Case and Research Letter
Secondary Syphilis Mimicking Lichen Planus in a Patient With HIV Coinfection
Sífilis secundaria simulando liquen plano en el paciente con infección por VIH
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B) Estudio histológico: detalle de células plasmáticas perivasculares <span class="elsevierStyleBold">(</span>Hematoxilina-eosina ×40). C) Estudio inmunohistoquímico positivo para <span class="elsevierStyleItalic">Treponema pallidum</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Jiménez-Gómez, Á. Hermosa-Gelbard, R. Carrillo-Gijón, P. Jaén" "autores" => array:4 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Jiménez-Gómez" ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "Hermosa-Gelbard" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Carrillo-Gijón" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Jaén" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219016301457" "doi" => "10.1016/j.adengl.2016.06.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016301457?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101630014X?idApp=UINPBA000044" "url" => "/00017310/0000010700000007/v2_201609150132/S000173101630014X/v2_201609150132/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219016301469" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.06.015" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "1376" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:614-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1057 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 822 "PDF" => 192 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Nevus <span class="elsevierStyleItalic">Spilus</span> Associated With Agminated Blue Nevus: A Rare Combination" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "614" "paginaFinal" => "616" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nevo <span class="elsevierStyleItalic">spilus</span> asociado a nevus azul agminado: una combinación infrecuente" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 686 "Ancho" => 975 "Tamanyo" => 224334 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology revealed a combined lesion, with findings characteristic of a blue nevus (a dermal proliferation of spindle-shaped melanocytes associated with melanophages) and findings corresponding to nevus spilus (a lentiginous proliferation of melanocytes at the dermoepidermal junction and nests of melanocytes with no atypia in the superficial dermis). Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>x10.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Ayala, M.D. Ramón, M. Cabezas, E. Jordá" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Ayala" ] 1 => array:2 [ "nombre" => "M.D." "apellidos" => "Ramón" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Cabezas" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jordá" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101600096X" "doi" => "10.1016/j.ad.2016.01.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101600096X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016301469?idApp=UINPBA000044" "url" => "/15782190/0000010700000007/v2_201704140340/S1578219016301469/v2_201704140340/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016301858" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.02.025" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "1379" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:610-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 672 "formatos" => array:3 [ "EPUB" => 41 "HTML" => 466 "PDF" => 165 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Majocchi Granuloma of the Breast: A Rare Clinical Entity" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "610" "paginaFinal" => "612" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granuloma de Majocchi: Una rara entidad" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 600 "Ancho" => 800 "Tamanyo" => 75893 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Complete resolution of the plaque after finishing treatment.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "U. Khanna, T. Kumar Dhali, P. D'Souza, S. Chowdhry" "autores" => array:4 [ 0 => array:2 [ "nombre" => "U." "apellidos" => "Khanna" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Kumar Dhali" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "D'Souza" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Chowdhry" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0001731016300138" "doi" => "10.1016/j.ad.2016.02.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016300138?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016301858?idApp=UINPBA000044" "url" => "/15782190/0000010700000007/v2_201704140340/S1578219016301858/v2_201704140340/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Secondary Syphilis Mimicking Lichen Planus in a Patient With HIV Coinfection" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "612" "paginaFinal" => "614" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "N. Jiménez-Gómez, Á. Hermosa-Gelbard, R. Carrillo-Gijón, P. Jaén" "autores" => array:4 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Jiménez-Gómez" "email" => array:1 [ 0 => "natjgomez@gmail.com" ] "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" => "Á." "apellidos" => "Hermosa-Gelbard" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Carrillo-Gijón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Jaén" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sífilis secundaria simulando liquen plano en el paciente con infección por VIH" ] ] "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" => 1125 "Ancho" => 1500 "Tamanyo" => 428097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Histologic findings: lichenoid dermatitis with effacement of the basal layer, exocytosis of neutrophils, and a band-like lymphoplasmacytic infiltrate together with numerous plasma cells on the wall and around the vessels of the dermis (hematoxylin-eosin, original magnification ×10). B, Histologic findings: detailed view of perivascular plasma cells (hematoxylin-eosin, original magnification ×40). C, Positive immunohistochemical staining for <span class="elsevierStyleItalic">Treponema pallidum</span>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Syphilis rates have been on the rise in recent years. In Spain, this sexually transmitted infection mainly affects men who have sex with men (MSM), many of whom are coinfected with human immunodeficiency virus (HIV).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> The natural history of both syphilis and HIV infection is affected by the coexistence of these diseases. The clinical manifestations of syphilis can progress more rapidly in patients with concomitant HIV infection, and aggressive and atypical forms of syphilis are also more common in this population.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of 2 MSM with HIV infection who visited their dermatologist with genital lesions. The first man, aged 35 years, reported slightly pruritic lesions on the genitals that had appeared a month and a half earlier. He had applied topical corticosteroids, but there had been no improvement. Good immunologic control of his HIV infection had been maintained since 2009 without antiretroviral therapy. The physical examination revealed erythematous plaques with a lichenoid appearance and a tendency to coalesce on the dorsal aspect of the penis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> A and B). Blood test results brought by the patient, which included biochemistry, a complete blood count, and coagulation studies, were unremarkable. Skin biopsy revealed lichenoid dermatitis with effacement of the basal layer, exocytosis of neutrophils, and a band-like lymphoplasmacytic infiltrate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Numerous plasma cells were also observed on the wall and around the vessels of the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Immunohistochemical staining for <span class="elsevierStyleItalic">Treponema pallidum</span> was positive (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Syphilis serology was requested; the nontreponemal rapid plasma reagin (RPR) test showed antibody titers of 1/128 and the treponemal antibody test was positive.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The second man, aged 29 years, had been diagnosed with HIV infection in 2011 and had achieved good immunologic control without pharmacologic treatment. He presented with mildly pruritic scrotal lesions of 1 month's duration. The lesions had been diagnosed as eczema and treated with topical corticosteroids, but there had been no improvement. The physical examination showed numerous pink plaques with a lichenoid appearance on the scrotum and at the base of the penis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Laboratory tests, including biochemistry, a complete blood count, and coagulation studies, showed no alterations, and serology for syphilis was also negative. Histologic examination of a skin biopsy sample showed lichenoid dermatitis and immunohistochemical staining was positive for <span class="elsevierStyleItalic">T pallidum</span>. The RPR test was positive (titer, 1/64), as were the enzyme-linked immunosorbent assay and hemagglutination results.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Both patients were diagnosed with secondary syphilis mimicking lichen planus, with exclusive genital involvement. The clinical outcome was satisfactory in both cases, with complete resolution of lesions following treatment with intramuscular benzathine penicillin G 2.4 million units and a decline in RPR titers.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Cutaneous manifestations of secondary syphilis appear 3 to 12 weeks after the onset of the primary chancre, although they can occur months later or even before this sore disappears.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Secondary syphilis typically presents as maculopapular and erythematous scaling lesions, although lichenoid, nodular, and ulcerated lesions may also be observed, though less frequently.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,4</span></a> HIV infection accelerates the progression of syphilis by altering cell-mediated immunity, and it is sometimes associated with atypical syphilis manifestations.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Known as the <span class="elsevierStyleItalic">great imitator</span>, syphilis is a true diagnostic challenge for clinicians. Although secondary syphilis is known to mimic other diseases (pityriasis rosea, psoriasis,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> sarcoidosis, etc.), lichenoid eruptions are uncommon.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> These eruptions were reported prior to the introduction of penicillin, i.e., when arsenic-based compounds were still being used as the treatment of choice for syphilis, and it was assumed that these compounds for responsible for the lichenoid appearance of the lesions. Similar lesions, however, continued to be observed when they were replaced with penicillin.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Serology, together with histologic findings, has an important diagnostic role, with positive results shown by both treponemal and nontreponemal tests. Most patients with HIV infection have normal serology, although they may present false-positive nontreponemal responses and higher-than-expected titers in the absence of reinfection. It should also be noted that delayed positives and false negatives are also possible with nontreponemal tests.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The treatment of secondary syphilis in patients with HIV infection has generated some controversy. The latest edition of the Sexually Transmitted Diseases Treatment Guidelines from the Centers for Disease Control<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> recommends a single dose of intramuscular benzathine penicillin G 2.4 million units, regardless of whether the patient has concomitant HIV infection or not, as additional doses have not proven to be more effective.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Although the literature contains reports of secondary syphilis mimicking lichen planus, our cases are interesting in that the lesions were exclusively genital. We found only 2 similar cases in our literature search.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Both clinicians and pathologists should be aware of the highly variable clinical and histologic features of secondary syphilis to ensure prompt diagnosis and treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jiménez-Gómez N. Sífilis secundaria simulando liquen plano en el paciente con infección por VIH. Actas Dermosifiliogr. 2016;107:612–614.</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" => 975 "Ancho" => 1300 "Tamanyo" => 168826 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Erythematous, well-delimited plaques with a lichenoid appearance on the dorsal surface of the penis (patient #1). B, Erythematous 3-mm plaque with an erosive center and clear, whitish edges in the same patient.</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" => 1125 "Ancho" => 1500 "Tamanyo" => 428097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Histologic findings: lichenoid dermatitis with effacement of the basal layer, exocytosis of neutrophils, and a band-like lymphoplasmacytic infiltrate together with numerous plasma cells on the wall and around the vessels of the dermis (hematoxylin-eosin, original magnification ×10). B, Histologic findings: detailed view of perivascular plasma cells (hematoxylin-eosin, original magnification ×40). C, Positive immunohistochemical staining for <span class="elsevierStyleItalic">Treponema pallidum</span>.</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" => 735 "Ancho" => 980 "Tamanyo" => 123240 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Photograph showing pinkish lichenoid plaques on the scrotum of patient #2.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increase in syphilis and gonorrhoea among men who have sex with men in Madrid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 19 | 9 | 28 |
| 2024 Octubre | 129 | 48 | 177 |
| 2024 Septiembre | 115 | 35 | 150 |
| 2024 Agosto | 163 | 62 | 225 |
| 2024 Julio | 195 | 42 | 237 |
| 2024 Junio | 162 | 59 | 221 |
| 2024 Mayo | 146 | 40 | 186 |
| 2024 Abril | 105 | 29 | 134 |
| 2024 Marzo | 138 | 29 | 167 |
| 2024 Febrero | 133 | 36 | 169 |
| 2024 Enero | 164 | 41 | 205 |
| 2023 Diciembre | 148 | 17 | 165 |
| 2023 Noviembre | 129 | 22 | 151 |
| 2023 Octubre | 147 | 30 | 177 |
| 2023 Septiembre | 127 | 31 | 158 |
| 2023 Agosto | 87 | 12 | 99 |
| 2023 Julio | 118 | 29 | 147 |
| 2023 Junio | 65 | 20 | 85 |
| 2023 Mayo | 129 | 20 | 149 |
| 2023 Abril | 95 | 13 | 108 |
| 2023 Marzo | 151 | 30 | 181 |
| 2023 Febrero | 135 | 28 | 163 |
| 2023 Enero | 117 | 24 | 141 |
| 2022 Diciembre | 146 | 27 | 173 |
| 2022 Noviembre | 80 | 25 | 105 |
| 2022 Octubre | 82 | 15 | 97 |
| 2022 Septiembre | 120 | 26 | 146 |
| 2022 Agosto | 119 | 25 | 144 |
| 2022 Julio | 73 | 33 | 106 |
| 2022 Junio | 50 | 26 | 76 |
| 2022 Mayo | 111 | 42 | 153 |
| 2022 Abril | 159 | 28 | 187 |
| 2022 Marzo | 146 | 37 | 183 |
| 2022 Febrero | 138 | 15 | 153 |
| 2022 Enero | 135 | 35 | 170 |
| 2021 Diciembre | 73 | 33 | 106 |
| 2021 Noviembre | 92 | 41 | 133 |
| 2021 Octubre | 93 | 50 | 143 |
| 2021 Septiembre | 102 | 36 | 138 |
| 2021 Agosto | 85 | 19 | 104 |
| 2021 Julio | 60 | 25 | 85 |
| 2021 Junio | 74 | 19 | 93 |
| 2021 Mayo | 81 | 47 | 128 |
| 2021 Abril | 208 | 43 | 251 |
| 2021 Marzo | 125 | 24 | 149 |
| 2021 Febrero | 76 | 32 | 108 |
| 2021 Enero | 53 | 18 | 71 |
| 2020 Diciembre | 51 | 17 | 68 |
| 2020 Noviembre | 28 | 8 | 36 |
| 2020 Octubre | 42 | 6 | 48 |
| 2020 Septiembre | 22 | 14 | 36 |
| 2020 Agosto | 44 | 12 | 56 |
| 2020 Julio | 26 | 17 | 43 |
| 2020 Junio | 46 | 35 | 81 |
| 2020 Mayo | 35 | 23 | 58 |
| 2020 Abril | 34 | 21 | 55 |
| 2020 Marzo | 28 | 12 | 40 |
| 2020 Febrero | 5 | 1 | 6 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Junio | 2 | 0 | 2 |
| 2019 Abril | 1 | 1 | 2 |
| 2019 Marzo | 2 | 3 | 5 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Febrero | 22 | 2 | 24 |
| 2018 Enero | 44 | 7 | 51 |
| 2017 Diciembre | 45 | 3 | 48 |
| 2017 Noviembre | 35 | 6 | 41 |
| 2017 Octubre | 47 | 7 | 54 |
| 2017 Septiembre | 31 | 1 | 32 |
| 2017 Agosto | 46 | 8 | 54 |
| 2017 Julio | 29 | 12 | 41 |
| 2017 Junio | 35 | 7 | 42 |
| 2017 Mayo | 26 | 10 | 36 |
| 2017 Abril | 23 | 10 | 33 |
| 2017 Marzo | 21 | 7 | 28 |
| 2017 Febrero | 69 | 10 | 79 |
| 2017 Enero | 21 | 7 | 28 |
| 2016 Diciembre | 37 | 24 | 61 |
| 2016 Noviembre | 34 | 17 | 51 |
| 2016 Octubre | 29 | 14 | 43 |
| 2016 Septiembre | 1 | 1 | 2 |
| 2016 Julio | 2 | 2 | 4 |
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