellidos" => "Domínguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de la Merced, Área de Gestión Sanitaria de Osuna, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de la Merced, Área de Gestión Sanitaria de Osuna, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital de la Merced, Área de Gestión Sanitaria de Osuna, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mucormicosis cutánea primaria por <span class="elsevierStyleItalic">Saksenaea vasiformis</span> en paciente inmunocompetente" ] ] "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" => 677 "Ancho" => 900 "Tamanyo" => 112798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Forearm 3 months later. The ulcer had almost completely re-epithelialized following treatment with amphotericin B, surgical debridement of the wound, and topical application of silver sulfadiazine.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 76-year-old man with a history of hypertension, dyslipidemia, and cerebral vascular accident presented with a necrotic lesion and intense inflammation of the surrounding soft tissues on the left forearm. He attributed the lesion to a sting or bite of unknown origin during a hunting outing in the month of July. The ulcer worsened despite treatment with oral doxycycline and intravenous amoxicillin-clavulanic acid, and the patient was administered intravenous broad-spectrum empiric antibiotic therapy with imipenem and amphotericin B (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Hematoxylin-eosin staining of a biopsy specimen showed branching hyphae in the subcutaneous tissue together with necrosis and an intense inflammatory infiltrate. Cultures were negative for aerobic and anaerobic bacteria and mycobacteria. Fungal culture in Sabouraud-dextrose agar permitted the identification of the microorganism responsible for the infection after 48<span class="elsevierStyleHsp" style=""></span>hours incubation at 30<span class="elsevierStyleHsp" style=""></span>°C. Microscopic examination with lactophenol cotton blue revealed the growth of a white downy colony, without sporulation, in addition to typical wide, aseptate hyphae with right-angle branching characteristic of Mucorales fungi. The strain was sent to the Mycology Laboratory at Instituto de Salud Carlos III, where it was identified as <span class="elsevierStyleItalic">Saksenaea vasiformis</span> with a minimum inhibitory concentration of 2<span class="elsevierStyleHsp" style=""></span>μg/mL for amphotericin B, ><span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>μg/mL for itraconazole and voriconazole, 2<span class="elsevierStyleHsp" style=""></span>μg/mL for posaconazole; ><span class="elsevierStyleHsp" style=""></span>16<span class="elsevierStyleHsp" style=""></span>μg/mL for caspofungin, and 0.03<span class="elsevierStyleHsp" style=""></span>μg/mL for terbinafine. No accumulation of liquid or gas was observed on ultrasound. The ulcer started to heal after treatment with amphotericin B 100<span class="elsevierStyleHsp" style=""></span>mg daily for 10 days combined with surgical debridement of the wound. Re-epithelization occurred 3 months after topical application of silver sulfadiazine (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Fungi of the order Mucorales are ubiquitous in nature, and can be found in soil, organic substrates (wood, fruit, excrements, etc.) or as pathogens in animals and plants.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Approximately 70% to 80% of Mucorales infections in humans are caused by <span class="elsevierStyleItalic">Rhizopus</span>, <span class="elsevierStyleItalic">Mucor</span>, or <span class="elsevierStyleItalic">Lichtheimia</span> genera and tend to affect immunodepressed individuals. Infections progress fast, do not respond to standard antifungals, and have high morbidity and mortality. The remaining 20% to 30% of cases are caused by the rarer genera <span class="elsevierStyleItalic">Cunninghamella, Rhizomucor</span>, <span class="elsevierStyleItalic">Saksenaea</span>, <span class="elsevierStyleItalic">Apophysomyces, Syncephalastrum, Cokeromyces</span>, and <span class="elsevierStyleItalic">Actinomucor.</span> Infections in these cases tend to run a benign course, with exclusive skin and subcutaneous tissue involvement. They are associated with low mortality and respond well to amphotericin B and azoles.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Infections due to <span class="elsevierStyleItalic">S vasiformis</span> have been reported worldwide, although most cases have been described in the United States, Central America, Brazil, Europe, India, and Australia.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In our search of PubMed, we found 6 cases of <span class="elsevierStyleItalic">S vasiformis</span> infection reported for Spain.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–8</span></a> One of these was in the same area as our hospital,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and they all occurred in adults aged over 45 years (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In most of the cases, the fungus had penetrated the skin following an accident involving contact with soil. The cases involving local cutaneous involvement were resolved by administration of specific treatment or amputation of the affected limb.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> The patients with noncutaneous forms of <span class="elsevierStyleItalic">S vasiformis</span> infection forms died regardless of their underlying immune status.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">These opportunistic fungi gain entry through injuries or wounds caused by trauma, with most cases involving major trauma, such as traffic accidents, farming accidents (wound contamination) and surgery. There have, however, also been descriptions of infections by Mucorales fungi following minor trauma, including bites and stings. There have been reports of <span class="elsevierStyleItalic">S vasiformis</span> infection in a patient pecked by a magpie<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and stung by a scorpion.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The first case was resolved by wound debridement and administration of amphotericin B, although a skin graft was required to repair the wound defect. In the second case, amputation of the affected leg was necessary.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Infections due to <span class="elsevierStyleItalic">S vasiforms</span> are probably underdiagnosed as these fungi do not easily produce spores in standard fungal media. A high index of clinical suspicion is therefore necessary to ensure early treatment and avoid amputations and fatal outcomes.</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: Coronel-Pérez I, Rodríguez-Rey E, Castilla-Guerra L, Domínguez M. Mucormicosis cutánea primaria por <span class="elsevierStyleItalic">Saksenaea vasiformis</span> en paciente inmunocompetente. Actas Dermosifiliogr. 2015;106:516–518.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 447 "Ancho" => 975 "Tamanyo" => 104252 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Necrotic 5-cm ulcer surrounded by friable tissue, areas with a lumpy cotton-like appearance, and swelling of the forearm and dorsum of the left hand.</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" => 677 "Ancho" => 900 "Tamanyo" => 112798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Forearm 3 months later. The ulcer had almost completely re-epithelialized following treatment with amphotericin B, surgical debridement of the wound, and topical application of silver sulfadiazine.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex/Age, y \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mechanism of Infection \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Presentation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immune Status \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cefai et al.,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> 1987 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Woman/55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fall with elbow fracture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gangrenous cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution after amputation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gómez Merino et al.,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> 2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Man/66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cranioencephalic trauma due to traffic accident \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Immunocompetent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">García Martínez et al.,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> 2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Man/71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Possible inhalation of spores (gardener) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Invasive rhinocerebral mucormycosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Immunodepressed (diabetes, metastatic gastric adenocarcinoma, corticosteroid therapy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Death \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Domínguez et al.,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Woman/82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disseminated infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Immunocompetent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Death \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mayayo et al.,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Woman/46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Traffic accident \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Necrotizing fasciitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Immunocompetent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Death \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gómez Camarasa et al.,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> 2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Man/58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Farm accident \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cutaneous mucormycosis with subsequent dissemination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Immunodepressed (diabetes) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Death \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Present case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Man/76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bite/sting of unknown origin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Immunocompetent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cure \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab849503.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 9 | 21 |
| 2024 Octubre | 66 | 41 | 107 |
| 2024 Septiembre | 74 | 33 | 107 |
| 2024 Agosto | 103 | 57 | 160 |
| 2024 Julio | 95 | 47 | 142 |
| 2024 Junio | 107 | 38 | 145 |
| 2024 Mayo | 92 | 44 | 136 |
| 2024 Abril | 75 | 23 | 98 |
| 2024 Marzo | 89 | 32 | 121 |
| 2024 Febrero | 101 | 36 | 137 |
| 2024 Enero | 70 | 32 | 102 |
| 2023 Diciembre | 75 | 18 | 93 |
| 2023 Noviembre | 88 | 35 | 123 |
| 2023 Octubre | 101 | 22 | 123 |
| 2023 Septiembre | 90 | 34 | 124 |
| 2023 Agosto | 70 | 20 | 90 |
| 2023 Julio | 78 | 43 | 121 |
| 2023 Junio | 75 | 26 | 101 |
| 2023 Mayo | 65 | 30 | 95 |
| 2023 Abril | 85 | 23 | 108 |
| 2023 Marzo | 78 | 32 | 110 |
| 2023 Febrero | 67 | 30 | 97 |
| 2023 Enero | 49 | 36 | 85 |
| 2022 Diciembre | 65 | 42 | 107 |
| 2022 Noviembre | 25 | 36 | 61 |
| 2022 Octubre | 33 | 27 | 60 |
| 2022 Septiembre | 40 | 42 | 82 |
| 2022 Agosto | 24 | 36 | 60 |
| 2022 Julio | 26 | 31 | 57 |
| 2022 Junio | 37 | 22 | 59 |
| 2022 Mayo | 55 | 51 | 106 |
| 2022 Abril | 70 | 39 | 109 |
| 2022 Marzo | 70 | 61 | 131 |
| 2022 Febrero | 48 | 44 | 92 |
| 2022 Enero | 71 | 58 | 129 |
| 2021 Diciembre | 45 | 44 | 89 |
| 2021 Noviembre | 42 | 55 | 97 |
| 2021 Octubre | 45 | 52 | 97 |
| 2021 Septiembre | 36 | 41 | 77 |
| 2021 Agosto | 75 | 29 | 104 |
| 2021 Julio | 54 | 27 | 81 |
| 2021 Junio | 47 | 36 | 83 |
| 2021 Mayo | 37 | 28 | 65 |
| 2021 Abril | 80 | 59 | 139 |
| 2021 Marzo | 78 | 13 | 91 |
| 2021 Febrero | 48 | 26 | 74 |
| 2021 Enero | 40 | 27 | 67 |
| 2020 Diciembre | 37 | 20 | 57 |
| 2020 Noviembre | 19 | 16 | 35 |
| 2020 Octubre | 21 | 13 | 34 |
| 2020 Septiembre | 22 | 11 | 33 |
| 2020 Agosto | 27 | 14 | 41 |
| 2020 Julio | 27 | 18 | 45 |
| 2020 Junio | 39 | 27 | 66 |
| 2020 Mayo | 31 | 9 | 40 |
| 2020 Abril | 39 | 21 | 60 |
| 2020 Marzo | 45 | 16 | 61 |
| 2020 Febrero | 7 | 1 | 8 |
| 2020 Enero | 0 | 1 | 1 |
| 2019 Diciembre | 4 | 5 | 9 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 3 | 1 | 4 |
| 2019 Septiembre | 10 | 2 | 12 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 8 | 8 |
| 2019 Junio | 0 | 23 | 23 |
| 2019 Mayo | 2 | 65 | 67 |
| 2019 Abril | 0 | 15 | 15 |
| 2019 Marzo | 0 | 4 | 4 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Noviembre | 4 | 0 | 4 |
| 2018 Octubre | 7 | 0 | 7 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 5 | 5 |
| 2018 Abril | 0 | 3 | 3 |
| 2018 Marzo | 5 | 6 | 11 |
| 2018 Febrero | 39 | 8 | 47 |
| 2018 Enero | 39 | 5 | 44 |
| 2017 Diciembre | 52 | 14 | 66 |
| 2017 Noviembre | 42 | 9 | 51 |
| 2017 Octubre | 32 | 9 | 41 |
| 2017 Septiembre | 36 | 10 | 46 |
| 2017 Agosto | 27 | 10 | 37 |
| 2017 Julio | 30 | 13 | 43 |
| 2017 Junio | 32 | 8 | 40 |
| 2017 Mayo | 36 | 16 | 52 |
| 2017 Abril | 34 | 11 | 45 |
| 2017 Marzo | 18 | 14 | 32 |
| 2017 Febrero | 13 | 9 | 22 |
| 2017 Enero | 13 | 9 | 22 |
| 2016 Diciembre | 35 | 14 | 49 |
| 2016 Noviembre | 47 | 14 | 61 |
| 2016 Octubre | 40 | 33 | 73 |
| 2016 Septiembre | 0 | 4 | 4 |
| 2016 Agosto | 0 | 10 | 10 |
| 2016 Julio | 3 | 2 | 5 |
| 2016 Junio | 12 | 12 | 24 |
| 2016 Mayo | 9 | 21 | 30 |
| 2016 Abril | 7 | 21 | 28 |
| 2016 Marzo | 10 | 3 | 13 |
| 2016 Febrero | 10 | 2 | 12 |
| 2016 Enero | 4 | 9 | 13 |
| 2015 Diciembre | 0 | 1 | 1 |
| 2015 Noviembre | 0 | 15 | 15 |
| 2015 Octubre | 0 | 4 | 4 |
| 2015 Septiembre | 0 | 4 | 4 |
| 2015 Agosto | 0 | 2 | 2 |
| 2015 Julio | 1 | 4 | 5 |
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